Title
HEARING - Health and Human Services Agency (HHSA) recommending the Board:
1) Hold a hearing to consider a transfer of management of the Multipurpose Senior Services Program (MSSP), a public health service provided by El Dorado County, as required by State law (Beilenson Act);
2) Receive a presentation from the Public Health Division regarding the status of the Multipurpose Senior Services Program (MSSP); and
3) Authorize HHSA to take initial steps to transition the MSSP to the State of California Department of Aging to ensure required staffing matrix and service levels are maintained for eligible residents in need of home and community-based physical and social health services
FUNDING: Federal funding through an annual contract with California Department of Aging.
Body
DISCUSSION / BACKGROUND
The California Department of Aging (CDA) Multipurpose Senior Services Program (MSSP) Waiver program provides Home and Community-Based Services to residents age 65 or older who are Med-Cal eligible with an aid code reflective of risk for placement in a skilled nursing or intermediate care facility. The program provides physical and social health management, which includes coordination of available community resources, assessment/monitoring of both physical and psychological well-being, provision of durable medical equipment, education, and advocacy designed to maintain independent living status. These core services are maintained by the State’s requirement that MSSP operators utilize a staffing matrix which includes a Site Director, Supervising Care Manager, Nurse Case Manager(s), Social Work Care Manager(s) and Program Assistant(s). The staffing matrix ensures responsibility for and capability to provide in-community medical management of the client population through prescribed in-home visitation intervals and direct assessment of acute illness episodes which directly support the maintenance of client self-care and activities of daily living independence.
In the County of El Dorado, the MSSP program started operating under the direction of Community Services in 1999; and effective Fiscal Year 2016-17, the program transitioned to Public Health. Over the past seven years, frequency of staff turnover has created ongoing challenges in maintaining the staffing matrix requirements while ensuring continuity of care for eligible residents. More specifically, over this time, the program has experienced the loss of four program supervisors, four Care Management Counselors, and four Program Assistants. Rigidity of the staffing matrix requirement allows little flexibility in addressing loss of staff, and therefore as recruitments have been undertaken to fill each vacancy, the Public Health Division has been forced to utilize staff from other programs to fill in. The ongoing staffing challenges have resulted in heightened scrutiny by CDA with regard to contractual obligations, required minimum staffing standards, ability to achieve required caseload thresholds, etc., and have impacted the County’s ability to sustain the program. It’s important to note that the disruptions have impacted not only the provision of services to MSSP clients, they have also impacted service levels in subsequent, mandated programming that staff were pulled from to provide support to MSSP.
HHSA executive and program staff have held phone meetings with CDA to hear their concerns around our local program and to understand how MSSP is operated across the state. The meetings have allowed for the opportunity to gather ideas as to how successful communities are maintaining staffing and service levels more consistently. Through those discussions, CDA has pointed out that of the 38 MSSP sites across California, only 8 are operated by County staff, or approximately 1 in 5 sites. CDA indicates that over the past decade, MSSP sites have been moving away from County Governments implementing the program because the State is able to manage contracts with regional non-profit providers to maintain the mandated staffing matrix and service levels more consistently and at a lower cost. This dynamic is largely attributed to the ongoing increases in services cost, coupled with a fixed funding allocation for the program and largely increasing costs for County government staffing.
MSSP funding allocations are predicated on client counts, and the total CDA allocation to El Dorado County is up to $321,372.To draw down the total allocation, the State requires that El Dorado HHSA maintain a caseload of no less than 60 clients. If there are less than 60 clients served in a case load, the full allocation cannot be realized, and that is where El Dorado has stood with its average count landing between 54-57 clients due to attrition. With that, the total cost for maintaining the staffing matrix requirement is being realized while the full allocation is not being received. As this occurs, the fully burdened cost of the program requires supplementation with Public Health Realignment to cover staffing costs, with an average usage of approximately $135,000 per year. It is important to note that even if the program census were regularly maintained at 60 clients, Public Health Realignment funding would still be expended as the cost for HHSA to offer the program is more than the State allocation.
Section 1442.5 of the California Health and Safety Code, otherwise known as the "Beilenson Act," requires that before transferring management of a county medical service, the Board of Supervisors must provide public notice not less than 14 days prior to a public hearing. Notice of this item was posted at the El Dorado County Public Health Office and fulfills the requirements of the Beilenson Act.
After careful consideration and financial analysis, HHSA is recommending the Board authorize the department to take initial steps to transition MSSP back to the State, thereby beginning the process to withdraw from administering the MSSP program. If approved by the Board, HHSA will proceed in collaboration with CDA to develop a required transition plan. The transition plan will be used to map out how service levels are maintained throughout the transition period and it will also be used to lay out the process for selecting a qualified managed care provider to administer MSSP, moving forward. CDA will work closely with Public Health to identify a qualified MSSP provider from neighboring areas, and as they are identified the end result will ensure that all MSSP requirements and staffing levels can be maintained so that services are more consistently available for current participants, moving forward. It is estimated that once the State has accepted the request to transfer the service, the full transition period will take up to 180 days. CDA has affirmed that through collaborating with Public Health, program participants will be communicated with and updated throughout the transition plan period, also suggesting that due to staff turnover in El Dorado over the years, service levels may likely improve through more consistent staffing from an established provider.
Relinquishing this program back to CDA will have no impact on Public Health staff allocations. Existing staff will be maintained through filling other Public Health vacancies, thereby improving and increasing service levels in those mandated programs.
ALTERNATIVES
Should the Board decline to approve this recommendation, HHSA would continue to be challenged with insufficient staffing and program allocations to meet the program requirements. Additionally, Public Health mandated program service levels would continue to be impacted as staff would be pulled from those programs to meet MSSP requirements.
PRIOR BOARD ACTION
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Human Resources/Risk Management and Local 1.
CAO RECOMMENDATION
Approve as recommended.
FINANCIAL IMPACT
There is no impact to Net County Cost by this Board item. The recommendation to transition the MSSP program back to CDA would result in no additional costs to the County; however, there would be an annual Public Health Realignment savings of approximately $135,000.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to provide Minute Order indicating the Board’s direction on next steps to Health and Human Services Agency Contracts Unit located at 3057 Briw Road.
STRATEGIC PLAN COMPONENT
Healthy Communities strategic goal of “partnering with all stakeholders, we are prepared to meet the needs of our growing older adult population.”
CONTACT
Don Semon, Director