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Agenda Item
ASR
Control 18-000926 |
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MEETING DATE: |
05/21/19 |
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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): |
Cheryl Meronk (714) 834-4099 |
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Steve Thronson (714) 834-4418 |
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Subject: Master Agreements for
Medical Safety Net Program
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ceo CONCUR |
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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 2019-20 $1,850,000 |
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Staffing Impact: |
No |
# of Positions:
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Sole Source:
No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 05/19/2015
#41, 03/03/2015 #31, 12/17/2013 #45 |
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RECOMMENDED ACTION(S):
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1. |
Approve the Master Agreement with various providers for provision of Network Hospital Services for the Medical Safety Net Program for the period July 1, 2019, through June 30, 2024. |
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2. |
Approve the Master Agreement with various providers for provision of Emergency and Stabilization Hospital Services for the Medical Safety Net Program for the period July 1, 2019, through June 30, 2024. |
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3. |
Approve the Master Agreement with various providers for provision of Clinic Services for the Medical Safety Net Program for the period July 1, 2019, through June 30, 2024. |
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4. |
Authorize the Health Care Agency Director, or designee, to execute the Master Agreements, and any subsequent individual agreements under each Master Agreement, as referenced in the Recommended Actions above. |
SUMMARY:
Approval of Master Agreements with various providers for the provision of health care services and administrative support will meet the County's mandate under Welfare & Institutions Code 17000 and Orange County California Code section 1-4-250.
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, medical homes, chronic disease case management or preventive health care. These persons are lawful residents of Orange County who are otherwise eligible for, but have not purchased, health coverage through California’s Health Exchange Program, Covered California. MSN enrollment for Calendar Year 2018 was 114. Projected MSN enrollment for Calendar Year 2019 is 100.
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 $1.85 million per fiscal year based on prior utilization cost trends and the unpredictability of claims volume and associated claims.
On December 17, 2013, your Honorable Board of Supervisors (Board) approved the Master Agreements for the Provision of Network Hospital Services, Emergency and Stabilization Hospital Services and Clinic Services for the MSN Program for the period of January 1, 2014, through June 30, 2015. On March 3, 2015, the Board approved an 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 the remaining undistributed portion of contract funds used to meet the maintenance of effort requirement for TSR. On May 19, 2015, the Board approved the current agreements for the provision of health care services, which expire on June 30, 2019. See the table below for a listing of current MSN contracts. HCA is proposing a five-year term for the health care services agreements covering the period July 1, 2019, through 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 Network Hospital Service Agreement, (2) an Emergency and Stabilization Agreement 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 agreement, if any.
Hospitals electing to enter into the Emergency and Stabilization Agreement 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. If a hospital does not contract with CalOptima, then reimbursement will be based on All Patient Refined Diagnosis-Related Groups (APR-DRG), which is a statistical system used by both Medi-Cal and Medicare to classify any inpatient stay into various diagnosis groups for the purposes of payment. 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.
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Contract
Option |
Reimbursement
Amount |
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1) Network Hospital Agreement |
100 percent of CalOptima rate |
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2) Emergency and Stabilization Agreement |
75 percent of CalOptima rate |
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3) Non-Contract |
45 percent of APR-DRG |
Clinic and Emergency Dental Services:
Community Clinics choosing to enter into an agreement with the MSN program will continue to play an important role in reducing non-emergency utilization of hospital emergency rooms.
The MSN Clinic Agreement 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 in order to meet the maintenance of effort requirement for 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 Agreement 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 aforementioned Agreements do not currently include subcontractors or pass through to other providers. All of the Agreements 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 Attachments G, H and I for Contract Summary Forms. See Attachment J, K and L for Risk Management Waivers.
HCA requests that your Board approve the Master Agreements with various providers for Network Hospital Services, Emergency and Stabilization Services and Clinic Services for the Medical Safety Net Program, as referenced in the Recommended Actions.
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
18-19 |
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CLINICS |
NETWORK HOSPITALS |
ER & STABILIZATION HOSPITALS |
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Altamed Health Services Corporation |
Anaheim Global Medical Center |
Anaheim Regional Medical Center |
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Camino Health Center |
Chapman Global Medical Center |
Hoag Memorial Hospital |
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Center for Inherited Blood Disorders |
Fountain Valley Regional Hospital |
Kaiser Foundation Hospitals |
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Central City Community Health Center |
Long Beach Memorial Medical Center |
Los Alamitos Medical Center |
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Families Together of Orange County |
Mission Hospital Regional Medical Center |
Placentia Linda Hospital |
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Friends of Family Health Center |
Orange Coast Memorial Medical Center |
University of California Irvine Medical Center |
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Hurtt Family Health Clinic |
Orange County Global Medical Center |
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Korean Community Services |
Prime Healthcare La Palma |
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Laguna Beach Community Clinic |
Prime Healthcare Anaheim |
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Livingstone Community Development Corporation |
Prime Healthcare Huntington Beach |
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Nhan Hoa Comprehensive Healthcare Clinic |
Prime Healthcare Garden Grove |
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North Orange County Regional Health Center |
South Coast Global Medical Center |
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Serve The People |
Saddleback Memorial Medical Center |
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Share Our Selves Free Clinic |
St. Joseph Hospital |
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Sierra Health Center |
St. Jude Medical Center |
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Southland Integrated Services |
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St. Jude Medical Center & Mobile Clinic |
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Vista Community Clinics: The Gary Center |
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FINANCIAL IMPACT:
Appropriations for these Master Agreements will be included in the FY 2019-20 budget and will be included in the budgeting process for future years.
Services under these Agreements 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 agreements 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 - Agreement for Provision of Network Hospital
Services for the Medical Safety Net Program
Attachment B - Agreement for Provision of Emergency and Stabilization Hospital
Services for the Medical Safety Net Program
Attachment C - Agreement for Provision of Clinic Services for the Medical
Safety Net Program
Attachment D - Redline version to Attachment A
Attachment E - Redline version to Attachment B
Attachment F - Redline version to Attachment C
Attachment G - Contract Summary Form for Attachment A
Attachment H - Contract Summary Form for Attachment B
Attachment I - Contract Summary Form for Attachment C
Attachment J - Risk Management Waiver to Attachment A
Attachment K - Risk Management Waiver to Attachment B
Attachment L - Risk Management Waiver to Attachment C
Attachment M - Welfare and Institutions Code Section 17000
Attachment N - Orange County California Code section 1-4-250