HomeMy WebLinkAboutMINUTES - 09222015 - D.45(&200(1'$7,21 6
$33529(DQG$87+25,=(WKH+HDOWK6HUYLFHV'LUHFWRUWRHVWDEOLVKD&RQWUD&RVWD&$5(6SURJUDPIRUWKH
SXUSRVHRISURYLGLQJSULPDU\KHDOWKFDUHVHUYLFHVWRDGXOWVQRWFRYHUHGE\WKH$IIRUGDEOH&DUH$FW
$33529(DQG$87+25,=(WKH+HDOWK6HUYLFHV'LUHFWRURUGHVLJQHHWRH[HFXWHDFRQWUDFWZLWK&RQWUD&RVWD
&RPPXQLW\&OLQLF&RQVRUWLXP &RQVRUWLXP WRDFFHSWIXQGVLQDQDPRXQWXSWRIRUWKHSXUSRVHRI
GLVEXUVLQJSD\PHQWWRFRPPXQLW\FOLQLFVSURYLGLQJSULPDU\KHDOWKFDUHWRHQUROOHHVLQWKH&RQWUD&RVWD&$5(6
SURJUDPRQDSHUSDUWLFLSDQWSHUPRQWKEDVLVFRQWLQJHQWRQILQDODSSURYDOE\ORFDOKRVSLWDOVRIWKHLUFRQWULEXWLRQRI
WRWKLVSURJUDP
$33529(DQG$87+25,=(WKH+HDOWK6HUYLFHV'LUHFWRUWRDOORFDWHXSWRLQ&RXQW\IXQGLQJWR
GLVSHUVHWRSDUWLFLSDWLQJFRPPXQLW\FOLQLFVRQDSHUSDUWLFLSDQWSHUPRQWKEDVLVIRUSULPDU\FDUHVHUYLFHVSURYLGHG
XQGHUWKH&RQWUD&RVWD&$5(6SURJUDPFRQWLQJHQWRQILQDODSSURYDOE\ORFDOKRVSLWDOVRIWKHLUFRQWULEXWLRQRI
WRWKLVSURJUDP
$87+25,=(&RQWUD&RVWD+HDOWK3ODQWREHFRPHWKHILVFDODJHQWPDQDJHHQUROOPHQWVDQGWUDFNXWLOL]DWLRQIRU
WKH&RQWUD&RVWD&$5(63URJUDP
$33529( 27+(5
5(&200(1'$7,212)&17<$'0,1,675$7255(&200(1'$7,212)%2$5'
&200,77((
$FWLRQRI%RDUG2Q $33529('$65(&200(1'(' 27+(5
&OHUNV1RWHV 6HH$GGHQGXP
927(2)683(59,6256
$<( -RKQ*LRLD'LVWULFW,6XSHUYLVRU
0DU\13LHSKR'LVWULFW,,,6XSHUYLVRU
.DUHQ0LWFKRII'LVWULFW,96XSHUYLVRU
)HGHUDO'*ORYHU'LVWULFW9
6XSHUYLVRU
12 &DQGDFH$QGHUVHQ'LVWULFW,,
6XSHUYLVRU
&RQWDFW :LOOLDP:DONHU0'
,KHUHE\FHUWLI\WKDWWKLVLVDWUXHDQGFRUUHFWFRS\RIDQDFWLRQWDNHQDQGHQWHUHGRQWKHPLQXWHVRIWKH
%RDUGRI6XSHUYLVRUVRQWKHGDWHVKRZQ
$77(67(' 6HSWHPEHU
'DYLG-7ZD&RXQW\$GPLQLVWUDWRUDQG&OHUNRIWKH%RDUGRI6XSHUYLVRUV
%\ -XQH0F+XHQ'HSXW\
FF
'
7R %RDUGRI6XSHUYLVRUV
)URP :LOOLDP:DONHU0'+HDOWK6HUYLFHV'LUHFWRU
'DWH 6HSWHPEHU
&RQWUD
&RVWD
&RXQW\
6XEMHFW &RQWUD&RVWD&$5(6
),6&$/,03$&7
&RXQW\*HQHUDO)XQGLQWKHDPRXQWRI3URFHHGVIURPWKH6WDWH¶VRQHWLPHSD\PHQWRIWKH
&RXQW\
V6WDWH0DQGDWHG)XQGLQJFODLP 6% ZLOOEHXWLOL]HG
%$&.*5281'
3DVVDJHRIWKH$IIRUGDEOH&DUH$FW $&$ LQFUHDVHGDFFHVVWRKHDOWKFRYHUDJHIRUPRVWORZLQFRPHDGXOWVDQG
FKLOGUHQOLYLQJLQ&RQWUD&RVWD&RXQW\$QHVWLPDWHG DGXOWVOLYLQJLQ&RQWUD&RVWDDUHLQHOLJLEOHIRU
&RYHUHG&DOLIRUQLDRUIXOOVFRSH0HGL&DO&RQWUD&RVWD&$5(6ZLOOSURYLGHFRPSUHKHQVLYHSULPDU\KHDOWKFDUH
FRYHUDJHDQGPHGLFDOKRPHVWRDSSUR[LPDWHO\ORZLQFRPHXQLQVXUHGDGXOWVUHVLGLQJLQ&RQWUD&RVWDZKR
GRQRWTXDOLI\IRUIXOOVFRSH0HGL&DORU&RYHUHG&DOLIRUQLD7KHSURJUDPZLOOWDNHIXOODGYDQWDJHRI358&2/
3HUPDQHQW5HVLGHQFH8QGHU&RORURI/DZ DQGRWKHUVWDWHFRYHUDJHSURJUDPV(OLJLEOHSDUWLFLSDQWVPXVWDSSO\
IRUVWDWHSURJUDPVVXFKDV)DPLO\3$&7(YHU\:RPDQ&RXQWVDQG%UHDVW&DQFHU(DUO\'HWHFWLRQ3URJUDP
7KHSURJUDPZLOOFRYHUXQLQVXUHGDGXOWV \HDUVRIDJHRUROGHUOLYLQJLQ&RQWUD&RVWDZKRDUHLQHOLJLEOHIRU
IXOOVFRSH0HGL&DORU&RYHUHG&DOLIRUQLDDQGZKRVHKRXVHKROGJURVVLQFRPHGRHVQRWH[FHHGRIWKH
)HGHUDO3RYHUW\/HYHO +RXVHKROGRILQGLYLGXDO )DPLO\RI DQQXDOLQFRPH
7KHSURJUDPZLOOFRYHUSULPDU\FDUHVHUYLFHVLQFOXGLQJEDVLFODERUDWRU\DQGUDGLRORJ\VHUYLFHV6SHFLDOW\FDUH
GHQWDOYLVLRQHPHUJHQF\FDUHDQGKRVSLWDOL]DWLRQDUHQRWFRYHUHGEHQHILWVRIWKHSURJUDP
3DUWLFLSDWLQJSULPDU\FDUHSURYLGHUVDUH/D&OtQLFDGHOD5D]D/LIH/RQJ+HDOWK&DUH%ULJKWHU%HJLQQLQJVDQG
$[LV+HDOWK&DUH3URYLGHUVZLOOUHFHLYHRQDFDSLWDWHGEDVLVSHUSDUWLFLSDQWSHUPRQWKIRUDWRWDODQQXDO
FRVWRI7KHSURJUDPDQWLFLSDWHVHQUROOLQJXSWRLQGLYLGXDOV&RQWUD&RVWD+HDOWK3ODQZLOOEHWKH
ILVFDODJHQWDQGPDQDJHWKHSURJUDPE\LVVXLQJPHPEHUVKLSFDUGVWRSDUWLFLSDQWVHGXFDWHQHZHQUROOHHVDERXWWKH
EHQHILWVRIWKHSURJUDPDQGWKHXVHRIWKHLUPHGLFDOKRPHSURYLGHQXUVHDGYLFHVHUYLFHVDQGOLQNHQUROOPHQW
LQIRUPDWLRQHOHFWURQLFDOO\EHWZHHQSULPDU\FDUHSURYLGHUVDQGKRVSLWDOHPHUJHQF\URRPVWDII
7KHSURSRVHG&RQWUD&RVWD&$5(6SURJUDPZDVGHYHORSHGWKURXJKDQH[WHQVLYHSODQQLQJSURFHVVUHSUHVHQWLQJ
PDQ\ORFDOVWDNHKROGHUVRYHUWKHSDVW\HDUZLWKOHDGHUVKLSSURYLGHGE\&RQWUD&RVWD+HDOWK6HUYLFHV+RVSLWDO
&RXQFLORI1RUWKHUQ &HQWUDO&DOLIRUQLDDQGWKH&RQWUD&RVWD&RPPXQLW\&OLQLF&RQVRUWLXPLQFOXGLQJ
UHSUHVHQWDWLYHVIURP.DLVHU3HUPDQHQWH6XWWHU'HOWD0HGLFDO&HQWHU-RKQ0XLU+HDOWK/D&OtQLFDGHOD5D]D
/LIH/RQJ0HGLFDO&DUH%ULJKWHU%HJLQQLQJVDQG3ODQQHG3DUHQWKRRG7KHSODQQLQJSURFHVVZDVIXQGHGE\
JUDQWVIURPWKH%OXH6KLHOGRI&DOLIRUQLD)RXQGDWLRQDQG-RKQ0XLU0W'LDEOR&RPPXQLW\+HDOWK)XQG
/RFDOKRVSLWDOUHSUHVHQWDWLYHVKDYHUHFRPPHQGHGWRWKHLUOHDGHUVKLSDQG%RDUGVWKDWWKH\FRQWULEXWHFXPXODWLYH
IXQGLQJRIWRHVWDEOLVK&RQWUD&RVWD&$5(67KH%RDUGVRI'LUHFWRUVRIORFDOKRVSLWDOVZLOOEHWDNLQJ
DFWLRQRQWKLVUHFRPPHQGDWLRQLQWKHQHDUIXWXUH7KHUHLVVWURQJVXSSRUWDPRQJWKHEXVLQHVVFRPPXQLW\ VXSSRUW
OHWWHUIURP(DVW%D\/HDGHUVKLS)RUXPUHSUHVHQWLQJ&RQWUD&RVWDEXVLQHVVHVDQGLQGXVWU\ ODERUFRPPXQLW\
VXSSRUWOHWWHUIURP&RQWUD&RVWD&HQWUDO/DERU&RXQFLO DQGQXPHURXVFRPPXQLW\EDVHGDQGIDLWKRUJDQL]DWLRQV
VXSSRUWOHWWHUVDWWDFKHGWRWKLV%RDUG2UGHU
&216(48(1&(2)1(*$7,9($&7,21
/RZLQFRPHXQLQVXUHGDGXOWVUHVLGLQJLQ&RQWUD&RVWD&RXQW\ZKRGRQRWTXDOLI\IRUIXOOVFRSH0HGL&DORU
&RYHUHG&DOLIRUQLDZLOOQRWKDYHDFFHVVWRSULPDU\SUHYHQWDWLYHFDUHVHUYLFHVDQGPD\XWLOL]HPRUHH[SHQVLYH
KRVSLWDOHPHUJHQF\GHSDUWPHQWVIRUWKHLUFDUH
7KHXQLQVXUHGKDYHORZHUVFUHHQLQJUDWHVIRUSUHYHQWDEOHKHDOWKFRQGLWLRQVDQGH[SHULHQFHSRRUKHDOWKRXWFRPHV
IRUFKURQLFGLVHDVHVVXFKDVGLDEHWHVK\SHUWHQVLRQDQGRWKHUFRQGLWLRQV/DFNRIDFFHVVWRFDUHSXWVUHVLGHQWVDW
KLJKHUULVNRIVHULRXVKHDOWKSUREOHPVDQGSUHPDWXUHGHDWK
,QIHFWLRXVGLVHDVHVVXFKDVLQIOXHQ]DPHDVOHVDQGWXEHUFXORVLVPD\QRWEHGHWHFWHGHDUO\EHIRUHDIIHFWLQJ
SRSXODWLRQVOLYLQJDQGZRUNLQJLQWKH&RXQW\3UHYHQWDWLYHDQGSULPDU\FDUHDUHVLJQLILFDQWO\OHVVH[SHQVLYHWR
DGPLQLVWHUWKDQLWLVWRWUHDWVHYHUHFKURQLFLOOQHVVDQGGLVHDVHV+DYLQJDFFHVVWRSULPDU\FDUHQRWRQO\EHQHILWV
SDWLHQWVWKHUHLVFRVWVDYLQJVWRWKH&RXQW\
VSXEOLFKHDOWKKRVSLWDOHPHUJHQF\GHSDUWPHQWVDQGWKHJHQHUDO
SXEOLF
&/(5.
6$''(1'80
6SHDNHUV 0DU\+HOHQ5RFKD8QLWHG/DWLQR9RLFHV$QWLRFK&LW\&RXQFLO 0DULDQQD0RRUH5HEHFFD5R]HQ
+RVSLWDO&RXQFLO .DWLD5HJHVUHVLGHQWRI$QWLRFK 3DWULFLD6Q\GHU/HDJXHRI:RPHQ9RWHUV±'LDEOR9DOOH\
%UHQGD4XLQWDQD/DWLQR&DXFXV&DOLIRUQLD6WDWH$VVRFLDWLRQRI&RXQWLHV -RKQ:LOVRQ 0LFKDHO6DUDJRVD
$3$3$$VLDQ3DFLILF,VODQGHU$PHULFDQ3XEOLF$IIDLUV$VVRFLDWLRQ /HH/DZUHQFH&&,6&2 5HYHUHQG)UHG
:HLGPDQQ0XOWLIDLWK$FWLRQ&RDOLWLRQRI&RQWUD&RVWD&RXQW\ (PLO\5RVVUHVLGHQWRI5LFKPRQG 0HORG\
+RZH:HLQWUDXE0XOWLIDLWK$FWLRQ&RDOLWLRQ :LOO:KLWH8QLWHG:D\RIWKH%D\$UHD 5HYHUHQG -RKQ
:LOVRQ 1LFROH5HJDODGR3ODQQHG3DUHQWKRRG1RUWKHUQ&DOLIRUQLD 0DU\+DUPV&HQWUDO/DERU&RXQFLO
*DLO)LHQZHLVV$&&(UHVLGHQWRI5LFKPRQG 3DWULFLD$JXLDU$&&( 'DYLG6KDUSOHVUHVLGHQWRI5LFKPRQG
-DYDQD)DMDUGRUHVLGHQWRI&RQFRUG &KULV.HLIHU/LIHORQJ0HGLFDO $QGUH6RWR53$&%( .RDN+XEHU
UHVLGHQWRI5LFKPRQG &DURO:HHG0'2UJDQL]LQJIRU$FWLRQ 0HOYLQ:LOOLV$&&(5RVD$UULDJDUHVLGHQW
RI5LFKPRQG 5RVDOYD5H\HV$&&(YLDLQWHUSUHWHU (GLWK3DVWUDQR 'RQQHOO-RQHV&&,6&2 7LP/DLGPDQ
*UHHQ3DUW\RI&RQWUD&RVWD .DWKOHHQ:LPHUUHVLGHQWRI5LFKPRQG *DEULHO+DJODQG6(,8 0LOOLH
&OHYHODQGUHVLGHQWRI2DNOH\ .RDN+XEHUUHVLGHQWRI5LFKPRQG 3DWULFLD'DOEH\$QWLRFK 5RVH$XJXVWH
+HDOWK$FFHVV&DOLIRUQLD$OYDUR)XHQWHV&RPPXQLW\&OLQLF&RQVRUWLXP 'DQ-DPH\VRQ6(,8
$QWKRQ\:ULJKW([HFXWLYH'LUHFWRU+HDOWK$FFHVV&DOLIRUQLD 5LFDUGR'DYLV &DVVLH5RPHUR*RQ]DOH] 5RVD
(VFDULOOD 0DULD5H\HV .DWKOHHQ:LPHU =DN:HDU 1LFROH5HJDODGR 'RQQHOO-RQHO&&,6&2 :ULWWHQ
FRPPHQWVSURYLGHGE\2UDQHHW6KLNPDK2UHYLUHVLGHQWRI%HUNHOH\ *ZHQ:DWVR0XOWL)DLWK$FWLRQ6RFLDO
-XVWLFH$OOLDQFH 9LROD/XMDQ/D&OLQLFDGH/D5D]D (PLO\5RVVUHVLGHQWRI5LFKPRQG 3DW'DLO\UHVLGHQWRI
3OHDVDQW+LOO$33529('DQG$87+25,=('WKH+HDOWK6HUYLFHV'LUHFWRUWRHVWDEOLVKD&RQWUD&RVWD
&$5(6SURJUDPIRUWKHSXUSRVHRISURYLGLQJSULPDU\KHDOWKFDUHVHUYLFHVWRDGXOWVQRWFRYHUHGE\WKH
$IIRUGDEOH&DUH$FW
$33529('DQG$87+25,=('WKH+HDOWK6HUYLFHV'LUHFWRURUGHVLJQHHWRH[HFXWHDFRQWUDFWZLWK&RQWUD
&RVWD&RPPXQLW\&OLQLF&RQVRUWLXP &RQVRUWLXP WRDFFHSWIXQGVLQDQDPRXQWXSWRIRUWKH
SXUSRVHRIGLVEXUVLQJSD\PHQWWRFRPPXQLW\FOLQLFVSURYLGLQJSULPDU\KHDOWKFDUHWRHQUROOHHVLQWKH&RQWUD
&RVWD&$5(6SURJUDPRQDSHUSDUWLFLSDQWSHUPRQWKEDVLVFRQWLQJHQWRQILQDODSSURYDOE\ORFDOKRVSLWDOVRI
WKHLUFRQWULEXWLRQRIWRWKLVSURJUDP $33529('DQG$87+25,=('WKH+HDOWK6HUYLFHV
'LUHFWRUWRDOORFDWHXSWRLQ&RXQW\IXQGLQJWRGLVSHUVHWRSDUWLFLSDWLQJFRPPXQLW\FOLQLFVRQD
SHUSDUWLFLSDQWSHUPRQWKEDVLVIRUSULPDU\FDUHVHUYLFHVSURYLGHGXQGHUWKH&RQWUD&RVWD&$5(6SURJUDP
FRQWLQJHQWRQILQDODSSURYDOE\ORFDOKRVSLWDOVRIWKHLUFRQWULEXWLRQRIWRWKLVSURJUDP DQG
',5(&7('WKH+HDOWK6HUYLFHV'HSDUWPHQWWRZRUNZLWKKRVSLWDOVFRPPXQLW\FOLQLFVDQGRWKHUUHOHYDQW
VWDNHKROGHUVWRUHWXUQWRWKH%RDUGUHJDUGLQJWKHPDQDJHPHQWRIWKHSURJUDP
$UHTXHVWIRUDSSURSULDWLRQRIIXQGVZLOOFRPHWRWKH%RDUGDWDIXWXUHGDWH
$*(1'$$77$&+0(176
&RQWUD&RVWD&$5(63URJUDP'HVFULSWLRQ
/HWWHURI6XSSRUWB(DVW%D\/HDGHUVKLS&RXQFLO
2WKHU/HWWHUVRI6XSSRUWIRU&RQWUD&RVWD&DUHV3URJUDP
2WKHU/HWWHUVRI6XSSRUWIRU&RQWUD&RVWD&DUHV3URJUDP
0,187(6$77$&+0(176
&RUUHVSRQGHQFH5HFHLYHG
A New Program For Uninsured Contra Costa Residents
Contra Costa CARES is a new organized system of care to provide comprehensive primary health care coverage
and medical homes to low income, uninsured adults residing in Contra Costa who do not qualify for full-scope Medi-
Cal or Covered California. The program will take full advantage of PRUCOL and other state funded programs. It
is anticipated that Contra Costa CARES will provide medical homes to an estimated ,000 uninsured residents living
in Contra Costa County out of an approximate 19,000 uninsured individuals who might qualify for this program.
Contra Costa CARES has been developed through an extensive planning process representing many local
stakeholders over the last year with leadership provided by Contra Costa Health Services Agency, Hospital
Council of Northern & Central California and the Contra Costa Community Clinic Consortium. The Contra
Costa Health Services Agency Director along with representatives from Kaiser Permanente Community
Benefits, Sutter-Delta Medical Center Community Benefits, John Muir Health Community Benefits and La
Clinica de la Raza, LifeLong Medical Care and Planned Parenthood were very active in the discussions. The
planning process was funded by grants from the Blue Shield of California Foundation and John Muir/Mt. Diablo
Community Health Fund.
ELIGIBILITY CRITERIA:
ïUninsured adults 19 years of age or older living in Contra Costa County
ïNot eligible for full-scope Medi-Cal or Covered California
ïHousehold gross Income does not exceed 138% of the Federal Poverty Level (Household of
1 individual = $16,105; Family of 4 = $32,913 annual income).
PROVIDER NETWORK:
Participating community health
centers listed below will be
designated as the medical homes
and provide primary care services to
the participants:
ïLa Clinica de la Raza with sites in
Pittsburg, Oakley and Monument
Corridor
ïLifeLong Medical Care with sites in
Richmond and San Pablo
ïAxis Health with sites in
Pleasanton and Livermore to serve
south county residents
ïBrighter Beginnings with sites in
Antioch and soon in Richmond.
Planned Parenthood of Northern California
with sites in Antioch, Central Richmond, Hilltop
Richmond, Pittsburg, San Ramon, El Cerrito,
Walnut Creek and Concord will provide limited
primary care services for selected primary
care conditions. Planned Parenthood will
refer clients for more extensive services and
complicated conditions to other participating
comprehensive primary care providers in the
CARES network.
EASY ACCESS AND ON-SITE ENROLLMENT:
The community health center sites that are
participating as primary care providers and
medical homes for these individuals have
committed to providing easy access to services
as a result of participation. Enrollment will be
done at the participating community health
center sites at the time of care and enrollment
will continue for up to one year.
A New Program For Uninsured Contra Costa Residents
continued
PRIMARY CARE SERVICES WILL INCLUDE:
ïAssignment of a medical home at one of the participating community health centers
ïPhysician services and medical office visits at the community health centers
ïIntegrated mental health services for patients with mild and moderate conditions
ïNurse advice line and member services through Contra Costa Health Plan
ïHealth evaluations, as well as diagnosis and treatment services
ïAdult immunizations
ïBasic laboratory services related to primary care
ïBasic radiology (x-ray) services at locations contracted with community health centers
ïHealth education and chronic disease management services
ïPharmacy services and medications provided at certain pharmacies affiliated with the community health centers’340B program and Patient Assistance Programs.
The program will include primary care services only. Specialty care, dental, vision, emergency care and
hospitalization are not covered benefits of the program. Participants needing emergency care or hospitalization
may go to any hospital. Most hospitals will screen participants for all eligible programs, including Medi-Cal, charity
care and other health insurance and coverage programs, and make referrals to participating community clinics for
enrollment in CARES as appropriate.
Certain specialty care services will be provided pro bono by local hospital systems where programs currently
exist including Contra Costa Health Services, and by Operation Access.
Mental health services to participants with serious mental illness will be provided by Contra Costa Health Services.
Care and services provided by state coverage programs are not provided under this program and eligible
participants must apply for these state programs such as FamilyPACT, Every Woman Counts, and Breast Cancer
Early Detection Program.
Program Impact: Contra Costa CARES will measure its impact on the following indicators over a two year period:
ïnumber of individuals enrolled in primary care and with a designated medical home;
ïreduction in unnecessary or inappropriate emergency room utilization for enrollees;
ïeffective hospital transitions to a primary care medical home; and
ïother quality measures already in place for Medi-Cal and Covered California.
Program Administrator: The Contra Costa Health Plan (CCHP) will be the fiscal agent and manage the program
at no additional charge to the program. CCHP issue membership cards to participants so that they can easily be
identified for services, educate new enrollees about the benefits of the program and the use of their medical
home, provide nurse advice services and link information electronically between the primary care providers and
hospital emergency rooms.
Provider Payments: Primary care providers will be paid on a capitated basis estimated at $28.00/per participant/
per month for a total annual cost of $336.00/per year per participant to cover primary care services as well
as basic laboratory and radiology services. The program anticipates enrolling up to ,000 individuals for
an annual cost in its first year of less than $,0,000. Planned Parenthood will be paid on a fee-for-service
basis for their limited primary care services. Because participants will have incomes at or below 138% of
federal poverty level, no co-payments will be charged for primary care services. There is a co-payment
for 340B pharmacy services.
Start Date: The program is anticipated to begin by 129(0%(5 2015, pending funding availability.
4/8/15