HomeMy WebLinkAboutMINUTES - 03261991 - 1.33 1-033
y TO:" BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts AdministratoCoS♦a
DATE: March 19, 1991 County
SUBJECT: Approval to participate in a Major Risk Medical Insurance
Program and to negotiate and execute a Standard Agreement with
the State Department of Consumer Affairs
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
A. Approve Contra Costa Health Plan participation in the State's
newly created Major Risk Medical Insurance Program (MRMIP) ; and
B. Approve and authorize the Health Services Director or his
designee to negotiate and execute on behalf of the County, a
Standard Agreement #29-764, and any modifications or amendments
to increase the maximum amount of the agreement or
administrative costs, with the State Department of Consumer
Affairs, effective June 1, 1991 through June 30, 1992, for
first year funding for the program.
II. FINANCIAL IMPACT:
MRMIP is funded through a combination of subscriber premiums and
State funding from tobacco tax monies. The Health Plan and the
County are not at risk for costs of service in the Major Risk
Program. Each subscriber will pay 125% of the usual premium and the
State will fund the difference between that and the total cost of
care. The State will also pay a monthly administrative fee which
will be negotiated before execution of the final contract. Total
revenue to the County will depend entirely upon enrollment volume.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
The California Major Risk Medical Insurance Program is a new State
program designed to provide health insurance to Californians who are
unable to obtain coverage on the open market. Eligible Californians
include those who have been denied individual or small group
coverage within the previous twelve months, those who have been
involuntarily terminated from health insurance coverage for reasons
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
__ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMM D TION OF BOARD COMMITTEE
__APPROVE OTHER
SIGNATURE(S) n
ACTION OF BOARD ON MAR 2 A 1991 APPROVED AS RECOMMENDED _A OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
CC: Health Services (,Contracts) ATTESTED MAR 2 6 1991
Auditor-Controller (Claims)
Phil Batchelor, Clerk of the Board of
State Department of Consumer Affairs
$!s$eNISOfSaWOntyAdmilii* 4qs
M382/7-83 BY DEPUTY
w ' M
BOARD ORDER
Standard Agreement #29-764
Page 2
other than non-payment of premiums, and those who have been
requested to pay health insurance premiums higher than the MRMIP
subscriber rate. The subscriber pays 125% of the usual premium
cost, a $500 deductible per household per year, and a 20% copayment
for most services up to an annual maximum requirement of $2 , 000 per
year per subscriber or $3, 000 for the entire household. The State
pays all remaining health care costs and an administrative fee per
member per month. The program is capped at $50, 000 cost per year
per member and a lifetime cap of $500, 000.
Contra Costa Health Plan has been invited by the State to
participate as one of the health plans in this newly created
Program. The State is particularly interested in the Contra Costa
Health Plan because of its status as a local government-run
Federally-qualified, State-licensed HMO and its expertise in case
management.
In order to participate in the Program this year, the State has
given the Department a very short time frame in which to develop
the details of our package, and a contract must be approved by your
Board to be considered by the MRMIP Board at their meeting of April
2, 1991.
The HMO Advisory Board endorsed participation in this Program at its
meeting of March 13, 1991.