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Home My WebLink AboutMINUTES - 07221997 - C73 Contra TO: BOARD OF SUPERVISORS Costa FROM: William B.Walker Coirty DATE: July 17, 1997 SUBJECT: LETTER TO STATE DEPARTMENT OF HEALTH SERVICES CONCERNING LOCAL INITIATIVE ENROLLMENT ISSUES SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION I. RECOMMENDATION AUTHORIZE Health Services Director or Designee to send letter to Kim Belshe, Director of State Depart- ment of Health Services, protesting proposed decrease in the Local Initiative enrollment minimum and changes in the default/assignment methodology. II. FINANCIAL IMPACT Reducing the Local Initiative minimum enrollment and changing the default/assignment methodology will reduce the Local Initiative enrollment by one-third to one-half, thereby reducing premium payments with an annual revenue loss between $15 million and $20 million. These revenues are needed to help maintain the County's safety net health care system. III. BACKGROUND AND JUSTIFICATION The State Department of Health Services is proposing to decrease the Local Initiative minimum enrollment number and to change the default/assignment methodology which will result in a loss of 13,000 to over 21,000 members. CONTINUED ON ATTACHMENT: YES SIGNATURE: oa'• p x op RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON July 22, 1997 APPROVED AS RECOMMENDED OTHER APPROVED the above recommendations and DIRECTED thaC County Counsel review the legal considerations and assist the County Administrator and the Health Services Director in drafting correspondence relative to the legal issues, as appropriate. VOTE OF SUPERVISORS X UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT AYES: NOES: COPY OF AN ACTION TAKEN AND ENTERED ON THE ABSENT: ABSTAIN: MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. cc: William B, .Walker, M.D. Milt Camhi ATTESTED July 22, 1997 Contact: Bobbi Baron - 313-6004 BY DEPUTY Moardord.pm4 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR . V , Suite 100 595 Center Avenue MCC Martinez, CA 94553 Phone: 510\313-6000 Fax: 510\313-6002 Managed Care Commission July 17, 1997 S/v Mark DeSaulnier Chair Board of Supervisors 651 Pine Street Martinez, CA 94553 Dear Supervisor DeSaulnier: The Managed Care Commission, at our meeting last night, discussed a Local Initiative issue that could have a detrimental impact on the safety net in our County. We are pleased to be able to report to you that the Local Initiative (Contra Costa Health Plan) in June had 43,942 Medi-Call members and Foundation an estimated 3,450. However, we wanted to alert you to this new, potentially detrimental situation. Back in April the State Department of Health Services recalculated the Local Initiative minimum guaranteed enrollment from 39,783 to 21,418 and, upon pressure from the commercial plans, developed proposals for drastically altering the longstanding default methodology. After protest by the Local Initiatives throughout California, the State Department of Health Services agreed that there should be local discussions between the Department and plans participating in the two plan model regarding min/max number and default/assignment procedures. Indeed, the Department has just released draft guidelines for such discussions. While we appreciated the opportunity to review the guidelines, we were dismayed to learn that the State Department of Health Services was willing to reduce the Local Initiative minimum enrollment in Contra Costa County to 21,418. We have also been informed by the State Department of Health Services that they are now giving au defaults to Foundation until the Local Initiative reaches 39,783, then they will split the defaults evenly. On top of this, Foundation has essentially asked the State to implement the 21,418 minimum level. Together these actions will negatively affect the safety net in our County. It abrogates the Department's commitment to maintain disproportionate share hospital (DSH) days and the safety net providers who have consistently served the most vulnerable populations. In Contra Costa County, Foundation does not currently even contract with the largest DSH hospital 1 (Merrithew) nor with the largest safety net/FQHC system (County Clinics). In contrast the Local Initiative contracts not only with Merrithew and the County Clinics, but with all the other community traditional and safety net providers. While these proposed actions could reduce the Local Initiative's enrollment by more than half, it would have a minimal impact on Foundation, increasing its statewide Medi-Cal enrollment by only 4%. 'What is most important is that the State Health Services Department's own regulations do ►= require them to change the previously established minimum (39,783) or the existing default rules (all defaults to the Local Initiative up to this minimum, then 1:1 with Foundation). It makes no sense to dismantle the safety net system in Contra Costa County today and then try to resurrect'it in a year when the new managed care model, namely the County Organized Health Care System, may be implemented. We have used the 39,783 minimum to build our provider network; we have assigned all these members to primary care providers in our system, and we are delivering comprehensive services to this vulnerable population. This is not the time to disrupt a system that is working. This is not the time to replace the safety net with a roller coaster (see our attachment). We believe there is a more rational alternative in Contra Costa County for mandatory aid eligibles who do not choose a Plan: 1. For one time only default/assign all mandatory eligibles to Foundation until L/1's enrollment is reduced to 39,783 minimum; this includes all mandatory aid eligibles still in fee-for-service (minimum defined as mandatory eligibles). 2. If L/I mandatory eligible enrollment falls below 39,783, all defaults/assignments go to the L/I until it reaches its minimum enrollment; above 39,783 defaults to be everily divided between LII and Foundation. This is consistent with current state regulations. 3. Maintain the L/1's 39,783 minimum enrollment number until a COHS-like one plan model is implemented in Contra Costa County. This will assure stability to the safety net: We believe our proposal is fair, implementable, and would help to stabilize a fragile safety net system. Our proposal would stabilize the L/I's total Medi-Cal enrollment at approximately 42,000 and Foundation's total Medi-Cal in Contra Costa County would likely triple from its current level. It would also give us critical time to convertlthe two plan model in Contra Costa County to a one plan model (County Organized Health System). The State Department of Health Services, Foundation and Contra Costa County Board of Supervisors are all in agreement that any managed care redesign must ensure Contra Costa County, the providers, the plans, and most especially the Medi-Cal individuals are treated fairly. 2 The Managed Care Commission voted unanimously to ask the Board of Supervisors to communicate this proposal to the State Department of Health Services as soon as possible. For your convenience we have included a draft letter. We are available, if you wish to discuss this further. Please contact either me or Milt Camhi at 313-6004' if you would like more information. Sincerely, Carl Doolittle Vice Chair Managed Care Commission Enclosure CD:smp 93:1i2 ccs: Phil Batchelor, County Administrator Managed Care Commission Bill Walker, M.D., HS Director Milt Camhi, Executive Director, Health Plan CONTRA COSTA COUNTY 30K MINIMUM ROLLER COASTER Enrollment in Thousands Local Initiative minimum of 30,000 = roller coaster ride for safety net Local Initiative minimum of 39,000 = safety net stability .. .... .. _.... ..i .. ...... ::�: 'i�.'... ..i' Q _ _ 79 54 30 10 JAN MAR MAY J U L SEP NOV JAN MAR MAY 1997 1998 (EVERY OTHER MoNyrI IOENTIFIEO) July 17, 1997 Kimberly S Belshe Director ='; State Department of Health Services 714 P Street Room 125 Sacramento, CA 95814 Dear Ms. Belshe: The Board of Supervisors in Contra Costa County on Tuesday, Jul, voted to express to you our concern with some recent developments regarding cal IniYx' tr County. While we were pleased to learn that the Local Initiative(Conf.�L:',.- ealth Pl i?ae had 43,942 Medi-Cal members and Foundation had an estimated 3,45£0ejw to len that the State is considering reducing the Local Initiative mi um enroll frritt Costa County and revising the default/assignment methodology from your.A&g sta-iAii g ru ' 01p, lations. These actions would have a detrimental impact on the safety 'din Corina'Costa Ctnty and lead to adverse consequences for the most vulnerable populations Y P il serve:" �a1i . rite While these pr -0sed actions uce th five7s enrollment by more than half, it would have a m' ' 'pact on 5, inincr atewide Medi-Cal enrollment by only 61 4%. WhafrtanState Health Services Department's own regulations do P2 require them tia '` e previaiablished minimum(39,783) or the existing default rules (all default,-,to the L ii €al the up to tnum,then 1:1 with Foundation). It makes no se` '�' ,se. to dish ''_&afety net system in Contra Costa County today and then try to resurrect;it; a year when �aged care model, namely the County Organized Health Care e have used the 39,783 minimum to build our provider network;we System,may be implemente ''': it have assigned all these me4b s to primary care providers in our system, and we are delivering comp 6ensive services tot> is vulnerable population. This is not the time to disrupt a system that is worlOA,. This is notatl 'time to replace the safety net with a roller coaster(see our attachment). We believe:€fi ,_W is a more rational alternative in Contra Costa County to the State's proposed changes-*inithe al Initiative minimum enrollment number and default/assignment methodologies for mandatory and,eligibles who do not chose a Plan: 1 L For one time only default/assign all mandatory eligibles to Foundation until L/I's enrollment is reduced to 39,783 minimum;this includes all mandatory aid eligibles still in fee-for-service (minimum defined as mandatory eligibles). 2. If L/I mandatory eligible enrollment falls below 39,783, all defaults/assignments go to the L/I until it reaches its minimum enrollment; above 39,783 defaults to be evenly divided between L/I and Foundation. This is consistent with current state regulations. 3. Maintain the L/I's 39,783 minimum enrollment number until a CORS-tike Qrffkplan model is implemented in Contra Costa County. This will assure stability t i net. We believe our proposal is fair,implementable, and would stabilize �,� �� ety net system. Our proposal would stabilize the L/I's total Medi-Cal enrolment at appy and Foundation's total Medi-Cal in Contra Costa County woul+ cely m its died, It would also give us critical time to convert the two plan ntra Costa Cot' ( 'one plan model (County Organized Health System). The Contra Co =�: Board of Supervisors seriously believes that any managed care redesign must ensure Con 1 ty, the providers, the plans, and most especially the Medi-Cal individuals are treated f' ly. As always, we are available to discuss this situation Iease cori `tlier me at 510\646-5763, .. k or Milt Camhi, Contra Costa Health Plan(Localihr `hettive Ditor at 510\313-6004. ._.. I look forward to hearing your reactions to .proposal: Sincerely, 3" V Mark DeSa r; _.. Chair Contra Costa Boar sorshrr_a55,, 93:117 h: ccs: .-Qontra Costa Co un Board of Supervisor i�1?hil Batchelor,Co,>%ity Administrator William Wa1k .D. HS Director • ." ed CI mmission Gre.Financing ',txecutive Director,Health Plan Administration Les Spahn 2 CONTRA COSTA COUNTY 30K MINIMUM ROLLER COASTER Enrollment in Thousands Local Initiative minimum of 30,000 = roller coaster ride for safety net Local Initiative minimum of 39,000 = safety net stability. ... .. +........... .. _ 9 7Q .. - 5� - 30 .. 10 Y J U L SEP NOV JAN MAR MAY .SAN MAR MAY 1997 1 1998 (EVERY OTHER MONTH iDENTIFIVO) •- 1 (Same letter to entire State delegation) July 17, 1997 The Honorable Dion Aroner State assembly: State Capitol Btiulding Room 2163 Sacramento, CA 95814 Dear Assembly,Member Aroner: We very much appreciate your past assistance in addressi serio t have arisen about the implementation of the Medi-Cal Local Initiative in Co osta Co e, the Local Initiative in Contra Costa County, Contra Costa Health PZ edi- rs and Foundation had an estimated 3,450. However,you should be a do at could have a detrimental impact on the safety net in Contra Costa Co Back in April the State Department of h Se s recalc ed the Local Initiative minimum guaranteed enrollment from 39,783 18 Pon pr a from the commercial plans, developed proposals for drastically ring th stan ' default methodology. After protest by the Local Initia ' es througho rnia, ent of Health Services agreed that there should he 1 ssions a Dep d plans participating in the two plan model regarding ber signment procedures. Indeed,the Department has released draft guideline sous While we appre ' ty iew the guidelines, we were dismayed to learn that the State Dep of He was willing to reduce the Local initiative minimum enrollment in Contra C County to 2l have also been informed by the State Department of Health Servic t they are now 1 defaults to Foundation until the Local Initiative reaches 39,733, then will split the def evenly. On top of this,Foundation has essentially asked the State to imp t the 21,418 um level. Together these actions will negatively affect the safety net.in our It abro he Department's commitment to maintain disproportionate share hospital (D ty net providers who have consistently served the most vulnerable populations. In ty,Foundation does not currently even contract with the largest DSH hospital (Mem with the largest safety net/FQHC system(County Clinics). In contrast the Local Initiative contracts not only with Merrithew and the County Clinics, but with all the other community traditional and safety net providers. 1 While these proposed actions could reduce the Local Initiative's enrollment by more than half, it would have a minimal impact on Foundation, increasing its statewide Medi-Cal enrollment by only 4%. What is most important is that the State Health Services Department's own regulations do not require them to Xchange the previously established minimum (39,783) or the existing default rules (all defaults to the Local Initiative up to this minimum,then 1:1 with Foundation). It makes no dense to dismantle the safety net system in Contra Costa Co d then try to resurrect it in a year when the new managed care model,name a Co 'zed Health Care System, may be'implemented. We have used the 39,783 to bui der network;&e have assigned all these members to primary care provider us syste verin comprehensive services to this vulnerable population. T not a to di t is working. This is not the time to replace the safety net wi aster(see our t). We believe there is a more rational alternative in Contra Co r mandatory aid eligibles who do not choose a Plan: 1. For one time only default/assign all mandat to Fou til L/I's enrollment is reduced to 39,783 minimum; this includ id elig" s still in fee-for-service (minimum defined as mandatory elig' 2. if L/I mandatory eligible enrol falls b 39,78 defaults/assignments go to the L/I until it reaches its minimum ent; ve 39,711 defaults to be evenly divided between l,/I and Foundation. This i sistent curr ate regulations. 3. Main e L/I's 3 imum a number until a CORS-like one plan model is im Con unty. s will assure stability to the safety net. We believe aur: air, im , and would help to stabilize a fragile safety net system. Our proposal w(o e L/F edi-Calenrollment at approximately 42,000 and Foundation' e tra sta County would likely triple from its current level. It would gide us criti nvert the two plan model in Contra Costa County to a one plan model ty Organized ystem). The State Department of Health Services, Foundation and Con osta County Boaz f upervisors are all in agreement that any managed care redesign must ens ontra Costa Cou the providers, the plans, and most especially the Medi-Cal individuals are tre rly. 2 •' i If you agee with this proposal, we would appreciate your communicating this to the State Department of Health Serviees as soon as possible. For your convenience, we have included a draft letter. As always, we are available to discuss this situation further,please contact either me at 510\646-5763, or Milt Camhi, bontra Costa Health Plan(Local Initiative) Executive Director at 510 -6004. Sincerely, Mark DeSaulaier, Chair Contra Costa Beard of Supervisors 93:li ccs: Contra Costa County Board of Supervisors Phil Batphelor, County Administrator William:Walker,M.D.,HS Director Managed Care Commission Milt Carnhi, Executive Director th P Heath Care Financing Adminn Les Spahn 3 CONTRA COUNTY 30K MINIMUM ROLLER COASTER Enrollment in Thousands Local Initiative minimum of 30,000 = roller coaster ride for safety net Local initiative minimum of 39.000 = safety net stability ..................... 90 ...................... ......... .... 70 .. 0 _ . 30 JAN MAR MAY JUL SEP NOV JAN MAR MAY 1997 1998 (EVERY OTnEP MONTH IDENTIFIEO) July 17, 1997 Kimberly S Belshe Director State Department of Health Services 714 P Street Room 1253 Sacramento,CA 95814 Dear Ms. Belshe: We are disturbed to learn from the Board of Supervisors ' on ty that your Department is willing to redliice the Local Initiative minimum euro numbe assignment methodology it Contra Costa. These changes w trous on the major DSH hospitals and safety net providers in our Co un c adv consequences for the most vulnerable populations that they primarily s It makes no sense to dismantle the saf t syste Con osta County today and then try to resurrect it in a year when the new d car -del, n y the County Organized Health Care System,may be implemented. Th. ntra C oun Initiative has used the 39,783 minimum to b ' its provider ;they all these members to primary care providers in stem, vering ive services to this vulnerable population. This is trot imp t is working. This is not the time to replace the safety net with a roller c ttac We believe th a1 alt ve in Contra Costa County for mandatory aid eligibles who do not choo an: 1. one� 'e only d ssign all mandatory eligibles to Foundation until L/I's enrollment is ducedto 39,783 imam;this includes all mandatory aid eligibles still in fee-for-service tim defin mandatory eligibles). 2. eligible enrollment falls below 39,783,all defaults/assignments go to the L/I es its minimum enrollment; above 39,783 defaults to be evenly divided between oundation. This is consistent with current state regulations. 3. Maintain the L/I's 39,783 minimum enrollment number until a COHS-like one plan model is implemented in Contra Costa County. This will assure stability to the safety net. 1 We believe this proposal is fair, implementable, and would help to stabilize a fragile safety net system. This proposal Would stabilize the L/T's total Medi-Cal enrollment at approximately 42,000 and Foundation's total Medi-Cal in Contra Costa County would likely triple from its current level. It would also give the County critical time to convert the two plan model in Contra Costa County to a one plan model(County Organized Health System). We know you will agree with us, Foundation and the Contra Costa County Board of Supervisors that any managed care redesign must ensure Contra Costa County,tie providers, the plans,and most especially the Medi-Cal individuals are treated fairly. Please let me 4ow your reactions to this proposal. i Sincerely, Assembly Member Dion Aroner Enclosure DA:smp 93:16 ccs: Ann Kuhns (;CC Ba d of Supervi C'on Mana mmis I le anct ration 2 CONTRA COSTA COUNTY 30K MINIMUM ROLLER COASTER Enrollment in Thousands Local Initia4e minimum of 30,000 = roller coaster ride for safety net Local lnitia6e minimum of 39,000 = safety net stability . ......................... . .. ..... ............... ..............:.*:,:.."".,.,*.*................I............ ........................... . .... ...... . ....... ........ . ...........:................... .. .................................... .................. ............... ......... ........................... ...................... ....... .................................... ......... ....... ............ ...... . ...................*......................... ........... ...... .......................................... ........... .. .............. 90 . . .. ...................................... ....... ......... ............ ........................... ............... . ....................................... .................................:....................... ................. .............................. % ...............:,*........... ........................ .......................................... . .............. ....... . .............................................. .............I.:... .: - .. ................ .....................::*".,........... ........ .................... ....................... .. ........ ...... ..................... ......... ....... ...I .:...:.................... ........................ ............... ........:�,*:.-.-.:.-�-.-:...,.,.*....-.-.�.'.*..,:.,:.-.-.-.-....,.*.....*.:.'.'...' . ..'......,. .......... .................... .......... ................... ... ....... ............................ .................. 70 .............................. ........... ...........-.......... ................. . ............... .............. ........ ..................... .......... .............................. .............. . ...... ................. ...........:.*...... ...... ...... ............... ........... ....... ..................... .. ...................... ...... ...... ............... .......... ... ...... ........... .......... .......... ..........- ........... ........ .. ........ ...... ........... ........... .......... .... ....... ................ ............. .............. ............. ................ . ...... ............. . ........................... ............. .............. .......... . .......... .................. 50; ....... .... . . .... ........ ........ .............. ....... ...... ..... ................ ........ ........................ ...... .. ............... ............. ........ ............ -... ............ .......-............... . ............. .......... ......... .. ..... ............... ............. . ..................... ............... .... ......... ..................-- .......... ................. ,.:...:1.......- w ............. .......... ................:-.., , I �'-:,. .......... ................. ... ........... - :....... ................ ..... ........... ........ �.... � .. .:. .. .. -........... ............ .. .. - --, ... -:-*-,-... -...... ....... ..... ..................... ....... ........... .. ..............;�.............. ..................... ......... ............ ......... .............. .......... .............. 30 .......... ........................ ............... ....... ...... .......... ........... ............... 10 JAN MAR MAY JUL SEP NOV JAN MAR MAY 1997 1998 (EVERY OTi-ER MONTH iMNTIFIED) TOTAL P.15 m U ca •y N v � � � O r d a O L � O o � O C V 4� o � ............ ............. cn ° 0 3 0 U G .-% N m 0 V w a UC � Q � a U `■/ V o cl um 0 a w V � ■� a o U U s .......... M a W M 00 cri m Icea E � ' .E ,c y' ■ WCL pl- a M CL _ I = 4W Q� a o � w Ice4 4 a U W U L LM ^ o A N V V u U 0 r M 00 (AM a V o p o L M a s = � O mw _ n - o a� i pp,p = o � 4J W o _ .�.r u. _ � o o E 4w - L ■w 4W _ 3 V a � � 3 M i U L O E a 4w s E o � - o m o 4w 4wE o ._ o E 4w cn roLMi ... o = E o E E V' 0 LM E o E o CL o V V ■_ CL o M .._ L■ 00 0 3 V ^ 4 = Otn ° U ......... ......... .......................................... ..... .................... ........ ......... ....... . . f.0 d M Go O IL Go 74 O N O O O ■o � . . mc V = 4wo � o o cr o �. w ce a _ 4 V ° O � U V u. (A d a� a Z � L V CD LM E o 0 U L ao = cn Q M V t V ■- W E 0 ................................................... .. ................. ............................................... .......... 3 9 a a 0 a G G t ............-mml....gi.ggp 11........ .........pj.jj.lp CONTRA COSTA COUNTY 30K MINIMUM ROLLER COASTER Enrollment in Thousands ... ....... .......... .............................................................. .......................... ................ ........ ................... ............ .............................. ............ ........... ............................................... . ....... ........... .... .. . ......................-.............. ............ ................ .................... ........................ ....................:............................... ................... ........................................ ....................I...--....................... ................. ............ ................................ .................. ......... . . ............-. .... ........ ... ...........-....... ........... ...........--............................... .....................-.1....... 11............................. .................-........................I..........-...... .......... ..... . ....... . ... .................................... .--........................... .................I..,..........11.1.............................................................. ....... . ........ . ....... ....... ....... ....... ....... .................... ............ ....................... ...... ........ . . ........................................... ............. ............. .................... ...........I.''..................... 90 ... .. .-....I........................................................I....1.....1..1.,1.1.,........................................................... ........ .................................................................................... 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JAN MAR MAY JUL SEP NOV JAN MAR MAY co 1997 I 1998 (EVERY OTHER MONTH IDENTIFIED) .............. ................... ............................... .......................... CONTRA COSTA COUNTY 39K MINIMUM STABILITY Enrollment in Thousands ....................... ....... ...... ............ .. ........ ....... .............. ........... ............................. ........ ....... ............................... ....... ..... .. ... ... . ......... ...... .......... ..........-11'......... ......... ...... ........................................... ........... ...................... .......... ....... ........ ...... .................-......... ......- .. ..... ..... ............ ....... .......... ........- ... ...........- 90 . ....... ...... ... .-......- .. . ................ ....... ........ ....... ........ 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Lo Mr :.............................................................................................................................................................................................................................................................................................. Request to Speak Form l C ( THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: -,l —Phone,-- AddrftL._____eL AJ A cay. I am speaking for myself or 11-91 (Dame of 0 sm- taa m, DUCK ONE: 1 wish to speak on Agenda Item #. —V— pate: My oom rents will be: general _for_ftWnd . _ 1 wish to speak on the subject of _ I do not wish to speak but leave these comments for the Board to consider: