LA County Board

27. Medicare Enrollment Agreement\nRecommendation: Authorize the Director of Public Health to execute and\nsubmit an application for Medicare Enrollment with the Centers for\nMedicare and Medicaid Services (CMS) that will enable Public Health to\nre-enroll in Medicare and bill CMS as a participating Medicare provider\nunder Public Health’s newly issued Tax Identification Number; negotiate,\nprepare, execute, and operationalize future agreements to receive\nreimbursement for eligible Public Health services from health payors\nincluding, but not limited to, public payors such as Medi-Cal and Medi-Cal\nManaged Care Organizations, Medicare and Medicare Managed Care\nOrganizations, commercial health insurance companies, Accountable Care\nOrganizations, provider groups, pharmacy benefit networks, and State or\nFederal specialty programs with these agreements including, but not limited\nto, memoranda of understanding, provider agreements and other\nagreements, to use rates that are at or above Public Health's aggregate\naverage variable cost for all services or other prevailing market/industry\nreimbursement rates, Department of Health Services rates, Medi-Cal Fee\nSchedule, Medi-Cal Interim Reimbursement Rates, Medicare rates, a\npercentage above Medi-Cal or Medicare rates, or a combination thereof;\nagreements may include indemnification provisions that deviate from the\nCounty's standard indemnification provisions and require use of binding\narbitration to resolve disputes; and authorize the Director to take the\nfollowing actions: (Department of Public Health) APPROVE\nNegotiate, prepare, and accept agreements for incentives, awards,\ngrants, and other payments from health payors, which may include\nindemnification provisions that deviate from the County's standard\nindemnification provisions;\nExecute amendments, renewals, and extensions to agreements for\nreimbursement, incentives, awards, grants, and other payments from\nhealth payors, add new services, incorporate new or revised State or\nFederal law and regulations, accreditation requirements, or County\nrequirements, as applicable, adjust rates on a prospective basis,\nbased on reimbursement rate mechanisms noted above, make\nappropriate changes to the agreements to improve clarity and correct\nagreement deficiencies, errors, and omissions;\nTake actions to effectuate the agreements as required by law,\nregulation, rule, or guideline, to enable Public Health to receive\npayment, required actions may include executing subsidiary\nagreements, filing certifications or attestations, paying administrative\nfees, or making intergovernmental transfers, as required to obtain\nsuch funds under such agreements; and\nTerminate any health payor agreements that the Director determines\nare not cost-effective, are non-performing, or do not meet the\nrequirements of the County, or a combination of these. (23-4116)\nAttachments: Board Letter\nPublic Comment/Correspondence