Title
a. Approve and authorize the Director of Health or Assistant Director of Health to execute a no-extension Amendment No. 1 to the Medi-Cal 2020 Demonstration Waiver Whole Person Care (WPC) Pilot Agreement A-13345 with the California Department of Health Care Services (DHCS), providing for additional matching non-federal funds, the source of which shall be funds from the Monterey County Health Department and not the County’s General Fund, in the amount up to $1,028,720 for each CY 2017, CY 2018, CY 2019, and CY 2020, for a total non-federal match of up to $3,600,520, for a revised total agreement amount of $34,035,670, subject to approval of County Counsel and County Auditor-Controller; and
b. Authorize the Director of Health or Assistant Director of Health to sign up to two (2) future amendments to Agreement A-13345, where the amendments in the aggregate, do not exceed 10% of the original Agreement amount ($2,683,463) and which do not significantly change the scope of the pilot project.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and authorize the Director of Health or Assistant Director of Health to execute a no-extension Amendment No. 1 to the Medi-Cal 2020 Demonstration Waiver Whole Person Care (WPC) Pilot Agreement A-13345 with the California Department of Health Care Services (DHCS), providing for additional matching non-federal funds, the source of which shall be funds from the Monterey County Health Department and not the County’s General Fund, in the amount up to $1,028,720 for each of CY 2017, CY 2018, CY 2019, and CY 2020, for a total non-federal match of up to $3,600,520,for a revised total agreement amount of $34,035,670, subject to approval of County Counsel and County Auditor-Controller; and
b. Authorize the Director of Health or Assistant Director of Health to sign up to two (2) future amendments to Agreement A-13345, where the amendments in the aggregate, do not exceed 10% of the original Agreement amount ($2,683,463) and which do not significantly change the scope of the pilot project.
SUMMARY/DISCUSSION:
The Whole Person Care pilot is a five-year pilot program (WPC Pilot) authorized under California’s Medi-Cal 2020 waiver to test locally-based initiatives that will coordinate physical health, behavioral health, and social services for vulnerable Medi-Cal beneficiaries who are high users of multiple systems and continue to have or are at risk of poor health outcomes. Monterey County (County) applied for $26.8 million in funding (half local and half federal) to be used over five years under this program and its application was approved in late 2016. Programs under this approved application are currently in the beginning stages of implementation.
After the approval of the initial application the State announced the availability of additional funding in the WPC Pilot. The additional funding is available to first time and returning applicants. Accordingly, the County applied for additional funds in the amount of $7,201,040 in March 2017. If the funding is approved, the County will be required to sign an amendment to the original funding agreement which needs to be signed within 10 calendar days from the date it is received. The amendment document is not yet available but due to short turnaround timeframe, advance approval is being requested. This action, if approved, will authorize the Director of Health or Assistant Director of Health to sign the agreement to receive the additional funding.
The Amendment will not change the effective dates of the original Agreement which will continue to be in effect through June 30, 2021. The WPC Pilot focus population continues to be the same as in the original application, however under the amendment is allows for more flexibility to serve more individuals. The individuals to be served include high utilizers of hospital emergency department and inpatient services who are exclusively homeless/chronically homeless Medi-Cal recipients or Medi-Cal eligible persons with no medical health home (including those released from jail) and having two or more of the following characteristics: diagnosed mental illness, two or more mental health unit admissions in the prior year, diagnosed Substance Use Disorder, two or more chronic health diagnoses, two or more emergency department visits within the prior 12 months, one or more hospital admissions within the prior 12 months, or two or more significant medications prescribed.
The WPC Pilot continues with the same features under the original application but adds the funding for programs such as:
• A new sobering center;
• Incentives for service integration for individuals leaving jail or Institutions of Mental Health Disease;
• A new respite center; and
• Targeted outreach to individuals in the neighborhoods occupied by highest concentrations of WPC Pilot enrollees
The original application included funding for programs such as:
• Complex care management solutions that will enable participating agencies to contribute to and access information relevant to the Pilot;
• Community-based, coordinated complex care and case management services that encompass medical and mental health screening, patient navigation, homeless social services benefit assessments and supports, housing supports, mobile outreach, establishment of primary care medical home, and transportation to necessary appointments;
• Staff to administer and deliver services; and
• All resources necessary to ensure Health Department (MCHD) can provide the reporting necessary to monitor the service delivery with a multi-disciplinary team and subsequent outcomes to ensure sustainability beyond the WPC Pilot term.
Both the original and new application allows for the opportunity to develop a plan for agency collaboration, a multi-disciplinary team approach, and solicit participation from fellow County departments and community service agencies that serve the same cross section of the community with a shared objective for the provision of supporting the “whole” person vs. the individual resulting issues.
MCHD will continue being the fiscal lead in this project. MCHD and partners has established a governance structure chaired by the Director of Health, and supported by data, financing, social, clinical, housing, and evaluation workgroups. Appropriate partners will participate in a data sharing agreement that is sufficient in scope for purposes of the WPC Pilot. The approval of this recommended action will enable service interoperability, information sharing, and most importantly enable the County to plan, develop, and implement a seamless service delivery system that will have symbiotic benefits. In addition, the County will be able to take longitudinal view of the service delivery system across multiple disciplines of which individually may be successful but may operate in silos.
The original WPC Pilot agreement specifies reporting of universal and variant metrics that shall be reported by the pilot on a timeline specified by the DHCS and projected performance on them. The Pilot agreement may include additional components and requirements as issued by the DHCS during the implementation process. Modifications to the WPC Pilot activities and deliverables may be made on an annual basis in furtherance of WPC Pilot objectives to incorporate learnings from the operation of the WPC Pilot as approved by the DHCS. MCHD will continue to provide annual updates to the Board of Supervisors and bi-annual updates to the Health and Human Services Committee (HHSC) of the Board of Supervisors. The last report was provided to the HHSC on implementation of the WPC Pilot in April 2017.
This report supports the Monterey County Health Department Strategic Plan Initiative: 3) Ensure access to culturally and linguistically appropriate, customer friendly, quality health services, and it supports one or more of the ten essential public health services: 4) Develop policies and plans that support individual and community health efforts; 7) Link people to needed personal health services and assure the provision of health care when otherwise unavailable; and 9) Mobilize community partnerships and action to identify and solve health problems.
OTHER AGENCY INVOLVEMENT:
The Department of Social Services, Probation, Sheriff’s Office, and Natividad Medical Center are County partners which were involved in the original application collaboration and development of the recommendation brought before the Board. Community partners that were integral in development of proposal and/or will participate in the WPC Pilot include the Central California Alliance for Health, Salinas Valley Memorial Healthcare System, Community Health Innovations, community and rural health centers, Coalition of Homeless Services Providers, Franciscan Workers, Interim, Inc., Community Homeless Solutions, Community Human Services, Gathering for Women, Mid-Pen Housing, City of Salinas, and Housing Authority of Monterey County. The County Auditor Controller and County Counsel have reviewed and approved original Agreement as to fiscal provision and legal form. County Risk Management did not approve agreement due to the non-standard risk provisions. The amended agreement will also be reviewed and approved by all the same County departments as the amendment document is available.
FINANCING:
As a condition of participation in the WPC Pilot program, MCHD agrees to provide county/state intergovernmental transfer of funds necessary to meet the non-federal share obligation for the WPC Pilot program. The total non-federal share for the new funding provided under this Amendment is up to $1,028,720 per year for a total up to $3,600,520 over a five period which will be matched by DHCS dollar-for-dollar annually on a bi-annual reporting schedule for a total of federal match up to $3,600,520 over the five years as authorized by California's 2020 Medi-Cal Waiver. The matching dollars required by Amendment 1 will be funded by the MCHD using departmental revenue. The original contract amount is $26,834,630. The amendment will add up to $7,201,040 for a revised total agreement amount of $34,035,670.
Interim payments will be made to the County upon approval of its mid-year and annual reports highlighting deliverables and metrics met in accordance with the WPC Agreement. The County will only be eligible for federal match for deliverables successfully accomplished during each reporting period. Any cost submitted which is found to be ineligible by the State will not be matched and be the sole responsibility of the County.
The services included in the County's new WPC pilot proposal as referenced in the Summary/Discussion section of this report, will enhance and expand existing services directly provided by and/or funded by Health Department.
The funding and sharing of services under the original application remain unchanged.
The Health Department will return to the Board for any further actions required regarding any changes to the Health Department's Adopted FY 2017-18 Budget appropriations and revenues as it is too early in the fiscal year to determine if any changes will be needed.
The County’s participation in the WPC Pilot is dependent on its ability to provide services (incur costs), meet deliverables, and have the required non-federal funding match as stipulated in the WPC Agreement. If the County is unable to meet the provisions in the WPC Agreement, or fails to meet a deliverable, DHCS is entitled to recoup its funding, however, before that occurs, DHCS will work with the County to modify Agreement scope and payment provisions as necessary to ensure continued participation of the County in the WPC Pilot.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Approval of this action supports the following Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
X Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
X Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Ezequiel Vega, Assistant Director of Health, x4622
Approved by: Elsa Jimenez, Monterey County Director of Health, x4526
Attachments:
Summary of Financial Changes to Whole Person Care Pilot Grant is on file with the Clerk of the Board
Original Whole Person Care Agreement is on file with the Clerk of the Board