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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 3344 (MOU) with Blue Cross of California Partnership Plan, Inc. (Anthem), establishing the roles and responsibilities in the provision of Substance Abuse Disorder services for the beneficiaries of the Medi-Cal Managed Care program administered by Anthem, for a perpetual term beginning upon final execution of the MOU;
2) Authorize the Chair to execute further documents relating to the MOU, including amendments that 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 the Health and Human Services Agency, or designee, to execute any administrative documents relating to said MOU including required fiscal and programmatic reports.
FUNDING: This is a non-financial MOU.
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DISCUSSION / BACKGROUND:
On May 23, 2017, the Board authorized the HHSA Director to opt in to the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System (DMC-ODS) and to continue to develop opportunities for expanding the local continuum of care for substance use treatment (File ID: 17-0525; Item 13). Accordingly, HHSA has held meetings with community stakeholders and providers, and developed and submitted a preliminary plan and proposed rate structure to the State of California. HHSA has been working with the State on an Agreement which will be brought back to the Board for approval.
The DMC-ODS is a voluntary pilot program that offers California counties the opportunity to expand access to quality care for Medi-Cal enrollees with substance use disorders (SUD). The goal of the program is to demonstrate how organized SUD care improves beneficiary health outcomes, while decreasing system-wide health care costs. Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of SUD benefits utilizing the American Society of Addiction Medicine (ASAM) Criteria. This approach is expected to provide eligible Medi-Cal enrollees with access to the care and services they need for a sustainable and successful recovery.
The ASAM Criteria is a proven model for the provision of outcome-oriented and results-based care in the treatment of addiction. It is the most widely used and comprehensive set of guidelines for assessing patient needs and optimizing placement into SUD treatment. Counties that implement the DMC-ODS are required to use the ASAM Criteria to ensure that eligible Medi-Cal beneficiaries have access to the SUD services that best align with their treatment needs.
One of the requirements that must be completed in order for the County to enter into an agreement with the State Department of Health Care Services (DHCS) for DMC-ODS is that the County must enter into a Memorandum of Understanding (MOU) with each health care organization that provides medical services to Medi-Cal eligible beneficiaries within the County. MOU 3344 establishes specific roles and responsibilities of the County and of Blue Cross of California Partnership Plan, Inc. (Anthem), regarding the provision of Medi-Cal services to Medi-Cal eligible beneficiaries who are members of Anthem. The MOU coordinates care for screening, referral, coordination, and delivery of alcohol and other drug services for Medi-Cal beneficiaries of Anthem who meet the medical necessity criteria for Medi-Cal services and identified by DHCS as a Medi-Cal Managed Care Health Plan benefit.
HHSA is also working with California Health and Wellness Plan and with Kaiser to enter into similar MOU’s with each of those organizations and will bring each MOU separately to the Board for approval and signature.
ALTERNATIVES:
The California Department of Health Care Services requires that this MOU, and similar MOUs with California Health and Wellness Plan and with Kaiser, be fully executed while HHSA works with DHCS to complete implementation plans and receive DHCS’s approval to enter into an agreement with DHCS for DMC-ODS.
PRIOR BOARD ACTION:
- 05-23-2017, File ID 17-0525, Approval for HHSA to “opt in” to the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System.
- 12-05-2017, File ID 17-1252, Receive and file HHSA’s update on the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System implementation pilot project.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources, and Risk Management.
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
There is no financial impact or Net County Cost associated with this MOU. Additionally, there is no Net County Cost associated with the provision of services provided under the DMC-ODS Waiver.
Services provided under the DMC-ODS Waiver will be funded by Federal Financial Participation (FFP) funds that are matched with local Realignment funds in the Behavioral Health Subaccount. Since many of the individuals in need of these services are in the expanded population enrolled in Medi-Cal, the FFP portion will cover between 90% and 95% of the cost for those individuals.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on two (2) originals of MOU 3344.
2) Clerk of the Board to return both partially signed MOU 3344 to HHSA Contracts Unit, 3057 Briw Road, to obtain final signatures.
STRATEGIC PLAN COMPONENT:
County Strategic Plan:
- Goal #1 - “Public Safety: Protects the community, prevents crime, enforces the law, administers justice, provides rehabilitative services, and promptly responds to emergency and calls for service.”
- Goal #5 - “Healthy Communities: Improved health, well-being and self-sufficiency of El Dorado County communities, residents and visitors.”
CONTACT
Don Semon, Director