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HomeMy WebLinkAboutRESOLUTIONS - 01012002 - 2002-312 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on may 14, 2002 , by the following vote : AYES : SUP'ERV'ISORS UILKEMA, GERBER, DeSAULNIER, GLOVER ANIS GIOIA NOES : NONE ABSENT: NONE ABSTAIN: NONE SUBJECT: Standards for Administration ) of Indigent Health Care ) RESOLUTION 2002/ _ 3_U (Basic Health Care Program) ) WHEREAS the County is responsible under Welfare and Institutions Code Section 17000 for the health care of persons qualified as indigent for its General Assistance program; and WHEREAS the County established the Basic Adult Care Program by Resolution No. 82/1486, superseded by Resolution No. 83/191 as amended by Resolution No. 83/1025; superseded these Resolutions by Resolution No. 85/35 as amended by Resolution No. 85/114 ; and thereafter superceded these Resolutions by Resolution No. 85/376; WHEREAS the Basic Adult Care Program was transferred out of the Contra Costa Health Plan by Resolution No. 92/760; WHEREAS the County desires to change the name of the Basic Adult Care Program to the Basic Health Care Program and to otherwise update the administrative elements of the program; The Contra Costa County Board of Supervisors hereby adopts the following standards for the provision of health care services to eligible indigents, effective May 1, 2002: I. BASIC HEALTH CARE PROGRAM The Basic Adult Care Program (BAC) is hereby replaced by the Basic Health Care (BHC) Program as the county health care program for the General Assistance and medically indigent eligibles described herein. II. ELIGIBILITY A. The following persons are eligible for the Basic Health Care Program: 1 . Residents of Contra Costa County who are medically indigent as determined by the income and resources criteria established by regulation by the Health Services Director and who are not eligible for any other health insurance program, including, but not limited to, the California Medi--Cal program and employer-sponsored health programs . 2 . Persons eligible for Contra Costa County General Assistance as determined by the Department of Employment and Human Services under those Resolutions of the Board of Supervisors governing General Assistance eligibility pursuant to Welfare and Institutions Code section 17000 . -I- RESOLUTION NO. 2002/ 312 B. Eligibility Determination: Medically indigent eligibility will be determined, and General Assistance eligibility will be verified, by the Health Services Department . III. TERM OF ELIGIBILITY A. The Health Services Director, by regulation, shall determine and may modify the term of eligibility of persons entitled to receive BHC Program benefits . A determination that a person is eligible for the BHC Program shall be effective for not less than five calendar months, including the month during which application is made, provided that at all times during such period such person meets the eligibility requirements set forth in. Section II .A. and fulfills the Health Partnership obligation, if any, set forth in Section VII .B. The Health Services Director may, by regulation, establish the terms and conditions under which persons enrolled in the BHC Program may be re-enrolled for consecutive eligibility periods . B. Upon termination of eligibility, the person must reapply and his or her eligibility must be redetermined. Neither an initial application for enrollment nor an application for re-enrollment after termination may be made, nor may eligibility be determined for a person not then enrolled, until the applicant needs health care services under the BHC Program and applies at a Contra Costa County Health Services Department facility. C. An applicant is entitled to receive medically necessary services at a Contra Costa County Health Services Department facility before eligibility has been determined. If the applicant who has received medical services is determined to be ineligible for the BHC Program, the Health Services Department shall bill the recipient for the services rendered. IST. ENROLLMENT IN BASIC HEALTH CARE PROGRAM Eligible persons who are enrolled in the Basic Health Care (BHC) Program are subject to termination as follows : A. Termination for Cause . If, after reasonable efforts, any BHC member, hospital, or medical staff member is unable to establish and maintain a satisfactory hospital- patient or physician-patient relationship with any BHC member, then the rights of the BHC member may be terminated after the mailing of written notice of termination to the BHC member, at least 15 days before the proposed effective date, specifying the reasons for termination, and providing the BHC member with 10 days to respond (orally or in writing) to the BHC Program Grievance Coordinator, who shall make a written recommendation to the BHC Program for or against termination. B. Loss of Eligibility. If a BHC members ' eligibility ceases for any reason, including failure to pay a Health Partnership fee, such loss of eligibility shall result in an automatic loss of benefits concurrent with the loss of eligibility. Services received after the effective date of termination will be billed directly to the recipient . -2- RESOLUTION NO. 2002/ 312 C. Ay .]2eals on Termination, A BHC member may appeal a termination for cause to the Contra Costa County Health Services Director. V. SERVICES PROVIDED The services provided by the BHC Program are limited to those set forth in Attachment A, attached hereto. The County of Contra Costa is not responsible for unauthorized medical services rendered by non-County facilities . VI. PROGRAM CHANGES Nothing in this Resolution shall preclude the County of Contra Costa from modifying, reducing, or eliminating any or all of the services provided by the BHC Program or from terminating the BHC Program at any time. VII . HEALTH PARTNERSHIP PAYMENTS A. Hgalth Partnership obligation.• Individuals otherwise qualified under Sect'ion II .A. for the BHC Program who are determined by the Health Services Department to be able, based on income and resources, to contribute to the cost of their health care, will be required as a condition of eligibility to pay a proportionate share of their Health Plan monthly cost . Said proportionate share shall be based on each eligible ' s gross income, resources, and family size . B. Payment of the Health Partnershi-o Obligation 1 . Persons subject to a Health Partnership obligation will be enrolled in the BHC Program, advised of their financial obligation, and asked to pay for not less than the minimum five, (5) month eligibility period upon approval of their application. 2 . Persons who do not pay the entire amount of the five month Health Partnership Obligation in advance, must pay the balance due by the first day of the following month, and must pay any further obligation as directed by the Health Services Director. 3 . Persons who fail to make timely payment of their Health Partnership Obligation are subject to disenrollment from the BHC Program effective as of the date of eligibility after notice and the opportunity for an appeal to the Enrollment Supervisor of the Contra Costa Health Plan. 4 . Persons with an unpaid Health Partnership Obligation under the BHC Program are ineligible for re-enrollment upon the expiration of their eligibility period. VIII. CHOICE OF PROGRAM Eligible persons who choose not to participate in the County' s BHC Program will not be enrolled in the Program and will be treated by the County as private pay fee-for-service patients . The County will not pay for care provided to such fee-for- service patients at non-County facilities . -3- RESOLUTION NO. 2002/312 IX. REGULATIONS The County Health Services Director is empowered to adopt written regulations and procedures consistent with this Resolution for the operation of the Basic Health Care Program. Resolution No. 85/375 is hereby superseded. Contact: William Walker, M.D. (370-5003) cc: County Administrator Health Services Director Contra Costa Health Plan Director County Counsel Auditor-Controller VLD: Id H:\Hoard Actiona\HaaiC Adult Care\2002 Draft #2 Reaolution.wpd -4- RESOLUTION NO. 2002/312 ADDENDUM TO ITEM SD.2 May 14, 2002 On this day, the Board was scheduled to consider adopting a policy regarding Basic Health Care Program for Indigent Adults and Children. The Chair invited the public to comment. The following person presented testimony: Aimee Chitayat, from Community Clinic Consortium of Contra Costa, 13925 San Pablo Avenue#207, San Pablo, Following discussion, the Board took the following actions: ADOPTED Resolution No. 2002/312 and approved Administration of Indigent Health Care and authorized the Health Services Director to establish Basic Health Care Program regulations including a sliding fee schedule for indigents with incomes up to 300% of Federal Poverty Guidelines; and DIRECTED the Health Services Director to return to the Board within six months to a year with a status of the program. 1 ATTACHMENT A BASIC HEALTH CARE PROGRAM COVERED BENEFITS, LIMITATIONS, AND EXCLUSIONS Abortions Not covered (pregnancy is covered by Medical) Acupuncture Not Covered Advice Nurse Covered Allergy Injections and Allergy Covered Testing — Alcohol Abuse Not covered (covered by other programs administered by the health Services Department) Biofeedback Not covered Blood Covered, except self donation is not covered Chi ro ractic Care Not covered Contact Lenses Not covered, except for implants following cataract surgery or for Aphakia or Keratocomas Cosmetic Surgery ^ Not covered ATTACHMENT A (PAGE 1 of 5 PAGES) Custodial Care Not covered Dental Care Not covered, except for emergency dental services limited to dental x- rays, dental examinations, and extractions, only. Children ages 5 through 14, inclusive, are limited to the following covered services: 1. Emergency dental services 2. Dental examinations 3. Dental x-rays 4. Dental fillings 5. Extractions i 6. Preventive dental care that includes teeth cleaning, sealants, and fluoride applications. Diabetic Supplies Covered Diabetic Testing Covered Drug Abuse Not covered (covered by other programs administered by the Health Services Department) Durable Medical Equipment Covered Emergency and Urgent Care Covered Eye Glasses Not covered ATTACHMENT A (PAGE 2 of 5 PAGES) _Experimental Treatment Not covered Family Planning Covered i..Hearing Aids & Batteries Not covered Hearin Tests Audiolo ) Covered Hemodial sis Acute Covered Hemodialysis -- Chronic Not covered Home Health Services Not covered Hospitalization Covered Hospice Not covered Hypnotherapy Not covered Immunizations and Inoculations Covered, except travel inoculations and medications are not covered. ..Infertility Services Not covered Long Term. Care at Skilled Nursing Not covered Facility Maternity Care Not covered covered by Medical ATTACHMENT A (PAGE 3 of 5 PAGES) Mental Health Services Not covered (covered by other programs administered by the Health Services Department) tNewbomcovers e Not covered (covered by Medical) Or an Trans lant Not covered Ortho tic (eye trainin Not covered k.Outpatient Visits Covered, but some visits require prior authorization j Over the Counter Drugs Only those drags listed on the Preferred Drug List, as periodically amended by the Pharmaceuticals and Therapeutics Committee, are covered. Personal & Comfort Items Not covered Physical Examinations Not covered, except back-to-work ro rams are covered Prescription Drugs, Outpatient Only those drugs listed on the (legally require a prescription) Preferred Drug List, as periodically amended by the Pharmaceuticals and Therapeutics Committee, are covered. Prosthetic devices, corrective appliances & Not covered artificial aids ATTACHMENT A (PAGE 4 of 5 PAGES) Radial Keratotomy Not covered Refraction Covered Skilled Nursing Facility Not covered Sterilization Covered i Su lies, dis osable Covered Therapy: outpatient, physical, speech and Covered only in cases of expected occupational short term improvement (2 month maximum) TMJ Treatment Not covered LTransportation Not covered _ NOTE: All covered services are provided only at Contra Costa County facilities unless referred and preauthorized by Contra Costa County. H:\Board Actioas\Basic Adult Care\Basic Health Care Cavern!Services.wpd ATTACHMENT A (PAGE 5 of 5 PAGES)