Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise Rogers, Chief, Health System
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the agreement with CareAdvantage Hospital Service San Mateo Health Commission, Doing Business as Health Plan of San Mateo
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the agreement with the San Mateo Health Commission, doing business as Health Plan of San Mateo, to add a pilot quality-reporting program effective February 1, 2018, and authorizing San Mateo Medical Center to accept an estimated $2,700,000 in revenue.
body
BACKGROUND:
The County of San Mateo, through San Mateo Medical Center (SMMC), has contracted with San Mateo Health Commission, doing business as Health Plan of San Mateo (HPSM), since January 1994. HPSM is responsible for coverage of the vast majority of San Mateo County's safety net population.
HPSM's current CareAdvantage Hospital Service agreement with SMMC offers a prepaid health benefits plan for individuals covered under the federal Medicare program and was originally approved for the term of January 1, 2009 to December 31, 2009. This agreement automatically renewed for successive twelve-month periods with the same terms and conditions, subject to any subsequent amendments. On January 25, 2011, the agreement was amended to increase the per diem rate for psychiatric hospital services.
DISCUSSION:
HPSM and SMMC have mutually agreed to implement a pilot quality-reporting program at SMMC's two Skilled Nursing Facility (SNF) locations: Burlingame Long-Term Care and onsite at SMMC. As part of the pilot program, HPSM will reimburse SMMC for CareAdvantage SNF services based on Medicare's current Resource Utilization reimbursement rate instead of the previous negotiated rate. This represents an increase in the daily reimbursement rate from approximately $425 to $625-...
Click here for full text