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Non-Contracted Services at Heart of Two Court Cases

A woman named Fucino, who is eligible for the County Medically Indigent Services Program (CMISP) and gets her care in Sacramento County, one day traveled to Monterey County to visit family. While in Monterey, she had a health issue that landed her in the emergency department in that county.

Does Sacramento County have to pay for that out-of-county ED visit? And more important, what does all of that have to do with a multimillion-dollar lawsuit filed against the county by UC-Davis?

The answer to the latter question is: non-contracted services. It’s the same principle at the core of both cases, where the court has to decide whether or not the county should pay for non-contracted services.

So far, the courts have been saying yes, the county needs to pay, according to David Levine, in-house legal counsel for UC-Davis.

“The center of it relates to county’s responsibility to pay for services rendered to indigents,” Levine said. “[For some of the time], there was no contract between the county and UC-Davis,” Levine said.

And that’s precisely what’s at-issue in the Fucino case, Levine said. “On balance, Fucino basically validates what we’ve been saying all along. The county can’t escape paying for the main provider of care in the area for indigents.”

Sacramento County officials declined to speak on the record. They said they can’t discuss cases that are in litigation.

It was a year ago this month when a U.S. district court judge first ruled that the county was liable for non-contracted services provided by UC-Davis Medical Center. Part of the appeal likely will be heard in late September, both sides said.

“We’re talking large sums of money,” Levine said. “In the rough sense, the county entered into a three-year arrangement to pay for CMISP services, and the total was $102 million, roughly $30 million that first year.” So it’s at least that $30 million-plus a year at stake here, Levine said, “but their exposure is far greater than that, I think.”

Sacramento County lost a lawsuit last year when it tried to cut outpatient mental health services as a cost-saving measure.

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