Special Notice / Hearing: None
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Lisa Mancini, Director, Aging and Adult Services
Subject: Agreement for Aging and Adult Services to Provide Medi-Cal Community Supports Services for Clients of the San Mateo Health Commission dba Health Plan of San Mateo
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement for Aging and Adult Services to provide Medi-Cal Community Supports Services for clients of the San Mateo Health Commission dba Health Plan of San Mateo for the term of January 1, 2022, through December 31, 2022.
body
BACKGROUND:
Prior to 2014, San Mateo County Health’s Aging and Adult Services (AAS) division contracted with the California Department of Aging to provide Multipurpose Senior Services Program (MSSP) services, a program of social and health care management services for frail elders. In 2014, the County, through Health Plan of San Mateo (HPSM), was selected by the State to be one of eight counties to participate in Cal MediConnect. That program promoted coordinated health care delivery for Californians dually eligible for Medicare and Medi-Cal. HPSM paid the County a fixed monthly amount for each Cal MediConnect participant who received MSSP services. This arrangement continued after the three-year pilot.
The new California Advancing and Innovating Medi-Cal (CalAIM) initiative is moving Medi-Cal toward a population health approach that prioritizes prevention and whole person care. The program is designed to extend supports and services beyond hospitals and health care settings, directly into California communities.
Medi-Cal enrollees with complex health needs and unmet social needs are at particularly high risk of hospitalization and institutionalization, and often need high-cost services. To respond to the needs of this community, the California Department of Health Care Services (DHCS), as part of CalAIM, established a new statewide benefit called Community Supports (CS).
Enhanced Care Management (ECM) and CS are foundational components of CalAIM. AAS is contracting with HPSM to provide ECM services for HPSM clients.
CS are new services provided by Medi-Cal managed care plans, designed to address social drivers of health. All Medi-Cal managed care plans are encouraged to offer as many of the 14 pre-approved CS services as possible. These services are available to eligible Medi-Cal members, regardless of whether they qualify for ECM services (the CalAIM program directed at the highest-need enrollees).
The 14 CS services are:
• Housing Transition Navigation Services
• Housing Deposits
• Housing Tenancy and Sustaining Services
• Short-Term Post-Hospitalization Housing
• Recuperative Care (Medical Respite)
• Day Habilitation Programs
• Caregiver Respite Services
• Nursing Facility Transition/Diversion to
Assisted Living Facilities
• Community Transition Services/Nursing
Facility Transition to a Home
• Personal Care and Homemaker Services
• Environmental Accessibility Adaptations
(Home Modifications)
• Medically Supportive Food/Meals/Medically
Tailored Meals
• Sobering Centers
• Asthma Remediation
DISCUSSION:
AAS had experience providing respite and attendant care services to MSSP recipients prior to the launch of CalAIM. HPSM approached AAS to provide: 1) Caregiver Respite services; and 2) Personal Care and Homemaker services under the CS program (in addition to the separately contracted ECM services). At first, CS will be primarily offered to ECM participants, but will ultimately become available to all HPSM members.
Under the new CS agreement, the County will contract with community-based organizations and individual caregivers to provide services. This agreement is coming to your Board late due to prolonged negotiations with all stakeholders, including HPSM.
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that this agreement will allow 90% of HPSM clients referred to AAS for CS services to successfully receive CS services in FY 2022-23 and 95% in FY 2023-24.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Estimated |
FY 2023-24 Projected |
|
Percentage of HPSM clients referred to AAS for CS services who successfully receive CS services |
90% |
95% |
FISCAL IMPACT:
The term of the agreement is January 1, 2022 through December 31, 2022. It is estimated that a total of $247,000 will be received by AAS for CS services, which is calculated based on 6,500 Caregiver Respite hours, with a $38 hourly rate for services (rate set by HPSM and approved by DHCS). CalAIM CS is a MediCal funded program. Approval of this agreement allows the County to receive funding for CS services. Funding and appropriation for CS services are included in the recommended budget. There is No Net County Cost associated with this agreement.