DATE: June 18, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment II to Agreement with WestCare California, Inc. for Payment Structure Changes
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment II to Agreement with WestCare California, Inc. for payment structure changes, effective July 1, 2024, with no change to the term of January 1, 2019 through June 30, 2025, and decreasing the maximum by $111,801 to a total of $7,603,568.
REPORT
There is no additional Net County Cost associated with the recommended action, which will allow the Supervised Overnight Stay Program to better utilize the program’s funding and allow WestCare California, Inc. (WestCare) the option to pay their staff more competitive wages by changing their billing structure from Medi-Cal billing and a line-item budget to Medi-Cal billing and a daily bed rate. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the program’s sustainability will be at risk due to high staff turnover and non-competitive staff wages and existing individuals served will experience a gap in services and/or Overnight stay services will not be provided to mentally ill individuals, impacting the local emergency departments and 5150 designated facilities and client care.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum cost of the recommended Agreement for the entire contract period, $7,603,568, will be funded with Mental Health Services Act Community Services and Supports (MHSA CSS) funds as well as Medi-Cal Federal Financial Participation (FFP) funds. Sufficient appropriations and estimated revenues are included in DBH’s Org 5630 FY 2024-25 Recommended Budget and will be included in all future recommended budgets throughout the remainder of the contract terms.
DISCUSSION:
On December 11, 2018, your Board approved Agreement number 18-686 which allowed for The Supervised Overnight Stay Program to increase client access to appropriate mental health services by providing after-hours overnight stay, 24-hour/7-day-a-week clinical response, pee support, discharge, transportation and linkage services to appropriate mental health programs.
On June 20, 2023, your Board approved amendment I (No. 23-302) to the agreement, which extended the program for an additional 12 months along with ensuring compliance with CalAIM requirements.
Under the CalAIM transformation effort, the County is required to change existing payment methods from cost-based reimbursement to a fee-for-service (FFS) structure beginning July 1, 2023. On June 20, 2023, The Overnight Stay Program was extended for an additional twelve (12) months to allow for this. During this time, it was decided that the program would be able to maximize their services and make the program more financially sustainable if the billing structure was switched to a daily bed rate.
Approval of the recommended amendment II will change the billing structure from Medi-Cal billing and a line-item budget to Medi-Cal billing and a daily bed rate to better utilize the program’s funding and allow WestCare the option to pay their staff more competitive wages. The program’s maximum compensation is being decreased after review of Medi-Cal billing in the past and using a more accurate dollar figure based off actual billing.
Specific services provided by WestCare California, Inc. include transportation from the referring agency to the overnight stay facility, provision of beds, showers and food, immediate mental health assistance, transportation the following business day to a separate office for specialty mental health services, transportation to the appropriate level of care program in accordance with discharge plans, and follow up to ensure individuals are following through with their recommended plans of action.
The Supervised Overnight Stay Program has successfully increased client access to appropriate mental health services since May 2012. The program provides after-hour overnight stay, 24-hour/7-day-a-week clinical response, peer support, discharge, transportation, and linkage services to appropriate mental health programs. The program serves adults deemed appropriate for the program, pursuant to discharge from designated hospital emergency departments and W&IC, §5150 facilities within the County.
OTHER REVIEWING AGENCIES:
The Mental Health Board has been made aware of the recommended Amendment.
REFERENCE MATERIAL:
BAI #46, June 20, 2023
BAI #30, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment II with WestCare California, Inc.
CAO ANALYST:
Ron Alexander