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Health and Human Services Agency recommending the Board:
1) Approve and authorize the Chair to sign non-financial Memorandum of Understanding 124-M1510 (MOU) with Kaiser Permanente to establish the roles and responsibilities of the Health and Human Services Agency and Kaiser Permanente for the provision of services for the beneficiaries of the Medi-Cal Managed Care program for Kaiser Permanente Members with a retroactive three-year term that commenced on March 1, 2015;
2) Authorize the Chief Administrative Officer to execute further documents relating to the above noted Agreement, including amendments which do not increase the maximum dollar amount or term of the MOU, and contingent upon approval by County Counsel; and
3) Authorize the Director of Health and Human Services Agency, or designee, to administer said MOU and execute any subsequent administrative documents relating to said MOU including required fiscal and programmatic reports.
FUNDING: Medi-Cal Managed Care.
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DEPARTMENT RECOMMENDATION:
The Health and Human Services Agency (HHSA) provides a variety of mandated health services to the community. Approval of Memorandum of Understanding 124-M1510 (MOU) with Kaiser Permanente (Kaiser) will ensure compliance with AB 1467 and the various statutes amended by AB 1467 to expand Medi-Cal Managed Care within the State of California.
DISCUSSION / BACKGROUND:
In June 2013, the Governor's Budget expanded managed health care into rural areas that had previously been Fee-For-Service (FFS) only. This rural expansion provides beneficiaries throughout the State with care through an organized delivery system. El Dorado County is one of 28 FFS counties being transitioned to Medi-Cal Managed Care rural expansion, which is the result of State Assembly Bill 1467 and that added Article 2.82 (commencing with Section 14087.98) to the Welfare and Institutions Code. Section 14087.98 includes a procedure for transitioning to a Medi-Cal Managed Care Plan (MCMCP) and requires the State to establish a methodology for selecting vendors to administer MCMCP. The State utilized a Request for Application (RFA) process that resulted in the State selection of vendors to administer MCMCP in the counties.
California has six models of managed care: 1) County Organized Health Systems, 2) Geographic Managed Care, 3) Two-Plan, 4) Regional, 5) Imperial, and 6) San Benito. El Dorado County is designated a Regional model county. In Regional model counties, there are two Commercial Plans that contract with the Department of Health Care Services (DHCS): Anthem Blue Cross and California Health and Wellness Plan.
Affordable Care Act insurance exchanges were opened October 1, 2013. Beginning November 1, 2013, Medi-Cal recipients were required to enroll in one of these two MCMCP's or access other insurance opportunities through the Covered California Insurance Exchange.
El Dorado County has some residents who are Kaiser members and eligible for Medi-Cal Managed Care. To ensure continuity of care for these residents, HHSA is required to contract with Kaiser as a Medi-Cal Managed Care Plan. MOU 124-M1510 is a non-financial MOU establishing certain roles and responsibilities regarding the provision of services to member (beneficiaries) of Kaiser. The majority of the activities defined in the MOU are also included in the agreement with the State Department of Health Care Services that establishes the County as the Mental Health Plan for the residents of El Dorado County.
The MOU is being signed in counterpart to expedite processing.
ALTERNATIVES:
HHSA has statutory requirements for access and service delivery assurance to the disenfranchised population generically addressed under Welfare and Institutions Code 17000. Failure to execute the MOU will result in the inability of HHSA to effectively carry out the legally required activities as identified in statute, and could jeopardize both State and Federal funding to those programs.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel
CAO RECOMMENDATION:
It is recommended that the Board approve this item if it wants to provide access to health care as described above.
FINANCIAL IMPACT:
There is no Net County Cost associated with the non-financial Memorandum of Understanding.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1. Clerk of the Board to obtain signature of Chair on two (2) originals of MOU 124-M1510.
2. Clerk of the Board to return one (1) fully executed MOU to HHSA at 3057 Briw Road.
STRATEGIC PLAN COMPONENT:
This MOU reflects HHSA's Strategic Plan goal number 3: Program Effectiveness/Integration - To develop collaborative partnerships and community networks that focus on quality, performance standards, outcomes, and accountability through mutual goals and continuous improvement.
CONTACT
Don Ashton, M.P.A., Director