Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, Health System
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to Agreement with San Mateo Health Commission dba Health Plan of San Mateo
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with San Mateo Health Commission dba Health Plan of San Mateo for the administration of the Access and Care for Everyone program extending the term through March 31, 2020, in an amount not to exceed $49,085,000.
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BACKGROUND:
On July 21, 2015, your Board approved an agreement pursuant to which the San Mateo Health Commission dba Health Plan of San Mateo (HPSM) would provide third party administrator (TPA) functions on behalf of the San Mateo Medical Center (SMMC) for the term of April 1, 2015 through March 31, 2018, with the option to extend the term through March 31, 2020, in an amount not to exceed $24,750,000. The agreement has subsequently been amended to include a data usage agreement on behalf of the Family Health Services Division.
DISCUSSION:
This amendment is to extend the term of the Agreement by two years, through March 31, 2020 and to increase the funding available to pay HPSM for the ACE-related TPA services provided under the agreement. Specifically, the amendment will increase the amount payable under the agreement by $24,335,000, to $49,085,000.
As a TPA, HPSM shall continue to provide various services, which include, but are not limited to, claims processing and data management, outpatient pharmacy benefits, provider relations, and collection of participant fees relating to ACE members. The amounts included in this contract cover both HPSM TPA fees as well as fee-for-service payments made to non-SMMC medical providers for care provided to ACE patients.
The agreement and resolution have been reviewed and approved by County Coun...
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