Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise Rogers, Chief, Health System
Stephen Kaplan, Director, Behavioral Health & Recovery Services
Subject: Agreement with Health Plan of San Mateo to Deliver Expanded Medi-Cal Benefits for Mental Health
RECOMMENDATION:
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Adopt a resolution authorizing a revenue agreement with the Health Plan of San Mateo to provide expanded Medi-Cal benefits to members with mild to moderate mental health conditions for the term of January 1, 2017 through June 30, 2018, for an estimated total of $4,500,000.
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BACKGROUND:
Specialty outpatient mental health services for individuals with serious and persistent mental illness have long been a Medi-Cal benefit, managed and provided by Behavioral Health and Recovery Services (BHRS). However, Medi-Cal members with mild to moderate mental health conditions that did not meet specialty mental health medical necessity criteria have had limited access to outpatient mental health services.
In June 2013, the Governor approved California Senate Bill X1-1, adding mental health services and substance use disorder services to the schedule of Medi-Cal benefits provided by Medi-Cal managed care plans. As of January 1, 2014, the expanded mental health services provide assessment and treatment to health plan members with mild to moderate mental health diagnoses. Services include:
1. Individual and group mental health evaluation and treatment;
2. Psychological testing when clinically indicated to evaluate a mental health condition;
3. Psychiatric consultation for medication management;
4. Screening and brief intervention for alcohol use disorder;
5. Outpatient laboratory, supplies and supplements; and
6. Medications
DISCUSSION:
BHRS currently partners with the Health Plan of San Mateo (HPSM) to deliver behavioral health care services to HPSM members in the CareAdvantage, HealthWorx and Healthy Kids programs. HPSM has identified BHRS as a strategic partner for the delivery of expanded mental health services to the mild to moderate population due to the familiarity BHRS has with the County’s low-income population, the robust network of mental health providers BHRS employs or contracts with in the local area, and BHRS’ extensive experience with offering many of the services now covered as Medi-Cal benefits.
BHRS is working closely with HPSM to strengthen BHRS’ administrative capacity to deliver these additional benefits. This includes ensuring that oversight, monitoring, and evaluation processes are in place to allow HPSM to meet its obligations to the California Department of Healthcare Services and the California Department of Managed Health Care. Protocols are being developed between BHRS and HPSM to establish coordination of care and to allow HPSM’s providers to have direct access to BHRS for clinical support, through peer-to-peer consultations between primary care physicians and BHRS psychiatrists.
Mild to moderate services for all HPSM Medi-Cal members except the Medi-Cal Expansion (MCE) population will be covered through this agreement. Mild to moderate services for HPSM MCE members will be covered through a separate agreement coming to your Board.
The agreement is late due to prolonged negotiations between BHRS and HPSM.
The resolution contains the County’s standard provisions allowing amendments of the County’s fiscal obligation by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by County Counsel as to form.
Approval of this agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing psychiatry services in San Mateo County. It is anticipated that 80% of consumers who receive these services will be maintained at a current or lower level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2016-17 Actual |
FY 2017-18 Projected |
|
Percentage of consumers receiving outpatient mental health services maintained at current or lower level of care |
80% 1,191 of 1,489 clients |
80% 1,191 of 1,489 clients |
FISCAL IMPACT:
The term of the agreement is January 1, 2017 through June 30, 2018, for an estimated revenue total of $4,500,000 for the two-year term. Projected annual revenue from this agreement is $3,000,000 and has been included in BHRS FY 2016-17 Final Budget. Similar arrangements will be made for future budget years. There is no Net County Cost. The payment provisions and levels of service remain essentially the same as those of the prior agreement.