“The County of Orange (County) Health Care Agency (HCA) is seeking proposals from qualified organizations to provide behavioral health outpatient services for children and youth ranging in age from 0 to 17 and transitional age youth ranging in age from 18 to 21 who qualify for early and periodic screening, diagnostic, and treatment (EPSDT) services because they are eligible for fullscope Medi-Cal. The County currently contracts with multiple agencies for the provision of behavioral health outpatient services for children and youth up to the age of 21 throughout the County in the various service areas. Behavioral health outpatient services include: assessment; individual, group, and family therapy; case management; crisis intervention; medication support; collateral services, therapeutic behavioral services (TBS); and the more recently added intensive care coordination and intensive home-based services.
As the Mental Health Plan (MHP) in Orange County, HCA is responsible to provide EPSDT related services to children and youth under the age of 21. Clients eligible for EPSDT services are Medi- Cal clients who qualify for full-scope Medi-Cal. The Medi-Cal Specialty Mental Health Services (SMHS) program is authorized pursuant to a waiver approved by the Centers for Medicare and Medicaid Services under Section 1915(b) of the Social Security Act1. Under the Medi-Cal Specialty Mental Health Services Waiver, the MHP must ensure provision of Medi-Cal Specialty Mental Health Services, as described in California’s Medicaid State Plan and Title 9, California Code of Regulations, Section 1810.2472, to all Medi-Cal beneficiaries who meet medical necessity criteria.
Changes to the Medi-Cal program pursuant to Assembly Bills 1468 (Chapter 438, Statutes of 2012)3 and 1494 (Chapter 28, Statutes of 2012)4 provided for the transition of children from the State Children’s Health Insurance Program known as the Healthy Families Program, to the California Medi-Cal program and has increased the number of children needing services from the County’s MHP. The four (4) phase implementation of the transition from commercial health plans began January 1, 2013 and concluded on December 31, 2013 with approximately 1,200 active clients transitioned to the MHP. The Federal Affordable Care Act5 initiated in January 2014, has also contributed to the expansion of eligible Medi-Cal clients and placed other requirements on those receiving federal financial reimbursement.
Additionally, the California Department of Health Care Services and the Department of Social Services continue to implement the requirements of the “Katie A. vs. Bonta et. al Settlement Agreement”6 for the class of eligible Medi-Cal beneficiaries (foster youth). MHP is also mandated to serve the foster and probation youth population of Medi-Cal eligible beneficiaries who need medically necessary Mental Health Services. Overall, the number of Medi-Cal eligible children and youth between the ages of 0 to 21 has increased 14% from 351,139 in 2014 to 399,195 in 2016.
Interested bidders who wish to provide behavioral health outpatient services for children and youth are asked to submit a proposal that identifies the geographical service areas of Orange County, as outlined in the table below, and indicate where they intend to locate their clinics and/or provide the majority of their services. Bidders may submit a proposal to provide services in any or all of the requested service areas.”
– Excerpted from County of Orange request for proposals Solicitation CS18-12016190-LG