Special Notice / Hearing: None
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Lee Pullen, Director, Aging and Adult Services
Subject: Amendment to the Agreement for California Advancing and Innovating Medi-Cal Community Supports services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement for Aging and Adult Services to provide California Advancing and Innovating Medi-Cal Community Supports services for clients of the San Mateo Health Commission dba Health Plan of San Mateo, to increase the agreement to an amount not to exceed $316,640.
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BACKGROUND:
Prior to 2014, San Mateo County Health’s Aging and Adult Services (AAS) division contracted with the California Department of Aging to provide Multipurpose Senior Services Program (MSSP) services, a program of social and health care management services for frail older adults. In 2014, San Mateo County (County) was selected by the State, through Health Plan of San Mateo (HPSM), to be one of eight counties to participate in Cal MediConnect, a program that promoted and coordinated health care delivery for Californians dually eligible for Medicare and Medi-Cal. HPSM paid the County a fixed monthly amount for each Cal MediConnect participant who received MSSP services. This arrangement continued after the three-year pilot.
The new California Advancing and Innovating Medi-Cal (CalAIM) initiative was introduced in January 2022. CalAIM offers Medi-Cal recipients services that aim to improve the health and well-being of the whole person, moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care ( the model that coordinates health, behavioral health and social services in a client centered manner). The program is designed to extend supports and services beyond hospitals and health care settings, directly into California communities.
Medi-Cal enrollees with complex health needs and unmet social needs are at particularly high risk of hospitalization and institutionalization and often need high-cost services. To respond to the needs of this community, the California Department of Health Care Services (DHCS), as part of CalAIM, established a new statewide benefit called Community Supports (CS).
Enhanced Care Management (ECM) and CS are foundational components of CalAIM. AAS also provides ECM services for HPSM clients. ECM services is a program that helps clients with complex medical and social needs beyond traditional medical
services.
Medi-Cal managed care plans are designed to address social drivers of health and are encouraged to offer as many of the 14 pre-approved CS services as possible. CS services are available to eligible Medi-Cal members, regardless of whether they qualify for ECM.
The 14 CS services are:
• Housing Transition Navigation Services
• Housing Deposits
• Housing Tenancy and Sustaining Services
• Short-Term Post-Hospitalization Housing
• Recuperative Care (Medical Respite)
• Day Habilitation Programs
• Caregiver Respite Services
• Nursing Facility Transition/Diversion to Assisted Living Facilities
• Community Transition Services/Nursing Facility Transition to a Home
• Personal Care and Homemaker Services
• Environmental Accessibility Adaptations (Home Modifications)
• Medically Supportive Food/Meals/Medically Tailored Meals
• Sobering Centers
• Asthma Remediation
DISCUSSION:
AAS provided respite and attendant care services to MSSP clients prior to the launch of CalAIM. Beginning in 2022, HPSM contracted with AAS to provide: 1) Caregiver Respite services and 2) Personal Care and Homemaker services under the CS program (in addition to the separately contracted ECM services). At first, CS was primarily offered to ECM participants but is now available to all HPSM members who receive AAS services. Between January 2022 and June 2023, AAS provided 7,498 respite services hours to support the caregivers of 78 San Mateo County Medi-Cal recipients and 1,308 Personal and Homemaker services hours to three Medi-Cal eligible recipients. AAS plans to expand its services to more eligible members in need.
Beginning January 1, 2024, AAS began offering Community Transition Services /Nursing Facility Transition to a Home. This additional CS service coordinates with community partners and reduces re-admissions to healthcare institutions.
Under the new CS amendment, the County will also expand program eligibility from AAS ECM recipients to any AAS clients who need and are eligible for respite services or personal care and homemaker services. The County contracts with community-based organizations and individual caregivers to provide respite, personal care, and homemaker services. This amendment is coming to your Board late due to prolonged negotiations with all stakeholders, including HPSM.
The amendment and resolution have been reviewed and approved by the County Attorney as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that this amendment will allow 90% of HPSM clients referred to AAS for CS services to successfully receive these services in FY 2024-25.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Percentage of HPSM clients referred to AAS for CS services who successfully receive CS services |
89% 31 out of 35 clients |
90% 180 out of 200 clients |
FISCAL IMPACT:
It is estimated that a total of $316,640 will be received by AAS in FY2024-25; this agreement automatically renews at the end of each year, unless either party notifies the other of the desire to terminate. The $316,640 total includes $260,000 for (1) Personal Care and Homemaker Services, and (2) Caregiver Respite Services, which is calculated based on 6,500 Caregiver Respite hours per year, with a $38 to $40 hourly rate for services (rate set by HPSM and approved by DHCS). For the Community Transition Services/Nursing Facility Transition to a Home services, it is estimated that 15 CalAIM members will transition for eight months at a cost of $472 per client per month, for a total of $56,640. Approval of this amendment allows the County to receive funding from HPSM for CS services. Funding and appropriation for CS services are included in the AAS FY2024-25 Recommended Budget. There is No Net County Cost associated with this agreement.