Title
HEARING - Health and Human Services Agency (HHSA) recommending the Board adopt and authorize the Chair to sign Resolution 174-2025, to implement an updated Behavioral Health Fee Schedule (Exhibit A) for Medi-Cal eligible services, effective on December 2, 2025, in accordance with the Department of Health Care Services (DHCS) updated fee schedule, thereby replacing Board adopted Resolution 192-2024.
FUNDING: Combination of Federal Medi-Cal, State, and local realignment, including State Mental Health Services Act funds, reimbursed to HHSA from DHCS for claims for client services, with the funding percentages dependent upon the beneficiary.
Body
DISCUSSION / BACKGROUND:
DHCS is responsible for developing and administering fiscal policies for the State’s Mental Health Programs, including Medi-Cal Specialty Mental Health Services (SMHS), and Drug Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) programs (collectively referred to as the Medi-Cal programs). The SMHS program provides mental health services to Medi-Cal beneficiaries who meet medical necessity criteria; and the DMC/DMC-ODS programs provide Substance Use Disorder (SUD) treatment and expanded SUD treatment services to Medi-Cal beneficiaries who meet medical necessity criteria for those services.
The Mental Health Plan (MHP) in each county is responsible for providing or arranging for the provision of SMHS to local residents that are Medi-Cal beneficiaries. Mandated SMHS programs include outpatient mental health services such as medication therapeutic services, inpatient services such as acute psychiatric hospitalizations, and certain types of residential placements, including psychiatric health facility (PHF) placements. HHSA’s Behavioral Health Division (BHD) also contracts with DHCS under the County DMC-ODS Intergovernmental Agreement to provide SUD treatment to Medi-Cal eligible beneficiaries.
Beginning in early 2023, DHCS developed program and payment reform across the Medi-Cal program, called the CalAIM initiative. CalAIM is a multi-year initiative by DHCS to improve the quality of life and health outcomes of Californians by implementing broad delivery system, program, and payment reform across the Medi-Cal program. Under CalAIM, DHCS transitioned counties from a cost-based reimbursement methodology to a fee-for-service reimbursement structure to better enable counties and providers to deliver value-based care that improves quality of life for Medi-Cal beneficiaries.
Beginning July 1, 2023, under the CalAIM payment reform, DHCS reimburses Mental Health Providers (MHPs) and counties participating in the DMC programs for services rendered to Medi-Cal beneficiaries. On an annual basis, DHCS publishes all SMHS, Adult Residential, and DMC fee reimbursement rates on its website. These posted rates do not include costs incurred by MHPs to administer the SMHS, Residential and DMC programs or costs incurred by counties to administer these Medi-Cal programs. MHPs and counties administering these programs receive separate payments for administrative, utilization review, and quality assurance costs.
DHCS rate increases allow HHSA BHD to improve provider reimbursements and continue funding non-Medi-Cal reimbursable services. The DHCS rates (Exhibit A) are listed by provider type, and the services are delivered and billed per the DHCS SMHS and DMC-ODS Billing Manual. These new rates for El Dorado County reflect an approximate three percent increase over the State Fiscal Year 2024-25 rates, and include two new positions and rates for a Medical Assistant and Community Health Worker to ensure the County can bill for these services. Additionally, Marriage Family Therapist/Licensed Professional Clinical Counselor (Licensed, Waivered, or Registered) has been added for clarity although it is included in DHCS’ overarching category of Licensed Practitioner of Healing Arts. These DHCS-published rates are also used to bill insurance companies, private payers, and other counties that utilize the El Dorado County PHF.
Due to DHCS’ mandate for CalAIM implementations, HHSA BHD is recommending the Board approve and authorize the Chair to execute this Resolution, thereby approving the BHD Fee Schedule rates changes be effective December 2, 2025, which will replace the prior Board adopted rates for these behavioral health services under Resolution 192-2024 (Legistar file 24-1465). Approval of this item will ensure compliance with all federal and state requirements and will continue to uphold parameters such as consistency in service delivery expectations, performance measures and outcomes, productivity, and funding.
A Notice of Public Hearing was published in the Mountain Democrat on November 7, 2025, and November 12, 2025, and in the Tahoe Tribune on November 7, 2025, and November 14, 2025, announcing that the Board would hold a public hearing on this agenda item.
ALTERNATIVES:
Should the Board decline to approve this recommendation, the existing Fee Schedule for Behavioral Health Services established in Resolution 192-2024 would be retained, however, the County would be out of compliance with the DHCS rate changes and the CalAIM payment reform requirements.
PRIOR BOARD ACTION:
1) 11/07/23, 23-1832, HHSA BH Rates Hearing
2) 11/12/24, 24-1465, HHSA BH Rates Hearing
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this item. The Behavioral Health program is funded primarily through State and Federal Medi-Cal funding, grants, and allocations.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
1) Clerk of the Board to obtain the Chair’s signature on one original of the Resolution.
2) Clerk of the Board to return one certified Resolution to Health and Human Services Agency, Contracts Unit via email at hhsa-contracts@edcgov.us.
STRATEGIC PLAN COMPONENT:
Area of Focus: Safe and Healthy Communities
Priority: Achieve CalAIM requirements and maximize opportunities for service delivery
Action Item: Implement CalAIM payment reform within the Behavioral Health Division
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency