Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the 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, 2022, and increasing the amount by $24,335,000, to an amount not to exceed $73,420,000.
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BACKGROUND:
On July 21, 2015, the Board approved an agreement with the San Mateo Health Commission, dba Health Plan of San Mateo (HPSM), to provide third party administration (TPA) on behalf of the San Mateo Medical Center (SMMC) for the term of April 1, 2015 through March 31, 2018. The agreement has been amended several times since then to include a data usage agreement and to extend the term of the agreement through March 31, 2020, with a corresponding increase in funding.
DISCUSSION:
HPSM will continue to provide various services to the County related to the Access and Care for Everyone (ACE) program, including, but are not limited to, TPA claims processing and data management, outpatient pharmacy benefits, provider relations, and collection of ACE member participant fees. 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. This amendment will extend the term of the agreement through March 31, 2022 and increase the amount payable thereunder by $24,335,000, to an amount not to exceed $73,420,000. This amendment is coming to your Board late due to prolonged negotiations.
The amendment and resolution have been reviewed and approved by County Counsel as to form. ...
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