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: Enhanced Care Management Services for Health Plan of San Mateo California Children’s Services Clients
RECOMMENDATION:
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Adopt a resolution authorizing Family Health Services to enter into an agreement with the San Mateo Health Commission dba Health Plan of San Mateo to provide Enhanced Care Management services for California Children’s Services clients for the term of July 1, 2023, through June 30, 2024, and automatically renewing for subsequent terms of one year for payment to the County in an amount estimated at $399,835 annually, and authorizing the Chief of San Mateo County Health or their designee to execute any and all amendments related to the agreement.
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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 assistance beyond hospitals and healthcare settings directly into California communities.
As part of CalAIM, based in part, upon the successes of the Whole Person Care pilots, DHCS established a new statewide benefit entitled Enhanced Care Management (ECM). ECM provides a whole-person approach to care that addresses the clinical and non-clinical circumstances of high-need Medi-Cal recipients. 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 children participating in California Children’s Services (CCS) who may be high utilizers, have experienced homelessness, have been involved in foster care or child welfare, or whose health and/or behavioral health conditions place them at high-risk for poor health outcomes. ECM will provide these clients with long-term help coordinating their services across delivery systems to address their needs.
DISCUSSION:
The Health Plan of San Mateo (HPSM) seeks to contract with FHS as a provider of ECM services effective July 1, 2023. Under this agreement, FHS will provide direct services for HPSM's CCS members eligible for ECM. HPSM will pay the County a fixed monthly rate of $472 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 agreement is a template provided to HPSM by DHCS and is structured to renew annually automatically. FHS will review the agreement annually and determine whether to continue providing services and requests Board authorization to continue providing services under the agreement until the FHS determines it is not in the County's best interests to continue to do so. FHS will keep the Board apprised of ongoing contract revenues through its annual budget submissions.
The County Attorney has reviewed and approved the agreement and resolution as to form.
This agreement is late due to delayed contract negotiations between FHS and the HPSM.
The resolution requests the Board to allow the Chief of San Mateo County Health of their designee to execute any and all amendments impacting the amount of revenue, term, and services proposed by DHCS.
It is anticipated that 90% of Family Health Whole Child Model (WCM) CCS clients enrolled in ECM services will complete a comprehensive assessment within 30 days of enrollment.
PERFORMANCE MEASURE:
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FY 2023-24 Estimated |
FY 2024-25 Projected |
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Percentage of FHS WCM CCS clients enrolled in ECM services that have a comprehensive assessment completed within 30 days of enrollment |
90% 27 of 30 clients |
90% 54 of 60 clients |
FISCAL IMPACT:
The term of the agreement is July 1, 2023, through June 30, 2024, and is structured to automatically renew annually. The amount payable to the County under the agreement is estimated at $399,835 per year. This amount will be included in the FHS FY 2023-24 Recommended Budget. Similar arrangements will be made for future years. There is no Net County Cost associated with this agreement.