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Health and Human Services Agency, Mental Health Division, recommending the Board consider the following:
1) Approve and authorize the Chair to sign non-financial Memorandum of Understanding 622-M1410 with Blue Cross of California Partnership Plan, Inc. (Anthem) to establish each party's roles and responsibilities in the delivery of Specialty Mental Health Services to Blue Cross members for a term that becomes effective upon execution and continues in perpetuity;
2) Approve and authorize the Chair to sign revenue-generating Memorandum of Understanding 164-M1310 with Blue Cross of California Partnership Plan, Inc. for the reimbursement of authorized Specialty Mental Health Services provided to Blue Cross members for a term that becomes effective upon execution and continues in perpetuity; and
3) Authorize the Chief Administrative Officer or their designee to execute further documents relating to 622-M1410 or 164-M1310, including amendments which do not affect the maximum dollar amount or term of the Memorandum of Understandings, and contingent upon approval by County Counsel and Risk Management and further authorize the Director of the Health and Human Services Agency or their designee to execute any administrative documents relating to said Memorandum of Understandings, including required fiscal and programmatic reports.
FUNDING: Medi-Cal Managed Care.
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Fiscal Impact/Change to Net County Cost
There is no net County cost associated with the non-financial Memorandum of Understanding (MOU) 622-M1410 or the revenue-generating MOU 164-M1310. Sufficient appropriations were included in the Fiscal Year (FY) 2014/15 budget, and will be included in future budgets for the term of the MOUs.
Background
Medi-Cal Managed Care Rural Expansion is the result of State Assembly Bill 1467, which added Article 2.82 (commencing with Section 14087.98) to the Welfare and Institutions Code (WIC). WIC Section 14087 et al. includes a procedure for the transition to a Medi-Cal Managed Care Plan (MCMCP) and requires the State establish a methodology for selecting vendors to administer MCMCP. The State has utilized a Request for Application (RFA) process resulting in the State's selection of various insurance plan vendors to administer MCMCP in its counties.
In June 2013, the Governor's Budget expanded managed health care into rural areas that had previously been Fee-For-Service (FFS) only. This expansion provides Medi-Cal beneficiaries throughout the State with care through an organized service delivery system. The County of El Dorado is one of 28 primarily rural FFS counties being transitioned to Medi-Cal Managed Care and is designated as one of 18 Regional Model counties. For Regional Model counties, the State has chosen two insurance plans to administer the State's MCMCP Plan: California Health and Wellness Plan and Blue Cross of California (Anthem).
The Health and Human Services Agency (HHSA) and Anthem have developed MOU 622-M1410 to establish each party's roles and responsibilities in the delivery of Specialty Mental Health Services to Blue Cross members.
HHSA provides a variety of mandated Specialty Mental Health Services (SMHS) to the community who are members of Anthem, MOU164-M1310 was developed to provide a mechanism for reimbursement of SMHS services provided by the County to Anthem members.
Reason for Recommendation
The majority of County residents eligible to receive Medi-Cal are required to enroll in a Managed Care Plan to receive services, except as otherwise provided by law.
HHSA provides a variety of mandated SMHS services to the community who are members of Anthem, one of the two State selected insurance plans under the Medi-Cal Managed Care Rural Expansion.
Approval of MOU 622-M1410 provides the roles and responsibilities in which the County provides mandated SMHS to Anthem Managed Care members.
Approval of MOU 164-M1310 provides the mechanism in which the County may seek reimbursement for mandated services provided to Anthem Managed Care members. Failure to approve his MOU would result in the County absorbing the costs incurred while providing mandated SMHS to Anthem Managed Care Members.
Clerk of the Board Follow Up actions
1. Clerk of the Board to have Chair sign two (2) original copies of MOU 622-M1410, and two (2) original copies of MOU 164-M1310.
2. Clerk of the Board to return all signed documents to HHSA at 3057 Briw Road, Contracts Unit for further processing.
Contact
Don Ashton, M.P.A., Director
Concurrences
County Counsel, Risk Management and Human Resources