Agenda Item   



                                                                                                                        ASR Control  23-000861




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


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: N/A

Current Year Cost:  N/A

Annual Cost: N/A




    Staffing Impact:


# of Positions:           

Sole Source:   No

    Current Fiscal Year Revenue: See Financial Impact Section

   Funding Source:    N/A

County Audit in last 3 years: No

   Levine Act Review Completed: N/A


    Prior Board Action:         8/23/2022 #18, 1/25/2022 #23, 9/14/2021 #5, 7/13/2021 #16






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.





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.







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.






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



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.






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.










Attachment A - Amendment 13 with CalOptima
Attachment B - Redline to Attachment A
Attachment C - Risk Assessment Waiver