TITLE
Recommendation to authorize City Manager, or designee, to execute an agreement, and any subsequent documents or amendments, with the State of California Department of Health Care Services, for the continued provision of Targeted Case Management Services to eligible Medi-Cal beneficiaries, effective July 1, 2017 and continuing in full force and effect until terminated by either party, for an estimated annual revenue of $120,000. (Citywide)
DISCUSSION
The Targeted Case Management (TCM) is a federal program of the Centers for Medicare and Medicaid Services (CMS), which is a part of the U.S. Department of Health and Human Services. This program is administered via the State of California Department of Health Care Services (State), which acts as a pass-through agency. Since 1997, the Health Department has provided TCM services under a TCM Provider Participation Agreement (PPA) with the State.
The TCM program assists defined target populations in accessing needed medical, social, educational, and other services. TCM service components include: a) comprehensive assessment and periodic reassessment of client status; b) development of an Individual Service Plan (ISP) for each beneficiary; c) referral and related activities; and, d) monitoring and follow up activities. There are five defined target population groups for the TCM program: a) children under the age of 14; b) medically fragile individuals; c) individuals at risk of institutionalization; d) individuals in jeopardy of negative health or psycho-social outcomes; and, e) individuals with communicable diseases. Since July 2016, over 400 individuals have received TCM services through the City of Long Beach Health and Human Services Department (Health Department), with mostly children and medically fragile individuals being the primary beneficiaries.
TCM services are provided to targeted groups via several City programs, including the Maternal, Child and Adolescent Health Program (MCAH), Nurse Family Partnership (NFP) Program, and Black Infant Health (BIH) Program. Funding for these programs is provided by various sources, including county, State, and federal grants. Funding from these external sources is insufficient to cover all of the City’s costs associated with these programs. Thus, the City is required to use Realignment funds to fill the funding gap. The City recovers a portion of its Realignment expenditures via the TCM program.
On June 11, 2013, the City Council approved TCM PPA 61-1318A, effective July 1, 2013 through June 30, 2018, with the State. The State has now issued Agreement PPA 61-17EVRGRN, which replaces the previous agreement and includes a Medi-Cal Provider Agreement (DHCS Form 6208), a new State requirement.
This matter was reviewed by Deputy City Attorney, Linda T. Vu on April 4, 2017 and by Budget Management Officer Rhutu Amin Gharib on March 31, 2017.
TIMING CONSIDERATIONS
City Council action is requested on May 2, 2017, to allow for timely billing and revenue capture.
FISCAL IMPACT
The Health Department will receive reimbursement from the State based on the number of qualified TCM encounters provided to eligible Medi-Cal beneficiaries. While the agreement does not specify a dollar amount, annual reimbursement of $120,000 is estimated and budgeted in the Health Fund (SR 130) in the Health and Human Services Department (HE). Subsequent years budgets will be appropriated as part of the annual budget process. All anticipated costs will be offset by reimbursements from the State. There is no local job impact associated with this recommendation.
SUGGESTED ACTION
Approve recommendation.
Respectfully Submitted,
KELLY COLOPY
DIRECTOR
HEALTH AND HUMAN SERVICES
APPROVED:
PATRICK H. WEST
CITY MANAGER