LA County Board

12. Cultivating a Care First, Inclusive, and Diverse Network of Providers\nOffering Enhanced Care Management Services to Justice-Impacted\nIndividuals\nRecommendation as submitted by Supervisor Solis: Instruct the Director of\nJustice, Care and Opportunities, in coordination with the Chief Executive\nOfficer, the Chief Information Officer, the County Office of Privacy, the\nAuditor-Controller, and County Counsel, to develop the infrastructure to provide\nMedi-Cal Post-Release Enhanced Care Management (ECM) Services, using\nexisting funding and staffing, including the following:\nTaking all necessary steps to be designated as a covered component of\nthe County hybrid entity to comply with the Health Insurance Portability\nand Accountability Act (HIPAA) and comply with the HIPAA regulatory\nrequirements;\nObtaining a Type 2 Organizational National Provider Identifier from the\nCenters for Medicare and Medicaid Services, if necessary;\nEnrolling as a Medi-Cal provider if a State pathway exists; and\nInstruct County Counsel to determine if any County ordinance changes\nare required for the Justice, Care and Opportunities Department’s\n(JCOD’s) expanded ECM responsibilities and, if so, draft the necessary\namendments for the Board’s consideration;\nInstruct the Directors of Justice, Care and Opportunities, Health Services,\nMental Health, and Public Health, to establish an inter-Departmental workgroup\nto coordinate their respective Post-Release ECM Services programs, where the\nworkgroup should work to establish generally agreed-upon guidelines for\nidentifying which Department’s ECM program would be the ideal fit for each\nindividual based on both their holistic care needs and their preferences and\nsubject to the final determination of their Managed Care Plans (MCP), and to\ndevelop and/or enhance inter-Departmental workflows to facilitate care\ncoordination activities for Medi-Cal Beneficiaries who are assigned by the\nMCPs to these County Departments’ respective ECM Programs, and building\non the working group efforts, JCOD should also work to identify opportunities\nfor Countywide capacity-building efforts, and to coordinate, integrate, and\npotentially, share costs and infrastructure with other Departments as JCOD\nproceeds to implement ECM;\nAuthorize the Director of Justice, Care and Opportunities, in consultation with\nthe Chief Information Officer, if appropriate, and in consultation with County\nCounsel, to take any necessary contract actions needed to the extent legally\npermitted, with 10 days advance notice to the Board and Chief Executive\nOfficer before executing any new or amended contracts or agreements, to do\nthe following:\nWaive the County’s standard open competitive solicitation or bidding\nrequirements, the need to comply with the County’s Sole Source Policy,\nand the need to comply with any other County Contracting Policies, and\nwaive any other County standard terms and conditions;\nNegotiate and execute new agreements, and any additional contracts,\namendments, or extensions, starting with Health Net and provider groups,\nand expand to other health plans as necessary to provide Post-Release\nECM Services, the authority includes, without limitation, the power to\nestablish new rates of payment whether capitated, fee-for-service or\notherwise, adjust rates, and secure incentives and incentive payments\nfrom the foregoing parties or the State related to ECM Services;\nNegotiate, prepare, and accept California Advancing and Innovating\nMedi-Cal - related incentives, awards, and other payments related to\nECM whether deriving from Federal or State governments or health\nplans; and\nNegotiate, execute, and amend contracts or subcontracts with third\nparties, including service providers, for the purpose of providing ECM;\nand\nInstruct the Director of Justice, Care and Opportunities to report back to the\nBoard in writing each year, for the first three years of program implementation,\nthat evaluates the program model and operational effectiveness based on initial\nassumptions, including staffing levels, workflows, system performance, and\n"hub and spoke" contracting, and provides an update on ECM program\nprogress by comparing actual outcomes to initial expectations for client mix,\nenrollment, services, and revenue, and on the agreed upon guidelines and\ninter-Departmental workflows developed by the working group detailed above.\n(24-5524)