HomeMy WebLinkAboutMINUTES - 01141997 - D1 TA: BOARD OF SUPERVISORS
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FROM: William B. Walker, M.D., Health Services Director 1 Contra
Costa
DATE: January 14, 1997 �a -.e County
SUBJECT: Fee-For-Service/Medi-Cal Specialty Mental Health Services Transfer to the County
SPECIRC REQUESTIS)OR RECOMMENDATION(S) &BACKGROUND AND JUSTIRCATION
RECOMMENDATION:
1. Adopt Board Resolution No. 97/ 17 An agreement with the State to assume responsibility for Fee-for Service
Medi-Cal specialty mental health services as of July 1, 1997.
2. Authorize the Health Services Director, William B. Walker, M.D., or his designee (Donna M. Wigand, L.C.S.W.,
Mental Health Director)to negotiate and execute contracts for Fee-for-Service Medi-Cal specialty mental health services
with various providers for the period July 1, 1997 through June 30, 1998.
FISCAL IMPACT:
The State preliminary planning estimated Fee-for-Service Medi-Cal (FSS/MC) allocation for Medi-Cal specialty mental
health services for the period July 1, 1997 to June 30, 1998 is $531,315. This represents the projected cost of FFS/MC
specialty mental health services based on historical State General Fund costs. Under terms of the agreement with the
State, as delineated in Board Resolution No. 97/17 , $531,315 constitutes full payment for FFS specialty mental health
services for the period July 1, 1997 through June 30, 1998.
BACKGROUND:
1. Chapter 633, Statutes of 1994 (AB 757) authorized the transfer of state funding for FFS/MC specialty mental health
services from the Department of Health Services (DHS) to the Department of Mental Health (DMH). (Specialty mental
health services are those mental health services provided by a mental health provider, i.e., not a physical health provider.)
Effective January 1, 1995, the responsibility and funding for psychiatric inpatient hospital services (Phase 1) were
transferred to participating counties. On July 1, 1997, DMH will transfer the funds and the responsibility for
authorization and funding of FFS/MC non-hospital specialty mental health services (Phase 11) to counties. This Board
Order represents Contra Costa County's preliminary letter of intent to participate as the Mental Health Plan in Phase 11
of the consolidation of Medi-Cal mental health services.
2. The preliminary planning estimate of the amount of state funds available for Contra Costa County for the fiscal year
1997-98 for FFS/MC psychiatric inpatient hospital and specialty mental health services is $1,843,681 (of which
$1,312,367 are for psychiatric inpatient hospital services and $531,315 are for non-hospital specialty mental health
services). These funds are not limited in use for inpatient or specialty services specifically, as long as they are expend-ed
on mental health services. The preliminary planning estimate methodology is consistent with that used for the
consolidation of psychiatric inpatient hospital services.
CONSEQUENCES OF NEGATIVE ACTION
If the County does not assume responsibility for FFS/MC specialty mental health services, the State will contract with
another entity to do so. Under provisions of AB 757, this entity would then assume responsibility for all Mental Health
Medi-Cal services. This would result in a loss of$21 million in federal financial participation, matching realignment and
other State/General funds which represent 47% of Contra Costa County's mental health budget.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE(S):
ACTION OF BOARD ON January 14, 1997 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT ---- ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact Person: Donna M. T,-Jig
and (313-6411)
CC: Health Services Director ATTESTED January 14, 1997
r4ental Health Director PHIL BATCHELOR, CLERK OF THE BOARD.OF
County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR
7-
BY(
Christine Wampler, Deputy C erk
To: BOARD OF SUPERVISORS ,�/
. II -- �✓ :�• Contra
FROM: William B. Walker, M.D., Health Services Director °'• .��' Costa
DATE: January 14, 1997 r----K ' County/
SUBJECT: Fee-For-Service/Medi-Cal Specialty Mental Health Services Transfer to the County
SPECIRC REQUESTIS)OR RECOMMENDATIONIS) &BACKGROUND AND JUSTIFICATION
RESOLUTION NO. 97/17
The Contra Costa County Board of Supervisors:
1. Agrees as of July 1, 1997 to assume responsibility for Medi-Cal authorization and payment of the
state/local Medi-Cal match for all medically necessary specialty mental health services for Medi-Cal
beneficiaries from Contra Costa County.
1 .1 Agrees to the proposed financial risk sharing of increases to the obligations of the Mental
Health Plan when the new requirements are specifically tied to increases in statute or
regulation or the interpretation of statute or regulation. In choosing to share risk with the
State, County is required to leave mental health funds in mental health services to be eligible
for an increase to State/General Fund allocation due to changes in federal or state
requirements. (DMH intends to propose legislation to obtain the authority to implement this
proposal.)
2. Assures that access for covered specialty mental health services will continue to be at least as good
as it was prior to the.transfer of responsibility to the Mental Health Plan.
3. Acknowledges that the preliminary planning estimated allocation of state funds, $531 ,315, is for the
period July 1, 1997 to June 30, 1998.
4. Assures that the County has a public planning process which involves consumers, family members,
other stakeholders, and the local mental health commission.
5. Agrees to submit an Implementation Plan that meets Department of Mental Health requirements. The
local mental health commission will be required to review,the Implementation Plan.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE(S):
ACTION OF BOARD ON January 14, 1997 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT --- ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact Person:Donna M. THigand. (313-6411)
cc: Health Services Director ATTESTED J r14. 1997
Mental Health Director PH AT OR, CLERK OF THE RD OF
County Administrator P I S AND COUNTY MI TR R
BY
-stine Wampler, Deputy Clerk
Contra Costa Count
The Board of Supervisors HEALTH SERVICES DEPARTMENY , 0 F1CiE OF THE DIRECTOR
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Jim.Rogers,1st District sE-•L William B.Walker, M.D.
Jeff Smith,2nd District . ��, °� Director&health Officer
-Gayle Bishop,3rd District
Mark DeSaulnier,4th Districts ':' 20 Allen Street
Tom Torlakson,5th District Martinez,California 94553-3191
CountyAdministrator �� a:;,� (510)370-5003
�, y� FAX(510)370-5099
Phil Batchelor °°s_----------
_ _ `
County Administrator a couriT'
DATE: January 7, 1997
TO: Board of Supervisors (
FROM: William B. Walker,M.D., Health Services Director
VIA: --y Donna M. Wigand, LCSW, Mental Health Direct`e�%
SUBJECT: Mental Health Managed Care Consolidation, Phase II
On January 14, 1997 I will be conducting a presentation before the Board of Supervisors
,regarding Phase H of Mental Health Managed Care implementation in Contra Costa County.
In an effort to keep the presentation as brief as possible, yet fully inform you about this complex
subject, I am providing the following preliminary information for your review.
As you may be aware, the State Department of Mental Health is in the process of transferring
the management of.the mental health care of Medi-Cal beneficiaries from the State to the '
counties. Phase I included all private inpatient psychiatric hospital care, and was approved by
the Contra Costa County Board,of Supervisors in December 1994. The State is now preparing
to transfer the remaining Medi-Cal funded non-hospital mental health services that are currently
being delivered in the private sector to the County Mental Health systems. This is called Phase
II of Medi-Cal Consolidation. All counties are required to notify the State by February 1, 1997
as to their participation in Phase II of Consolidation. There is both some benefit and some risk
to.the county involved in this decision. The enclosed briefing paper will provide you-with a
baseline of information to prepare you for the discussion regarding Consolidation, Phase IL
I look forward to_meeting with you'personally in the near future to further discuss the mental
health needs of Contra Costa County residents.
WW/DMW:slt
Enclosure
dmwdisk2:mcare.bos
Merrithew Memorial Hospital&Health Centers • Public Health Mental.Health substance Abuse Environmental Health
Contra costa Health Plan Emergency Medical Services Home Health Agency Geriatrics
A-345 (1/96)
Medi-Cal Mental Health Managed Care Consolidation, Phase H
Background
There-has been a statewide effort for several years to evaluate the mental health needs of, and
treatment of, Medi-Cal beneficiaries in California. The first conclusion from this effort was that
Medi-Cal beneficiaries were receiving very expensive inpatient mental health care in private
psychiatric hospitals, but there was little evidence of coordinated care planning regarding
admissions and post-discharge services. The result of this lack of'coordinated planning was a
staggering increase in the annual cost of inpatient care with no indication that a single point of
responsibility existed to look at the full needs of care of these consumers. The solution decided
upon, with significant input from the California Mental Health Directors Association, became
known as Medi-Cal Managed Care Phase I. The decision was made to place the responsibility
for managing the inpatient care of Medi-Cal beneficiaries with the counties - who for years have
been providing competent, effective, and cost efficient services to,this client population. The
State shifted the inpatient dollars from the State General Funds to the counties and gave counties
authority to use the funds for continued hospitalizations or to `use the funds to develop local
alternatives to hospitalizations. This shift of funds was extremely, successful in reducing the
costs of inpatient care, and in facilitating the development of expanded outpatient alternatives
to inpatient care.
This entire process of shifting responsibility for inpatient care to counties for Medi-Cal
beneficiaries previously treated in private psychiatric hospitals is known as Medi-Cal Managed
Care Phase I.
What is Phase II?
Medi-Cal Managed Care Phase II will complete the process of moving the responsibility for
managing the mental health care of Medi-Cal beneficiaries from the State to the counties. In
Phase II counties will become responsible for all specialty mental health care'needed by these
beneficiaries. Though the dollar amount to be transferred in this phase of Managed Care is
small compared to the inpatient.phase{locally we receive approximately $1.3 million to manage
inpatient care, but will only receive about $531,000 for outpatient/Phase II), the volume of
services is much higher, as many more clients receive outpatient care than receive inpatient care.
The State recognizes that there is continuing pressure to move.to a.Managed Care model of
provision of services for Medi-Cal beneficiaries and, more importantly, the State recognizes that
County Mental Health systems have the skill and range of services (i.e., continuum of care) to
best meet the needs of this unique population. Though'the State could contract with a large
number of private managed care firms (many of whom are actively trying to market themselves
to the State as being able to provide services "quicker, cheaper, better"), experience in other
states has shown that these companies are often not equipped to meet the wide variety of
treatment needs presented by this diverse population. Thus, at this point the State is committed
to working with the counties to meet the mental health needs of Medi-Cal beneficiaries.-
Why would our county accept the responsibility in Phase H? County Mental-Health systems
are already providing, almost all of the mental health services to this population through the
Short-Doyle/Medi-Cal system. The inclusion of the small portion of outpatient services that
currently are delivered in the Fee-for-Service. (private) Medi-Cal sector seems a logical
progression of the County's role in the mental health care of Medi-Cal beneficiaries.
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Additionally, the State has structured Phase I and Phase II of Medi-Cal Managed Care as an all
or nothing" offering. The essence of this is.that a county that desires to participate in Managed
Care must accept the responsibility for both Phase I and Phase II. Contra Costa County.should
participate in.both Phase I and Phase II as this will provide us with the valuable opportunity to
manage the mental health care and the cost of care for all Medi-Cal beneficiaries in the county.
Should Contra Costa County decide not to participate in either Phase I or Phase II, the monies
currently available to Contra Costa County to expand our System of Care would be withdrawn.
Additionally, we would be ineligible to bill for any services to Medi-Cal beneficiaries via the
Short-Doyle/Medi-Cal program as the authority for this billing would be transferred to whatever
private managed care company that the State would then be forced to contract with. for the
provision and management of services. Our only funding source would be via realignment
funds, and without the ability to draw down matching funds through Medi-Cal billing, our
mental health system would likely collapse under the burden of treating only the uninsured or
the occasional client with private insurance who chooses to seek care in the public sector.
Meanwhile, Medi-Cal beneficiaries who had previously been very competently treated in our
system would be forced to receive treatment from the private Managed Care company. It is
likely that many clients would experience a decompensation in functioning as a result of the
stress of dealing with a new provider and clinician.
How will Phase H affect the care of beneficiaries and the risk for counties?
Phase II should enhance the care for those beneficiaries who are.currently being "under treated"
in-the Fee-for-Service Medi-Cal program. These individuals are typically in need of a more
extensive system of care (e.g., access to services which include individual and family therapy,.
case management, psychiatric evaluation for medicines, group therapy, etc.) Phase II will also
result in some clients who are currently receiving services in the Fee-for-Service sector losing
their access to services via their Medi-Cal,benefits. Typically these are.individuals who have
been seeing a therapist long past the time in which serviceswere actually required to address
the presenting problem (Medical Necessity). Often these individuals are remaining in treatment
to address problems not related to a mental disorder but rather problems with daily living (e.g.,
the individual may have started treatment for depression but is now free of severe depression
and is staying in treatment to work on issues such as parent-child problems with discipline).
Though there will be some individuals who will be denied service in Phase II, we anticipate that
a greater number of individuals will be served in Phase II of Managed Care than are currently
being served in the.Fee-for-Service Medi-Cal program. However, we also expect that only a
relatively small number of those newly served individuals.will remain in treatment beyond a few
months.
The obvious benefit to the County and the.taxpayer is better use of scarce resources to treat
those individuals with genuine needs while minimizing over utilization of services by individuals
who are and have been "over served", or by individuals who could be more appropriately treated
in some other sector than mental health.
There is some risk to the.County in Phase II of Medi-Cal Managed Care. One element of risk
is what is referred to as "pent-up demand." It is well known that there are citizens who desire
mental health care, but have been unable to find a Fee-for-Service provider who would accept
them for treatment. Historically, these people would not now receive services in the County
Mental Health Division, as their presenting problem was not of sufficient intensity.to qualify for
services in the Short-Doyle/Medi-Cal system (e.g., though these individuals may have real
needs, they do not have a diagnosable mental disorder), Under Phase II,. the County would be
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required to provide services to all individuals.who present themselves for treatment if these
individuals meet the statewide criteria for services. The risk factor is then the determination of
the criteria.for treatment (known as Medical Necessity) versus referral elsewhere.
.There is an intensive planning process occurring during this fiscal year to determine exactly what
the Medical.Necessity criteria will be. The current version of that criteria appears to strike a
good balance between requiring service for individuals with treatable disorders while permitting
the exclusion of individuals who can be treated elsewhere or would not be likely to respond to
any form of treatment. It is anticipated that the current criteria will change very little between
now, and Phase 11 implementation in July 1997. The California Mental Health Directors
Association will continue to be involved in the final determination of Medical Necessity.
It will not be an option to simply deny service due to lack of capacity. By accepting the
responsibility for Phase I and II the County agrees to meet the mental health service needs of
all.eligible beneficiaries (all who have Medi-Cal in Contra Costa County and meet the criteria
of Medical Necessity).
Summary
The pilot counties that have already implemented both Phase I and II' have not seen or
experienced any significant increase in demand for services. Therefore, the fear that there was
a "pent-up demand" has not materialized. Since we are probably already seeing the majority
of Medi-Cal clients,the calculated risk in Phase II is not significant. New funds to be received
should cover the cost for additional outpatient services to be provided. ,
Therefore, it is the recommendation of the Contra Costa County Health Services Director and
Mental Health Director to accept the responsibility for Medi-Cal Managed Care for:Mental
Health and agree.to fully participate in Phase I and Phase II.
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