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Health and Human Services Agency (HHSA) recommending the Board:
1) Approve the Children’s Medical Services Program Projected Budgets and Work Plans for the County of El Dorado for Fiscal Year 2021-22 for the provision of required preventive and specialized health care services to children from birth to 21 years of age who are afflicted with life-threatening and/or severe life-altering chronic medical conditions, with an estimated maximum reimbursement amount of $1,012,726;
2) Delegate authority to the HHSA Director to execute the Certification Statements and any additional documents related to this funding, if any; and
3) Authorize the HHSA Director or the Agency Chief Fiscal Officer to execute any required fiscal reports.
FUNDING: 26% Federal Children’s Medical Services Allocation, 31% State Children’s Medical Services Allocations, 5% Public Health Realignment Fund Match, 19% Social Services Realignment Fund Match, and 19% County General Fund Match.
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DISCUSSION / BACKGROUND:
Children’s Medical Services (CMS) Programs consists of Child Health and Disability Prevention (CHDP) Administrative Services, Health Care Program for Children in Foster Care and California Children’s Services (CCS). These are mandated intensive case management and intervention activities that target high risk and medically fragile children to ensure effective and coordinated preventative and specialty medical care. CMS is essential for preserving optimal health and wellness while minimizing morbidity and mortality in the County's pediatric population.
Funding for local CCS services is administered as a partnership between the County, California State Department of Health Care Services (DHCS) and the Federal Government. In accordance with Health and Safety Code Section 123940, the Board must annually allocate twenty-five percent (25%) of the annual program expenditure to a level at least equivalent to the actual FY 1990-91 contribution, and an additional 25% from the County Social Services Trust Account. The annual funding allocation for CHDP and CCS programs has an effective date of July 1 through June 30. Historically, the allocation is finalized by the State after the Governor signs the State’s budget.
DHCS’s suggested deadline for programs to submit the required Budgets and Work Plans was November 23, 2021. Due to the continuing impact of the COVID-19 pandemic response Public Health administration submitted the preliminary Budgets and Work Plans to DHCS on December 17, 2021, with completion of submission pending the date and receipt of Certification. Board receipt and review of the attached Budgets and Work Plan is required. After that occurs, the certifications are then signed by the HHSA Director and are submitted to DHCS. After these events are completed, HHSA will be able to submit claim expenditures for reimbursement.
ALTERNATIVES:
The services outlined in the CMS workplans are mandated at the local level through a variety of statutes including, but not limited to California Health and Safety Code, Welfare and Institution Code, Government Code, Code of California Regulations Title 17, Code of California Regulations Title 22, Code of Federal Regulations Title 42, and the Social Security Act (42 USC).
Failure to endorse and submit the workplans to the State would discontinue services to approximately 750 children, countywide. In addition, it would mean the disruption to general health care oversight and care coordination to all children currently placed in Foster Care and who could be placed in Foster Care.
Lastly, noncompliance with the mandated services could result in the State placing sanctions on the County.
PRIOR BOARD ACTION:
1) 02-09-2021, File ID 21-0109, HHSA CMS workplans/budgets FY 2020-2021
2) 01-07-2020, File ID 19-1859, HHSA CMS workplans/budgets FY 2019-2020
3) 12-11-2018, File ID 18-1841, HHSA CMS workplans/budgets FY 2018-2019
4) 12-05-2017, File ID 12-1479, HHSA CMS workplans/budgets FY 2017-2018
5) 12-06-2016, File ID 12-1479, HHSA CMS workplans/budgets FY 2016-2017
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
The majority of the revenue that pays for costs of the CHDP and CCS programs is from Federal Children’s Medical Services allocations (approximately 26%). The next largest portion of revenue is from the State Children’s Medical Services allocations (approximately 31%). Actual staff time spent in these programs are billed to the State. A complex worksheet is used to bill the State who reimburses HHSA with the appropriate mix of federal and state monies.
Matching amounts are comprised of a mixture of Social Services Realignment, Public Health Realignment, and County General Fund.
The estimated County General Fund match in Fiscal Year (FY) 2021-2022 is $13,099 and is included in HHSA’s FY 2021-22 Budget. Sufficient revenue appropriations were included in HHSA’s FY 2021-2022 Budget. The revenue and the County match provide the means for PHN staff to deliver general health care oversight and care coordination for all children currently placed in Foster Care (currently 200 children). The PH nurses are responsible for the highly specialized monitoring of those children in placement receiving psychotropic pharmacotherapy.
This agenda item is a renewal of annual funding to various Public Health Nursing programs. Estimated revenue rates of the Programs for this year and the last four years are as follows:
|
Fiscal Year |
Estimated Revenue |
Percent Change From The Prior Year |
|
2021-2022 |
$1,012,726 |
10% Decrease |
|
2020-2021 |
$1,120,526 |
17% Decrease |
|
2019-2020 |
$1,351,570 |
26% Increase |
|
2018-2019 |
$1,076,198 |
13% Increase** |
|
2017-2018 |
$956,587 |
1% Increase* |
** This includes the first year that Caseload Relief services were included within the Health Care Program for Children in Foster Care.
* This was the first year that Psychotropic Medication Monitoring and Oversight services were included within the Health Care Program for Children in Foster Care.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to provide a Certified Minute Order to HHSA Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT:
County Strategic Goal of 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