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Approve an intergovernmental agreement with the California Department of Health Care Services (DHCS) to provide covered Drug Medi-Cal Organized Delivery System (DMC-ODS) services for substance use disorder treatment for Solano County beneficiaries for the period July 1, 2023 through June 30, 2027; Approve a second amendment to the master agreement with Partnership HealthPlan of California (PHC) to oversee the delivery of services under the DMC-ODS regional model; and Delegate authority to the County Administrator to sign the agreements
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Published Notice Required? Yes ___ No _X _
Public Hearing Required? Yes ___ No _X _
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services recommends that the Board approve an intergovernmental agreement with the California Department of Health Care Services (DHCS) to provide covered Drug Medi-Cal Organized Delivery System (DMC-ODS) services for substance use disorder treatment for Solano County beneficiaries for the period July 1, 2023 through June 30, 2027; approve a second amendment to the master agreement with Partnership HealthPlan of California (PHC) to oversee the delivery of services under the DMC-ODS regional model; and delegate authority to the County Administrator to sign the agreements.
SUMMARY:
Beginning July 1, 2020, Solano County entered into a contract with DHCS to participate in the Organized Delivery System (ODS), and simultaneously, for the implementation of the ODS, and entered into a master agreement with Partnership HealthPlan of California (PHC) in which Solano County delegated and oversaw the implementation of related federal and state requirements. PHC developed this approach to include Solano County and six other counties as a strategy to promote county participation in the Drug-Medi-Cal Organized Delivery System (DMC-ODS), as the provision of substance use treatment is known to positively impact other high-cost healthcare services and outcomes. While most individuals receiving public behavioral health services are Medi-Cal eligible, Solano County had historically served a relatively small number of “safety net” clients with substance use disorders (SUDs) who are uninsured and not Medi-Cal eligible. To eliminate the need for Solano County to create a duplicate drug Medi-Cal system for this smaller population, PHC included these clients in their regional approach. Previously, SUD services were mainly funded by the federal Substance Use Block Grant.
As a county subcontractor, PHC has fulfilled the contracted obligations associated with implementation, and Solano County collaborated and provided oversight to ensure compliance. The recommended contract amendment will allow the continuation for PHC to contract with providers to reimburse for services directly, strengthen the fiscal and administrative health of the contracted community-based agencies, give Solano County access to the SUD network of providers across seven counties, and improve the quality of care and client outcomes.
FINANCIAL IMPACT:
Federal, state, and local funding provides reimbursement for services delivered in the ODS. Counties pay PHC an interim Per Utilizer Per Month (PUPM) and the federal and state reimbursement comes to the county from DHCS. PHC, Solano County, and DHCS are to participate in a yearly cost reconciliation process; however, DHCS and PHC will need to finalize the data for the yearly reconciliations with the regional counties, so reconciliations have not occurred. Without the reconciliations finalized, Solano County’s fiscal risk continues to be unknown.
DISCUSSION:
On May 12, 2020, the Board authorized participation in the California Department of Health Care Services’ (DHCS) Organized Delivery System pilot for substance use treatment services under Medi-Cal and the execution of an agreement with Partnership HealthPlan of California (PHC) to oversee the delivery of services under the Organized Delivery System (ODS). PHC developed this approach to include Solano County and six other PHC counties as a strategy to promote county participation in the ODS, as the provision of substance use treatment is known to positively impact other high-cost healthcare services and outcomes.
While most individuals receiving public behavioral health services are Medi-Cal eligible, Solano County has historically served a relatively small number of “safety net” clients with substance use disorders (SUDs) who are uninsured and not Medi-Cal eligible. To eliminate the need for Solano County to create a duplicative system for this smaller population, PHP included these clients in their regional approach. Previously, SUD services were mainly funded by the federal Substance Use Block Grant.
Solano County, in partnership with PHC, successfully implemented the DMC-ODS regional model pilot program that began on July 1, 2020. The current agreement goes through June 30, 2023. Specifically, there have been more than 2,100 beneficiaries in Solano County served, with a total of 201,289 visits. In addition, 12 providers have been added to the network since its inception. As of Spring 2023, the following state-required measurement results include:
• Seven-day follow-up after emergency room admission and follow-up after 30-day admission measured 12.38% of beneficiaries in the seven-county regional model who had an emergency room visit successfully connected for a follow-up visit within 7 days, versus non-regional model counties at a rate of 4.95%. In addition, 20.38% of beneficiaries from the regional model who had an emergency room visit had a follow-up visit within 30 days, versus non-regional model counties at a rate of 10.10%. Both measures reflect success at twice the average of non-regional model counties.
• Penetration rate for the regional model in calendar year 2021 was 1.57%. The state average is 0.85%; during the pilot, the penetration rate has doubled the state penetration rate average.
• Program consistently receives high score ratings for the treatment perceptions survey. Year over year, the Treatment Perception Survey, given to clients receiving treatment, reports more than 90% satisfaction in treatment programing.
• Impact in the community and on people who initiated substance use disorder treatment is noteworthy. In addition to the above-mentioned outcomes since inception, timely access to treatment has been a significant outcome for beneficiaries in the Solano County community.
Due to the regional model, individuals seeking residential treatment can be placed anywhere in the seven counties, significantly increasing the opportunity for treatment availability when the beneficiary is ready. This is a notable change in years prior to 2020, when it was common for beneficiaries to have a lengthy wait time for a placement location to open within Solano County. With PHC administering the program, beneficiaries have been able to access incentive funds, benefit from the increased workforce development among regional-model providers, and better access to integrated healthcare options overall.
The first amendment to the intergovernmental agreement with PHC was effective July 1, 2021 and incorporated assistance with administrative and compliance requirements associated with federal Substance Abuse Block Grant (SABG) allocations that support prevention and treatment and recovery support services.
ALTERNATIVES:
The Board could decide not to continue participation in the ODS and the subsequent contract with Partnership HealthPlan. However, this is not recommended because participation has improved the service array and reimbursement available for substance use disorder treatment. All neighboring counties have implemented the ODS and to not continue participating would put Solano County at a competitive disadvantage with higher rates of payment in the region.
OTHER AGENCY INVOLVEMENT:
Solano County worked in close collaboration with Partnership HealthPlan and DHCS. County Counsel has reviewed the associated agreements.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION