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Agenda Item
ASR
Control 21-000332 |
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MEETING DATE: |
05/25/21 |
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legal entity taking action: |
Board of Supervisors |
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board of supervisors
district(s): |
All Districts |
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SUBMITTING
Agency/Department: |
Health Care Agency
(Approved) |
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Department contact
person(s): |
Steve Thronson (714) 834-4418 |
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Clayton Chau (714) 834-2830 |
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Subject: Whole Person Care Pilot
Extension Agreement and Amendments
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ceo CONCUR |
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Clerk of the Board |
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Concur |
Approved Agreement to Form |
Discussion |
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3 Votes Board Majority |
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Budgeted: Yes |
Current Year Cost:
$2,089,710 |
Annual Cost:
FY 2021-22 $5,477,740 |
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Staffing Impact: |
No |
# of Positions:
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Sole Source:
Yes |
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Current Fiscal Year Revenue: $2,089,710
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Prior Board Action: 08/25/2020
#7, 02/25/2020 #6, 11/19/2019 #S38G, 05/21/2019 #S74F |
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RECOMMENDED ACTION(S):
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1. |
Authorize the Health Care Agency Director, or designee, to accept Whole Person Care Pilot program additional grant funding in an amount not to exceed $6,861,960, for a Whole Person Care Pilot program grant funding cumulative total amount not to exceed $61,469,437 over a six-year period, and to execute an Amendment to the Agreement with the California Department of Health Care Services for the Whole Person Care Pilot program. |
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2. |
Approve Amendment No. 5 to the Contract for the provision of Housing Navigation and Sustainability Services for Non-Behavioral Health Involved Clients with various providers, effective May 26, 2021 through December 31, 2021, increasing the aggregate amount not to exceed by $3,107,520, for a revised cumulative total aggregate amount not to exceed $6,107,520. |
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3. |
Approve the Grant Agreement with Orange County Health Authority dba CalOptima for reimbursement of Housing Navigation and Supportive Services provided through the Whole Person Care Pilot program to qualifying CalOptima Medi-Cal members for the term of June 15, 2021, through December 31, 2021. |
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4. |
Authorize the County Procurement Officer or authorized Deputy to execute Amendment No. 6 to extend the Contract with Safety Net Connect, Inc. for Whole Person Care Platform, effective January 1, 2022, through June 30, 2022, non-renewable, in an amount not to exceed $1,028,950, for a revised cumulative amount not to exceed $4,982,600. |
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5. |
Authorize the Auditor-Controller to send to the California Department of Health Care Services, via an electronic funds transfer and as required by the agreement with the California Department of Health Care Services for the Whole Person Care Pilot, an amount not to exceed $3,430,980, resulting in a total amount not to exceed $30,734,719 transferred over six years. |
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6. |
Authorize the Health Care Agency Director, or authorized designee, to execute Amendment to the Contract with California Department of Health Care Services for Whole Person Care Pilot program, to execute Amendment No. 5 to the Master Agreement and the individual Amendments with various providers for Housing Navigation and Sustainability Services, and to execute the Grant Agreement with Orange County Health Authority dba CalOptima for reimbursement of Housing Navigation and Supportive Services, as referenced in the Recommended Actions #1, #2 and #3 above. |
SUMMARY:
Approval of Amendment to the Contract for Whole Person Care Pilot program with California Department of Health Care Services will allow extension of and funding for Orange County's Whole Person Care Pilot program for an additional one year; and approval of Amendment No. 5 to the Master Agreement for Housing Navigation and Sustainability Services for Non-Behavioral Health Involved Clients with various providers, Amendment No. 6 to the Contract for the Whole Person Care platform with Safety Net Connect, Inc. and the Grant Contract for Housing Navigation and Supportive Services with Orange County Health Authority dba CalOptima will allow continuation of services for an additional one year under the pilot, add additional housing navigation and sustainability revenue and increase the number of Whole Person Care Clients securing and sustaining permanent housing placement.
BACKGROUND INFORMATION:
Whole Person Care (WPC) Pilot Program Amendment
On June 28, 2016, your Honorable Board of Supervisors (Board) approved the Health Care Agency’s (HCA) application to the California Department of Health Care Services (DHCS) to implement a WPC Pilot Program. The Board also approved an application for additional WPC funding on March 14, 2017, (WPC Round Two), as well as a third opportunity for additional WPC funding on May 21, 2019, (WPC Round Three).
The table below summarizes the most recent prior Board actions specific to the WPC Pilot Program Agreement, Housing Navigation and Sustainability Services Agreement, Safety Net Connect Contract and related Intergovernmental Transfer (IGT) electronic funds transfer:
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Board Date |
Contract / Amendment |
Action |
Term |
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May 21, 2019 |
Other |
Ratify Grant Agreement, Receive Funds, Direct Auditor-Controller |
July 1, 2019 - December 31, 2020 |
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November 19, 2019 |
Other |
Direct HCA To Allocate WPC And Mental Health Services Act Funds For Supportive Services |
N/A |
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February 25, 2020 |
Contract |
Board Approved Contract |
February 26, 2020 - December 31, 2020 |
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August 25, 2020 |
Amendment No. 4 |
Board Approved Term Renewal |
August 26, 2020 - December 31, 2020 |
The overarching goal of the
five-year WPC Pilot Program was the coordination of health, behavioral health
and social services in a patient-centered manner with the goals of improved
beneficiary health and wellbeing through more efficient use of resources. One
of the main objectives of the WPC Pilot Program was to increase integration,
coordination and appropriate access to care among County agencies, CalOptima,
providers and community entities within Orange County that serve high-risk,
high-utilizing Medi-Cal beneficiaries.
The WPC Pilot Programs were scheduled to end on December 31, 2020, with all WPC programs transitioning to the California Advancing and Innovating Medi-Cal Initiative (CalAIM) program. In May 2020, DHCS announced the delay of the transition to CalAIM due to the impact of the public health emergency caused by COVID-19. As a result of the delay of CalAIM implementation, DHCS requested an extension of the 1115(a) Waiver with the Centers for Medicare and Medicaid Services in order to approve a 12-month extension of WPC Pilot Programs.
On March 30, 2021, DHCS notified HCA of their award allocation of $6,861,960, along with the proposed Amendment to the WPC Pilot Program Agreement, extending Orange County’s WPC Pilot Program for a sixth and final year. Given the reduced funding allocation, the following services are planned to be continued with the volume of services tapered to stay within funding parameters:
· Community Clinic Homeless Navigation and Supportive Services
· Housing Navigation and Sustainability Services
· Recuperative Care Services
· Whole Person Care Coordination Platform
· Community Referral Network
Please note that the contract for the Community Referral Network with Lestonnac Free Clinic is also on the May 25, 2021 Board agenda for approval.
Consistent with the WPC grant,
funding to counties will be done through an IGT with arrangement DHCS. In this arrangement, the County sends a
specified amount of non-federal funds to DHCS, which are matched with federal
funds, and then the entire amount is returned to the County to fund the pilot.
HCA is proposing to increase the amount of the IGT provided by a maximum of
$3,430,980, which DHCS will match with $3,430,980 in federal dollars, and
return $6,861,960 to the County.
Amendment No. 5 to the Contract for Housing Navigation and Sustainability Services
A key client service component under the WPC Pilot Program is housing supportive services. The WPC Program team recognized a very real need to also develop a corresponding level of assistance for medically fragile beneficiaries who do not suffer from mental illness or substance use disorders, and/or do not qualify for Behavioral Health Services (BHS) programs funded by Mental Health Services Act dollars, and on November 19, 2019, the Board approved establishment of a Housing Supportive Services Funding Pool.
In December 2019, The Orange County Housing Authority and the Santa Ana Housing Authority received U.S. Department of Housing and Urban Development funding for housing vouchers targeted for WPC clients, of which a requisite for use of these vouchers is housing supportive services. Following completion of a Request for Applications for Housing Navigation and Housing Sustainability Services, the Board approved the Master Agreement for the provision of Housing Navigation and Sustainability Services on February 26, 2020. There are currently four providers contracted under the Master Agreement as follows:
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Provider Name |
Location City |
Regional Service Area |
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Orange County Housing Collaborative |
Midway City |
All |
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Volunteers of America of Los Angeles |
Santa Ana |
All |
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Community Action Partnership of Orange County |
Garden Grove |
All |
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Lutheran Social Services of Southern California |
Fullerton |
All |
Contract providers were anticipated to serve 350 individuals in 2020, however they exceeded that goal and served a total of 388 clients. Those clients received 3,023 months of housing navigation and/or sustainability services. This was a 62.7 percent increase over the expected number of housing member months. The number of clients engaged in housing navigation was 309 percent higher than expected. There were 233 clients housed during 2020, 547.2 percent higher goal than proposed with DHCS for 2020. Housing data were obtained related to percent of clients receiving housing services, days homeless, days sustaining housing and clients sustaining housing for six or more months. In 2020, 78.5 percent of clients referred for housing services received those services. WPC clients receiving housing sustainability services averaged 185.3 days in independent living or permanent supportive housing in 2020. The majority of non-BHS clients were ongoing in sustainability as they did not begin housing services until 2020. Among clients receiving housing sustainability services on or prior to June 30, 2020, those eligible to reach six months, 82.2 percent sustained housing for six months or more.
Given the extension of the WPC Pilot for an additional year and the significant increase in the number of available vouchers, from approximately 175 in 2020 to 469 in 2021 as provided by our collaborating housing authorities and partners, the proposed Amendment is adding $3,107,520 in funding, for a total not to exceed $6,107,520, effective May 26, 2021, through December 31, 2021.
Grant Agreement with CalOptima for Housing Navigation and Sustainability Services
HCA is looking to enter into a Grant Agreement with CalOptima that would help bridge the gap in funding shortfall for the Housing Navigation and Sustainability services. Under the CalOptima Grant Agreement, CalOptima shall reallocate IGT funds to pay the County 50 percent of the County’s WPC Housing Navigation and Sustainability Services costs retroactive to January 1, 2021, through December 31, 2021. Under this Grant Agreement, the WPC housing navigation and sustainability providers will provide housing and supportive services to CalOptima Medi-Cal members consistent with all the requirements of the DHCS and County WPC Agreement.
Amendment No. 6 to Contract with Safety Net Connect, Inc. for WPC Platform
This platform allows for the opportunity to collect and share client data among participating WPC community-based entities such as hospitals, community clinics, recuperative care providers and various HCA programs. WPC Connect supports ongoing case management and monitoring of the WPC enrollees, as well as on-going evaluation for strategic improvements in the WPC Pilot program.
The table below summarizes the prior Board actions specific to the Contract with Safety Net Connect, Inc. for the WPC Connect Care Coordination platform:
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Board Date |
Summary |
Term |
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June 27, 2017 |
Execution of Contract with Safety Net Connect, Inc. for development, training and implementation of the WPC Platform |
July 1, 2017 – December 31, 2020 |
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September 10, 2019 |
Amendment No. 2 to amend the Contract with Safety Net Connect, Inc for development, training and implementation of the WPC Platform for development enhancement has approved by DHCS in the WPC round three application |
September 10, 2019 – December 31, 2020 |
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August 25, 2020 |
Amendment No. 4 to amend the Contract with Safety Net Connect, Inc for development, training and implementation of the WPC Platform for additional professional service fee |
August 26, 2020 – December 31, 2020 |
The Amendment No. 6 proposes
funding for FY 2020-21 and FY 2021-22 in the amount of $1,028,950, effective
May 26, 2021, through June 30, 2022, for the following:
· System Maintenance
· Project Management
· Professional Services
· Data feeds to an enhanced care coordination management system
The WPC platform was developed
through modification of Safety Net Connect, Inc.’s proprietary system that was
previously used in another County program. The "WPC Connect" Platform
was designed to link with pre-existing systems used by the WPC Community
Partners, which already contains information on the population experiencing
Homelessness and at risk of Homelessness in Orange County. For these reasons,
HCA has not conducted a separate solicitation of bids for the feature and
function enhancements contained in the proposed Amendment. Sole Source
justification has been submitted to the County Procurement Office, and the
approved Sole Source/Proprietary Request is attached to this Agenda Staff
Report as Attachment G.
The Contractors' performances have been confirmed as satisfactory with no identified issues. The Contracts do not currently include subcontractors or pass through to other providers. See Attachment E and F for Contract Summary Forms.
HCA requests the Board accept the WPC Pilot program additional funding and approve Amendment to extend the Agreement with DHCS for the WPC Pilot program, approve Amendment No. 5 to the Contract for Housing Navigation and Sustainability Services for Non-Behavioral Health Involved Clients with various providers, approve the Grant Agreement with CalOptima for Housing Navigation and Supportive Services, approve Amendment No. 6 to the Contract with Safety Net Connect, Inc. for WPC Platform Services and authorize Auditor-Controller to transfer funds to DHCS, as referenced in the Recommended Actions.
FINANCIAL IMPACT:
Appropriations for these Contracts are included in Budget Control 042 FY 2020-21 Budget and will be included the budgeting process for future years.
Should services need to be reduced or terminated due to lack of funding, the Contracts contain language that allows HCA to give a 30-day notice to either terminate or renegotiate the level of services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.
Revenue related to the grant agreements are included in Budget Control 042 FY 2020-21 Budget and will be included in the budgeting process for future years. The total amount of funding available through the grant agreements and current fiscal year revenue estimate are based on services provided and is subject to change per fiscal year in the funding period.
STAFFING IMPACT:
N/A
ATTACHMENT(S):
Attachment A - Whole Person Care Agreement - Amendment A-02 Program Year
6 Extension
Attachment B - Amendment No. 5 to Contract MA-042-20011404 for Housing
Navigation and Sustainability Services
Attachment C - Grant Agreement for Housing Navigation and Supportive Services
with Orange County Health Authority dba CalOptima
Attachment D - Amendment No. 6 to Contract No. MA-042-17011762 with Safety Net
Connect, Inc.
Attachment E - Contract Summary Form for Attachment B
Attachment F - Contract Summary Form for Attachment D
Attachment G - Sole Source Justification Form for Attachment D
Attachment H - Redline Version to Attachment B
Attachment I - Redline Version to Attachment D