Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Tamarra Jones, Interim Director, Public Health, Policy and Planning
Subject: Agreement for Public Health Policy and Planning to Provide Enhanced Care Management Services for Health Plan of San Mateo Clients
RECOMMENDATION:
title
Adopt a resolution authorizing an automatic annual renewal of the agreement with San Mateo Health Commission dba Health Plan of San Mateo for Public Health, Policy and Planning to provide Enhanced Care Management services for clients of Health Plan of San Mateo for the term of January 1, 2022, through December 31, 2023, to receive an estimated $1,996,800 annually until terminated or amended by either party.
body
BACKGROUND:
The California Department of Health Care Services (DHCS), through the California Advancing and Innovating Medi-Cal (CalAIM) initiative, seeks to move Medi-Cal services toward a population health approach that prioritizes prevention and whole-person care. The program is designed to extend support and services beyond hospitals and healthcare settings directly into California communities.
As part of CalAIM, based in part upon the successes of the Whole Person Care (WPC) pilots, DHCS established a new statewide benefit entitled Enhanced Care Management (ECM). ECM provides a whole-person approach to care that addresses high-need Medi-Cal recipients' clinical and non-clinical circumstances. The goals of ECM are 1) improving care coordination, 2) integrating services, 3) facilitating community resources, 4) improving health outcomes, 5) addressing social determinants of health, and 6) decreasing inappropriate utilization. ECM is intended for the highest-risk, highest-cost Medi-Cal managed care members with the most complex medical and social needs. ECM targets specific populations, including adult high utilizers, individuals experiencing homelessness, adults with Serious Mental Illness/Substance Use Disorders, adults/youth transitioning from incarceration, adults at risk of institutionalization and eligible for Long Term Care, and nursing facility residents who want to transition back into the community. ECM will provide these clients long-term help coordinating their services across delivery systems to address their needs.
WPC is a pilot program funded under the Section 1115 Medicaid Waiver through a contract with DHCS. San Mateo County Health (County Health) participated in the WPC pilot during 2016-2021 to provide a coordinated, efficient, and effective medical, behavioral health, and social services delivery to the County's highest-risk and vulnerable populations. The WPC pilot established the Bridges to Wellness program in the Public Health, Policy, and Planning (PHPP) division of County Health to provide intensive care management services. The Bridges to Wellness program serves individuals who are high utilizers of emergency services, are often homeless, and whose health and/or behavioral health conditions place them at high risk for poor health outcomes.
DISCUSSION:
The Health Plan of San Mateo (HPSM) contracted with PHPP to engage Bridges to Wellness as a provider of ECM services effective January 1, 2022. Under this agreement, the Bridges to Wellness program provides direct services for HPSM's members eligible for ECM. HPSM will pay the County a fixed monthly rate of $520 per enrolled and engaged client for these services. In addition to the monthly rate, HPSM will pay for outreach services to its members to engage them in ECM services at a rate of up to $50 per month for three months in a 12-month period.
This Board approved the agreement and resolution for a one-year term on May 3, 2022. When first presented to this Board, it was understood that this agreement would be renewed annually. HPSM subsequently clarified that this agreement will automatically be renewed annually until terminated or amended by either party. PHPP will review the agreement on an annual basis and determine whether to continue providing services. As a result, PHPP requests Board authorization to continue providing services under the agreement until such a time that PHPP determines it is not in the County's best interests to continue to do so. PHPP will keep the Board apprised of ongoing contract revenues through its annual budget submissions.
This resolution is being presented to this Board to authorize an automatic annual renewal of this agreement until terminated or amended by either party.
The agreement 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 90% of Bridges to Wellness clients enrolled in ECM services will have a comprehensive assessment completed within 30 days of enrollment.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Actual |
FY 2023-24 Estimated |
|
Percentage of Bridges to Wellness clients enrolled in ECM services that have a comprehensive assessment completed within 30 days of enrollment |
90% 270 clients |
90% 270 clients |
FISCAL IMPACT:
The term of the agreement is January 1, 2022, through December 31, 2023, and will renew annually until terminated. The amount of the agreement payable to the County is approximately $1,996,800 annually. This amount is included in the PHPP FY 2023-24 Recommended Budget. Similar arrangements will be made for future years. There is no Net County Cost associated with this agreement.