HomeMy WebLinkAboutMINUTES - 01231990 - 1.41 TO; BOARD OF SUPERVISORS. �
FROM: Mark Finucane, Health Services Director. Contra
By: Elizabeth A. Spooner, Contracts Administrator . Costa
DATE: January 11, 1990 County
SUBJECT: Approval of Contra Costa Health Plan Medicare' Contract #29-608-5 1
with the U.S. Department of Health and Human Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
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I. RECOMMENDED ACTION:
Approve and authorize the Chair to execute on behalf of the County,
Contra Costa 'Health Plan Medicare Contract #29-608-5 with the U.S.
Department of Health and Human Services for the period January 1,
1990 through December 31, 1990, and automatically renewed for
successive periods of one year unless terminated by written notice
of intention not to renew at least 90 days before the ehd of the
current contract period.
II. FINANCIAL IMPACT:
Contract #29-608-5 is a cost reimbursement agreement and will
produce a total annual revenue of $3,434, 029 in Federal, member
premiums and State payments. Cost of this group of members depends
on the use of services by Medicare-eligible members and the Health
Services Department costs.
Terms of the contract provide for reimbursement to Contra Costa
Health Plan for the cost of Medicare-covered services. State
provided rates for Medi-Cal and Medicare eligibles in the Plan, and
Board approved premiums for private Medicare members, cover
benefits and serviceswhich exceed the Medicare level.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Since 1976 the County has contracted with the federal government
for prepaid health services by the County for Medicare-eligible
persons. The Department of Health and Human Services developed a
new standard contract for health insurance benefits for the aged
and disabled which continues the reimbursement agreement previously
approved by the Board on November 8, 1988.
The only change in the new contract is Article IV, Paragraph S
which establishes a 60-day standard for the HMO stage of the
reconsideration decision-making process, during which the Health
Plan must review and act upon its initial denial of a claim or a
request for services. This change does not affect the operation
of Contra Costa Health Plan since it already meets the 60 day
requirement.
The Board Chair should sign and date five copies of the contract,
four of which should then be returned to the Contra s and Grants
Unit for submission to the Department of Health an I Services.
CONTINUED ON ATTACHMENT; - YES SIGNATURE; `
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEND IO OF BOAR . COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OP BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
g 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.
JAN 2 3 1990
CC: Health Services (Contracts) ATTESTED
Auditor-Controller (Claims) PHIL BATCHELOR, CLERK OF THE BOARD OF
U.S. Department of Health and Human Services SUPERVISORS AND COUNTY ADMINISTRATOR
M DG °Y. �� DEPUTY
382/7-83