Title
Approve and Authorize the Director of Health to sign Amendment No. 5 to the Primary Care Physician Services Agreement, between the Health Department's Clinic Services Bureau and Central California Alliance for Health, changing the Payment Methodology for Primary Care Services from Fee For Service (FFS) to Capitation and changing CCAH's criteria for 2015 for Care Based Incentives.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Approve and Authorize the Director of Health to sign Amendment No. 5 to the Primary Care Physician Services Agreement, between the Health Department's Clinic Services Bureau and Central California Alliance for Health, changing the Payment Methodology for Primary Care Services from Fee for Service (FFS) to Capitation and changing CCAH's criteria for 2015 for Care Based Incentives.
SUMMARY/DISCUSSION:
The report will provide information regarding the two changes Central California Alliance for Health (CCAH) is presenting in this Fifth Amendment to the Primary Care Physician Services Agreement:
1. A change in reimbursement methodology from Fee for Service (FFS) to Capitation.
2. A change in the Care Based Incentive criteria for 2015.
1. The Change in Reimbursement Methodology:
Under the current FFS reimbursement agreement, CCAH pays the Health Department's primary care clinics the Medi-Cal rate for services provided in a face to face visit with a credentialed medical provider. The State of California then pays the balance to equal the Federally Qualified Health Center prospective payment rate.
Under the proposed Amendment, CCAH would pay a Per Member Per Month (PMPM) rate or Capitation, for Primary Care Physician Services for CCAH linked members. This payment methodology would take effect after approval by the County Board of Supervisors and the Community Health Center Board. PMPM rates are based on the patient's Medi-Cal aid code, which is ascertained by the Department of Social Services a...
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