HomeMy WebLinkAboutMINUTES - 05191987 - 1.66 1-®66
TO: ; BOARD OF SUPERVISORS
FROM: Mk Finucane , Health Services Director Contra
By : Elizabeth A. Spooner , Contracts Administrator
@ . Costa
DATE: May 7, 1987 County
SUBJECT: Approval of Contra Costa Health Plan Medicare Contract #29-608-2 `�
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 Medicare Contract #29-608-2
with the . U. S_. Department of Health and Human Services for the
period July 1 , 1987 - June 30, 1988 , 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 end
of the current contract period .
II . FINANCIAL IMPACT :
The current Medicare contract covers 860 Health Plan members and
is budgeted to cover 862 members in Fiscal Year 1987-88 . As in
the current agreement , Contract #29-608-2 is a cost reimburse-
went agreement and will produce $734, 424 in premium revenue and
approximately $280, 000 in annual cost . settlement for a total
annual revenue of approximately $1 , 014 , 424 . In addition, for
those members crossed over to Medi-Cal membership , the State of
California pays the County _ annual revenue of $659 , 451 so that
the total revenue is $1 , 673 , 875 . 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 services which exceed the Medicare level .
III . REASONS FOR RECOMMENDATIONS/BACKGROUND :
On October 26 , 1976 the Board approved Contract #29-608 with the
U . S. Secretary of Health , Education and Welfare 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 was approved by the Board on June 25 , 1985 .
Contract #29-608-2 continues this reimbursement arrangement with
the U. S . Department of Health and Human Services .
CONTINUED ON ATTACHMENT: X- YES SIGNATURE: `
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATI N OF BOARD COMIXTTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ONMAY 1
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.
T987
cc: Health Services (Contracts) ATTESTED MAY 1 9_
County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF
Auditor-Controller SUPERVISORS AND COUNTY ADMINISTRATOR
U.S. Dept. of Health & Human Services �jfJ
BY � ! iL ,DEPUTY
M382/7-83
f
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U. S . Department of Health and Human Services
Health Plan Medicare Contract #29-608-2
Board Order
Page 2
The only significant change in the new contract is the require-
ment that the County Health Plan process and pay 95 percent of
all clean claims for services rendered by non-contracted physi-
cians and providers within 30 days of receipt . Clean claims are
defined as those which do not require additional information
from the provider in order to make a payment decision . This
claims processing requirement was enacted into Federal law as
part of the Omnibus Budget Reconciliation Act of 1986 . Since
the new contract was printed prior to the 1986 legislation, the
Department of Health and Human Services has changed the claims
processing paragraph (Article IV. J. 5) on page six from 27 to 30
days . The Board Chair should initial this change on each copy
of the document .
The document has been approved by County Counsel . The Board
Chair should initial on page six and sign five copies of the
contract on page ten . 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