REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 11, 2022
FROM
LEONARD X. HERNANDEZ, Chief Executive Officer
SUBJECT
Title
Master Employment Agreement for Enhanced Care Management and Community Supports
End
RECOMMENDATION(S)
Recommendation
1. Approve the Master Employment Agreements for both the Enhanced Care Management and Community Supports programs to hire program staff, as detailed on Attachment A, which are part of the new California Advancing and Innovating Medi-Cal Program.
2. Delegate Authority to the Chief Executive Officer, or the designated Department Director, to execute individual Employment Agreements for the California Advancing and Innovating Medi-Cal Program effective January 1, 2022 through June 30, 2024, with the option to extend the term for a maximum of three, successive one-year periods in the event that the Board of Supervisors approves an extension beyond June 30, 2024 to the term of Agreement No. 21-983 between Inland Empire Health Plan and IEHP Health Access and the County, on behalf of Arrowhead Regional Medical Center, Department of Behavioral Health, Department of Public Health, and the Office of Homeless Services.
3. Delegate Authority to the Chief Executive Officer to approve and sign nonfinancial documents as they pertain to the Enhanced Care Management Provider Agreement No. 21-983 between Inland Empire Health Plan and IEHP Health Access and the County, on behalf of Arrowhead Regional Medical Center, Department of Behavioral Health, Department of Public Health, and the Office of Homeless Services, subject to review by County Counsel, provided that any such documentation does not result in additional costs to be incurred by the County, and does not extend the duration of the contract beyond the approved term of January 1, 2022 through June 30, 2024.
(Presenter: William L. Gilbert, Director, Arrowhead Regional Medical Center, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Improve County Government Operations.
Operate in a Fiscally-Responsible and Business-Like Manner.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the program expenses are funded by the California Department of Health Care Services and reimbursed to the County on behalf of Arrowhead Regional Medical Center (ARMC), the Department of Behavioral Health (DBH), Department of Public Health (DPH), and Office of Homeless Services (OHS), through the Inland Empire Health Plan and IEHP Health Access (collectively referred to as “IEHP”) based on a capitation (healthcare payment) system that uses a value-based methodology.
Based on financial modeling, revenues from IEHP (including incentive funding under Enhanced Care Management Provider Agreement No. 21-983) are expected to cover the majority of the program expenses. The County anticipates covering expenses that exceed the funding allocation from IEHP through the State’s California Advancing and Innovating Medi-Cal (CalAIM) grant “Providing Access and Transforming Health (PATH)”. Through ARMC, the County meets the criteria for PATH funding, which gives priority to Designated Public Hospitals and Whole Person Care Programs. The application for and acceptance of PATH funding will follow the County guidelines for grant processing, and the California Association of Public Hospitals will notify ARMC when the funding will be awarded. If PATH funding is not awarded to the County, then ARMC, DBH, DPH, and OHS will use departmental funding to offset the remaining expenses through the program’s agreement term. In the event that the funding ceases from IEHP, the program will be discontinued.
At this time, budget adjustments are not requested but will be included in a future Board Agenda Item presented to the Board of Supervisors (Board) for approval and will be included in future recommended budgets.
BACKGROUND INFORMATION
Effective January 1, 2022, the California Department of Health Care Services (DHCS), through CalAIM, is establishing new, statewide programs called Enhanced Care Management (ECM) and Community Supports (CS). Through a whole-person care approach, the medical and non-medical circumstances of high-need Medi-Cal beneficiaries will be met at their County medical location of preference, thereby reducing the need to transfer these individuals between providers or County departments. High-need Medi-Cal beneficiaries include individuals who are homeless and/or have serious mental illness, adults and children with complex medical conditions, justice-involved populations with significant clinical needs, and the growing aging population. ARMC and DPH are working in collaboration to provide ECM services to Medi-Cal beneficiaries at DPH clinics.
Beyond medical services, the inclusion of CS will be led by OHS, a division of Community Revitalization, which will focus on sustaining services such as housing transition navigation services, housing deposits, and housing tenancy. San Bernardino County (County) may consider other types of services in the future.
To implement ECM, staffing must be in place to provide services. County Human Resources (HR) has drafted the Master Employment Agreements for both the ECM and CS programs and will approve the contract staff needed for the multi-departmental implementation of ECM and CS in the County. The departments will utilize the Master Employment Agreements to delineate duties for the individual staff positions that comprise the ECM and CS teams and ensure program staff adhere to County and State policies and procedures as well as meet the Scope of Work for the ECM and CS programs. The agreements will also specify salary ranges and rate increases.
Recommendation No. 1 seeks approval of the Master Employment Agreement and Recommendation No. 2 delegates authority to the Chief Executive Officer, or the designated Department Director, to execute individual Employment Agreements for the implementation of ECM and CS. The County or contract staff may terminate the Agreements at any time without cause with a 14-day prior written notice to the other party. The Agreements may be terminated for just cause immediately by the Director of the applicable department. Contract staff shall serve at the pleasure of the Director of the applicable department, or their designee, who shall have the full authority and discretion to exercise County rights.
The Board approved revenue Agreement No. 21-983 between IEHP and the County, on behalf of ARMC, DBH, DPH and OHS, on December 14, 2021, that establishes the parameters for the ECM funding in the County. IEHP may issue various non-financial documents related to the ECM with shortened timeframes for response and execution. Therefore, Recommendation No. 3 requests delegated authority for the Chief Executive Officer to execute such documents to implement ECM.
The details regarding the 133 contract positions for ECM and CS are included in Attachment A. As an overview, the following number of contract staff will be added to the County departments indicated:
|
Department |
Number of Positions |
|
Arrowhead Regional Medical Center |
78 |
|
Behavioral Health |
34 |
|
Office of Homeless Services |
13 |
|
Public Health |
8 |
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Principal Assistant County Counsel, Cynthia O’Neill and Kristina Robb; Deputy County Counsel, Charles Phan, Suzanne Bryant, and Dawn Martin 387-5455) on December 28, 2021; Arrowhead Regional Medical Center (William L. Gilbert, Director, 580-6150) on December 28, 2021; Behavioral Health (Georgina Yoshioka, Interim Director, 252-5142) on December 27, 2021; Public Health (Joshua Dugas, Director, 387-6222) on December 21, 2021; Office of Homeless Services (CaSonya Thomas, Assistant Executive Officer, 387-4717) on December 29, 2021; Human Resources (Diane Rundles, Director, 387-5570 and Gina King, HR Deputy Director, 387-5571) on December 29, 2021; Finance (Administrative Analysts, Chen Wu, 580-3165, and Paul Garcia, 386-8392) on December 22, 2021; and County Finance and Administration (Deputy Executive Officer, Diana Atkeson, 387-5423) on December 22, 2021.