| Present: | Excused: | Unexcused: |
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Ingrid Lamirault Jane Garcia (Chair) Michael Mahoney (Vice-Chair) Ray Davis, Jr. MD Pamela Gumbs Wright Lassiter Marty Lynch John Norton Linda Price Gail Steele Richard Thomason |
Pamela |
| Agenda Item (& Supporting Documents) | Speaker | Discussion Highlights | Action | Follow-Up Required | ||||||||||||||||||||||||
| Call to Order | Jane Garcia | Meeting was called to order at 9:35 a.m. by Jane Garcia. A quorum of the members was present. | None | None | ||||||||||||||||||||||||
| Approval of Agenda Attachment 1.17.08 Agenda |
Jane Garcia | J. Garcia asked for a motion to accept this month's agenda. | Motion: L. Price Second: R. Davis Vote: Unanimouss |
None | ||||||||||||||||||||||||
| Approval of November Meeting Minutes Attachment 11.29.07 Meeting Minutes |
Jane Garcia | J. Garcia asked for a motion accepting the November meeting minutes. | Motion: M. Lynch Second: W. Lassiter Vote: Unanimous |
None | ||||||||||||||||||||||||
| Chair’s Report | Jane Garcia | The Chair summarized the single action taken during the 11-29-07 Closed Session meeting/ Approval of PRCC recommendations for provider credentialing. | None | None | ||||||||||||||||||||||||
| CEO’s Report Six Attachment o CEO Report o 2007 HEDIS Rates o IPs 2007 HEDIS o Provider Bulletin August o Provider Bulletin October o Provider Bulletin November/December |
I. Lamirault | None | None | |||||||||||||||||||||||||
| Finance Committee Attachment 12.31.07 Financial Report |
John Volkober | Financial report for month ended December 31, 2007. J. Garcia asked for a motion accepting the December's financial statements. | Motion: M. Lynch Second: G. Steele Vote: Unanimous |
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| Overview of State Challenges | Jim Gross Peter Harbage |
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| Adjourned for Break | Jane Garcia | A break was taken at 11:20 a.m. | None | None | ||||||||||||||||||||||||
| Readjourned from Break | Jane Garcia | Meeting was resumed at 11:35 a.m. | None | None | ||||||||||||||||||||||||
| Strategic Planning Meeting Medi-Cal |
I. Lamirault | • Modest membership growth • At best, we will see no increase premium revenue; more likely to receive a decrease in premiums • Rising medical expense: prescription drugs; inpatient services • Will break even this fiscal year • Losses next year $5-$7 million range • Last year, we were encouraged by the State’s implementation of the new premium setting methodology. Believed there was now rationality in the process and that we could make a case for a rate increase. • Although State still kept latitude to set actuarially sound rates within a range, if we could show increased utilization and cost for our market, we could at least get the lower end of the range. • We submitted our documentation in December – making a compelling case for 10% increase ($13.2 million given current member mix). If the State sticks to its stated process, we will be meeting with them in February to make a verbal case. |
------ | • Finance Committee review feasibility of obtaining a line of credit to ensure cash flow. • Staff prepare a resolution for Board review and approval outlining a contract reimbursement policy to guide staff negotiations over the next 6-12 months. |
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| • If we were in normal times and the State kept its commitment for actuarially sound rates based on utilization, the Medi-Cal fee schedule, and unique cost pressures associated with the Bay Area, I am convinced that we would get some type of modest rate increase. • Page 7 summarizes our current and projected position for Medi-Cal only:
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| Critical Issue • We will not have enough cash to handle anticipated and anticipated delayed payments and provide provider rate increases for Medi-Cal. For providers, vendors, and payroll, we spend approximately $12-$13 million a month. We currently have $25 million in reserves. • As a body we need to agree that increases for Medi-Cal services are impossible to give to providers over the next year, maybe two. We need to be clear about the implications of this decision (shrinkage of provider network, providers having to shut down to new patients to make their patient mix more profitable; access problems for members). • Review current Board-approved policy that shapes our negotiations with providers and see if there is agreement for a temporary tightening of the parameters. If our discussion takes the shape of some type of consensus, we will prepare a Board resolution for our March meeting. Current Board-approved policy includes: |
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| Hospitals: 100% CMAC levels; increases provided upon notice to plan once CMAC grants a hospital FFS rate increase Directly Contracted PCPs: 110% Medi-Cal FFS rates Specialists: Most at 100% Medi-Cal FFS or Medicare equivalent; harder to access specialists are paid at higher rates Medical Groups: No Board policy |
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| Chief Medical Officer’s Report Attachment Formulary Updates |
A. Chen, MD | J. Garcia asked for a vote to accept the proposed changes on the December 2007 Forumulary Changes. | Motion: M. Lynch Second: L. Price Vote: Unanimous |
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| Other Business | J. Garcia | None | None | None | ||||||||||||||||||||||||
| Public Comments | J. Garcia | None | None | None |