Title
Health and Human Services Agency, Public Health Division, recommending the Board consider the following:
1) Approve and authorize the Chair to sign non-financial Memorandum of Understanding 180-M1511 with The Permanente Medical Group, Inc., for the provision of physiatrist services to eligible children through the California Children's Services program for the term of January 1, 2014 through December 31, 2014 and continue thereafter on a month-to-month basis until terminated by either party; and
2) Authorize the Purchasing Agent to execute further documents relating to Memorandum of Understanding 180-M1511, including amendments thereto, contingent upon approval by County Counsel and Risk Management.
FUNDING: None. This is a Non-financial Memorandum of Understanding.
Body
Fiscal Impact/Change to Net County Cost
There is no Net County Cost associated with this non-financial Memorandum of Understanding (MOU).
Background
The California Children's Services (CCS) program is administered as a partnership between the County of El Dorado (EDC) and the California Department of Health Care Services (DHCS). Currently 100 EDC children (up to age 21) receive intervention services through the CCS Medical Therapy Program (MTP).
The CCS MTP program provides diagnostic and treatment services, medical case management, and physical and occupational therapy intervention to children under age 21 with CCS-eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, chronic medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae (a disease resulting from another disease).
The legislative intent of the CCS program is to provide necessary medical services for children with medical conditions that are eligible for CCS services, whose parents are unable to pay for these services, either wholly or in part. The statute also requires the DHCS and the EDC CCS program to seek eligible children by cooperating with local public or private agencies and providers of medical care to bring potentially eligible children to sources of expert diagnosis and treatment.
The CCS program is mandated by the Welfare and Institutions Code and the California Code of Regulations (Title 22, Section 51013) to act as an "agent of Medi-Cal" for Medi-Cal beneficiaries with CCS medically eligible conditions. Medi-Cal is required to refer all CCS-eligible children to CCS for case management services and authorization for treatment. The statute also requires all CCS applicants who may be eligible for the Medi-Cal program to apply for Medi-Cal. The Medi-Cal program reimburses for medical care provided pursuant to the CCS Program.
California Code of Regulations, Title 2, Division 9 §60300, CCS MTP Definitions, requires that physicians with a specialty in pediatric rehabilitative therapy evaluate and prescribe the delivery of physical and occupational therapy to eligible children participating in the CCS Medical Therapy Program.
Previously Dr. Manhart donated his time to the regional MTP network, including El Dorado County, and no formal Agreement was required. However, on or about August 5, 2014, The Permanente Medical Group, Inc. (TPMG) notified all regional CCS MTPs that continuation of Dr. Manhart's services would require an agreement between TPMG and each local CCS MTP, retroactive to January 2014. This enables TPMG to be reimbursed retroactively by Medi-Cal for services provided by their employee, Dr. Manhart, beginning January 1, 2014.
Immediately after HHSA Public Health Division was notified that TPMG now requires an agreement for Dr. Manhart to continue to provide CCS services, HHSA began contract negotiations with TPMG. The negotiation process was lengthy due to the use of non-standard language, but mutually agreeable terms and conditions were ultimately reached. It should be noted that several local Counties have, or are, experienceing similar challenges negotiating agreeable terms and conditions with TPMG. It was also determined after extensive research, Dr. Manhart, is the only available option for CCS Services in the area.
Reason for Recommendation
Approval of this MOU enables the EDC CCS Program to continue providing physiatry services to CCS medically eligible pediatric clients as required and outlined by State regulation.
Failure to approve this MOU would result in EDC being unable to provide specialty medical services mandated by the CCS Program, specifically physiatry intervention.
Clerk of the Board Follow up Actions
1. Clerk of the Board to obtain signature of Chair on two (2) original MOU.
2. Clerk of the Board to return one (1) fully executed original MOU to HHSA Contracts Unit, 3057 Briw Road.
Contact
Don Ashton, M.P.A., Director
Concurrences
County Counsel and Risk Management