HomeMy WebLinkAboutMINUTES - 07242001 - D.2 ontra
R-
KI.BOARD OF SUPERVISORS
FROM: William B. Walker, M.D. ___
-- .�
Health Services Director .�., °o ;�
Costa
CountJDATE: July 11, 2001
SUBJECT: .SB-1255 Medi-Cal Contract
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Authorize the Health Services Director to transfer a maximum of $10,000,000 to the
State of California as authorized under SB-1255.
FISCAL IMPACT:
Contra Costa Regional Medical Center (CCRMC) will be eligible for a maximum of
$10.0 million in matching Federal funds. See background information for full
discussion.
BACKGROUND:
Federal grants to the State of the Medicaid program (Medi-Cal in California) are
authorized under Title XIX of the Social Security Act to provide medical assistance to
certain persons with low income. These Medicaid programs are jointly financed by the
Federal and State governments and administered by the States. State Medicaid
agencies conduct their programs according to the Medicaid State plan approved by the
Administrator of the Health Care Financing Administration (HCFA). To carry out the
Medicaid Program, the State agency pays providers for medical care and services
provided to eligible Medicaid recipients.
The Federal government pays its share of Medicaid program expenses to the State on
a quarterly basis according to a formula. The State share of Medicaid program
expenses is paid from "State funds", that is, those funds over which the State
legislature has unrestricted power of appropriation. In California, the program "split" is
50% Federal financing, 50% State financing.
SB-1255 (Chapter 996, Statutes of 1989) added Section 14085.6 to the Welfare and
Institutions Code and established a program whereby certain voluntary transfers and
donations will be utilized by the State to provide funds to disproportionate share
hospitals to assist them in enhancing or maintaining access for Medi-Cal beneficiaries.
This program is similar in nature to those established in Tennessee and other states.
CONTINUED ON ATTACHMENT: x YES SIGNATURE: le�
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
,/APPROVE OTHER
SIGNATURE(S):
ACTION OF BOA L o J� APPROVE AS RECOMMENDED_ OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT /ZU�'LZ _) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTED
CONTACT: George Washnak 370-5036 JOHN SWE N,CL OF THE OARD OF SUPERVISORS
AND CO Y DMI STRATOR
CC: Health Services Administration
CAO
BY DEPUTY
� a
-2- -�`i-���
These voluntary transfers would be used to match Federal dollars under the Medi-Cal
Program, thereby increasing the total revenue base available for distribution (i.e., $1
donation will generate $1 in Federal funding back to the disproportionate hospital.
CCRMC is a disproportionate hospital eligible for reimbursement under this program.
The California Medical Assistance Commission (CMAC) is responsible for administration
of SB-1255. The Commission solicits the donations and distributes the funds collected
through the Medi-Cal contracting processing.
ISSUES:
Issue 1: The State SB-1255 Plan may be disallowed at the Federal level.
Discussion: If a disallowance were to occur, some part of the "increased" Federal
share might be required to be reimbursed.
Issue 2: SB-1255 payments are subject to Federal "Upper Payment Limits"
Imposed on the State of California's Selective Contracting Program waiver.
Discussion: Federal approval of the State of California's most recent Selective
Contracting Program waiver included a provision that on a statewide basis,
the aggregate amount paid to hospitals through their contracts with
CMAC, including SB-1255 payments, may not exceed the aggregate
amount that would have been paid for those same services under the
Medicare Program. While the Federal limit is not hospital specific, at this
time the State has not issued regulations specifying how they intend to
perform the required calculation and implement the Federal limitation, nor
have they specified how they would recoup any such overage should one
occur.
Issue 3: Facilities which make a "voluntary" donation are not guaranteed of return
of either the matching Federal funds or the donation itself.
Discussion: SB-1255 is intended to provide a workable program. If the most "needy"
facilities in the State make donations and do not receive back, at a
minimum $1.50 for each $1.00 donation, the program will fail. While,
because of Federal restrictions, the State cannot guarantee the return of
the transferred funds, it is the intent of the program that no "donating"
facility will be disadvantaged.
To date, the Medi-Cal Commission has held thirteen rounds of voluntary donations and
supplemental contract negotiations. CCRMC has voluntarily contributed a total of
$45,250,000; supplemental Medi-Cal contract payments have been $78,800,000.