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: Amendment to the Agreement with Health Plan of San Mateo to Implement the California Children's Services Whole Child Model Program
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the agreement with Health Plan of San Mateo to provide funding to the Family Health Services division for the California Children’s Services Whole Child Model Program, extending the term through December 31, 2023 and increasing the amount by $5,830,698 to an amount not to exceed $15,831,260.
body
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 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 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.
On March 12, 2019, your Board approved an agreement with HPSM to provide funding in support of the WCM, for the term January 1, 2019 through December 31, 2020, in an amount not to exceed $7,250,000.
On January 5, 2021, your Board approved an amendment to the agreement with HPSM, extending the term through December 31, 2021, and increasing the amount by $2,750,562 to an amount not to exceed $10,000,562.
DISCUSSION:
The purpose of the amendment 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 amendment and resolution have been reviewed and approved by County Counsel as to form. The amendment is late due to prolonged discussion and review of the agreement between HPSM and FHS.
The Board is being asked to authorize the Health Chief or his/her designee to execute subsequent amendments which do not to exceed an aggregate of $25,000.
It is anticipated that FHS will serve an average monthly caseload of 1,600 clients, with 95% of authorizations for service being processed within five business days.
PERFORMANCE MEASURE:
|
Measure |
FY 2020-21 Actual |
FY 2021-22 Estimated |
|
Average monthly caseload |
1,500 clients |
1,600 clients |
|
Percentage of authorizations for service processed within five business days |
95% 2,185/2,300 authorizations |
95% 3,044/3,205 authorizations |
FISCAL IMPACT:
The term of the amended agreement is January 1, 2019 through December 31, 2023. This amendment increases the contract amount by $5,830,698 to an amount not to exceed $15,831,260 for the forty-eight months term. Funds in the amount of $2,850,710 are included in the FHS Adopted FY 2021-22 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.