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, 2025 through June 30, 2026, in an aggregate amount not to exceed $8,316,849.
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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 (FFS) payment structure, BHRS paid its Mental Health and Substance Use Disorder providers on a 1/12th basis, and BHRS’s previous contracts reflected that payment structure. In FY 2024-25, BHRS, as required by CalAIM, introduced FFS 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 periodic reconciliations from the 1/12th payments to the actual units and services delivered (i.e., FFS).
DISCUSSION:
In some cases, BHRS providers’ FFS volumes have exceeded projections, and their current agreements do not provide sufficient funding from the County. For these providers, BHRS is seeking this Board’s approval to amend their respective agreements, as listed in detail on Attachment A, in order to ensure that they have sufficient funding to continue providing essential services to BHRS clients.
Under the CalAIM FFS model, reimbursement is directly tied to the volume and type of services delivered, which creates opportunities for providers to increase units of service as they adapt to the new structure. Since implementation, some providers have successfully adjusted their service delivery models, workflows, and staffing patterns to align with FFS requirements. As a result, these providers have demonstrated increased service utilization and corresponding growth in reimbursable units, contributing to the need for increased funding to support expanded service delivery.
At the same time, not all providers have transitioned at the same pace. To address this, BHRS is providing targeted technical assistance and support to underperforming providers. This support includes regularly scheduled check-in meetings, data review, documentation guidance, and performance improvement planning. These efforts are intended to strengthen provider capacity, improve service capture, and support consistent implementation of CalAIM requirements.
The net fiscal impact reflects increased expenditures associated with higher service utilization among providers that have successfully adapted to the FFS model, which is partially offset by ongoing underperforming providers. Overall, the requested funding adjustment aligns with actual utilization trends and supports continued implementation of CalAIM FFS requirements across the Mental Health and Substance Use Disorder Contracted Provider Network.
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 2025-26 Estimated |
FY 2026-27 Projected |
|
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 need 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, 2025, through June 30, 2026. The total amount of the agreements is not to exceed $8,316,849. Of the FY 2025-26 amount, it is anticipated that $3,326,740 will be funded by Medi-Cal Patient Care Revenue, and $4,990,109 will be funded by 2011 Realignment. Funds are included in the BHRS FY 2025-26 Approved Budget. There is no Net County Cost.