Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with the State of California Department of Health Care Services for Drug Medi-Cal Organized Delivery System Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement and/or subsequent amendments with the State of California Department of Health Care Services for Drug Medi-Cal Organized Delivery System services, for the term of July 1, 2025 through December 31, 2026, for a zero-dollar amount, and authorizing and directing the Chief of San Mateo County Health, or designee, to execute the agreement on behalf of the County.
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BACKGROUND:
In August 2015, the California Department of Health Care Services (DHCS) waiver application with the Center for Medicare and Medicaid Services was approved to begin implementation of the Drug Medi-Cal Organized Delivery System (DMC-ODS). The waiver allowed counties to “opt in” to provide a full continuum of substance use disorder (SUD) treatment services previously unavailable to Medi-Cal beneficiaries. Additionally, the waiver allows for Federal Financial Participation to offset treatment-related costs. Counties opting in were required to submit and receive approval of an Implementation Plan.
San Mateo County was the first California county to apply and be approved for the waiver. For the last ten years, the County has continued to participate in the DMC-ODS waiver and provide the full continuum of SUD treatment services.
The DMC-ODS demonstrates how organized SUD care increases the success of DMC beneficiaries in their journey towards recovery, while decreasing other health care costs. Critical elements of the DMC-ODS include a continuum of care modeled after the American Society of Addiction Medicine Criteria for SUD treatment services; an increase in local control and accountability; creation of utilization management to improve care and provide efficient use of resources; implementation of evidence-based practices; and coordination with other systems of care. Services range from early intervention to intensive inpatient services.
DISCUSSION:
State recommends that the County enter into an agreement with DHCS for DMC-ODS services for a term of July 1, 2025 through December 31, 2026 (“Agreement”).
Through this Agreement, Behavioral Health and Recovery Services (BHRS) will continue to strengthen and expand SUD treatment throughout San Mateo County. Specifically, the Agreement allows BHRS and DMC-certified SUD treatment and recovery providers to access federal funding for Medi-Cal beneficiaries who need SUD treatment. In addition, providers will strengthen their organizational infrastructure to enhance access to care and to increase the quality of treatment provided through implementation of evidence-based practices. Finally, the Agreement ensures continuous quality improvement in treatment through the development and continued refinement of a quality management program that measures and analyzes both beneficiary and system outcomes, developing strategies for improvements where needed. The expanded continuum of care for SUD services includes Mobile Crisis, Early Intervention Services, Outpatient and Intensive Outpatient, Residential Services, Opioid Treatment and expanded Medication for Addiction Treatment (MAT), Withdrawal Management, Recovery Services, Care Coordination, Contingency Management, and Clinician Consultation.
In addition, DHCS determined that the new Agreement no longer required a stated contract dollar amount, as funding used to pay for substance use services flows through a variety of payment mechanisms, such as realignment distributions and per claim federal financial participation reimbursement. DHCS determined that the Agreement is not the vehicle by which those funds are paid to counties. DHCS has statutory authority to reimburse counties, and this approach eliminates the need for future contract amendments that would otherwise be needed to change funding amounts based on actual or estimated expenditures.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The Agreement and resolution have been reviewed and approved by the County Attorney as to form. The Agreement is late coming to this Board due to delayed receipt of the agreement from DHCS.
It is anticipated that 65% of clients will indicate a successful outcome of treatment provided by the Agreement.
PERFORMANCE MEASURES:
|
Measure |
FY 2024-25 Actual |
FY 2025-26 Estimated |
|
Percentage of clients that indicate a successful outcome of treatment provided by the Agreement |
67%
(731 clients)
|
65%
(711 clients)
|
COMMUNITY IMPACT:
The purpose of the Agreement is to deliver comprehensive DMC treatment services to the local Medi-Cal population struggling with SUD. These services have been implemented under an organized delivery system that provides a comprehensive approach and continuum of care that improves engagement, retention, and successful outcomes for those who choose to seek treatment. BHRS provides additional activities covered through other funding sources to plan and promote services relevant to current community needs, such as the opioid crisis, and through programs like Integrated Medication Assisted Treatment, where clients are engaged and followed so when they are ready to recover, action can be taken immediately, which has saved lives.
FISCAL IMPACT:
This is a zero-dollar Agreement. 2011 Realignment and Net County Cost will continue to be used as the required match to draw down Patient Care Revenue for Medi-Cal eligible services.