Title
a. Approve participation in the California Department of Health Care Services (DHCS) Medi-Cal 2020 Demonstration Waiver Whole Person Care Pilot Program (WPC Pilot), including providing matching non-federal funds in the amount up to $2,683,463 per year, for five years for a total non-federal match up to $13,417,315; and
b. Approve and authorize the Director of Health or Assistant Director of Health to sign the WPC Agreement with DHCS to participate in DHCS's Medi-Cal 2020 Demonstration Waiver Whole Person Care five year pilot program which aims to improve coordination of health, behavioral health, and social services to improve Medi-Cal beneficiary health and wellbeing through more efficient and effective use of resources effective from the date DHCS and County have executed the WPC Agreement through June 30, 2021 unless the application is renewed or the WPC Pilot program is extended, for an annual amount up to $5,366,926 and total WPC Agreement amount up to $26,834,630; and
c. Authorize the Director of Health or Assistant Director of Health to sign up to three (3) future amendments to the DHCS WPC Agreement 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 participation in the California Department of Health Care Services (DHCS) Medi-Cal 2020 Demonstration Waiver Whole Person Care Pilot Program (WPC Pilot), including providing matching non-federal funds in the amount up to $2,683,463 per year, for five years for a total non-federal match up to $13,417,315; and
b. Approve and authorize the Director of Health or Assistant Director of Health to sign the WPC Agreement with DHCS to participate in DHCS's Medi-Cal 2020 Demonstration Waiver Whole Person Care five year pilot program which aims to improve coordination of health, behavioral health, and social services to improve Medi-Cal beneficiary health and wellbeing through more efficient and effective use of resources effective from the date DHCS and County have executed the WPC Agreement through June 30, 2021 unless the application is renewed or the WPC Pilot program is extended, for an annual amount up to $5,366,926 and total WPC Agreement amount up to $26,834,630; and
c. Authorize the Director of Health or Assistant Director of Health to sign up to three (3) future amendments to the DHCS WPC Agreement 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’s WPC Pilot will be in effect from date of execution of Agreement through June 30, 2021. The initial WPC Pilot focus population is 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 three or more of the following characteristics: diagnosed mental illness, four or more mental health unit admissions in the prior year, diagnosed Substance Use Disorder, two or more chronic health diagnoses, three or more emergency department visits within the prior six months, two or more hospital admissions within the prior six months, or five or more significant medications prescribed.
The WPC Pilot features pay for health outcomes, pay for health outcome reporting, and incentive payments for achieving reductions in hospital and mental health unit readmissions, and scheduling prompt medical appointments for Pilot participants (up to 100 annually) who are recently discharged from hospital or released from jail.
Other approved uses of Monterey County WPC Pilot funds include:
a. Complex care management solutions that will enable participating agencies to contribute to and access information relevant to the Pilot;
b. 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;
c. Staff to administer and deliver services; and
d. All resources necessary to ensure Health Department (MCHD) is able to 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.
DHCS has provided MCHD 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 be the fiscal lead in this project. MCHD and partners will establish 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 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. The Health Department will provide annual updates to the Board of Supervisors and quarterly updates to the Health and Human Services Committee of the Board of Supervisors on implementation of the WPC Pilot starting 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 involved in the 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 Agreement as to fiscal provision and legal form. County Risk Management did not approve agreement due to the non-standard risk provisions; therefore the Health Department is recommending approval from the Board of Supervisors.
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 provided by the County is up to $2,683,463 per year for a total up to $13,417,315 over a five period as outlined below, which will be matched by DHCS dollar-for-dollar annually on a bi-annual reporting schedule for a total of federal match up to $13,417,315 over the five years as authorized by California's 2020 Medi-cal Waiver. 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 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, Natividad Medical Center, and Department of Social Services.
Health Department
The Health Department's annual non-federal share of $1,422,863 is comprised of FY 2016-17 Adopted Budget Health Realignment ($422,863), Mental Health Realignment ($500,000) and General Fund Contribution (GFC) ($500,000). This Agreement will be included in Health Department's FY 2017-18 through FY 2020-21 Requested Budgets using a combination of Health Realignment, Mental Health Realignment, and GFC to finance its non-federal share up to $7,114,315 over the five year pilot period based on availability of these funding sources. If it is determined during the annual budgeting process that an annual amount up to $1,422,863 is not available, the Department will bring this to the attention of DHCS and start negotiations for a reduced scope of match and non-federal matching dollars. Any resulting actions will be brought before the Board of Supervisors for consideration.
Department of Social Services
The Department of Social Service's annual non-federal share of $465,600 is comprised of FY 2016-17 Adopted Budget GFC. This amount will be include in Department of Social Services' FY 2017-18 through FY 2020-21 Requested Budgets using GFC to finance its non-federal share up to $2,328,000 over the five year pilot period. Sustainability is based on current GFC remaining the same in future years. An evaluation will take place in the event that the GFC changes and impacts the current contracts and requests. Any contemplated increase is first subject to augmentation approval.
Natividad Medical Center
Natividad Medical Center's annual non-federal share of $795,000 is comprised of FY 2016-17 Adopted Budget revenues. This amount will be included in Natividad Medical Center's FY 2017-18 through FY 2020-21 Requested Budgets revenues for a total non-federal share of $3,975,000 over the five year pilot period.
The Health Department will return to the Board for any further actions required regarding any changes to the Health Department's Adopted FY 2016-17 Budget appropriations and revenues as it is too early in the fiscal year to determine if any changes will be needed. The Health Department will enter into Memorandums of Understanding with the County Departments providing portions of the non-federal match required and will execute necessary agreements with community service providers responsible for provision of services included in WPC Agreement.
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.
Prepared and Approved by: Elsa Jimenez, Monterey County Director of Health, x4526
Attachment:
Whole Person Care Agreement is on file with the Clerk of the Board
Whole Person Care Application Attachment A is on file with the Clerk of the Board