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HomeMy WebLinkAboutMINUTES - 04122011 - C.42RECOMMENDATION(S): APPROVE and AUTHORIZE the County Administrator, or his designee, to amend a contract with Health Management Associates, Inc., to change the term from January 19, 2011 through June 13, 2011 to a new term of January 1, 2011 through June 30, 2011 and to make other administrative changes, with no change in the hourly rates or payment limit. (No fiscal impact) FISCAL IMPACT: No fiscal impact from the recommendation. BACKGROUND: On January 18, 2011 the Board of Supervisors approved a contract with Health Management Associates, Inc . (HMA) to conduct a sustainability review of the County's hospital, clinic and health plan system; and approved an appropriation adjustment to provide funding for the contract. To ensure the lowest cost to the County for travel expenses associated with HMA staff attendance at their first meeting with County staff, travel arrangement were made prior to APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 04/12/2011 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Gayle B. Uilkema, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor Contact: Dorothy Sansoe, 925-335-1009 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 12, 2011 David J. Twa, County Administrator and Clerk of the Board of Supervisors By: Carrie Del Bonta, Deputy cc: C.42 To:Board of Supervisors From:David Twa, County Administrator Date:April 12, 2011 Contra Costa County Subject:Amendment to Contract with Health Management Associates, Inc. the effective date of the contract. The County BACKGROUND: (CONT'D) Administrator is now asking the Board of Supervisors to approve a contract amendment to revise the term of the contract to allow for the reimbursement of travel expenses incurred. During the course of the study to date, a key member of the HMA team became unavailable due to an unexpected health issue. This has pushed back critical portions of the work to be completed. Therefore, the County Administrator is requesting that the Board approve amendments to time frames reflected in the service plan, including extending the termination date of the contract by two weeks. Finally, County Administrator's staff is recommending that information previously required to be provided under "Stage I" of the contract be moved to "Stage II", where it fits more logically into the structure of the study. There is no change in the scope of the information to be provided by HMA, only in the stage of the study under which the information is to be provided. CHILDREN'S IMPACT STATEMENT: Not applicable. ATTACHMENTS Draft Board Order L-7 (Page 1 of 1) Contra Costa County CONTRACT AMENDMENT AGREEMENT Number 45529 Standard Form L-7 (Purchase of Services - Long Form) Fund/Org# 1200 Revised 2008 Account # 2310 Other # 1. Identification of Contract to be Amended. Number: 45529 Effective Date: January 19, 2011 Department: County Administrator's Office Subject: Hospital & Health Services Sustainability Audit 2. Parties. The County of Contra Costa, California (County), for its Department named above, and the following named Contractor mutually agree and promise as follows: Contractor: Health Management Associates, Inc. Capacity: Michigan Corporation Address: 3. Amendment Date. The effective date of this Contract Amendment Agreement is January 1, 2011 . 4. Amendment Specifications. The Contract identified above is hereby amended as set forth in the "Amendment Specifications" attached hereto which are incorporated herein by reference. 5. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA BOARD OF SUPERVISORS By Chairman/Designee ATTEST: Clerk of the Board of Supervisors By Deputy CONTRACTOR Name of business entity: By (Signature of individual or officer) (Print name and title A, if applicable) Name of business entity: By (Signature of individual or officer) (Print name and title B, if applicable) Note to Contractor: For Corporations (profit or nonprofit), the contract must be signed by two officers. Signature A must be that of the president or vice-president and Signature B must be that of the secretary or assistant secretary (Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set forth on Form L-2. 120 N. Washington Square, #705, Lansing, MI 48933 Form L-2 ( Page 1 of 1) Contra Costa County Standard Form L-2 Revised 2008 ACKNOWLEDGMENT/APPROVALS (Purchase of Services - Long Form) Number 45529 ACKNOWLEDGMENT STATE OF CALIFORNIA ) ) COUNTY OF CONTRA COSTA ) On , before me, (insert name and title of the officer), personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS MY HAND AND OFFICIAL SEAL. (Seal) Signature ACKNOWLEDGMENT (by Corporation, Partnership, or Individual) (Civil Code §1189) APPROVALS RECOMMENDED BY DEPARTMENT FORM APPROVED COUNTY COUNSEL By: By: Designee Deputy County Counsel APPROVED: COUNTY ADMINISTRATOR By: Designee Contract No. 45529  Contractor:  Health Management Associates, Inc.  AMENDMENT SPECIFICATIONS      1. Paragraph 3. of Form L‐1 Term.  is amended to read:  The effective date of this Contract is January 1,  2011.  It terminates on June 30, 2011 unless sooner terminated as provided herein.    2. The Service Plan Outline (Form L‐3) is deleted in its entirety and replaced with the attached revised  Service Plan Outline.      Initials: Form L-3 (Page 1 of 4) Contra Costa County SERVICE PLAN OUTLINE Number 45529 Standard Form L-3 (Purchase of Services - Long Form) Revised 2008 Service Plan Contractor will provide professional evaluation, consultation and advisory services concerning the policies, operations and structures of the Contra Costa Regional Medical Center (CCRMC), County Health Centers, and the Contra Costa Health Plan (CCHP). Contractor will develop recommendations designed to secure the financial sustainability of the County’s health care system and to ensure the most efficient and effective delivery of medical services to County residents that are consistent with the implementation of health care reform. Contractor’s services under this contract will be delivered in three stages in order to ensure effective oversight and consultation with County staff. I. Stage I Informational Memorandum (January 19, 2011 – March 14, 2011) Stage I consists of data collection and interviews, resulting in an Information Memorandum. The Information Memorandum will include the following elements: A. Demographic and health care utilization data for the County’s Medi-Cal and uninsured populations to guide decision-making. B. Description of the current overall capacity of Contra Costa County’s facilities, programs, and services to provide an appropriate continuum of health care services to County’s target populations, and collection of relevant operational data for County health care programs to enable evaluation of County’s performance based on industry “best practices.” C. Identification of areas where the County’s current level of service for medically indigent and uninsured residents through the Basic Health Care (BHC) program either exceeds or is insufficient to meet legally mandated minimum service levels, as compared to comparable counties. D. A description of the impact of the new Federal “Low Income Health Program” (LIHP - comprised of “Medicaid Coverage Expansion” and a renewal of the existing “Health Care Coverage Initiative”) on the County’s ability to provide legally required health care services to medically indigent residents and other medically vulnerable residents of Contra Costa County. E. An estimate of the expected net effect of the new LIHP on Medi-Cal reimbursements to the County in FY 2011-12. F. Identification of new service capacity needs that may arise as a result of expanding access to health care services and implementing expanded managed care programs under Medi-Cal through the new LIHP; G. Financial and service utilization data and quality and performance indicators for CCRMC and County Health Centers that describe the efficiency, sufficiency, and cost effectiveness of County-operated health care facilities. H. Identification of all areas where the performance of CCRMC and County Health Initials: Form L-3 (Page 2 of 4) Centers is not comparable to overall industry averages or standards, and assessment of reasons for such variance. Information Memorandum Due Date Contractor will provide the Information Memorandum to the County Administrator’s Office on or before March 14, 2011. II. Stage II Preliminary Report (March 15, 2011 – April 4, 2011 April 18, 2011) Stage II consists of Contractor’s preliminary professional assessment, analysis, and evaluation of relevant data for the purpose of constructing policy and program alternatives and developing specific recommendations for consideration by the County, resulting in a Preliminary Report. The Preliminary Report will include the following elements: A. Preliminary findings, based on industry standards for “best practices” and performance measurement, concerning the overall performance, including cost effectiveness, of the County Health Services Department, CCRMC, County Health Centers, CCHP, and affiliated health care organizations and institutions within the County, in providing a comprehensive health care network for the County’s low- income, uninsured and/or medically vulnerable populations. B. A preliminary strategic analysis of CCHP, CCRMC and County Health Centers that includes an assessment of their competitive position under health care reform in terms of local market conditions and expected increases in utilization of health care services by Medi-Cal recipients and the uninsured. C. Presentation of potential alternative governance models that would address any identified operational and/or financial barriers to continued financial sustainability of CCRMC, County Health Centers, and CCHP, or that would improve the efficiency and cost effectiveness of delivering health care services to patients. D. Recommend strategies and programs designed to maximize Federal reimbursements to the County for health care services for Medi-Cal recipients and uninsured persons, including a description of eligibility requirements for any potential new revenue sources and an evaluation of the County’s ability to obtain such funding. E. Assess the impact of the LIHP on the financial status of CCHP, including expected changes in annual County General Fund costs for the BHC Program. F. Assess the prospective role of CCHP in providing comprehensive managed care to an expanded patient population under the new LIHP, in comparison with other health plans and/or other provider networks. G. Assess the County’s ongoing labor needs for medical staff, including physicians, nurses, specialists, and other health care providers. H. Review the County’s recruitment and retention procedures and practices for providing the required complement of professional medical staff for the County’s health care operations. Develop medical staffing alternatives or proposals for County consideration that are reflective of industry “best practices” for cost containment and patient care, as health care reform is implemented. I. Assess the availability and capacity of other (non-profit and private) health care providers to participate in a “community-based collaborative care network” providing Initials: Form L-3 (Page 3 of 4) “medical homes” and coordinated managed care services for Medi-Cal patients. J. Prepare and submit a draft outline of a work plan for the establishment of a “medical home system of care” for the expanding Medi-Cal population, the uninsured, and other medically vulnerable residents of the County. K. A description of the impact of the new Federal “Low Income Health Program” (LIHP - comprised of “Medicaid Coverage Expansion” and a renewal of the existing “Health Care Coverage Initiative”) on the County’s ability to provide legally required health care services to medically indigent residents and other medically vulnerable residents of Contra Costa County. Preliminary Report Due Date Contractor will provide the Preliminary Report to the County Administrator’s Office on or before April 4, 2011 April 18, 2011. III. Stage III Draft Final Report and Final Report (April 5, 2011 – May 31, 2011 June 13, 2011) Stage III consists of Contractor’s preparation and submission of a Final Report documenting its findings and recommendations. In the first part of Stage III, Contractor will draft and submit a draft version of the Final Report to the County Administrator’s Office on or before May 13, 2011 June 13, 2011. After consultation with, and feedback from, the County Administrator and his designees, Contractor will prepare a final version of the Final Report and submit it to the County Administrator on or before May 31, 2011 June 13, 2011. The Final Report will include the following elements: A. A final work plan for the establishment of a “medical home system of care” of sufficient depth and specificity to enable the County to plan and implement a “medical home system of care” and comprehensive managed care network for the target populations. B. A management review of Health Services Department programs, including CCRMC and County Health Centers, that identifies structural, organizational, and program changes needed to contain costs and maximize return on County investments (including potential changes in service lines or methods of program or service delivery). C. An evaluation of alternative governance structures (such as a hospital district or community-based collaborative care network) that could enhance the County’s ability to provide appropriate, accessible, and effective health care services to its customers. D. An evaluation of local labor market conditions, medical staff recruitment and retention strategies, labor agreements, and the use of contracted vendors, in order to ensure access by Contra Costa residents and others to appropriate and effective medical services at CCRMC and County Health Centers (or through alternative service delivery options) at the least cost to the County. Initials: Form L-3 (Page 4 of 4) E. Recommendations for changes in the County’s current procedures for data collection and analysis, and in the use of performance indicators, program outcomes, and customer satisfaction reports for CCRMC and County Health Center operations that will enhance the County’s oversight and management of its health care programs and support sustainability. F. Recommendations for changes and/or enhancements to the County’s organizational capacity for ongoing strategic planning, evaluation, and oversight of the County’s health care programs and policies that would enhance the County’s oversight and management of its health care programs and support sustainability. IV. General Provisions In providing the above-described services, Contractor agrees to: (1) Coordinate with the County Administrator’s Office for obtaining records, scheduling meetings with departmental administrative and/or fiscal staff, and resolving problems or challenges as they arise; (2) Provide an oral progress report, or status update on any issue or matter of inquiry related to this contract, upon request of the County Administrator’s Office; and, (3) Perform other related services as are requested by the County Administrator or his designee, that are mutually agreed to be necessary in fulfilling the requirements of this contract. V. HIPAA Requirements. Contractor must comply with the applicable requirements and procedures set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any modifications thereto, including, but not limited to, the attached HIPAA Business Associate Attachment, which is incorporated herein by this reference.