Upon approval, this action will result in an approximate annual cost of $9,949,822, with pension costs of $2,259,011 included. All positions will be funded by Contra Costa Health Plan revenues related to the new Enhanced Care Management (ECM) Medi-Cal benefit (50%) and the Cal AIM 5-year initiative funding (50%). The fiscal impact to current fiscal year is expected to be minimal to none due to the time needed for the recruitment and selection process. Should any positions be filled prior to June 30th, the department will be able to fund the costs within Cal AIM allocations and Medi-Cal reimbursement and the budget will be adjusted accordingly during year-end reconciliation. The salary and benefit cost and full-time equivalent (FTE) of these 61 positions are included in the adopted FY 2022/23 budget.
In order to successfully transition to a Single Plan Model, meet the National Committee for Quality Assurance (NCQA) re-accreditation requirements, and implement the California Advancing and Innovating Medi-Cal (Cal AIM) Initiatives, Contra Costa Health Plan (CCHP) requires significant staffing augmentations. Expanding current staffing levels are also urgently needed to maintain compliance with three major oversight agencies (Department of Managed Health Care, Department of Health Care Services, and the Centers for Medicare & Medicaid Services) and multiple accreditation agencies.
CCHP conducted an evaluation of the current staffing levels and determined the needed staffing structure moving forward to be understaffed by approximately 100 employees, when compared to other Managed Care Plans in the Bay Area with similar membership. Addionally, CCHP's bid to be a Single Plan Model can add approximately 30,000 new Medi-Cal members, which the current staffing model cannot support.
CCHP is currently in the launch phase of the largest renovation of Medi-Cal Managed Care under California Advancing and Innovating Medi-Cal (Cal AIM). Over the next 4 years, several new programs will enhance access to care within CCHP's oversight. These new programs include Long Term Care, Dual Special Needs Program, and Population Health. To effectively develop and successfully launch these new Medi-Cal programs, it’s critical to establish a staffing infrastructure with the appropriate skill set to develop policies, procedures, workflows, and training plans.
The department has identified a total need of 61 positions to provide the appropriate staffing for the equity, emergency and disaster preparedness, project management, and Medicare & Medi-Cal Compliance units, which include the specific staffing needs below that are also critical to the staffing expansion:
1. Behavioral Health/Mental Health: 2 Administrative Services Assistant II positions are requested to support Student Behavioral Health and address the new demand from DMHC implementing SB 855 for the Commercial members and the No Wrong Door Behavior Health requirement.
2. Project Management Office & Training - 10 Health Services Information Systems positions are requested to create the infrastructure needed to roll out new programs and build a new Training Program.
3. Compliance Office – four Administrative Services Assistant III positions are requested to expand this office, which has historically been staffed by one staff person and requires additional staff to be fully functional.
4. Dual Special Needs Program (DNSP) - four Administrative Services Assistant III positions are requested to implement this program that will bring Medicare as a product line for the most vulnerable and older population. The DSNP is a combination of Medi-Cal and Medicare. The Centers for Medicare & Medicaid Services (CMS) directly manages Medicare and will have direct oversight of the DSNP. Filling the requested positions with Medicare experienced staff will be essential to meet the rigorous requirements.
Approval of these requested positions, will give CCHP the appropriate staffing levels and expansion of staff expertise needed to design and launch new major Cal AIM programs and meet Single Plan Model, NCQA, and Cal AIM regulatory guidelines.
If not approved, CCHP will lack the operational structure it needs to respond effectively to business changes stemming from its transition to a Single Plan Model, implementing Cal AIM, and building appropriate staffing levels to ensure compliance with NCQA and other regulatory agencies. The lack of staff will significantly hinder Contra Costa Health Services' ability to provide care management services to the highest need Medi-Cal enrollees.