To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
California Mental Health Services Authority Inter-Member Transfer Participation Agreement
End
Recommended Action:
Recommended action
Authorize the Director of Health Services to execute a participation agreement with the California Mental Health Services Authority to facilitate the County’s participation in the Inter-Member Transfer Program for children in foster care.
end
Executive Summary:
To ensure timely access to Medi-Cal specialty mental health services for foster youth placed outside of their county of jurisdiction, state law was recently amended to place responsibility for arranging and providing mental health services to the county in which the foster child resides and is receiving care. As a result, the Department of Health Services Behavioral Health Division is responsible for providing needed mental health services to foster youth placed in Sonoma County by another county. The county of jurisdiction is responsible to reimburse Sonoma County for the local match portion of the services provided. Similarly, Sonoma County is responsible to reimburse counties providing services to foster youth from Sonoma County. Under the proposed Inter-Member Transfer Participation Agreement, the California Mental Health Services Authority will act as the fiscal agent for participating counties to make and receive inter-county transfer payments.
Discussion:
Counties who provide Medi-Cal specialty mental health services to foster youth are reimbursed through federal financial participation and county match through Medi-Cal billing. Recent amendments to Welfare and Institutions Code Section 14717.1 change the responsibility for arranging and providing specialty mental health services to foster youth from the county of original jurisdiction to the county in which the foster youth resides and is receiving care. This is known as “presumptive transfer.” Presumptive transfer enables foster youth who are placed outside of their county of jurisdiction to access specialty mental health services in a timely manner.
Implementation of the statute requires a system for counties to make prompt payments to each other for the provision of specialty mental health services to foster youth. The proposed participation agreement provides for timely reimbursement to counties providing specialty mental health services to foster children from another county and requires prompt reimbursement by counties of jurisdiction to counties providing services. Through participation agreements with participating counties, California Mental Health Services Authority will act as the fiscal agent to make and receive transfer payments. California Mental Health Services Authority is a joint powers authority created to perform administrative and fiscal services on behalf of its members. Sonoma County became a member of the California Mental Health Services Authority is a joint powers authority in May 2010.
California Mental Health Services Authority will operate a banking pool for participating counties. Each participating county will have separate financial ledger account that will be interest bearing. Counties will receive periodic statements of the year-to-date balance, payments made to other counties, payments received from other counties, administration costs, and interest earned.
Medi-Cal claims paid data from fiscal year 2015-2016 (the most recent fully adjudicated claims data) showed 22 unique Sonoma County foster youth were placed outside the county and that the claims paid equaled $431,738. The local match of $215,869 was used to estimate quarterly funding of $53,968, which will be processed through the participation agreement. This initial funding will be reconciled as actual transfers occur. Required future funding will be based on the projection of actual expenses in order to make funding continuously available for program. California Mental Health Services Authority will transfer funds back to the participating counties that have more funding than deemed necessary for the program. California Mental Health Services Authority will charge an administrative fee equaling five percent of the funds transferred from the Sonoma County account to the counties who provided services to Sonoma County youth.
Department tracking data shows that in fiscal year 2018-2019 there were 43 Sonoma County foster kids placed out of county who received mental health services. Fiscal year 2017-2018 data shows that Sonoma County provided services to 45 kids from other counties. The level of care required by foster youth is a significant factor in the overall cost of the services provided through presumptive transfer.
Strategic Plan Alignment - Participating in the Inter-Member Transfer program supports the County’s goal of a Safe, Healthy, and Caring Community by ensuring that foster youth are able to access specialty mental health services in a timely manner, consistent with their individual strengths and needs and the requirements of federal Early and Periodic Screening, Diagnosis, and Treatment services. In addition to alignment with the County’s Strategic Plan, this program supports the Department’s Strategic Plan goal of ensuring that individuals have access high quality and coordinated services for health, recovery, and well-being by strengthening the behavioral health infrastructure.
Prior Board Actions:
On May 7, 2013 the Board approved a second amended and restated Joint Exercise of Powers Agreement governing the operations of the California Mental Health Services Authority.
On November 9, 2010 the Board approved an amended and restated Joint Exercise of Powers Agreement (JPA) to join the California Mental Health Services Authority (CalMHSA).
On May 4, 2010 the Board approved a Joint Exercise of Powers Agreement (JPA) to join the California Mental Health Services Authority (CalMHSA) for the purpose of joint development and administration of MHSA programs.
Fiscal Summary
|
Expenditures |
FY 19-20 Adopted |
FY 20-21 Projected |
FY 21-22 Projected |
|
Budgeted Expenses |
215,869 |
226,663 |
226,663 |
|
Additional Appropriation Requested |
10,794 |
|
|
|
Total Expenditures |
226,663 |
226,663 |
226,663 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
226,663 |
226,663 |
226,663 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
226,663 |
226,663 |
226,663 |
Narrative Explanation of Fiscal Impacts:
The Department has included budgeted costs for specialty mental health services provided to Medi-Cal beneficiaries including the foster youth who are the focus of this process and funding. Because this process may bring in revenues not previously received and create costs not previously incurred, the Department will track the impact of this process and may return to the Board for additional appropriations if needed. The additional requested appropriation is for the forecasted administrative fees paid to California Mental Health Services Authority. These appropriations will be added to the FY 19-20 budget via the consolidated budget adjustments process. The actual amount will reflect the actual funds transferred on behalf of Sonoma County to other counties who provided services for Sonoma County youth.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
California Mental Health Services Authority Inter-Member Transfer Participation Agreement
Related Items “On File” with the Clerk of the Board:
None