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 Health Care Services for Medi-Cal Managed Care and Specialty Mental Health services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement an agreement and/or subsequent amendments with the State of California Department of Health Care Services for Medi-Cal Managed Care and Specialty Mental Health 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 to execute the agreement on behalf of County.
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BACKGROUND:
The State of California requires County Mental Health Plans to enter into an agreement with the Department of Health Care Services (DHCS) for the delivery of Specialty Mental Health Services and corresponding activities that are similar to the administration of a health plan (managed care). The agreement is the instrument by which Behavioral Health & Recovery Services (BHRS) exists and the mechanism by which Medi-Cal beneficiaries with severe and complex mental health needs receive treatment. BHRS delivers substance use treatment services through a similar agreement with the state for DMC-ODS. BHRS delivers Medicare services through a contract with the Health Plan of San Mateo.
The agreement specifies the services to be provided; various administrative activities such as contract requirements, conflict of interest requirements, and delegation limitations; access criteria, staffing requirements, data system requirements, quality improvement, utilization management, service authorizations, network adequacy, timely access standards, provider requirements, care coordination, client notification requirements, language and interpretation standards, a grievance and problem resolution process, hearing and appeals process, reporting requirements, compliance requirements, and other general provisions.
The contract continues the requirements of CalAIM, which is the initiative to reform Medi-Cal. This is only a year-long contract because it is anticipated that the contract will be modified in order to align with Proposition 1 and the implementation of the Behavioral Health Services Act.
DISCUSSION:
BHRS is requesting approval of a new agreement for the term of July 1, 2025 through December 31, 2026. This new zero-dollar agreement between DHCS and BHRS will allow BHRS to provide the following specialty mental health services as defined in this intergovernmental agreement (the “Agreement”) to Medi-Cal members residing in San Mateo County who meet the applicable access criteria.
This new agreement continues the Medi-Cal reform requirements, more commonly known as CalAIM, including new Medical Necessity requirements, access criteria that simplify client access to care and allows treatment to begin immediately, and introduces lessened documentation requirements. This agreement extends existing requirements through to the implementation of Proposition 1: The Modernization of the Mental Health Services Act (MHSA), at which point BHRS will begin to implement and operate under the Behavioral Health Services Act (BHSA). The BHSA expands the MHSA to include substance use disorder treatment, establishes new housing priorities under statewide direction, establishes new spending requirements and reporting, and expands state oversight of the counties.
Under the previous contract with DHCS, DHCS determined that the agreement no longer required a stated contract dollar amount, as funding used to pay for specialty mental health services flows through a variety of payment mechanisms, such as realignment distributions and per claim federal financial participation reimbursement. DHCS determined that the contract 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. This agreement is coming to this Board late due to delayed notification from DHCS.
It is anticipated that 91% of clients will be maintained at an equal or lower level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25
Actual |
FY 2025-26
Estimated |
|
Percentage of clients maintained at an equal or lower level of care |
91%
8,947 clients |
91%
8,947 clients |
COMMUNITY IMPACT:
The purpose of this agreement is to deliver comprehensive specialty mental health services to the local Medi-Cal population struggling with severe mental illness. These residents represent some of the County’s most vulnerable individuals that are supported with case management, psychiatry and medication support, therapy, and other interventions that allow individuals to manage their illness and remain in the community. BHRS strives to maintain individuals at lower levels of care and in the least restrictive setting, allowing individuals to be maintained in their communities, which is the most efficient and effective approach to care.
FISCAL IMPACT:
This is a zero-dollar Agreement. BHRS anticipates that San Mateo County will receive federal funding for mental health Managed Care services and Early Periodic Screening, Diagnosis and Treatment (EPSDT) services, and all federal financial participation funding for Short-Doyle Medi-Cal services. The required match for Managed Care and EPSDT services will be provided through 2011 Realignment, 1991 Realignment, and the Mental Health Services Act, and other funds the State Controller distributes to the counties. Projected revenues of $54,471,849 for these services have been included in the BHRS FY 2025-26 Adopted Budget. Similar arrangements will be made in future budget years.