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 Doing Business as the Health Plan of San Mateo
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, to increase the rates for inpatient medical-surgical services to its members due to recent changes in regulations by the Centers for Medicare and Medicaid Services.
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BACKGROUND:
San Mateo Medical Center (SMMC) has contracted with San Mateo Health Commission, doing business as Health Plan of San Mateo (HPSM), since January 1994. The current agreement started on January 1, 2007, through December 31, 2009, and automatically renews for successive twelve-month periods with the same terms and conditions, subject to any subsequent amendments.
The agreement provides for the care of inpatient, outpatient, and emergency services to patients who are eligible to receive Medi-Cal benefits. HPSM reimburses SMMC for providing such care.
The conditions upon which payments are made continue to include: working with HPSM medical staff to reduce hospital readmissions from the skilled nursing facility; agreeing not to terminate the agreement; agreeing not to close the Emergency Department at SMMC; and exploring medical management collaborative initiatives.
DISCUSSION:
Due to the COVID-19 pandemic, the California Department of Health Care Services (DHCS) allowed hospitals to resubmit their cost report projections to account for the higher cost of caring for COVID-19 patients. Reimbursement rates for Medi-Cal inpatient services are based on the hospital's cost per patient day, and for SMMC the reimbursement rate increased from $2,529 per day to $4...
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