DATE: May 21, 2024
TO: Board of Supervisors
SUBMITTED BY: Susan Holt, Director, Department of Behavioral Health
SUBJECT: Retroactive Amendment No. 3 to Master Agreement No. 24-021 for Individual and Group Providers for the Fresno County Mental Health Plan
RECOMMENDED ACTION:
TITLE
Approve and authorize the Chairman to execute a retroactive Amendment 3 to Master Agreement to revise the billing rates, remove one provider, Bashful Elephant Consulting, from the agreement and add three providers, Inspire Psychological Services, Inc., Joint Opportunities, and West Side Church of God to the agreement, effective July 1, 2023 with no change to the term of July 1, 2020 through June 30, 2025, and increasing the maximum by $4,498,209 to a total of $27,239,838.
REPORT
There is no additional Net County Cost associated with approval of the recommended action, which will revise the provider billing rate sheet to correct an error in the per minute rates, remove Bashful Elephant Consulting from the agreement and add three additional providers, Inspire Psychological Services, Inc., Joint Opportunities, and West Side Church of God, to the agreement. The addition of these providers will allow additional qualified community mental health professionals to provide Specialty Mental Services to Medi-Cal recipients. This item is countywide.
ALTERNATIVE ACTIONS:
There is no viable alternative action. Should your Board not approve the recommended action, the Department would continue to pay providers at an inaccurate per minute rate and not have sufficient expenditure limits to reimburse contracted providers for FY 2023-24 and 2024-25. The County would not be able pay providers for services related to the Supplemental/Add-On service codes and lose out on the opportunity to bill Medi-Cal for those services. Should Inspire Psychological Services Inc., Joint Opportunities and West Side Church of God not be added to the Master Agreement, the Department would not be able to increase its network of providers, possibly leading to longer wait times and potentially causing the Department to be out of compliance for providing State-mandated timely service.
RETROACTIVE AGREEMENT:
The recommended amendment is retroactive to July 1, 2023 as the previously approved billing rate sheet includes incorrect rates, which was due to a mutual oversight by the Department and Providers at the time of approval. The Department seeks to correct the error to reimburse the providers properly dating back to the effective date of the first amendment (No. 23-271) to the agreement.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The combined increase of $4,498,209 for FY 2023-24 and 2024-25 increases the total contract maximum compensation to $27,239,838 for all providers for the total contract term. Specialty Mental Health Services under this agreement are funded in part by Medi-Cal Federal Financial Participation (FFP) and Realignment funds. Sufficient appropriations and estimated revenues are included in the Department’s Behavioral Health Org 5630 FY 2023-24 Adopted Budget and will be included in future budgets for the duration of the Agreement. Actual costs are determined by actual services provided.
DISCUSSION:
On June 23, 2020, the Board approved Master Agreement No. 20-236 with licensed and registered Individual and Group providers for mental health services to be delivered through a broad base of providers including psychiatrists, psychologists, licensed clinical social workers, licensed professional clinical counselors, and licensed marriage and family therapists to Medi-Cal eligible clients.
On June 20, 2023, the Board approved Amendment 1 (No. 23-271) to Master Agreement No. 20-236 to update the rates to be in compliance with the new California Advancing and Innovating Medi-Cal (CalAIM) initiative set forth by the Department of Health Care Services (DHCS). The initiative changed the way the Department claims federal reimbursement for persons served with Medi-Cal benefits. Due to mutual oversight by the Department and Providers, the County included a rate sheet with inaccurate reimbursement rates. The proposed Amendment III will revise the rate sheet to reflect the correct rates. Additionally, the amended rate sheet will include the newly DHCS-approved Supplemental/Add-on service codes for Interactive Complexity and Sign Language or Oral Interpretive Services.
On January 9, 2024, the Board approved Amendment No. 2 (No. 24-021) to add additional providers to the Master Agreement. Inspire Psychological Services, Inc., Joint Opportunities and West Side Church of God have completed their site certification and have been approved by the DBH Credentialing Committee. Adding these providers to the Master Agreement will result in more services available to Medi-Cal recipients.
The CalAIM initiative nearly doubled the reimbursement rate for subsequent inpatient professional services fees which are paid through this agreement. With the increased rate, the Department estimates the FY 2023-24 to be exhausted before June 30, 2024 and estimates that the current contract maximum for FY 2024-25 will be insufficient. In addition, existing providers on the Master Agreement have increased their capacity, thereby resulting in increased anticipated expenditures. Approval of the recommended action will correct the per minute rates included within the agreement rate sheet and account for the increase in reimbursement costs and the addition of three providers.
Approval of the recommended action will also remove Bashful Elephant Consulting from the agreement. On December 23, 2023, Patricia Buffaloe, owner of Bashful Elephant Counseling, passed away. Certification of Vital Records was received on February 2, 2024. All payable claims for services rendered have been completed and are currently in the processed to be paid. Bashful Elephant Counseling must be removed from the Master Agreement.
DBH intends to return to the Board in the months ahead to request approval to remove Providers delivering inpatient professional services and to present a separate agreement for those Providers and payment of these required inpatient professional service fees. Negotiation for a new separate Agreement for those services trails this requested Board action.
REFERENCE MATERIAL:
BAI #32 January 9, 2024
BAI #43 June 20, 2023
BAI #33 June 23, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment No. 3 to Master Agreement
CAO ANALYST:
Ron Alexander