Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Cassius Lockett, Director, Public Health, Policy and Planning
Subject: Authorization of Amendment to the Whole Person Care Pilot Program Agreement
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health to sign an amendment to the Whole Person Care pilot program agreement, on behalf of the County of San Mateo, with the California Department of Health Care Services, to extend participation in the program from June 30, 2021 to June 30, 2022.
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BACKGROUND:
On May 13, 2016, the Department of Health Care Services (DHCS) received approval from the Centers for Medicare and Medicaid Services (CMS) for the Whole Person Care (WPC) pilot program. The purpose of the WPC pilots is the coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner in order to improve beneficiary health and wellbeing through more efficient and effective use of resources.
DHCS published a Request for Applications (RFA) relating to the WPC pilot program on May 16, 2016. San Mateo County Health (SMCH) submitted its WPC application in response to DHCS’ RFA on July 1, 2016. DHCS accepted SMCH’s WPC application to the RFA on October 24, 2016 with an allocation of $16,536,771 available for each calendar year for five years for the WPC pilot beginning January 1, 2016 and ending December 31, 2020.
In May 2020, DHCS officially announced the delay of California Advancing and
Innovating Medi-Cal Initiative (CalAIM) due to the impact of the public health emergency
caused by COVID-19. As a result of the delay of CalAIM, CMS approved a one-year extension of WPC pilot program.
On December 29, 2020, DHCS extended SMCH’s WPC pilot with an allocation of $16,536,771 available for the program’s sixth calendar year ending December 31, 2021.
DISCUSSION:
The WPC pilot provides support to integrate care for a particularly vulnerable group of Health Plan of San Mateo’s Medi-Cal beneficiaries who have been identified as high users of multiple systems and continue to have poor health outcomes. Through collaborative leadership and systematic coordination, the WPC pilot has identified target populations, shared data between systems, coordinated care in real time, and evaluated individual and population progress - all with the goal of providing comprehensive coordinated care for the beneficiary resulting in better health outcomes.
The amended agreement and resolution have been reviewed and approved by County Counsel as to form. It is anticipated that the number of Emergency Department (ED) visits for eligible clients served will decrease from 5,571 visits (FY 2020-21) to 5,292 visits (FY 2021-22).
PERFORMANCE MEASURE:
|
Measure |
FY 2020-21 Estimated |
FY 2021-22 Projected |
|
Number of ED visits for eligible clients served |
5,571 visits |
5,292 visits |
FISCAL IMPACT:
The term of the amended agreement is January 1, 2016 through June 30, 2022 in an amount not to exceed $16,536,771 for each program year for six years, totaling $99,220,626. The amendment extends the agreement by one year from June 30, 2021 to June 30, 2022, adding $16,536,771 to the contract amount. This amount is included in the Health FY 2020-21 Adopted Budget and FY 2021-22 Recommended Budget. There is no Net County Cost associated with this agreement.