Inter-Departmental Correspondence
Health System



October 19, 2009


November 10, 2009







Honorable Board of Supervisors



Jean S. Fraser, Chief, Health System


Louise Rogers, Director, Behavioral Health & Recovery Services



Agreement with Health Plan of San Mateo for Medicare CareAdvantage program funding



Adopt a Resolution:

1) Authorizing the President of the Board to execute a revenue Agreement with the Health Plan of San Mateo for Medicare CareAdvantage services for the term January 1, 2009 through December 31, 2011; and


2) 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.



On May 24, 2005, your Board approved an Agreement with the Health Plan of San Mateo (HPSM) whereby Behavioral Health and Recovery Services (BHRS) is reimbursed for the provision of mental health services to clients with Medicare CareAdvantage coverage through the HPSM. That Agreement was for the term January 1, 2006 through December 31, 2006, and automatically renews for one-year periods. This funding arrangement has made it possible for clients who have both Medi-Cal and Medicare insurance coverage to avoid having multiple coverage plans, which would have caused considerable hardship for clients in managing their healthcare.


The Agreement with the HPSM for mental health services was an essential component of the HPSM proposal to the federal Centers for Medicaid and Medicare Services for certification as the Medicare Advantage Plan for San Mateo County.



The HPSM has presented a superseding Agreement for Medicare Advantage program services for the term January 1, 2009 through December 31, 2011. This Agreement includes necessary revised Medicare administrative requirements. Through this Agreement BHRS will continue to provide mental health services to clients with HPSM Medicare Advantage health coverage. BHRS will present to your Board for approval a separate Agreement with HPSM, which shall be a revenue Agreement for the provision of services to clients with Healthy Families, Healthy Kids and HealthWorx insurances coverages.


The Agreement has been reviewed and approved by Risk Management and the Agreement and the Resolution have been reviewed and approved by County Counsel. 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 The final Agreement, which included a favorable rate increase for BHRS retroactive to January 1, 2009, was sent to BHRS from the Health Plan of San Mateo in early October, 2009 which caused the delay in the presentation to the Board of Supervisors.


The Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing funding for mental health services through our provider network. BHRS provides a range of services to promote wellness and recovery and to support consumers remaining in the lowest possible level of care. The provision of outpatient mental health services through our provider network is one established level of care. The services funded through this Agreement contribute to this measure. It is anticipated that eighty-seven percent of clients who receive these services will be maintained at a current or lower level of care.


Performance Measure:


FY 2008-09

    FY 2009-10

Percentage of clients receiving outpatient mental health services maintained at current or lower level of care.





The term of the Agreement is January 1, 2009 through December 31, 2011. Services will be reimbursed on a per-unit basis at rates that are ninety (90) percent of federal Medicare rates. These rates are equivalent to current reimbursement rates for these services. It is anticipated that this Agreement will have a neutral effect on current reimbursements. Projected annual revenue from this Agreement is approximately $1,525,000 and has been included in the BHRS FY 2009-10 Adopted Budget. There is no net County cost associated for services provided through this Agreement.