COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

May 21, 2003

BOARD MEETING DATE:

June 10, 2003

TO:

Honorable Board of Supervisors acting as governing Board of the In-Home Supportive Services Public Authority of San Mateo County

FROM:

Margaret Taylor, Director of Health Services

Charlene Silva, Director of Aging and Adult Services

SUBJECT:

Agreement with the Health Plan of San Mateo for Fiscal Year 2002-03

Recommendation

Adopt a resolution authorizing an agreement with the Health Plan of San Mateo to provide health benefits to independent providers of the In-Home Supportive Services Program.

Background

In September 1993 your Board approved an ordinance establishing a separate Public Authority to administer the provider components for the In-Home Supportive Services Program (IHSS) and designating the San Mateo County Board of Supervisors as the governing Board of the Public Authority.

The goal of IHSS is to assist eligible aged, blind, and disabled individuals to remain in their own homes and avoid institutionalization. Using independent providers, IHSS provides participants with a wide variety of personal care and domestic services such as meal preparation, feeding, bathing, dressing, transferring, protective supervision, laundry, shopping, transportation, and certain paramedical services authorized by a physician.

A worker registry and referral system to assist clients in securing qualified workers (independent providers) has been an integral part of the Public Authority's model from the start. The Public Authority recruits, screens, and matches independent providers with clients. Recruitment, training, and retention of service providers have been key to effective service delivery. Furthermore, the creation of the Public Authority as the "employer of record" has allowed the independent provider work force to engage in collective bargaining. The independent providers are represented by Service Employees International Union (SEIU), and the Public Authority negotiates with the union.

In November 2000 the IHSS Public Authority signed an agreement with SEIU, Local 715. This agreement included provision for health benefits to the independent providers. In accordance with the agreement between the Public Authority and SEIU, independent providers who are authorized to work a minimum of 35 hours a month are offered the opportunity to request health benefits. In August 2001 the Public Authority began providing health benefits to eligible providers.

On July 31, 2001, your Board as the Public Authority approved the first agreement with the Health Plan of San Mateo (HPSM). This agreement established HPSM as the administrator of health benefits for the IHSS independent providers. The term of this agreement was July 31, 2001 through the end of the contract between the Public Authority and Local 715, SEIU, IHSS workers or June 30, 2002.

Discussion

The proposed renewal agreement between the Public Authority and HPSM is substantially the same as the previous agreement. The changes that have been included in the renewal agreement were written specifically to allow HPSM to request a rate change and outline the process that would be required in order to do that.

Renewal of this agreement was delayed for several reasons. Negotiations with SEIU, Local 715, regarding wages and benefits for the IHSS independent providers continued into late September 2002 for the 2002-03 year. During that time there was no existing MOU with the union for provider wages and benefits. In addition, during that same time period, the union was exploring the possibility of changing the independent providers' health insurance provider from HPSM to another carrier/provider. And finally, the financial viability and actual continuation of HPSM were in question during that time. Now that these issues have been settled, it is possible to move forward with finalizing the agreement with HPSM for 2002-03.

County Counsel has reviewed and approved this agreement.

Vision Alignment

An agreement with the Health Plan of San Mateo keeps the commitment of ensuring basic health and safety for all and goals number 5: People - Residents have access to healthcare and preventive care and 8: People - Help vulnerable people - the aged, disabled, mentally ill, at-risk youth and others - achieve a better quality of life. Services provided by the contractor will contribute to this commitment and goals by assisting eligible aged, blind, and disabled individuals to remain in their own homes and avoid institutionalization.

Fiscal Impact

The term of the new agreement is July 1, 2002 through June 30, 2003. The monthly premium per provider is $185.31 plus the provider pays a co-pay of $10.00. The maximum number of providers who can be insured is 718 per month from July 2002 through January 2003. Total cost of this time period is $931,368. The maximum number of providers increases to 740 per month from February 2003 through June 2003 for a total of $685,647. The combined total for 2002-03 is $1,617,015, and the projected county share of this cost is $382,101. Costs for the health insurance coverage that is administered through HPSM are included in the 2002-03 adopted budget for the Public Authority for IHSS. There is no additional impact on the county General Fund as a result of this action.