HomeMy WebLinkAboutMINUTES - 06221993 - 1.74 ,.
1
TO: BOARD OF SUPERVISORS M
FROM: Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts Administrato Costa
DATE: June 10, 1993 County
SUBJECT: Approval of Standard Agreement (Amendment) #29-609-40 with the
State Department of Health Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors, to execute on
behalf of the County, Standard Agreement (Amendment) #29-609-40 (State
#88-94695 A-04) with the State Department of Health Services,
effective May 1, 1993 , to amend Standard Agreement #29-609-35 (as
amended by Amendment Agreements #29-609-36, #29-609-37 and #29-609-
39) , for prepaid health services for Medi-Cal beneficiaries. This
amendment increases the FY 1992-93 contract payment limit by $556, 774,
from $18 , 543 , 226 to a new fiscal year total of $19, 100, 000.
II. FINANCIAL IMPACT:
Approval of this amendment will increase the State's funding
encumbrance for FY 1992-93 by $556,774 , for a new total, of
$19, 100, 000, to reflect increases in the dental program premium rates.
However, the net effect of this increase on Health Plan revenues is
dependent upon enrollment levels.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On December 13 , 1988, the Board approved Standard Agreement #29-609-35
with the State Department of Health Services, for prepaid health
services for Medi-Cal beneficiaries, for the period from January 1,
1989 through December 31, 1993 . Subsequent amendment agreements (#29-
609-360, #29-609-37 and #29-609-39) were approved by the Board on
September 19, 1989, February 5, 1991 and November 17, 1992,
respectively. The State developed an amendment (#29-609-38) to delete
eligibility codes specified in Article II - Definitions, Paragraph J,
but has decided not to process it at this time.
Standard Agreement (Amendment) #29-609-40 sets new per capita rates of
payment as as follows:
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
c
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME ATI NOF BOARD OMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: Zi 3.346 5' NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Milt Camhi (313-5604) a
CC:Health Services (Contracts) ATTESTED
Auditor-Controller (Claims)
State Department of Health Services Ph' a1&lor, Clerk of the Board of
$ eI111S(1!�8Ad��AQNIDISt(3tOt
M382/7-83 BY DEPUTY
Amendment #29-609-40
Board Order
Page 2
EFFECTIVE JULY 1, 1992 - OCTOBER 31, 1992
Medically Needy
Public Assistance No Share of Cost
Aged $ 110. 39 Aged $ 160.72
AFDC $ 92 . 53 AFDC $ 135.43
Disabled/Blind $ 211.46 Disabled/Blind $ 914 .27
AIDS $1, 933 .26 MI Children $ 182 .02
MI Pregnant Women $ 622 .76
AIDS $1, 933.26
EFFECTIVE NOVEMBER 1, 1992
Medically Needy
Public Assistance No Share of Cost
Aged $ 113 . 84 Aged $ 164. 17
AFDC $ 95. 98 AFDC $ 138.88
Disabled/Blind $ 214 .91 Disabled/Blind $ 917.72
AIDS $1,936. 71 MI Children $ 185.47
MI Pregnant Women $ 626.21 ,
AIDS $1,936.71
The Board Chair should sign ten copies of the agreement, nine of which
should be returned to the Contracts and Grants Unit for submission to
the State Department of Health Services.
STATE OF CALIFORNIA
APPROVED BY THE
CONTRACTNUMBER
ST6t'\1DARQ.A1qT1EEMENT AM.N67 N
a r"% I ATTORNEY GENERAL 1" ?q
SM.2{REVS 88-94695
04
TAXPAYERS FEDERAL EWWM MTIMADON HUMBER
THIS AGREEMENT,made and entered into this First day of MaY .19 93 94-6000509
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
TITLE OF OFFICER ACTING FOR STATE
AG
Chief, Program Support Branch Department of Health Services
CONTRACTOR'S NAME hereafter called the State,and
; 2 9 - 40
The County of Contra Costa - 609
hereafter .called the Contractor.
WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed,
does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor,
time far performance or completion,and attach plans and specifications,if any.)
AMR=
L7U 04 TO 02WITRALT 88-94695 BENEEN ME aXNIY OF arMA CCSM PND
THE S= OF CARNIA.
VZE REAS the State of California and the County of Ccntra Costa entered into a.
contract for prepaid health services dated January 1, 1.989 and was subsequently
arrended on July 1, 1989, July 1, 1990, December 1, 1.992 and;
WK THEP=RE, the contract is an-p—nded as follows:
CONTINUED ON 2- SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written..
STATE OF CALIFORNIA CONTRACTOR
AGENCY CONTRACTOR(it other than an n in.lykka(slab--dw a mp--OM pw--hp eta)
—Department of Health Services The County of Contra Costa
BY(AUTHORIZED ATUR EL-i—�T'
BY(AUTHORIZED SIGNATURE)
>
PRINTED NAME OF PERSON SIGNING PRINTED NAME TITLE OF pkRSONSIGNING
Edward E. Stahlberg Chair, Board of Supervisors
TITLE ADDRESS
-
Chief, Program Su pport Branch 651 Pine Street, Njart±nez, CA 94553
AMOUNT ENCUMBERED BY THIS PROGRAMiCATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
DOCUMENT
$ 556,774 Local Assistance Sect. 14157 W&I Code Health Care P2P2!2!t Use only
(OPTIONAL USE)
PRIOR AMOUNT ENCUMBERED FOR Fed. Cat. No. 93M 4260-101-M -EKOpt from Public Contract
& M
THIS CONTRACT Code
ITEM CHAPTER `� Pursuan
STATUTE ISCAL YEAR F_Ts t to Section
$76,500,513 T 4260--601-912 1597 11%2 1992--93 142(Y4 Of the Welfare and
TOTAL AMOUNT ENCUMBERED Institutions Code
DATE OBJECT CF EXPENDITURE(CODE AND TITLE)
$ 77,057,287 N/A
I hereby certify upon my own personal knoMedge-that budgeted funds T.B.A.NO. BR NO.
are available for the period and purpose of the expenditure stated above.
SIGNATURE OF ACCOUNTING OFFICER DATE
Fl CONTRACTOR STATE AGENCY ED DEPT.OF GEN.SER. CONTROLLER
The County of Contra Costa -2- 88-94695 A-04
1. ARTICLE IX -- PAY=, Sections A, B and C are amended to read:
"A. Amamts Payable
The maximum an=t payable for:
o the 1988-89 Fiscal year ending June 30, 1989 will not exceed
. . . . . . . . . . . . . . . . . . . . . . . $ 3,900.000;
o the 1989-90 Fiscal year ending June 30, 1990 will not exceed
. . . . . . . . . . . . . . . . . . . . . . .. . $17,386,891;
o the 1990-91 Fiscal year ending June 30, 1990 will not exceed
. . . . . . . . . . . . . . . . . . . . . . . . $18,210 381;
o the 1991-92 Fiscal year ending June 30, 1992 will not exceed
. . . . . . . . . . . . . . . . . . . . . . . . $18,460,015;
o the 1992-93 Fiscal year ending June 30, 1993 will not exceed
. . . . . . . . . . . . . . . . . . . . . . . . $19,100,000;
Any requirement of performance by the Department and the Contractor for
the period of the contract subsequent to June 30, 1993 will be
dependent upon the availability of future appropriations by the
Legislature for the purpose of this contract. If funds become
available for purposes of this contract frau future appropriations by
the Legislature, the naxinu.IIn amount payable under this contract for:
o the 1993-94 Fiscal year ending June 30, 1994 will not exceed
. . . . . . . . . . . . . . . . . . . . . . . . $ 9,608,000;
The naxirnun amount payable under this contract will not exceed
. . . . . . . . . . . . . . . . . . . . . . . . . . .$86,665,287.-1
"B. Capitation Rates (effective July 1, 1992 thru October 31,1992)
The State will remit to. the Contractor a capitation payment for each
member, for each month in which such madber is eligible for Medi-Cal
benefits and appears on the approved list of manbers supplied to the
Contractor by the Department. Capitation payments will be nade in
accordance with the following schedule of capitation payment rates:
Public Assistance Medically Needy Only
No Share of Cost
Aged $ 110.39 Aged $ 160.72
AFDC $ 92.53 AFDC $ 135.43
Disabled/Blind $ 211.46 Disabled/Blind $ 914.27
AIDS $1,933.26 MI Children $ 182.02
MI Pregnant Women $ 622.76
AIDS $1,933.26"
The County of Contra Costa -3- 88-94695 A-04
"B. Capitation Rates (effective November 11 1992)
The State will remit to the Contractor a capitation payment for each
member, for each month in which such manber is eligible for Medi-Cal
benefits and appears on the approved list of members supplied to the
Contractor by the Department. Capitation payments will be made in
accordance with the following schedule of capitation payment rates:
Public Assistance Medically Needy Only
No Share of Cost
AGED $ 113.84 Aged $ 164.17
AFDC $ 95.98 AFDC $ 138.88
Disabled/Blind $ 214.91 Disabled/Blind $ 917.72
AIDS $1,936.71 MI Children $ 185.47
MI Pregnant Woman $ 626.21
AIDS $1,936.71"
"C. Rates Constitute Payment in Full
The capitation payment constitutes payment in full by the Department on
behalf of a ma her for all covered services required by such member,
subject to the provisions of Article VI, Section L and for all
administrative costs incurred by the Contractor in providing or
arranging for such services, but does not include payment for the
recougnent of current or previous losses incurred by the Contractor.
The basis for the determination of the capitation payment rates is
outlined in Attachment II (consisting of 18 pages) ."
.2. Attachment II-A, Revised July 1, 1992, entitled "PREPAID HEALTH PLANS RATE
DEv=PmEgr FISCAL YEAR 1992-93 RATES", consisting of thirteen (13)
pages,and Attachment II-B Revised November 1, 1992, entitled "PREPAID HEALTH
PLANS RATE DEVELOPMENT FISCAL YEAR 1992-93 RATES B", consisting of thirteen
(13) pages is incorporated herein and made part hereof by this reference.
Upon effective date, all references to Attachment II in the body of this
agreewmt in any attachment hereto will hereinafter be deemed Attachment
II-A, Revised July 1, 1992 or Attachment II-B, Revised November 1, 1992.
3. The effective date of the rate change for Attachment II-A is July 1, 1992
through October 31, 1992.
4. The effective date of the rate change for Attachment II-B is November 1,
1992.
5. The effective date of this airerdrent is May 1, 1993.
6. . All rights, duties, obligations, and liabilities of the parties hereto
otherwise resin unchanged.
Attachnent II-B
November 1, 1992
PREPAID HEALTH PLANS
RATE DEVEL(WE Tr
FISCAL YEAR
1992-93 RATES B
PART B. OVERVIEW OF THE RATE CALCULATION PROCESS
AND WORKSHEET
The purpose of the rate calculation process, as explained in
p
this manual , is to develop a monthly rate per eligible Medi-Cal
beneficiary for a time period in the *future called the Rate
Period. This year' s rate period is July 1, 1991 to June 30,
1992 .
This a two step process with some
process can be seen as
miscellaneous adjustments.
The first step in evaluating a given plan is to calculate
what rates . would have been paid- in some past period. . This must
take into consideration all the specific contract requirements,
particularly 'as they differ from the entire fee-for-service (FFS)
group. It must consider all the demographic aspects of the
population being served, including aid code, sex, age, and _
geographic area.
The second step is. to project this rate into the future.
There are two major considerations here: legislative changes and
trend. The first of these relates to bills that have been passed
or are expected t'o be enacted. The latter of these is a
conglomerate of changes in physician practices, changes in Medi-
Cal beneficiary practices, changes in hospital practices, and
anything else which might affect the.cost of medical care.
Adjustments are then made for Child Health and Disability
Prevention (CHDP) , Short/Doyle, health insurance recoveries, stop
loss reinsurance, administration and dental.
The Capitation Rate Worksheet, on page 7, shows how a single
capitation rate is calculated. A short line-by-line description-
of
escriptionof this process follows . Each line number also . refers to a
section .in Part C- :which gives a more. detailed explanation of the
adjustment.
At the top .right of' the worksheet, the Base Period and Rate
Period are shown. The base period refers to the first step in
the process, that is, calculating the monthly cost per eligible
for a given period -in the past. The rate period refers to the
period for which capitation payments will be made.
Note that rates are calculated for specific aid code
and each of six different types of services, or vendor
groupings
code groupings.
The general methodology is to start with a dollar number and
multiply it by a series of factors, each of which is rounded to
three decimal places.. The Contract Cost and the Projected .Cost
are each rounded to cents.
-2-
Each numbered line is defined as follows
1. Base _Cost - These 'are the cost per person per eligible
month (CPPM) figures for each of six vendor code groupings.
CPPM f igures are calculated on other worksheets for each of
the four geographic regions, and nine aid code groupings.
2. Area Adjustments - This factor adjusts the base costs to
specific counties or to specific plans. that operate in Los
Angeles county. There are no adjustments on this line for
counties other than Los Angeles, Alaieda, Contra Costa,
Orange, Riverside, San Bernardino, San Diego, San Francisco,
and Santa Clara. No adjustment means that a factor of 1..000
appears on the worksheet. For example $6.23 x '1.000
$6 . 23 .
3 . AaelSex Adjustments These adjustments are all specific to
the plan which is being rated. Based on age/sex factors
calculated for the entire State, a plan's age/sex mix in a =
given aid code grouping is used to calculate its specific
age/sex factors. There is no' adjustment if a plan averaged
less than 100 eligibles per month in an aid code grouping
during the most recent available past. year of data.
4 . Contract Adjustments - In many cases, a particular plan will
contractually exclude coverage of certain medical services.
These services will then be paid through the fee-for-service
(FFS) system, and the plan will therefore not be capitated
for these potential costs. Note that no factors on this
line are greater than 1. 000. This is because reduced
services imply a reduction in the capitation rate.
5. Eli ibil it Ad 'ustments - This section represents
adjustments to the base cost because the distribution of
eligible months by aid code in a plan (within an aid code
grouping) differs from the statewide FFS distribution.
6 . Interest Offset - This adjustment relates to the way the
-State pays out funds. on the average, it takes three to four
months before all the bills relating to a single service-..are
paid under Medi-Cal FFS. Because money is paid out earlier
to capitated plans, the State loses interest. This
adjustment intends to make up for this loss by reducing the
capitation payment.
7. Lecrislative Adjustments - This section evaluates the
financial impact of legislative changes on the FFS program.
In some instances, laws have already been passed, -and only
the financial affect must. be estimated. In other .cases
legislation is only expected to occur, and in these cases
the expected financial impact may be tempered. only changes
which are included in the May 1991 .Medi-Cal Estimate are
considered,
-3-
8 : Trend - This adjustment predicts the affect of all other
changes that may take place in the .Medi-Cal population and
in the medical services area, including fee-for-service
(FFS) rate increases not covered by legislative adjustments.
9. Medical Cost Ad`iustments additional amount is added to
the rate if a plan will cover services generally provided by
the Child Health and Disability Prevention (CHOP) or short)
Doyle Mental Health (SDMH) programs. �Ef a plan is expected
to recover amounts from a- Medi-Cal beneficiary's private
health coverage, then an amount is subtracted from the rate
for other health insurance.
10. StoT? Loss Reinsurance - After the FFS Medical Cost is
determined, a further adjustment is . made for stop loss
reinsurance. This means the- State will pay costs for claims
from a single beneficiary once they exceed a certain amount
during the Rate Period. Since these are costs which the
plan will not have to pay, the rate must be reduced.
11. Administration Allowance - -A flat dollar amount is allowed
for administrative expenses for each Medi-Cal eligible -per
month, depending on the aid code grouping. Aid code
groupings which are expected to have higher claim costs
receive greater allowances. These amounts differ for PHPs
and PCCMs because the State continues to handle certain
claims under the PCCM arrangement.
12 . percent of Fee-far-Service Ecruivalent Cost Payable - The
total FFS Equivalent Cost is multiplied by a percentage to .
get the Initial Capitation Rate. . This year the percentage
has been set at 97% for the PHPs 951 and for the PCCMs.
13 '. Dental coverage - This adjustment is made only when a plan
elects to . cover dental services. The amount covers these
services plus an administrative component.
-4-
CAPITATION RATE WORKSHEET Date: 3/17/1993
Base Period: FY 88/89
Aid Group: Public Assistance Aged Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =_=__> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 7.03 23.13 34.74 7.52 40.34 5.07 $117.88
2. Area Adjustments .962 1.151 .933 1.247 .976 ;898
3. Age/Sex Adjustments .998 1.019 1.015 1.002 1.107 1.025
4. Contract Adjustments
a. Hemo, Maj Org, LTC .998 1.000 1.000 1.000 ,278 1.000
b. AIDs 1.000 1.000 1.000 1.000 1.000 1.600
c. Procedures 1.000 1.000 1.000 1..000 1.000 1.000
5. Eligibility Adjustments
a. Aid Codes 1.002 .988 .998 .996 .997 .963
b. Medicare 1.052 .997 1.042 1.000 1.005 1.012
6. Interest Offset. .982 .992 .968 .975 ,989 .983
CONTRACT COST FY 88/89 $6.97 $26.51 $33.16 $9.12 $12.01 $4.47 $92.24
7- Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1,000 1.000 1.000 1.000 1.000
3Q/90. 1.000 1.000 1.000 1.000 1,072 1.000
40!90 1.000 1,000 1.000 1.000 1.000 1.000
IQ/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.000 1.000 1.000 "
b. Benefits 30/89 .998 .996 1.023 1.033 .998 .998
40/89 1.015 .995 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.004 1.038
2Q/90 1.000 1.000 1.000 1.000 1.000 1.000
3Q/90 1.000 1.000 1.004 1.014 1,000 .957
4Q/90 1.000 1.000 1.000 1.000 1,000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 ,974 1.238 1.143 .251 1.075 1.875
PROJECTED COST FY 90/91 $6.88 $32-52 $38.93 $2.41 513.87 $8.37 $102.98
9. Medical Cost Adjustments
a. CHDP .00
b. Short/Doyle Mental Health .79.
c. Health Insurance Recoveries ( .31)
FEE-FOR-SERVICE MEDICAL COST 5103.4E
10. Stop Loss Reinsurance at 100,000 is .04)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE
$103.37
11. Administration Allowance 4.62
TOTAL FEE-FOR-SERVICE EQUIVALENT COST 5107.99
12. Percent of Fee-for-Service Equivalent Cost Payable 97.0X
INITIAL CAPITATION RATE5104:75
13. Dental Coverage 9.09 .
FINAL CAPITATION RATE $113.84
CAPITATION RATE WORKSHEET Date: 3/17/1993
Base Period: FY 88/89
Aid Group: Public Assistance Family Rate Period- 11/42.9193
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 13.93 4.29 32.30 7.52 .04 4.05 $62.13
2. Area Adjustments 1.052 .980 1.046 1.131 1.000 _ _999
3, Age/Sex Adjustments 1,043 .975 1.032 1.027 1.000 1.D1i .
4. Contract Adjustments
a. Remo, Maj Org, LTC .999 1.000 1.000 1.000 MO 1»000
b. AIDS 1.000 1.000 1.000 1.000 1.000 1-d00
c: Procedures 1.000 1.000 1.000 1.000 1.000 1.000
5. Eligibility Adjustments
a. Aid Codes 1.006 .982 1.026 1.022 1.000 .954
b. Medicare 1.000 1.000 1.000 1.000 1.000 1.000
6. Interest Offset .985 .992 .980 .985 .990 .985
CONTRACT COST FY 88/89 $15.13 $3.99 $35.06 $8.79 $-02 $3.84 $66.83
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 . 1.000 1.000 1,000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
.30/90 1.000 1,000 1.000 1.000 1.072 1.000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.000 1.000 1,000
b. Benefits 30/89 1-048 .996 1.023 1.085 .998 ,998
40/89 1:015 .995 1.000 1.000 1.000 1.000
10190 1.000 1.000 1.000 1.000 1.004 1.038
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957 .
40/90 1.000 1.000 1.000 1.000 1.000 1,000
10/91 1.000 1.000 1.000 .1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 1.053 1.118 1.215 1.131 1,000 1.604 .
PROJECTED COST FY 90191 $16.95 $4.42 $43.75 $11.01 $.02 $6.15 $82.30
9. Medical Cost Adjustments
a. CHDP 2.02
b. Short/Doyle Mental Health 2.88
c. Health Insurance Recoveries { .04)
FEE-FOR-SERVICE MEDICAL COST $87.16
10. Stop Loss Reinsurance at 100,000 is .8X C . ,66)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE 1 586.50
11. Administration Allowance 3.08
TOTAL FEE-FOR-SERVICE EQUIVALENT COST S89.5$ .
12. Percent of Fee-for-Service Equivalent Cost Payable 97-0%
INITIAL CAPITATION RATE
•gg
13. Dental Coverage 9.09
FINAL CAPITATION RATE $95.98
CAPITATION RATE WORKSHEET Date- 3/17/1993
Base Period: FY 88/89
Aid Group: Public Assistance Disabled Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 23.40 34:66 100.24 15.78 32.86 18.81 5225.75
2. Area Adjustments .907 1,036 .887 1.098 .549 _ 1991
3. Age/Sex Adjustments. .956 1,077 .898 .993 1.001 .898
4. Contract Adjustments
a. Hemo, Maj Org, LTC .992 1.000 1.000 . .999 .140 1.000
b. AIDS .989 .976 .966 .958 ,999 .491
c. Procedures 1.000 1.000 1.000 1.000 1.0(30 1.000
5. Eligibility Adjustments
a. Aid Codes 1.008 .995 1.010 1.001 .998 .985
b. Medicare .920 1.008 .916 -- '.973 .960 .970
6. Interest Offset .982 .991 .976 .979 .990 .981
CONTRACT COST FY 88/89 $18.13 $37.52 $69.64 $15.70 $2.40 $15.55 $158.94
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1,000 1,000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1..000 1.072 1.000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1,000 1.000 1.000 1.000 1.000
b. Benefits 30/89 .998 .996 1.023 1.033 ,998 ,998
40/89 1.015 .995 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1,000 1.004 1.038
2Q/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1,000 1.000 1.000
2Q/91 1,000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 1.009 1.200 . 1.165 .841 1.142 1.302
PROJECTED COST FY 90/91 $18.53 $44.62 $83.33 $13.93 $2,94 $20,21 $183,56
9. Medical Cost Adjustments
a. _ CHDP .
06
b. Short/Doyle Mental Health 25.24
c. Health Insurance Recoveries ( .54)
FEE-FOR-SERVICE MEDICAL COST
$208.32
10. Stop Loss Reinsurance at 100,000 is 1.6% ( 2.89)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $205.43
Ii_ Administration Allowance 6.76
TOTAL FEE-FOR-SERVICE EQUIVALENT COST
$212.19
12. Percent of Fee-for-Service Equivalent Cost Payable
97.0%.
INITIAL CAPITATION RATE 5205.82
13. Dental Coverage 9.09
FINAL CAPITATION RATE $214.91 '
CAPITATIQN RATE WORKSHEET Date; 3/17/1993
Base Period: FY 88/89
Aid Group: Medically Needy No Share Aged Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =====> Phys Pharm HIP HOP LTC Other TOTAL
i
r 1. Base Cost 16.14 17.79 69.96 12.09 26.16 12.87 $155.01
2. Area Adjustments 1.000 1.000 1.000 1.000 1.000 _ 1.000
3. Age/Sex Adjustments 1.000 1.000 1.000 1.000 1.000 1.000
4.. Contract Adjustments
i
a, Hemo, Maj Org, LTC .991 1.000 1.000 .999 .482 1.000
! b. AIDS 1.000 1.000 1.000 1.000 1.000 1,600
c. Procedures 1.000 1.000 1.000 1.000 1.000 1.000
R 5. Eligibility Adjustments
a. .Aid Codes 1.000 1.000 1.000 1.000 1.000 1.000
b. Medicare 1.000 1.000 1.000 1.000 1.000 1.000
6. Interest Offset .969 .991 .963 .967 _986 _975
CONTRACT COST FY 88/89 $15.50 $17.63 $67.37 511.68 $12.43 512.55 $137.16
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.072 1.000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 30/89 .998 .996 1.023 1.033 .998 .998
40/89 1.015 .995 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.004 1,038
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1,004 1.014 1.000 .957
40/90 1.000 1.000 1.000 .1.000 1.000 1.000
10/91 1.000 1.000 1.000, 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 ,981 1.233 1.143 .592 1.049 1.339
PROJECTED COST FY 90/91 $15.40 $21.54 579.09 $7.29 $14.01 516.78 5154.11
9. Medical Cost Adjustments
a. CHOP .00
b., Short/Doyle Mental Health 1.27
.i
c. Health Insurance Recoveries t .67)
FEE-FOR-SERVICE.MEDICAL COST
$154.71
10. Stop Loss Reinsurance at 100,000 is .OX ,00
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE 5154.71
11. Administration Allowance 5.1T
i .
TOTAL FEE-FOR-SERVICE EQUIVALENT COST S159.8$
12. Percent of Fee-for-Service,Equivatent Cost Payable 97.0%
INITIAL CAPITATION RATE _ $155.08
13. Dental Coverage 9.09
FINAL CAPITATION RATE $164.17
t
CAPITATION RATE WORKSHEET Date: 3/17/1993
Base Period: FY 88/89
Aid Group: Medically Needy No Share - Family Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =____>, Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 21.35 4.62 73.57 12.31 .31 8.36 S120.52
2. Area Adjustments 1.028 1.068 .898 1.190 1.000 1:121
3. Age/Sex Adjustments .914 .961 .891 .942 1,000 .950
4. Contract Adjustments
i
a. Hemo, Maj Org, LTC .998 1.000 1.000 1.000 .491 1.000
b. AIDs 1.000 1.000 1.000 1.000 1.000 1.000
c. Procedures 1.000 1.000 1.000 1,000 1,000 1,000
5. Eligibility Adjustments
a. Aid Codes 1.000 1.000 1.000 . 1.000 1,000 1.000
b. Medicare 1.000 1.000 1.000 1-000 1.000 1.000
6. Interest Offset .980 .990 .970 .978 .985 .982
CONTRACT COST FY 88/89 $19.62 $4.69 $57.10 $13.50 S-15 58,74 $103.80
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000- 1,000 1,000 -
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1,000 1.000
20/90 1.000 1.000 1,000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.072 1.000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1,000 1.000 1.000 1.000 1.000
b. Benefits 30/89 1.048 .996 1.023 1.085 .998 .998
40/89 1.015 .995 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 .1.000 1.004 . 1.038
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
8, Trend 1/89-1/91 1.032 1.146 1.252 1.066 1.000 1.174
PROJECTED COST FY 90/91 $21.54 $5.33 573.43 $15.94 $.16 $10.24 $126-64
9. Medical Cost Adjustments
a. CHOP
•. 1.82 -
b. Short/Doyle Mental Health 2-51 f
c. Health Insurance Recoveries ( .21)
FEE-FOR-SERVICE MEDICAL COST
$130.76
10. Stop Loss Reinsurance at 100,000 is .8% ( 1.01)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $124.75
11. Administration Allowance 4.05
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $133.80
12. Percent of Fee-for-Service Equivalent Cost Payable 97.0%
INITIAL CAPITATION RATE
$129.74
13. Dental Coverage 9.09
FINAL CAPITATION RATE $138.88
CAPITATION RATE WORKSHEET Date: 3/17/1993
Base Period: FY 88/89
Aid Group: Medically Needy No Share Disabled Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
i
i Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 50.77 41.01 637.53 43.09 26.17 36.64 $835.21
2. Area Adjustments 1.000 1.000 1.000 1.000 1.000 - 1:000
3. Age/Sex Adjustments 1.000 1.000 1.000 1.000 1.000 1.000
4. Contract Adjustments
a. Hemo, Maj Org, LTC .969 1.000 1.000 .998 .491 1.000
b. AIDS .978 .741 .919 .828 .979 1.004
c. Procedures 1.000 1.000 1.000 1.000 1.000 1.000
5. Eligibility Adjustments
a. Aid Codes 1.000 1.000 .999 .999 1.000 1.001
b. Medicare 1.000 1.000 1.000 1.000 1.000 1.000
6. Interest Offset .968 .985 .958 .971 .985 .973
CONTRACT COST FY 88/89 $46.57 $29.93 $560.72 $34.54 $12.39 $35.83 $719.98
7. Legislative Adjustments -
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.072 1.000
40/90 1.000 1.000 1.000. 1.000 1.000 1.000
10/91. 1.000 1.000 1.000 1.000 1.000 1.000 .
20/91 1.000 1.000 1.000 1.000 . 1.000 1.000
b. Benefits 30/89 .998 .996 1.023 1.033 .998 .998
40/89 1.015 .995 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.004 1.038
20/90 1.000 1.000 1.000 1.000 1.000 .1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 1.048 1.204 1.273 1.042 1.209. 1.161 ..
PROJECTED COST FY 90/91 $49.44 $35.71 $733.13 S37.96 $16.09 541.53 5913.86
9. Medical Cost Adjustments
a. CHDP .01
b. Short/Doyle Mental Health 22.48 `
c. Health Insurance Recoveries ( 1.76)
FEE-FOR-SERVICE MEDICAL COST $934.59
10. Stop Loss Reinsurance at 100,000 is 1.6% ( 14.36)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $920.23
11. Administration Allowance 16.50
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $936.73
12. Percent of Fee-for-service Equivalent Cost Payable 97.0%
INITIAL CAPITATION RATE $908.63
13. Dental Coverage 9.09
FINAL CAPITATION RATE $917.72
CAPITATION RATE WORKSHEET Date; 3/17/1983
Base Period: FY 88/89
Aid Group: Medically Indigent Children Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
f
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 16.18 3.04 101.40 10.13 .63 5.16 $136.54
2. Area Adjustments 1.000 1.000 1.000 1.000 1.000 . 1.000
3. Age/Sex Adjustments 1.000 1.000 1.000 1.000 1.000 1.000
:i 4. Contract Adjustments
a. Hemo, Maj Org, LTC .997 1.000 1.000 .999 .292 1.000
b. AIDS 1.000 1.000 1.000 1.000 1.000 1.600
`! c. Procedures 1.000 1.000 1.000 1.000 1.000 1.000
5. Eligibility Adjustments
-= a. Aid Codes 1.009 .945 1.023 1.026 1.000 .893
b. Medicare 1.000 .1.000 1.000 1.000 1.000 1.000
6. Interest Offset .979 .988 .969 .976 .985 ,980
CONTRACT COST FY 88/89 $15.93 $2.84 $100.52 $10.13 S.18 54.52 5134.12
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.072 1.000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20191 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 30/89 .998 .996 1.023 1.033 .998 ,998
40/89 1-015 .995 1-000 1.000 1.000 1.00U
10/90 1.000 1.000 1.000 1.000 1.004 1.038
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000. 1.000 1.000 1.000 1.000 1.000
20/91 1,000 1.000 1.000 1.007 1.000 1.007
8. Trend 1/89-1/91 .972 1.061 1.339 1.086 1.000 1.167
PROJECTED COST FY 90/91 $15.68 $2.99 $138.24 $11.60 $.19 55_27 $173.97
9. Medical Cost Adjustments
a. CHDP
3.19
b. Short/Doyle Mental Health 4.96
c. Health Insurance Recoveries ( .13}
FEE-FOR-SERVICE MEDICAL COST
$181.99
10. Stop Loss Reinsurance at 100,000 is 2.2X t 3.82}
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE 5178.17
11. Administration Allowance 3.66 .
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $181.83
12. Percent of Fee-for-Service Equivalent Cost Payable 97.0X
INITIAL CAPITATION RATE S176.38
13. Dental Coverage
9.09 .
FINAL CAAPITATION RATE S185.47
-11-
CAPITAZIOIJ RATE WORKSHEET Date: 3/17/1993
Base Period: FY 881899
Aid Group: Medically Indigent Adults - Rata Period: 11/92-9193
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
. Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost 100.72 3.25 325.74 41.21 .00 29.77 $500.69
2. Area Adjustments 1-000 1.000 1.000 1.000 1.000 _ 1:000
3. Age/Sex Adjustments 1.000 1.000 1.000 1.000 1.000 - 1,000
4. Contract Adjustments
a. Hemo, Maj Org, LTC 1.000 1.000 1.000 1.000 .999 1.000
b. AIDS 1.000 1.000 1.000 1.000 1.000 1.000
c. Procedures 1.000 1.000 1.000 1.000 1.000 1,000
5. Eligibility Adjustments
a. Aid Codes 1.000 1.000 1.000 1.000 1.000 1.000
b. Medicare 1.000 1.000 1.000 " 1.000 1.000 1.000
6. Interest Offset .977 .988 .972 .971 .985 «980
CONTRACI COST FY 88/89 598.40 $3.21 $316.62 $40.01 $29.17 $487.41
7. Legislative Adjustments
a. Fees 30/89 1.000 1..000 1.000 1.000_ 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
1Q/90 1.000 1.000 1.000 1.000 1.000 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.072 1,000
40/90 1.000 1.000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 30/89 1.048 .996 1.023 1.085 .998 ,998
40/89 1.015 .995 1.000 1.000 1.000. . 1.000
10/90 1.000 1.000 1.000 1.000 1.004 1.038
2Q/90 1.000 1.000 1.000 1.000 1-000 1.000
30/90 1.000 1.000 1.004 1.014 1.000 .957
40/90 1.000 1.000 1.000 1.000 1.000 1.000 .
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1-007 1.000 1.007
8. Trend 1/89-1/91 1.081 1.272 1.267 1.085 1.000 1.370
PROJECTED COST FY 90/91 $113.15 $4.05 $412,03 548.09 $39.90 5617.22
9. Medical Cost Adjustments
a. CHOP
1.56
b. Short/Doyle Mental Health 8.03
c. Health. Insurance Recoveries .93)
FEE-FOR-SERVICE MEDICAL COST 5625.88
10. Stop Loss Reinsurance at 100,000 is .1% ( .62)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE 562.5.26
11. Administration Allowance 10.95
TOTAL FEE-FOR-SERVICE EQUIVALENT COSI 3636.21
12_ Percent of Fee-for-Service Equivalent Cost Payable 97.0%
INITIAL CAPITATION RATE $617.12
13. Dental Coverage 9.09
FINAL CAPITATION RATE $626.21
T12_
CAPITATION RATE WORKSHEET Date: 3/17/1993
Base Period: F7 88/89
Aid Group: AIDS Rate Period: 11/92-9/93
County: Contra Costa Base: North Counties
Contract: 45 Contra Costa
Services =_-__> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost $83.59 $316.78 $1,478.16 $140.68 $14.81 $82.39 $2,116.41.
2. Area Adjustments 1.000 1.000 1.000 1.000 1.000 . 1.000
3. Age/Sex Adjustments 1.000 1.000 1.000 1.000 ,. 1.000 1,000
4. Contract Adjustments
a. Hemo, Maj Org, LTC 1.000 1.000 1.000 1.000 0 1.000
b. AIDS 1.000 1.000 1.000 1.000 1.000 1.600 .
c. Procedures 1.000 1.000 1.000 1.000 1.000 1.000 .
5. Eligibility Adjustments
a. Aid Codes 1.000 1.000 1.000 1.000 1.000 1.000
b. Medicare 1.000 1.000 1..000 - 1.000 1.000 1.000
6. Interest Offset .975 .978 .966 .973 ,982 1 ,972
CONTRACT COST FY 88/89 $81.50 $309.81 $1,427.90 $136.88 $2.04 580.08 $2,038.21
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
40/89 1.000 1.000 1.000 1.000 1.000 1.000
10/90 1.000 1.000 1.000 1.000 1.000 1-000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1,072 1.000
40/90 1.000 1,000 1.000 1.000 1.000 1.000
10/91 1.000 1.000 1.000 1.000 1,000 1.000 "
20/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 30/89 .998 .996 1.023 1.033 ,998 .998
40/89 1.015 .987 1.000 1.000 1.000 1.000 _
10/90 1,000 1.000 1.000 1.000 1.004 1.000
20/90 1.000 1.000 1.000 1.000 1.000 1.000
30/90 1.000 1.000 1.000 1.000 1.000 1.000
40/90 1.000 1.000 1..000 1.000 1,000 1.000
10/91 1.000 1.000 1.000 1.000 1.000 1.000
20/91 1.000 1.000 1.000 1.007 1.000 1.007
'8. Trend 1/89-1/91 .855 1.320 .855 1.102 1.000 1.155
PROJECTED COST FY 90/91 $70.59 $402.02 $1,248.93 5156.91 $2.19 $92.95 51,973.59
9- Medical Cost Adjustments
a. CHDP
-00
b. Short/Doyle Mental Health .00 i
C. Health Insurance Recoveries -.54
FEE-FOR-SERVICE MEDICAL COST $1,973.05
10. Stop Loss Reinsurance at 100,000 is ,7X { 13.80)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $1,959.25
11. Administration Allowance 27.99
TOTAL FEE-FOR-SERVICE EQUIVALENT COST
$1,987.24
12. Percent of Fee-tor-Service Equivalent Cost Payable 97.0X
INITIAL CAPITATION RATE $1,927.62
13. Dental Coverage, 4.09
FINAL CAPITATION RATE
S1,936.71
-I3-