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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings in accordance with El Dorado County Ordinance Code, Chapter 3.13.030(B) and El Dorado County Charter, Section 210(b)(6) that the provision of Drug Medi-Cal Organized Delivery System services provided by Recover Medical Group P.C. include specialty skills and qualifications not expressly identified in County classifications;
2) Approve and authorize the Chair to sign Agreement for Services 7107 with Recover Medical Group P.C., with a not-to-exceed amount of $300,000 and for the term of two years effective upon execution; and
3) Authorize the HHSA Director or Behavioral Health Director to execute further documents relating to Agreement 7107, contingent upon approval by County Counsel and Risk Management, including amendments which do not increase the maximum dollar amount or term of the Agreement.
FUNDING:85% Drug Medi-Cal Federal Financial Participation/State General Fund and 15% Behavioral Health Realignment.
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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) (File ID: 17-0525). Since that time, the Health and Human Services Agency (HHSA) has developed service agreements with providers to provide substance use disorder (SUD) services for County clients in accordance with the terms and conditions of the DMC-ODS agreement between the State and County of El Dorado (County).
The County’s DMC-ODS is a managed care plan as defined under 42 Code of Federal Regulations (CFR) Section 438.2 as a Prepaid Inpatient Health Plan (PIHP). As a PIHP delivering Medicaid services, the County and its network of contracted providers, must adhere to Medi-Cal Managed Care laws and regulations governed by the Center for Medicare & Medicaid Services. These regulations include many requirements designed to ensure that DMC eligible adults and adolescents residing in the County receive high quality services without barriers to access.
In adherence with the DMC-ODS Agreement, the County is required to develop 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. Outpatient treatment services are intended to treat clients experiencing alcohol and/or drug use disorders by helping them: a) Reduce substance abuse usage and/or achieve a substance-free life; b) Maximize multiple aspects of life functioning; c) Prevent or reduce the frequency and severity of drug and alcohol relapse; and d) Improve their overall quality of life. SUD outpatient treatment providers must have and maintain an active Drug-Medical (DMC) certification for the facility where services are provided, issued by the Department of Health Care Services (DHCS) of a substance abuse treatment program for the contracted American Society of Addiction Medicine (ASAM) Level of Care.
In order to solicit DMC-certified outpatient service providers for youth and adult clients in the County, the Chief Administrative Office (CAO) Procurement and Contracts Division, released Request for Proposal (RFP) 22-952-009 on October 29, 2021, for ASAM Level 1.0 Outpatient and 2.1 Intensive Outpatient Services. Due to HHSA’s Behavioral Health Division’s (BHD) need to contract for multiple ASAM Levels of Care (LOC), locations, and targeted client populations for services, this RFP was posted to run continuously until closed. A proposal was received by Recover Medical Group P.C., a California Professional Corporation on May 31, 2022, that met the eligibility requirements to provide adult and youth 1.0 and 2.1 LOC outpatient services. After a successful evaluation, the Board approved the award on August 30, 2022 (File ID 22-1351).
This proposed Agreement for Services 7107 with Recover Medical Group P.C. will provide Adult and Youth Level Outpatient drug treatment services to El Dorado County beneficiaries. The proposed Agreement for Services would ensure compliance with all Federal and State requirements and will continue to uphold parameters such as consistency in service delivery expectations, performance measures and outcomes, productivity, and funding. Upon Board approval of this Agreement for Services with Recover Medical Group P.C., HHSA BHD can establish telehealth outpatient service provisions to youth and adult clients across the County.
ALTERNATIVES:
Should the Board decline to approve the Agreement with Recover Medical Group P.C., HHSA would continue to provide services through existing contracts; however, it could result in difficulty meeting the needs of the community and could result in HHSA being out-of-compliance with the DMC-ODS Waiver Plan authorized by the Board in 2017.
PRIOR BOARD ACTION:
1) 05/23/17, 17-0525, HHSA Federal 1115 Waiver for DMC-ODS
2) 08/30/22, 22-1351, HHSA Request to Award a proposal received under RFP No. 22-952-009 by Recover Medical Group P.C. for DMC ODS Outpatient Services
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources, Procurement and Contracts, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with Agreement for Services 7107. Services provided under the DMC-ODS program will be funded by Medicaid Federal Financial Participation (FFP) and State General Funds (SGF) that will be matched with Behavioral Health Realignment. There are sufficient appropriations for Federal Medicaid, Behavioral Health Realignment, and State General Funds.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on one (1) original Agreement for Services 7107.
STRATEGIC PLAN COMPONENT:
Health Communities, Improved Health, Well-being, and Self-sufficiency of El Dorado County communities, residents, and visitors.
CONTACT
Olivia Byron-Cooper, Interim Director, Health and Human Services Agency