COUNTY OF SAN MATEO

County Manager’s Office

DATE:

November 27, 2007

BOARD MEETING DATE:

December 4, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

County Financial Assistance Policies – Charity Care and Revisions to Discounted Health Care Policies To Comply With AB774 regulations

RECOMMENDATION:

Adopt a Resolution approving standards of aid specified in the following Financial Assistance Programs for the provision of healthcare to uninsured patients of the San Mateo Medical Center:

1. Charity Care Policy; and

2. Discounted Health Care (DHC) Program for low-income residents

VISION ALIGNMENT:

Commitments: Ensuring Basic Health and Safety for All; and Responsive, Effective and Collaborative Government.

Goals 5 and 20: Residents have access to healthcare and preventative care; and Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

These financial assistance programs contribute to these commitments and goals by ensuring that the County meets its legal mandates in providing healthcare to low income individuals.

BACKGROUND

Under Section 17000 of the California Welfare and Institutions Code, counties are mandated to provide health care to their uninsured medically indigent residents. San Mateo County has fulfilled its obligation through the WELL Program, and using WELL eligibility requirements as a basis for Section 17000 eligibility.

In addition to WELL, the County also provides financial assistance through its Discounted Health Care (DHC) and Self-Pay Prompt Pay and Extended Repayment policies. The Board of Supervisors last adopted these financial assistance policies in December 2005.

DISCUSSION

In September 2006, the Governor signed AB774 requiring each hospital, as a condition of licensure, to maintain written policies on charity care and payment discounts for financially qualified patients. The legislation was targeted toward private hospital pricing practices and did not recognize the impact on public hospitals with their existing mandate to provide indigent healthcare under Welfare and Institutions Code §17000. California Health and Safety Code §127435 requires each hospital to submit a copy of its discount payment and charity care policies to the Office of Statewide Health Planning and Development by January 1, 2008.

A County Policy Review Group and their staff have been meeting since February of this year to review changes to the policies to comply with AB774. Members of the group are:

• Maya Altman, Health Plan of San Mateo

• Reyna Farrales, County Manager’s Office

• Beverly Beasley Johnson, Human Services Agency

• John Nibbelin, County Counsel’s Office

• Charlene Silva, Health Department

• David Spitler, San Mateo Medical Center

• Nancy Steiger/Sang-ick Chang, San Mateo Medical Center

Overview of New Charity Care Policy to Comply with AB774

• County residency not required

• Income at or below 100% federal poverty level (FPL)

• Limit of $250 in monetary assets (excludes first $10,000 monetary assets and 50% of assets thereafter)

• Limited to emergency care, urgent care, and inpatient care and ambulatory surgery transfers from the Emergency Department

Overview of Revised Discounted Health Care Policy to Comply with AB774

• County residency not required

• Income requirement unchanged (at or below 400% FPL)

• No asset limit test

• For outpatient visits and inpatient stays, patient no longer pays 50% of charges – patient pays the highest amount that SMMC receives for medical services from Medicare, Medi-Cal, Healthy Families or other government-sponsored program

• Liens to defer charges but cannot be placed on primary residence

• Patients must lack third party coverage or have “high medical costs”

The Medical Center Board of Directors approved the policies on November 1, 2007 for recommendation to the Board of Supervisors. Upon adoption, the County will submit the policies to comply with AB774.

FISCAL IMPACT:

The fiscal impact of the policies is unknown at this time. Because all hospitals must comply with AB774, low-income residents and non-residents should be able to access services at other area hospitals. Because there is no residency requirement, there could be an increase in patients at the Medical Center who do not live in San Mateo County, resulting in increased cost. Services provided under the recommended Charity Care Policy have been limited to emergency care, urgent care, and inpatient care and ambulatory surgery transfers from the Emergency Department. Payments for services provided under the Discounted Health Care policy could be more or less than the existing 50% discount, depending on the procedures performed. Under AB774, the patient pays the highest amount that SMMC receives for medical services from Medicare, Medi-Cal, Healthy Families or other government-sponsored program.

Attachments

Attachment A – Charity Care Policy

Attachment B – Discounted Healthcare (DHC) Policy