Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, Health System
Srija Srinivasan, Deputy Chief, Health System
Subject: Amendment to the Agreement with the Health Plan of San Mateo for the California Children’s Services Demonstration Project
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Health Plan of San Mateo extending the term through December 31, 2018 and increasing the amount by $200,000 to an amount not to exceed $7,450,000.
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BACKGROUND:
In July 2011, the Health Plan of San Mateo (HPSM) and California Children’s Services
(CCS) submitted a proposal for a CCS Demonstration Project (Project) to the California Department of Health Care Services (DHCS) to jointly provide health care services to eligible enrollees of CCS. The intent of the Project was to create an integrated, family-centered care delivery and coordination system that eliminated fragmentation of specialty, primary and ancillary services. Care coordination is driven by the needs of the “whole child”, including primary care, specialty care, social and psychological needs, as well as any other services necessary to address child and family well-being. HPSM is the contractor with DHCS and receives payment for services under the Project. In April 2013, HPSM and CCS entered a Memorandum of Understanding outlining the two organization’s roles and responsibilities within the Project.
In January 2016, your Board approved an agreement with HPSM for the CCS Demonstration Project in the amount of $7,250,000 for the term of November 1, 2015 through March 31, 2018. In January 2018, the agreement was amended to extend the term to June 30, 2018 to align with the extension of the DHCS’ contract with HPSM.
DISCUSSION:
This Project is the only “whole child” pilot statewide in which a Medi-Cal managed care plan and a County CCS program are partnering. Project successes achieved during the pilot period include: expanding the HPSM drug formulary for CCS providers to simplify pharmacy requests, implementing a Family Subcommittee and Youth Subcommittee (of the Project Advisory Committee) to provide client input into the Project, decreasing the requirement for service authorization requests from a major service provider, expanding options for families to submit grievances and appeals, conducting comprehensive assessments on all new Project participants, and piloting a mail order option for some medications.
Given the Project’s success, DHCS is implementing a statewide rollout of the “Whole Child Model” beginning July 1, 2018. In the future, we expect to adapt our contract with HPSM to incorporate new DHCS requirements introduced after its statewide expansion.
The agreement and resolution have been reviewed and approved by County Counsel
as to form.
The resolution contains the County’s standard provision allowing amendment of the
County’s fiscal obligations by a maximum of $25,000 (aggregate).
Approval of this amendment contributes to the Shared Vision 2025 outcome of a
Healthy Community by providing timely authorizations for services and ensuring comprehensive assessments for all Project clients. It is anticipated that the Project will serve an average monthly caseload of 2,000 clients, 90% of authorizations for service will be processed within 5 days, and all children will receive a comprehensive assessment.
PERFORMANCE MEASURE:
|
|
FY 2016-17 Actual |
FY 2017-18 Projected |
|
Average monthly caseload |
1935 clients |
1925 clients |
|
Percent of authorizations processed within 5 business days |
96% |
97% |
FISCAL IMPACT:
The term of the revised agreement is July 1, 2011 through December 31, 2018. The amount of the agreement is not to exceed $7,450,000. This amendment increases the contract amount by $200,000. Funds in the amount of $1,150,000 are included in the Family Health Services FY 2018-19 Recommended Budget. Similar arrangements will be made in future years. The CCS Administration Program is partially funded through an annual State allocation of $1,000,000 and has an annual Net County Cost of $634,324.