COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

June 21, 2005

BOARD MEETING DATE:

July 12, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Gale Bataille, Director of Mental Health Services

SUBJECT:

Amendment to the Agreement with the State Department of Mental Health for Managed Care Services

RECOMMENDATION:

Adopt a resolution authorizing the President of the Board to execute an Amendment to the Agreement with State Department of Mental Health for Managed Care services for the term July 1, 2004, through June 30, 2005, increasing the Agreement maximum by $661,439 to $9,153,862.

VISION ALIGNMENT:

Commitment: To ensure basic health and safety for all.

Goal 8: Help vulnerable people-the aged, disabled, mentally ill, at risk youth, and others- achieve a better quality of life.

This amended Agreement contributes to this commitment and goal by providing managed care mental health services to a vulnerable population.

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 annual DMH Managed Care Agreements have authorized the San Mateo Mental Health Plan to provide mental health services under the conditions of these federal waivers to Medi-Cal eligible clients and provides State General Fund revenue to support managed care and other specified services. Our current waiver is for the period July 26, 2003, through July 25, 2005.

On June 8, 2004, your Board approved an agreement with DMH for mental health Medi-Cal managed care services for FY 2004-05 with an interim allocation.

DISCUSSION:

The Agreement defines the requirements for quality assurance, record keeping, client rights, and availability and accessibility of services, and it delineates the unique requirements of the San Mateo County waiver including case rate reimbursements, responsibility for medications prescribed by psychiatrists, and laboratory services. It also establishes requirements for Day Treatment Services, Therapeutic Behavioral Services (TBS), certification of program integrity, and the Health Insurance Portability and Accountability Act (HIPAA), and other program requirements.

This Agreement is being amended to revise regulations pertaining to Day Treatment Services, Therapeutic Behavioral Services, and other administrative requirements. This amendment also establishes a finalized allocation for this fiscal year.

While this agreement was received from the State in February, there were errors in the agreement. DMH provided a corrected agreement in late May.

FISCAL IMPACT:

The amended Agreement maximum is $9,153,862 for FY 2004-05, an increase of $661,439 over the interim amount for FY 2004-05. This includes $6,385,000 as the state share of Medi-Cal expenses for pharmacy and related laboratory services. The 2004-05 approved budget for Mental Health included the full amount of this contract, including the amended amount, so no budget amendment is needed.

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 $22,500,000. The state and federal revenue is included in the FY 2004-05 Mental Health Services budget.