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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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December 16, 2010
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BOARD MEETING DATE:
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January 25, 2011
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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 No. 1 to the CareAdvantage Hospital Service Agreement with San Mateo Health Commission, doing business as Health Plan of San Mateo
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RECOMMENDATION:
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Adopt a Resolution authorizing the President of the Board to execute Amendment 2010-01 (Amendment No. 1) to the CareAdvantage Hospital Service Agreement with San Mateo Health Commission, doing business as Health Plan of San Mateo, increasing the inpatient mental health services per diem rate by $42.93, from $1,129.78 to $1,172.71, per acute day effective January 1, 2011.
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BACKGROUND:
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The County of San Mateo has contracted with San Mateo Health Commission, doing business as Health Plan of San Mateo (HPSM), since January 1994. The current CareAdvantage Hospital Service Agreement (the Agreement) is for the term January 1, 2009 through December 31, 2009. This Agreement automatically renews for successive twelve month periods with the same terms and conditions, subject to any subsequent amendments.
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HPSM operates a Medicare Advantage Plan (CareAdvantage), which offers a prepaid health benefits plan for individuals covered under the Federal Medicare Program. The Agreement provides for the care of patients who are members of the CareAdvantage Plan. HPSM reimburses SMMC for providing such care.
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DISCUSSION:
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HPSM, San Mateo Medical Center (SMMC) and Behavioral Health and Recovery Services (BHRS) participated in the Psychiatry and Long Term Care workgroup of the Healthcare Redesign. It was established that HPSM will reimburse SMMC at a per diem rate equal to the rate established by BHRS for CareAdvantage participants.
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Pursuant to the Agreement, inpatient mental health services are reimbursed at an all-inclusive per diem rate of $1,129.78 per day. Under this Amendment, inpatient mental health services will be reimbursed at an all-inclusive per diem rate of $1,172.71 per acute day. As already set under the Agreement, payment may not be made for more than a total of 190 days of inpatient psychiatric hospital services during the plan member’s lifetime.
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County Counsel has reviewed and approved this Amendment and Resolution as to form.
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This Amendment 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. It is anticipated that the percentage of reimbursements for member services will be 100%.
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Performance Measure:
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Measure
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FY 2009-10
Actual
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FY 2010-11
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 this Agreement is January 1, 2009 through December 31, 2009. Pursuant to its terms, the Agreement automatically renews for successive twelve month periods with the same terms and conditions, subject to any subsequent amendments. The revenue from this Amendment is included in SMMC’s FY 2010-11 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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