DATE: December 6, 2016
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Amendment II to Agreement with Corizon Health, Inc. and Authorization to Approve Reimbursement Claims for County inmates eligible for Medi-Cal County Inmate Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment II to Agreement No. 14-118 with Corizon Health, Inc., for a refund to the County for Medi-Cal covered inpatient hospitalization and associated services for eligible inmates, effective December 6, 2016, with no change to the compensation amount or term of August 1, 2015 through June 30, 2019, ($105,515,146).
2. Authorize the Director of the Department of Public Health, or designee, to approve claims for reimbursement from providers for medical care provided to eligible inmates with service dates as of January 1, 2015 through March 31, 2017.
REPORT
Approval of the first recommended action will allow Corizon Health, Inc. (Corizon) to provide an initial $3,400,000 refund by December 30, 2016, and approximately $3,500,000 by May 2017 to the County for Medi-Cal covered inpatient hospitalization services. The refunded amount would be used to pay Community Regional Medical Center (CRMC) and other medical providers for inpatient hospitalization services provided to eligible County adult inmates and juvenile wards (eligible inmates) from January 1, 2015 through March 31, 2017.
Approval of the second recommended action would authorize the Director of the Department of Public Health to approve and reimburse claims for services as of January 1, 2015 through March 31, 2017, as provided by the Department of Health Care Services (DHCS) Medi-Cal County Inmate Program (MCIP) to eligible inmates. It is anticipated the County would later be able to seek reimbursement for these retrospective services from the DHCS MCIP. The recommended amendment would also execute one of the two one-year extensions in the existing contract, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department will not be able to participate in the retrospective reimbursement for MCIP from DHCS. In addition, an alternative would need to be developed to reimburse CRMC and other providers for those services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The proposed amendment does not change the term or maximum compensation ($105,515,146) of the agreement. The recommended amendment will allow Corizon to refund the County for unpaid Medi-Cal covered services for eligible inmates provided by CRMC and other medical providers with dates of service between January 1, 2015 and March 31, 2017.
Effective, December 30, 2016, a refund to the County of $3,400,000 will be made by Corizon, the estimated remaining balance ($3,500,000) of provider claims will be reimbursed in one-third increments by the fifth day of each month of March, April and May 2017. The Department will pass-through the refunded amount to providers for MCIP covered services by service date order from January 1, 2015 through September 30, 2016. For those retrospective services, the County will share 75% of the MCIP net Federal Financial Participation (FFP) reimbursement with Corizon. For the services from October 1, 2016 through March 31, 2017, Corizon will adjudicate the claims, forward the claims to the Department for payment, thereby deducting from Corizon’s monthly payment for those claims.
It is anticipated that the retrospective claims (prior to April 1, 2017), would eventually be covered and reimbursed by DHCS through the MCIP, in what the Department anticipates will include FFP. The reimbursement is only available if the County paid the providers and not a third party such as Corizon. Corizon will provide the claims, and the County will, in turn, bill DHCS for MCIP reimbursement.
Sufficient appropriations and estimated revenues are included in the Department Org 5620 FY 2016-17 Adopted Budget.
DISCUSSION:
On March 25, 2014, your Board approved Agreement No. 14-118 with Corizon to provide comprehensive medical and behavioral health care services to the adult inmates and juvenile wards housed within County detention facilities including inpatient hospitalization costs effective June 23, 2014. On July 14, 2015 your Board approved Amendment I to Agreement No. 14-118 to implement provisions for staff and services identified in the Quentin Hall Settlement Remedial Plan (remedial plan).
The existing agreement with Corizon includes payment in addition to the base compensation, for emergency, inpatient hospitalization and outpatient specialty care services. The recommended amendment would provide for a refund of payments made to Corizon for the inpatient hospital services and identify the Medi-Cal covered claims for eligible inmates. Your Board’s approval of the recommended actions would allow for the payment process to medical service providers.
The recommended Amendment II would:
a. implement one of the two one-year extensions (July 1, 2017 to June 30, 2018);
b. provide a correction action plan to further implement provisions for staff and services under the remedial plan; and,
c. provide funds to the County to reimburse providers for retrospective inpatient hospitalization and associated medical services provided to Medi-Cal-eligible inmates.
On April 1, 2017, DHCS is expected to begin the implementation of the MCIP which allows for reimbursement of prospective covered claims for services provided to Medi-Cal eligible inmates. Counties are required to enter into an agreement with DHCS to participate in MCIP. The Department will bring the MCIP agreement to your Board for approval when it becomes available from DHCS.
MCIP allows for reimbursement of certain correctional health, inpatient hospitalization care for County Medi-Cal-eligible inmates directly to medical providers effective with service dates on or after April 1, 2017. Services provided before April 1, 2017, retrospective services, may be reimbursed to counties who have paid providers for MCIP covered services. Reimbursement for the retrospective services will be for the FFP portion of the Medi-Cal fee-for-service rate.
The recommended amendment would be effective December 6, 2016 and would execute one of the two one-year extensions in the existing Corizon contract. The designation would be retroactive to January 1, 2015 allowing for the pass-through reimbursement of inpatient hospital care and associated medical services to MCIP eligible inmates.
REFERENCE MATERIAL:
BAI #58 - July 14, 2015 - Corizon Health, Inc. Amendment I to Agreement No. 14-118
BAI #6 - March 25, 2014 - Corizon Health, Inc. Agreement No. 14-118
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment II to Agreement No. 14-118 with Corizon Health, Inc.
CAO ANALYST:
Sonia M. De La Rosa