DATE: June 21, 2022
TO: Board of Supervisors
SUBMITTED BY: Susan Holt, Director, Department of Behavioral Health
SUBJECT: Amendment to Memoranda of Understanding with Managed Care Plans CalViva Health and Anthem Blue Cross
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment II to Agreement with Fresno-Kings-Madera Regional Health Authority, a memorandum of understanding, to update Department of Health Care Services requirements, effective upon execution, with no change to the term of June 10, 2018 with unlimited one-year auto-renewals unless terminated by either party ($0);
2. Approve and authorize the Chairman to execute Amendment II to Agreement with Blue Cross of California Partnership Plan, Inc., a memorandum of understanding, to update Department of Health Care Services requirements, effective upon execution, with no change to the term of June 10, 2018 with unlimited one-year auto-renewals unless terminated by either party ($0); and,
3. Approve and authorize the Director of the Department of Behavioral Health, or designee, upon review by County Counsel as to legal form and Auditor-Controller/Treasurer-Tax Collector as to accounting form, to approve changes to the scope of work for the Agreements with Fresno-Kings-Madera Regional Health Authority and Blue Cross of California Partnership Plan, Inc., to accommodate changes in the law and state-mandated requirements related to mental health and substance use disorder treatment services, as needed.
REPORT
Approval of the recommended actions will allow the Department of Behavioral Health and the Managed Care Plans (MCPs) [Fresno, Kings, Madera Regional Health Authority (CalViva Health) and Blue Cross of California Partnership Plan, Inc. (Anthem)] to update the Memorandum of Understanding (MOU) with state-county contract language from the California Department of Health Care Services (DHCS) and the scope of work with allowable substance use disorder diagnosis codes. There is no money associated with the recommended MOU amendments. This item is countywide.
ALTERNATIVE ACTION(S):
If your Board does not approve the recommended actions, the Department and the MCPs will be out of compliance with the state-county contracts for requirements related to clinical integration between the County and MCPs, and the Specialty Mental Health Dispute Resolution Process.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. There is no money associated with the recommended MOU amendments. The MOUs are required by DHCS to establish the coordination of specialty mental health and substance use disorder treatment services with the MCPs.
DISCUSSION:
On April 24, 2012, the County entered into MOUs with the MCPs to meet Managed Health Plan requirements. As defined in California Code of Regulations, Title 9, Section 1810.370, MOUs with Medi-Cal MCPs were to improve care coordination for Medi-Cal beneficiaries identified as needing specialty mental health services.
The MOUs were revised on July 10, 2018, to integrate care coordination between physical health providers and the new Drug Med-Cal Organized Delivery System (DMC-ODS) implemented in the County on January 1, 2019. The DMC-ODS is an MCP for substance use disorder treatment services.
On June 8, 2021, your Board approved Amendment I to Agreement No. 18-361 and Agreement No. 18-362 to update the MOUs with state-county contract language from DHCS, as well as incorporate an additional insurance and Non-Discrimination clause to both agreements.
DHCS allocates funding annually for physical health care and behavioral health services provided to eligible Medi-Cal beneficiaries. DHCS will fund the costs of physical health care directly to 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 recommended amendment will bring the Department and MCPs into compliance with DHCS requirements. All other terms to the MOU remain unchanged.
Human Resources Department - Risk Management Division has reviewed the recommended amendment and while the current insurance language is sufficient, Risk has advised that additional insurance requirements may need to be addressed in a future amendment.
REFERENCE MATERIAL:
BAI # 26, June 8, 2021
BAI #34, December 11, 2018
BAI #42, July 10, 2018
BAI #42, April 24, 2012
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment II to Agreement with CalViva Health
On file with Clerk - Amendment II to Agreement with Blue Cross (Anthem)
CAO ANALYST:
Sonia M. De La Rosa