BOARD OF SUPERVISORS, COUNTY OF SAN MATEO, STATE OF CALIFORNIA
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RESOLUTION AUTHORIZING THE CONTROLLER TO PAY NON-CONTRACT MEDICAL SERVICE PROVIDERS AT OTHER LOCATIONS TO PROVIDE SERVICES NOT OFFERED AT SAN MATEO MEDICAL CENTER IN AN AMOUNT NOT TO EXCEED $1,500,000 FOR THE PERIOD JULY 1, 2009 THROUGH JUNE 30, 2011
RESOLVED, by the Board of Supervisors of the County of San Mateo, State of California, that
WHEREAS, the County of San Mateo is responsible for providing medical care to medically indigent residents; and
WHEREAS, at times it is necessary to send medically indigent patients from San Mateo Medical Center (SMMC) to non-contract outside medical care providers when the services or procedures they require are not available on-site; and
WHEREAS, on July 24, 2007, this Board approved and adopted Resolution No. 068884, whereby the Controller was authorized and directed, under certain circumstances, to pay non-contract medical providers at other locations for services rendered to medically indigent patients for whom the County has responsibility for the period from July 1, 2007 through June 30, 2009; and
WHEREAS, on December 9, 2008, the Board executed an Agreement with the Health Plan of San Mateo (HPSM), effective January 1, 2009, to administer the Consolidated ACE Program, said Agreement calling for HPSM to to serve as the conduit for funding directed to the provision of care to the medically indigent population; and
WHEREAS, the Board has determined that the continuation of funding for such non-contract providers at other locations is warranted, including the ability of the Chief of the Health System to negotiate rates of payment for such medical services when deemed appropriate to ensure appropriate access to medical care required by County medically indigent patients.
NOW, THEREFORE, IT IS HEREBY DETERMINED AND ORDERED that the Controller is authorized to pay non-contract medical service providers submitted by the Chief, Health System, or designee or the Chief Executive Officer of SMMC or designee for and on behalf of the County of San Mateo in an amount not to exceed a total of $1,500,000 for the period July 1, 2009 through June 30, 2011.
IT IS FURTHER DETERMINED AND ORDERED that the Controller is authorized and directed to execute payments for such authorized medical services to non-contract medical service providers who provide services at facilities other than SMMC to medically indigent patients for whom the County has responsibility as follows: the first procedure will be paid at 100% of the prevailing Medicare participating fee schedule for San Mateo County for all Part “B” services that can be reimbursed pursuant to the Center for Medicare and Medicaid Services (CMS) guidelines or the Medicare Labor Adjusted Ambulatory Surgery Classification (ASC), and all services not found on the Part “B” Medicare Fee Schedule of the ASC that are considered reimbursable pursuant to CMS guidelines will be paid under the Ambulatory Payment Classification (APC) rate; and all additional procedures will be paid at 50% of the Medicare Allowable reimbursement rate for and on behalf of the County of San Mateo as requested and approved by Chief of the Health System and the Chief Executive Officer (CEO) of SMMC, or their authorized designee(s).
IT IS FURTHER DETERMINED AND ORDERED that, notwithstanding the foregoing, the Chief of the Health System, acting in consultation with the County Manager and the County Counsel, shall have the authority to negotiate rates different from those set forth in the preceding paragraph where, in the judgment of the Chief of the Health System, such rates are necessary in order to timely secure required care for County medically indigent patients, and the Controller shall have the authority to make payments to non-contract medical care providers on the basis of such rates negotiated by the Chief of the Health System.
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