RECOMMENDATION(S): (CONT'D)
(3) AUTHORIZE the County Administrator to fund the $1,500,000 cumulative contract total as a one- time, non-recurring expenditure from County reserves.
FISCAL IMPACT:
100% County. The Health Services Department projects a savings of $6 million, minus the one time reserve expenditure of $1.5 million, for a net savings in fiscal year 2009/10 of $4.5 million and $6 million thereafter.
BACKGROUND:
On March 31, 2009 during the 2009/10 Budget Hearings, the Board of Supervisors approved the following:
• CHANGE the Eligibility Standards for the Basic Health Care Program to make certain adults ineligible for non-emergency health care services; DIRECT the Health Services Director and County Counsel to draft a new resolution that amends Resolution No. 2002/312 to reflect this change in the BHC eligibility standards;
• DIRECT the Health Services Director to continue to meet with community health care providers to identify a collaborative plan to address, to the extent possible, the gap in the provision of primary and specialty medical care services for adults who will no longer be eligible for the BHC Program;
• AUTHORIZE the Health Services Director to negotiate contracts with Brookside Clinic and La Clinica, for subsequent presentation to and consideration by the Board of Supervisors, that will assist those community health care clinics in the provision of non-emergency health care services to adults who will no longer be eligible for the BHC Program;
County Counsel has drafted the new resolution (attached) that amends Resolution No. 2002/312 to reflect the change in the BHC eligibility standards, as directed by the Board.
The Health Services Department has scheduled the second of a series of meetings with community partners to develop a collaborative plan to address the gap in medical services to adults who will no longer be eligible for the BHC Program.
The Health Services Department (HSD) has a tentative agreement with the community clinics to provide primary care services to adults who will no longer be eligible for the BHC Program under the following terms:
HSD Contract Assumptions:
a. Certain adults will are no longer be eligible for the Basic Health Care program (effective May 1st for new applicants; June 1st through November 1st for renewals).
b. Adults who will no longer be eligible for the BHC Program (effective May 1st for new applicants; June 1st through November 1st for renewals), will receive primary care services at the community clinics in the same fashion as all other patients of those clinics (citizen and non citizen).
c. Specialty care and Ancillary services for adults who will no longer be eligible for the BHC Program will not be provided by the County.
Deal Points:
a. One year, one time, cumulative contract total maximum of $1,500,000.
b. $100,000 up front payment, per clinic ($300,000 cumulative total) for capacity building.
c. Monthly payments to be made on a per visit basis at a per visit rate not to exceed $100 (patient fees permissible, subject to negotiation).
d. Patients will be referred by HSD with an authorization for a predetermined number of visits. Referrals may originate from the CCRMC clinics, Emergency Room, Inpatient unit, or Financial Counseling.
e. Payment will not be made for patients who self refer to the community clinics (all patients must have prior HSD authorization).
f. After nine months of operation and only in the event that sufficient funding is available in the contract, self-referred patients may be considered eligible.
Contract negotiations are underway. A number of procedural issues need to be resolved, but HSD does not expect those negotiations to impact the May 1st implementation date.
CLERK'S ADDENDUM
Dr. William Walker, Health Services Director, presented the staff report.
The Chair invited public comment. The following people commented:
§ Rollie Katz, Public Employees Union Local 1, spoke.
§ Written comments in opposition to the funding mechanism for the clinics were provided by a County Worker.
Supervisor Gioia suggested authorizing the Health Services Director to continue to explore and develop a sustainable funding plan to address the future of the program. He also requested updates on the discussions taking place at the Contra Costa Health Plan Joint Conference Committee.
Supervisor Uilkema requested that the Contra Costa Health Plan Joint Conference Committee meeting minutes be included in the Board’s agenda packets.
David Twa, County Administrator, said he would soon be submitting a request to the Board for a Request For Proposal (RFP) in the amount of approximately $250,000 for assistance with the health care sustainability study [as directed by the Board on March 31, 2009].
Chair Bonilla suggested that the authorization to fund contracts with the Community Clinics include the funding for the RFP/sustainability study.
Supervisor Uilkema said she would prefer to wait for more a concrete cost figure from Mr. Twa.
Supervisor Piepho noted it is important to remain aware of any possible grants or future avenues of revenue that could be used to reimburse the reserve fund.