DATE: September 13, 2016
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Amendment I to Master Agreement for Individual and Group Providers for the Fresno County Mental Health Plan
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment I to Master Agreement No. 15-247 with Individual and Group Providers of specialty mental health services for the Fresno County Mental Health Plan, effective upon execution through June 30, 2020, with no increase to the maximum compensation ($18,142,695).
REPORT
Approval of the recommended action will adjust insurance requirements; remove references to cost reporting requirements that do not apply to contracted providers and correct references to State and County requirements. The changes will enable the Department of Behavioral Health to continue to provide Medi-Cal beneficiaries medically necessary inpatient and outpatient specialty mental health services by licensed and certified community mental health professionals contracted with the Fresno County Mental Health Plan (FCMHP). There is no change to the maximum compensation and the proposed Amendment is fully funded with Short/Doyle Medi-Cal Federal Participation and Behavioral Health Realignment revenues, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended Amendment, many providers would not be able to provide services to County clients and wait times for mental health services will increase for other contracted Medi-Cal providers on the Master Agreement.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum cost of the Agreement remains unchanged ($18,142,695) and will be financed with Short/Doyle Medi-Cal Federal Financial Participation and Behavioral Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department Org 5630 FY 2016-17 Adopted Budget, and will be included in future budget requests for the duration of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On March 17, 1998, your Board approved the Fresno County Mental Health Plan (FCMHP) with an effective date of April 1, 1998, through annual agreements with the California Department of Mental Health, now known as the California Department of Health Care Services (DHCS). The FCMHP is responsible for ensuring Medi-Cal beneficiaries of all ages have access to medically necessary inpatient and outpatient specialty mental health services.
The Master Agreement allows the services to be delivered through a wide variety of providers including psychiatrists, psychologists, licensed clinical social workers, and licensed marriage and family therapists. Every provider accepted by the FCMHP must:
• be approved through the Department’s Managed Care credentialing process;
• adhere to the requirements set forth in the FCMHP Provider Manual;
• follow quality assurance and utilization review guidelines;
• maintain appropriate clinical records; and,
• provide medical records upon request from the FCMHP.
On June 16, 2015, your Board approved Master Agreement No. 15-247 with individual and group specialty mental health service providers for the FCMHP, effective July 1, 2015 through June 30, 2020. The recommended Amendment will enable the Department to allow a larger number of individual and group service providers to become a part of the existing Master Agreement, comply with all related laws, policies, and regulations. All qualified providers that are interested in providing services may be included by signing the proposed Amendment accepting all incorporated terms and conditions. The current service requirements will be retained in the recommended Amendment, changes include:
• removal of insurance language pertaining to “Property Insurance”, “All Risk Property Insurance”, and “Fire Insurance and Extended Coverage”, as the providers do not purchase any property with County funds and operate from their personal offices;
• removal of references to cost reporting requirements;
• removal of references to the single audit requirements that do not apply to contracted providers;
• corrects and updates references to State requirements, County requirements, and several exhibits; and
• authorizes the Director, or their designee, to remove provider(s) with the written mutual consent of both parties.
Currently, there are 49 individual providers and 18 group providers on the Master Agreement. In FY 2015-16 services were provided to 4,907 unique clients. The fee schedule is established by the FCMHP and is dependent upon the provider’s professional discipline and specific mental health service, and is comparable to rates in other central valley counties.
The recommended Amendment allows either party to terminate their respective contract without cause upon giving 60 days advance written notice to the other party regarding an intention to terminate, with consideration for the welfare of the clients and necessary allowance for transition to another provider in order to maintain a continuum of care for the affected clients.
REFERENCE MATERIAL:
June 16, 2015, BAI # 37 - Master Agreement No. 15-247
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file With Clerk - Amendment I to Agreement 15-247
CAO ANALYST:
Sonia De La Rosa