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Manatee County Government Administrative Center Commission Chambers, First Floor 9:00 a.m. - December 1, 2015
December 1, 2015 - Regular Meeting
Agenda Item #39


Subject
Health Care Resolution 15-184

Briefings
Briefing Provided Upon Request

Contact and/or Presenter Information

Brenda Rogers, Director, Community Services, x3489

Andy Guyre, Human Services Division Manager, x3493



Action Requested

Motion to adopt Resolution 15-184 creating a funding mechanism for payments to participating healthcare providers for medically necessary healthcare services to eligible Manatee County Residents; and adopt Budget Amendment Resolution B-16-024.



Enabling/Regulating Authority

F.S. 125



Background Discussion

This program is designed to create a mechanism to fund primary care physicians, specialists, clinics, urgent care centers, and other health care providers that do not fit into one of those categories.  Historically, the funding of physicians related to indigent care was tied to an emergency room/hospital visit and was limited to 3 follow-up visits.  This new program encourages citizens to seek help through less expensive options such as doctor's office or clinic for non-emergency health issues instead of calling an ambulance and going to the emergency department.  Participating Providers will sign a document acknowledging that they understand the requirements of the attached program.  They will be trained to use the county purchased software solution (IHS) programmed to allow practices to review a patient's eligibility or to do on-the-spot eligibility determinations.  Participating providers are also required to participate in the HIE Network health information exchange.

This program includes the requirements previously discussed in work sessions and includes:

  • Funding allocated for this program not to exceed $1,250,000 for the entire program, regardless of the number of Participating Providers
  • Invoices will be processed in the order received
  • Covered services are medically necessary treatments as defined by Medicare: "Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine"
  • Services covered by insurance, Medicare, Medicaid, or other funding mechanism are not eligible for coverage in this program
  • This program is effective 10/1/15-9/30/16 and may be extended until a new program is put in place
  • Participation in the HIE.
  • Compliance with HIPAA legislation
  • Participation in partner meetings as scheduled by the county.
  • Participation in Pilot Programs as approved by the Board of County Commissioners.
  • Eligibility is determined at or below 200% of the Federal Poverty Level and county residency
  • Physician Providers may use the county software to determine program eligibility of patients or refer patients to the county for eligibility screenings.

Reimbursement is at the Medicare rate as defined by CMS.

County staff will conduct site visits and monitoring.



County Attorney Review
Other (Requires explanation in field below)

Explanation of Other
Mr. Eschenfelder assisted in the review of the resolution and plan pursuant to RLS 15-306.

Reviewing Attorney
Eschenfelder

Instructions to Board Records

Copy to Community Services once executed.



Cost and Funds Source Account Number and Name
$1,250,000 from General Fund Reserves for Health Care

Amount and Frequency of Recurring Costs
N/A


Attachment:  Resolution 15-184.pdf
Attachment:  Transition Program.pdf
Attachment:  B-16-024 Participating Providers Health Care Funding.pdf
Attachment:  2015 Federal Poverty Level Charts.pdf