HomeMy WebLinkAboutMINUTES - 01201987 - 1.44 BOARD OF SUPERVISORS 1-044 P
FROM: Mark Finucane, Health Services Director p C,Q�r�.�,}tra
By: Elizabeth A. Spooner, Contracts Administrator CWIa
DATE; January 8, 1987 C"�" "1
SUBJECT: Approval of Revised Contra Costa Health Plan Service Agreement Format
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve revisions to format of Contra Costa Health Plan Service Agreement as
directed by the Office of Health Maintenance Organizations and authorize Executive
Director of Contra Costa Health Plan to use new format with current and new private
individual enrollees .
II. FINANCIAL IMPACT:
The format revision will update the Health Plan Service Agreements so that the
documents conform to Medicare regulations. Current practice conforms to the
Medicare regulations, therefore, there is no financial impact.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
The Office of Health Maintenance Organizations has directed the Department to make
revisions to and clarifications of descriptions in the Group and Individual Service
Agreements of the basic health care benefits covered by the Contra Costa Health
Plan. These revisions and clarifications are being made so that the Agreements
conform to current Title XIII regulations. The revisions and changes are:
1. Inpatient and outpatient physical therapy, speech therapy and occupational
therapy and other rehabilitation services and benefits are defined as
those services which are expected to result in the significant improvement
of a member's condition within a period of two months. The current
contracts do not contain the time limitation.
2. The 100 hours per member per calendar year limitation on home health ser-
vices has been deleted.
3. The Health Plan provides diagnosis, medical treatment and referral ser-
vices (including referral services to appropriate ancillary services) for
the abuse of, or addiction to, alcohol and drugs, including detoxification
on either an outpatient or an inpatient basis. The contracts will no
longer state an absolute limit on the number of methadone detox visits.
4. Experimental organ transplants are not covered. Transplants that are no
longer considered experimental are covered.
CONTINUED ON ATTACIMENT: X_ YES SIGNATURE;
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDAT O OF BOARD CIOMMITTEE
APrROVE OTHER
SIGNATURE S :
ACTION OF BOARD ON APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
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 DATE SHOWN.
JRIC: Health Services (Contracts) JAN 2 0 1981
Cc: Count Administrator ATTESTED
Auditor-Controller PHIL BATCHELOR, CLERK OF THE BOARD OF
Contractor SUPERVISORS AND COUNTY ADMINISTRATOR
QRZ '7_83 BY +V" ,DEPUTY
Revised CCHP Format
Board Order
Page 2
S. The limitation on covered hospital and medical services to those
"which are generally and customarily provided in our service area"
has been deleted.
The above revisions apply to both the Individual and Group Health Plan Service
Agreements. The Department is asking for Board of Supervisor's approval of the
new format for these agreements since the Board of Supervisors has delegated to the
Executive Director of the Contra Costa Health Plan the authority (with Board
ratification) to execute Individual Service Agreements.
Group Agreements are submitted to the Board for approval and execution prior to
enrollment of group members, therefore, the Department is not asking for approval
of the new format for Group contracts at this time.
These formats have been approved as to legal form by the County Counsel.
GM