Fremont City
California

Staff Report
3768

FY 2019/20 MEMORANDA OF UNDERSTANDING WITH ALAMEDA COUNTY REGARDING MEDI-CAL - Authorize the City Manager to Execute Two Memoranda of Understanding with the Alameda County Health Care Services Agency for Fremont Human Services FY 2019/20 Medi-Cal Administrative Activities and Targeted Case Management Services

Information

Department:Human Services DepartmentSponsors:
Category:Agreements and Contracts

Item Discussion

Executive Summary: The purpose of this report is to authorize the City Manager to execute FY 2019/20 Memoranda of Understanding (MOUs) with the Alameda County Health Care Services Agency (ACHCSA) to enable the City to continue to receive reimbursement of funds through Alameda County’s Targeted Case Management (TCM) and Medi-Cal Administrative Activities (MAA) programs for eligible activities carried out by Human Services Department staff. Staff is also recommending the City Council adopt a resolution delegating to the City Manager or designee the authority to sign, certify or execute documents on behalf of the City with respect to the MAA and TCM programs.

 

Staff anticipates receiving up to a maximum of $350,000 for eligible TCM activities. Staff anticipates receiving approximately $545,000 in reimbursement for eligible activities through the MAA program.

Body

BACKGROUND: Both the TCM and MAA programs are funded by Medicaid Title XIX through the federal Centers for Medicare and Medicaid Services (CMS).  The California Department of Health Care Services (DHCS) administers the programs at the state level, with each county in California designating a Local Government Agency (LGA) to administer the program locally.  In Alameda County, the Alameda County Health Care Services Agency (ACHCSA) serves as the LGA for the City of Fremont.  These TCM and MAA programs allow service providers to receive partial federal reimbursement of local funds, (i.e. City, County and State funding), expended on certain direct services and administrative activities necessary for the proper and efficient provision and administration of the Medi-Cal program. Funding flows from CMS through DHCS, then to ACHCSA, and finally to the City. The City has participated in the TCM program since FY 2002/03 and the MAA program since FY 2006/07.

 

DISCUSSION/ANALYSIS:

 

Targeted Case Management (TCM) Program: The City is reimbursed for targeted case management services provided by the Family Service Team at the Fremont Family Resource Center (FRC), and Older Adult Support Specialists in the Aging and Family Services Division (AFS). FRC staff work with families and individuals that fit within the TCM target population of “Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes.”  AFS staff works primarily with seniors that fit within the TCM target population of “Medically Fragile Individuals.”

 

Eligible Activities: Targeted case management services are defined as services provided to individuals in gaining access to needed medical, social, educational and other services. Services must fall under one of the following components:

 

  1. Assessment and reassessment of individual needs
  2. Development and periodic revision of a care plan
  3. Referral and linkage activities
  4. Monitoring and follow-up activities

 

Reimbursement: The TCM program reimburses the City for approximately 48% of the estimated costs associated with providing case management encounters to Medi-Cal eligible clients. The exact amount of funding the City receives is generally based on the following:

 

  1. An ongoing time survey of time spent supporting TCM activities;
  2. A cost report completed by the City’s Finance Department in cooperation with the Human Services Department;
  3. The actual number of face-to-face encounters case managers have with Medi-Cal eligible individuals during the year; and
  4. The Federal Medical Assistance Percentage (FMAP) rate.  The City’s cost of providing these services varies each year; therefore, new cost reports and an MOU must be completed for each year the City participates in the program.

 

Medi-Cal Administrative Activities (MAA) Program: Many of the administrative activities carried out through the Human Services’ Family Resource Center, Youth and Family Services and Aging and Family Services Divisions are eligible for reimbursement under MAA.  These administrative activities support the provision of case management, counseling, and health promotion services in our community.

 

Eligible Activities: DHCS has approved the City’s four current MAA claiming plans, which describe the reimbursable activities to be carried out, the staff for whom claiming will be done, and the methodology for determining costs. Eligible activities include the following:

 

  1. Outreach that brings potentially Medi-Cal eligible people into the Medi-Cal system for the purpose of determining their Medi-Cal eligibility, or links Medi-Cal eligible individuals with Medi-Cal covered services;
  2. Referral, Coordination and Monitoring of Medi-Cal Services;
  3. Facilitating the completion of Medi-Cal applications;
  4. Arranging and/or providing non-emergency, non-medical transportation to a Medi-Cal covered service;
  5. Administering contracts for Medi-Cal services and administrative activities; and
  6. Program planning and policy development with the goal of increasing the Medi-Cal system’s capacity.

 

Reimbursement:  Participating staff will complete a MAA program time survey each month to determine the percentage of time spent on reimbursable administrative activities during FY 2019/20.  Once FY 2019/20 closes, ACHCSA and City staff will use the time surveys and actual FY 2019/20 expenses to calculate the reimbursement for eligible administrative activities during the fiscal year.  ACHCSA will then submit the request for reimbursement to DHCS on the City’s behalf.

 

Local Public Entity (LPE) Requirements: The City is recognized by DHCS as a Local Public Entity (LPE) for the purposes of participating in the MAA and TCM programs. This designation allows the City to self-certify local public expenditures that support the provision of Medi-Cal programs.

 

Therefore, staff also recommends the City Council adopt a resolution delegating to the City Manager or designee the authority to sign, certify or execute documents on behalf of the City with respect to the Medi-Cal Administrative Activities and Targeted Case Management Programs.

 

FISCAL IMPACT:  Based on revenue from prior years, for FY 2019/20 TCM activities, staff estimates that the City may be reimbursed up to a maximum of approximately $350,000, including up to $140,000 for AFS case management services and $210,000 for FRC case management services.  For MAA activities, based on the most recent completed reimbursement cycle, staff anticipates receiving approximately $545,000 in reimbursement for eligible activities.

 

TCM and MAA revenues are important components of the Human Services Department’s strategy to cultivate outside revenue sources needed to sustain safety net services and support administrative overhead costs associated with these services. This funding was anticipated and appropriated as part of the FY 2019/20 adopted budget.

 

ENVIRONMENTAL REVIEW:  N/A

Document Comments

RECOMMENDATION: Authorize the City Manager or designee to execute Memoranda of Understanding with the Alameda County Health Care Services Agency to enable the City’s Human Services Department to receive reimbursement for eligible FY 2019/20 expenses through Alameda County’s Targeted Case Management (TCM) Program and for Medi-Cal Administration Activities (MAA), as described in this staff report. Adopt a resolution delegating to the City Manager or designee the authority to sign, certify or execute documents on behalf of the City with respect to the MAA and TCM programs.