Agenda Item AGENDA STAFF REPORT ASR Control 12-000205
MEETING DATE:	05/08/12
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Donna Fleming (714) 834-2980

Subject: Agreement for Public Health Medical Services

ceo Concur	County Counsel Review		Clerk of the Board
Concur	Approved Agreement to Form		Discussion
			3 Votes Board Majority
Budgeted: Yes		Current Year Cost: N/A		Annual Cost: FY 2012-13: $500,000; FY 2013-14: $500,000
Staffing Impact: No		# of Positions:		Sole Source: No
Current Fiscal Year Revenue: N/A
Funding Source: 10% Net County Cost, 86% State: (Health Realignment), 4% Other (Medi-Cal Disease Control)
Prior Board Action: 6/22/2010 #74

RECOMMENDED ACTION(S):

1.	Approve the Agreement with The Regents of the University of California, a Constitutional Corporation, on behalf of UC Irvine Healthcare for Provision of Public Health Medical Services for the period July 1, 2012 through June 30, 2014.
2.	Authorize the Health Care Agency Director or designee, on behalf of the Board of Supervisors, to execute the Agreement with The Regents of the University of California, a Constitutional Corporation, on behalf of UC Irvine Healthcare for Provision of Public Health Medical Services

SUMMARY:

The Health Care Agency requests approval of the Agreement with The Regents of the University of California, a Constitutional Corporation, on behalf of UC Irvine Healthcare for Provision of Public Health Medical Services.

BACKGROUND INFORMATION:

The Health Officer, under Health and Safety Code Section 120175, is required to take measures within his or her jurisdiction to prevent the spread of diseases made reportable by State regulations. The Health Care Agency (HCA) currently contracts with The Regents of the University of California, a Constitutional Corporation, on behalf of University of California, Irvine Medical Center and the UC Irvine School of Medicine (The Regents) for specialty care services for communicable disease and adult mental health patients whose medical needs are beyond the scope of services available in HCA's clinics and who do not have other sources of payment for needed medical care. The current Agreement with The Regents, which is based on a Solicitation completed in April 2010, was approved by your Honorable Board on June 22, 2010 and will end on June 30, 2012. The proposed Agreement will allow services to continue to be provided through June 30, 2014.

The proposed Agreement enables The Regents to provide comprehensive medical services to communicable disease (predominantly tuberculosis) patients and adult mental health patients referred by HCA. Services are provided on an as-needed and pre-authorized basis, and include the following:

-	Inpatient Services: including physician services, nursing, ancillary, diagnostic, pharmacy and other medical services
-	Outpatient Services: including physician services required during an outpatient visit for services such as emergency, specialty, or diagnostic services.
-	Pulmonary Disease Liaison Services: including physician services that provide clinic consultations and expedite admissions, guidance regarding medical progress management, examinations of patients with difficult diagnostic problems; and coordination of interdisciplinary patient care conferences.

The proposed fee-for-service Agreement includes payment for services at rates the same as the current Agreement. HCA shall compensate The Regents for providing inpatient services and outpatient services at cost, which is 22.76% of billed Usual and Customary Charges as reported to the Office of Statewide Health Planning and Development. In addition, HCA shall compensate The Regents for providing physician services at 130% of the current Medicare Area 126 Resource-Based Relative Value Scale and anesthesia services at $45 per American Society of Anesthesiologists Base Unit, which are the same rates as the current Agreement. Clinical services will be paid through HCA's contracted Fiscal Intermediary under a separate Agreement. HCA will reimburse The Regents directly for liaison services in an annual amount of $40,000, which is level from the current Agreement.

Annual expenditures are determined by need, other than liaison services, and all referrals and services are preauthorized and monitored by HCA’s Pulmonary Disease Services. Annual Public Health Medical Services expenditures from FY 2006-07 through FY 2010-11 ranged from $229,885 to $497,556 with an annual average of $352,152. It is anticipated that costs for these services will not exceed $500,000 annually. If costs for these services exceed this amount, HCA will manage the additional costs within its existing budget.

In FY 2010-11, a total of 455 patient referrals involving more than 900 clinical procedures were performed by The Regents for HCA Public Health Medical Services. HCA’s administrative and programmatic evaluations indicate that The Regents is meeting expectations in providing Public Health Medical Services to these County-responsible patients.

This Agreement contains mutual indemnification provisions, which varies from the County standard of sole indemnification. CEO/Risk Management has approved the indemnification provision and determined the risk to be acceptable for these services.

The proposed Agreement does not have subcontracts.

The Health Care Agency requests that your Board approve the Agreement with The Regents of the University of California, a Constitutional Corporation, on behalf of University of California, Irvine Medical Center and the UC Irvine School of Medicine for Provision of Public Health Medical Services.

FINANCIAL IMPACT:

This Agreement is included in the Health Care Agency's FY 2012-13 Requested Budget and will be included in the budgeting process for FY 2013-14.

It is estimated that funding for these services represents less than ten percent of the contractor's total annual operating budget. Should services need to be reduced or terminated due to lack of funding, this Agreement contains 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. HCA staff has reviewed the contractor's financial documentation, including their most recent financial statements. At this time there appear to be no issues that would impact the contractor's ability to perform the services.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

A. Agreement for Provision of Public Health Medical Services with The Regents of the University of California, a Constitutional Corporation, on behalf of UC Irvine Healthcare

B. Redline Version to Attachment A