COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

 

DATE:

June 13, 2005

BOARD MEETING DATE:

June 28, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center

SUBJECT:

HPSM Care Advantage Program Agreement with the San Mateo Health Commission

 

RECOMMENDATION:

Adopt a resolution authorizing the President of the Board to execute three Agreements with the San Mateo Health Commission:

 

1.

Care Advantage Medical Services Agreement Between San Mateo Health Commission and Primary Care Physicians

2.

Care Advantage Hospital Service Agreement Between San Mateo Health Commission (dba Health Plan of San Mateo) and County of San Mateo, San Mateo Medical Center

3.

Care Advantage Medical Services Agreement Between San Mateo Health Commission and Referral Provider

 

VISION ALIGNMENT:

Commitment: Ensuring Basic Health and Safety for All.

Goal 5: Residents have access to healthcare and preventive care.

 

The agreement contributes to this commitment and goal by providing a mechanism to pay for Medicare/Medi-Cal reimbursable hospital and medical services provided to eligible recipients under the Medicare Advantage Program at the San Mateo Medical Center (SMMC).

Performance Measure(s):

Measure

FY 2004-05
Actual

FY 2005-06
Projected

Number of Medicare/ Medi-Cal recipients in San Mateo County eligible for the new Medicare Advantage Program

8,000

8000

 

BACKGROUND:

On January 11, 1994, your Board approved an agreement with the San Mateo Health Commission for San Mateo County General Hospital (SMCGH), now San Mateo Medical Center (SMMC), to serve as a participating hospital in HPSM, the Medi-Cal capitated program. All San Mateo County Medi-Cal patients are automatically enrolled in the HPSM and are assigned to hospital affiliated primary care providers. The term of the agreement was one year, from December 1, 1993 through November 30, 1994.

As with all Insurance companies, specific separate agreements for practitioners, referral providers, and the medical facility need to be signed due to their distinct operational requirements and payment methodologies.

Collectively, your Board approved 25 more amendments to the Hospital Agreement after 1995. These amendments revised fee schedules, adjusted allocations, updated or replaced exhibits, and extended terms.

 

DISCUSSION:

The San Mateo Health Commission is now entering into the Medicare business to address the changes to the Medicare Modernization Act parts C and D that take effect January 2006. These changes will primarily affect patients who are eligible for Medicare/Medi-Cal (“Medi/Medi” or “Dual Eligible”) benefits. The group consists mainly of low income residents under age 65 with significant disabilities. While this population is not well documented, estimates show that approximately 8,000 eligible residents in San Mateo County would be impacted by these new changes.

Area health plans have a June 2005 deadline to show CMS that they can put together a robust provider network to support the new Medicare Part C and Part D initiatives and be eligible to receive CMS funding support. SMMC is the largest medical facility provider in the health commission’s network and our participation is key to the program’s success in San Mateo County. The benefit to SMMC is increased funding to offset the rising cost of drugs and medical treatment for dual eligible members qualifying under this plan.

Risk management and County Counsel have reviewed and approved this agreement.

 

FISCAL IMPACT:

The Agreement term is one year that becomes effective upon final signature by all parties and automatically renew for one year periods unless terminated sooner by either party. This Agreement will have an overall positive impact for the San Mateo Medical Center of $2,000,000 as increased funds to offset the cost of healthcare provided to dual eligible members qualifying under new Medicare Modernization Act rules are paid to the hospital. The revenue from these payments is included in SMMC’s FY2005-06 Recommended Budget.