COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health System

 

DATE:

February 16, 2010

BOARD MEETING DATE:

April 27, 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:

Agreement with San Mateo Health Commission for Long Term Care Nursing Facility

 

RECOMMENDATION:

Adopt a Resolution:

1.

Authorizing the President of the Board to execute an Agreement with San Mateo Health Commission for the provision of Medi-Cal services for Health Plan of San Mateo clients who are residing in San Mateo County Long Term Care facilities for the term February 1, 2010 through January 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.

 

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. There are several Agreements in place with HPSM to provide specific and varied services for Medi-Cal patients.

 

DISCUSSION:

This Agreement provides for the care of Medi-Cal patients who are residents of the County’s Long Term Care facilities. As with the other Agreements, HPSM reimburses SMMC for providing such care.

 

HPSM will reimburse SMMC for Long Term Care (LTC) services in lieu of Administrative days for its covered patients who no longer require acute care. SMMC bills $1800 per day for acute care. The Medi-Cal reimbursement rate for acute care is $1758 per day. When the number of acute care reimbursable days has been reached, reimbursement ceases and patients are considered Administrative. SMMC bills $650 per day for an Administrative day. The Medi-Cal reimbursement rate for an Administrative day is $351 per day. When a patient is moved to LTC facility the revenue for Administrative day is increased from $351 per day to $401 per day. It is in the best interest of the County to move patients to a LTC facility to receive the appropriate level of care and free up beds for incoming acute care patients.

 

County Counsel has reviewed and approved the Resolution and Agreement as to form.

 

Approval of this Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing care for residents of the County’s Long Term Care facilities who are members of HPSM. It is anticipated that the percentage of the Administrative days will be held to no more than 10% as a result of this LTC agreement with HPSM.

 

Performance Measure:

Measure

FY 2008-09
Actual

FY 2009-10
Projected

Percentage of patient Administrative days in acute medical/surgical

11%

10%

 

FISCAL IMPACT:

The initial term of the Agreement is February 1, 2010 through January 31, 2011. Pursuant to its terms, the Agreement automatically renews for successive twelve month periods on the same terms and conditions, subject to any subsequent amendments.

 

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.