DATE: March 12, 2019
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: California Mental Health Services Authority Inter-Member Transfer Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a Participation Agreement with California Mental Health Services Authority for the Inter-Member Transfer Program, effective upon execution through June 30, 2022, total not to exceed $600,000.
2. Approve and authorize the Director of the Department of Behavioral Health, or designee, to execute related reports and documents.
REPORT
Approval of the first recommended action will allow Fresno County to participate in California Mental Health Services Authority’s (CalMHSA) Inter-Member Transfer Program where CalMHSA will act as the fiscal agent for participating counties to facilitate prompt payments between counties as required by Welfare and Institutions Code (WIC) § 14717.1 for Specialty Mental Health Services (SMHS) provided to or arranged for foster children. The second recommended action allow the Director of the Department of Behavioral Health (DBH) or designee to sign any reports and documents related to the recommended agreement, at no increase in Net County Cost.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended actions, the Department would not be able to participate in the CalMHSA Inter-Member Transfer program to facilitate prompt payments between counties as required by WIC § 14717.1 and result in the need to contract with each county individually, which would be an inefficient use of time and resources, with no certainty of procurement.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The cost of the recommended agreement ($600,000) will be fully offset with Medi-Cal revenues and mental health realignment funds. Sufficient appropriations and estimated revenues are available in the Department’s Org 5630 Fiscal Year 2018-19 Adopted Budget and will be included in future budget requests for the duration of the contract term.
DISCUSSION:
Counties who provide foster youth Specialty Mental Health Services (SMHS) are reimbursed through Federal Financial Participation (FFP) and county match through Medi-Cal billing. Recent amendments to the Welfare and Institution Code (WIC) § 14717.1 changed the responsibility for providing or arranging for SMHS for foster youth from the county of original jurisdiction to the county in which a foster child resides, subject to any exceptions established pursuant to that section. This is known as “presumptive transfer”. Counties have agreed that the county of original jurisdiction (sending county) remains responsible for reimbursing the receiving county for SMHS provided or arranged by the receiving county. Implementation of this statute requires a system for counties to make prompt payments to each other. Under this program, CalMHSA acts as a fiscal agent for participating counties to make and receive transfer payments. The County of Fresno is already a member of the CalMHSA, a joint powers authority created to perform administrative and fiscal services on behalf of its members. Approval of this item will allow the County to participate in CalMHSA's Inter-Member Transfer Program to facilitate prompt payments between counties as required by WIC 14717.1.
CalMHSA will operate a banking pool. Each participating member county will have separate financial ledger accounts and will receive periodic statements of year-to-date balance, payments to other counties, payments from other counties, administration costs and interest earned. The initial amount required is estimated to be the first quarter of expenditures but will be reconciled as actual expenses are made. Required future funding will be based on the projection of actual expenses in order to make funding continuously available for the program. CalMHSA will transfer funds back to the participating counties that have more funding than deemed necessary for the program. In addition, there would be an administrative charge by CalMHSA for its services, currently estimated at less than 5%. CalMHSA’s administration of programs or projects will result in more cost-effective rates for services, reduced demands on County administrative services, and increased efficiency in implementing services.
By June 2019, Fresno County will have converted approximately 25 group homes into Short Term Residential Therapeutic Program facilities serving the foster youth population. As a result, it is anticipated that Fresno County will receive an influx of foster youth placements from other counties that would lead to greater revenue loss without a payment mechanism in place. Approval of this item will allow foster children who are placed outside of the County of Fresno to access SMHS in a timely manner and County of Fresno to be reimbursed timely for SMHS provided to foster children placed in this county.
Fresno County Charter Section 13 states that if the County employs independent contractors to perform any County service being performed by County employees, then contract approval shall require four affirmative votes of the Board of Supervisors. County Counsel has indicated this requirement does not apply to this item as the service covered under the recommended agreement is not being provided by County employees.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board has been informed of this item at their February 20, 2019 meeting.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Participation Agreement for CalMHSA Inter-Member Transfer Program
CAO ANALYST:
Ronald W. Alexander