COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

 

DATE:

October 5, 2006

BOARD MEETING DATE:

October 24, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Gale Bataille, Director, Mental Health Services

   

SUBJECT:

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

 

RECOMMENDATION:

Adopt a resolution authorizing the President of the Board to execute an agreement with the State of California Department of Mental Health for Managed Care Services for the term July 1, 2006 through June 30, 2009, for a maximum obligation for FY 2006-07 of $7,334,138.11.

 

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 agreement contributes to this commitment and goal by providing funding for Medi-Cal managed care services and other specified mental health services for San Mateo County residents.

 

BACKGROUND:

In April 1995, under a waiver granted to the State of California Department of Health Services (DHS) by the federal Centers for Medicare and Medicaid Services (CMS), San Mateo was the first California county to implement a mental health managed care system for Medi-Cal beneficiaries. Our annual State of California Department of Mental Health (DMH) Managed Care agreements have authorized Mental Health Services, under the conditions of these federal waivers, to be the San Mateo County Mental Health Plan to provide mental health services to Medi-Cal eligible clients. These agreements have provided State General Fund revenue to support managed care and other specified mental health services.

 

From 1995 through FY 2004-05 Mental Health Services applied for and received federal CMS waivers allowing the operation of our managed care mental health system with case rate reimbursement from the DMH. Effective July 1, 2005, San Mateo County was folded into a federal waiver submitted by DMH for all other California counties. Under that waiver reimbursement from the DMH is made on a fee-for-service basis.

 

DISCUSSION:

The agreement defines the requirements for quality improvement, record keeping, client rights, availability and accessibility of services, utilization management, provider certification, fee-for-service reimbursement, 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, the Health Insurance Portability and Accountability Act (HIPAA), and other program requirements.

 

In prior years these agreements have been for a one-year term. DMH is now requiring a three-year agreement term. The term of this agreement is July 1, 2006 through June 30, 2009. The agreement has been reviewed and approved by County Counsel and Risk Management.

 

FISCAL IMPACT:

The agreement maximum for FY 2006-07 is $7,334,138.11. This includes $4,565,000 as the State general fund match for Medi-Cal expenses for pharmacy and related laboratory services. The balance of $2,769,138.11 is the State general fund match for Medi-Cal expenses for other managed care activities and services. The County FY 2006-07 Adopted Budget includes the full amount of this agreement. DMH will provide amendments to this agreement early in 2006 and 2007 to reflect the amounts included in the approved State budgets for FY 2007-08 and FY 2008-09 respectively.

 

In addition to the State allocation, Mental Health Services bills the State separately for the federal financial participation (FFP) portion of Medi-Cal. Both the State and Federal revenues are included in Mental Health’s FY 2006-07 Adopted Budget.