THE COUNTY STANISLAUS ACTION AGENDA SUMMARY YES i ?j · Pediatric Subspecialty services including...

THE BOARD OF SUPERVISORS OF THE COUNTY OF STANISLAUS ACTION AGENDA SUMMARY

'k, HEALTH SERVICES AGENCY ' ii?;cp DEPT: BOARD AGENDA # lo \;.

AGENDA DATE m e ; 4 . 2001 . . ' Urgent Routine

CEO Concurs with Recommendation YES ?j NO- i" NO /"' 415 Vote Required YES- - ( In fo a t i o n Attached)

SUBJECT: APPROVAL OF TTlE DESCRIPTICIN OF PROPOSED EXPENDITURE OF CALIFORNIA HEALTHCARE FOR lNDIGENTS PROGRAM FUNDS FOR FISCAL YEAR 2001102.

STAFF RECOMMEN- 1. APPROVAL OF THE DESCRIPTION OF PROPOSED EXPENDITURE OF DATIONS: CALIFORNIA HEALTHCARE FOR INDIGENTS PROGRAM FUNDS FOR

FISCAL YEAR 2001/02.

2. AUTHORIZE THE HEALTH SERVICES AGENCY MANAGING DIRECTOR OR HER DESIGNEE TO SIGN THE DESCRIPTION OF PROPOSED EXPENDITURE CERTIFICATION.

FISCAL IMPACT

Stanislaus County has been allocated $924,356 in Tobacco Tax revenue for Fiseal Year 2001102. At the time the County's final budget was adopted on September 18,2001, these revenues were estimated and appropriated to budgets that reimburse providers for cost of hcath care to indigents, including non-County health care providers. The use of Tobacco Tax Revenue for local health care programs requires a County maintenance of cffort of approximately $19.1 million. 'l'he MOE is funded with realignment Health 'Trust Fund revenue: Sales 'I'ax revenue, $4.5 million; Vehicle 1.icense Fecs revenue, $1 I . I million; and the County general fund revenuc, $3.5 million.

........................................................................................... BOARD ACTION BS FOLLOWS: No. 2001-940

On motion of SuPeNisorC?!!E . Seconded by Supervisor_B!cim and approved by the following vote. Ayes: Supe~isors:._M_a~eLd~~d,Bk~m~_s_i_m_~n~~a_r~~~~~~a_~d-Chair~PauL .______________---_---------------------

~~~

None Noes: Supervisors: - . - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - . . - - - - - . - - - . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . - . - - - . - - .

Excused or Absent: Supefvlsors~None ---.----------------------------------------.------------.-..----.------ Abstaining: SupeNisoK -.----.-- Nane F:F:F:F:-F:F:F:.F:F:F:F:F:F:F:-.--------------------------------------------.---.----

1) x Approved as recommended 2) Denied 3) Approved as amended MOTION:

- ATTEST: CHRISTINE FERRARO TALLMAN, Clerk By: Deputy File No.

APPROVAL OF THE DESCRIPTION OF PROPOSED EXPENDITURE OF CALIFORNIA HEALTHCARE FOR INDIGENTS PROGRAM FUNDS FOR FISCAL YEAR 2001102.

DISCUSSION: As a pre-requisite for receiving Tobacco Tax revenues, the County is required to submit to the State Department of Health Services (DHS) an annual Description of Proposed Expenditure of California Healthcare for Indigent Program (CHIP) Funds. According to Sections 16936 and 16980 of the Welfare and Institutions Code (W&I), this report must describe how the county intends to use the CHIP funds to supplement service levels offered during fiscal year 1988-89 rather than hnding existing levels of services in each of the three funded categories: Hospital Services Account, Physician Services Account, and Other Health Services Account. The description indicates (a) increases in benefits or scope of services, (b) increases in eligibility and (c) increases in utilization, expanded access or service capacity. A description of the county's CHDPT and Dental programs are also included. Funding levels in the budget of Health Services Agency, Indigent Health Care Program, Public Health and Environmental Resources are used to determine net county cost for maintenance of effort requirements. This document is used by the State to monitor the County's expenditures on indigent health care.

POLICY ISSUE: The program promotes the Board of Supervisors' goal of economic development and efficient government operations. Board approval is essential to the continued flow of Tobacco Tax Funds unto Stanislaus County for use by the community and Health Services Agency in providing health care services to indigents.

STAFFING IMPACT:

STANISLAUS COUNTY

FISCAL YEAR 2001 -02

DESCRIPTION OF PROPOSED

EXPENDITURE OF CALIFORNIA HEALTHCARE

FOR INDIGENTS PROGRAM FUNDS

ORIGINAL

BOARD CERTIFICATION

I, CYNTHIA A cOIT . hereby certify that, to the best of my knowledge, (Please type or pnnt name)

the information provided in the attached Description of Proposed Expenditure of [ ] Rural

Health Services Program funds or $1 California Healthcare for Indigents Program funds (check one)

is correct and is drawn from the officially adopted county budget for fiscal year 2001-02.

Original Signature: Date: ,>/II b y (~haupeno; Board of S u p e ~ s o n or duly authorized representative)

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS

FISCAL YEAR 2001-02

CLINIC SERVICES - COUNTY HOSPITAL SERVICES FUNDS ORIGINAL

CHIP funds will be used for services rendered to qualifying indigents at Stanislaus County Health Services Agency clinics. In a continuing effort to increase access to health care, the Stanislaus County Health Services Agency is responsible for promoting a healthy community, integrating health care services to decrease duplication and increase access to health care services. The following program and service enhancements are proposed for 200112002:

1. Medical Ads Building Services:

t Pediatrics: a. Existing Services: general pediatrics. CCS paneled physicians,

Immunizations, Well Child Care (CHDP) Public Health CHDP Van volume incorporated into clinic to expand access and establish a medical home patients for CHDP well child check services Pediatric Subspecialty services including pediatric neurology consultation, GI services, orthopedics, cardiology and genetics services Administration of synagis in outpatient setting for newbornslinfants with RDS Expansion of same day appointments and planned expansion into evening or Saturday hours

t Obstetrics a. Existing Services: OBtGYN. Prenatal Education & Counseling,

Breast Health b. Low cost annual breastlpap examinations offered c. Breast cancer treatment fund applications available for women not

qualifying for Medi-Cal and have no other third-party coverage d. Expanded Family Planning services through Family PACT e. Title X provider for Family Planning Services; coverage for

Women's health expanded through Federal 11 15 waiver

t Family Practice (PMP Clinic) a. Existing Services: Family Practice, Family Planning, Well Child Care

(CHDP), Geriatrics. Pediatrics b. Expanded Family Planning services through Family PACT c. Expanded coverage for Women's health through Federal 11 15

waiver for Title X d. Change in provider mix affecting patient mix, providing greater level

of service to MIA, Medi-Cal, and patients with higher level of acuity e. Expanded access to geriatrics and expanded geriatric teaching

clinics f. Expansion of same day appointments and planned expansion into

evening or Saturday hours

STANISLAUS comn DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 2 of 10 ORIGINAL

r Dental Care a. Existing Services: Pediatric and Adult Dental Care b. Increased access to services for CHDP and Adults through

recruitment of additional providers. Addition of pediatric dental specialist

c. Hospital privileges obtained for oral surgery that must be done under anesthesia

d. Ability to perform defined scope of in office oral surgery procedures for children and adults

a. Existing Services: GYN & Family Planning Services, Pregnancy Care & Education. Pregnancy Testing. Screening & Referral. Children's Physicals & Immunizations, Dental Screening & Referral, WIC, Health Education, Medical Care for Sick Children

b. Service locations include Chrysler Elementary School. Shackelford Elementary School, Orville Wright Elementary School, Del Rio Mobile Home Park, West Modesto - King Kennedy Center

c. Expanded Family Planning services through Family PACT d. Expanded coverage for Women's health through Federal 11 15

waiver for Title X e. Service locations to change in Spring 2002 (West Modesto) as full

service clinic is opened in this community. Evaluating alternative site(s)

r Pharmacy a. Full service outpatient pharmacy

+ Lab/Radiology Services a. Services include mammography, ultrasound, plain film, and

phlebotomy to support needs of Medical Arts Building and other clinics within HSA system of care

b. Replaced Ultrasound and plain radiography equipment to enhance image and quality of care

c. Installed dedicated mammography film processor to improve quality of image

Provider Chanaes r Replacement of Family Practice NP with PA + General dentist (Part-time) + Replacement of Family Practice Physician in January

2. Specialty Clinic services: -

t Existing Services: Orthopedics, General Surgery, ENT, Neurology, Neuro Surgery, Urology, Ophthalmology, Dermatology, Cardiology, Oncology, Gastroenterology

+ Access to specialty services for Medi-Cal, IHCP and other payors for patients from through-out Stanislaus County

r Orthopedics a. Expansion of Orthopedics clinic space to accommodate additional providers

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 3 of 10 ORIGINAL

r Oncology a. Expansion of clinic hours for chemotherapy and patient consultations to

accommodate growing patient population r General Surgery

a. Move to praceptorship model for general surgical teaching

New Providers: t Recruitment of Oncology Trained NP to assist in accommodation of Oncology

practice growth

3. Empire Medical Office Services:

t Existing Services: Family Practice. Family Planning, Well Child Care (CHDP), Geriatrics. Pediatrics: Opened October 1998, to provide improved access for general family practice clinic for the residents of Empire and surrounding area. Partnership with Community collaborative, Healthy Start, Sheriff and County Library

t Public Health CHDP Van volume incorporated into clinic to expand access and establish a medical home patients for CHDP well child check services

t STD testing and treatment site as the result of the decentralization of County STD services

t Expanded coverage for Women's health and Male STD treatment and screening through Federal 11 15 waiver for Title X

t Expanded provider hours as clinic volume grows

4. Huahson Medical Office - Services:

t Existing Services: Family Practice. Family Planning, Well Child Care (CHDP), Geriatrics. Pediatrics, OBIGYN., keep baby safe classes in English and Spanish. (Designated Rural Health Clinic) Collaborating with WIC and CSA as they co-locate in clinic1 community resource center complex to improve access to services and coordination of services for mutual clients Active participant in Healthy Start Planning and Implementation grant(s) for Hughson schools Working with schools to provide health care services, health education, and screening Expanded Family Planning services through Family PACT Public Health CHDP Van volume incorporated into clinic to expand access and establish a medical home patients for CHDP well child check services STD testing and treatment site as the result of the decentralization of County STD services Expanded coverage for Women's health and Male STD treatment and screening through Federal 11 15 waiver for Title X Behavioral Health Services in partnership with Department of Mental Health Continued expansion of Telemedicine program for Stanislaus County as part of rural demonstration project grant through MRMlB (DHS Grant to Blue Cross). Expanded access to patients through out HSA system and community Local Initiative providers for timely access to specialty care, including areas of inappropriate wait times for consultations such as dermatology, neurology, endocrinology, rheumatology, and pediatric subspecialties Expansion of same day appointments and planned expansion into evening or Saturday hours

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 4 of 10

5. Familv Practice Center

Existing Services: Family Practice, Family Practice Residency Program. OB, Pediatrics, Family Planning. Mental Health Services, Pharmacy, Financial Counseling, Well Child Care (CHDP). Health Education. Diabetes Education, Prenatal Education 8 Counseling (CPSP) Keep baby safe classes in English and Spanish Expanded Family Planning services through Family P.4CT Public Health CHDP Van volume incorporated into clinic to expand access and establish a medical home patients for CHDP well child check services STD testing and treatment site as the result of the decentralization of County STD services Expanded coverage for Women's health and Male STD treatment and screening through Federal 11 15 waiver for Title X Expansion of same day appointments and planned expansion into evening or Saturday hours

t Renovation and replacement of flooring, furnishing and waiting areas to improve clinic flow and enhance appearance

New Providers: + Expand number of residency clinics

6. Turlock Medical Office Services:

t Existing Services: Family Practice. Family Planning. Women's Health, Perinatal Care, Well Child Care (CHDP), and keep baby safe classes in English and Spanish

t Acquired Community safety net provider practice when closed in June 1998. Maintained access to Medi-Cal uninsured and underinsured by preserving two providers and Consolidated two clinic locations in to one location. March 2000

t Public Health CHDP Van volume incorporated into clinic to expand access and establish a medical home patients for CHDP well child check services

t STD testing and treatment site as the result of the decentralization of County STD services

t Expanded coverage for Women's health and Male STD treatment and screening through Federal 11 15 waiver for Title X

+ Expanded Family Planning services through Family PACT t Working collaboratively with Public Health to provide anonymous HIV testing once a

week t Collaborative Prenatal Education & Counseling (CPSP) program with Emanuel

Medical Center + Partner in Wakefield School Healthy Start Collaborative . Expansion of same day appointments and planned expansion into evening or

Saturday hours

New Providers: t 1 part-time Family Practice Physician r Replacement of one Family Practice Physician with new provider

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 5 of 10 ORIGINAL 7. Ceres Medical Office Services:

r Existing Services: Family Practice, Family Planning. OB. Well Child Care (CHDP), Prenatal EducationlCounseling, WIC

+ Expanded Family Planning services through Family PACT + Public Health CHDP Van volume incorporated into clinic to expand access and

establish a medical home patients for CHDP well child check services + STD testing and treatment site as the result of the decentralization of County STD

services + Expanded coverage for Women's health and Male STD treatment and screening

expanded through Federal 1 11 5 waiver for Title X + Keep baby safe classes in English and Spanish r Expansion of Family Planning afternoon for teens afler school + Active member of Ceres Community Collaborative and partner in Ceres Healthy Start

Collaborative r Relocated Clinic in April 1999. New site includes WIC, Mental Health Services and

crew quarters for EMS ambulance. Expanded clinic space and improved access with location and addition of providers

+ Expansion of same day appointments and planned expansion into evening or Saturday hours

New Providers: t 2 new Family Practice Physicians (replacing other providers)

8. McHenry Medical Office Services

r Existing Services: Family Practice, Family Planning, 06 , Well Child Care (CHDP), Prenatal Education & Counseling. Southeast Asian Clinic, Sterilization CounselinglServices. Acute Clinic

+ Keep baby safe classes in English and Spanish t Expanded Family Planning services through Family PACT r Public Health CHDP Van volume incorporated into clinic to expand access and

establish a medical home patients for CHDP well child check services r STD testing and treatment site as the result of the decentralization of County STD

services + Expanded coverage for Women's health and Male STD treatment and screening

through Federal 11 15 waiver for Title X r Title X provider for Family planning services + Salida Women's Health - satellite of McHenry operating 16 hrs per week. Services

include family planning, women's health care, immunizations, and CHDP. First Stop Demonstration Project with WIC at same location (Title X funding). Expanded CHDP and immunization services

+ Evaluating new facility necessary to improve customer service and expand access to accommodate two additional providers

t Expansion of same day appointments and planned expansion into evening or Saturday hours

New Providers: + Part-time Family Nurse Practitioner

STANISLAUS COUNTY DESCRmTION OF PROPOSED EXPEUDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 6 of 10 ORIGINAL

- 9. Urgent Care Services Services . Opened December 1997 to provide access to patients utilizing emergency room

services at community hospitals and former Stanislaus Medical Center Open for easy access 7-days a week from 9 3 0 a.m. to 9:30 p.m. Existing Services: Family practice urgent cares, walk-in services for urgent primary care needs after clinic hours Expanded access to primary care services for patients require acute patient appointment during regularly scheduled clinic hours when primary care provider patient schedule is full STD testing and treatment site as the result of the decentralization of County STD Testing and treatment site for Public Health communicable disease team working on outbreaks (TB, STD, Hepatitis) Expansion of Occupational Health Services provided through this location Facility refurbished

10. West Modesto Clinic t Scheduled to open February 2002 with the following services: Family Practice,

Family Planning, OB, Well Child Care (CHDP), Prenatal Education & Counseling, Keep baby safe classes in English and Spanish, STD testing and treatment site as the result of the decentralization of County STD services

+ Title X funded Teen peer family planning clinic + Anticipate 7,000 - 10,000 patient visits in first full year of operation + Will replace MoMobile site in West Modesto r Expanded coverage for Women's health and Male STD treatment and screening

through Federal 11 15 waiver for Title X . Title X provider for Family planning services Part of 30,000 square foot facility that will also provide services and coordinate services with WIC, Mental Health, Social Services (TANF and Medi-Cal eligibility), probation, Adult Literacy, and Department of Employment and Training

+ Strong partner in facility development and community based activities with West Modesto King Kennedy Neighborhood Collaborative

New Providers: r Family Nurse Practitioners . ~amil; practice Physicians

71. Laboratow Services . Full service CLIA approved lab and Public Health Lab (CLIA Approved).

r Expanded Bact-T testing capability . New Chemistry analyzers and equipment to test arterial blood gas. . Expansion of hours for patient registration . New testing methodology for chlamydiaiGonorrhea (urine based) + Addition of courier service to community providers for results reporting + Functioning as STAT lab for commercial HMO

12. Radiology Services

+ Existing Services: Plain film, angiography. CT, fluoroscopy, mammography (FNA only at this site), Ultrasound, Nuclear Medicine, echocardiography

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITURE OF CHIP FUNDS FISCAL YEAR 1001-02 Page 7 of 10

+ Replaced ultrasound and CT equipment with state-of-the-art technology to expand capability, improve diagnostic image and increase through put of patients due to technological advances in equipment

+ E-Med system to allow radiographic images to be transmitted over PC LAN for primaly care MO evaluation (planned 2001 installation)

r Addition of courier service to community providers for results reporting

13. Rehabilitation Services1 Audiology Services

r Existing Services: PT, OT, Speech Therapy, Audiology, EMG, EEG Services and Wound Care

+ Expanded access to wound care services for patients within HSA system of care t Audiology department expansion of access to services r Increase in scope of physical therapy modalities and scope of occupational therapy

services + Expansion of workers compensation business

14. Pharmacy + Full service retail pharmacy on scenic drive campus + Provides outpatient admixture services for oncology patients

15. Ambulatory-wide initiatives r Facility Masterplan for agency to evaluate current facility capabilities and functionality and to

plan facility replacement for the future based upon population based needs tied to updated Agency Strategic Plan

+ Continuation of Family Planning Outreach grant through Community Services Agency (TANF re-investment dollars) to enhance outreach and clinical services targeting teen pregnancy prevention and reduction of unintentional pregnancies for TANF recipients. Targeted communities identified by state based upon incident rates include Oakdalel Waterford, Patterson, Grayson, Westly. Newman corridor and continued efforts in Modesto. Ceres and Turlock. Community based input solicited to identify strategies and areas of need. Partnerships developed to enhance existing services where available in order not to duplicate services in the communities.

STANISLAUS COUNTY DESCRIPTION OF PROPOSED ENPEXDITURE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 8 of 10

HOSPITAL SERVICES - NONCOUNTY HOSPITAL DISCRETIONARY FUNDS

Non-county hospital discretionary funds are being used to supplement the formularj funds allocated by the State to the Non-County hospitals.

The county has required via contract that Non-county Hospital CHlP eligibility standards be filed with the county. Each facility applies the charity standards filed with the county to each account submitted for reimbursement under CHIP. In addition, contract provisions require supporting claim documentation which displays insurance. Medi-Cal. Medicare, and other payer information on computer-generated forms.

PHYSICIAN SERVICES - EMERGENCY MEDICAL SERVICES FUND

Stanislaus County contracts with the Foundation for Medical Care (FMC) to administer Physician Emergency Medical Services funds. All claims processing and check-writes are done by FMC, who submits a check register to the County Auditor for the release of funds from the Emergency Medical Services special revenue sub-account.

These funds will be used for emergency services performed by any physician in any emergency room in Stanislaus County, except the County clinics, provided that the eligibility criteria have been met. Emergency. 08 and pediatric services will be paid from the EMS portion of the Physician Services sub-account.

Eligibility criteria for the Emergency Medical Services (EMS) portion of the Physician Services Account require (1) that physicians submit with their claims, proof that the patient account has been billed to the patient or a third-party payer for 90 days with no response or (2) that physicians have received actual notification from the patient or responsible third-party payer that no payment will be made for services rendered. Physicians are required to make every reasonable effort to seek payment from the patient or a responsible third-party payer prior to billing Foundation for Medical Care.

No physician rendering services in a county facility or in a primary care clinic, which receives tobacco tax funds for any losses incurred in the provision of those services, may receive reimbursement from the Physician Services Account.

Any patient whose account has been paid in whole or in part by federal funds is also deemed ineligible for Physician EMS funds.

No physician claim which lacks adequate documentation as required by A8816 will be processed for payment. Remittance advice documents showing denials and patient responsibility must be presented where the worksheet or HCFA 1500 form indicates a potential third-party payer. Evidence of the initial billing date must also be submitted to verify that physicians have complied with the 90-day billing period.

Reimbursement is at 50% of the established Foundation allowable reimbursement.

Physicians receiving payment from the patient or third-party payer subsequent to receiving CHlP funds is obligated under a signed agreement to notify the Foundation for Medical Care of such reimbursement and to refund any CHlP funds paid up to the amount that had been reimbursed by FMC.

PHYSICIAN SERVICES - NEW CONTRACT FUNDS

Stanislaus County has elected to use New Physician Contract funds to help pay for services provided to children under the CHDPT program. The eligibility criteria for this sub-account makes the program available to children age 18 or below whose family income is equal to or below 200% of the federal poverty level who have no other third-party-payer coverage. Children in this age

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITLrRE OF CHlP FUNDS FISCAL YEAR 2001-02 Page 9 of 10

group who qualify for Medi-Cal but have a share of cost are also eligible for New Physician Contract sub-account funds.

CHDPT is the Child Health and Disability Prevention Treatment Program for which CHlP funds may be used to provide medically necessary treatment for conditions detected in CHDP examinations. Initially the child will undergo a CHDP exam by a licensed CHDP screening provider. If a condition is found at the time of this initial examination, which requires treatment, the patient will be referred to a treating provider on a Confidential CHDP Referral Form (PM161). A copy of the CHDP assessment form (PM160), the eligibility form (4073), and the Confidential CHDP Referral Form (PM161) are forwarded by the screening provider to the lndigent Health Care Program where the information is keyed into a database. When the treating provider bills the lndigent Health Care Program for these services the patient data contained on the claim is verified through the database for eligibility.

The lndigent Health Care Program and the CHDP program at the Stanislaus County Department of Public Health have widely disseminated CHDPT program information throughout the County. CHDP program nurses continually go out into the community to instruct physicians and other vital contact persons. The lndigent Health Care Program (IHCP) works with others via telephone and countywide mailings.

There are currently 55 community providers participating in the CHDPT program whose services are reimbursed with New Physician Contract Funds. These include, but are not limited to, such specialty services as podiatry, ophthalmology, pediatric cardiology, audiology, and neurology. No physician rendering services in a county facility or in a primary care clinic, which receives tobacco tax funds for any losses incurred in the provision of those services, may receive reimbursement from the Physician Services Account.

OTHER HEALTH SERVICES FUNDS

While the limited funds in the Other Health Services sub-account remain available, they will be used to cover services ensuing from the expanded access program or those associated with the CHDPT program.

In most cases, except for CHDPT services provided to children whose family income is equal to or less than 200% of the federal poverty level, patients whose services are covered by the Other Health Services fund must have met Section 17000 indigent income standards as administered by the lndigent Health Care Program under the auspices of the Health Services Agency.

$6,100 of Other Health Services funding will be allocated to the Health Services Agency for the purchase of exam room equipment at the Urgent Care and Family Practice Center. This equipment will benefit the clients served, many who are CHDPT eligible children. This is an essential contribution towards the success of HSA's expanded access and continuous quality improvement.

Urgent Care: Analyzer, urine dip electronic $650 Audiometer 800 2-Exam room lights 3,200

Family Practice: Analyzer, urine dip electronic $650 Audiometer 800

----.---

Total Equipment Costs: $!sJ&

STANISLAUS COUNTY DESCRIPTION OF PROPOSED EXPENDITCRE OF CHIP FUNDS FISCAL YEAR 2001-02 Page 10 of 10 ORIGINAL CHDP TREATMENT

The lndigent Health Care Program will reimburse from the Physician Services Account and the Other Health Services Account treatment rendered to eligible children as the result of a CHDP referral. Such children will have been medically and financially screened by a CHDP referral provider.

Physicians and other health care providers have been and will continue to be contacted by Public Health, the lndigent Health Care Program, Migrant Education, and other various agencies via telephone, mail, and meetings. Instruction is being provided regarding contracts, billing procedures, and data collection requirements.

Screening Providers are required to notify the Department of Public Health when a referral has been made. The Public Health Department follows up each referral to determine that treatment has been rendered. A Public Health nurse is responsible for contacting parents and other responsible parties to encourage follow-up treatment.

Additionally, a copy of the CHDP assessment form (PM160), the eligibility form (4073), and the Confidential CHDP Referral Form (PM161) are forwarded to the lndigent Health Care Program by the screening provider where the information is keyed into a database and the patient is assigned an authorization number for the necessary treatment.

Providers submitting CHDP claims to the lndigent Health Care Program must comply with all CHIP data collection requirements. They are required to complete and sign (1) a HCFA 1500 or UB -92, (2) a CHDP referral form, (3) an approved Treatment Authorization Request for services requiring prior authorization, and (4) a remittance advice or explanation of benefits showing denial by any potential third-party payer or patient responsibility.

DENTAL SERVICES

Demand for both adult and CHDPT dental services continues to expand in Stanislaus County, having grown from $170,000 in expenditures in FY 1988-89 to $966,490 in FY 2000101. To accommodate this demand, the lndigent Health Care Program utilizes the services of 6 community dentists, 1 oral surgeon, in addition to the services provided by the Stanislaus County Dental Clinic.

The lndigent Health Care Program's dental scope of benefits provides incentives for patient participation in maintaining good oral hygiene and adds an education program with emphasis on prevention and early intervention. The scope of benefits is offered to both adult and CHDPT beneficiaries of the program through a TAR process, which includes, but is not limited to, the following services:

Dental Exams Specialist Consultations Dental Prophylaxis and Education Emergency Treatment X-Rays, including Panographic Film Simple and Surgical Extractions Comprehensive Oral Surgery General Anesthesia Restorative Dentistry Prosthetics, Including Dentures Operating Room Services, as Required

- County of STANISLAUS - 50

FY 2001-02 Description of Proposed Expenditure of CHlPlRHS Program Funds

HOSPITAL SERVICES FUND DETAIL SHEET

COUNN HOSPITAL FUNDS

Revenue County Hospital Allocation

lnterest Carryover from Prior Year

Projected Interest for FY 2001-02

Total

Aopro~riations for Services bv Budclet Unit

Budget Unit # 141 1 Title County Health Services $ 469,359

Budget Unit # Title Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title


Budget Unit # Title

Aporopriations for Administrative Costs bv Budclet Unit


Budget Unit # Title

Budget Unit # Title

Appropriations for CHDP Treatment Services bv Budclet Unit


Budget Unit # Title

Budget Unit # Title

Total $8 689,132

County of STANISLAUS - 50 2001-02 Description of Proposed Expenditure of CHlPlRHS Program Funds


NON-COUNTY HOSPITAL FORMULA FUNDS

Revenue

Noncounty Hospital Formula Allocation

Interest Carryover from Prior Year


Total

Appropriations for Services bv Budqet Unit

Budget Unit # 1412 Title Non County Health Services

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title


Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title


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Budget Unit # Title

Total

ORIGINAL County of STANISLAUS - 50

2001-02 Description of Proposed Expenditure of CHIPIRHS Program Funds


NONCOUNiY HOSPITAL DISCRETIONARY FUNDS

Revenue

Noncounty Hospital Discretionary Allocation

Interest Carryover from Prior Year


Total

Appropriations for Services bv Budqet Unit

Budget Unit # 1412 Title Non County Health Services Budget Unit # Title

Budget Unit # Title

Budget Unit # Title


Budget Unit # Title

Budget Unit # Title


Budget Unit # Title

Budget Unit # Title

Appropriations for Administrative Costs bv Budqet Unit

Budget Unit # 1412 Title Non County Health Services $ 5,405

Budget Unit # Title

Budget Unit # Title

Appropriations for CHDP Treatment Services by Budqet Unit

Budget Unit # Title pp

Budget Unit # Title

Budget Unit # Title

Total $ 70,161


2001-02 Description of Proposed Expenditure of CHIPIRHS Program Funds

PHYSICIAN SERVICES FUND DETAIL SHEET

PHYSICIAN SERVICES-NEW CONTRACT FUNDS

Revenue

Physician Services - New Contract Allocation $ 12,134

(Not to exceed 50% of the total Physician's Services Account on Table 1 for CHIP counties)

Interest Carryover from Prior Year $

Projected Interest for FY 2001-02 $ 728

Total $ 12,862

Appropriations for Obstetric Services by Budqet Unit

Budget Unit # Title - Budget Unit # Title

Appropriations for Pediatric Services bv Budqet Unit

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Appropriations for Emerqencv Services bv Budaet Unit

Budget Unit # Title - Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Appropriations for CHDP Treatment Services bv Budqet Unit

Budget Unit # 1414 Title New Physician Contracts $ 1 1.649

Budget Unit # Title

Appropriations for Administrative Costs bv Budqet Unit

Budget Unit # 1414 Title New Physician Contracts $ 1,213

Budget Unit # Title

Total $ 12,862


2001-02 Description of Proposed Expenditure of CHlPlRHS Program Funds

PHYSICIAN SERVICES FUND DETAIL SHEET

PHYSICIAN SERVICES - EMERGENCY MEDICAL SERVICES (EMS) FUNDS

Revenue

Physician Services - EMS Allocation


Projected lnterest for FY 2001-02 Total

Appropriations for Sewices bv Bud~et Unit

Budget Unit # 1413 Title Emergency Medical Sewices $ 11.892

Budget Unit # Title

Budget Unit # Title

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Budget Unit # Title

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Budget Unit # Title


Budget Unit # Title

Appropriations for Administrative Costs bv Budqet Unit (not to exceed 10% of the Physician Services Account)

Budget Unit # 1413 Title Emergency Medical Sewices $ 1.213

Budget Unit # Title

Total $ 13,105

t/ County of STANISLAUS - 50

q R i ~ i i \ i ~ ~ 2001-02 Description of Proposed Expenditure of CHIPIRHS Program Funds

OTHER HEALTH SERVICES FUND DETAIL SHEET

Revenue Other Health Services Allocation


Projected lnterest for FY 2001-02

Total

Appropriations for Services by Budqet Unit

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Budget Unit # Title

Appropriations for Administrative Costs by Budqet Unit

Budget Unit # 1415 Title Other Health Services $ 9.832 Budget Unit # Title

Budget Unit # Title

Appropriations for Equipment bv Budqet Unit

Budget Unit # 1415 Title Other Health Services $ 6,100

Budget Unit # Title

Budget Unit # Title

Appropriations for CHDP Treatment Services by Budqet Unit

Budget Unit # 1415 Title Other Health Services $ 82,390

Budget Unit # Title

Budget Unit # Title

Total $ 98,322

ORIGINAL County of STANISLAUS- 50

Fiscal Year 2001-02 Description of Proposed Expenditure of CHIPIRHS Program Funds

-

Total

DETAIL SHEET FOR CHILD HEALTH DISABILIN PREVENTION TREATMENT FUNDING

Outpatient Care

Dental Services

Vision Services

Hearing Services

Mental Health Services

Other (please specify) Orthopedics

1404 1411 1414 1415 1404 1411 1414 1415 1404 1411 1415

1404 1411 1415

$ 122.917 $ 118.414

$ 5.813 $ 26.518 $ 15.073 $ 1.526 $ 1.106 $ 8.852 $ 368 $ 3.784 $ 404

$ 682 $ 7.356 $ 788

X

X

X

X

X

X

X

X

X

X

X

X

X

X

County of STANISLAUS- 50 Fiscal Year 2001-02 Description of Proposed Expenditure of CHIPIRHS Program Funds

Schedule - 1 CHIPIRHS Financial Maintenance of Effort

ORIGINAL

FEB 1 9 ZOO2 STANDARD AGREEMENT "bMCE''

FOR CALIFORNIA HEALTHCARE FOR INDIGENTS PROGRAM FUNDING

FOR FISCAL YEAR 2001-02

The State of California, by and through the Department of Health Services (hereinafter called the "Department") and the County of Stanislaus (hereinafter called the "County") in consideration of the covenants, conditions, agreements, and stipulations hereinafter expressed, do hereby agree as follows:

This Agreement is entered into pursuant to the provisions of the Welfare and Institutions (W&l) Code, Section 16900 et The definitions of terms used in this Agreement shall be determined under W&l Code Section 16900 et sea. In the event of a subsequent statutory amendment or Budget Act language to W&l Code Section 16900 et sea., the amended statute shall be controlling.

As a condition of receiving California Healthcare for lndigents Program funds (hereinafter called CHlP funds), the County agrees to all of the following statutory provisions:

GENERAL REQUIREMENTS

1. (a) CHlP funds shall be expended to supplement existing levels of services provided and shall not be used to fund existing levels of services. (Section 23 of Chapter 199, Statutes of 1996 - Assembly Bill [AB] 3487)

(b) CHlP funds shall not be used to support health services provided to persons detained in a county or city jail or other correctional facility. (W&l Code Section 16995)

(c) All providers receiving any CHlP funds shall not require a fee or charge before they render medically necessary services to persons entitled to services supported by CHlP funds. (W&l Code Sections 16942(a) and 16804.1)

(d) Accepting CHlP funds does not relieve the County of its obligation to provide indigent health care as required by W&l Code Section 17000. (W&l Code Section16995.1)

(e) Facilities receiving CHlP funds shall be required to provide individual notice at the time treatment is sought as to the availability of reduced cost health care and conspicuously post notices of the procedures for applying for reduced cost health care in all emergency rooms and patient waiting rooms for services supported by CHlP funds. (W&l Code Sections 16942(a) and 1681 8)

FY 2001 -02 CHlP Agreement - County of Stanislaus Page 2 of 16

2. (a) As a condition of receiving CHlP funds, it shall provide, or arrange and pay for, medically necessary follow-up treatment, including prescription drugs and necessary follow-up dental treatment at least equal in scope and frequency to dental services available to Medi-Cal eligible children of the same age, for any condition detected as part of a Child Health and Disability Prevention (CHDP) screen for any child eligible for services under Section 104395 of the Health and Safety Code, if the child was screened by the County, or upon referral by a CHDP Program provider, unless the child is eligible to receive care with no share of cost under the Medi-Cal Program, or is covered under another publicly funded program, or the services are payable under private insurance coverage. (W&l Code Sections 16970(a) and (c))

(b) Noncounty hospitals which receive a formula allocation pursuant to paragraph 10, and physicians who receive payment from the Physician Services (PS) Account of the Emergency Medical Services (EMS) fund, established pursuant to paragraph 25, shall not be required to participate in complying with the CHDP treatment provisions of paragraph 2(a) as a condition of receiving those allocations or payments. (W&l Code Section 16970(b)(l))

(c) Only providers which contract with the County and receive payments of Noncounty Hospital Discretionary, Physician New Contracts, and Other Health Services funds specified in paragraphs 12, 30, and 31 may be required to participate in complying with the CHDP treatment provisions of paragraph 2(a), as a condition of receiving those payments. (W&l Code Section 16970(b)(2))

(d) The CHDP treatment provisions of paragraph 2(a) shall be implemented in consultation and coordination with the County's CHDP Programs. (W&l Code Section 16970(d))

ADMINISTRATION OF FUNDS

3. Prior to transferring or expending any CHlP funds received, the County shall:

(a) Deposit the CHlP funds received in a special revenue fund or trust fund (hereinafter called the Fund) established solely for the purposes of the provisions of Part 4.7 (commencing with Section 16900) of Division 9 of the W&l Code. (W&l Code Sections 16909(a) and (b))

FY 2001-02 CHIP Agreement - County of Stanislaus Page 3 of 16

(b) Establish a Hospital Services Account in the Fund and deposit all hospital funds received pursuant to paragraph 9 in that account. The county further assures that it shall establish a Noncountv Hosoital Subaccount in the Hosoital Services Account and deposit all ~oncoun t~ ~ b s ~ i t a ~ Formula and ~iscrekonary funds received pursuant to paragraphs 10 and 12, in that subaccount. If the County owns and operates a county hospital, the County further assures that it shall establish a County Hospital Subaccount in the Hospital Services Account and deposit all County Hospital Discretionary funds received pursuant to paragraph 15, in that subaccount. (W&l Code Sections 16909(a) and (b))

(c) Establish a PS Account in the Fund and deposit all PS funds received pursuant to paragraph 24 in that account. The County further assures that it shall establish an EMS Subaccount in the PS Account and deposit all PS funds proposed for expenditure pursuant to paragraph 25, in that subaccount prior to transferring the funds to any other account. If the County chooses to expend Physician New Contracts funds pursuant to paragraph 30, the County assures that it shall establish a Physician New Contracts Subaccount in the PS Account and deposit all Physician New Contracts funds proposed for expenditure pursuant to paragraph 30, in that subaccount. (W&l Code Sections 16909(a) and (b))

(d) Establish an Other Health Services Account in the Fund and deposit all Other Health Services funds received pursuant to paragraph 31, in that subaccount. (W&l Code Sections 16909(a) and (b))

INTEREST EARNINGS ON THE FUND

4. la) All interest earned on the Fund and on each account or subaccount shall be \ ,

accrued to the benefit of the Fund, account, or subaccount, respectively, and all accrued interest shall be expended for the same purposes as the other funds in . . the Fund, accounts, or subaccounts, respectively. (W&l Code Section 16909(c)(l))

(b) All interest or other increments earned on the Noncounty Hospitals Subaccount shall be expended on noncounty hospitals pursuant to the provisions of paragraphs 10 and 12. (W&l Code Section 16909(c)(2))

FY 2001-02 CHlP Agreement - County of Stanislaus Page 4 of 16

ADMINISTRATIVE COSTS

5. County administrative costs associated with the administration of the Fund and each account or subaccount shall be reimbursed from the Fund, account, or subaccount, respectively. The County further assures that it shall not reduce or utilize Noncounty Hospital Formula funds received pursuant to paragraph 10, to offset the costs of administering the Noncounty Hospital Services Subaccount. (W&l Code Sections 16909.1 and 16946(b)(l)(E))

REPORTING

6. (a) Information on programs and services which shall receive CHlP funds shall be included in the County's Description of Proposed Expenditures of CHIP Funds and shall be subject to review and approval by the Department for compliance with Part 4.7 (commencing with Section 16900) of Division 9 of the W&l Code. (W&l Code Section 16980(b)(l))

(b) Indigent health care program demographic, expenditure, and utilization data shall be reported as specified by the Department pursuant to the provisions of W&l Code Section 16915 and the procedures specified by the Department. (W&l Code Section 1691 5)

(c) Services, associated costs, and socio-demographic characteristics of persons served under W&l Code Section 17000 and persons supported in whole or in part by CHlP funds shall be incorporated into the reports required pursuant to W&l Code Section 16915. (W&l Code Section 16942(c))

(d) The County shall include an estimate of, and the costs and funding arrangement for, dental services in its Description of Proposed Expenditures of CHlP Funds. (W&l Code Section 16980(b)(2))

(e) The County shall submit reports which display cost and utilization data for each account in the Fund as specified in the W&l Code Section 16909 to the Department on a preliminary annual and a final annual basis, in a form prescribed by the Department. (W&l Code Section 16909(d))


(f) The County shall provide the Department with information the Department deems necessary to determine compliance with the provisions of Part 4.7 (commencing with Section 16900) of Division 9 of the W&l Code. The information shall be provided according to the procedures and due dates established by the Department. (W&l Code Section 16981 (a))

FISCAL ASSURANCES

7. (a) CHlP funds shall be accounted for as revenue in the Description of Proposed Expenditures of CHlP Funds and in other information required by the Department. (W&l Code Sections 16990(c) and 16981)

(b) CHlP funds shall not be used as county matching funds for any other program requiring a county match. (W&l Code Section 16990(c))

(c) The County shall, at a minimum, maintain a level of financial support of county funds for health services as specified in W&l Code Section 16990. This amount shall not include any county funds expended pursuant to W&I Code Section 16809.3. Net disproportionate share hospital revenues shall be included in computing county financial maintenance of effort only as specified in the W&l Code Section 16990.5. (W&l Code Sections 16990 and 16990.5)

(d) In accordance with procedures established by the Department, the County may, uoon notifvina the Deoartment of the transfers authorized oursuant to W&l Code < - section 17600.20, reduce the level of financial maintenan'ce of effort soecified in subparagraph (c) above by the amount of funds transferred from the Health Account of the Local Revenue Fund pursuant to W&l Code Section 17600.20 for N 2001 -02. (W&l Code Section 16990(a)(2))

(e) If the County desires to use any of its CHlP allocation for programs and costs not associated with county health services as defined in W&l Code Section 16801, the County, as a condition of using its allocation for these purposes, shall maintain an amount of county funding for those programs and costs at least equal to 1988-89 fiscal year levels. (W&l Code Section 16990(b))

FY 2001-02 CHlP Agreement - County of Stanislaus Page6of 16

8. (a) In the event financial support of county funds for health services is less than the amount specified in paragraph 7(c), the Department shall recoverthe amount of the difference from the CHlP funds provided to the County proportionately from the Hospital Services Account, the PS Account, and the Other Health Services Account. (W&l Code Sections 16981 (b) and 16990(d))

(b) In the event financial support of county funds for programs and costs not associated with county health services as defined in W&l Code Section 16801 is less than the FY 1988-89 levels for those se~ces , the Department shall recover the amount of the difference from the CHlP funds provided to the County. (W&l Code Sections 16981 (b) and 16990(b))

(c) CHlP funds shall be returned to the Department if they are not encumbered or expended within the fiscal year according to this Agreement, and the requirements of Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the W&l Code. (W&l Code Section 16981 (b))

(d) The Department shall withhold payment of any funds specified in this Agreement and W&l Code Section 16900 et seq., if any of the reports specified in this Agreement and W&l Code Section 16900 et, have not been received from the County by the dates specified therein, unless an extension for submission of such reports is formally granted by the Department. Any funds withheld from the County pursuant to this Article shall be released upon receipt of the required reports by the Department. (W&l Code Sections 1691 6 and 16942)

(e) The Department shall conduct fiscal and program reviews to ensure county compliance with the provisions of this Agreement. The Department may withhold funds. uo to the total amount of funds allocated underthis Aareement. if . *

the county fails to correct deficiencies in the program after receiGng written notice of noncompliance from the Department. (W&l Code Section 16981 (a))

HOSPITAL SERVICES

9. The County agrees to expend all of its 2001 -02 Hospital Services allocation received pursuant to W&l Code Section 16943 to support uncompensated services provided during FY 2001-02 by county and noncounty hospitals. (W&l Code Sections 16941 and 16943(b)(c)(e) and (f))


NONCOUNTY HOSPITAL FORMULA FUNDS

10. The County agrees to allocate all of its 2001-02 Noncounty Hospital Formula allocation received pursuant to paragraph (1) of subdivision (b) of W&l Code Section 16946, to noncounty hospitals within the County in amounts determined pursuant to paragraph (1) of subdivision (b) of W&l Code Section 16946 for support of services provided by noncounty hospitals to any eligible patient treated at any time during the FY 2001 -02. (W&l Code Sections 16945, 16946(a)(l) and (b)(l)(A))

11. (a) Each noncounty hospital's share of Noncounty Hospital Formula funds specified in paragraph 10 shall be distributed to each noncounty hospital within ten (10) working days of receipt of monthly CHlP payments. (W&l Code Section 16948(a))

(b) Each noncounty hospital shall provide posted and individual notices pursuant to Section 16818 for the duration of any quarter during which funds allocated pursuant to paragraph (1) of subdivision (b) of W&l Code Section 16946 are used. (W&l Code Section 16946(b)(l )(D))

(c) Each noncounty hospital shall account for the funds on a quarterly basis. (W&l Code Section 16946(b)(l)(B))

NONCOUNTY HOSPITAL DISCRETIONARY FUNDS

12. The County agrees to distribute all of its 2001-02 Noncounty Hospital Discretionary allocation received pursuant to paragraph (2) of subdivision (b) of W&I Code Section 16946 to noncounty hospitals to maintain access to emergency care and to purchase other necessary hospital services provided during FY 2001 -02. (W&l Code Sections 16945 and 16946(b)(2)(A)(i))

13. The funds specified in paragraph 12 shall be distributed only after consulting with those hospitals and considering the following:

(a) The historic and projected patterns of care provided by hospitals, by geographic catchment areas within both urban and nonurban areas. (W&l Code Section 16946(b)(2)(B)(i))

(b) The unique costs associated with treating disproportionate numbers of severely ill, indigent patients. (W&l Code Section 16946(b)(2)(B)(i))

(c) The disproportionate losses sustained by hospitals in the provision of care. (W&l Code Section 16946(b)(2)(B)(i))


(d) The patterns of care of its residents provided by Level I trauma care hospitals in contiguous counties and the County may make proportionate allocations to those trauma centers. (W&l Code Section 16946(b)(2)(B)(ii))

(e) The use of those funds to meet emergency room patient needs and follow-up treatment, including the need for special hospital services. (W&l Code Section 16949(c))

14. When contracting with hospitals in neighboring counties for emergency care, the County shall not impose conditions to accept transfers that it does not impose on hospitals within its own boundaries. (W&l Code Section 16946(b)(2)(A)(ii))

COUNTY HOSPITAL FUNDS

15. The County agrees to expend all of its 2001 -02 County Hospital allocation received pursuant to subdivision (c) of W&l Code Section 16946 for payment or support of services provided in county or noncounty hospitals as determined by the County during FY 2001 -02. (W&l Code Sections 16945, 16946(a)(2) and (c))

REQUIREMENTS

16. As a condition of receiving the Hospital Services funds specified under paragraph 9, each county and noncounty hospital shall be required to do all of the following:

(a) Except as otherwise provided in W&l Code Section 16946 (i), maintain the same number and classification of emergency room permits and trauma facility designations as existed on January 1, 1990. This condition shall be deemed to be met for any hospital that maintained two special permits for basic emergency services on July 1, 1989, if each of the emergency rooms was located on separate campuses of the hospital and was located not more than two miles from the other emergency room. This condition shall also be deemed to be met even if one of the emergency room permits is surrendered after July 1, 1989. (W&l Code Sections 16946(d)(l )(A) and (B)(i)(ii))

(b) In a county that comprises not more than one-half of one percent (1%) of the total state population and in which there is a county hospital and a noncounty hospital with emergency room pennits located within two miles of each other, the county hospital may surrender its emergency room permit without penalty for violation of subparagraph (a) above provided all requirements of W&l Code Section 16946(h)


are met. If the Department determines that the County is not in compliance with the requirements of subdivision (h) of W&l Code Section 16946 it shall require the County to recover funds and deny further payments pursuant to subdivision (e) of W&l Code Section 16946, until compliance is resumed. (W&l Code Section 16946(h))

(c) Provide data and reports on the use and expenditure of all funds received in a form and according to procedures specified by the County and the Department. (W&l Code Section 16946(d)(2))

(d) Assure that Noncounty Hospital Discretionary and County Hospital Discretionary funds received pursuant to paragraphs 12 and 15 are used only for services for persons who cannot afford to pay for those services, and for whom payment shall not be made through any private coverage or by any program funded in whole or in part by the federal government. (W&l Code Section 16946(d)(3))

(e) Assure that Noncounty Hospital Formula funds allocated pursuant to paragraph 10 are used only for patients who cannot afford to pay or who meet the Office of Statewide Health Planning and Development's (OSHPD) definition of charity care as prescribed under subdivision (d) of Section 128740 of the Health and Safety Code and for whom payment shall not be made through any private coverage or by any program funded in whole or in part by the federal government. (W&l Code Sections 16946(d)(3) and 16908.5)

(f) Cease all current and waive all future collection efforts, by itself and by its agents, to obtain any payment from the patient with respect to whom the services funded with funds specified in paragraph 9 were rendered within ninety (90) days of the receipt of those funds. (W&l Code Section 16947(a))

(g) Notify the County if the hospital receives payment from a patient or responsible third-partv paver and reimburse the Countv in an amount eaual to the amount . . . - collected from the patient or third-party but not more than the amount of the payment received from the County for the patient's care. (W&l Code Section 16947(c))

17. As a condition of receiving the hospital funds specified under paragraph 9, each noncounty hospital shall be required to report to the County within thirty (30) days after the receipt of Noncounty Hospital Formula funds distributed pursuant to paragraph 10, information on patients for whom the distributions shall be used, pursuant to the requirements of W&l Code Section 16909. (W&l Code Section 16948(b))


18. Hospitals receiving Noncounty Hospital Discretionary funds under paragraph 12 shall be required to report to the County and OSHPD on any reduction in hospital emergency room specialist capabilities below the level which was provided at that facility on October 2, 1989. (W&l Code Section 16949(d))

RECOVERY, WITHHOLD. AND SUSPENSION OF PAYMENTS TO HOSPITALS

19. The County shall recover from any county or noncounty hospital:

(a) That portion of funds received which equal the ratio of the number of months the hospital violates the provisions of paragraph 16(a) to twelve (12) months. (W&l Code Section 16946(e)(l)(A))

(b) All funds received if the hospital violates the provisions of paragraph 16(c). (W&l Code Section 16946(e)(l)(B))

(c) The difference between the amount received and the amount which the hospital can document that the funds were used according to the provisions of paragraphs 16(d) and 16(e) on a monthly basis. (W&l Code Section 16946(e)(l)(C))

20. Further payment of funds may be denied to a hospital which has violated the provisions of paragraphs 16 through 18 until the hospital demonstrates compliance. (W&l Code Section 16946(e)(2))

21. Payments to any noncounty hospital shall be suspended if the hospital fails to provide the information required in paragraph 17. (W&l Code Section 16948(c))

REALLOCATION AND REDISTRIBUTION

22. Funds withheld or recovered pursuant to paragraph 19 may be reallocated and distributed according to the Noncounty Hospital Discretionary provisions contained in paragraphs 12 and 13. (W&l Code Section 16946(f))

23. Noncounty Hospital Formula and Discretionary funds available for allocation or distribution pursuant to paragraphs 10 and 12, which are not expended because a hospital does not participate shall be redistributed pursuant to the Noncounty Hospital Discretionary provisions contained in paragraph 12. If no noncounty hospitals remain to participate, the County may distribute the unexpended funds pursuant to the County Hospital Discretionary provisions contained in paragraph 15. (W&l Code Section 16946(g))


PHYSICIAN SERVICES

24. The County agrees to expend all of its 2001-02 PS allocation received pursuant to subdivision (a) of W&I Code Section 16950, for the support of or payment for uncompensated services provided during FY 2001-02 by a licensed physician. (W&l Code Sections 16908,16941 and 16950(a))

EMERGENCY MEDICAL SERVICES FUND - PHYSICIAN SERVICES ACCOUNT

25. As a condition of receiving CHlP funds, the County shall:

(a) Establish an EMS fund as authorized by subdivision (a) of Health and Safety Code Section 1797.98a. This shall not be interpreted to require the County to impose the assessment authorized by Section 1465.5 of the Penal Code. (W&l Code Section 16951)

(b) Establish a PS Account within the EMS fund and deposit in the PS Account at least fifty percent (50%) of the PS amount specified in paragraph 24 and any other funds appropriated by the Legislature for the purposes of the PS Account of the EMS fund. (W&l Code Sections 16950(c) and 16952(a)(l))

(c) Funds deposited in the PS Account in the EMS fund are exempt from the percentage allocations set forth in subdivision (a) of Section 1797.98a of the Health and Safety Code. (W&l Code Section 16952(b))

EMERGENCY MEDICAL SERVICES FUND - PHYSICIAN SERVICES ACCOUNT PURPOSE AND USE OF FUNDS

26. The PS Account in the EMS fund shall be used to reimburse physicians for losses incurred for services provided during FY 2001-02 and the County shall: (W&l Code Section 16952(f))

(a) Limit reimbursement to emergency services, as defined in W&l Code Section 16953, obstetric services, as defined in W&l Code Section 16905.5, and pediatric services, as defined in W&l Code Section 16907.5. (W&l Code Section 16952(g)(l))

(b) Reimburse each physician for no more than fifty percent (50%) of the losses submitted. (W&l Code Section 16952(h))


(c) Not reimburse for physician services provided by physicians employed by county hospitals. (W&l Code Section 16952(b))

(d) Not reimburse any physician who provides physician services in a primary care clinic which receives funds pursuant to Part 4 of Division 106 of the Health and Safety Code commencing with Section 124900. (W&l Code Section 16952(b))

(e) Limit reimbursement for losses incurred by any physician for services provided to patients who cannot afford to pay for those services, and for whom payment shall not be made through any private coverage or by any program funded in whole or in part by the federal government, and where all of the following conditions have been met: (W&l Code Sections 16952(f) and (g))

(i) The physician has inquired if there is a responsible third-party source of payment. (W&l Code Section 16955(a))

(ii) The physician has billed for payment of services. (W&l Code Section 16955(b))

(iii) A oeriod of not less than three months has ~assed from the date the . *

physician billed the patient or responsible third-party, during which time the physician has made reasonable efforts to obtain reimbursement and has not received reimbursement for any portion of the amount billed, or the physician has received actual notification from the patient or responsible third-party that no payment shall be made for the services rendered by the physician. (W&l Code Section 16955(c))

(iv) The physician has stopped any current, and waives any future, collection efforts to obtain reimbursement from the patient, upon receipt of funds from the County PS Account in the County EMS fund. (W&l Code Section 16955(d))

EMERGENCY MEDICAL SERVICES FUND - PHYSICIAN SERVICES ACCOUNT ADMINISTRATIVE COSTS

27. The County shall expend no more than ten percent (10%) of the amount deposited in the PS Account of the EMS fund pursuant to paragraph 25 for costs of administering the PS Account. (W&l Code Section 16952(d))


EMERGENCY MEDICAL SERVICES FUND - PHYSICIAN SERVICES ACCOUNT EXPENDITURES

28. The County shall provide a reasonable basis for its estimate of PS Account funds in the EMS fund which are encumbered to reimburse physicians losses incurred during the fiscal year for which bills shall not be received untilafter the fiscal year and agrees to exoend or disencumber these funds orior to the submission of the reDort of actual expe;lditures required by W&l Code siction 16980 (b). (W&l Code Section 16952(a)(2))

EMERGENCY MEDICAL SERVICES FUND - PHYSICIAN SERVICES ACCOUNT PROCEDURES

29. The County shall:

(a) Establish procedures and time schedules for submission and processing of reimbursement claims submitted by physicians. (W&l Code Section 16956(a))

(b) Establish schedules for payment which shall provide for disbursement of the funds available in the PS Account of the EMS fund periodically and at least annually to ail physicians who have submitted claims containing accurate and complete data for payment by the dates established by the County. (W&l Code Section 16956(b))

(c) Deny, at its discretion, claims which are not supported by records and recover any reimbursement paid to any physician for claims which lack supporting records. (W&l Code Section 16956(c))

(d) Require a listing of patient names to accompany a physician's claim, and give full confidentiality protection to those names. (W&l Code Section 16956(e))

(e) Require physicians to notify the administering agency if, after receiving payment from the PS Account of the EMS fund, the physicians are reimbursed by patients or responsible third-parties. In these instances the County assures that it shall reduce the physician's future payment of claimsfrom the account or, in the event there is not a subsequent submission of a claim for reimbursement within one year, require the physicians to reimburse the PS Account of the EMS fund in an amount equal to the amount collected from the patient or third-party payer but not greater than the amount of reimbursement received from the PS Account of the EMS fund for the patient's care. (W&l Code Section 16958)

FY 2001-02 CHIP Agreement - County of Stanislaus Page 140f 16

(f) Require physicians who submit claims for funding from the PS Account of the EMS fund to keep and maintain records of the services rendered, the person to whom services were rendered. and anv additional information the administerina - agency may require, for a period of three years after the services were provided. (W&l Code Section 16957)

NEW CONTRACTS

30. (a) The difference between the physician services amount received in paragraph 24 and the amount transferred to the PS Account of the EMS fund pursuant to paragraph 25 shall be expended by the County to pay for new contracts during FY 2001-02 with private physicians for provision of emergency, obstetric, and pediatric services in facilities which are not owned or operated by a county, and where access to those services has been severely restricted. (W&l Code Section 16950(b))

(b) The County shall require physicians who receive funds specified in subparagraph (a) to stop any current, and waive any future, collection efforts to obtain reimbursement from the patient, upon receipt of funds from the County. The contracts may provide for partial or full reimbursement for physician services provided to patients who cannot afford to pay for those services, and for whom payment shall not be made through any private coverage or by any program funded in whole or in part by the federal government. (W&l Code Section 16950 (b))

OTHER HEALTH SERVICES FUNDS - PURPOSE

31. The County agrees to expend all of its 2001-02 Other Health Services allocation received pursuant to W&l Code Section 16960 to maintain and enhance health care services which are:

(a) Provided during FY 2001-02.

(b) Specified in W&l Code Sections 14021 and 14132, and in former Division 1 (commencing with Section 100) and the Communicable Disease Prevention and Control Act as set forth in subdivision (a) of Section 27, of the Health and Safety Code.

(c) Provided to patients, who cannot afford to pay for those services, and for whom payment shall not be made through private coverage or by any program funded in whole or in part by the federal government. (W&l Code Sections 16941,16960(a) and 16961)


OTHER HEALTH SERVICES FUNDS - CONSIDERATIONS AND LIMITATIONS

32. No more than five percent (5%) of the Other Health Services funds specified in paragraph 31 or fifty thousand dollars ($50,000), whichever is greater, shall be expended for costs related to the purchase of equipment and fixed assets and that no single expenditure shall exceed ten thousand dollars ($10,000). (W&l Code Section 16960(b))

33. Consideration shall be given to city public health departments within the County in the use of Other Health Services funds specified in paragraph 31. (W&l Code Section 16960(a))

CONTRACTUAL CONSIDERATIONS AND LIMITATIONS

34. The Department or County may terminate this Agreement by giving at least thirty (30) days written notice to the other party. The notification shall state the effective date of termination.

35. Nothing in this Agreement shall be interpreted to require additional expenditures of County funds for health services beyond those required herein. Also, nothing in this ~ ~ r e e m e n t shall be interpreted to relieve the county of its other obligations to provide health care services to its residents.

36. The Agreement may be amended to conform to any applicable changes in the statutes governing the funds and programs covered in this Agreement.

37. Section 86 of SB 391 (Chapter 294, Statutes of 1997) is hereby incorporated by reference into this Agreement. Reductions in appropriations for CHlP pursuant to Section 86 shall be prorated among the CHlP Counties and the allocations under paragraphs 9, 10, 12, 15,24, and 31, shall be reduced accordingly upon notification by the Department.

APPEAL PROCESS

38. The County may appeal a decision involving CHlP by writing to the Department within twenty-one (21) working days of receipt of written notification. The County's appeal shall be directed to the Department's Chief of the Medically Indigent Services Section. The appeal must clearly describe the issue(s) in question, the fiscal year applicable and include all supporting documentation. The Department shall issue a written decision to the County. The County may, within twenty-one (21) working days of receipt of this decision, pursue a second level appeal. The County must direct the


second level appeal to the Department's Chief of the Office of County Health Services. The second level appeal must clearly describe the issue(s) in question, the fiscal year applicable, and include all supporting documentation. The Chief of the Office of County Health Services has the authority to overrule any part or all of the first level appeal decision. The second level appeal decision is precedent and overrules the first level appeal decision. The Department shall issue a written decision to the County. There is no other level of appeal within the Department.

THIS AGREEMENT FOR FUNDING HAS BEEN SIGNED BY THE COUNTY'S GOVERNING BODY AND IS HEREBY EXECUTED.

THE COUNTY STANISLAUS ACTION AGENDA SUMMARY YES i ?j · Pediatric Subspecialty services including...

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Transcript of THE COUNTY STANISLAUS ACTION AGENDA SUMMARY YES i ?j · Pediatric Subspecialty services including...