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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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San Mateo Medical Center
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DATE:
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August 31, 2006
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BOARD MEETING DATE:
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September 19, 2006
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center
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SUBJECT:
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Amendments 2006-02, 2006-02A, and 2006-3 to the Hospital
Agreement with the San Mateo Health Commission
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RECOMMENDATION:
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Adopt a resolution authorizing execution of Amendments 2006-02, 2006-02A, and 2006-3 to the Hospital Agreement with the San Mateo Health Commission
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VISION ALIGNMENT:
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Commitment: Ensuring Basic Health and Safety for All.
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Goal 5: Residents have access to healthcare and preventive care.
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The agreement contributes to this commitment and goal by providing a mechanism to pay for Medi-Cal reimbursable hospital and medical services provided to San Mateo County Medi-Cal recipients at San Mateo Medical Center (SMMC).
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Performance Measure(s):
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Measure
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FY 2005-06
Actual
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FY 2006-07
Projected
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Number of Medi-Cal recipients treated at SMMC
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14,500
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14,500
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BACKGROUND:
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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.
Collectively, your Board approved 27 more amendments to the Hospital Agreement after 1995. These amendments revised fee schedules, adjusted allocations, updated or replaced exhibits, and extended terms.
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DISCUSSION:
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In addition to the San Mateo Health Commission’s share of rate increases for Medi-Cal Managed Care Plans, including County Organized Health Systems health plans, the San Mateo Health Commission received an increase in compensation under its Medi-Cal Services Contract with the State of California for the State Fiscal Years 2005-06 and 2006-07. San Mateo Medical Center is the only disproportionate share hospital in San Mateo County. Amendment 2006-02 revises the Acute Medical/Surgical Day per diem rate, includes language regarding a mid-year supplemental payment to San Mateo Medical Center, and includes language on what the rate increase and the supplemental payment are conditioned upon for Fiscal Year 2005-06. Amendment 2006-02A revises Amendment 2006-02 to include Fiscal Year 2006-07.
Due to State and HPSM funding crises, HPSM has been unable to grant hospital per diem increases for serving HPSM members in the past several years. For HPSM’s 2006 budget, the Commission approved “payment incentives” to be distributed to their contract hospitals in recognition of their willingness to continue serving HPSM members during difficult financial times.
The San Mateo Health Commission has approved a supplemental incentive payment to SMMC in the amount of $967,287.49. This allocation is based on inpatient hospital utilization by HPSM Medi-Cal members. Since there can be a significant lag time for claims to be submitted to the Health Plan and to minimize the impact of any yearly fluctuations, the utilization over three years, 2002, 2003, 2004, has been used. Amendment 2006-3 will allow HPSM to implement this supplemental payment to SMMC.
County Counsel has reviewed and approved these Amendments.
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FISCAL IMPACT:
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These Amendments have an overall positive impact on SMMC. These funds represent a payment of $8,000,000 for SMMC and are contingent on continuing SMMC’s relationship with the San Mateo Health Commission. The revenue from this payment is included in SMMC’s FY2006-07 Recommended Budget.
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