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Health Services Department, Mental Health Division, recommending the Board authorize the Chair to sign Agreement 038-S1011 with Blue Cross of California for the term August 15, 2010 through June 30, 2011 to provide reimbursement to the county for CMSP-eligible patients receiving treatment in the Psychiatric Health Facility.
FUNDING: Payments from Blue Cross for services provided.
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Fiscal Impact/Change to Net County Cost: This is a revenue generating agreement. There is no Net County Cost associated with this Agreement.
Contract Termination: This Agreement includes a provision for either party to terminate the Agreement without cause in ninety (90) days upon written notice.
Reason for Recommendation: In 1982 California law was amended to eliminate the medically indigent adult (MIA) category of Medi-Cal eligibility and this population became the responsibility of counties under California Welfare and Institutions Code (WIC) Section 17000. The County Medical Services Program (CMSP) was established in 1983 to assist counties with populations below 300,000 to address the health care needs of medically indigent adults. Currently, thirty-four (34) counties participate in CMSP. CMSP is funded by realignment revenue (motor vehicle license fees and sales tax). County General Funds are used to support payment of the County's participation fee in CMSP (budgeted at $233,492 for FY 2010-11).
The Governing Board of CMSP is in the process of implementing agreements with selected Psychiatric Health Facilities (PHFs) to provide inpatient mental health services to CMSP eligible members. Without this agreement, CMSP will not reimburse the County for PHF services provided to otherwise eligible CMSP patients. CMSP eligible individuals are ages 21 through 64 who reside in a participating county, have incomes at or below 200% of the federal poverty level, and are not eligible for Medi-Cal benefits.
Blue Cross of California is acting as third party administrator for the program to administer health care services, including contracting with providers, claims processing and utilization management.
This Agreement will allow the County to bill CMSP for PHF stays for indigent adults living in the County who are not otherwise insured. Benefits are limited to ten (10) inpatient days per year per member, and no more than six (6) inpatient days per episode. Inpatient mental health services will be reimbursed at a rate of $531 per diem per patient.
Action to be taken following Board approval:
1. Chair to sign three (3) original Agreements.
2. Board Clerk's Office to return three (3) signed original Agreements to the Health Services Department, Mental Health Division.
3. Board Clerk's Office to submit a certified copy of Board minutes authorizing Chair signature on Agreement.
4. Mental Health Division to submit one (1) certified copy of Board minutes and three (3) signed Agreements to CMSP Governing Board for final execution.
5. Upon receipt of a fully executed Agreement from CMSP, Mental Health Division to return one (1) original to Board Clerk's Office.
Contact: Neda West, Health Services Department
Concurrences: This Agreement has been approved by County Counsel and Risk Management and a copy is on file in the Board Clerk's Office.