Title
a. Approve and authorize the Director of Health or Assistant Director of Health to execute a Central California Alliance For Health Allied Health Care Management Services Agreement with the Santa Cruz-Monterey-Merced Managed Medical Care Commission, dba Central California Alliance for Health (CCAH), for participation in CCAH’s network of contracting providers by providing Enhanced Care Management Services to CCAH members, for a term commencing on the first of the month following the date that CCAH completes credentialing of Provider and expiring on December 31 of the same year of the Commencement Date, subject to one-year automatic renewals, in substantially the same form as that which has been presented to the Board without significant change to its content; and
b. Approve and authorize the Director of Health or Assistant Director of Health to sign up to three (3) future amendments to this Agreement where the amendments do not significantly change the terms of the Agreement.
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 Central California Alliance For Health Allied Health Care Management Services Agreement with the Santa Cruz-Monterey-Merced Managed Medical Care Commission, dba Central California Alliance for Health (CCAH), for participation in CCAH’s network of contracting providers by providing Enhanced Care Management Services to CCAH members, for a term commencing on the first of the month following the date that CCAH completes credentialing of Provider and expiring on December 31 of the same year of the Commencement Date, subject to one-year automatic renewals, in substantially the same form as that which has been presented to the Board without significant change to its content; and
b. Approve and authorize the Director of Health or Assistant Director of Health to sign up to three (3) future amendments to this Agreement where the amendments do not significantly change the terms of the Agreement.
SUMMARY:
Monterey County Health Department (MCHD) has provided wrap-around case management services for high utilizers of the Medi-Cal services for almost six years as part of California’s Department of Health Care Services (DHCS) Whole Person Care (WPC) Pilot Program as part of the DHCS Medi-Cal 2020 Section 1115 Demonstration. DHCS is transitioning the components developed as part of the pilot program into the new CalAIM program. One of the components, the case management services, will transition to Enhanced Case Management (ECM) services managed by Medi-Cal Managed Care plans through subcontracts with providers. In Monterey County, the Medi-Cal Managed Care plan, Central California Alliance for Health (CCAH), is offering this Memorandum of Understanding (MOU) to MCHD to provide ECM services to referred CCAH clients. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care plan members through systematic coordination of services.
The term of this Agreement shall commence on the first of the month following the date that the
Plan completes credentialing of Provider and shall expire on December 31 of the same year of the Commencement Date. The Plan will provide written notification to Provider of the Commencement Date of this Agreement. Thereafter, the term of this Agreement shall be automatically extended for a one (1) year term on each succeeding January 1 (the “Renewal Date”), unless terminated by either party as provided herein.
Plan will pay MCHD for ECM Services provided to ECM Provider’s ECM Assigned Members for the months in which Plan provides authorization for such Members to receive ECM Services (excluding outreach) by their assigned ECM Provider by the fifteen (15th) day of the following month. Capitation Payments by Member Category and MCHD where the ECM Provider is located are as follows in the table below:
|
Member Category |
Monterey County capitation rate $/PEPM |
|
New ECM Member |
$419.67 |
|
Member Transitioning from WPC |
$370.38 |
DISCUSSION:
In accordance with the terms and conditions set forth within the Central California Alliance For Health Allied Health Care Enhanced Care Management Services Agreement, the ECM Provider Manual, the CCAH’s QI and UM Programs, the applicable Program Requirements, applicable Accreditation Organization standards and the Law. MCHD shall ensure that ECM Services provided under the Central California Alliance For Health Allied Health Care Enhanced Care Management Services Agreement are readily available, accessible, appropriate, and provided in a prompt and efficient manner. Health shall also comply with the specific requirements set forth in the ECM Services Schedule.
MCHD seeks to become an Enhanced Care Management provider to serve Medi-Cal members currently enrolled in CCAH throughout the duration of the CalAIM program. ECM is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of high-need and/or high-cost members through systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered. ECM is a Medi-Cal benefit.
MCHD will provide ECM Services to CCAH members authorized by Plan and provided by Health in accordance with its license upon referral from a Primary Care Physician or as otherwise permitted by and in accordance with the Plans UM Program.
This work supports the Monterey County Health Department Strategic Plan Initiative: 3. Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports five of the ten essential public health services, specifically: 9. Inform, educate, and empower people about health issues; 4. Mobilize community partnerships and action to identify and solve health problems; 5. Develop policies and plans that support individual and community health efforts; 6. Enforce laws and regulations that protect health and ensure safety; and 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT:
The office of the County Counsel has reviewed and approved this MOU as to form.
FINANCING:
No financial terms to this MOU.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related 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.
☒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.
☐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: Patricia Alcocer, Management Analyst II, 755-4583
Approved by:
______________________________Date:_____________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachment:
Agreement