Title
a. Approve and authorize the Director of Health Services or designee to execute a non-standard Memorandum of Understanding (MOU) with Kaiser Foundation Health Plan, Inc. (KFHP) to coordinate care, conduct administrative activities, and engage in information exchange activities required for the effective and seamless delivery of California Children’s Services (CCS) services to CCS eligible individuals, effective January 1, 2027 through December 31, 2031, with no exchange of funds;
b. Approve non-standard liability provisions as recommended by the Director of Health Services; and
c. Approve and authorize the Director of Health Services or designee to sign up to three future amendments to the MOU, provided that these amendments do not substantially change the Scope of Services, do not add funds to the MOU, and are approved by the Office of the County Counsel.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and authorize the Director of Health Services or designee to execute a non-standard Memorandum of Understanding (MOU) with Kaiser Foundation Health Plan, Inc. (KFHP) to coordinate care, conduct administrative activities, and engage in information exchange activities required for the effective and seamless delivery of California Children’s Services (CCS) services to CCS eligible individuals, effective January 1, 2027 through December 31, 2031, with no exchange of funds;
b. Approve non-standard liability provisions as recommended by the Director of Health Services; and
c. Approve and authorize the Director of Health Services or designee to sign up to three future amendments to the MOU, provided that these amendments do not substantially change the Scope of Services, do not add funds to the MOU, and are approved by the Office of the County Counsel.
SUMMARY:
CCS in Monterey County provides diagnostic and treatment services, medical case management, and rehabilitative medicine services to individuals under 21 years with CCS-eligible medical conditions. As a CCS Whole Child Model County, Medi-Cal managed care plans are required to provide medical case management to their members that are enrolled in CCS while county CCS programs are required to provide medical case management to CCS participants that are not Medi-Cal managed care plan members. All CCS participants that are eligible for rehabilitative services are offered physical and occupational therapy at one of Public Health’s CCS Medical Therapy Units. KFHP will operate as a Medi-Cal managed care plan in Monterey County beginning January 1, 2027. This MOU delineates the roles and responsibilities of both KFHP and County of Monterey for coordinated delivery of CCS services to CCS eligible individuals and their families.
DISCUSSION:
CCS in Monterey County provides diagnostic and treatment services, medical case management, and physical and occupational therapy services to individuals under 21 years with CCS-eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae.
CCS is administered as a partnership between the County of Monterey Health Department, local Medi-Cal managed care plans, and the California Department of Health Care Services (DHCS). Health Department Public Health CCS program staff receive referrals from local health plans and medical providers. Public Health then determines an individual’s eligibility for CCS based on medical, financial and residential criteria. As a CCS Whole Child Model County, Medi-Cal managed care plans are required to provide medical case management to CCS participants that are plan members, while Public Health CCS program staff are required to provide medical case management to CCS participants that are not Medi-Cal managed care plan members. All CCS participants that are eligible for rehabilitative medicine services are offered physical and occupational therapy at one of Public Health’s CCS Medical Therapy Units. Services are supported by a combination of federal, state, and local funding.
The California Department of Health Care Services requires that State licensed Medi-Cal managed care plans enter into an MOU with County CCS programs. Kaiser Foundation Health Plan, Inc will operate as a licensed Med-Cal managed care plan beginning January 1, 2027. This MOU delineates the roles and responsibilities of both KFHP and County CCS program for coordinated delivery of CCS services to CCS eligible individuals and their families.
This MOU supports the County of Monterey Health Department 2025-2028 Strategic Plan Goals: 2) Provide exceptional person-centered care through accessible, community-focused health services. It also supports two of the ten essential public health services, specifically: 4) Mobilize community partnerships and action to identify and solve health problems; and 7) Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT/COMMITTEE ACTIONS:
The Offices of County Counsel and Auditor-Controller has reviewed and approved this MOU as to legal form and fiscal provisions, respectively.
FINANCING:
There is no exchange of funds between the County of Monterey and Kaiser Foundation Health Plan, Inc.
BOARD OF SUPERVISORS STRATEGIC PLAN GOALS:
This Memorandum of Understanding aligns with the Strategic Goal of Well-Being and Quality of Life by promoting and coordinating access to CCS services for KFHP Medi-Cal Managed Care Plan members.
Mark a check next to the related Board of Supervisors Strategic Plan Goals:
_X_ Well-Being and Quality of Life
____ Sustainable Infrastructure for the Present and Future
____ Safe and Resilient Communities
____ Diverse and Thriving Economy
____ Dynamic Organization and Employer of Choice
Prepared by: Patricia Velarde, Management Analyst II, 796-1377
Approved by: Elsa Mendoza Jimenez, Director of Health Services, 755-4526
Attachments:
Board Report
Memorandum of Understanding