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PUBLIC SERVICES COMMITTEE
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November 7, 1991
MISCELLANEOUS RESOLUTION #91243
BY: PUBLIC SERVICES COMMITTEE, RUTH JOHNSON, CHAIRPERSON
IN RE: SHERIFF'S DEPARTMENT - OAKLAND COUNTY CORRECTIVE SERVICES
MEDICAL PROGRAM
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Mr. Chairperson, Ladies and Gentlemen:
WHEREAS the Sheriff's Department has experienced an increase
in hospitalization and other medical costs; and
WHEREAS Oakland County anticipates cost reductions by
contracting with Blue Cross/Blue Shield who will act as
administrator of a self insured program; and
WHEREAS Blue Cross/Blue Shield will monitor and contain costs,
review for inmates insurance coverage, bill Medicaid and qualify
Oakland County for a hospital discount; and
WHEREAS the administrative fee charged by Blue Cross Blue
Shield is more than offset by the discount provided by the
designated hospital provider; and
WHEREAS the County Executive and Sheriff's Department has
reviewed the proposed program and is in concurrence; and
WHEREAS this is a pilot program effective for eighteen (18)
months with continuation subject to the approval by both parties;
and
WHEREAS the attached contract has been approved by the County
Executive's Contract Review Process.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners authorizes the Chairman of the Board to enter into an
Administrative contract with Blue Cross/Blue Shield for the Oakland
County Corrective Services Medical Program.
Mr. Chairperson, on behalf of the Public Services Committee,
I move the adoption of the foregoing resolution.
WAYN\BCBS.MR
OCT j 0-1991
OAKLAND COUNTY PRISONERS
[El IER OF UNDERSTANDING
o Pilot program for 18 months.
o Program can be cancelled by either party if program becomes unworkable.
o Outpatient services such as office calls and consultations will continue to be
processed by the county.
o Elective procedures ie a sterilization procedure performed during the delivery of a
newborn will be controlled by the hospital and the county.
o Explanation of Benefit forms will be surpressed by Blue Cross and Blue Shield of
Michigan. The hospital will send rejected charges for services to the county.
o Identification cards will not be issued.
o Blue Cross and Blue Shield of Michigan will be unable to split a hospital bill
because another party may be liable for a portion of the admission.
o The prisoner group will have its own group number and data will be compiled
and reported separately.
o Blue Cross and Blue Shield of Michigan agrees to furnish the county with a listing
of available reports. However some may be furnished at an additional cost.
o Blue Cross and Blue Shield of Michigan agrees to perform Automated Reporting
Mechanism training.
o Blue Cross and Blue Shield of Michigan agrees not to change the proposed
administrative percentage should fewer than expected prisoner contracts be
administered.
o The county agrees to input prisoner social security numbers into the ARM system
within 72 hours of a hospital stay.
BCBSM Representative Oakland County Official
BCBSM Underwriter
BENEFIT EXPLANATION
This is not a contract. It is intended as a brief description of benefits. An official
description of benefits is contained in applicable coverage documents. Any benefits will be
provided pursuant to a contract entered into in the State of Michigan and shall be
construed according to the laws of the State of Michigan.
Cornorehensive
Hospital (0959-7)
Complete hospital care without any co-payments of
deductibles. 120 days for general medical conditions, 30 of
these days may be used for nervous and mental conditions,
another 30 may be used for Pulmonary TB.
DNM365 (1099-1) Increases the maximum number of inpatient hospital care
days:
- For General conditions from 120 to 365 days
- For nervous/mental from 30 days to 365 days
- For pulmonary tuberculosis from 30 days to 45 days
NM365 (4660-7 Increases the inpatient physician care days for treatment of
nervous/mental conditions from 45 days to 365 days.
OPC (2290-5) Provides for out-patient psychiatric care to a maximum
of $400 per member per calendar year.
CC (2286-3) Provides for convalescent care up to 730 days, with
each day of care being charged against the maximum
benefit period as 1/2 day of hospital care
MVF-II (1880-4)
ML (1892-9)
FA.E-RC (0218-8)
PPS (4832-2)
Benefits include surgery, anesthesia, 08 delivery, accidental
injury first aid, diagnostic radiology, therapeutic radiology,
consultation, technical surgical assistance, laboratory and
pathology services; also obstetrics including pre and post
natal care, laboratory services, out-patient psychiatric care
and convalescent care.
This rider eliminates a subscriber's contribution (of $5.00 or
10%, whichever is greater) for diagnostic laboratory and
pathology, diagnostic radiology and therapeutic radiology.
Provides benefits for treatment of medical emergencies and
accidental injury as part of Emergency First Aid, but pays
the reasonable and customary charges of the physician.
-Routine Pap Smear benefits.
AS-1 (4848-8) Ambulance Services - Covers medically necessary
ambulance transportation to or from a hospital.
,Coordination of Benefits against other group health
coverage. The percent of the member's coordination
towards the subscription fee is not a factor.
C0B -3 (0540 -5)
SAT 365 (4967-6) Provides rehabilitation care benefits for substance abuse
- when performed in an approved facility.
HCB-1 (7021-U
Level of coverage is determined based upon location of
service subject to applicable deductibles and coinsurance as
f ollows:
Residential/Inpatient:
According to the available number of nervous/mental days
Each days of care reduces, in equal amounts, the number of
available hospital days.
Benefits renew only when there has been a lapse of at least
60 days between the date of the last admission from a
hospital and the date of the next admission, whether or not
benefits were provided the last hospital confinement.
Outpatient:
35 visits per member, per caldendar year. The total number
of visits is limited to a lifetime maximum of 140 visits under
one or more BCBSM contracts.
Professional Services:
Benefits are provided for inpatient medical care a
inpatient consultations.
Provides Hospice Care Benefits for terminally ill patients
when provided by an approved Hospice program when the
following conditions are met.
1. Member has filed a statement with an
approved Hospice Program electing
Hospice Care Benefits.
2. Member's election occurs on or after
the effective date of the Hospice Care
Benefits Rider.
3. Written certification that the member
is terminally ill must be signed by
the medical director or physician
member of the Hospice Program, and if
the member has an attending physician,
by that physician.
4. Member must sian an agreement waiving
other BCBSM benefits by electing
hospice care. The member must also
sign a statement verifying that they
completely understand the benefits.
Days of Care - Eligible members may elect
Vospice Care which consists of the following:
- one period of 90 consecutive days
- a second period of 90 consecutive days
- a third period of 30 consecutive days
Levels of Care:
- Routine Home Care (less than 8 hours
per day)
- Continuous Home Care (up to 24 hours
during crisis periods)
- Occasional Facility care (up to 5 days
in a 30 day period)
- Short term general inpatient (when
member is admitted for pain control or
systems management).
SOT-FE (9909-3) Normal Services for Human Cornea, Kidney, Skin & Bone
Marrow transplants - plus additional services in approved
facilities, with no copayments, only for Liver, Heart, Heart-
Lung or Pancreas - from 5 days before to one year after,
including: $10,000 for transportation, meals & lodging for
patient &. one companion (two if patient is a minor) - up to
$10,000 a year for anti-rejection drugs, renewed yearly - to
a lifetime maximum of $1 million (for additional services
only) - contracts effective on or after 4-1-85, subject to a 9
month wait for pre-existing conditions.
GLE-1 (9930-9) Excludes benefits for care, services, supplies or devices
which are experimental or research in nature.
RM (7562)
EF/XF (Exact Fill)
(0627-0/1991-9)
Provides benefits for routine mammograms to screen for
cancel of the breast subject to the following frequency
1. One baseline mammogram when the member
is at least age 35 and less than 40.
2. One mammogram in any calendar year
when the member is age 40 and older.
More frequent mammograms will be covered when
specifically prescribed because of the presence of suspect
malignancy or required as a postoperative mammogram.
Benefits for mammogram are subject to any members
liability requirements for diagnostic services.
Complements Medicare Part A by paying covered basic
benefits in amounts which are not covered by Medicare
benefits. Eligible subscribers are entitled to
receive benefits qual to those in the Comprehensive
Hospital Certificate and any benefit riders
excluding benefits provided by Medicare.
Case Management
Prosthetic Appliances
ICMP (6003)
PA (6234-4)
FINANCE COMMITTEE
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November 21, 1991
FISCAL NOTE
BY: FINANCE COMMITTEE, DR. G. WILLIAM CADDELL, CHAIRPERSON
IN RE: SHERIFF'S DEPARTMENT - OAKLAND COUNTY CORRECTIVE SERVICES
MEDICAL PROGRAM -MISCELLANEOUS RESOLUTION #91243
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Mr. Chairperson, Ladies and Gentlemen:
Pursuant to Rule XI-G of this Board, the Finance Committee has
reviewed Miscellaneous Resolution #91243 and finds:
1) For the period January through September 1991, the
Sheriff's Department spent $769,176 for hospitalization
and other outside medical costs.
2) Blue Cross Blue Shield has estimated Oakland County's
annual cost for Corrective Services to be $1,051,600.
By contracting with Blue Cross/Blue Shield, the County
would be able to obtain a 23.3% hospital discount at the
North Oakland County Hospital (which amounts to $200,500)
thus reducing medical costs to $851,100.
The cost to contract with Blue Cross/Blue Shield is
11.35% of medical costs (estimated at $96,602.)
The proposed pilot program (covering the period January
1992 - June 1993) contemplates reduced costs by
monitoring costs and paying no more than Blue Cross/Blue
Shield's established maximum rates.
If funds are available at the close of 1992, a reserve
will be established to provide for future fluctuations in
patient days and anticipated increases in daily rates.
7) The 1992 - 1993 Budget will be amended during the budget
process.
wayn\bcbs.mr
Resolution # 91243 November 21, 1991
Moved by Johnson supported by Moffitt the resolution be adopted.
—AYES: Oaks, Olsen, Palmer, Pernick, Schmid, Serra, Skarritt, Wolf, Aaron, Bishop,
Caddell, Crake, Ferrens, Gosling, Nuntoon, Jensen, Johnson, Krause, McCulloch, McPherson,
Millard, Moffitt. (22)
NAYS: None. (0)
A sufficient majority having voted therefor, the resolution was adopted.
• STATE OF MICHIGAN)
COUNTY OF OAKLAND
I, Lynn D. Allen, Clerk of the County of Oakland, do hereby certify that the foregoing
resolution is a true and accurate copy of a resolution adopted by the Oakland County
.Board of Commissioners on November 21, 1991
with the original record thereof now rKna1iiing -TF1 my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County
of Oakland at Pontiac, Michigan this 21st day af—) November 1991
x - , y
Lynn/Z Ainn, County Clerk