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: Authorizing the Chief of San Mateo County Health or Designee to Execute Agreements with Mental Health and Substance Use Disorder Contracted Providers that Require an Increase to their Agreement Maximum Obligations Due to Increased CalAIM Fee for Service
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health, or designee(s), to execute agreements and negotiate amendments with Mental Health and Substance Use Disorder Contracted Providers for the increase in CalAIM fee-for-service units, for each contract listed in Attachment A, for the term of July 1, 2024 through June 30, 2025, in an aggregate amount not to exceed $5,002,244.
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BACKGROUND:
Mental Health and Substance Use Disorder contracts provide essential services to our County clients. Prior to implementation of the fee-for-service payment structure, BHRS paid its Mental Health and Substance Use Disorder providers on the basis of a monthly payment equal to 1/12th of the annual contract amount and BHRS’s previous contracts reflected that payment structure. In FY 2024-25, BHRS, as required by CalAIM, introduced fee-for-service payments to these contracted providers, which requires that these providers be paid for all units of services delivered. Therefore, BHRS entered into updated agreements with these providers for quarterly reconciliations from the 1/12th payments to the actual units and services delivered (i.e., fee-for-service). In some cases, the provider fee-for-service volumes have surpassed expectations, and the updated reconciliation agreements do not provide for sufficient funding from the County to the contractor.
DISCUSSION:
To accommodate payments for these service volume increases, FY 2024-25 contract maximum obligations for the affected providers will be retroactively amended through this action. Payment will be reconciled for the full fiscal year in September based on contractors’ final submission of Medi-Cal claims data.
Attachment A of the resolution lists the contractors affected, along with the estimated payment amount needed to account for the difference between payment received to date and the fee-for-service amount owed based on the actual units of service delivered. The not-to-exceed aggregate amount of $5,002,244 will authorize the Chief of San Mateo County Health, or designee(s), to execute agreements and associated amendments with the contractors listed in Attachment A.
On June 24, 2025, this Board approved an Appropriations Transfer Request (ATR) in the amount of $5,002,244 to support these amendment amounts.
These agreements will be approved by the County Attorney as to form, and by Risk Management if necessary, and will comply with applicable County ordinances.
The resolution has been reviewed and approved by the County Attorney as to form.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that the percentage of clients who receive services that are maintained at a current or lower level of care will be 80%.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Actual |
FY 2025-26 Estimated |
|
Percentage of clients who receive services that are maintained at a current or lower level of care |
80% 410 of 513 participants |
80% 410 of 513 participants |
COMMUNITY IMPACT:
These agreements will positively impact a critically underserved community of behavioral health clients who are in need of Mental Health and Substance Use Disorder treatment services. These providers are essential to assure equitable access to quality care for underserved and vulnerable people in San Mateo County.
FISCAL IMPACT:
The term of the agreements is July 1, 2024, through June 30, 2025. The total amount of the agreements is not to exceed $5,002,244. Of the FY 2024-25 amount, it is anticipated that $2,000,897 will be funded by Medi-Cal Patient Care Revenue, and $3,001,347 is 2011 Realignment. Funds are included in the BHRS FY 2024-25 Approved Budget. There is no Net County Cost