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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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September 16, 2009
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BOARD MEETING DATE:
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October 20, 2009
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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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Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center
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SUBJECT:
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Agreement with San Mateo Health Commission, dba Health Plan of San Mateo for CareAdvantage
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RECOMMENDATION:
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Adopt a Resolution:
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1.
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Authorizing the President of the Board to execute an Agreement with San Mateo Health Commission, dba Health Plan of San Mateo, for services provided by the San Mateo Medical Center in connection with the Medicare Advantage Plan for the period January 1, 2009 through December 31, 2009; and
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2.
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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
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BACKGROUND:
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The County of San Mateo has contracted with San Mateo Health Commission, dba Health Plan of San Mateo (HPSM), since January 1994. HPSM operates a Medicare Advantage Plan (CareAdvantage), which offers a prepaid health benefits plan for individuals covered under the Federal Medicare Program. This Agreement provides for the care of patients who are members of the CareAdvantage Plan.
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DISCUSSION:
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Pursuant to the proposed Agreement, HPSM will reimburse San Mateo Medical Center (SMMC) for services rendered to inpatients at 100% of the Diagnostic Related Group (DRG) payment rate. Outpatient services will be reimbursed at 90% of the Ambulatory Payment Classification (APC) payment rate. Skilled nursing services will be paid an all inclusive per diem rate of $425 per day for a maximum of 100 days of stay. Inpatient mental health services will be reimbursed at an all inclusive per diem rate of $1,129.78 per day.
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The term of the Agreement is January 1, 2009 through December 31, 2009. It will then automatically renew for successive twelve month periods on the same terms and conditions, subject to any subsequent amendments, unless terminated pursuant to the terms of this Agreement. This Agreement is generated by HPSM. It was delayed due to revisions by HPSM to the per diem rates.
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County Counsel has reviewed and approved the Resolution and Agreement as to form.
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Approval of this Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing access to medical and mental health services to patients in San Mateo County who are covered by CareAdvantage. Reimbursement of the cost of care for CareAdvantage members allows the contributions from the General Fund to cover quality care for those patients who are medically indigent.
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Performance Measure(s):
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Measure
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FY 2008-09
Actual
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FY 2009-10
Projected
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Percentage of reimbursements for member services
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100%
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100%
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FISCAL IMPACT:
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The initial term of the Agreement is January 1, 2009 through December 31, 2009. Net revenue received from HPSM during FY 2007-08 totaled $6,951,494. The anticipated revenue for FY 2009-10 is $8,920,587 and is included in the SMMC FY 2009-10 Adopted Budget.
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Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care are covered by the County’s General Fund contribution to SMMC.
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