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Health and Human Services Agency, Public Health Division, recommending the Board:
1) Approve and authorize the Chair to sign non-financial Memorandum of Understanding (MOU) 546-M1411 with Anthem Blue Cross for a term effective upon signature and continuing until terminated by one of the parties thereto. This MOU establishes the roles and responsibilities of the Parties in the provision of services for the beneficiaries of the Medi-Cal Managed Care Plan and administered by Anthem Blue Cross;
2) Authorize the Chief Administrative Officer to execute further documents relating to the above noted MOU, including future amendments, contingent upon approval by County Counsel; and
3) Authorize the Director of the 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. (State and Federal Funding)
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DEPARTMENT RECOMMENDATION:
The Health and Human Services Agency (HHSA) Public Health Division has statutory requirements to ensure access and service delivery to the disenfranchised populations in compliance with Welfare and Institutions Code Section 17000. This MOU between Anthem Blue Cross and HHSA establishes the roles and responsibilities of each party in the performance of Public Health activities for those beneficiaries of the Anthem Blue Cross Medi-Cal Managed Care Plan.
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 expansion provides beneficiaries throughout the state with healthcare through an organized delivery system. The County of El Dorado was one of the 28, primarily rural, FFS counties being transitioned to Medi-Cal Managed Care in this process. Medi-Cal Managed Care Rural Expansion is the result of State Assembly Bill 1467, which added Article 2.82 to the Welfare and Institutions Code (commencing with Section 14087.98). Section 14087.98 includes a procedure for transitioning to a Medi-Cal Managed Care Plan (MCP) and requires the State to establish a methodology for selecting vendors to administer MCP. The state utilized a Request for Application (RFA) process that resulted in the State selection of vendors to administer MCP in the counties. The State selected two vendors, California Health and Wellness Plan and Anthem Blue Cross, later adding Kaiser Permanente as a third, to administer the MCP in a group of 18 counties, including the County of El Dorado.
As of November 1, 2013, Medi-Cal recipients have been required to enroll in the Anthem Blue Cross Plan, California Health and Wellness, or Kaiser. To ensure continuity of care, HHSA is required to contract with Anthem as a Medi-Cal Managed Plan. MOU 546-M1411 establishes Public Health Division activities specific to the Maternal, Child and Adolescent Health (“MCAH”) program, California Children’s Services (“CCS”) program, Family Planning Services, Sexually Transmitted Disease Services, Confidential HIV Testing, Immunizations, Women, Infants, and Children (“WIC”) Program, Child Health and Disability Prevention (“CHDP”) program, and direct observation of Tuberculosis therapy. This MOU between Anthem Blue Cross and HHSA establishes the roles and responsibilities of each party in the performance of Public Health activities for those beneficiaries of the Anthem Blue Cross Medi-Cal Managed Care Plan.
ALTERNATIVES:
Disapproval of MOU 546-M1411 will result in the inability of Public Health to effectively carry out the legally required activities as identified in the statute and procedurally could result in program default jeopardizing both State and Federal funding.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel.
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
There is no Net County Cost associated with this 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) original MOU 546-M1411.
2) Clerk of the Board to return one (1) fully executed MOU to the HHSA Contracts Unit 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