Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Cassius Lockett, PhD, Director, Public Health, Policy and Planning
Subject: Amendment to Memorandum of Agreement with San Mateo Health Commission dba Health Plan of San Mateo
RECOMMENDATION:
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Measure K: Adopt a resolution authorizing an amendment to the Memorandum of Agreement with the San Mateo Health Commission dba the Health Plan of San Mateo to extend the term through June 30, 2022, clarify the deadlines for required reports in section 3(b), add Section 2(f) to increase the fiscal obligation by $5,992,990 from $24,340,463 to $30,333,453, amend the scope of work now properly labeling it as Exhibit A, amend the payment plan to include recuperative care services properly labeling it as Exhibit B, include WPC and Measure K Payment Plan in Exhibit B, and properly label the WPC Care Coordination policy and approach as Exhibit C.
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BACKGROUND:
Whole Person Care (WPC) is a pilot program funded under the five-year renewal of California’s Section 1115 Medicaid Waiver (Medi-Cal 2020). San Mateo County Health (SMCH) is implementing the WPC pilot to provide a coordinated, efficient, and effective delivery of medical, behavioral health, and social services to the County’s highest-risk and vulnerable populations. Through an agreement with the California Department of Health Care Services (DHCS), SMCH receives up to $16,536,771 in new revenue annually, with funds rolling over from year to year, as needed, for WPC services for the period January 1, 2017 through December 2020.
This Board approved the allocation of Measure K funds - $1,000,000 in FY 2016-17 and $2,000,000 per fiscal year thereafter - for WPC client housing services for the term of the pilot.
On June 6, 2017, this Board approved Resolution 075225, as amended by Resolution 077133, approving a Memorandum of Agreement (MOA) between the County of San Mateo and the Health Plan of San Mateo (HPSM) to enhance the Community Care Setting Pilot (CCSP) and implement Measure K housing services for SMCH clients for the term of the WPC pilot. The CCSP has been successfully implemented to support member transition from Skilled Nursing Facilities (SNF) and Long-Term Care (LTC) back into the community. Data indicates that the percentage of residents who maintain their community placement continues to be at least 90%. A cost analysis indicates that Per Member Per Month (PMPM) costs (which include healthcare and LTC/SNF charges) showed significant cost savings of 37%.
The MOA between the County and HPSM was amended on March 6, 2018 to incorporate the scope of work inadvertently labeled as Section One, to add the WPC Care Coordination Policy and Approach inadvertently labeled as Section Two, and to add WPC and Measure K Payment Plan inadvertently labeled as Section Three. On December 10, 2019, the MOA was further amended the scope of work inadvertently labeled as Section One, to add required reports inadvertently labeled as Section Two, and to amend the payment plan inadvertently labeled as Section Three.
DISCUSSION:
In 2019, DHCS conducted significant planning for a transition away from the Section 1115 waiver authority for many aspects of the Medi-Cal program. At the time, it was anticipated that WPC would transition into the California Advancing and Innovating Medi-Cal (CalAIM) initiative effective January 1, 2021. CalAIM creates two new benefit packages for most at risk populations, some of whom are currently served under WPC: In Lieu of Services (ILOS) and Enhanced Care Management (ECM). ILOS includes selected housing and transportation services, including nursing home transitions to community living currently funded by WPC.
The impact of the COVID-19 pandemic has delayed the planned transition from WPC to CalAIM initiative until January 1, 2022. On December 29, 2020 the Centers for Medicare and Medicaid services (CMS) approved the DHCS’ proposal for an extension of the 1115 Waiver through December 2021. SMCH submitted a budget for additional $16,536,771 in new revenue for the period January 1, to December 31, 2021.
In order to avoid a gap in services and ensure continuity of the CCSP and the housing program pending the roll out of CalAIM on January 1, 2022, SMCH seeks to extend our agreement with the HPSM through June 30, 2022, as set out in this amendment to the MOA.
The amendment to the agreement and resolution have been reviewed and approved by County Counsel as to form.
The County’s Contract Compliance Committee has approved a 5-year waiver request for this agreement.
The resolution contains the County’s standard provisions allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that 95% of residents in the CCSP program will maintain their community placement at 12 months and 90% of clients referred for housing services will receive a housing service.
PERFORMANCE MEASURE:
|
Measure |
FY 2020-21 Estimated |
FY 2021-22 Projected |
|
Percentage of residents who maintain their community placement at 12 months |
90% |
95% |
|
Percentage of clients referred for housing services who will receive a housing service |
90% |
90% |
FISCAL IMPACT:
The term of the amended agreement is January 1, 2017 through June 30, 2022 increases the agreement by $5,992,990 from $24,340,463 to $30,333,453. Of this amount, Measure K will fund $2,000,000 and WPC will fund $3,992,990. Funds in the amount of $2,996,495 are included in the San Mateo Medical Center FY 2020-21 Adopted Budget. Similar arrangements will be made for future years for the remaining $2,996,495.