Undocumented+Patients

Obtaining care for Undocumented Patients: (per email from Oliver, August 2009)
Basically, if you think a patient needs specialty appt at CCRMC you get your attending to fill out a form. If you are in the ER, you need to call a surgical/FP/medicine inpt attending for authorization. Note this is a temporary process for certain select patients who need specialty care.... for primary care they will go to a non-CCHP community clinic.

Also note that this is a brand new process that will require some time for our staff to learn about... it may not go super smoothly for the time being.

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Due to a serious budget deficit, Contra Costa County’s Board of Supervisors eliminated non-emergency benefits in the Basic Health Care Program (BHC) for adults who are undocumented effective May 1, 2009. This decision only affects undocumented adult residents of Contra Costa County with incomes less than 300% of poverty.

In an effort to provide improved care for uninsured patients with complex medical or surgical conditions, it was also decided to allow certain patients to recieve temporary care through CCHS. Patients who recieve this service will be eligible for labs, studies, medications, and specialty clinic visits through the CCHS system for 30 days.

The "gatekeepers" to determine which patients are eligible for these exceptions will be the inpatient surgical, family practice and medicine attendings. The expectation is that these exceptions will only be implemented in the following situations: • Patients who have medical or surgical issues that cannot be effectively managed by the community clinic and require temporary treatment by a CCHS specialty physician • Authorization can also be granted as a temporary effort to reduce hospital admission/readmission rates, frequent ER visits, or prolonged inpatient stay. For outpatients who may be candidates for these exceptions not seen in the ER or inpatient setting, authorization from Steve Tremain is required.

Below is a summary of the protocol that has been developed to help streamline the process for identifying patients that may be candidates for temporary CCHS specialty care. For further details, please see the attached document.

For undocumented patients admitted to the hospital: • 1. The financial counselor will see the patient and determine his/her financial class. If the patient is undocumented and financially eligible, the financial counselor will obtain an authorization for followup at one of the non-CCHS community clinics for ongoing primary care. The financial counselor will document this information on the "financial assessment form" which will be put in the chart next to the face sheet. • 2. At discharge, if the providing doctors determine that temporary outpatient specialty care is required at CCHS, the attending physician fills out and signs the bottom section of the "financial assessment form". The patient will then be able to receive labs, studies, medications and specialty clinic visits at CCHS for up to 30 days. These patients will continue to receive ongoing primary care at their non-CCHS community clinic.

For undocumented patients seen in the ER, not admitted to hospital: • 1. The financial counselor will see the patient and determine his/her financial class. If the patient is undocumented and financially eligible, the financial counselor will obtain an authorization for followup at one of the non-CCHS community clinics for ongoing primary care. The financial counselor will document this information on the "financial assessment form" which will be put in the ER chart. • 2. If the providing ER doctor determines that temporary outpatient specialty care is required at CCHS, s/he will contact the surgical/family practice/medicine attending on call to get authorization, then document this on the "financial assessment form." The patient will the be able to receive labs, studies, medications, and specialty clinic visits at CCHS for up to 30 days. These patients will continue to receive ongoing primary care at their non-CCHS community clinic.



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