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 CBIZ Optumas for Consultation Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with CBIZ Optumas for consultation services, for the term June 1, 2025 through June 30, 2027, in an amount not to exceed $370,000.
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BACKGROUND:
Behavioral Health and Recovery Services (BHRS) provides Outpatient Services for both Mental Health (MH) and Substance Use Disorder (SUD) through county-operated clinics and contracted providers using a variety of rate-setting strategies for reimbursement.
In 2024, BHRS began the implementation of CalAIM, introducing new payment reform requirements, infrastructure, and training support to continue to drive the quality of care and a more equitable health system throughout San Mateo County (SMC). One year into the program, BHRS now needs to examine the new CalAIM rate structure and develop a comprehensive provider rate strategy that will ensure a productive and fair reimbursement for both MH and SUD outpatient and inpatient services.
In December 2024, BHRS released a Request for Proposals for the provision of consultation services to develop a comprehensive rate-setting strategy for behavioral health services in SMC. CBIZ Optumas responded and has been recommended for its expertise in data analysis and its collaboration with the County Behavioral Health Directors Association to design a comprehensive CalAIM rate-setting tool.
DISCUSSION:
CBIZ Optumas will develop a strategic rate methodology that will encompass the entire BHRS delivery system rather the current siloed practice that separates MH and SUD services. Because the CalAIM rates set by the California Department of Health Care Services were designed to cover both County and provider expenses, the Medi-Cal rates for BHRS’s contracted providers are a percentage of the County’s CalAIM rates. BHRS needs a comprehensive review of rates and methodologies for both contracted providers and BHRS operations to determine how best to support all services and venues.
Approval of this agreement will allow BHRS to create rate setting methodologies that may include local economic conditions, intensity of service, and productivity expectations while maximizing Medi-Cal Patient Care Revenue. The goal of this work is to create a system that maintains operational sustainability in all essential components to delivering MH and SUD services to SMC residents.
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.
It is anticipated that 100% of the CalAIM rate setting deliverables will be completed by CBIZ Optumas.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of CalAIM rate setting deliverables that will be completed, by CBIZ Optumas |
N/A |
100% 3 items |
COMMUNITY IMPACT:
This contract will advance the implementation of CalAIM to improve the quality of life and health outcomes of individuals on Medi-Cal. CBIZ Optumas will utilize its expertise in data analysis to assist BHRS’ efforts in creating a more equity-focused and whole-person care system for SMC residents with mental health needs and other complex needs, including homelessness, justice system involvement, and other physical health conditions. Ultimately, the contract will allow BHRS to strengthen its current relationships with Community Based Organizations that assist SMC with delivering MH and SUD services to its residents.
FISCAL IMPACT:
The term of the agreement is June 1, 2025, through June 30, 2027. The amount of the agreement is not to exceed $370,000 for the 25-month term. For FY 2024-25, the maximum amount is $30,000 and is included in the BHRS FY 2024-25 Recommended Budget. Of that amount, Medi-Cal Administrative Activities funds will fund 100% of the agreement. There is no Net County Cost.