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MINUTES - 11011994 - 2.2
TO: BOARD OF SUPERVISORS Contra ' Mark Finucane, c__a z FROM: Health Services Director J� Costa October 25, 1994 ,:: �4 CourYty DATE: County Specific Requirements for Medi-Cal Managed Care SUBJLCT: SPECIFIC REOUEST(S)OR RECOMMENDATION(S)8 BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION APPROVE the attached County Specific Requirements for Medi-Cal Managed Care, and FORWARD the requirements to the State Department of Health Services. II. FINANCIAL IMPACT Fee-for-service revenue to providers in Contra Costa County, including Merrithew Memorial Hospital and Clinics, for services given to AFDC linked Medi-Cal eligibles amounts to over $36- million annually. As the State moves to managed care, this fee- for-service revenue will be transferred into capitation payments to the Contra Costa Health Plan Local Initiative and private HMO. The County Specific Requirements as recommended by the Medi-Cal Advisory Planning Commission, should help to ensure a level playing field for the Local Initiative and Commercial Plan . in Contra Costa County. III. REASONS FOR RECOMMENDATION/BACKGROUND The State Department of Health Services issued its Medi-Cal Managed Care RFA for Commercial Plans on September 30, 1994. On October 13, 1994, it sent a letter to the chairperson of the Board of Supervisors in each of the 12 affected target counties soliciting recommendations for county specific requirements for Commercial Plans. The deadline for submitting such recommendations is Friday, November 4, 1994. Since the full Medi-Cal Advisory Planning Commission regularly scheduled meeting is being held too late to meet the State's deadline, the Medi-Cal Advisory P Commission Executive Committee at its Monday, October 24, 4 meet* g, eviewed and CONTINUED ON ATTACHMENT: 'k YES 81 RE. RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE S: ACTION OF BOARD ON )er TP APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE XX 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. Milt Camhi, Executive Director November 1 , 1994 CQ Contra Costa Health Plan ATTESTED PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR BY DEPUTY M382 (10/88) _p -2- approved the attached County Specific Requirements and recommended that the Board of Supervisors approve these requirements and forward them to the State Department of Health Services before the November 4, 1994 4 p.m. deadline. The County Specific Requirements build on the core requirements for Commercial Plans as recommended by the Medi-Cal Advisory Planning Commission and approved by the Board of Supervisors on April 19 , 1994. Coun y Specific Criteria for Private Plans in Contra Costa County Approved by Medi-Cal Advisory Planning Commission Executive Committee on October 24, 1994 1. Public Oversight * Agrees to conduct 3 regional public hearings prior to March 31, 1995, and annually thereafter using the same protocols as used by the MAPC in its public hearings about the Local Initiative. Hearings to include issues of both mandatory and voluntary enrollees. * Agrees to establish a community advisory group to provide input for use in its planning and implementation of its program for mandatory and voluntary enrollees. 2. Ongoing Member Input * In addition to state required annual surveys, has mechanisms for providing Medi- Cal member input in a meaningful way. 3. Dietetic Services * Agrees to include a nutritional assessment form approved by the American Dietetics Association or the California Dietetics Association in the initial health assessment performed on all adults and children. * Agrees to have in place appropriate mechanisms for follow up dietetic services either by referral or performed directly by the physician. * Agrees to solicit provider letters of intent from Registered Dieticians prior to March 31, 1995. * To ensure compliance with above requirements, State agrees to put a registered dietician on the State Medical Audit Team. 4. Provision of Comprehensive Nutritional and Perinatal Services * Provides comprehensive nutritional and perinatal services equivalent to current CPSP standards and ensures those benefits, as well as immunization and other prevention services, are well publicized to all Medi-Cal beneficiaries and providers. 2 5. Provider Education * As part of provider education, clarifies and emphasizes prevention services as a benefit and makes providers aware of social support services, encouraging them to make referrals to these services and follow up afterward. 6. Community Prevention and Promotion Activities * Has a good record in sponsoring and/or running various prevention and health promotion activities aimed at the general community and not targeted just for its members. Agrees to work with community groups and the local public health department in designing and carrying out prevention programs. * Agrees to reinvest a portion of any surplus from its Medi-Cal program into community health programs operating in Contra Costa County. 7. Access Standards * In addition to state's access standards, agrees to abide by access standards recommended by MAPC and approved by Board of Supervisors for the Local Initiative. These may include time and distance requirements and support services such as transportation and patient education. * Has mechanism to monitor compliance with local access standards and ensures an acceptable level of compliance to these standards. 8. Arrangements for Special Populations * Has arrangements to accommodate members with mobility problems; those who do not speak English; those who require special mental health and/or substance abuse services equivalent to standards recommended by the MAPC and approved by Board of Supervisors for the Local Initiative. 9. Plan's Experience with Low Income Enrollees * Has existing Medi-Cal contracts either in Contra Costa County or in other areas of the state. * Takes part in state programs for low income individuals. (e.g. AIM) * Has its own health insurance program for low income(non-Medi-Cal)individuals. 3 10. Contra Costa County Plan's Providers' Experience with Low Income Enrollees * Has traditional primary and specialty providers in those regions of Contra Costa County with the most number of Medi-Cal patients. * Has or will contract with at least one safety net provider in Contra Costa County. 11. Safety Net Providers * Agrees to enter into negotiations with Merrithew Memorial Hospital and clinics for specified inpatient and outpatient services. 12. Voluntary Eligibles * Agrees to enroll "voluntary" eligibles up to an enrollment limit agreeable to the Board of Supervisors. 13. Implementation Timing * Agrees to concurrent implementation with the Local Initiative unless the Local Initiative petitions to the state for an earlier start date. 14. Lock-In * Is a federally qualified HMO and agrees to lock-in. 15. Area Coverage * Has a provider network in areas of the county such as south central county which are not currently serviced by the Health Services Department. 16. Marketing Practices * Agrees to abide by the Marketing Guidelines and Code of Ethics adopted by the Medi-Cal Advisory Planning Commission and approved by Board of Supervisors for the Local Initiative. Guidelines/Code of Ethics to be based on GHAA Marketing Guidelines. ss/h SP56:C CONTRA COSTA COUNTY Medi-Cal Managed Care Program __ __ ___ ..._. .......................................................... ............................................................ .............................................................. ............. ........_ ._ _........_ ................................................ 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LOCAL FRIVATE TNI..... VE HMO (CGRP) _. _... _. _ .... ................ __ ... _ . _. _.. .................... ........ .. ........ ......... . ........._. _.......... _. _.__._ _. . . .........._..................... _._... ................................................................ ................................................................ ..........._._ ............_... _..... ..__ .._................... . _.........._...... COUNTY RII,UN : COMMUNITX DELIVERY CONTRACTS SYSTEM; LFik:l l-1 woo- d o -� 2 � 0 000 d d � d d d d o CA Or 7 �, • 0 os O '•�" ♦ � d v .. V o s, Oil 0 0 SO � �'► it �•, � L o _ V � � -8- Private HMO Selection Process State Department of Health Services Actions 1. Issued RFA for private plans 2. RFA requires MOU between County public health and private plan 3. Rejected Contra Costa's offer to evaluate private plans 4. Requested Board of Supervisors submit County specific criteria for state review -9- NATE ................................. ............... County-specific Criteria LOCAs. PRvA NIT�ATIV . HMO . LFile:l l-1 bD bb cd -t p,W � 3 LjWW N cn, ..-, V a; cd jV V � .,,` � a CIA 4) 'cd 4 c? t N