REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 20, 2024
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Addendum to the Memorandum of Understanding with Inland Empire Health Plan for the provision of Eating Disorder Treatment Services
End
RECOMMENDATION(S)
Recommendation
Approve Addendum No. 1 to the Memorandum of Understanding, Contract No. 23-1362, with Inland Empire Health Plan, effective January 1, 2024, updating contract language to add the provision of eating disorder treatment services for Medi-Cal eligible clients, for a total amount of $3,181,818, with no change to the contract period of January 1, 2024, through December 31, 2026.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The recommended increase of $3,181,818 with Inland Empire Health Plan (IEHP) for the treatment of eating disorders is funded by Mental Health Services Act funds. Adequate appropriation and revenue are included in the Department of Behavioral Health’s (DBH) 2024-25 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to County residents experiencing severe mental illness and/or SUD. DBH, as the County’s Mental Health Plan (MHP) and Drug Medi-Cal Organized Delivery System (DMC-ODS), is required by regulation (Title 9 of the California Code of Regulations Section 1810.370) and its Specialty Mental Health Services (SMHS) contract with the State Department of Health Care Services (DHCS) to enter into Memoranda of Understanding (MOUs) with any Medi-Cal Managed Care Plan (MCP) operating within the county.
DBH currently contracts with two MCPs, IEHP and Molina Healthcare of California, Inc DBH has had MOUs with both MCPs for over 20 years, with the purpose of ensuring that physical health, SMHS and DMC-ODS services delivered to Medi-Cal clients are coordinated. The MHP and MCPs develop and sustain a collaborative partnership for the coordination of SMHS and DMC-ODS to MCPs’ members who meet medical necessity with DBH. The MCPs provide non-specialty mental health services while DBH provides SMHS and SUD services through its network of care, which includes County clinics, Community Based Organizations, and fee for service providers.
On December 19, 2023 (Item No. 29), the Board of Supervisors (Board) approved MOU Contract No. 23-1362 (MOU) with IEHP, for the provision of coordination of benefits of Medi-Cal Mental Health and SUD services for Medi-Cal eligible clients, for the period of January 1, 2024, through December 31, 2026. The MOU clarifies roles and responsibilities between the MHP and MCP, supports local engagement, facilitates care coordination and the exchange of information necessary to improve care coordination, and improves referral processes between the parties.
The recommended Addendum No. 1 (Addendum) to the MOU with IEHP will update contract language to allow for the provision of services for a small percentage of Medi-Cal eligible clients identified as having a severe eating disorder in the total amount of $3,181,818, with no change to the MOU period of January 1, 2024, through December 31, 2026. Based upon actual clients served during 2022-23, DBH estimates 38 eligible clients will be served per fiscal year, for a total of 114 clients for the duration of the MOU, at an average cost of $27,911 per unduplicated client.
DBH will collaborate with IEHP to address the eating disorder service needs of these clients as these services (i.e., Residential Treatment Programs (RTP), Partial Hospitalization Programs (PHP), and Intensive Outpatient Program (IOP)) overlap in treatment responsibility. RTPs offer clients a structured environment where a person lives in a residential treatment center full-time. PHP includes six to eight hours of treatment, five to seven days per week, to clients to restore weight, reduce eating disorder behaviors, and build skills. An IOP typically offers clients four hours of treatment, three to five days per week, and is less structured.
Since DBH and IEHP are conjointly responsible for the eating disorder treatment services, DBH will collaborate with IEHP to determine the appropriate level of care and reimburse IEHP 50% of the costs for the eating disorder treatment services. Additionally, since clients require outpatient SMHS after receiving these services, DBH and IEHP will collaborate to ensure appropriate linkages to DBH programs are made as clients transition out of the above-noted services as appropriate.
DBH will implement mechanisms to regularly review 1) client service data and progress, conduct site visits and annual monitoring to ensure performance and compliance standards are met; and 2) provider invoices administratively and programmatically to ensure client and/or bed counts are accurate prior to payment processing.
Initially these services were to be included in the MOU approved by the Board on December 19, 2023 (Item No. 29). However, IEHP requested a standalone agreement for the eating disorder services. After discussion, DBH and IEHP agreed to include these services as an addendum to incorporate into the current MOU; a negotiated Addendum was provided by IEHP on March 14, 2024. In preparing the item to go to our Board in June, it was discovered that additional edits were necessary and that IEHP had to go back to their Board to obtain approval of the changes on August 12, 2024. DBH requests this item be retroactive to January 1, 2024, so that IEHP may be reimbursed for any eating disorder services provided. This item is being brought forward at this time as this is the first Board date following IEHP’s approval and the necessary program, fiscal, and legal reviews.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by (Natalie Kessee, Contracts Manager, 388-0869) on July 29, 2024; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on July 5, 2024; Finance (Paul Garcia, Administrative Analyst, 386-8392) on July 29, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on August 2, 2024.