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.
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. This resolution will allow the Controller to pay non-contract providers for services provided at 50% of billed charges for professional fee services and 50% of billed charges for all facility fees and those services not found either on the Part “B” Medicare Fee Schedule or on the Medicare Labor Adjusted Ambulatory Surgery Classification (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 two years, demand for these services has averaged approximately $750,000 per year.
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