DATE: July 9, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Memorandum of Understanding with Managed Care Plans; Blue Cross of California Partnership Plan, Inc. dba Anthem, Fresno-Kings-Madera Regional Health Authority dba Calviva Health and Kaiser Foundation Health Plan, Inc.
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a Memorandum of Understanding (MOU) with Blue Cross of California Partnership Plan, Inc. dba Anthem (Anthem), Fresno-Kings-Madera Regional Health Authority dba CalViva Health (CalViva Health), and Kaiser Foundation Health Plan, Inc. (Kaiser), for the coordination of Specialty Mental Health Services (SMHS) and Substance Use Disorder (SUD) treatment services provided to Medi-Cal beneficiaries, effective upon execution by all parties with unlimited (12) month auto-renewals unless terminated by either party ($0).
REPORT
Approval of the recommended actions will allow the Department of Behavioral Health to coordinate care with Medi-Cal Managed Care Plans (MCPs) for Medi-Cal beneficiaries who are identified as needing specialty mental health and substance use disorder treatment services. DBH currently has MOUs in place with Anthem and CalViva Health, which will be superseded by the recommended MOU to satisfy new Department of Health Care Services (DHCS) requirements. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. This MOU is contractually required by the DHCS to establish Specialty Mental Health and Substance Use Disorder treatment services managed care plans.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action since the MOU is for care coordination purposes. All services delivered will be billed to Medi-Cal.
DISCUSSION:
Per the Medi-Cal Mental Health Plan contract with the DHCS, the County is required to enter into a MOU with MCPs to ensure the coordination of services for Medi-Cal members. The County has two separate agreements with Anthem (A-22-258) and CalViva Health (A-22-257).
On October 12, 2023, the DHCS released Behavioral Health Information Notices (BHINs) 23-056 and 23-057. The BHINs updated requirements to the MOU’s between the County and Medi-Cal MCPs due to new California Advancing and Innovating Medi-Cal (CalAIM) regulations. Additionally, the BHINS clarified and reiterated responsibilities, oversight, compliance and DHCS reporting requirements between the County and the MCPs.
The current MOUs with Anthem and CalViva Health will be superseded by the recommended MOU. On January 1, 2024, the DHCS added Kaiser as an approved MCP for the Fresno County region. All three MCPs will be included in one single MOU as the DHCS requirements apply to all three MCP’s.
The DHCS allocates funding annually for physical health care, behavioral health services and SUD provided to eligible Medi-Cal beneficiaries. DHCS will fund the costs of physical health care directly to the MCPs for State sponsored programs. The funding for the behavioral health services is a "carve out" of the overall health plan funding and is managed separately by the Department. The County receives the Medi-Cal Behavioral Health funds directly from DHCS.
The Department is requesting these MOUs be executed as “evergreen” agreements due to the MOU between the County and MCPs being a requirement by DHCS for the foreseeable future. Anthem, CalViva Health and Kaiser are the only MCPs in Fresno County as well as surrounding counties. This MOU shall become effective upon execution and shall automatically be extended for an unlimited number of years upon the same terms and conditions, unless written notice of non-renewal is given by the providers or the Department’s director, or designee, not later than thirty (30) days prior to the close of the fiscal year.
REFERENCE MATERIAL:
BAI #39 June 21, 2022
BAI #26 June 8, 2021
BAI #42 July 10, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - MOU with Anthem, CalViva Health, and Kaiser
CAO ANALYST:
Ron Alexander