Memorandum
Date: September 12, 2023
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Behavioral Health Services Director
Subject: Approve Intergovernmental Agreements Regarding the Transfer of Public Funds Between the County of Lake and the California Department of Health Care Services for the Specialty Mental Health Services and Drug Medi-Cal Programs Spanning Fiscal Years 2023-26 and Authorize the Behavioral Health Director to Sign the Agreements.
Executive Summary:
Through realignment efforts in 1991 and 2011, funding for the majority of the non-federal share of costs associated with the Specialty Mental Health Services (SMH) and Substance Use Disorder (SUD) services became the responsibility of the counties. Currently, counties are reimbursed for these programs via Medicaid Certified Public Expenditure (CPE) methodologies. Under the Certified Public Expenditure (CPE) structure, reimbursements to counties are limited to costs incurred by the counties and are subject to a lengthy and labor-intensive cost reconciliation process. The CalAIM Behavioral Health Payment Reform initiative seeks to move counties away from cost-based reimbursement to enable value-based reimbursement structures that reward better care and quality of life for Medi-Cal beneficiaries.
Payment reform will transition counties from cost-based reimbursement funded via Certified Public Expenditures (CPEs) to fee-for-service reimbursement funded via Intergovernmental Transfers (IGTs), eliminating the need for reconciliation to actual costs. As part of payment reform, Specialty Mental Health (SMH) and Substance Use Disorder (SUD) services will transition from existing Healthcare Common Procedure Coding System (HCPCS) Level II coding to Level I coding, known as Current Procedural Terminology (CPT) coding, when possible.
You may view the relevant Behavioral Health Information and FAQs Notices here:
<https://www.dhcs.ca.gov/Documents/BHIN-23-026-County-Behavioral-Health-Intergovernmental-Transfers.pdf>
<https://www.dhcs.ca.gov/Documents/BHIN-23-036-CalAIM-Behavioral-Health-Payment-Reform-Allocation.pdf>
https://www.dhcs.ca.gov/Documents/CalAIM-BH-Payment-Reform-Intergovernmental-Transfer-FAQ.pdf
If not budgeted, fill in the blanks below only:
Estimated Cost: __N/A__ Amount Budgeted: ________ Additional Requested: ________ Future Annual Cost: ________
Purchasing Considerations (check all that apply): ☒ Not applicable
☐ Fully Article X. <https://library.municode.com/ca/lake_county/codes/code_of_ordinances?nodeId=COOR_CH2AD_ARTXPU_S2-38EXCOBI>- and/or Consultant Selection Policy <http://lcnet.co.lake.ca.us/Assets/Intranet/Policy/Policies+$!26+Procedures+Manual/Ch4_2021v2.pdf>-Compliant (describe process undertaken in “Executive Summary”)
☐ Section 2-38 <https://library.municode.com/ca/lake_county/codes/code_of_ordinances?nodeId=COOR_CH2AD_ARTXPU_S2-38EXCOBI> Exemption from Competitive Bidding (rationale in “Executive Summary,” attach documentation, as needed)
☐ For Technology Purchases: Vetted and Supported by the Technology Governance Committee <http://lcnet.co.lake.ca.us/Assets/Intranet/Intranet+Forms/Information+Technology/AdvPlan.pdf> (“Yes,” if checked)
☐ Other (Please describe in Executive Summary)
Consistency with Vision 2028 <http://www.lakecountyca.gov/Government/Directory/Administration/Visioning/Vision2028.htm> (check all that apply): ☒ Not applicable
☐ Well-being of Residents ☐ Public Safety ☐ Disaster Prevention, Preparedness, Recovery
☐ Economic Development ☐ Infrastructure ☐ County Workforce
☐ Community Collaboration ☐ Business Process Efficiency ☐ Clear Lake
Recommended Action: Approve Intergovernmental Agreements Regarding the Transfer of Public Funds Between the County of Lake and the California Department of Health Care Services for the Specialty Mental Health Services and Drug Medi-Cal Programs Spanning Fiscal Years 2023-26 and Authorize the Behavioral Health Director to Sign the Agreements.