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Home My WebLink AboutMINUTES - 09151987 - 1.51 1- s� M TO BOARD OF SUPERVISORS ROMn• Mark F i n u c an e '��n'�'`"�`�',/��— F Contra Health Services Director CWa DATE: September 15, 1987 coin/ SUBJECT: CSAC Resolutions SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND Atm JUSTIFICATION RECOMMENDED ACTION: Support resolutions on Medi -Cal restructuring, uncompensated care, and capital needs from the California Association of Public Hospitals, to be submitted to the CSAC General Assembly in November, REASON FOR RECOMMENDATION/BACKGROUND: At its Annual Meeting the General Assembly of the County Supervisors Association of California considers adoption of resolutions of significant statewide interest. Members of the California Association of Public Hospitals recommend approval of the above resolutions for submission to the General - Assembly as issues of grave importance to counties. i CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: ATTESTED SEP 15 1987 Health Services Director PHIL BATCHELOR, CLERK OF THE BOARD OF County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR County Supervisors Association of California BYDEPUTY M382/7-83 J � BEFORE THE GENERAL ASSEMBLY OF THE COUNTY SUPERVISORS ASSOCIATION OF CALIFORNIA Resolution Concerning RESOLUTION PROPOSED BY Uncompensated Care CONTRA COSTA COUNTY WHEREAS the most pressing health policy issues in California, as around the country, are the combined impacts of governmental cutbacks and private sector competition on access to care by the working poor and unsponsored population; and WHEREAS from a patient perspective, strategies for improving care to the unspon- sored should incorporate both expanded employer coverage for employed indivi- duals and their dependents and means of improving access to quality care for the unemployed who do not qualify for Medi-Cal but are medically indigent; and WHEREAS future improvements in overburdened county hospital systems, which pro- vide 65 percent of the "uncompensated care" in their counties, depend not only on uncompensated care strategies which provide new revenue streams for the non-MIA poor, but also a reduction in the crippling burden of undercompensated care they now provide through inadequate MISP and AB8 support; and WHEREAS counties must insist on state indigent care strategies which promise that a majority of relief or revenues will flow to their overburdened, under- funded facilities; and AE-RES2.1 2. WHEREAS coverage-based strategies for the employed and possibly unemployed may require counties to be prepared to offer well-designed, cost-effective capitated contracting options for the unsponsored poor; NOW, THEREFORE, BE IT RESOLVED that the Contra Costa County Board of Supervisors supports the California Supervisors Association of California in its efforts to place a major emphasis on insuring that counties receive a majority of new resources dedicated to reducing provider losses and improving access for unspon- sored Californians and that State seed money and enrollment guarantees be pro- vided county facilities in any coverage-based strategies employed by the State. AE-RES2.2 BEFORE THE GENERAL ASSEMBLY OF THE COUNTY SUPERVISORS ASSOCIATION OF CALIFORNIA Resolution Concerning) RESOLUTION PROPOSED BY Medi-Cal ) CONTRA COSTA COUNTY ''Restructuring" ) WHEREAS county health systems account for 44 percent of Medi -Cal inpatient expenditures in their counties and are dependent on these revenues for over 37 percent of their hospitals ' revenue base; and WHEREAS maintenance and expansion of this revenue base is essential for the pre- servation of the breadth and quality of county hospital services available both to the poor, as well as to the recipient of trauma and other specialty services which are heavily utilized by the community at large; and WHEREAS any "Restructuring" of the Medi -Cal program, particularly as these pro- posals relate to a conversion to capitated contracting for Medi-Cal services, hold the potential to impose either great damage or significantly improve the quality of the programs and finances of these vital safety net systems; and WHEREAS county hospitals account for a disproportionate 53 percent of Medi -Cal contract hospital expenditures for the more costly Medically Needy eligibles; and WHEREAS Medically Needy Aged, Blind, and Disabled individuals treated in county facilities require from 47 to 61 percent more services than those treated in the private sector; and AE-RES1.1 2. WHEREAS the Administration appears to have embraced Medi -Cal "Restructuring" as a means of further reducing program costs in a program ;which already ranks 47th in the nation in pre-eligible expenditures; and WHEREAS inadequate provider payments 'have already seriously compromised benefi - ciary access to necessary services and made the current "fee-for-service" system less costly than HMO/PHP costs for these eligibles, thereby seriously jeopar- dizing program integrity if an attempt is made to reduce capitated plan reimbur- sement below "fee-for-service" equivalent. NOW, THEREFORE, BE IT RESOLVED that the Contra Costa County Board of Supervisors supports the California Supervisors Association of California in its efforts to ensure that only Medi -Cal "Restructuring" proposals which expand access, ensure a reduction in providers ' Medi -Cal losses, and preserve or expand the role of county health systems in provision of care to this population be seriously entertained or enacted in the 1988 legislative session. AE-RES1.2 BEFORE THE GENERAL ASSEMBLY OF THE COUNTY SUPERVISORS ASSOCIATION OF CALIFORNIA Resolution Concerning RESOLUTION PROPOSED BY Capital CONTRA COSTA COUNTY WHEREAS the capital needs of county health facilities comprise a large propor- tion of the vast capital financing needs facing California's counties;_ and WHEREAS county hospital utilization has grown 11.5 percent over the last three years, while private hospital use has declined 3.4 percent; and WHEREAS county hospitals are serving as providers of 44 percent of Medi-Cal ser- vices in the 25 counties in which they operate and 65 percent of care to the unsponsored poor and serve as the recipient of an increasing share of unwanted, unprofitable patients which competitive pressures are driving out of the private health care delivery system; and WHEREAS these increasingly important facilities are threatened by chronically insufficient operating support, over 80 percent of which derives from state programs, resulting in years of inattention to critical capital needs; and WHEREAS this pattern of chronic underfunding has resulted in capital expenditure levels almost 90 percent below private sector standards, and serious inattention to urgent equipment needs; and AE-RES3.1 2. WHEREAS failure of the State to provide for the capital needs of the safety net providers, on which it depends for the majority of state mandated or managed indigent care, is crippling counties in their attempts to respond aggressively to the competitive health marketplace through pursuit of private revenues that can help to offset gnawing indigent care losses; and WHEREAS not only county hospitals, but other county health facilities, which house public and mental health programs in all 58 counties, also have urgent capital needs as a result of their mandates to provide other state-mandated, but inadequately funded programs; NOW, THEREFORE, BE IT RESOLVED that the Contra Costa County Board of Supervisors supports the County Supervisors Association of California in its efforts to advance consideration of either State G.O. bond or capital pass-through programs in the Legislature during the 1988 session. Such proposals shall be predicated on the fact that the State is the major shareholder and beneficiary of county health operations and should play a commensurate role in addressing urgent county health facility needs. AE-RES3.2