HomeMy WebLinkAboutMINUTES - 04212009 - D.1RECOMMENDATION(S):
(1) APPROVE Resolution # 2009- on Standards for Administration of Indigent Health Care
(Basic Health Care Program).
(2) AUTHORIZE the Health Services Director to continue to pursue contract negotiations
with the Community Clinics (Brookside, Planned Parenthood, La Clinica) for the provision
of primary care services to adults who will no longer be eligible for the BHC Program based
on the following terms: (a) a 12 month contract term for a total cumulative amount not to
exceed $1,500,000; (b) a total cumulative up-front payment of $300,000 for start-up and
capacity building purposes; and (c) payment on a fee-for-service basis at a rate not to
exceed $100 per visit.
(3) AUTHORIZE the County Administrator to fund the $1,500,000 cumulative contract
total as a one- time, non-recurring expenditure from County reserves.
FISCAL IMPACT:
100% County. The Health Services Department projects a savings of $6 million, minus the
one time reserve expenditure of $1.5 million, for a net savings in fiscal year 2009/10 of $4.5
APPROVE OTHER
RECOMMENDATION OF CNTY
ADMINISTRATOR
RECOMMENDATION OF BOARD
COMMITTEE
Action of Board On: 04/21/2009 APPROVED AS RECOMMENDED OTHER
Clerks Notes:See Addendum for details
VOTE OF SUPERVISORS
AYE:John Gioia, District I
Supervisor
Gayle B. Uilkema, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Susan A. Bonilla, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact:
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board
of Supervisors on the date shown.
ATTESTED: April 21, 2009
David J. Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc: Dorothy
D.1
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:April 21, 2009
Contra
Costa
County
Subject:Standards for Administration of Indigent Health Care (Basic Health Care Program)
million and $6 million thereafter.
BACKGROUND:
On March 31, 2009 during the 2009/10 Budget Hearings, the Board of Supervisors
approved the following:
• CHANGE the Eligibility Standards for the Basic Health Care Program to make certain
adults ineligible for non-emergency health care services; DIRECT the Health Services
Director and County Counsel to draft a new resolution that amends Resolution No.
2002/312 to reflect this change in the BHC eligibility standards;
• DIRECT the Health Services Director to continue to meet with community health care
providers to identify a collaborative plan to address, to the extent possible, the gap in the
provision of primary and specialty medical care services for adults who will no longer be
eligible for the BHC Program;
• AUTHORIZE the Health Services Director to negotiate contracts with Brookside Clinic
and La Clinica, for subsequent presentation to and consideration by the Board of
Supervisors, that will assist those community health care clinics in the provision of
non-emergency health care services to adults who will no longer be eligible for the BHC
Program;
County Counsel has drafted the new resolution (attached) that amends Resolution No.
2002/312 to reflect the change in the BHC eligibility standards, as directed by the Board.
The Health Services Department has scheduled the second of a series of meetings with
community partners to develop a collaborative plan to address the gap in medical
services to adults who will no longer be eligible for the BHC Program.
The Health Services Department (HSD) has a tentative agreement with the community
clinics to provide primary care services to adults who will no longer be eligible for the
BHC Program under the following terms:
HSD Contract Assumptions:
a. Certain adults will are no longer be eligible for the Basic Health Care program
(effective May 1st for new applicants; June 1st through November 1st for renewals).
b. Adults who will no longer be eligible for the BHC Program (effective May 1st for new
applicants; June 1st through November 1st for renewals), will receive primary care
services at the community clinics in the same fashion as all other patients of those clinics
(citizen and non citizen).
c. Specialty care and Ancillary services for adults who will no longer be eligible for the
BHC Program will not be provided by the County.
Deal Points:
a. One year, one time, cumulative contract total maximum of $1,500,000.
b. $100,000 up front payment, per clinic ($300,000 cumulative total) for capacity
building.
c. Monthly payments to be made on a per visit basis at a per visit rate not to exceed $100
(patient fees permissible, subject to negotiation).
d. Patients will be referred by HSD with an authorization for a predetermined number of
visits. Referrals may originate from the CCRMC clinics, Emergency Room, Inpatient
unit, or Financial Counseling.
e. Payment will not be made for patients who self refer to the community clinics (all
patients must have prior HSD authorization).
f. After nine months of operation and only in the event that sufficient funding is available
in the contract, self-referred patients may be considered eligible.
Contract negotiations are underway. A number of procedural issues need to be resolved,
but HSD does not expect those negotiations to impact the May 1st implementation date.
CLERK'S ADDENDUM
Dr. William Walker, Health Services Director, presented the staff report.
The Chair invited public comment. The following people commented:
§ Rollie Katz, Public Employees Union Local 1, spoke.
§ Written comments in opposition to the funding mechanism for the clinics were
provided by a County Worker.
Supervisor Gioia suggested authorizing the Health Services Director to continue to
explore and develop a sustainable funding plan to address the future of the program. He
also requested updates on the discussions taking place at the Contra Costa Health Plan
Joint Conference Committee.
Supervisor Uilkema requested that the Contra Costa Health Plan Joint Conference
Committee meeting minutes be included in the Board’s agenda packets.
David Twa, County Administrator, said he would soon be submitting a request to the
Board for a Request For Proposal (RFP) in the amount of approximately $250,000 for
assistance with the health care sustainability study [as directed by the Board on March
31, 2009].
Chair Bonilla suggested that the authorization to fund contracts with the Community
Chair Bonilla suggested that the authorization to fund contracts with the Community
Clinics include the funding for the RFP/sustainability study.
Supervisor Uilkema said she would prefer to wait for more a concrete cost figure from
Mr. Twa.
Supervisor Piepho noted it is important to remain aware of any possible grants or future
avenues of revenue that could be used to reimburse the reserve fund.
ATTACHMENTS
Resolution No. 2009/187
Attachment to Resolution
ADDENDUM
April 21, 2009 D.1 Standards for Administration of Indigent Health Care
Dr. Walker presented the staff report.
The Chair invited public comment. Rollie Katz, Public Employees Union Local One spoke. Written comments
in opposition to the funding mechanism for the clinics were provided by A County Worker.
Supervisor Gioia suggested an addition to the recommendations to authorize the Health Services Director to
continue working to explore and develop a sustainable funding plan to address the future of the program, and
requested updates on the discussions taking place at the Joint Conference Committee.
Supervisor Uilkema requested that the Joint Conference Committee meeting minutes be included in the Board’s
agenda packets.
Mr. Twa, County Administrator, said he would soon be submitting a request to the Board for a Request For
Proposal (RFP) of approximately $250,000 for assistance with the performance of the health care sustainability
study (as directed by the Board on March 31st).
Chair Bonilla suggested that the authorization to fund the contracts with the Community Clinics should include
funding for the RFP for the sustainability audit.
Supervisor Uilkema said she would prefer to wait for more concrete estimates of cost from Mr. Twa.
Supervisor Piepho noted it was important to remain aware of any future possibility of grants or avenues of
revenue that could be used to reimburse the reserve fund.
By unanimous vote with all Supervisors present the Board:
APPROVED the recommendations; DIRECTED the Health Services Director to continue working with the
community clinics and hospitals of Contra Costa County to explore and develop a sustainable funding plan and
report back to the Board in six months; REQUESTED regular update reports on the activities of the Joint
Conference Committee.
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