County of Ventura - Health Care Agency
UNCOMPENSATED CARE PROGRAM

Tobacco Settlement Funds (TSF) - Private Physician Funds

Supplement to EMSF/CHIP Policies & Procedures

I. INTRODUCTION:

The Ventura County Board of Supervisors, upon recommendation of the Tobacco Evaluation and Allocation Oversight/Advisory Committee, approved the allocation of $900,000 for 2001 to reimburse Private Physicians for certain professional emergency medical services rendered in Ventura County. Subsequent year funding will be announced and is contingent upon approval of the County Board of Supervisors. The "EMSF/CHIP Uncompensated Care Program Policies and Procedures" will be the basis for which claims will be eligible and processed, with the exception of additional rules and criteria as provided herein.

II. Eligible Service Criteria:

A. Supplement to the "EMSF/CHIP Uncompensated Care Program": Historically, the reimbursement through the EMSF/CHIP Uncompensated Care Program has been well below the 50% of eligible claimed charges as provided by statute.

If EMSF/CHIP funds are not sufficient to pay all eligible claims up to 50% of eligible charges "based on RBRVS Unit Values and 200% of Medicare Allowable Conversion rates", then allocated Tobacco Settlement Funds (TSF) will be utilized to supplement the reimbursement up to the 50%.

B. Emergency Services Beyond 48 Hours: The "EMSF/CHIP Uncompensated Care Program" only provides reimbursement to physicians for care rendered in an Emergency Room within 48 hours of admission to a hospital within Ventura County.

Allocated Tobacco Settlement Funds will be utilized to cover the provision of emergency services rendered by a physician or surgeon beyond 48 hours of admission to a hospital and within 60 days of the initial services rendered in an Emergency Room within Ventura County, regardless of location (in office, hospital in-patient or out-patient).

Claims for services rendered beyond 48 hours of admission to a hospital and within 60 days of the initial services rendered in the Emergency Room must reference the date and Provider of the initial emergency Room visit (See section 19(4) of Client Data Form).

III. Funding Availability:

The availability of Tobacco Settlement Funds for this program is contingent upon the annual allocation of the Board of Supervisors. The total funds allocated for Private Physicians administered through aforementioned "Policies and Procedures" are to be distributed as follows:

1) As per Section II.A. above, a maximum of 60% of the total allocated Tobacco Settlement Funds for Private Physicians will be utilized to supplement the EMSF/CHIP reimbursement up to the 50% of the eligible charges.

2) As per Section II.B. above, a minimum of 40% or the remaining balance of the total allocated for Private Physicians will be utilized to reimburse emergency services provided beyond 48 hours of admission to a hospital.
Jan. 2002