REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
June 22, 2021
FROM
VERONICA KELLEY, Director Department of Behavioral Health
SUBJECT
Title
Amendment to Memorandum of Understanding with Inland Empire Health Plan for the Coordinated Medi-Cal Mental Health Managed Care Plan
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 5, effective January 1, 2021, to the Memorandum of Understanding, County Contract No. 18-78, for Managed Care Plans with Inland Empire Health Plan for the provision of health care services to eligible San Bernardino County residents, updating General Provisions and rate structure with no change to total contract amount of $2,798,013 or the total contract period of February 13, 2018 through December 31, 2022.
(Presenter: Veronica Kelley, Director, 388-0801)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). Expenditures for the managed care health plan services are funded through reimbursements by Inland Empire Health Plan and Health Access (IEHP). Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2020-21 and 2021-22 budgets.
BACKGROUND INFORMATION
As the San Bernardino County Mental Health Plan (MHP), DBH is responsible for a collaborative partnership with Medi-Cal Managed Care Plans for coordination of Medi-Cal specialty mental health and Substance Use Disorder Recovery for San Bernardino County Medi-Cal beneficiaries who have Medicare/Medi-Cal coverage. DBH has partnered and maintained a Memorandum of Understanding (MOU) with IEHP since 2002 to provide and arrange health care services for eligible residents. Health care services provided by IEHP includes the Health Homes Program (HHP), a clinical service delivery model that focuses on providing individualized complex care management delivered by an integrated care team, known as the Community Based Care Management Entity (CB-CME). The recommended amendment from IEHP increases the allowable caseload size from 200 clients per care team to 250 clients per care team. Upon approval, DBH anticipates services will be provided to a maximum of 750 clients through December 31, 2022
IEHP and DBH began discussions regarding the HHP payment methodology for CB-CMEs in July 2020. IEHP’s Amendment No. 5 will decrease the base rate from $300 Per Engaged Member Per Month (PEMPM) to $250 PEMPM through March 31, 2021, and $200 PEMPM beginning April 1, 2021, with the addition of a value-based payment incentive plan for improvement in three identified measures. The payment methodology initially established was based on estimated Department of Health Care Services (DHCS) reimbursement rates. The original rate was based on estimated DHCS reimbursement rates and the DHCS rates were lower than estimated. As a result the base rate to DBH for these services is being reduced. The revised payment methodology is designed to encourage CB-CMEs to conduct certain evidence-based activities and track progress over time in order to compensate and allow CB-CME care teams the opportunity to meet the maximum potential contract amounts.
Through the IEHP HHP, CB-CME care teams work closely with the beneficiary’s Primary Care Provider and all other network providers, providing an intensive set of services for a small subset of Medi-Cal members who have chronic conditions requiring coordination of care at the highest levels. HHP focuses on whole-person, complex care management, which includes changing behaviors and patterns of health care with the goal of reducing avoidable, high cost interventions and increasing the use of appropriate, timely interventions, along with improved self-care management.
On February 13, 2018 (Item No. 19), the Board of Supervisors (Board) approved MOU No. 18-78 with IEHP for the provision of coordinating the delivery of health care services to Medi-Cal beneficiaries, for the period of February 13, 2018 through December 31, 2020, with authorization for a maximum of two successive one-year extensions, subject to review by County Counsel.
On June 11, 2019 (Item No. 20), the Board approved Amendment No. 1 to the MOU with IEHP to provide coordination of benefits with Medi-Cal Mental Health Managed Care Plans and Substance Use Disorder and Recovery Services for Medi-Cal eligible individuals for participation in the Health Homes Program, with no change to the contract period of February 13, 2018 through December 31, 2020.
On March 10, 2020 (Item No. 22), the Board approved Amendment No. 2 to the MOU with IEHP to update contract language and terms to better address the needs of beneficiaries who require specialty mental health services.
On November 17, 2020 (Item No. 31), the Board authorized payment to IEHP in the amount not to exceed $605,310 for the period of July 1, 2014 through February 12, 2018, and approved Amendment No. 3 to the MOU, adding Addendum II - Eating Disorder Services in the amount not to exceed $1,448,013, for the period of February 13, 2018 through December 31, 2020.
On December 15, 2020 (Item No. 25), the Board approved Amendment No. 4 to the MOU with IEHP increasing the contract amount by $1,350,000, from $1,448,013 to $2,798,013, and extending the contract for a total contract period of February 13, 2018 through December 31, 2022 and extending HHP effective January 1, 2021 through December 31, 2021.
On April 12, 2021, DBH received the draft of Amendment No. 5 from IEHP with the updated contract language, revising the payment methodology for HHP, to be effective January 1, 2021, with no change to the MOU amount or contract period. The item is being presented at this time, as this is the first date available for presentation following the completed contract negotiations and required operational, fiscal, and legal reviews. Approval at this time will have no impact on DBH’s services or activities.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on May 21, 2021; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on May 25, 2021; Finance (Christopher Lange, Administrative Analyst, 386-8393) on June 4, 2021, and County Finance and Administration (Tanya Bratton, Deputy Executive Officer, 388-0332) on June 4, 2021.