DATE: June 6, 2023
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, LMFT, Director of Behavioral Health
SUBJECT: Retroactive Amendment I to California Mental Health Services Authority Participation Agreement
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute retroactive Amendment I to Participation Agreement with California Mental Health Services Authority to allow the Department to include Subject Matter Expert services including Interoperability services, effective February 23, 2023 with no change to the term of August 9, 2022 through June 30, 2024, or compensation maximum of $200,590.
2. Approve and authorize the Department of Behavioral Health Director, or designee, to be the signatory and act as the Fresno County representative on behalf of the Board of Supervisors on associated California Mental Health Services Authority related forms, and approve services as needed via a work order, without modifying the maximum compensation.
REPORT
There is no additional Net County Cost associated with the recommended action. The Department of Behavioral Health is responsible for meeting select milestones required to complete the California Advancing and Innovating Medi-Cal (CalAIM) Behavioral Health Quality Improvement Program (BHQIP) deliverable in areas including payment reform policy changes and data exchange. Approval of the recommended actions will reallocate FY 2022-23 funds to allow Optional Subject Matter Expert (SME) services and authorize the Director to execute related forms as needed. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended action, the Department would be out of compliance with DHCS milestone requirements.
RETROACTIVE AGREEMENT:
The recommended amendment is retroactive to February 23, 2023 to reallocate funds from Clinical services to Interoperability services without changing the overall agreement compensation. This will allow the Department to receive additional guidance and consultation, as well as Behavioral Health Quality Improvement Plan (BHQIP) incentive dollars as the department implements the CalAIM initiative. In order to meet BHQIP Interoperability deliverables in March 2023, the Department changed an objective to include a data hub by CalMHSA, rather than the original Health Information Exchange due to our transition to a new Electronic Health Record in July 2023.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum amount allocated for this agreement shall not exceed $200,590 and will be fully offset with Realignment funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2022-2023 Adopted Budget and will be included in future budget requests.
DISCUSSION:
On September 14, 2010, the Board approved Agreement No. 10-489 with California Mental Health Services Authority (CalMHSA) authorizing the Department to join the CalMHSA Joint Powers Authority (JPA), to develop, implement, administer, and provide fiscal oversight of Mental Health Services Act (MHSA).
On June 18, 2013, the Board approved Amendment No. 10-489-1 with CalMHSA, broadening the stated purpose for the JPA to allow CalMHSA to perform additional services for behavioral health departments acting alone or in collaboration, which included but was not limited to data management, research, and development.
On August 9, 2022, the board approved Agreement 22-343 with California Mental Health Services Authority to provide support in developing Behavioral Health Quality Improvement Program projects. The Department works with CalMHSA to develop and implement strategies required to meet DHCS milestones in the BQHIP, which will be governed by CalMHSA Agreement and Bylaws. CalMHSA’s primary responsibilities will be to develop these projects to support counties in meeting required BHQIP deliverables and implementing the CalAIM transformation. The projects are identified in the following categories: Payment Reform, Policy Changes, and Data Exchange categories.
• Project 1 (Payment Reform) - CalMHSA will work with the Department to draft updated subcontracted provider boilerplate language to incorporate new code sets and claiming requirements in order to meet the Milestone 1a(iii) requirement.
• Project 2 (Policy Changes) - CalMHSA will conduct a landscape analysis of documentation audit practices and draft an updated Utilization Management protocol to comply with best practices and updated document audit standards to meet the Milestone 2d(iv) requirement.
• Project 3 (Data Exchange) - CalMHSA will collaborate with the Department to receive and analyze Managed Care Plan data for the July 2022/July 2023 measurement period and analyze the data to establish Department baseline performance to meet the Milestone 3d(i) requirement.
• Project 4 (Optional Data Exchange Services) - CalMHSA will support the Department in developing and implementing Performance Improvement Project (identifying, implementing, and tracking interventions to improve performance related to measures indicated under Milestone 3d(i) to meet Milestones 3d(i), 3d(ii), 3d(iii) requirements.
Additional Professional Services (project management clinical training and policy changes implementation support) will be used to further assist in developing communication strategies for the entire network of care and training resources.
Selecting to participate in all four (4) Projects will ensure each Milestone deadline is met.
Interoperability services provides the Department with guidance on data systems management specific to CalAIM Data Exchange, BHQIP deliverables, and consulting and/or configuring on coordination and integration of systems operations across county agencies. In order to submit the BHQIP CalAIM Incentive deliverables by March 1, 2023, the Department needed the assistance of CalMHSA without further delay.
Approval of the recommended action will allow the Department to add CalMHSA consultation services as needed to meet the required CalAIM deliverables on time.
The current agreement varies from the standard County templates as it was drafted by CalMHSA and is utilized by CalMHSA to execute Participation Agreements with multiple counties and is consistent statewide. The Agreement with CalMHSA requires a six-month advance written notice to terminate. It is disclosed that the County’s insurance language and limits are not contained within this Agreement. The Department believes that the benefits of the recommended agreement outweigh any potential risk and recommends approval of the agreement.
REFERENCE MATERIAL:
BAI #34, August 9, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to CalMHSA Participation Agreement No. 22-343
CAO ANALYST:
Ron Alexander