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: Agreement with Health Plan of San Mateo to Implement the California Children's Services Whole Child Model Program
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with the Health Plan of San Mateo to provide funding to the Family Health Services division for the California Children’s Services Whole Child Model Program, for the term of January 1, 2019 through December 31, 2020, in an amount not to exceed $7,250,000.
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BACKGROUND:
For over 25 years, Family Health Services (FHS) has operated the California Children’s Services (CCS) Program for Health Plan of San Mateo (HPSM) beneficiaries. Over this time period, FHS has developed expertise in arranging for and managing health service delivery to children with complex health care needs. In July 2011, HPSM and FHS submitted a Request for Proposals to the California Department of Health Care Services (DHCS) for the CCS Demonstration Project (Project) to jointly provide health care services to eligible CCS enrollees. The intent of the Project was to create an integrated, family-centered, care-delivery and coordination system that eliminates fragmentation of specialty, primary, and ancillary services. Care coordination is driven by the health, social, and psychological needs of the child, as well as any other services necessary to address child and family well-being. In April 2013, HPSM and FHS entered into a Memorandum of Understanding (MOU) outlining the two organization’s roles and responsibilities; as part of this agreement, HPSM delegated to FHS the management of all authorizations and care coordination functions for CCS-eligible HPSM members. In November 2015, your Board approved an agreement formalizing this relationship.
Based on DHCS’ learnings from various demonstration projects across California, Senate Bill 586 (2016) authorized DHCS to establish the Whole Child Model Program (WCM) for CCS program members in Medi-Cal managed care. HPSM is the contractor with DHCS and receives payment for WCM services.
DISCUSSION:
The purpose of this agreement is to outline HPSM’s and FHS’ roles and responsibilities, as required under DHCS’ WCM regulations, and to define the County reimbursement for WCM implementation. As stated in the agreement, the goal of the program is to address the needs of the “whole child” by performing the following actions: reduce fragmentation of care between HPSM and CCS, improve overall care coordination for children with complex medical needs, remove barriers to healthcare access, and improve health outcomes.
The agreement and resolution have been reviewed and approved by County Counsel as to form. The contract has been presented late due to prolonged discussion and review of the agreement between HPSM and FHS.
The resolution contains the County’s standard provisions allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
Approval of this contract contributes to the Shared Vision 2025 outcome of a Healthy Community by providing timely authorizations for services and ensuring comprehensive assessments for all clients. It is anticipated that FHS will serve an average monthly caseload of 1,500 clients, with 95% of authorizations for service being processed within 5 business days.
PERFORMANCE MEASURE:
|
Measure |
FY 2018-19 Estimated |
FY 19-20 Projected |
|
Average monthly caseload |
1,500 clients |
1,500 clients |
|
Percent of authorizations processed within 5 business days # of Processed/Total # of Authorizations |
95% 2,185/2,300 authorizations |
95% 2,185/2,300 authorizations |
FISCAL IMPACT:
The term of the agreement is January 1, 2019 through December 31, 2020. The amount of the agreement is not to exceed $7,250,000 for the two-year term. Funds in the amount of $1,303,502 are included in the FHS FY 2018-19 Adopted Budget. Funds in the amount of $2,685,214 will be included in the FHS FY 2019-20 Recommended Budget. Similar arrangements will be made for future years. Because the County is receiving funds in this agreement, there is No Net County Cost incurred.