REPORT TO SHASTA COUNTY BOARD OF SUPERVISORS

BOARD MEETING DATE:  July  17, 2018
CATEGORY:  Consent - Health and Human Services-9.

SUBJECT:

Retroactive Agreement with California Department of Health Care Services for the Mental Health Managed Care Plan, Salary Resolution and Budget Amendment

Supervisorial District No. :  All

DEPARTMENT CONTACT:  Donnell Ewert, Director, Health and Human Services Agency, (530) 225-5899

STAFF REPORT APPROVED BY:  Donnell Ewert, Director, Health and Human Services Agency

RECOMMENDATION

Take the following actions: (1) Adopt a resolution regarding the California Department of Health Care Services (DHCS) Mental Health Plan (MHP) agreement which: (a) approves a retroactive renewal revenue agreement (No. 17-94616) with DHCS for the MHP in Shasta County; (b) delegates signature authority to the HHSA Director, Donnell Ewert, to sign retroactive revenue renewal Agreement No. 17-94616, and accompanying certification documents, including retroactive, with DHCS for Medi-Cal covered specialty mental health services through the MHP for the period July 1, 2017 through June 30, 2022, provided they otherwise comply with Administrative Policy 6-101, Shasta County Contracts Manual; and (c) delegates signature authority for amendments and other subsequent related documents, including retroactive, to the HHSA Director, Donnell Ewert, that do not result in a functional or substantial change, provided they otherwise comply with Administrative Policy 6-101, Shasta County Contracts Manual; (2) adopt a salary resolution, effective July 22, 2018, which amends the Shasta County Position Allocation List as follows: (a) adds 1.0 Full-Time Equivalent (FTE) Clinical Program Coordinator and 1.0 FTE Staff Services Analyst I/II in the Mental Health budget; and (3) approve a budget amendment (4/5 vote required) to increase appropriations by $197,644 and to increase revenue by $189,038 in federal and state revenue, with the balance offset by use of Mental Health Restricted State Realignment 1991/2011 fund balance in the amount of $8,606.

SUMMARY

N/A

DISCUSSION

The Department has provided mental health services to Medi-Cal recipients through its Shasta County Mental Health Plan since January 1997. The proposed renewal agreement with the State of California, Department of Health Care Services (DHCS) establishes the Medicaid Managed Care regulations that govern Shasta County’s provision of inpatient and outpatient mental health services to Medi-Cal clients. As many of the requirements in the Medicaid Managed Care regulations became effective and applicable on July 1, 2017 DHCS is retroactively aligning the proposed agreement with the July 1, 2017 date. Execution of this agreement is required for the County to receive Medi-Cal reimbursement funds.

Due to the extensive changes and new requirements related to implementation of the Managed Care Final Rule and Parity, including Network Adequacy (the ability of health plan provider networks to deliver the right care, at the right time, without having to travel unreasonably far), timeliness standards, monitoring and reporting, concurrent review and authorization oversight, and provider credentialing, monitoring and reporting requirements, HHSA is requesting two additional position allocations.  The Clinical Program Coordinator will oversee the Quality Improvement functions for the Mental Health Plan, including serving as a liaison with stakeholders, including consumers, family members, and community partners.  The Staff Services Analyst duties will consist of monitoring and reporting on new requirements implemented due to the Managed Care Final Rule.  Both positions will also assist with Presumptive Transfer Short Term Residential Treatment Program (STRTP) site certifications and ongoing monitoring.  Federal and State revenue is available for approximately 95% of costs included in the budget amendment due to enhanced funding for federal financial participation and additional state funding for the new regulations. Therefore, a related budget amendment is also requested.

ALTERNATIVES

DHCS has indicated that there is no ability for counties to further modify the terms of the agreement.  The Board could choose not to approve some or all of the recommendations.  If the MHP agreement is not approved, it could result in a loss of significant amounts of realignment funding to the County and/or the state administration of the County’s mental health program.  If the delegating signature authority to the HHSA Director is not approved, it may result in a decrease of efficiency in contract maintenance during the five-year term of the agreement. Finally, the Board could choose not to approve the budget amendment and salary resolution, and if so, current HHSA staff would need to absorb the additional work related to the additional agreement requirements.

OTHER AGENCY INVOLVEMENT

The MHP agreement will be discussed at the Shasta County Mental Health, Alcohol and Drug Advisory Board meeting on September 5, 2018.  County Counsel has approved the agreement as to form.  Risk Management and County Information Technology have reviewed and approved the agreement. The Support Services Department-Personnel Unit prepared the salary resolution. The Auditor-Controller has reviewed the budget amendment. County Counsel and Risk Management will be asked to review and approve the PHC MOU prior to being presented to the CEO for his review and approval.  This recommendation has been reviewed by the County Administrative Office.

FINANCING

Compensation payable to Shasta County by the federal Medicaid funding can be obtained over the five years through expenditure of local general funds and 1991 and 2011 mental health realignment as match.  Federal reimbursement is contingent on certified public expenditures made by Shasta County and then claimed through the Medi-Cal billing process. The agreement will allow for the continued pass-through of approximately $14.1 million in federal Medicaid funds annually to Shasta County.  Payment to Shasta County is processed as claims are made for mental health services provided by the HHSA as well as through contractors.  A cost reporting/reconciliation process takes place after the close of the fiscal year and any differences between the billed costs and the cost of providing services are paid to or recouped from Shasta County’s Mental Health Fund.  Matching funds are provided through a combination of 1991 and 2011 realignment as well as a County General Fund contribution of $266,778.  There is no additional General Fund impact.