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MEMORANDUM
TO: BOARD OF SUPERVISORS
FROM: Todd Metcalf, B.S.
Behavioral Health Services Administrator
DATE: May 14, 2019
SUBJECT: Consideration of Amendment Three to the Agreement between the County of Lake and Native American Mental Health Services dba North American Mental Health Services (NAMHS) for Fiscal Year 2018-19 in the amount of $745,840 for a new contract total of $1,045,840 and authorize the Chair to sign
EXECUTIVE SUMMARY: North American Mental Health Services (NAMHS) will provide psychiatric evaluations and medication management for Lake County Behavioral Health Services (LCBHS) clients. As LCBHS does not have a psychiatrist on staff at this time, telepsychiatry services are a necessary component in providing overall mental health care for Lake County Medi-Cal beneficiaries.
BACKGROUND AND DISCUSSION: Department of Health Care Services (DHCS) is required to analyze and certify a county mental health plan (MHP) provider network to ensure that the MHP is in compliance with capacity and adequacy requirements. Federal law requires that a MHP comply with the network data submission requirements as a condition for receiving payment under Medi-Cal. If DHCS determines that Lake MHP is out of compliance with the reporting requirements, Lake MHP will be subject to fines, sanctions, and penalties in accordance with state law.
Lake MHP is now required to submit an extensive report entitled Network Adequacy Certification Tool (NACT) to DHCS on a quarterly basis (July 1st, Oct 1st, January 1st, and April 1st) so that the MHP can be certified as having an appropriate network.
Lake MHP submitted the NACT on 3/30/18, and received a Corrective Action Plan (CAP) on 9-21-18. DHCS informed Lake MHP must increase the existing telehealth contract to increase its network by 1.64 FTE adult psychiatry providers, and .88 FTE children/youth psychiatry providers by 12/31/18. DHCS recommended that LCBHS increase the contract to a dollar amount that would cover the 2.52 FTE’s.
Lake submitted a Plan of Correction to DHCS on 10/22/18 that stated the current contract with NAMHS would be increased to $1,370,000.00 to secure compliance with the mandate. A contract was initiated to bring us into compliance with the mandate; however, it was pulled from the BOS agenda as the funds were not allocated to the current year’s fiscal budget.
On April 8, 2019, DHCS sent a Sanction Letter to Lake MHP informing of possible sanctions. Below is important information regarding the sanction process:
• DHCS Letters mailed today, thus the 60-day clock begins April 8, 2019.
• Sanctions, which would be achieved by withholding 50% of a county’s monthly average FFP, begin June 8, 2019.
• Sanctions will be withheld and refunded to the county upon proof of compliance.
• Civil Penalties will be calculated beginning July 1, 2019. These penalties will equal 10% of (the number of beneficiaries x $500 per beneficiary).
• Civil penalties WILL NOT BE REFUNDED to the county.
• Counties may appeal within 60 days to the DHCS Office of Administrative Hearings and Appeals, but the appeal will not stay any sanctions or penalties.
• DHCS must submit its second annual network certification to the Centers for Medicare and Medicaid Services in July; upon completion of its analysis, DHCS may impose additional corrective actions upon the MHPs for inadequate network access.
According to the DHCS Sanction Letter, Lake MHP must increase psychiatric services by 2.06 FTE (which is a decrease from our original CAP). This works out to approximately $1,113.840.00 (at a rate of $260.00 an hour) for the Fiscal Year.
CURRENT PLAN OF CORRECTION:
1. A third Amendment to the existing FY 18/19 contract with Northern American Mental Health Services (NAMHS) will increase this contract to $1,045,840.00 with a term date of 6-30-19.
2. A new contract was initiated with Locum Tenens for a psychiatrist for 32 hours a week starting 5-1-19 through 6-30-19 for $68,000.00.
3. We proposed in our FY 19-20 budget to allocate funds to support the continuation of both psychiatric services contracts to total $1,113,840.00.
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FISCAL IMPACT: __ None _X_Budgeted __Non-Budgeted
Original Contract Amount: $ 250,000
Amendment 1 Change: Address Change
Amendment 2 Increase: $ 50,000
Amendment 3 Increase: $ 745,840
New Contract Amount: $1,045,840
FISCAL IMPACT (Narrative): In order to ensure LCBHS is in compliance with the State mandated Network Adequacy requirements, the parties desire to increase the Agreement by $745,840 for a new contract maximum of $1,045,840. Although the services performed will not reach this contract maximum by the end of Fiscal Year 18-19, as we are currently averaging $25,000 per month, the contract maximum will bring LCBHS into compliance with the NACT requirements thus alleiviating any current and future fines, sanctions, and penalties.
STAFFING IMPACT (if applicable): N/A
Recommended Action
RECOMMENDED ACTION: Consideration of Amendment Three to the Agreement between the County of Lake and Native American Mental Health Services dba North American Mental Health Services (NAMHS) for Fiscal Year 2018-19 in the amount of $745,840 for a new contract total of $1,045,840 and authorize the Chair to sign.