COUNTY OF SAN MATEO
Inter-Departmental Correspondence

Health System

 

DATE:

February 18, 2009

BOARD MEETING DATE:

March 31, 2009

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System
Sang-ick Chang, MD, Chief Executive Officer, San Mateo Medical Center

   

SUBJECT:

Agreement with Toyon Associates, Inc.

 

RECOMMENDATION:

Adopt a Resolution:

   

1.

Waiving the Request for Proposals process; and

   

2.

Authorizing the President of the Board to execute an Agreement with Toyon Associates, Inc. to provide third-party reimbursement services to San Mateo Medical Center for the term March 1, 2009 through June 30, 2012, in an amount not to exceed $708,940; and

   

3.

Authorizing the Chief of the Health System or designee to execute contract amendments which modify the County’s maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions.

 

VISION ALIGNMENT:

Commitment: Responsive, effective and collaborative government.
Goal 20:
Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

The Agreement contributes to this commitment and goal by ensuring that San Mateo Medical Center collects revenues, files cost reports and facilitates audits in a timely manner.

 

Performance Measure

   

Measure

FY 2007-08
Actual

FY 2008-09
Projected

Timely preparation and submission of Regulatory Reports

95%

98%

 

BACKGROUND:

Toyon Associates, Inc. (Toyon) has been providing third party reimbursement consulting services to San Mateo Medical Center (SMMC) for approximately eight years. Toyon has extensive knowledge of SMMC’s operations and challenges. Toyon’s thorough knowledge of Medicare and Medi-Cal regulatory matters, combined with their in-depth understanding of SMMC, allows for high quality, efficient services, enabling SMMC to optimize its reimbursements and maintain compliance with reporting requirements.

 

DISCUSSION:

All healthcare facilities are required to report to Medicare, Medi-Cal and the Office of Statewide Health Planning and Development (OSHPD). In addition, County healthcare facilities must also submit data for: Federally Qualified Health Care (FQHC) reporting (including change of scope calculations and the annual FQHC payment reconciliation), SB 1732 and AB 915 calculations, Skilled Nursing Facilities (SNF) Supplemental payment calculations, Medi-Cal Waiver (Paragraph #14) and Access of Care for Everyone (ACE) reimbursement calculations. These additional County facility supplemental reports account for approximately 30% of SMMC’s annual net revenue.

Toyon’s extensive knowledge of SMMC’s financial operations, as well as their unique understanding of the complex and frequently-changing supplemental revenue calculations, specific to County healthcare operations, makes the continued utilization of their services essential to SMMC’s efforts to maximize third-party reimbursements. A waiver of Request for Proposals (RFP) process was approved in March 2007. A second RFP waiver request was approved by the County Manager on March 11, 2009.

The contractor has assured compliance with the County's Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.

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

 

FISCAL IMPACT:

The term of this Agreement is March 1, 2009 through June 30, 2012. The maximum amount payable will not exceed $708,940. Funds in the amount of $70,000 are included in the SMMC FY 2008-09 Adopted Budget and the remaining $638,940 will be included in future Recommended Budgets. The Net County Cost is $708,940.