COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

April 26, 2004

BOARD MEETING DATE:

May 11, 2004

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Managed Care Agreement with the State Department of Mental Health

Recommendation

Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with the State Department of Mental Health for mental health Medi-Cal managed care services.

Background

In April 1995, under a 1915(b) waiver granted to the State Department of Health Services (DHS) by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), San Mateo was the first California county to implement a managed mental health care system for Medi-Cal beneficiaries. At the end of the initial two-year waiver period, the San Mateo Mental Health Services Division worked with DHS and the Department of Mental Health (DMH) to submit a second federal waiver request, which was approved effective July 1, 1998, and was extended through October 31, 2001. Since that time Mental Health Services has applied for and received waivers allowing the continued operation of our managed care mental health system. Our current waiver is for the period July 26, 2003 through July 25, 2005.

On April 6, 2004, your Board approved an agreement with DMH for mental health Medi-Cal managed care services. That agreement established the allocation for the mental health plan for Medi-Cal eligible clients. It also defines the requirements for quality assurance, record keeping, client rights, and availability and accessibility of services, new requirements for Day Treatment Services, Therapeutic Behavioral Services, certification of program integrity, and the Health Insurance Portability and Accountability Act (HIPAA). In addition, it delineates the unique requirements of the San Mateo County waiver including case rate reimbursements, responsibility for medications prescribed by psychiatrists, and laboratory services.

When that agreement was brought before your Board, it was noted that DMH was planning to amend the agreement prior to the end of this fiscal year.

Discussion

This Agreement is being amended at the initiation of DMH to make many changes in program requirements. Significant changes in this amendment include: the County must have a compliance plan and a designated compliance officer; the County must submit timely claims to the DMH that are certified as to their appropriateness and quality of the covered services; the County is to provide clients with a list of County's providers upon request and when a client first receives a specialty mental health service; in emergency situations, the County must expedite authorization for payment decisions and make an expedited decision within 3 days of an authorization request; and, the County must have policies and procedures on advance directives in place by May 31, 2004.

Vision Alignment

This amended Agreement with DMH keeps the commitment to Ensure Basic Health and Safety for All and goal number 8: Help vulnerable people-the aged, disabled, mentally ill, at risk youth, and others-achieve a better quality of life. The amended Agreement contributes to this commitment and goal by providing managed care mental health services to a vulnerable population.

Fiscal Impact

The amount of this agreement is $8,105,927 for FY 2003-04, an increase $303,286 over the amount for FY 2002-03. This includes $5,469,504 000 as the state share of Medi-Cal expenses for pharmacy and related laboratory services. In addition to the state allocation, Mental Health bills the State separately for the federal fee portion (FFP) of Medi-Cal. The anticipated federal revenue for case rates, TBS and pharmacy is approximately $23,000,000. The state and federal revenue is included in the FY 2003-04 Mental Health Services budget.