Title
a. Ratify United Health Care Insurance (“Agreement”) Between United Healthcare and Natividad Medical Center (“NMC”), executed by the former Chief Executive Officer for NMC, for an original one year term effective December 22, 2009, renewing annually effective January 1, 2011, until terminated pursuant to the Agreement.
b. Authorize execution by the Chief Executive Officer of NMC of Amendment No. 1 to Agreement, designating County of Monterey, on behalf of NMC, as the proper party to the Agreement, revising reimbursement rates and implementing medical necessity protocols effective January 1, 2016.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors
a. Ratify UnitedHealth Care Insurance (“Agreement”) Between United Healthcare and Natividad Medical Center (“NMC”), executed by the former Chief Executive Officer for NMC, for an original one year term effective December 22, 2009, renewing annually effective January 1, 2011, until terminated pursuant to the Agreement.
b. Authorize execution by the Chief Executive Officer of NMC of Amendment No. 1 to Agreement, designating County of Monterey, on behalf of NMC, as the proper party to the Agreement, revising reimbursement rates and implementing medical necessity protocols effective January 1, 2016.
SUMMARY/DISCUSSION:
United Healthcare Insurance provides health care coverage to members. United Healthcare and NMC have had a long standing relationship and desire to continue the relationship.
The initial agreement was entered into as of December 22, 2009 by the former CEO, without obtaining County Counsel approval. The renewal and Amendment No. 1 designates County of Monterey, on behalf of NMC, as the proper party to the Agreement, revises reimbursement rates to include trauma services and implements medical necessity protocols effective January 1, 2016. The Agreement renews annually, with a prior written notice of termination 120 days before the next annual renewal date.
United Healthcare has requested that the County of Monterey approve and sign the agreement before United Healthcare signs the amendment.
Section 1457 of the Health and Safety Code provides that the records of a hospital or any other county medical facility that reveal the rates of payment for health care services rendered by, or purchased by, the hospital or other medical facility shall not be considered public records subject to disclosure pursuant to the California Public Records Act. Cal. Health & Safety Code § 1457(c)(1). Accordingly, the payment rates have been redacted from the attached copy of the Agreement.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Agreement and Amendment No. 1 as to legal form and risk provisions. The Agreement and Amendment No. 1 has also been reviewed and approved by NMC’s Finance Committee on 10/22/15 and by the NMC Board of Trustees on 11/06/15.
FINANCING:
There are no costs associated with this Agreement and Amendment No. 1as United Healthcare will be paying NMC for services provided to United Healthcare patients.
Prepared by: Nancy Majewski, Managed Care Operations Manager, 783-2385
Approved by: Dr. Gary Gray, Chief Executive Officer, 783-2553
Attachments:
Amendment No. 1 UHC Agreement
UHC Agreement (rates redacted)
Attachments on file with the Clerk of the Board