DATE: June 4, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendments to Various Substance Use Disorder Treatment Master Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-289 with Drug Medi-Cal certified providers, to update agreement language including provider reporting requirements, contractor participation requirements, and updating fee reimbursement schedules, with no change to the term of July 1, 2023 through June 30, 2027.
2. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-290 with Drug Medi-Cal certified providers, to update agreement language including provider reporting requirements, contractor participation requirements, and updating fee reimbursement schedules, with no change to the term of July 1, 2023 through June 30, 2027.
3. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-291 with Drug Medi-Cal certified providers, to update agreement language including provider reporting requirements, contractor participation requirements, and updating fee reimbursement schedules, with no change to the term of July 1, 2023, through June 30, 2027.
4. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-292 with Drug Medi-Cal certified residential substance use disorder treatment providers, to update agreement language including provider reporting requirements and contractor participation requirements with no change to the term of July 1, 2023, through June 30, 2027, or compensation maximum of $27,353,032.
5. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-293 with Drug Medi-Cal certified providers, to update agreement language including provider reporting requirements, contractor participation requirements, and updating fee reimbursement schedules, with no change to the term of July 1, 2023, through June 30, 2027, or compensation maximum of $10,585,252.
6. Approve and authorize the Chairman to execute First Amendment to Master Agreement No. 23-294 with Drug Medi-Cal certified providers, to update agreement language including provider reporting requirements, contractor participation requirements, and updating fee reimbursement schedules, with no change to the term of July 1, 2023 through June 30, 2027, or compensation maximum of $11,027,632.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the Department of Behavioral Health (DBH) to update existing contract language to be in compliance with new Department of Health Care Services (DHCS) guidance, service delivery requirements, reporting requirements, and updated fee reimbursement schedules.
ALTERNATIVE ACTION(S):
If the Board does not approve the recommended actions, the Agreements will not reflect the policy changes directed by the Department of Health Care Services (DHCS). The Department and its contracted providers will be out of compliance with the Department’s Intergovernmental Agreement with DHCS and Behavioral Health Information Notices which may result in future site review audit deficiencies.
FISCAL IMPACT:
There is no additional Net County Cost associated with the recommended actions. Recommended actions one through three include agreements that are reimbursed by DHCS regardless of the volume. The Department projects expenditures of approximately $32,535,000 (about 47 percent of the Drug Medi-Cal annual funding allocation of $69,738,961). Recommended actions four through six have a total maximum compensation of $48,965,916. Each of the amendments identified within this agenda item will be fully funded by existing funding sources including, but not limited to: Medi-Cal Federal Financial Participation, Realignment funds, and Substance Use Block Grant funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2023-24 Adopted Budget and will be included in all future recommended budgets throughout the remainder of the contract terms.
DISCUSSION:
On June 23, 2023, the Department executed several agreements for substance use disorder treatment services to reflect the implementation of DHCS’s California Advancing and Innovating Medi-Cal (CalAIM) regulations including Medi-Cal payment reform changes throughout the behavioral health system, which included all master agreements referenced in the recommended actions. Since the execution of the master agreements, DHCS has issued additional guidance and clarification through behavioral health information notices that necessitate amending each agreement to incorporate new requirements. DHCS has also executed a new Intergovernmental Agreement with the Department that includes changes which impact service agreements requiring additional modifications. The recommended amendments include updated fee reimbursement schedules that reflect all service reimbursement rates by practitioner type as well as supplemental add-on fees for specific services.
There is no maximum compensation for recommended actions one through three to amend Master Agreements Nos. 23-289, 23-290, and 23-291 as they are reimbursed by Medi-Cal Federal Financial Participation. These Drug Medi-Cal services are reimbursed by DHCS regardless of the volume. The maximum compensation to recommended actions to amend Master Agreements Nos. 23-292, 23-293, and 23-294 remains unchanged, however the allocations have been re-distributed to existing providers on each contract to reflect current utilization of services.
The Department is adding a requirement to Master Agreements Nos. 23-293 and 23-294 for providers to support persons with applying for Medi-Cal benefits.
The recommended actions for amendments to Agreements Nos. 23-289, 23-290, 23-291, 23-293, and 23-294 include updates to the established fee reimbursement schedules incorporating the supplemental add-on codes for specific services related to interactive complexity and sign language or oral interpretation. The supplemental add-on codes were previously included via a letter signed by the Department and each contractor with Counsel approval.
REFERENCE MATERIAL:
BAI #45, June 20, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Master Agreement No. 23-289
On file with Clerk - Amendment I to Master Agreement No. 23-290
On file with Clerk - Amendment I to Master Agreement No. 23-291
On file with Clerk - Amendment I to Master Agreement No. 23-292
On file with Clerk - Amendment I to Master Agreement No. 23-293
On file with Clerk - Amendment I to Master Agreement No. 23-294
CAO ANALYST:
Ron Alexander