COUNTY OF SAN MATEO

Inter-Departmental Correspondence

SAN MATEO MEDICAL CENTER

 

DATE:

March 24, 2006

BOARD MEETING DATE:

April 18, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

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

SUBJECT:

Amendment to the Agreement with Health Advocates, LLP

   

RECOMMENDATION:

Adopt a resolution authorizing the President of the Board to execute an Amendment to the Agreement with Health Advocates, LLP to provide cost recovery services, increasing the amount by $513,000 and bringing the total obligation to $1,563,000 and adding Compliance with Contractor Employee Jury Service Ordinance language to the Agreement.

 

VISION ALIGNMENT:

Commitment: Ensure 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 process whereby Health Advocates will assist patients to complete the application process for insurance benefits.

 

Performance Measure(s):

Measure

FY 2003-06
Actual

FY 2003-06
Projected

Cost Recovery

$1,500,000

2,013,000

     
 

BACKGROUND:

On June 10, 2003, your Board approved an Agreement with Health Advocates for cost recovery services. The term of the Agreement was two years, from May 1, 2003 to April 30, 2005, with an option for a third year and a maximum of $600,000. On April 26, 2005, the Agreement was amended to extend the term by one year and to increase the maximum amount by $450,000.

Health Advocates was awarded a contract after San Mateo Medical Center (SMMC) conducted a Request for Proposals (RFP), to recover costs from selected uninsured inpatient accounts, in October 2002. Accounts are referred to Health Advocates by SMMC supervisory staff when program linkages such as Medi-Cal have been identified, but the patient is difficult to locate or fails to follow-up with the necessary paperwork. Health Advocates assists patients and in some circumstances functions as a designated representative for patients to complete the necessary documentation. Once approval of insurance eligibility is established, Health Advocates is required to deliver all eligibility documents to SMMC and bill the appropriate insurance program.

 

DISCUSSION:

The contract with Health Advocates, which is effective from May 1, 2003 to April 30, 2006, has a maximum amount of $1,050,000. From May 2003 through October 2005, the County has paid out $1,039,718. If this continues through the end of the contract, there will not be sufficient funds to meet SMMC’s obligation. San Mateo County has referred 1,614 inpatient accounts and Health Advocates has obtained Medi-Cal benefits for 662 or 41% of these accounts. The remaining 774 accounts are open and in process.

In per diem charges alone, San Mateo Medical Center has been able to recoup approximately $6,282,657. As a general rule, only the most difficult cases are assigned to Health Advocates. If it were not for the efforts of Health Advocates, many of these inpatient accounts would be charged to Medically Indigent Adult (MIA) funds and be otherwise uncollectible. Due to the number of referred accounts during the three-year term of the current Agreement, the maximum amount needs to be increased
by $513,000.

In February 2006, SMMC conducted a Request for Proposal (RFP) process for a new agreement. A new contract for these services will be presented to your Board in May 2006.

The amendment includes all provisions that are required by county ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination, equal benefits and jury service policy.

County Counsel and Risk Management have reviewed and approved this Amendment.

 

FISCAL IMPACT:

The Amendment increases the maximum amount of the Agreement by $513,000, from $1,050,000 to $1,563,000. The term of the Agreement remains the same, May 1, 2003 to April 30, 2006.

Health Advocates, LLP is paid on a contingency basis. Reimbursement is based on the amount collected from the identified health program. There is no net county cost. The revenue is included in SMMC’s FY2005-06 Adopted Budget.