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Agenda Item
ASR
Control 23-001113 |
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MEETING
DATE: |
04/09/24 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Mindy
Winterswyk (714) 834-5052 |
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Debra
Baetz (714) 834-2830 |
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Subject: Master Contracts for Medical Safety
Net Program
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ceo CONCUR |
County Counsel Review |
Clerk of the Board |
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Concur |
Approved
Agreement to Form |
Discussion |
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3
Votes Board Majority |
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Budgeted: N/A |
Current Year
Cost: N/A |
Annual Cost: FY 2024-25 $1,800,000 |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: N/A |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 5/21/2019 #42, 5/19/2015 #41, 3/3/2015
#31 |
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RECOMMENDED
ACTION(S):
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1. |
Approve the Master
Contract with various providers for provision of Medical Safety Net Program
Hospital Services, for the term of July 1, 2024, through June 30, 2027, in an
annual aggregate amount not to exceed $625,000, renewable for one additional
two-year term. |
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2. |
Approve the Master
Contract with various providers for provision of Emergency and Stabilization
Hospital Services, for the term of July 1, 2024, through June 30, 2027, in an
annual aggregate amount not to exceed $300,000, renewable for one additional
two-year term. |
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3. |
Approve the Master
Contract with various providers for provision of Medical Safety Net Program
Clinic Services, for the term of July 1, 2024, through June 30, 2027, in an
annual aggregate amount not to exceed $875,000, renewable for one additional
two-year term. |
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4. |
Authorize the County
Procurement Officer or Deputized designee to execute the Master Contracts
with various providers for Medical Safety Net Hospital and Clinic Services as
needed throughout the term of the contract. |
SUMMARY:
Approval of Master Contracts with
various providers for the provision of Hospital Services, Emergency and
Stabilization Hospital Services and Clinic Services, for the Medical Safety Net
Program will meet the County's mandate under Welfare & Institutions Code
17000 and Orange County California Code section 1-4-250 and will provide
urgent/emergent care to eligible uninsured Orange County residents.
BACKGROUND
INFORMATION:
The
Medical Safety Net (MSN) program of the Health Care Agency (HCA) was
established in 1983 for the purpose of meeting the County's mandate under the
California Welfare & Institutions Code Section 17000. In 2014, MSN was
modified as a result of implementation of the Affordable Care Act. Enrollment
in the MSN Program is limited to persons between 19 and 64 years with incomes
between 138 and 200 percent of the Federal Poverty Level who either: 1) present
at an emergency room with an urgent or emergency condition that if left
untreated would result in a serious disability, serious deterioration of health
or loss of life or limb; or 2) are patients of a contracted community clinic
and require a referral to specialty care that is beyond the community clinic's
scope of practice for an urgent condition, that if left untreated would result
in serious disability, serious deterioration of health or loss of life or limb.
The MSN Program does not provide primary care services, chronic disease case
management or preventive health care. These persons are lawful residents of
Orange County (County) who are otherwise eligible for, but have not purchased,
health coverage through California's Health Exchange Program, Covered
California.
The MSN Program
affords hospitals, clinics, physicians, and ancillary providers the opportunity
to contract with the County for rates not to exceed CalOptima Medi-Cal rates.
Projected costs associated with these contracts are estimated to total
approximately $1.8 million per fiscal year based on prior utilization cost
trends and the unpredictability of claims volume and associated claims. Actual
MSN program costs are variable each Fiscal Year (FY) as reimbursement is based
on the volume of eligible claims submitted and the types of services provided.
For example, total MSN program costs for FY 2020-21 were $760,870 with 923
eligible claims versus $75,261 with 92 eligible claims for FY 2021-22.
Your Honorable Board of Supervisors
(Board) approved the current Master Contracts for Provision of Hospital
Services, Emergency and Stabilization Hospital Services and Clinic Services in
May 2019. These Master Contracts will be expiring on June 30, 2024. The below
actions have been executed pursuant to appropriate authorities:
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Board Date |
Contract/Amendment |
Action |
Term |
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March 3, 2015 |
Amendment |
Board Approved amendment to the Clinic
Master Agreement allowing any community Clinic that is both an MSN and
Tobacco Settlement Revenue (TSR) funded, to be eligible to receive remaining
undistributed portion of contract funds used to meet the maintenance of
effort requirement for TSR. No financial impact. |
N/A |
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May 19, 2015 |
Master Contract |
Board Approved contracts for the
Provision of Network Hospital Services, Emergency and Stabilization Hospital,
and Clinic Services for the MSN Program for $3,520,299 for FY15-16, and
$3,436,229 for FY16-17 and FY17-18. |
July 1, 2015 – June 30, 2018 |
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May 21, 2019 |
Master Contract |
Board Approved the current contracts for
the Provision of Network Hospital Services, Emergency and Stabilization
Hospital, and Clinic Services for a total of $1.85 million in estimated
costs. |
July 1, 2019 – June 30,2024 |
Emergency Department and Inpatient
Hospital Services:
The MSN Program is
offering three contracting options to all Orange County hospitals that have
fully licensed and operational emergency rooms: (1) a Hospital Services
Contract, (2) an Emergency and Stabilization Hospital Services Contract or (3)
the option not to contract. Any hospital may change its contract status with
the MSN Program by providing 30 days written notification to terminate their
existing contract and then executing the desired contract, if any.
Hospitals electing to enter into the
Emergency and Stabilization Hospital Services Contract recognize the mandate to
treat these persons in their emergency departments (ED), but do not wish to
keep patients past the point they are medically stable for transport to a
Network Hospital.
Hospitals
will be reimbursed based on their individually contracted CalOptima Medi-Cal
rates at the percentages set forth below. Because hospitals are mandated to
treat all persons presenting in their EDs, a non-contract rate is also included
should an MSN patient present at a non-contract hospital's ED.
Contract Option
and Associated Reimbursement Rate:
Network Hospital
Services Contract: 100 percent of CalOptima rate
Emergency and
Stabilization Hospital Services Contract: 75 percent of CalOptima rate
Non-Contract: 45
percent of APR-DRG
Clinic
and Emergency Dental Services:
Community Clinics choosing
to enter into a contract with the MSN program will continue to play an
important role in reducing non-emergency utilization of hospital emergency
rooms.
The MSN Clinic
Services Contract proposes to continue reimbursing Community Clinics at rates
equivalent to CalOptima Medi-Cal reimbursement rates. HCA is required to spend
a minimum of $850,000 per year on community clinic services to meet the
maintenance of effort requirement for Tobacco Settlement Revenue (TSR) funding,
as specified in Orange County California Code section 1-4-250. If MSN
expenditures for Clinic Services do not reach the $850,000 threshold,
additional funds will be distributed as needed to meet the required spending
total of $850,000 in Clinic Services.
The MSN Clinic Services Contract proposes
to continue to distribute these additional funds to Community Clinics
contracted with both the MSN and TSR programs, based on the number of their unfunded
clinic services as reported to HCA. The contract also allows these funds to be
distributed based on other methods, as mutually agreed to by the Community
Clinics and County.
The Contracts do
not currently include subcontractors or pass through to other providers. See
Attachment D for Contract Summary Forms. All Contracts contain mutual
indemnification provisions that vary from the County standard of sole
indemnification. CEO/Risk Management has reviewed the indemnification and
insurance provisions and determined them to be acceptable for these services.
See Attachment E for Risk Management Waivers.
The
Orange County Preference Policy is not applicable to these Contracts.
The
current contracted providers for MSN are listed in the table below:
HCA anticipates that the
same providers will participate in the MSN program in subsequent fiscal years.
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MSN Contracts Fiscal Year 23-24 |
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HOSPITALS |
EMERGENCY AND
STABILIZATION HOSPITALS |
CLINICS |
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Alta
Newport Inc., Foothill Regional Medical Center |
Anaheim
Regional Medical Center |
Altamed
Health Services Corporation |
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Anaheim
Global Medical Center |
Hoag
Memorial Hospital |
Camino
Health Center |
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Chapman
Global Medical Center |
Kaiser
Foundation Hospitals |
Celebrating
Life Community Health Center |
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Fountain
Valley Regional Hospital |
Los Alamitos Medical Center |
Center
for Inherited Blood Disorders |
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Long
Beach Memorial Medical Center |
Placentia
Linda Hospital |
Central
City Community Health Center |
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Mission
Hospital Regional Medical Center |
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Families
Together of Orange County |
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Orange
Coast Memorial Medical Center |
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Friends
of Family Health Center |
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Orange
County Global Medical Center |
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Hurtt
Family Health Clinic |
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Prime
Healthcare La Palma |
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Korean
Community Services |
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Prime
Healthcare Anaheim |
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Laguna
Beach Community Clinic |
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Prime
Healthcare Huntington Beach |
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Livingstone
Community Development Corporation |
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Prime
Healthcare Garden Grove |
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Nhan
Hoa Comprehensive Healthcare Clinic |
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South
Coast Global Medical Center |
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North
Orange County Regional Health Center |
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Saddleback
Memorial Medical Center |
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Serve
The People |
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St.
Joseph Hospital |
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Share
Our Selves Free Clinic |
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St.
Jude Medical Center |
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Sierra
Health Center |
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Southland
Integrated Services |
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St.
Jude Medical Center & Mobile Clinic |
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University
of California Regents |
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Vista
Community Clinics: The Gary Center |
HCA requests that the Board approve the
Master Contracts with various providers for Hospital Services, Emergency and
Stabilization Hospital Services and Clinic Services for the Medical Safety Net
Program, as referenced in the Recommended Actions.
FINANCIAL
IMPACT:
Appropriations for these
Master Contracts will be included in the Budget Control 042 FY 2024-25 Budget
and in the budgeting process for future years.
Services under these Contracts have
multiple providers that share an aggregate maximum funding amount. Funding for
each provider will vary depending upon utilization of services. Should services
need to be reduced or terminated due to lack of funding, these contracts
contain language that allows HCA to give 30 days' notice to either terminate or
renegotiate the level of services to be provided. The notice will allow HCA
adequate time to transition or terminate services to clients, if necessary.
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A - Contract for Provision of Medical Safety Net Program Hospital Services
Attachment B - Contract for Provision of Emergency and Stabilization Hospital
Services
Attachment C - Contract for Provision of Medical Safety Net Program Clinic
Services
Attachment D - Contract Summary Forms for Attachments A, B, and C
Attachment E - Risk Management Waivers to Attachments A, B, and C
Attachment F - Welfare and Institutions Code Section 17000
Attachment G - Orange County California Code section 1-4-250