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 the Agreement with San Mateo Health Commission Doing Business as the Health Plan of San Mateo for Medi-Cal Primary Care Physicians Medical Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with the San Mateo Health Commission, doing business as the Health Plan of San Mateo, for Medi-Cal Primary Care Physicians Medical Services, to amend the reimbursement rates, beginning July 1, 2018.
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BACKGROUND:
On September 9, 2008, your Board approved an agreement with the San Mateo Health Commission, doing business as the Health Plan of San Mateo (HPSM), for Primary Care Medical Services for eligible HPSM members receiving services at the San Mateo Medical Center (SMMC), for the term of January 1, 2008 through December 31, 2008. Pursuant to its terms, the agreement renews each year for a new one-year period, subject to either party's right to give notice to terminate the agreement. On March 26, 2014, your Board approved an amendment to the agreement to bring it into compliance with AB 85, which requires that payments for Medi-Cal expansion populations be made directly to county hospitals and clinic systems. On January 23, 2018, your Board approved a further amendment to the agreement to ensure compliance with the State of California's Medi-Cal 2020 section 1115 waiver, which requires that the agreement contain an Alternative Payment Model.
DISCUSSION:
On April 27, 2018, the Superior Court of California ruled that payments to SMMC from the HPSM Pay for Performance (P4P) Program must be included in the calculation of supplemental payments that reconcile Federally Qualified Health Center (FQHC) providers' total payments received with Prospective Payment System entitlemen...
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