HomeMy WebLinkAboutMINUTES - 04251995 - 1.77 TO: BOARD OF SUPERVISORS Jt
FROM: Mark Finucane, Health Services Director Contra,
t
Costa
DATE: April 7, 1995 County
SUBJECT: Approval of Standard Agreement (Amendment) #29-609-42 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) #29-609-42 (State #93-18608 A-01) with the
State Department of Health Services, effective January 1, 1995, to amend Standard
Agreement #29-609-41, for prepaid health services for Medi-Cal beneficiaries. This
amendment increases the FY 1994-95 contract payment limit by $1,474,797, from
$16,265,808 to a new fiscal year total of $17,740,605, and extends the term of the
agreement through December 31, 1997.
II. FINANCIAL IMPACT:
Approval of this amendment will increase the State's funding encumbrance for FY
1994-95 by $1,474,797, for a new total of $16,265,808. However, the net effect of
this increase on Health Plan revenues is dependent upon enrollment levels.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On January 11, 1994, the Board approved Standard Agreement #29-609-41 with the State
Department of Health Services, for prepaid health services for Medi-Cal
beneficiaries, for the period from January 1, 1994 through December 31, 1995.
Standard Agreement (Amendment) #29-609-42 extends the term of the agreement through
December 31, 1997 and sets new per capita rates of payment, effective October 1,
1994, as as follows:
Medically Needy
Public Assistance No Share of Cost
Aged $ 111.47 Aged $ 160.56
AFDC $ 91.89 AFDC $ 134.47
Disabled/Blind $ 187.63 Disabled/Blind $ 882.20
AIDS $1,906.90 MI Children $ 178.00
MI Adults $ 609.00
AIDS $1,906.90
Other Paid Category
Refugee $ 174.87
The Board Chair should sign ten copies of the agreement. Nine copies of the
agreement and three sealed/certified copies of this Board Order should be returned
to the Contracts and Grants Unit for submission to the State Depar ent of Health
Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
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: 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)
CC: Health Services (Contracts) ATTESTED
State Dept. of Health Services Phil Batchelor, Clerk of the Board of
Su�ecrlisats aadGaunt� ��
M3e2/7-e3 BY DEPUTY
STATE OFCXIFORNIA { a5 q5 1717
- APPROVED BY THE CONTRACT NUMBER AM.NO.
STANDARD AGREEMENT
ATTORNEY GENERAL 93-18608 A01
STD.2(REV.5-91)
TAXPAYER'S FEDERAL EMPLOYER IDENTIFICATION NUMBER
THIS AGREEMENT,made and entered into this 1St day of January , 1995. 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 AGENCY
Chief, Program Support Branch Department of Health Services hereafter called the State,and
w
CONTRACTOR'S NAME �
The County of Contra Costa 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 for performance or completion,and attach plans and specifications,if any.)
Amendment A-01 to Contract Number 93-18608 BETWEEN Contra
Costa Health Plan AND THE STATE OF CALIFORNIA;
WHEREAS, the State of California and Contra Costa Health Plan
entered into a contract for prepaid health care services dated
January 1, 1994 ; and
NOW THEREFORE, this contract is amended as follows:
APPROVED
De rtmen t A T'i�,E��fc,e
CONTINUED ON _ _6 SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT MBER. Budget Div:isiOri
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 individual,state whether a corporation,partnership,etc.)
Department of Health Services The County of Contra Costa
BY(AUTHOZEDSIGNATURE) VPRIN
ORIAAND
URE)
D
PRINTED NAME SIGNING NXME OF PERSON SIGNIPO
Edward E. Stahlberg Chair, Board of Supervisors
TITLE ADDRESS
Chief, Program Support Branch 651 Pine Street, Martinez, CA 94553
AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
DOCUMENT Loc_Asst_Sect. 14147 W&I Code � Hlth Care De-posi use only
$ 1,474,797 (OPTIONAL USE) 50% Fed 50% State
THIS
CONTRACT
ENCUMBERED FOR Fed.Cat.No. 93778 4260-101-001 & 890
THIS CONTRACT
$24,903,&)8 ITEM CHAPTER STATUTE FISCAL YEAR
TOTAL AMOUNT ENCUMBERED TO 4260-601-92 139 1994 994_95 Exempt from PCC
DATE OBJECT OF EXPENDITURE(CODE AND TITLE) per W & I Code
$26,378,605 NJA Section 14204 (b)
I hereby certify upon my own personal knowledge that budgeted funds T.B.A.NO.
are available for the period and purpose of the expenditure stated above-
SIGNA OF C TING OFFICER DATE 1995
MAY D JUL 9 4. tM
El CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. F1 CONTROLLER
The County of Contra Costa 93-18608-A01
1. ARTICLE II - DEFINITIONS, Paragraph F, Covered Services, is
amended to read as follows:
F. "Covered Services" means those services set forth in
Title 22, CCR, Division 3, Subdivision 1, Chapter 4,
Article 3, Section 53210. Covered Services do not
include:
1. Services for chronic renal dialysis and ,major organ
transplants.
2 . Services in any federal or state government
hospital.
3 . Services in any county hospital for the treatment
of tuberculosis, or chronic medically uncomplicated
narcotism or alcoholism.
4. Serviceh rendered to members who have been
institutionalized for more than one full calendar
month in a skilled nursing or an intermediate care
facility.
5. Laboratory services provided under the State serum
alpha feto protein testing program administered by
the Genetic Disease Branch of the Department of
Health Services.
6 . The facility or per diem charge component of
services rendered to covered beneficiaries 64 years
of age and institutionalized in a non-joint
Commission on Accreditation of Healthcare
Organizations (JCAHO) accredited facility
designated by HHS as an Institution for Mental
Disease (IMD) , or services rendered to covered
beneficiaries 21 to 64 years of age
institutionalized in a JCADO accredited facility
designated by HHS as an IMD (except for covered
beneficiaries who were receiving such services
before turning 21 years of age and who may continue
to require and receive such services in which case:
(a) coverage may be extended until the beneficary' s
twenty-second (22) birthday and (b) the Contractor
will be liable for such services subject to subpart
4 above) .
7 . Short-Doyle/Medi-Cal Services
2
The County of Contra Costa 93-18608-A01
8. Local Educations Agency (LEA) assessment services as
described in Title 22, CCR, Section 51360 (b) (1)
provided to a member who qualifies for LEA services
based on Title 22, CCR, Section 51190.1 (a) .
9 . Any LEA services described in Title 22, CCR,
Section 51360 provided pursuant to an
Individualized Education Plan (IEP) as set forth
in Education Code, Section 56340 et seq. , or an
Individualized Family Service Plan (IFSP) as set
forth in Government Section 95020. "
2 . ARTICLE II - DEFINITIONS, Paragraph K, Eligible Beneficiary,
is amended to read as follows:
K. "Eligible Beneficiary" means any Medi-Cal beneficiary
with one of the following aid codes: Aid to Families with
Dependent Children (AFDC) - aid codes 30, 32, 33, 34, 35,
38, 39, 40, 42, 46,54, 59, 77, 78; Aid to the Blind
(AB) -aid codtes 20, 24, 26; Aged Supplemental Security
Income/State Supplementary Payment (SSI/SSP) -aid codes
10, 14, 16; Aid to Disabled (ATD) -aid codes 36, 60, 64,
66; Medically Indigent Children - aid code 82; Medically
Indigent Pregnant Women - aid code 86; and Refugees - aid
codes 1, 2, 8. "
3 . ARTICLE IV - TERM AND TERMINATION, Paragraph A, Term of
Contract, is amended to read as follows:
A. Term of Contract
"This contract will become effective on January 1, 1994
and will continue in full force and effect through
December 31, 1997 subject to the provisions of Article
IX, Sections A and H, because the State has currently
appropriated and available for encumbrance only funds to
cover costs through June 30, 1994. "
4 . ARTICLE IV - TERM AND TERMINATION, Local Initiative -
Termination, Paragraph F, is amended to read as follows:
"F. Local Initiative/Mainstream Plan Termination
The Director, will have good cause for termination of
this contract pursuant to Section B of this Article when
the Local Initiative or Mainstream managed care plan
begins operation in the services area pursuant to the
Department' s plan for Expanding Medi-Cal Managed Care.
The Director will have good cause for requesting
termination of any dental subcontracts when a contracted
3
The County of Contra Costa 93-18608-A01
dental managed care plan contract is awarded and begins
operation in the service area pursuant to the
Department' s plan for Expanding Medi-Cal Managed Care. "
5. ARTICLE VI - DUTIES OF THE STATE, Paragraph L, Risk
Limitation, is amended to read as follows:
L. Risk Limitation
"Terminate the Contractor' s financial liability to
provide covered services to a member on a risk basis in
those situations where, during the 12-month period
beginning July 1, 1993 and ending June 30, 1994 or any
succeeding 12-month period commencing July 1st, and
ending the following June 30th, the member has received
medically necessary covered services, as determined by
the Department, from the Contractor in an amount in
excess of $100, 000, based upon Medi-Cal schedules of
reimbursement, and exclusive of payments recovered by
Contractor from third-party payors. Affected members
will not.be disenrolled because of their need of services
in excess of $100, 000, and the Contractor will be
responsible to provide or arrange and pay for, medically
necessary covered services for members. Contractor will
be reimbursed for such continuing care in excess of
$100, 000 by the Department, based on Medi-Cal schedules
of reimbursement or the Contractor' s costs, whichever is
lower, and exclusive of payments recovered by the
Contractor from third-party payors, as determined by the
Department upon Contractor submission to the Department
of appropriately documented claims for services provided
during the 12-month period specified above.
The dates set forth in this paragraph only serve to
establish the beginning and ending dates of the risk
limitation period and will not be construed to extend the
Contractor' s responsibility to render services under this
contract nor the Department' responsibility to pay for
services rendered beyond the date on which this contract
terminates. The establishment of a risk limitation
period that extends beyond the term of the current
contract contemplates the possibility of (but does not
bind the parties ' to) renewal of the contract for an
additional term. In the event the contract is terminated
or not renewed, therisk limitation period will terminate
upon termination of the contract. "
4
The County of Contra Costa 93-18608-A01
6. ARTICLE VII - ELIGIBILITY AND ENROLLMENT, Paragraph C,
Enrollment Totals, is amended to read as follows:
C. Enrollment Totals
"Total enrollment under this contract will not exceed
15, 000 members. "
7 . ARTICLE IX - PAYMENT, Paragraph A, Amounts Payable, is amended
to read as follows:
"A. Amounts Payable
The maximum amount payable for the 1993-94 Fiscal Year
ending June 30, 1994 will not exceed $8, 638, 000.
"o the 1994-95 Fiscal Year ending June 30, 1995 will
not exceed . . . . . . . . . . . . . . . . . . . . . . . . . . .$17,740, 605;
Any requirement by the Department and the Contractor for
the period of the contract subsequent to June 30, 1995
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 from future appropriations by the Legislature,
the maximum amount payable under this contract for:
o the 1995-96 Fiscal Year ending June 30, 1996 will
not exceed. . . . . . . . . . . . . . . . . . . . . . . . . . . . $18,232,204;
o the 1996-97 Fiscal Year ending June 30, 1997 will
not exceed. . . . . . . . . . . . . . . . . . . . . . . . . . .$9,116, 102;
o The maximum amount payable under this contract will
not exceed. . . . . . . . . . $53,726, 911. 11
8. ARTICLE IX - PAYMENT, Section B, Capitation Rates, is amended
to read as follows:
"B. Capitation Rates
The State will remit to the Contractor a capitation
payment for each member, for each month in which such
member 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:
5
The County of Contra Costa 93-18608-A01
1
Capitation rates include coverage for Medi-Cal Dental
benefits.
Public Assistance
Aged $ 111.47 AFDC $ 91. 89
Blind/Disabled $ 187 . 63 AIDS $1906.90
Medically Needy - No Share of Cost
Aged $ 160.56 AFDC $ 134 .47
Blind/Disabled $ 882 .20 AIDS $1906.90
Medically Indigent - No Share of Cost
Children $ 178. 00 Adults $ 609 .00
Other Paid Category
Refugee t. $ 174.87
9 . ARTICLE IX - PAYMENT, Section C, Rates Constitute Payment in
Full, is amended as follows:
"C. Rates Constitute Payment in Full
The capitation payment constitutes payment in full by the
Department on behalf of a member 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
recoupment 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 14 pages) . "
10. The effective date of this rate change is October 1, 1994.
11. The effective date of this amendment is January 1, 1995.
12 . This Amendment Increases the amount payable for Fiscal Year
1994-95 by $1,474,797 .
13 . All rights, duties, obligations, and liabilities of the
parties hereto otherwise remain unchanged.
6
1
ATTACHMENT Il -D
October 1 , 1994
PREPAID HEALTH PLANS
t-
RATE DEVELOPMENT
FISCAL YEAR
1994-95 '
Part B . OVERVIEW OF THE RATE CALCULATION PROCESS AND WORKSHEET
The purpose of the rate calculation process, as explained in 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 October 1 , 1994 to September 30, 1995
This process can be seen as a two step process with some
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 to 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 denial .
The Capitation- Rate Worksheet, on page 7, shows how a single
capitation rate is calculated. A short line-by-line description of
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 i.nthe
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 groupings and
each of sixdifferent types of services, or vendor -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 .
Each numbered line is defined as follows :
2
1 . Base Cost - These are the cost per person per eligible month
(CPPM) figures for each of six vendor code groupings . CPPM
figures 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, Alameda, 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 . Age/Sex 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 that 100 eligibles per month in an aid code grouping
during the most recent available past year of data.
t.
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 . Eligibility Adjustments - 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 . Legislative 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.
S . Trend - This adjustment predicts the affect of all other
changes that may take place in the Medi-Cal population and in
3
the medical services area, including fee-for-service (FFS)
rate increases not covered by legislative adjustments .
9 . Medical Cost Adjustments - An additional amount is added to
the rate if a plan will cover services generally provided by
the Child Health and Disability Prevention (CHDP) or
Short/Doyle Mental Health (SDMH) programs . If 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 Stop 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-for-Service Equivalent 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 97o for the PHPs and 95o 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 .
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: Public Assistance Aged Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost $7.03 $23.13 $34.79 $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 1.000
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
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 .974 1.238 1.143 .251 1.075 1.875
PROJECTED COST FY 90/91 $6.88 $32.52 $38.93 $2.41 $13.87 $8.37 $102.98
9. Medical Cost Adjustments
a. CHDP .00
b. Health Insurance Recoveries "(.31)
FEE-FOR-SERVICE MEDICAL COST $102.67
10. Stop Loss Reinsurance at $100,000 is .1% (.09)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $102.58
11. Administration Allowance 4.62
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $107.20
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $102.38
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - Including Dental Coverage $111.47
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: Public Assistance Disabled Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost $23.40 $34.66 $100.24 $15.78 $32.86 $18.81 $225.75
2. Area Adjustments .907 1.036 .887 1.098 .549 .991
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 .991
c. Procedures 1.000 1.000 1.000 1.000 1.000 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 3Q/89 1.000 t., 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
2Q/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
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
2Q/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/89 .998 .996 1.023 1.033 .998 .998
4Q/89 1.015 .995 1.000 1.000 1.000 1.000
1Q/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
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 1.009 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. Health Insurance Recoveries (.54)
FEE-FOR-SERVICE MEDICAL COST $183.08
10. Stop Loss Reinsurance at $100,000 is 1.6% (2.89)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $180.19
11. Administration Allowance 6.76
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $186.95
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $178.54
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - Including Dental Coverage $187.63
CAPITATION RATE WORKSHEET Dote: 9/28/1994
Base Period: FY 88/89
Aid Group: Public Assistance Family Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
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 1.011
4. Contract.Adjustments
a. Hemo, Maj Org, LTC .999 1.000 1.000 1.000 .580 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 1.006 .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
4Q/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
2Q/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
1Q/91 1.000 1.000 1.000 1.000 1.000 1.000
2Q/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/89 1.048 .996 1.023 1.085 .998 .998
4Q/89 1.015 .995 1.000 1.000 1.000 1.000
1Q/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
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
1Q/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 1.053 1.118 1.215 1.131 1.000 1.604
PROJECTED COST FY 90/91 $16.95 $4.42 $43.75 $11.01 $.02 $6.15 $82.30
9. Medical Cost Adjustments
a. CHDP 2.02
b. Health Insurance Recoveries (.04)
FEE-FOR-SERVICE MEDICAL COST S84.28
10. Stop Loss Reinsurance at $100,000 is .8% (.66)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $83.62
11. Administration Allowance 3.08
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $86.70
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $82.80
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - Including Dental Coverago $ 91.89
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: Medically Needy No Share Aged Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
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
a. Nemo, Maj Org, LTC .991 1.000 1.000 .999 .482 1.000
b. AIDs 1.000 1.000 1.000 1.000 1.000 1.000
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 .969 .991 .963 .967 .986 .975
CONTRACT COST FY 88/89 $15.50 $17.63 $67.37 $11.68 $12.43 $12.55 $137.16
7. Legislative Adjustments
a. Fees 3Q/89 1.000 t, 1.000 1.000 1.000 1.000 1.000
4Q/89 J.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
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
1Q/91 1.000 1.000 1.000 1.000 1.000 1.000
2Q/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
1Q/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
40/90 1.000 1.000 1.000 1.000 1.000 1.000
1Q/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 .981 1.233 1.143 .592 1.049 1.339 .
PROJECTED COST FY 90/91 $15.40 $21.54 $79.09 $7.29 $14.01 $16.78 $154.11
9. Medical Cost Adjustments
a. CHDP .00
b. Health Insurance Recoveries (.67)
FEE-FOR-SERVICE MEDICAL COST .$153.44
10. Stop Loss Reinsurance at $100,000 is .0% .00
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $153.44
11. Administration Allowance 5.17
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $158.61
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $151.47
13. Dental Coverage $ 9.09
FINAL CAPITATION BATE - Including Dental Coverage $160.56
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: Medically Needy No Share Disabl Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
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 3Q/89 1.000 t 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
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
10/91 1.000 1.000 1..000 1.000 1.000 1.000
2Q/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
1Q/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
1Q/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 1.048 1.204 1.273 1.042 1.209 _ 1.161
PROJECTED COST FY 90/91 $49.44 $35.71 $733.13 $37.96 $16.09 $41.53 $913.86
9. Medical Cost Adjustments
a. CHOP .01
b. Health Insurance Recoveries (1.76)
FEE-FOR-SERVICE MEDICAL COST $912.11
10. Stop Loss Reinsurance at $100,000 is 1.6% (14.36)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $897.75
11. Administration Allowance 16.50
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $914.25
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $873.11
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - Including Dental Coverage $882.20
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: Medically Needy No Share Family Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
Services =_=__> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost $21.35 54.62 $73.57 - $12.31 $.31 $8.36 $120.52
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
a. Nemo, 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 $.15 $8.74 $103.80
7. Legislative Adjustments
a. Fees 3Q/89 1.000 1 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
2Q/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
1Q/91 1.000 1.000 1.000 1.000 1,000 1.000
2Q/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/89 1.048 .996 1.023 1.085 .998 .998
4Q/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
3Q/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 $73.43 $15.94 $.16 $10.24 $126.64
9. Medical Cost Adjustments
a. CHDP 1.82
b. Health Insurance Recoveries (.21)
FEE-FOR-SERVICE MEDICAL COST .$128.25
10. Stop Loss Reinsurance at $100,000 is .8% (1.01)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $127.24
11. Administration Allowance 4.05
TOTAL FEE-FOR-SERVICE EQUIVALENT COST, $131.29
12- Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning,of month $125.38
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - including Dental Coverage $134.47
CAPITATION RATE WORKSHEET Date: 9/28/1994
Base Period: FY 88/89
Aid Group: , Medically Indigent Children Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
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
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 1.000
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 $.18 $4.52 $134.12
7. Legislative Adjustments
a. Fees 3x/89 1.000 1-- 1.000 1.000 1.000 1.000 1.000
44/89 _1.000 1.000 1.000 1.000 1.000 1.000
1x/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
4x/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 $5,27 $173.97
9. Medical Cost Adjustments
a. CHDP 3.19
b. Health Insurance Recoveries . (.13)
FEE-FOR-SERVICE MEDICAL COST $177.03
10. Stop Loss Reinsurance at $100,000 is 2.2% (3.82)
FEE-FOR•SERVICE MEDICAL AFTER REINSURANCE $173.21
11. Administration Allowance 3.66
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $176.87
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $168.91
13. Dental Coverage $ 9.09
FINAL CAPITATION BATE - Including Dental Coverage $178.00
CAPITATION RATE WORKSHEET Dote: 9/28/1994
Bose Period: FY 88/89
Aid Group: Medically Indigent Adults Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
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
CONTRACT COST FY 88/89 $98.40 $3.21 $316.62 $40.01 $.00 $29.17 $487.41
7. Legislative Adjustments
a. Fees 30/89 1.000 1.000 1.000 1.000 1.000 1.000
4Q/89 ,.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
2Q/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
4Q/90 1.000 1.000 1.000 1.000 1.000 1.000
1Q/91 1.000 1.000 1.000 1.000 1.000 1.000
2Q/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/89 1.048 .996 1.023 1.085 .998 .998
4Q/89 1.015 .995 1.000 1.000 1.000 1.000
1Q/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
2Q/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 $48.09 $.00 $39.90 $617.22
9. Medical Cost Adjustments
a. CHDP 1.56
b. Health Insurance Recoveries (.93)
FEE-FOR-SERVICE MEDICAL COST $617.85
10. Stop Loss Reinsurance at $100,000 is .1% (,62)
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $617.23
11. Administration Allowance 10.95
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $628.18
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $599.91
13. Dental Coverage $ 9.09
FINAL CAPITATION RATE - Including Dental Coverage $609.00
CAPITATION RATE WORKSHEET Date: 9/28/1996
Base Period: FY 88/89
Aid Group: Refugees Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
Services =____> Phys Pharm HIP HOP LTC Other TOTAL
1. Base Cost $19.57 $9.32 $19.61 $13.56 $.00 $16.08 $78.14
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 .998 1.000 1.000 .999 .527 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 .985 .992 .976 .980 .990 .986
CONTRACT COST FY 88/89 $19.24 $9.25 $19.14 $13.28 $.00 $15.85 $76.76
7. Legislative Adjustments
a. Fees 3Q/89 1.000 1 1.000 1.000 1.000 1.000 1.000
4Q/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
2Q/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
10/91 1.000 1.000 1.000 1.000 1.000 1.000
2Q/91 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/89 .998 .996 1.023 1.033 .998 .998
4Q/89 1.015 .995 1.000 1.000 1.000 1.000
1Q/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
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 90/91 $20.52 $10.25 $23.89 $15.84 $.00 $25.38 $95.88
9. Medical Cost Adjustments
a. CHDP .53
b. Health Insurance Recoveries (.01)
FEE-FOR-SERVICE MEDICAL COST $96.40
10. Stop Loss Reinsurance at $100,000 is .0Y .00
FEE-FOR-SERVICE MEDICAL AFTER REINSURANCE $96.40
11. Administration Allowance 3.08
TOTAL FEE-FOR-SERVICE EQUIVALENT COST $99.48
12. Percent of Fee-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $95.00
13. Dental Coverage $ 79.87
FINAL CAPITATION RATE - Including Dental Coverage $174.87
CAPITATION RATE WORKSHEET Date: 9/28/1994 '
Base Period: FY 88/89
Aid Group: AIDS Rate Period: 10/94 - 9/95
County: Contra Costa Base: North Counties
Contract: Contra Costa 45
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. Nemo, Maj Org, LTC 1.000 1.000 1.000 1.000 $.14 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 .975 .978 .966 .973 .982 .972
CONTRACT COST FY 88/89 $81.50 $309.81 $1,427.90 $136.88 $2.04 $80.08 $2,038.21
7. Legislative Adjustments
a. Fees 3Q/89 1.000 l 1.000 1.000 1.000 1.000 1.000
4Q/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
2Q/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
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
2Q/91 , 1.000 1.000 1.000 1.000 1.000 1.000
b. Benefits 3Q/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
2Q/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
4Q/90 1.000 1.000 1.000 1.000 1.000 1.000
1Q/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 $156.91 $2.19 $92.95 $1,973.59
9. Medical Cost Adjustments
a. CHDP .00
b. Health Insurance Recoveries (.54)
FEE-FOR-SERVICE MEDICAL COST $1,973.05
10. Stop Loss Reinsurance at $100,000 is 7% (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-for-Service Equivalent Cost Payable 95.5%
FINAL CAPITATION RATE - Capitation payments at beginning of month $1,897.81
13. Dental Coverage $ 4.09
irngAL CAPITATION RATE - Including Dental Coverage $1,906.90
TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra
Costa
DATE: April 7, 1995 County
SUBJECT: Approval of Standard Agreement (Amendment) #29-609-42 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) #29-609-42 (State #93-18608 A-01) with the
State Department of Health Services, effective January 1, 1995, to amend Standard
Agreement #29-609-41, for prepaid health services for Medi-Cal beneficiaries. This
amendment increases the FY 1994-95 contract payment limit by $1,474,797, from
$16,265,808 to a new fiscal year total of $17,740,605, and extends the term of the
agreement through December 31, 1997.
II. FINANCIAL IMPACT:
Approval of this amendment will increase the State's funding encumbrance for FY
1994-95 by $1,474,797, for a new total of $16,265,808. However, the net effect of
this increase on Health Plan revenues is dependent upon enrollment levels.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On January 11, 1994, the Board approved Standard Agreement #29-609-41 with the State
Department of Health Services, for prepaid health services for Medi-Cal
beneficiaries, for the period from January 1, 1994 through December 31, 1995.
Standard Agreement (Amendment) #29-609-42 extends the term of the agreement through
December 31, 1997 and sets new per capita rates of payment, effective October 1,
1994, as as follows:
Medically Needy
Public Assistance No Share of Cost
Aged $ 111.47 Aged $ 160.56
AFDC $ 91.89 AFDC $ 134.47
Disabled/Blind $ 187.63 Disabled/Blind $ 882.20
AIDS $1,906.90 MI Children $ 178.00
MI Adults $ 609.00
AIDS $1,906.90
Other Paid Category
Refugee $ 174.87
The Board Chair should sign ten copies of the agreement. Nine copies of the
agreement and three sealed/certified copies of this Board Order should be returned
to the Contracts and Grants Unit for submission to the State Depar ment of Health
Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
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: NOES: AND CORRECT CO?Y CSF AN ACT!0N TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Milt Camhi (313-5604)
CC: Health Services (Contracts) ATTESTED �1�C 5�.
State Dept. of Health Services Phil Batchelor,Clerk of the Board of
Supecy=vd County Adman Wator
M3e2/7-e3 BY �"nr DEPUTY
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