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Health and Human Services Agency (HHSA) recommending the Board:
1) Approve and authorize the Chair to sign Amendment I to non-financial Memorandum of Understanding 3362 (MOU) with Kaiser Foundation Health Plan, Inc. (formerly identified as KP Cal, LLC [Kaiser]), establishing the roles and responsibilities in the provision of Substance Abuse Disorder services for the beneficiaries of the Medi-Cal Managed Care program administered by Kaiser, for a new term that shall renew automatically unless terminated by either party;
2) Authorize the HHSA Director, or designee, to execute further documents relating to the MOU, including amendments that do not add compensation or alter the term of the MOU, contingent upon approval by County Counsel and Risk Management; and
3) Authorize the HHSA Director, or designee, to execute any administrative documents relating to said MOU including required fiscal and programmatic reports.
FUNDING: This is a non-financial MOU.
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DISCUSSION / BACKGROUND:
On May 23, 2017, the Board authorized the HHSA Director to opt in to the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System (DMC-ODS) and to continue to develop opportunities for expanding the local continuum of care for substance use treatment. The DMC-ODS pilot status of the program in accordance with Federal 1115 Waiver ended on 12/31/2021. The DMC-ODS program continues pursuant to CalAIM, effective January 2022, and offers California counties the opportunity to expand access to quality care for Medi-Cal enrollees with substance use disorders (SUD). The goal of the program is to demonstrate how organized SUD care improves beneficiary health outcomes, while decreasing system-wide health care costs.
Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of SUD benefits utilizing the American Society of Addiction Medicine (ASAM) Criteria. This approach is expected to provide eligible Medi-Cal enrollees with access to the care and services that are medically necessary and that best align with their treatment needs, for a sustainable and successful recovery. The ASAM Criteria is a proven model for the provision of outcome-oriented and results-based care in the treatment of addiction. The ASAM Criteria is the most widely used and comprehensive set of guidelines for assessing patient needs and optimizing placement into SUD treatment.
In accordance with the requirements of DHCS for providing DMC-ODS service, the County entered into MOU 3362 with Kaiser on April 23, 2019 to establish specific roles and responsibilities of the County and Kaiser regarding the provision of Medi-Cal services to Medi-Cal eligible beneficiaries who are members of Kaiser. The MOU coordinates care for screening, referral, coordination, and delivery of alcohol and other drug services for Medi-Cal beneficiaries of Kaiser who meet the medical necessity criteria for Medi-Cal services and identified by DHCS as a Medi-Cal Managed Care Health Plan benefit.
This proposed Amendment is necessary to make the term of the MOU perpetual, thereby ensuring continuation of necessary administrative roles and responsibilities without any service interruption.
ALTERNATIVES:
This MOU is a requirement per the County’s DMC-ODS Intergovernmental Agreement with DHCS. Disapproval of this Amendment will result in noncompliance with said Agreement terms and conditions.
PRIOR BOARD ACTION:
1) 05/23/17, 17-0525, Opt in to Federal 1115 Waiver for a DMC-ODS
2) 04/23/19, 19-0614, Approved MOU 3362
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no financial impact or Net County Cost associated with this non-financial MOU. Additionally, there is no Net County Cost associated with the provision of services provided under the DMC-ODS Waiver.
Services provided under the DMC-ODS Waiver will be funded by Federal Financial Participation (FFP) funds that are matched with local Realignment funds in the Behavioral Health Sub-account. Since many of the individuals in need of these services are in the expanded population enrolled in Medi-Cal, the FFP portion will cover between 90% and 95% of the cost for those individuals.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on one (1) original Amendment I to non-financial MOU 3362.
STRATEGIC PLAN COMPONENT:
County Strategic Plan:
1) Goal #1 - “Public Safety: Protects the community, prevents crime, enforces the law, administers justice, provides rehabilitative services, and promptly responds to emergency and calls for service;” and
2) Goal #5 - “Healthy Communities: Improved health, well-being and self-sufficiency of El Dorado County communities, residents and visitors.”
CONTACT
Don Semon, Director, Health and Human Services Agency