Title
a. Authorize the Auditor-Controller to amend the FY 2016-17 Behavioral Health Department’s Budget 023-4000-HEA017-8473 to increase appropriations and revenues by $5,366,926 (4/5 vote required);
b. Approve and authorize the Auditor-Controller to amend the FY 2016-17 Behavioral Health Department’s Budget 023-4000-HEA017-8473 to reflect the changes in appropriations and revenues.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Authorize the Auditor-Controller to amend the FY 2016-17 Behavioral Health Department’s Budget 023-4000-HEA017-8473 to increase appropriations and revenues by $5,366,926 (4/5 vote required);
b. Approve and authorize the Auditor-Controller to amend the FY 2016-17 Behavioral Health Department’s Budget 023-4000-HEA017-8473 to reflect the changes in appropriations and revenues.
SUMMARY/DISCUSSION:
The County's Agreement with the California Department of Health Care Services (DHCS) for the Whole Person Care five-year pilot program (WPC Pilot) was approved by your Board on November 1, 2016. The WPC Pilot was 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 use of funds include 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; and 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.
The WPC Program Year 1, January 1 to December 21, 2016 Budget is $5,366,926 with two deliverables. Deliverable 1 is Approval of Application for 75% of total budget or $4,025,195 and Deliverable 2 is submittal of baseline data for 25% of annual amount or $1,341,732. With the execution of the County’s Agreement with DHCS, Deliverable 1 is considered complete. In fact, DHCS issued a request to participating counties for payment for Deliverable 1 the week of January 16, 2017. The Monterey County Health Department made an Intergovernmental Transfer (IGT) of funds to DHCS in the amount specified within seven (7) days of receiving DHCS's request. The payment from DHCS, 50% match provided plus 50% federal match, to the County is imminent. It is also anticipated additional local match in the amount of %670,866 will be paid to the State in April of 2017 and the County will receive double that amount back within a couple of weeks of making the payment. As such, the Health Department seeks approval to amend its FY 2016-17 Adopted Budget to change appropriations and revenues in the amount of $5,366,916 in order to accommodate those transactions.
In addition, the Health Department is in the process of drafting a Memorandum of Understanding with the County Departments providing portions of the non-federal match required in program year 2 (January to December 2017) and will execute necessary agreements with community service providers responsible for provision of services included in WPC Agreement. After the completion of this MOU, a separate action for addition of appropriations for the Department of Social Service and NMC will be brought to the Budget Committee and Board of Supervisors if appropriate.
The WPC Program 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 and Natividad Medical Center are County partners involved in the collaboration and development of the recommendation brought before the Board and implementation of WPC. The Offices of the Auditor-Controller and County Counsel have reviewed and approved recommendation as to fiscal provision and legal form. This report was presented at the February 22, 2017 Budget Committee Meeting.
FINANCING:
As a condition of participation in the WPC Pilot program, the County 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 for Program Year 1 which will be matched by DHCS dollar-for-dollar annually on a bi-annual reporting schedule for a total of federal match up to $2,683,463. These Program Year 1 dollars will be used to finance infrastructure needed for the implementation of the program.
Interim payments in similar amount to Program Year 1 will be made to the County in Program Years 2-5 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 in Program Years 2-5.
Program Year 1 deliverables are funded by Health Department as follows.
Health Department
The Program’s non-federal share of $2,683,463 is comprised of FY 2016-17 Mental Health Realignment. Match for Program 2-5 will be identified in the MOU with the Department of Social Services and NMC.
Prepared and Approved by: Elsa Jimenez, Director of Health, x4526