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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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November 2, 2009
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BOARD MEETING DATE:
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December 1, 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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Amendment to Agreement with San Mateo Health Commission
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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 of Supervisors to execute an Amendment to the Agreement with San Mateo Health Commission for the provision of Medi-Cal Services for Health Plan of San Mateo clients, incorporating supplemental payments and waiving the 45 business day notice provision set forth in Section 1375.7 of the California Health and Safety Code; 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 through San Mateo Medical Center (SMMC) has contracted with San Mateo Health Commission dba Health Plan of San Mateo (HPSM) since January 1994. The current Agreement is for a three-year term, January 1, 2007 through December 31, 2009.
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The Agreement provides for the care of inpatient, outpatient and emergency services patients who are eligible to receive Medi-Cal benefits. HPSM reimburses SMMC for providing such care.
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DISCUSSION:
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HPSM received an increase in total compensation under its Medi-Cal Services Contract with the State of California, in addition to its share of rate increases for Medi-Cal Managed Care Plans. SMMC is the only disproportionate share hospital in San Mateo County and is the largest provider of adult (non-obstetric) inpatient hospital service to HPSM members.
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In addition to other reimbursements and in consideration of services provided by SMMC to HPSM members, HPSM will make supplemental quarterly payments to SMMC in the amount of $4,500,000 for a total of $18,000,000.
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As a condition for the receipt of the supplemental payments, SMMC must remain a participating hospital; maintain current emergency room licensure status and not close the emergency room; explore collaborative initiatives with HPSM in the area of Medical Management; and submit a written report quarterly prior to receiving each supplemental payment. In addition, SMMC must agree to waive the 45 business day notice requirement as provided for in Section 1375.7 of the California Health and Safety Code.
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County Counsel has reviewed and approved the Resolution and Amendment as to form. Approval of this Amendment contributes to the Shared Vision 2025 outcome of a Healthy Community by providing care to inpatient, outpatient and emergency services patients who are clients of HPSM.
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Performance Measures:
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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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Number of Medi-Cal recipients treated at SMMC
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20,767
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21,000
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FISCAL IMPACT:
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The initial term of the Agreement is January 1, 2007 through December 31, 2009. Pursuant to its terms, the Agreement automatically renews for successive twelve month periods on the same terms and conditions, subject to any subsequent amendments, This Amendment has a positive impact on SMMC. These funds represent increased payments of $18,000,000 to SMMC and are contingent on continuing SMMC’s relationship with the San Mateo Health Commission. The revenue from this Amendment is included in SMMC’s FY 2009-10 Adopted Budget.
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