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Ratify the County Administrator’s approval of a contract with Chiropractic Integrative Partners, Inc. for $752,000 to provide chiropractic services for the Solano County Family Health Services’ clinics for the period February 1, 2025 through June 30, 2026; Delegate authority to the County Administrator to execute any amendments, with County Counsel concurrence, up to $74,999; and Approve an Appropriation Transfer Request for $208,000 from salaries and benefits to contracted services (4/5 vote required)
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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 of Supervisors ratify the County Administrator’s approval of a contract with Chiropractic Integrative Partners, Inc. for $752,000 to provide chiropractic services for the Solano County Family Health Services’ clinics for the period February 1, 2025 through June 30, 2026; delegate authority to the County Administrator to execute any amendments, with County Counsel concurrence, up to $74,999; and approve an Appropriation Transfer Request (ATR) for $208,000 from salaries and benefits to contracted services (4/5 vote required).
SUMMARY:
The Department of Health and Social Services seeks to enhance medical services in the Family Health Services’ clinics by introducing chiropractic care. Chiropractic Integrative Partners, Inc. provides rapid deployment of healthcare professionals and the operational structure to implement new clinic services. The service will fill care gaps where permanent staff is not currently available or trained in these modalities.
The addition of chiropractic care will activate a reassessment of the clinic Medi-Cal reimbursement rates by the California Department of Health Care Services (DHCS) that may increase clinic revenue. The service will qualify as a rate-triggering event, allowing the clinics to apply for higher Medi-Cal reimbursement rates. The clinics have not had their Medi-Cal reimbursement rates reassessed since their respective inceptions, with the current reimbursement rates falling well below the threshold of current healthcare costs.
FINANCIAL IMPACT:
The department has sufficient appropriations within its operating budget to cover the contract cost; however, an ATR is needed to adjust appropriations. The costs associated with preparing this agenda item are nominal and are absorbed by the department’s FY2024/25 Working Budget.
DISCUSSION:
The addition of chiropractic services will help address pain management needs for clinic clients and help FHS providers address symptoms related to the musculoskeletal system. These chiropractic services will complement the osteopathic services that Touro University of California clinic providers currently provide.
Federally Qualified Health Centers (FQHC), including the County’s FQHC clinics under Family Health Services, may be eligible for a Prospective Payment System rate adjustment if they experience a qualifying change in their scope of service. Adding chiropractic services to the clinic’s scope is anticipated to be an appropriate rate-changing event.
The Community Healthcare Board (CHB) includes community agency representatives and clinic patients and oversees the clinics’ operations. It partners with the County, which oversees fiscal and personnel matters for its clinics. The CHB must approve the new scope of work for both DHCS and the Health Resources Services Administration (HRSA) to approve the application for change in scope and application for rate change consideration. The CHB approved the scope change on December 20, 2024.
The application to request a rate change must be filed within 150 days of the end of the fiscal period during which the change occurred and must meet the thresholds set out in the State Plan Amendment. FQHCs continue to bill at their existing rate until the adjustment is approved. If approved, the new rates are applied retroactively to the beginning of the fiscal year, following the rate-setting triggering event. FHS aims to implement chiropractic services immediately and have the new rates apply retroactively to FY2025/26.
Chiropractic Integrative Partners, Inc. is well-equipped and experienced in working with FQHCs to place services in FQHCs designed to trigger rate changes. In addition, this vendor will assist with the rapid deployment of services to support the new scope, such as telehealth, marketing, electronic health record documentation, credentialing, integration into the clinic setting, and high-performance standards that meet or exceed practice benchmarks.
ALTERNATIVES:
The Board can choose not to ratify this contract with Chiropractic Integrative Partners, Inc. to provide placement for chiropractic services and the ATR. This is not recommended as these services address unmet clinical care needs for clients and enable the department to pursue better encounter rates for clinic services, thereby increasing clinic revenue.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract as to form.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION