COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

June 16, 2003

BOARD MEETING DATE:

July 15, 2003

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

SUBJECT:

Resolution Authorizing the Controller to Pay Non-Contract Medical Service Providers

Recommendation

Adopt a resolution authorizing the Controller to pay non-contract medical service providers for services to medically indigent adult (MIA) patients.

Background

San Mateo County is responsible for providing necessary medical care to its medically indigent (MIA) population. If an MIA patient needs services or procedures not offered at San Mateo Medical Center, the patient is referred to another facility and the expenses must be paid by the County. Examples of these services are invasive/non-invasive cardiac procedures and radiation therapy.

Since 1990, your Board has authorized the Controller to pay non-contract medical providers who provide medical services at other facilities to our MIA patients.

Discussion

This resolution will allow the Controller to pay non-contract providers for services provided at the prevailing Medicare participating fee schedule for all Part "B" services that can be reimbursed per Health Care Financing Administration (HCFA) guidelines or the Medicare Labor Adjusted Ambulatory Surgery Classification (ASC); and 40% of billed charges for all services not found on the Part "B" Medicare Fee Schedule or the ASC.

All referrals to non-contract providers must be authorized by Hospital Administration, and utilization review is concurrently provided by the Case Management Department at the hospital.

Due to the unpredictability of expensive diagnostic procedures that patients require and the increase in clinic utilization over the past three years, demand for these services has averaged approximately $900,000.

Vision Alignment

This agreement keeps the commitment to Ensure Basic Health and Safety for All and goal number 5: Provide residents access to healthcare and preventive care. The agreement contributes to this commitment and goal by continuing to provide healthcare services to county patients.

Fiscal Impact

The term is July 1, 2003 through June 30, 2005. Payments under this resolution will not exceed $1,800,000 for the term.

Funds for these services have been budgeted in the San Mateo Medical Center FY2003-04 Recommended Budget and will be included in the budget request for 2004-05 Recommended Budget.