HomeMy WebLinkAboutMINUTES - 12011987 - 1.96 To: BOARD OF SUPERVISORS
FRIM: Mark Finucane , Health Services Director Contra
By : Elizabeth A. Spooner , Contracts Administrator Costa
DATE: November 16, 1987 County
SUBJECT: Approval of Contra Costa Health Plan Medicare Contract Amendment
429-608-3 with the U. S. Department of Health and Human Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION :
Approve and authorize the Chair to execute on behalf of the
County, Contra Costa Health Plan Contract Amendment Agreement
#29-608-3 with the U. S. Department of Health and Human Services
[ Health Care Financing Administration (HCFA) ] to be effective on
January 1 , 1988 which modifies Contract X129-608-2 (effective
July 1 , 1987 ) for prepaid health services by the County for
Medicare-eligible persons .
II . FINANCIAL IMPACT:
This amendment includes provisions to provide as much protection
as possible under law to Health Maintenance Organizations (HMOs )
whose payments are reduced during the term of the contract as a
result of possible cuts mandated by Gramm-Rudman-Hollings
legislation . Specifically, risk-sharing organizations that
waive allowable premiums (i .e . , charge lower premiums than
allowed for services provided) , or that provide complimentary
services (i .e . , provide services for which no premium is
charged ) , may reduce these extra benefits to compensate for
Congressionally mandated payment reductions . As with any
changes in services or premiums , prior HCFA approval and prior
notice to Medicare beneficiaries will be required .
III . REASONS FOR RECOMMENDATIONS/BACKGROUND :
On May 19 , 1987 , the Board approved Contract #29-608-2 with the
U. S. Department of Health and Human Services for prepaid health
services by the County for Medicare-eligible persons . The
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) ,
Public Law 99-272 , and the Omnibus Budget Reconciliation Act of
1986 (OBRA) , Public Law 99-509 , changed the law governing
contracts between the Health Care Financing Administration and
organizations providing services to Medicare beneficiaries under
Section 1876 of the Social Security Act .
CONTINUED ON ATTACHMENT: _Y� YES SIGNATURE: ei�
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOA D COMMITTEE
APPROVE OTHER
SIGNATURE S : vv
ACTION OF BOARD ON nrc APPROVED AS RECOMMENDED ^ OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
Z-
UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES'. AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE1SpHOWN.
ORIG: Health Services (Contracts) DEC 1 19p1
cc-. County Administrator ATTESTED
Auditor-Controller PHIL BATCHELOR, CLERK OF THE BOARD OF
U.S. Dept. of Health & Human Services SUPERVISORS AND
/COUNTY ADMINISTRATOR
13Y IY �— ,DEPUTY
M382/7-83 -- `
U. S. Department of Health
and Human Services
Contract Amendment #29-608-3
Board Order
Page 2
The attached amendment to the standard contract includes provi-
sions required by Section 1876 , as amended by COBRA and OBRA.
In addition , several issues related to operational matters have
been included in this amendment .
This document has been approved by County Counsel . The Board
Chair should sign five copies of the amendment . Four original
signature copies should then be returned to the Contracts and
Grants Unit for submission to the U. S. Department of Health and
Human Services .
DG :gm