COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

September 19, 2003

BOARD MEETING DATE:

October 7, 2003

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

SUBJECT:

Appropriation Transfer Request

Recommendation

1.

Approve an Appropriation Transfer Request (ATR) Recognizing Unanticipated Revenue for the Health Care for the Homeless (HCH) Program Increasing Intergovernmental Revenues ($789,494) as follows: Fair Oaks (org. 68520) $422,604 Willow (org. 68620) $336,890; HealthCare for the Homeless (org. 68120, acct. #5856) $30,000.

2.

Approve Salary Ordinance Amendment which will increase the staffing levels at Fair Oaks and Willow Clinics.

Background

The San Mateo Medical Center has administered a Bureau of Primary Health Care (BPHC), Health Care for the Homeless (HCH), Section 330(H), Public Health Services Act grant since 1995. The HCH grant appropriation is $812,525 per year. HCH grant funding is currently used to provide health care services to homeless adults, adolescents and children through agreements with the Public Health Mobile Clinic, County Mental Health, Free At Last, Clara-Mateo Alliance, Youth and Family Assistance and the Jefferson Union High School District. In addition to providing healthcare to San Mateo County's homeless population, the 330(H) grant qualifies the Health Services' outpatient clinics for Federally Qualified Health Center (FQHC) status. FQHC status allows the Medical Center to claim cost-based reimbursement for outpatient clinic services.

The BPHC has awarded the HCH Program new funding to provide expanded medical capacity at Fair Oaks and Willow Clinics in the amount of $690,000 for fifteen months in FY 2003-04 and FY 2004-05. Beginning in FY 2004-05, $600,000 of this funding will be added to the County's annual base grant. The HCH Program has also received an increase in the base grant of $25,714 that will be used this year to renovate Fair Oaks Family Health Center.

Discussion

This past spring the HCH Program submitted a grant proposal to the BPHC to expand the medical capacity at Fair Oak and Willow Clinics by adding a "same-day clinic" team, including a physician, register nurse, medical assistance, and patient service assistant, at each of the clinics. In July the HCH Program received notice of grant award of $690,000 for this purpose. Of the total amount, $600,000 will fund the eight new positions, $30,000 will be used to improve the data collection and analysis system for the HCH Program, and $60,000 one-time only funds will be used for renovation at Fair Oaks and Willow Clinics. Of the $600,000 received, $440,000 will be budgeted in this current fiscal year 2003-04 and the remainder will be budgeted in fiscal year 2004-05. The increase in the base grant of $25,714 will also be used in the current fiscal year for renovations at the Fair Oaks Family Health Center.

The staffing levels include the following increase of positions: (2) staff physicians; (2) staff nurses; (2) medical services assistants; and (2) patient services assistants. A staff physician, staff nurse, medical assistant and patient services assistant will comprise the medical team and each clinic will have a team.

Vision Alignment

This ATR for the Health Care for the Homeless Program keeps the commitment of Ensuring Basic Health and Safety for All and goal number 8: Help vulnerable people - the aged, disabled, mentally ill, at-risk youth and others - achieve a better quality of life. The ATR contributes to this commitment and goal, as it will allocate funds for new patient care positions at Fair Oaks and Willow Clinics, for improving the data collection and analysis system for the HCH Program, and for renovating the Fair Oaks and Willow Clinics.

Fiscal Impact

The attached ATR allocates $555,714 to the HCH Program for expanded medical capacity awarded from the BPHC. These expenses are funded through the BPHC grant, as well as through third-party reimbursements in the amount of $233,780 generated by the new services. There is no net county cost. The continuation of the HCH funding for clinic positions will be included in the 2004-05 and subsequent budgets.