Sonoma County Health Services Attachment 1 Intergovernmental Transfer Flowchart & Timeline Sonoma County Health Services (DHS) IGT Payment $4.2 Million California Health Care Services (DHCS) $8.9 Million Partnership HealthPlan of California (PHC) ($257K Admin Fee) $8.3 Million Sept. Oct. 2015 Sonoma County Health Services (DHS) Note: Net payment to DHS equals $3.3 Million after return of $5.0 Million to account of origin. IGT Admin Fee $836K Federal Match $4.2 Million Managed Care Tax $351K Sept. Oct. 2015 California Health Care Services (DHCS) Centers for Medicare & Medicaid Services (CMS) California Health Care Services (DHCS)
IGT Revenue and Expenditure Summary Attachment 2 A. Rollover (from prior fiscal year) B. Revenue FY 11-12 (Year 1) FY 12-13 (Year 2) FY 13-14 (Year 3) FY 14-15 (Year 4) FY 15-16 (Year 5) Rollover Total $2,079,355 $3,783,555 $3,036,242 $207,058 IGT Revenue $2,828,024 $4,467,538 $5,386,041 $1,513,903 $3,291,889 $17,487,395 Interest $22,161 $52,848 $44,300 $24,624 $7,000 $150,933 C. Available Funds (Rollover + Revenue) D. Expenditures Total Revenue Total $2,850,185 $4,520,386 $5,430,341 $1,538,527 $3,298,889 $17,638,328 Available Funds Total $2,850,185 $6,599,741 $9,213,896 $4,574,769 $3,505,947 E. Rollover (to next fiscal year) Expenditures Total $770,830 $2,816,186 $6,177,654 $4,367,711 $3,298,889 $17,431,270 Rollover Total $2,079,355 $3,783,555 $3,036,242 $207,058 $207,058
Five-Year Summary of IGT Funded Services and Programs Attachment 3 Page 1 of 1 Printed on 8/6/2015 Description FY 11-12 FY 12-13 FY 13-14 FY 14-15 FY 15-16 (Proposed) Behavioral Health Mobile Support Team 27,503 370,002 440,000 440,000 484,100 CAPE - - 280,000 280,000 307,900 Clinic Integration Services - - 1,060,389 845,437 997,237 Medi-Cal Outpatient - DAAC 76,800 67,800 76,800 76,800 84,300 SUDS Residential Services 58,241-75,755 - - Perinatal ACE's 19,062 229,826 182,416 231,836 620,913 Subtotal Behavioral Health 181,607 667,628 2,115,360 1,874,073 2,494,450 Public Health Chronic Disease Prevention & Community Health Promotion - - 60,584 56,101 216,447 Perinatal ACE's-MCH 98,502 135,681 135,681 123,400 - Perinatal ACE's-First 5 101,280 215,399 190,567 - - MCH Field Nursing 32,530 171,061 171,061 183,342 - Subtotal Public Health 232,312 522,141 557,893 362,843 216,447 Health Policy, Planning & Evaluation Systems Improvement 149,472 587,838 562,397 868,291 - Health Action 88,450 185,215 448,377 157,171 - Oral Health - 314,598 122,278 340,901 580,992 CAA - Alliance contract - 45,047 - - - CAA - RCHC contract - 100,000 - - - Chronic Disease Prevention & Community Health Promotion - 43,466 478,157 264,433 - Specialist Services - 3,632 400,000 - - ACA Implementation - - 780,474 - - Subtotal HPPE 237,922 1,279,796 2,791,684 1,630,795 580,992 Administration Administration 118,990 346,621 500,000 500,000 (See note 1) Systems Improvement - - 60,000 - - ACA Implementation - - 152,717 - - Subtotal Administration 118,990 346,621 712,717 500,000-1. Per PHC Admin expenditures to be allocated into PHC Funding Priorities. Total Expenditures 770,830 2,816,186 6,177,654 4,367,711 3,291,889
Memorandum of Understanding For use of Plan Year 2013/2014 IGT Funds Between County of Sonoma And Partnership HealthPlan of California Partnership Health Plan of California (PHC) and the County of Sonoma, a political subdivision of the State of California, through its County Health Services Department (County) have participated in a Medi-Cal Managed Care Intergovernmental Transfer (IGT) for plan year 2013-2014 and for expenditure in Fiscal Year 2015-2016. As a result of the IGT, County will receive approximately $8,311,122 in Local Medi-Cal Managed Care Rate Range ( LMMCRR ) payments. After payment of the Managed Care Organization tax and State Administrative fee, the total new funds provided to the County will be approximately $3,291,889. Both organizations share a common goal of ensuring that the LMMCRRs are utilized in compliance with State and Federal regulations as well as the PHC Board policy regarding Medi- Cal Managed Care IGTs. In addition to supplementing the rates paid to County for services provided during the plan year 2013-2014, the LMMCRR funds will be expended for health services in accordance with the Plan/Provider Agreement Amendment. These include projects that promote the well-being of Medi-Cal beneficiaries by supporting the local safety net through improved behavioral health services, including substance abuse treatment and prevention, care coordination/case management services, oral health, and/or improving access to specialty and primary care. To achieve this goal, the organizations enter into this Memorandum of Understanding, which outlines their basic roles and responsibilities. 1. County will be responsible for the following activities: A. Project Overview. The IGT LMMCRRs for plan year 2013-2014 will support several existing programs in addition to providing the initial funding for the following focus areas: behavioral health services, care coordination, case management services, oral health, and services that promote access to specialty care. B. Project Summary. Please see Attachment A that provides a general description of each project or program funded with IGT LMMCRRs. C. Reporting Requirements. a. Interim Report. Six (6) months after receipt of the LMMCRRs, County will submit a report to PHC describing progress undertaken to date on each project or service in this MOU. The description will provide details on the steps taken to implement the project or service, describe how the program is serving PHC members, and identify the steps that will be taken toward further implementation. In addition, information regarding any unexpected issues that have arisen in the course of implementation will be included in the description. DHS No. 2015-0199-A00 Page 1 of 4
b. Final Report. Twelve (12) months after receipt of the LMMCRRs, the County Health Department will submit a final report describing the status of each project or service in the MOU. This will include information about whether the project was fully completed, partially completed, or not undertaken at all. An explanation will be included addressing whether the project or service will be an ongoing or whether it was a one-time undertaking. The final report will include a statement from the County Health Services Department that none of the LMMCRRs were recycled back to the State or to the County General Fund and the funds were expended in accordance with the Plan/Provider Agreement Amendment. 2. PHC will be responsible for the following activities: a. PHC IGT Oversight Responsibilities. PHC will request from the County Health Services Department an interim and final report as described under Section 1.C above. PHC staff will review and evaluate each report and provide a copy to the PHC Board for review. PHC will ensure that final report includes a statement that none of the LMMCRR funds were recycled back to the State or to the County General Fund and that LMMCRRs were expended in accordance with the Plan/Provider Agreement Amendment. This MOU will cover a twelve (12) month period. It will begin on the date the payment of LMMCRR funds is issued by PHC to the Sonoma County Health Services Department and will conclude three hundred and sixty five days (365) from that date. Date Date Rita Scardaci, MPH Director Sonoma County Health Services Jack Horn Chief Executive Officer Partnership HealthPlan of California DHS No. 2015-0199-A00 Page 2 of 4
Sonoma County Health Services Summary of Rate Year 2013-14 IGT Projects ATTACHMENT A RY 13-14 Net IGT Revenue ($3,291,889) I. Behavioral Health ($2,494,450) - Perinatal Behavioral Health Program: ($620,913) This ongoing program expands screening, assessment, brief intervention, referral, care coordination, and treatment opportunities for high risk, low-income pregnant and parenting women through Sonoma County's Drug Free Babies Program and Nurse Home Visiting services. The target population served includes low-income, Medi-Cal eligible pregnant and post-partum women and their children with multiple risk factors such as living in poverty, unemployment, lack of educational attainment, alcohol and drug use, homelessness; mental illness; developmental disabilities; and language or cultural barriers to accessing medical care. Evidence informed approaches are utilized to develop and support a system of care for identifying the target population, providing community and home based nursing assessments and interventions that also link clients to additional community resources, crisis assistance, and further evaluation and treatment. Funding of community-based providers expands and enhances substance use treatment and counseling in several facilities and settings. - Mobile Support Team (MST): ($484,100) This ongoing service responds to at risk individuals experiencing a behavioral health crisis. In coordination with law enforcement, hospitals, Emergency Medical Services and community advocates, family and friends, Behavioral Health staff provide therapeutic mental health and substance use disorder interventions, patient treatment and referral, frequently mitigating unnecessary Emergency Department visits, and linking at risk individuals to case management and complex care coordination, and improved coordination with primary health care providers. - Crisis Assessment Prevention Education (CAPE): ($307,900) This ongoing service provides early behavioral health treatment and interventions to transitional age youth (age 16-25) that are experiencing their first onset of mental illness. Services include health assessment, intervention, referral and treatment and coordination with primary health care providers. - Clinic Integration and Services: ($997,237) This ongoing service provides a bi-directional referral model with Sonoma County community clinics that will support the provision of integrated behavioral and physical health care services to individuals within the clinic setting. Behavioral health services will include prevention, assessment and treatment services consistent with ACA and what is currently known about implementation of Behavioral Health Parity. This will also include services provided in our Lab, immunizations, and communicable disease efforts. - Inpatient and Outpatient Services: ($84,300) This ongoing service provides Behavioral Health and Substance Use Disorder (SUDS) services, including residential treatment and care coordination. 6/18/2015 Page 3 of 4
Sonoma County Health Services Summary of Rate Year 2013-14 IGT Projects II. Oral Health ($580,992) - Oral Health Initiatives: ($580,992) This program continues support oral health services focused on areas such as expanded fluoride varnishes and dental sealants, oral health case management/care coordination services for underserved populations that are predominately Medi-Cal members. III. Care Coordination ($216,447) - Disease Prevention and Access to Care: ($216,447) Services include those that increase access to immunization, chronic disease prevention, health education, ACA enrollment outreach, and improved community health. Continue efforts and collaboration with primary health care providers and hospitals to increase access to specially care and decrease preventable hospitalizations. Expand focus on at risk individuals identified as high frequency utilizers and provide assessment, intervention, ongoing case management, and referral to stabilize services and improve individual health outcomes. IV. IGT Sustainability Reserve ($0) - The County does not anticipate contributing any additional revenue to the IGT Sustainability Reserve this year. 6/18/2015 Page 4 of 4