COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System

DATE:

September 3, 2010

BOARD MEETING DATE:

September 28, 2010

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System

Louise Rogers, Director, Behavioral Health & Recovery Services

SUBJECT:

Agreement with Health Plan of San Mateo for Administering Pharmacy Benefits

RECOMMENDATION:

Adopt a Resolution authorizing the:

A)

President of the Board to execute an Agreement with the Health Plan of San Mateo

(HPSM) for the administering of pharmacy benefits provided to indigent adults and

Medi-Cal members with share of cost for the period of July 1, 2010 through June 30,

2013, in the amount of $7,5000,000; and

B)

Chief of the Health System or designee to execute contract amendments which

modify the County's maximum fiscal obligation by no more than $25,000 (in

aggregate), and/or modify the contract term and/or services so long as the modified

term or services is/are within the current or revised fiscal provisions.

BACKGROUND:

In FY 2009-10, Behavioral Health and Recovery Services (BHRS) had a unique funding arrangement with the State Department of Mental Health (DMH) for pharmacy benefit management services. DMH has now revised the funding structure for these services to match that of other counties, with a start date of July 1, 2010. BHRS is no longer eligible to contract directly for PBM services and the State has transferred the Medi-Cal funding for pharmacy and laboratory services to HPSM.

DISCUSSION:

BHRS is entering into a separate Agreement with HPSM for the provision of PBM services to indigent adults and Medi-Cal members with share of cost who are not covered by the DMH Medi-Cal funding structure and for whom BHRS is financially responsible for. HPSM has contracted with InformedRx as the Pharmacy Benefit Manager. To promote service continuity and efficiency, BHRS wishes to partner with HPSM and utilize their Pharmacy Benefit Manager (PBM) to meet the needs of our clients. HPSM amended their agreement with InformedRx to include services for BHRS clients who are indigent or have a Medi-Cal share of cost. InformedRx will submit claims to HPSM for payment. HPSM will in turn submit claims to BHRS for reimbursement of these services.

The Agreement and Resolution have been reviewed and approved by County Counsel. The Contractor’s insurance has been reviewed and approved by Risk Management. The Contractor has assured compliance with the County's Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.

The Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing funding for mental health services. BHRS provides a range of services to promote wellness and recovery and to support consumers remaining in the lowest possible level of care. The provision of pharmacy benefit service (an outpatient mental health service) is one established level of care and has assisted clients to remain stable in the community. The services funded through this Agreement contribute to this measure. It is anticipated that eighty-seven percent of clients who receive services will be maintained at a current or lower level of care.

Performance Measure:

Measure

FY 2009-10
Actual

FY 2010-11
Projected

Percentage of clients receiving outpatient mental health services maintained at current or lower level of care.

87%

87%

FISCAL IMPACT:

The term of the Agreement is July 1, 2010 through June 30, 2013. The Agreement maximum will be $7,500,000. For FY 2010-2011 the maximum cost is expected to be $1,500,000. Of that amount, Realignment will fun $155,262, and $1,344,738 is Net County Cost. Similar funding arrangements will be made for subsequent years. Funds for these services have been included in the BHRS tentatively Adopted FY 2010-11 Budget.