Miami-Dade Legislative Item
File Number: 082589
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File Number: 082589 File Type: Resolution Status: Adopted
Version: 0 Reference: R-981-08 Control: Board of County Commissioners
File Name: BLUECROSS BLUESHIELD OF FLORIDA, INC. 3-YR. PILOT CONTRACT Introduced: 9/4/2008
Requester: NONE Cost: Final Action: 9/16/2008
Agenda Date: 9/16/2008 Agenda Item Number: 14A4
Notes: Title: RESOLUTION APPROVING THE MIAMI-DADE COUNTY - BLUECROSS BLUESHIELD OF FLORIDA, INC. CONTRACT FOR A THREE YEAR PILOT IMPLEMENTATION OF THE CO-DESIGNED HEALTH INSURANCE PRODUCT FOR UNINSURED RESIDENTS OF MIAMI-DADE COUNTY, AND DIRECTING THE COUNTY MAYOR OR DESIGNEE TO PROVIDE REPORTS TO THE BOARD – CONTRACT NO. EPP-8347A
Indexes: BLUECROSS/BLUE SHIELD
Sponsors: Joe A. Martinez, Prime Sponsor
  Jose "Pepe" Diaz, Co-Sponsor
  Audrey M. Edmonson, Co-Sponsor
  Carlos A. Gimenez, Co-Sponsor
  Sally A. Heyman, Co-Sponsor
  Dennis C. Moss, Co-Sponsor
  Dorrin D. Rolle, Co-Sponsor
  Rebeca Sosa, Co-Sponsor
Sunset Provision: No Effective Date: Expiration Date:
Registered Lobbyist: None Listed


Legislative History

Acting Body Date Agenda Item Action Sent To Due Date Returned Pass/Fail

Board of County Commissioners 9/16/2008 14A4 Adopted P
REPORT: Commissioners Edmonson, Rolle and Heyman asked to be added as co-sponsors to this item. Hearing no further comments or questions, the Board proceeded to vote.

County Manager 9/12/2008 Additions 9/16/2008

Health and Public Safety Committee 9/11/2008 2H Forwarded to the BCC by the BCC Chairperson with a favorable recommendation P
REPORT: Assistant County Attorney Gerald Sanchez read the foregoing proposed resolution into the record. Ms. Janet Perkins, Director, Office of Countywide Healthcare Planning, noted this resolution provided for approval of the contract for the product previously approved by the Commission, with the exact same benefits, price points, and services as approved. Honorable Commissioner Joe Martinez, District 11, Miami-Dade County, appeared as sponsor of this legislation and summarized the purpose of this resolution. He noted the County had come to an agreement with a Letter of Intent to all local hospitals. Commissioner Martinez stated it was hoped those 600,000 uninsured people in the County would be provided catastrophic care, emergency care, and preventive maintenance, at affordable rates. He noted the County’s Office of Countywide Healthcare Planning (OCHIP) would monitor the program to ensure that those using the services were among the 600,000 uninsured individuals. Chairman Moss and Commissioners Sosa, Gimenez, and Diaz commended Commissioner Martinez and Ms. Perkins for their leadership in bringing this program to this community; and each requested to be added as co-sponsor of this resolution. Commissioner Martinez commented that the BCC Healthcare Task Force was created with this program to serve the uninsured people in the County as its goal. He noted there had been no local media coverage on this accomplishment; however, calls had been received from representatives in New York, Washington, Chicago, and Los Angeles, expressing their desires to use the County’s program as a model in their articles. Assistant County Manager Hudak noted this program was accomplished through team effort and recognized the members of the Blue Cross/Blue Shield (BC/BS) organization and the members of the Department of Procurement Management (DPM), present in the audience, for their hard work in this process. Chairman Moss asked all members of the BC/BS, DPM, and OCHIP to stand and be recognized for their important work in developing this program. There being no further discussion regarding this resolution, the Committee proceeded to vote. Chairman Moss requested staff to prepare the appropriate memorandum to the Board of County Commissioners (BCC) Chairman Bruno A. Barreiro requesting a waiver of the Board’s Rules and Procedures to hear the foregoing proposed resolution at the September 16, 2008, Board meeting.

County Attorney 9/5/2008 Assigned Hugo Benitez 9/5/2008

County Manager 9/5/2008 Assigned County Attorney 9/16/2008
REPORT: PROCUREMENT (NEEDS WAIVER)

County Manager 9/5/2008 Assigned Alina Tejeda-Hudak 9/5/2008

Legislative Text


TITLE
RESOLUTION APPROVING THE MIAMI-DADE COUNTY - BLUECROSS BLUESHIELD OF FLORIDA, INC. CONTRACT FOR A THREE YEAR PILOT IMPLEMENTATION OF THE CO-DESIGNED HEALTH INSURANCE PRODUCT FOR UNINSURED RESIDENTS OF MIAMI-DADE COUNTY, AND DIRECTING THE COUNTY MAYOR OR DESIGNEE TO PROVIDE REPORTS TO THE BOARD – CONTRACT NO. EPP-8347A

BODY
WHEREAS, this Board desires to accomplish the purposes outlined in the accompanying memorandum, a copy of which is incorporated herein by reference; and

WHEREAS, Board of County Commissioners approved the design of the low cost health insurance Product on May 20, 2008 contingent on the approval of a contract for a three year pilot implementation of the Board approved Product;


NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY, FLORIDA, that this Board approves the Miami-Dade County - BlueCross BlueShield of Florida, Inc. contract for a three-year pilot implementation of the co-designed health insurance Product for uninsured residents of Miami-Dade County, including specified benefits, premiums, co-payments, coinsurance, and deductibles; in substantially the form attached hereto and made a part hereof, authorizes the County Mayor or County Mayor’s designee to execute same for and on behalf of Miami-Dade County, and directs the County Mayor or designee to provide periodic status reports to the Board.

HEADER
Date:


To: Honorable Chairman Bruno A. Barreiro
and Members, Board of County Commissioners

From: George M. Burgess
County Manager

Subject: Award to BlueCross BlueShield of Florida, Inc. for low cost
health insurance pilot implementation

STAFF RECOMMENDATION
RECOMMENDATION
It is recommended that the Board of County Commissioners (Board) approve a contract with BlueCross BlueShield of Florida, Inc. (BCBSF) to implement a three-year pilot for a co-designed (by the County and BCBSF), low cost health insurance Product for uninsured residents of Miami-Dade County. This Product design was approved by the Board on May 20, 2008.

CONTRACT NO: Contract No. EPP-8347A

CONTRACT TITLE: Low Cost Health Insurance Pilot Implementation

DESCRIPTION:
Pilot Implementation of the low cost health insurance Product for uninsured residents of Miami-Dade County

TERM: Three years from when initial coverage begins (tentatively July 1, 2009)

CONTRACT AMOUNT:
The cost of the pilot will be borne by BCBSF, enrollees and any business which provides coverage for its employees

USING/MANAGING AGENCY: Office of Countywide Healthcare Planning (OCHP)

FUNDING SOURCE:
No County funds will be expended. OCHP staff to provide in-kind resources for coordinated implementation including: monitoring and evaluation, outreach and chronic disease management, as well as possible refinements.

METHOD OF AWARD: Bid Waiver approved by the Board on December 4, 2007

LIVING WAGE: Not applicable

USER ACCESS PROGRAM:
The contract does not contain the 2% User Access Program. This provision does not apply to health benefit programs.

ESTIMATED CONTRACT COMMENCEMENT DATE:
Ten days after date adopted by the Board of County Commissioners, unless vetoed by the Mayor

MANAGER'S BACKGROUND
BACKGROUND
The BCC Healthcare Task Force, established by Ordinance (No. 05-169) through County Commissioner Joe A. Martinez’s leadership, recommended that the County develop a low cost health insurance product to help decrease the significant number of County residents who lack health insurance and to address the growing demand for charity care. Sponsored by Commissioner Martinez and approved by the Board on December 4, 2007, Contract No. 8347: Limited Benefits Insurance Product, directed staff to work collaboratively with BlueCross BlueShield of Florida, Inc. (BCBSF) to co-design a comprehensive insurance product with very low premiums and cost-sharing (deductibles and co-pays). Additionally, the Board waived the competitive process and authorized the Mayor or designee to negotiate a contract with BCBSF to pilot the implementation of the resultant approved health insurance Product (R-1316-07). On May 20, 2008, the Board approved the co-designed insurance Product and authorized the County Mayor or designee to finalize a contract with BCBSF for a three-year pilot implementation (R-602-08). The Board approved the Product’s benefits and rates, including monthly premiums and co-pays (see Appendix A, Attachments A and B respectively). The Board also directed that the Contractor file appropriate forms related to the pilot implementation with the Florida Office of Insurance Regulation (OIR) within thirty days following the effective date of the May 20 resolution. BCBSF submitted a letter of intent to file with OIR on June 23, 2008. This implementation contract must be approved by the Board before BCBSF can enter into contracts with its providers to implement this Product (Miami-Dade Blue). These two stages of contracting must be completed before the Product plan can be submitted to OIR for approval. BCBSF expects to file with OIR between October and November 2008. BCBSF will not modify the insurance coverage without thirty (30) days written advance notice to the County. Thereafter, the County may, at its sole discretion, terminate this contract.

The Product that will be offered to the uninsured residents of Miami-Dade County includes specified benefits, premiums, co-payments, coinsurance, and deductibles. The pilot will include providing a product to an estimated 600,000 uninsured County residents under age 65. Many of the residents targeted for participation in the pilot are unable to afford existing private health insurance and who do not qualify for public programs (such as Medicaid and KidCare). Small group employers who employ less than fifty employees and have not purchased health insurance will also be targeted for coverage. It is the County’s intent that eligibility for the Product shall not be contingent upon immigration status and citizenship.

The following hospitals and health systems are being contracted for participation in the pilot implementation: Hialeah Hospital, Baptist Health South Florida -- Homestead Hospital, Mount Sinai Medical Center, Mercy Hospital, Coral Gables Hospital, Palmetto General Hospital, and Jackson Health System (JHS) (including Jackson Memorial Hospital, Jackson North Medical Center, and Jackson South Community Hospital). Finalization of these provider contracts is contingent upon the completion of the pilot implementation contract between Miami-Dade County and BCBSF.

The provider network will include physician-based services provided by a broad spectrum of doctors ranging from primary care physicians to specialty care physicians, with admitting privileges to the contracted hospital systems including both JHS clinics and Federally Qualified Health Centers. Other ancillary providers will also be included in the network. These providers will include Independent Clinical Lab (Quest Diagnostic), Durable Medical Equipment providers, Independent Diagnostic Testing Facilities, Urgent Care Centers, Pharmacies, and others (see Appendix A, Attachment A).

OCHP staff has facilitated a meeting with representatives from Jackson Health System (JHS), BCBSF, and Federally Qualified Health Centers to begin planning the marketing and outreach campaign. Future meetings are planned to assess and develop marketing and outreach strategies for the pilot implementation thereby ensuring a collaborative approach with the safety-net providers, especially JHS. As part of a coordinated marketing and outreach approach, staff intends to utilize existing County communication resources, including all County media releases. Examples include adding pilot implementation information to the 3-1-1 knowledge base, posting information and outreach events on the County’s Web Portal, Miami-Dade TV (Miami-Dade Now and Miami-Dade Ahora), and in the County’s newsletter and eNewsletter, and Webcasting interviews with Commissioners about the pilot implementation.

The goals of the pilot and any post-pilot full implementation are to (1) increase the number of Miami-Dade County residents who have health insurance; (2) achieve increased sustainability for safety net providers, including Jackson Memorial Hospital, its broader Jackson Health System and Federally Qualified Health Centers; (3) reduce avoidable visits to emergency rooms and hospital admissions; (4) establish a "Medical Home" for enrollees who will have access to a full spectrum of services from primary to inpatient care; and over time, (5) a healthier Miami-Dade County resident population. BCBSF projects that in the first 12 months of enrollment, there will be approximately 4,000 to 6,000 new enrollees.

FISCAL IMPACT/FUNDING SOURCE
This contract with BCBSF is entered into at no cost to the County. Payments for services delivered to insured individuals are made directly to providers through BCBSF provider reimbursements and member co-pays at time-of-service. The Office of Countywide Healthcare Planning (OCHP) will continue to work with BCBSF to refine the design during the pilot period and will coordinate the implementation including: monitoring and evaluation, outreach and chronic disease management. OCHP will perform these responsibilities with existing staff. BCBSF will bear the cost of obtaining regulatory approval of the Product, preparing and implementing a marketing plan and marketing materials, obtaining media purchases and member enrollment, as well as assumption of all claims risk.

TRACK RECORD/MONITOR
BCBSF has more than 60 years of health care experience, with a demonstrated commitment to providing affordable health care solutions to Floridians. BCBSF has a proven track record of financial stability, strong reserves, quality provider networks, value-added services, and high customer satisfaction. BCBSF also has extensive experience in developing limited benefit health insurance products, as well as, innovative health insurance products. Their track record for obtaining the required regulatory approval to implement these products is favorable. OCHP staff will closely monitor enrollment and service utilization reported by BCBSF, and will work with the contractor to engage in continuous quality improvements throughout the three-year pilot implementation. BCBSF has agreed to contract with “safety-net” providers at market rates, thus providing new points of access to enrolled members and a new source of income to the safety-net providers. OCHP will closely monitor the impact to these providers. Staff will provide updates to the County Mayor and Board of County Commissioners after the first six months of the pilot period and regular reporting thereafter.

Upon contract approval, BCBSF will finalize agreements with providers, apply for OIR approval for the plan and rate filings, develop marketing materials and an outreach plan, commence sales, implement a marketing campaign during March-April 2009, and begin enrollment in May, for an effective date of July 1, 2009.



____________________________
Assistant County Manager



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