REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
November 17, 2020
FROM
VERONICA KELLEY, Director, Department of Behavioral Health
SUBJECT
Title
Agreement with Inland Empire Health Plan for Eating Disorder Services
End
RECOMMENDATION(S)
Recommendation
1. Authorize payment in the amount not to exceed $605,310 to Inland Empire Health Plan for Eating Disorder Services for the period of July 1, 2014 through February 12, 2018.
2. Approve Amendment No. 3 to Memorandum of Understanding No. 18-78 with Inland Empire Health Plan for the provision of behavioral health care services to eligible San Bernardino County residents, 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.
(Presenter: 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). The reimbursement cost (50% of the actual cost for services) for eating disorder services provided by Inland Empire Health Plan (IEHP) did not exceed $605,310 for the period of July 1, 2014 through February 12, 2018 and will not exceed $1,448,013 for the period of February 13, 2018 through December 31, 2020 and are funded by 1991 Realignment. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) FY 2020-21 budget.
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 services for San Bernardino County Medi-Cal beneficiaries who have Medicare/Medi-Cal coverage. DBH has collaborated and maintained a MOU with IEHP since 2002 to provide and arrange health care services for eligible residents. The recommended reimbursement for July 1, 2014 through February 12, 2018 and amendment to MOU No. 18-78 (February 13, 2018 through December 31, 2020) is necessary in order for DBH to reimburse IEHP 50% of the cost for eating disorder services provided to mutual clients during the indicated periods.
DBH, as the MHP, serves clients with the eating disorders diagnosis. DBH collaborates with IEHP to address the eating disorder needs of these clients as eating disorders overlap in treatment responsibility between the two entities, and includes adults and children. IEHP has a network of eating disorder providers who provide services not offered by DBH, such as a partial hospitalization program, Intensive Outpatient Program and inpatient services. Because a portion of the eating disorders are a covered diagnosis for treatment by DBH, and the clients need outpatient specialty mental health services after the eating disorder services, DBH reimburses IEHP 50% of the costs for eating disorder treatment services. Approximately 25 clients at an average cost of $24,212 were provided services during July 1, 2014 through February 12, 2018, and approximately 65 clients at an average cost of $22,277 will have been provided services during February 13, 2018 through December 31, 2020.
During the course of the collaboration between DBH and IEHP both entities believed the current MOU covered reimbursement for eating disorder services but upon further review these services were absent from the agreement. Additionally, DBH was not in receipt of invoices for services within this time period. Therefore, DBH is requesting payment authorization for July 1, 2014 to February 12, 2018 and an amendment to the existing MOU No. 18-78 in order to reimburse IEHP as required under the collaboration with IEHP for the delivery of health care services, and includes language requiring the timely submission of claims.
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 MOU No. 18-78 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 MOU No. 18-78 with IEHP to update agreement language and terms, with no change to the contract period of February 13, 2018 through December 31, 2020.
The recommended authorization to pay for July 1, 2014 to February 2018 and Amendment No. 3 to MOU No. 18-78 with IEHP is required for DBH to reimburse its portion of the cost of eating disorder services provided to beneficiaries in need of this service. This item is being presented at this time as this is the first Board date available following required negotiations with IEHP and DBH Administrative reviews. Approval of the payment authorization and amended MOU by the Board at this time will have no impact on DBH’s program related services.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Natalie Kessee, Contracts Manager, 388-0869) on October 20, 2020; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on October 26, 2020; Finance (Christopher Lange, Administrative Analyst, 386-8393) on October 28, 2020, and County Finance and Administration (Tanya Bratton, Deputy Executive Officer, 388-0332) on October 28, 2020.