HomeMy WebLinkAboutMINUTES - 10072014 - C.40RECOMMENDATION(S):
ADOPT Position Resolution No.21533 toadd one (1) permanent full-time Health Plan Member Services Coordinator
(VRHB) position ($4,024-4,892) in the Contra Costa Health Plan division of the Health Services Department. (100%
CCHP Enterprise Fund III)
FISCAL IMPACT:
Upon approval, this action will cost approximately $99,431 annually including salary and benefits.Th is cost will be
funded from the CCHP Enterprise Fund III offset by Health Plan member premiums.
BACKGROUND:
Member Grievance and Appeals have increased by 100% because of the large influx of new members and CCHP
expects that number to raise by another 25% by the end of December. The large influx of Medi-Cal members can be
directly attributed to the Affordable Care Act and the increased demand for health insurance. The County Health and
Human Services Department is a large backlog of health insurance Medi-Cal applications that they are processing
that will continue to add new members to CCHP each month. Last year CCHP averaged about 450 new members a
month. In the past 4 months CCHP has averaged 4000 new members a month which is a 1000% increase in the past
year. Currently,
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 10/07/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Kristen Cunningham,
925-957-5267
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: October 7, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: Chris Heck, Deputy
cc:
C. 40
To:Board of Supervisors
From:William Walker, M.D., Health Services
Date:October 7, 2014
Contra
Costa
County
Subject:Add One (1) Permanent Full-Time Health Plan Member Services Coordinator in the Health Services Department
BACKGROUND: (CONT'D)
there is only one (1) position in CCHP Member Services that handles the full processing of member quality of
care grievances and all member appeals. CCHP needs to have another dedicated employee for this important
function. CCHP has only 72 hours to handle an expedited grievance and 30 days to handle normal grievances. The
handling includes a full review, investigation and resolution of grievances. For member appeals the process is
very time consuming and requires preparation of the appeal for a full Appeals Medical Committee hearing in
under 30 days. Member Services falls behind in handling Grievances and Appeals because the sheer number is
increasing , the State Department of Health Care Services can issue a fine against the Plan for not meeting
timeliness regulations. In 2013 CCHP used to receive 8 appeals per month and now CCHP is receiving 19 per
month. CCHP used to receive 32 Grievances a month and is now receiving about 75 a month
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved and without additional staff, the Member Services unit will not be able to meet the
mandated requirements of the Health Plan. CCHP will also be subjected to fines by the State Health Department
related to timeliness standards of member grievances and appeals not being met.
CHILDREN'S IMPACT STATEMENT:
Not applicable.
ATTACHMENTS
P-300 #21533