|
Agenda Item
ASR
Control 23-000861 |
||
|
MEETING
DATE: |
11/28/23 |
|
|
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): |
Veronica
Kelley (714) 834-7024 |
|
|
|
Debra
Baetz (714) 834-2830 |
|
Subject: Amendment 13 for Coordination and
Provision of Public Health Care Services
|
ceo CONCUR |
County Counsel Review |
Clerk of the Board |
||||||||
|
Concur |
Approved
Agreement to Form |
Discussion |
||||||||
|
|
|
3
Votes Board Majority |
||||||||
|
|
|
|
||||||||
|
Budgeted: N/A |
Current Year
Cost: N/A |
Annual Cost: N/A |
||||||||
|
|
|
|
||||||||
|
Staffing Impact: |
No |
# of Positions: |
Sole Source: No |
|||||||
|
Current Fiscal Year Revenue: See Financial
Impact Section
|
||||||||||
|
Prior Board Action: 8/23/2022 #18, 1/25/2022 #23,
9/14/2021 #5, 7/13/2021 #16 |
||||||||||
RECOMMENDED
ACTION(S):
|
1. |
Approve Amendment 13 to renew the
Contract with Orange County Health Authority dba CalOptima Health for the
Coordination and Provision of Public Health Care Services, effective January
1, 2024, through December 31, 2026. |
|
2. |
Authorize the Health Care Agency
Director or designee to execute Amendment 13 to the Contract with Orange
County Health Authority dba CalOptima Health as referenced in the Recommended
Action above. |
SUMMARY:
Approval of Amendment 13 to renew
the Contract with Orange County Health Authority dba CalOptima Health for the
Coordination and Provision of Public Health Care Services will expand and
extend the California Advancing and Innovating Medi-Cal services under the
contract.
BACKGROUND
INFORMATION:
On May 21, 2013, your Honorable
Board of Supervisors (Board) approved the original contract effective June 1,
2013. The contract authorized the reimbursement to the Health Care Agency (HCA)
for services to Orange County Health Authority dba CalOptima Health (CalOptima)
beneficiaries. These services include pulmonary disease services, HIV services,
sexually transmitted disease services, medical assistance pursuant to the Child
Health and Disability Prevention/Early and Periodic Screening, Detection and
Treatment program, family planning services, perinatal services, medical
services to eligible clients under the California Children's Services program
and medical services to minors residing at the Orangewood Children's Home.
Prior board actions are summarized in the table below:
Prior Board
Actions
|
Board Date |
Contract/
Amendment |
Action |
Term |
|
July
13, 2021 |
Amendment
No. 8 |
Board
approved HCA’s Office of Care Coordination to work with CalOptima and provide
the distribution of COVID-19 vaccination incentives to CalOptima Medi-Cal
members. |
January
1, 2019 – December 31, 2023 |
|
September
14, 2021 |
Amendment
No. 9 |
Board
approved addition of CalOptima’s Program of All-Inclusive Care for the
Elderly (PACE) program. |
January
1, 2022 - December 31, 2023 |
|
January
25, 2022 |
Amendment
No. 10 |
Board
approved Enhanced Care Management (ECM) Services, as well as Targeted
Engagement and Coordination Services in support of the WPC transition. Retro
contract retroactive Amendment 10 for Coordination of Public Health Care
Services. |
January
1, 2022 - December 31, 2023 |
|
August
23, 2022 |
Amendment
No. 11 |
Board
approved addition of CalOptima for Coordination and Provision of Public
Health Services |
September
1, 2022 – December 31, 2023 |
|
Not Appliciable |
Amendment No. 12 |
Agency Director approved Administrative
Amendment to extend Coordination Services during WPC to CalAIM transition. |
October 18, 2022 – December 31, 2023 |
Amendment 13 will add California Advancing
and Innovating Medi-Cal (CalAIM) Enhanced Care Management Services and renew
the Contract with CalOptima.
CalAIM is a
multi-year initiative by California’s Department of Health Care Services (DHCS)
to improve the quality of life and health outcomes of Medi-Cal members by
implementing a broad delivery system, and program and payment reform across the
Medi-Cal program. The major components of CalAIM build upon the lessons learned
and successful outcomes of various pilots including, but not limited to, Whole
Person Care (WPC), Health Homes Program (HHP) and the Coordinated Care
Initiative from previous federal waivers. CalAIM is anticipated to result in a
better quality of life for Medi-Cal members as well as long-term cost savings
and avoidance towards a person-centered approach to care.
Enhanced Care Management (ECM)
Services are provided by the County of Orange for CalOptima Members who are
experiencing a Serious Mental Illness (SMI)/Substance Use Disorder (SUD) under
CalOptima’s CalAIM program. Priority populations include clients experiencing
homelessness and high utilizers of Mental Health and SUD services.
ECM Core Services
include:
1. Outreach and engagement;
2. Comprehensive assessment and care
management planning;
3. Enhanced coordination of care;
4. Health promotion;
5. Comprehensive transitional care;
6. CalOptima Member and family supports;
and
7. Coordination of and referral to
community and social support services.
Additionally,
Community Supports are optional services or settings that Managed Care Plans
(MCP) may offer in place of services or settings covered under the California
Medicaid State Plan and that are medically appropriate, cost-effective
alternatives to a State Plan covered service.
The County of
Orange may also provide Community Support services under this agreement.
Eligibility for service will be based on individualized assessment of member
needs. The services provided will also utilize best practices for members who
are experiencing homelessness and who have complex health, disability, and/or
behavioral health conditions.
The combination of
ECM and Community Supports represent an opportunity for MCPs to work with the
county as a provider and to deliver a strong set of integrated supports for
those who need them most.
The proposed
Amendment 13 will add Community Supports eight and nine below to the seven that
currently exist in the partnership with the County.
1. Day Habilitation Programs; effective
7/1/2022
2. Housing Transition Navigation Services;
effective 10/1/2022
3. Housing Deposits; effective 10/1/2022
4. Housing Tenancy and Sustaining Services;
effective 10/1/2022
5. Recuperative Care (Medical Respite);
effective 10/1/2022
6. Medically Tailored Meals; effective 1/1/2023
7. Short-Term Post-Hospitalization; effective
1/1/2023
8. Community/Nursing Facility Transition to a
Home; effective 1/1/2024
9. Nursing Facility Transition/Diversion
Services; effective 1/1/2024
ECM and Community
Supports were implemented under CalAIM for the following Populations of Focus
effective January 1, 2022:
|
Population of
Focus #1: Individuals and Families Experiencing Homelessness |
|
1.
Homeless, chronic homeless, or at-risk of homelessness (next 30 days);
AND |
|
2.
Serious medical condition, serious behavioral condition, or serious
developmental disorder |
|
Population of
Focus #2: Adult High Utilizers |
|
1.
Five or more emergency room visits in the past six months, or |
|
2.
Three or more hospitalizations in the past six months, or |
|
3.
Three or more nursing facility stays in the past six months |
|
Population of
Focus #3: Adult SMI/SUD |
|
1.
Serious Mental Health condition and/or Substance Use Disorder; AND |
|
2.
High risk for psychiatric institutionalization, or |
|
3.
Use of crisis services, urgent care, ER or hospital as primary source
of health care, or |
|
4.
ER or hospital stay in the past 12 months because of substance use or
overdose, or |
|
5.
At risk for overdose or suicide, or |
|
6.
Is pregnant or postpartum, or |
|
7.
Receiving services through the County that are similar to ECM, but not
covered by Medi-Cal |
Intent of
Amendment and Proposed Contracted Services
CalOptima desires
to continue to partner with County to leverage the existing infrastructure to
support a smooth and orderly conversion of clients and services to CalAIM, as
well as contract with County for the provision of ECM and Community Supports
under CalAIM.
The Orange County
Preference Policy is not applicable to this Contract.
The proposed
Amendment 13 contains the same mutual indemnification and insurance provisions
as the original contract, which varies from the County standard. County
Executive Office/Risk Management has approved the indemnification and insurance
provisions and determined the risk to be acceptable for these services. See
Attachment C for Risk Assessment Form.
HCA requests the Board approve
Amendment 13 to renew the Contract for Coordination and Provision of Public
Health Care Services with CalOptima, as referenced in the Recommended Actions.
FINANCIAL
IMPACT:
This contract allows the County to
claim revenues to Cal-Optima for eligible services. Revenue for this Amendment
is included in Budget Control 042 FY 2023-24 and will be included in the
budgeting process for future years. Revenue for Enhanced Care Management and
Community Supports is based on number of enrollees and cannot be estimated at
this time. Claims will be submitted to CalOptima for eligible services.
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A - Amendment 13 with CalOptima
Attachment B - Redline to Attachment A
Attachment C - Risk Assessment Waiver