Title
a. Approve and ratify execution by Director of Health of an Affiliation Agreement (“Agreement”) with Clinica de Salud del Valle de Salinas (“CSVS”), for the provision of dental care services by CSVS to County patients as referred, with a retroactive effective date of January 1, 2011 and which shall renew automatically for subsequent terms of five (5) years each unless earlier terminated or amended; and
b. Approve and ratify execution by Director of Health of Amendment No. 1 to Agreement, with a retroactive effective date of December 16, 2014, adding Sliding Scale Discount Fee, and Insurance and Indemnification language.
c. Approve and authorize execution by Director of Health of three (3) future amendments to Agreement that do not significantly change the scope of service.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and ratify execution by Director of Health of an Affiliation Agreement (“Agreement”) with Clinica de Salud del Valle de Salinas (“CSVS”), for the provision of dental care services by CSVS to County patients as referred, with a retroactive effective date of January 1, 2011 and which shall renew automatically for subsequent terms of five (5) years each unless earlier terminated or amended; and
b. Approve and ratify execution by Director of Health of Amendment No. 1 to Agreement, with a retroactive effective date of December 16, 2014, adding Sliding Scale Discount Fee, and Insurance and Indemnification language.
c. Approve and authorize execution by Director of Health of three (3) future amendments to Agreement that do not significantly change the scope of service.
SUMMARY/DISCUSSION:
The County currently operates ten Federally Qualified Health Center look-alike (FQHC-LA) clinic sites, which are mandated by Health Resources and Services Administration (HRSA) to provide primary health services to all patients regardless of ability to pay. Required primary health services, defined by the federal Section 330 statute, includes preventive dental services. FQHCs are permitted to provide required services either through staff and supporting resources of the center or through contracts or cooperative arrangements. The County does not provide direct dental services, so in September 2010, Clinic Services contracted with a local FQHC, CSVS to provide dental care services to County patients as referred.
FQHCs are required to establish a fee schedule for its services that is consistent with locally prevailing rates and reflects the health center’s reasonable costs of providing services. Centers must also establish a schedule of discounts (or sliding fee scale) for individuals who earn annual incomes equal to or less than 200% of the current Federal Poverty Guidelines. These discounts are applied to the schedule of charges for under-insured and uninsured patients when these patients incur out-of-pocket costs.
The Amendment No. 1 shall add language to the Affiliation Agreement, clarifying that Sliding Scale Discount Fees will be made available to those eligible patients referred to CSVS for dental care services. In addition, the Amendment includes County standard insurance and indemnification language that was not in the original Agreement.
The original Agreement with CSVS did not receive written approval from County Counsel or County Risk Management. There are no financial terms in the Agreement; therefore, approval from the County Auditor was not sought. County Counsel has reviewed and approved Amendment No. 1. County Risk Management did not sign the Amendment since they did not sign the original Agreement. Neither the Agreement nor Amendment No. 1 have fiscal terms. Contract negotiations and acceptance of County standard insurance language caused a delay in the Amendment going forward to the Board.
The Agreement and Amendment No. 1 support the Monterey County Health Department 2011-2015 Strategic Plan initiatives to: 3. Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports one or more of the ten essential public health services, specifically: 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and concurs with this recommendation. The Agreement and Amendment No. 1 are on file with the Clerk of the Board.
FINANCING:
There are zero County costs associated with the dental referral Affiliation Agreement. Sufficient appropriations and revenues are available in FY 2015-16 Health Department Adopted Budget 4000- HEA007 to cover any operational expenditure.
Prepared By: Stephanie Shonley, Management Analyst, 1313
Approved By: Ray Bullick, Director of Health, 4526
Attachments:
Agreement is on file with the Clerk of the Board
Amendment No. 1 is on file with the Clerk of the Board