|
Agenda Item
ASR
Control 20-000728 |
||
|
MEETING DATE: |
11/03/20 |
|
|
legal entity taking action: |
Board of Supervisors |
|
|
board of supervisors
district(s): |
All Districts |
|
|
SUBMITTING
Agency/Department: |
Health Care Agency
(Approved) |
|
|
Department contact
person(s): |
Annette Mugrditchian (714) 834-5026 |
|
|
|
Jeff Nagel (714) 834-7024 |
|
Subject: Approve Amendments to
CalOptima Contract for Behavioral Health Care Services
|
ceo CONCUR |
|
Clerk of the Board |
||||||||
|
Concur |
Approved Agreement to Form |
Consent Calendar |
||||||||
|
|
|
3 Votes Board Majority |
||||||||
|
|
|
|
||||||||
|
Budgeted: N/A |
Current Year Cost:
N/A |
Annual Cost:
N/A |
||||||||
|
|
|
|
||||||||
|
Staffing Impact: |
No |
# of Positions:
|
Sole Source:
N/A |
|||||||
|
Current Fiscal Year Revenue: N/A
|
||||||||||
|
Prior Board Action: 08/22/2017
#10, 03/24/2015 #10 |
||||||||||
RECOMMENDED ACTION(S):
|
1. |
Approve Amendment IV to incorporate required regulatory language and to provide clarification on the scope and compensation to the Contract with Orange County Health Authority dba CalOptima for Provision of Coordination of Behavioral Health Care Services. |
|
2. |
Approve Amendment V to renew the Contract with Orange County Health Authority dba CalOptima for Provision of Coordination of Behavioral Health Care Services for a one-year term effective January 1, 2021, through December 31, 2021. |
|
3. |
Authorize the Health Care Agency Director, or designee, to execute the Renewal of and Amendments to Contract as referenced in the Recommended Actions above. |
SUMMARY:
Approval of Amendments IV and V to Contract with Orange County Health Authority dba CalOptima for Provision of Coordination of Behavioral Health Care Services will provide coordination of care for CalOptima members who are in the OneCare and OneCare Connect programs and need behavioral health services from Orange County Health Care Agency Behavioral Health Services.
BACKGROUND INFORMATION:
Title 9, California Code of Regulations, Chapter 11 (Title 9) requires the existence of a Memorandum of Understanding (MOU)/Contract between the Medi-Cal Mental Health Plan (MHP) and Medi-Cal Managed Care Health Plans (MCP) within a county. In Orange County, the Health Care Agency (HCA) holds the contract with the California Department of Health Care Services (DHCS) to serve as the MHP and Orange County Health Authority dba CalOptima (CalOptima) holds the contract with DHCS to serve as the single MCP. Since 1999, an MOU between HCA and CalOptima has existed to delineate the responsibilities and processes for coordination of care for Medi-Cal beneficiaries.
In November of 2013, DHCS issued an All Plan Letter 13-018 requiring that MCPs across the state amend or replace the long-standing MOUs for coordination of care between MHPs and MCPs to address the significant changes in the Medi-Cal system that have occurred since the requirements were first set out in Title 9.
Your Honorable Board of Supervisors (Board) took the following actions:
|
Board Date |
Action |
|
March 24, 2015 |
The Board approved the current MOU for the Provision of Mental Health Services, which was updated pursuant to the DHCS All Plan Letter 13-018. The MOU provided additional detail on the processes for the coordination of care between HCA and CalOptima. There were no service requirements added. |
|
August 22, 2017 |
The Board approved Amendment I to the current MOU to set forth the responsibilities of HCA and CalOptima for the coordination of Substance Use Disorder (SUD) services in order to ensure CalOptima members were able to access necessary, appropriate and timely SUD services prior to the implementation of the Drug Medi-Cal pilot program. |
Subsequent non-Board actions:
|
Date |
Action |
|
December 31, 2017 |
Amendment II revised the start date of Cal MediConnect, revised the term end date of the Contract to December 31, 2017, and updated the Behavioral Health benefit matrix. |
|
January 1, 2018 |
Amendment III renamed the contract to “Contract for Provision of Coordination of Behavioral Health Care Services”, revised the term end date of the Contract to December 31, 2020, and updated the Behavioral Health benefit matrix in Amendment II. |
Amendment IV amends various terms and conditions of the
Contract as specified to incorporate required regulatory language and provide
clarification on the scope of and compensation under the Contract. The changes
aim to more closely align the language, definitions, and provider requirements
with Centers for Medicare & Medicaid Services (CMS) Medicaid Managed Care
Final Rule. For example, the Participation Status for mental health providers
is more specifically defined to mean they must meet with CalOptima’s Compliance
Program and Polices and the provider must not be on the CMS preclusion
list. Other requirements were added
regarding timeliness standards for offering appointments to beneficiaries,
reporting requirements and certification of document and data submissions.
These requirements align with those the MHP follows to comply with current DHCS
mandates..
Amendment V renews the Contract with CalOptima for Provision of Coordination of Behavioral Health Care Services for a one-year term from January 1, 2021, through December 31, 2021. An additional one-year renewal remains. Amendment V also seeks to update the Coverage Matrix 2: Substance Use Disorder Benefit to clarify Opioid Treatment is covered by Medicare so CalOptima members will not be referred to the County’s Drug Medi-Cal Organized Delivery System.
The Contract contains mutual indemnification provision, which varies from the County standard. County Executive Office/Risk Management has approved the indemnification provisions and determined the risk to be acceptable for these services. See Attachment D for Risk Assessment or Modification of Insurance Terms.
HCA requests that your Board approve Amendments IV and V to the Contract with CalOptima for Provision of Coordination of Behavioral Health Care Services through December 31, 2021, as referenced in the Recommended Actions.
FINANCIAL IMPACT:
N/A
STAFFING IMPACT:
N/A
ATTACHMENT(S):
Attachment A - Amendment IV to Contract with CalOptima for the provision
of Behavioral Health Care Services
Attachment B - Amendment V to Contract with CalOptima for the provision of
Behavioral Health Care Services
Attachment C - Redline to Attachment A
Attachment D - Risk Assessment or Modification of Insurance Terms
Attachment E - Title 9 California Code of Regulations, Chapter 11
Attachment F - DHCS All Plan Letter 13-018