Title
Authorize the Chief Executive Officer of Natividad Medical Center (NMC) to execute the Central California Alliance for Health (CCAH) Fifth (5th) Amendment to the Primary Care Physician (PCP) Services Agreement effective January 1, 2016, changing CCAH’s criteria for 2016 Care Based Incentive Program and updates the Agreement to reflect a program name change.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Chief Executive Officer of Natividad Medical Center (NMC) to execute the Central California Alliance for Health (CCAH) Fifth (5th) Amendment to the Primary Care Physician (PCP) Services Agreement effective January 1, 2016, changing CCAH’s criteria for 2016 Care Based Incentive Program and updates the Agreement to reflect a program name change.
SUMMARY/DISCUSSION:
The Central California Alliance for Health (CCAH) is the Medi-Cal Managed Care Commission for Santa Cruz-Monterey-Merced counties. NMC provides primary care physician services to CCAH members. The County of Monterey, on behalf of NMC, entered into a Primary Care Physician Agreement with CCAH with an original term of January 1, 2011 through December 31, 2011. Since then, the Agreement has been renewed automatically for successive one-year terms, subject to to three termination provisions (immediate termination, termination without cause, termination with cause).
The Care Based Incentive Program is designed to compensate Primary Care Physicians based on a point system for efforts undertaken to improve the care provided to eligible members as reflected by data measured by CCAH. For 2016, CCAH is adding four new measures and changing three others. The incentive payment is made annually to providers.
In addition, the Fifth Amendment updates the Agreement to reflect a name change for the Access for Infants and Mothers (AIM) Program to the Medi-Cal Access Program (MAP). The program benefits, structures and processes remain the same but are being managed by a different state entity. It was formerly overseen by the Managed Risk Medical Insurance Board (MRMIB) and is now managed by the California Department of Health Care Services.
CCAH requests that the County of Monterey sign the agreement prior to CCAH signing.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Amendment No. 5 as to legal form and risk provisions, and the Auditor-Controller has reviewed and approved as to payment provisions. The Amendment No. 5 has also been reviewed and approved by NMC’s Finance Committee on 10/22/15 and by its Board of Trustees on 11/06/15.
FINANCING:
The opportunity for the incentive payment is approximately $60,000. There is no impact to the General Fund.
Prepared by: Nancy Majewski, Managed Care Operations Manager, 783-2385
Approved by: Gary R. Gray, DO, Chief Executive Officer, 783-2504
Attachments:
Amendment 5 Central Calif Alliance for Health
Amendment 4 Central Calif Alliance for Health
Amendment 3 Central Calif Alliance for Health
Amendment 2 Central Calif Alliance for Health
Amendment 1 Central Calif Alliance for Health
Original Agreement with Central Calif Alliance for Health
Attachments on file with the Clerk of the Board