COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health System

 

DATE:

December 14, 2009

BOARD MEETING DATE:

February 23, 2010

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center

SUBJECT:

Amendment to Agreement with San Mateo Health Commission

 

RECOMMENDATION:

Adopt a Resolution authorizing the President of the Board to execute Amendment No. 2 to the Agreement with San Mateo Health Commission for the provision of Medi-Cal Services for Health Plan of San Mateo clients, revising the amounts of supplemental payments and amending conditions for receipt of supplemental payments.

   

BACKGROUND:

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. This Agreement automatically renews for successive twelve month periods on the same terms and conditions, subject to any subsequent amendments.

 

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.

 

DISCUSSION:

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.

 

In addition to other reimbursements and in consideration of services provided by SMMC to HPSM members, HPSM makes supplemental quarterly payments to SMMC. The amount of those payments is being increased by $4,166,667 from $18,000,000 to a new total of $22,166,667. The payment due on March 31, 2010 has been increased from $4,500,000 to $6,166,667. The payment due on June 30, 2010 has been increased from $4,500,000 to $7,000,000.

 

The conditions upon which the supplemental payments are made have been amended to include working with HPSM medical staff to reduce hospital readmissions from the skilled nursing facility.

 

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. It is anticipated that 21,000 Medi-Cal recipients will be treated at SMMC during FY 2009-10.

 

Performance Measures:

Measure

FY 2008-09
Actual

FY 2009-10
Projected

Number of Medi-Cal recipients treated at SMMC

20,767

21,000

 

FISCAL IMPACT:

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 an increase in supplemental payments totaling $22,166,667 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.