Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Lizelle Lirio de Luna, Director, Family Health Services
Subject: Amendment to the Agreement with Health Plan of San Mateo to Implement the California Children's Services Whole Child Model Program
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Health Plan of San Mateo to provide funding to the Family Health Services division for the California Children’s Services Whole Child Model Program, extending the term through December 31, 2026, and increasing the amount by $8,906,030 to an amount not to exceed $24,737,290.
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BACKGROUND:
For over 25 years, Family Health Services (FHS) has operated the California Children’s Services (CCS) Program for Health Plan of San Mateo (HPSM) beneficiaries. Over this time period, FHS has developed expertise in arranging for and managing health service delivery to children with complex health care needs.
In July 2011, HPSM and FHS submitted a response to a Request for Proposals to the California Department of Health Care Services (DHCS) for the CCS Demonstration Project (Project) to jointly provide health care services to eligible CCS enrollees. The intent of the Project was to create an integrated, family-centered, care-delivery and coordination system that eliminates fragmentation of specialty, primary and ancillary services. Care coordination is driven by the health, social and psychological needs of the child, as well as any other services necessary to address child and family well-being.
In April 2013, HPSM and FHS entered into a Memorandum of Understanding (MOU) outlining the two organizations’ roles and responsibilities; as part of this agreement, HPSM delegated to FHS the management of all authorizations and care coordination functions for CCS-eligible HPSM members.
In November 2015, this Board approved an agreement formalizing this relationship.
Based on DHCS’ learnings from various demonstration projects across California, Senate Bill 586 (2016) authorized DHCS to establish the Whole Child Model Program (WCM) for CCS program members in Medi-Cal managed care. HPSM is the contractor with DHCS and receives payment for WCM services.
In March 2019, this Board approved an agreement with HPSM to provide funding in support of the WCM, for the term of January 1, 2019 through December 31, 2020, in an amount not to exceed $7,250,000.
In January 2021, this Board approved an amendment to the agreement with HPSM, extending the term through December 31, 2021, and increasing the amount by $2,750,562 to an amount not to exceed $10,000,562.
In February 2022, this Board approved an amendment to the agreement with HPSM, extending the term through December 31, 2023, and increasing the amount by $5,830,698 to an amount not to exceed $15,831,260.
DISCUSSION:
This amendment will extend the agreement that outlines HPSM’s and FHS’ roles and responsibilities, as required under DHCS’ WCM regulations, by three years through December 31, 2026, and will define the County reimbursement for WCM implementation. This amendment will increase the agreement amount by $8,906,030 to an amount not to exceed $24,737,290. The goal of the program is to address the needs of the “whole child” by performing the following actions: reduce fragmentation of care between HPSM and CCS, improve overall care coordination for children with complex medical needs, remove barriers to healthcare access, and improve health outcomes.
The County Attorney has reviewed and approved the amendment and resolution as to form. The amendment is being presented late due to prolonged discussion and review of the agreement between HPSM and FHS.
This Board is also being asked to authorize the Chief of San Mateo County Health or their designee to execute subsequent amendments which do not exceed an aggregate of $25,000.
It is anticipated that FHS will serve an average monthly caseload of 1,600 clients, with 98% of authorizations for service being processed within five business days.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Average monthly caseload served by FHS |
1,525 clients |
1,600 clients |
|
Percentage of authorizations processed within five business days |
98% 1544/1569 authorizations |
98% 1568/1600 authorizations |
FISCAL IMPACT:
The term of the amended agreement is January 1, 2019, through December 31, 2026. The amount of the amended agreement is not to exceed $24,737,290 for the seven-year term. Funds in the amount of $1,426,517 are included in the FHS FY 2023-24 Adopted Budget. Funds in the amount of $2,910,095 will be included in the FHS FY 2024-25 Recommended Budget. Similar arrangements will be made for future years. Because the County is receiving funds in this amendment, there is No Net County Cost incurred.