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Agenda Item
ASR
Control 19-000835 |
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MEETING DATE: |
09/24/19 |
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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): |
Jenny Qian (714) 834-3074 |
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Richard Sanchez (714) 834-2830 |
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Subject: Fifth Amendment for
Coordination and Provision of Health Care Services Contract
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ceo CONCUR |
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Clerk of the Board |
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Concur |
Approved Agreement to Form |
Consent Calendar |
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3 Votes Board Majority |
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Budgeted: N/A |
Current Year Cost:
N/A |
Annual Cost:
N/A |
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Staffing Impact: |
No |
# of Positions:
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Sole Source:
No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 02/26/2019
#20, 06/26/2018 #16, 05/21/2013 #17 |
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RECOMMENDED ACTION(S):
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1. |
Approve the Fifth Amendment to the Coordination and Provision of Health Care Services Contract between the County of Orange and Orange County Health Authority, a Public Agency, dba CalOptima. |
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2. |
Authorize the Health Care Agency Director, or designee, to execute the Contract as referenced in the Recommended Action above. |
SUMMARY:
Approval of the Fifth Amendment to the Contract for Coordination and Provision of Health Care Services with Orange County Health Authority, a Public Agency, dba CalOptima will allow the Health Care Agency to update contract language to comply with Department of Health Care Services subcontracting requirements and incorporate respite care into Whole Person Care Recuperative Care services.
BACKGROUND INFORMATION:
The Orange County Health Authority, a Public Agency, dba CalOptima (CalOptima) has a current contract with the State of California, Department of Health Care Services (DHCS) to arrange and pay for the provision of health care services to Medi-Cal eligible beneficiaries in Orange County.
On May 21, 2013, your Honorable Board of Supervisors (Board) approved the original contract with CalOptima effective June 1, 2013. The agreement authorized reimbursement to the Health Care Agency (HCA) for services to CalOptima beneficiaries. These services include tuberculosis services, human immunodeficiency virus services, sexually transmitted disease services and 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 and medical services to minors residing at the Orangewood Children's Home.
The First Amendment to the contract, effective July 1, 2015, incorporated Targeted Case Management services into the agreement.
The Second Amendment to the contract, approved by the Board on June 26, 2018, extended the contract through December 31, 2018, with the same terms and conditions.
The Third Amendment to the contract, effective January 1, 2019, approved by the Board on February 26, 2019, extended the contract through December 31, 2023, and updated contract language to address programmatic and regulatory changes.
The Fourth Amendment to the contract, effective July 1, 2019, was to reflect changes related to the Whole Child Model program.
The proposed Fifth Amendment updates contract language to comply with DHCS' subcontracting requirements as well as incorporates medical respite care services for CalOptima Beneficiaries into the Whole Person Care (WPC) Recuperative Care Program. Through the implementation of the Recuperative Care program, HCA has identified the need for medical respite care, which is care for persons needing more than the 90-day maximum allowed by the WPC Program based on extended illnesses or medical need such as chemotherapy and clients in need of hospice services, yet not qualifying for skilled nursing care. On April 4, 2019, the CalOptima Board agreed to fund, up to $120 per day, the cost of WPC enrollees to remain in recuperative care from day 91 until the day they are discharged from the facility. See Attachment C for Contract Summary Form.
HCA requests that the Board approve the Fifth Amendment to the Coordination and Provision of Health Care Services Contract with CalOptima as referenced in the Recommended Actions.
FINANCIAL IMPACT:
This is a non-financial Agenda Staff Report. Reimbursement funds were approved in a prior Board action. Revisions to this Contract are to update terms to comply with DHCS' subcontracting requirements and add medical respite care to the scope of work at CalOptima's request.
STAFFING IMPACT:
N/A
ATTACHMENT(S):
Attachment A - Fifth Amendment for Coordination and
Provision of Health Care Services Contract between County of Orange and Orange
County Health Authority, dba CalOptima
Attachment B - Redline Version to Original Contract
Attachment C - Contract Summary Form