To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Memorandum of Understanding #77-812-1 with Carelon Behavioral Health, Inc.
Recommendation: Recommendation of the County Administrator
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to increase the payment limit for Memorandum of Understanding (MOU) #77-812-1 with Carelon Behavioral Health, Inc., a corporation, effective August 1, 2026, to increase the payment limit by $50,000, from $80,000 to an amount not to exceed $130,000, to provide additional 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, effective until a new MOU is executed.
FISCAL IMPACT:
Approval of this payment limit increase will result in additional expenditures of up to $50,000 and is funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
This MOU 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. understands the CCHP organization’s mission, values, and long-term objectives and has been providing these services since March 1, 2025.
This MOU 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 600.4, this MOU 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.
On April 28, 2026, the Board of Supervisors ratified MOU #77-812 with Carelon Behavioral Health, Inc. for the provision of claims processing and payment remittance services under the State-mandated Children and Youth Behavioral Health Initiative program and management of the school-linked statewide provider network of behavioral health practitioners for Contra Costa Health Plan members for the period March 1, 2025 until a new Contract is executed as directed by the DHCS.
Approval of this payment increase will allow Contractor to continue to provide claims processing and payment remittance services until a new MOU is executed. This MOU requires the parties to resolve any disputes arising out of this MOU by binding arbitration. This Contract Amendment was delayed due to an unanticipated increase in services and the inability of Division to project expenditures.
CONSEQUENCE OF NEGATIVE ACTION:
If this payment limit increase is not approved, the CCHP will not have funds to pay 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.