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Health and Human Services Agency recommending the Board:
1) Approve and authorize the Chair to sign Amendment I to Agreement for Services 4300 with Aegis Treatment Centers, LLC, for the provision of Drug Medi-Cal Organized Delivery System Services, increasing the not to exceed amount by $106,000 for a new maximum obligation of $788,922, with no change to the term of the Agreement;
2) Make findings in accordance with County Ordinance 3.13.030 that it is appropriate to contract with Aegis Treatment Centers, LLC. for services provided under this Agreement 4300 because (B) “Specialty skills and qualifications not expressly identified in classifications are involved in the performance of the work;” and
3) Authorize the Purchasing Agent, or designee, to execute further documents relating to Agreement for Services 4300, including amendments which do not increase the maximum dollar amount or term of the Agreement, and contingent upon approval by County Counsel and Risk Management.
FUNDING: Federal Medi-Cal with matched funding from 2011 Behavioral Health Realignment and State General Fund for Residential and Outpatient Intensive Treatment services for the expanded population.
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DISCUSSION / BACKGROUND:
On May 23, 2017, the Board authorized the County to “opt in” to the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System (DMC-ODS).
On April 30, 2019, the Board approved Funding Agreement 18-95146 with California
Department of Health Care Services, which allowed the County to move forward with the DMC-ODS Waiver plan and begin contracting with Drug Medi-Cal (DMC)-certified service providers. By opting in to participate in this program, the County is obligated to establish sufficient capacity to meet the needs of the target population. In accordance with the requirements of the DMC-ODS funding Agreement, the County must comply with 42 Code of Federal Regulations (CFR) Section 438.207 and maintain a network of providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of beneficiaries in the service area.
DMC-ODS services are expanded beyond those previously provided, as demonstrated below:
Benefits available from both the DMC-ODS Waiver Benefits as well as (prior) standard Drug Medi-Cal Benefits:
1) Outpatient Services
2) Intensive Outpatient Services
3) Narcotic Treatment Program Services
Additional benefits available from the DMC-ODS Waiver:
1) Residential Treatment services through DMC-ODS have no bed limitation and multiple levels of care; however, standard DMC Benefits are limited to perinatal clients in facilities with less than 16 beds.
2) Withdrawal Management services through DMC-ODS is a continuum of care; however, standard DMC Benefits are limited to Inpatient Hospital Detoxification.
3) Recovery Services, Case Management, Physician Consultation, Additional Medication-Assisted Treatment, and Partial Hospitalization benefits are provided through DMC-ODS; however, none of these services are provided by standard DMC Benefits.
On July 10, 2018, HHSA initiated a Request for Qualifications (RFQ) 19-918-004 to ensure standardized service agreements for DMC-ODS providers that meet the requirements of the DMC-ODS funding. This RFQ remains open to maximize the opportunity to contract with DMC-certified service providers to meet the need of clients in El Dorado County.
On July 23, 2019, the Board approved use of the DMC-ODS boilerplate Agreement to provide DMC-ODS services. Subsequently, on November 22, 2019, Agreement 4300 was executed with Aegis Treatment Centers, LLC. Aegis has the professional staff necessary to disperse medication as part of a narcotic treatment program. The County currently does not have a classification structure that supports the distribution of medication as part of a narcotic treatment program.
Amendment I is necessary to increase the maximum obligation to cover anticipated services through the term of the Agreement in order to maintain network adequacy which is a requirement of the Intergovernmental Funding Agreement for DMC-ODS services.
ALTERNATIVES:
Should the Board decline to approve this Amendment, HHSA would be out of compliance with the Intergovernmental Funding Agreement for DMC-ODS services.
PRIOR BOARD ACTION:
1) 05/23/17, 17-0525, Approved participation in the DMC-ODS Waiver plan.
2) 04/30/19, 19-0525, Approved DMC-ODS Interdepartmental Funding Agreement
3) 07/23/19, 19-0811, Approved DMC-ODS Boilerplate Agreement for Services
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
The agreement is funded through Federal Medi-Cal with matched funding from 2011 Behavioral Health Realignment and State General Fund for Residential and Outpatient Intensive Treatment services for the expanded population. There are sufficient appropriations in the Fiscal Year 2020-21 Behavioral Health Division budget to cover the $106,000 increase, and this item does not have an impact to the General Fund.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
1) Clerk of the Board to obtain signature of Chair on two (2) original Amendments to Agreement for Services 4300; and
2) Clerk of the Board to return one (1) fully executed Amendment to HHSA Contracts Unit at 3057 Briw Rd, Suite B.
STRATEGIC PLAN COMPONENT:
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