To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Memorandum of Understanding (MOU) #77-812 with Carelon Behavioral Health, Inc.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
RATIFY the March 4, 2025 action of the Health Services Director’s designee, Sharon Mackey, CEO, who executed a Memorandum Of Understanding (MOU) with Carelon Behavioral Health, Inc., a corporation, in an amount not to exceed $80,000, to provide claims processing and payment remittance services under the State-mandated Children and Youth Behavioral Health Initiative (CYBHI) program, and management of the school-linked statewide provider network of behavioral health practitioners for Contra Costa Health Plan (CCHP) members, for the period March 1, 2025 until a new contract is executed as directed by the California Department of Health Care Services (DHCS) or termination of either party from its role in the CYBHI Fee Schedule by DHCS.
FISCAL IMPACT:
Approval of this MOU will result in contractual service expenditures of up to $80,000 funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
This Contract meets the needs of the County’s population through the CYBHI, to provide an integrated, youth-centered system to meet the mental health and behavioral health needs of young people, particularly those who encounter the greatest systemic barriers to wellness. The CYBHI’s goal is to enable California students ages twenty-five (25) years and younger, attending a public school or college in California, to find school-linked support for their mental health and behavioral health and/or substance use needs. Such services include therapy, counseling, and case management. The CYBHI program is mandated by the DHCS and it is a mandatory requirement for Managed Medi-Cal Plans (MCP’s) in California to provide and pay for school-based counseling services, also known as the CYBHI Fee Program. CCHP is required to enter into this MOU by the DHCS.
This Contractor is the designated third-party administrator that DHCS contracted with to administer this program with the MCP’s in California. This Contractor is responsible for managing the school-linked statewide provider network of behavioral health practitioners, comprised of local education agencies (LEAs), county offices of education (COE), public institutions of higher education (IHEs), and community-based individual, group, and organizational providers designated in-network by LEAs, COEs, or IHEs for CCHP members. The Contractor’s claims processing and payment remittance services under this MOU include screening providers for eligibility and enrollment in the CYBHI program, processing claims for CYBHI services provided to CCHP members, and remitting payment for such services to providers after such claims are funded by CCHP for its enrolled members. Carelon Behavioral Health, Inc. is a new Contractor who will work to understand the CCHP organization’s mission, values, and long-term objectives starting March 1, 2025.
This Contract is entered into under and subject to the following legal authorities: California Government Code §§ 26227 and 31000; Welfare and Institution Code § 5961.4, Health and Safety Code § 1374.722, and Insurance Code § 10144.53. Health Services Personnel approved this Contract to ensure no conflicts with labor relations. Division and Contractor meet to ensure MOU terms are upheld. Per Administrative Bulletin 600.3, the request to ratify the execution of the Memorandum of Understanding is exempt from the solicitation requirements due to services being mandated by DHCS and Contractor being the designated third party administrator by DHCS to administer the CYBHI school-based program.
Approval by the Board of Supervisors will ratify the execution of this MOU and allow the Division to pay the Contractor to continue to provide services until a new MOU for the DHCS ASO Payment Model is executed by the parties, which the Division estimates will occur in June 2026. It is estimated that the contractual service expenditures under this MOU will cost approximately $80,000. This delay is due in part to the delayed release of the MOU template by DHCS and CCHP organizational implementation of the CYBHI Fee Program. This MOU requires the parties to resolve any disputes arising out of this MOU by binding arbitration.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract is not ratified, the department will not have authorization to reimburse Contractor for services provided and required by the DHCS and CCHP will risk being non-compliant with current regulations resulting in an adverse effect on patient care and revenue.
CHILDREN’S IMPACT STATEMENT:
The recommendation supports the following children's outcome(s): (1) Children Ready for and Succeeding in School; (2) Children and Youth Healthy and Preparing for Productive Adulthood; (3) Families that are Economically Self Sufficient; (4) Families that are Safe, Stable and Nurturing; and (5) Communities that are Safe and Provide a High Quality of Life for Children and Families.