Life Enrichment Committee
July 9, 2024
AGENDA REPORT
TO: Jestin D. Johnson FROM: Scott Means
City Administrator Interim Director, Human
Services
SUBJECT: Multipurpose Senior Services
Program FY 2024-2025 Standard
Agreement
DATE: June 13, 2024
City Administrator Approval Date:
RECOMMENDATION
Staff Recommends That The City Council Adopt a Resolution:
1. Authorizing The City Administrator To Accept And Appropriate An Estimated $1,976,364 Reimbursement For Fiscal Year 2024-2025 From The State Of California Department Of Aging (CDA) For The Crucial Multipurpose Senior Services Program (MSSP) Standard Agreement Number MS-2425-01;
2. Authorizing The City Administrator To Accept And Appropriate Additional Reimbursement Funds From CDA For Subsequent Program Years 2025-2026, 2026- 2027, 2027-2028, 2028-2029, Anticipated Standard Agreement Numbers MS-2526-01, MS-2627-01, MS-2728-01, MS-2829-01;
3. Authorizing Contributions From The General Purpose Fund In An Estimated Amount Of $472,971 Per Year Through Fiscal Year 2028-2029 For Departmental And Central Services Overhead Charges As Direct Offset;
4. Authorizing The City Administrator To Procure MSSP Related Goods And Award Professional Services Agreements To Bay Area Vital Link, Lifeline Systems, Community Care Services And Home Instead For Five-year Agreements Within The Limits Of MSSP Funding; And
5. Authorizing The City Administrator To Take All Actions Necessary To Accept And Appropriate The MSSP Agreements And Amendments From Fiscal Years 2024-2025 Through Fiscal Year 2028-2029.
EXECUTIVE SUMMARY
Adoption of the proposed resolution will allow the City Administrator to apply for and Jestin Johnson (Jun 27, 2024 21:07 PDT)
Jun 27, 2024
Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 2
Life Enrichment Committee
July 9, 2024
accept funds from the State of California, Department of Aging for the Multipurpose Senior Service Program (MSSP) in the amount of $1,976,364 for Fiscal Year (FY) 2023-2024. MSSP provides in-home supportive services to over 369 frail, low-income elderly individuals who are at risk of nursing home placement. Services include case management, the purchase of professional services, such as emergency response system installation and monitoring and respite for caregivers, goods including non-durable medical devices, and home accommodations necessary for health and safety. The resolution also authorizes a contribution from the General-Purpose Fund, equivalent to the Departmental and Central Services Overhead Charges estimated at $472,971, as a direct offset.
BACKGROUND / LEGISLATIVE HISTORY
The City of Oakland’s Human Services Department (HSD) Aging and Adult Service Division empowers seniors and adults with disabilities through life-enriching and life-sustaining programs and services such as MSSP. Oakland frail elders (age 65 and over) have multiple chronic disabilities that put them at risk of early death or institutionalization. MSSP provides culturally appropriate comprehensive case management services to keep Medi-Cal eligible frail elders out of nursing homes, safe and independent in their homes, increasing their quality of life when they are most vulnerable.
Enabling Legislation
In 1977, the California Legislature authorized the Multipurpose Senior Services Project as a four-year research and demonstration project. The project's objective was to obtain information on cost-effective methods of preventing the inappropriate institutionalization of elderly persons.
The Torres-Felando Long Term Care Reform Act of 1982 (Chapter 1453) provided for the conditional continuation of MSSP beyond its sunset of June 30, 1983.
The program would thereafter be ongoing if it proved cost-effective, and the State could obtain federal authority to fund it through a Medicaid Home and Community-Based Care Waiver. The authorizing State legislation is contained in California Welfare and Institution Code, Section 9560 et seq.
The City of Oakland, MSSP, has the distinction of being CDA, MSSP Site 01. It was the first to receive a Standard Agreement to provide these cost-effective, life-sustaining services in 1977.
In 2021, the Department of Health Care Services (DHCS) and the California Department of Aging (CDA) submitted an amendment of the Multipurpose Senior Services Program (MSSP) Waiver to the Centers for Medicare & Medicaid Services (CMS) for approval. Major changes to the MSSP Waiver include:
• Adding participant slots and corresponding funding effective January 1, 2022, due to changes in the State Governor’s 2021-22 Budget. Effective July 1, 2022, the three-year appropriation that allowed for a rate increase for care management and care management support for the first three years of the Waiver cycle is permanent.
Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 3
Life Enrichment Committee
July 9, 2024
• Carving the MSSP program out of the 1115 Bridge to Reform Demonstration Waiver, known as the Coordinated Care Initiative (CCI). Effective January 1, 2022, all MSSP sites operate under the Fee-For-Service (FFS) methodology.
The City of Oakland's MSSP maximum monthly participant slots increased from 328 to 369.
Oakland’s MSSP was not part of CCI and has always operated as a Fee-For-Service program.
ANALYSIS AND POLICY ALTERNATIVES
This recommended policy action advances citywide priorities, including holistic community safety, housing, economic, and cultural security.
MSSP is funded through a Standard Agreement with the California Department of Aging (CDA), which administers the federal 1915(c) Home & Community-Based Waiver to meet the needs of people who prefer long-term care services and support in their home and community. The goal of MSSP is to prevent or delay nursing placement and to provide community support and resources to seniors who are at risk of nursing home care and homelessness. The program promotes participant self-determination and fosters independent living for frail/disabled elders within the least restrictive environment and is a proven, cost-effective alternative to nursing home placement. Using a medical and psychosocial model, the multidisciplinary team of MSSP nurses and social workers ensure seniors who are frail, and disabled are connected to social and health services and other community supports. The alternative to not providing these services is the inequity of premature death, nursing home placement, and homelessness of our most vulnerable citizens – the oldest old, poorest poor, and largest growing segment of the population. With the imminent influx of baby boomers who will need care as they turn 80 in 6 years in 2030, advanced age poses the greatest risk for dementia, chronic diseases, and other co-morbid conditions, and this program provides a more person-centered and cost-effective alternative to institutionalization. For 47 consecutive years, the City of Oakland’s MSSP has prevented or delayed these consequences for thousands of Oakland residents. MSSP is essential to securing a safety net for frail/disabled elders of Oakland and ensures their ability to age in the least restrictive environment – their own home.
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Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 4
Life Enrichment Committee
July 9, 2024
As of April 26, 2024, 287 unduplicated Oakland residents were served in FY 2023-2024. The gender, racial, and zip code breakdown for City of Oakland participants is shown in Table 1 below.
Table 1
MSSP Unduplicated Client Counts as of April 26, 2024
Zip Code
Tot
al
Cou
nt
Race
Sex
Asian
Pacifi
c Isle
African
Amer.
Latino
White
Nativ
e
Ame
r.
Indian
Middl
e
Easte
rn
Declin
e
M
F
Homel
ess
0 0 0 0 0 0 0 0 0 0 0
94601 71 25 3 38 5 0 0 0 0 24 47
94602 11 4 2 1 4 0 0 0 0 2 9
94603 14 0 8 3 3 0 0 0 0 2 12
94605 16 1 9 3 3 0 0 0 0 6 10
94606 25 12 2 1 9 1 0 0 0 4 21
94607 43 26 16 0 1 0 0 0 0 10 33
94608 12 0 9 0 2 0 0 1 0 2 10
94609 8 0 6 0 2 0 0 0 0 3 5
94610 10 3 5 0 2 0 0 0 0 3 7
94611 21 11 5 2 2 0 1 0 0 7 14
94612 42 36 3 0 3 0 0 0 0 15 27
94618 1 0 0 0 1 0 0 0 0 1 0
94619 3 2 0 1 0 0 0 0 0 0 3
94621 10 1 7 2 0 0 0 0 0 1 9
Totals 287 121 75 51 37 1 1 1 0 80 207
100
%
42.0 0%
26.0 0%
18.0 0%
13.0 0%
0.30 %
0.30 %
0.30 %
0.00 %
28.0 0%
72.0 0%
FISCAL IMPACT
Without MSSP, potentially 369 frail elderly /disabled Oakland residents per month are immediately at risk of nursing home placement or homelessness, adding further strain to our healthcare and social service issues. In addition, fourteen current City of Oakland staff positions would be lost.
MSSP is a Medicaid Waiver, fee-for-service, reimbursement agreement program. To bill MediCal and collect the full $1,976,364, the City must serve 100 percent of the participant capacity, which is 369 monthly participants. This mandate requires adequate staff to meet the Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 5
Life Enrichment Committee
July 9, 2024
caseload ratio of 40 participants to 1 Case Manager. The resolution requests a direct offset of $472,971 from General Purpose Funds for Departmental and Central Services Overhead costs.
This ongoing agreement is funded by Title XIX, Social Security Act Funds, and the State of California. This funding is included in the City’s FY 2024- 2025 Proposed Midcycle Budget and appropriated in the Department of Health and Human Services Fund (2128), Multipurpose Senior Services Program Organization (75231), Empowering Seniors & People with Disability Program (YS14), and MSSP FY24-25 Admin Project (1006726), MSSP FY24-25 Case Management Project (1006727), and MSSP FY24-25 Waived Services Project (1006728).
The annual MSSP per-slot rate is $5,356 per year. Compared to the San Francisco Bay Area annual nursing home rate of $182,500, MSSP remains a significant cost saving for taxpayers and provides a more community-centered set of services.
1. AMOUNT OF STANDARD AGREEMENT RECOMMENDATION/COST OF
PROJECT
Project Delivery $1,818,253
Professional Services $158,111
TOTAL PROJECT COSTS $1,976,364
2. COST ELEMENTS OF AGREEMENT/CONTRACT
Professional Services Contracts/Purchases $158,111
Management/Support/Administration Salaries & Benefits $575,339 Case Management Salaries & Benefits $1,207,478
Operating Costs $35,436
TOTAL AGREEMENT/CONTRACT AMOUNT $1,976,364
1. COST ELEMENTS OF GENERAL PURPOSE FUND CONTRIBUTION
Departmental and Central Services Overhead Costs $472,971
TOTAL GENERAL PURPOSE FUND CONTRIBUTION
AMOUNT
$472,971
SOURCE OF FUNDING:
California Department of Aging, and the City of Oakland, General Purpose funds.
Historically, the Standard Agreement does not cover the Departmental and Central Services Overhead charges that the City assigns to every project as a part of the citywide overhead costs. This resolution would authorize the allocated total for the Agreement of $472,971 to be covered through a direct offset contribution from the General-Purpose Fund (GPF) 1010.
The CDA Standard Agreement funds include $158,111 designated to purchase goods and services needed to protect the health and safety of frail elderly participants. The CDA funds are used to buy personal care items, appliances, non-medical home equipment, and services such as respite. Due to the specialized nature of what is being purchased, there are a limited number of suppliers, often only a single supplier, who can meet the needs of the participants. The CDA Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 6
Life Enrichment Committee
July 9, 2024
mandates MSSP providers to purchase items promptly based on participant choice, including brand and vendor. This mandate is a part of the 1915c Waiver application between CDA, CMS, and the City of Oakland’s agreement, which states that individuals are given the choice among waiver services and providers. This mandate is referred to as Freedom of Choice.
Staff proposes that the City allow MSSP to enter into a Professional Service Agreement with local vendor Bay Area Vital-Link, Inc. (https://vital-link.com/), which has a track record of ensuring service delivery. The vendor provides Communication/Emergency Response Systems, including installation and monitoring services for elders at risk of falls and other issues requiring immediate medical attention.
PUBLIC OUTREACH / INTEREST
The MSSP Site Director/Senior Services Supervisor works closely with internal and external parties, including the Multipurpose Senior Services Program Association, CDA Program Analyst, Alameda County Senior Services Coalition, Health Care Services, Hospice, City of Fremont – Aging and Family Services, Center for Elders Independence and community-based organizations serving the elder population. Referrals come from hospital discharge planners, public health nurses, County Adult Protective Services (APS) nurses and social workers, MSSP staff case findings, community outreach presentations, and word-of-mouth. As of the end of the third quarter of 2024, the number of referrals was seven. The average number of days on the waitlist was 15.
The Human Services Department receives hundreds of calls from the public inquiring about services for seniors, particularly from family, friends, and neighbors concerned about declining elders who need case management.
The MSSP referral form is a fillable pdf document available at: https://cao-94612.s3.us-west-
2.amazonaws.com/documents/CM-Referral-Form-Final-Apr24-fillable.pdf.
COORDINATION
The Office of the City Attorney and Budget Bureau have reviewed this report and legislation.
PAST PERFORMANCE, EVALUATION AND FOLLOW-UP
Performance measurements are tracked, including the number of clients served, the number of services arranged or delivered, waitlist statistics, and the percentage of clients reporting satisfaction. Client satisfaction surveys are sent annually as mandated by the CDA. In FY 2022- 2023, 296 current and former clients were sent surveys (former clients who had moved out of the area or had passed away were excluded). Of these 149 clients - 50% of the total responded. The results show 92% believe the services provided by MSSP assist them in remaining independent, 90% rated their experience with the staff and services as excellent or good,3 % rated their experience with the staff and services as satisfactory, and 7% left this question blank. When asked if their case manager understood their problems enough to help them, 95% responded, “Yes.” When asked if they would recommend MSSP to other people they know who need services to remain at home, 91% of respondents said “Yes.” An internal Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 7
Life Enrichment Committee
July 9, 2024
peer review is conducted twice a year and reported to CDA. CDA conducts an external program Utilization Review biennially. The most recent CDA program review was conducted.
May 13, 2024, through May 17, 2024. The Utilization Review report will follow in 45 days.
The contracted service providers are assessed quarterly for satisfaction with services provided as mandated by the CDA. Case Managers from MSSP report any challenges they have with any services or complaints from clients. Staff work to resolve any issues or challenges, and the results are reported to the California State Department of Aging as part of a more comprehensive quarterly report.
We also track informal feedback from clients, such as phone calls, thank you cards, and letters expressing satisfaction with the service.
SUSTAINABLE OPPORTUNITIES
Economic: MSSP contractors are primarily Oakland-based business operators. They employ Oakland residents who provide frail elder program participants with the necessary services.
MSSP will continue to invest in the Oakland community by purchasing services and equipment for frail seniors from Oakland-based businesses whenever possible.
Environmental: There are no environmental impacts associated with this policy recommendation.
Race & Equity: The average age of the City of Oakland MSSP participants is 82.00. Eighty- eight percent are ethnic/racial minorities, 100 percent are low-income, and participants disproportionately utilize hospital emergency rooms or become nursing home patients due to lack of knowledge of the healthcare system and inability to coordinate their own care. Services provided by MSSP make it easier for seniors who are frail and disabled to access services to which they are entitled. The social and health services provided by MSSP improve the quality of life for seniors who are frail and homebound, who are socially disadvantaged, and at risk of placement into nursing homes. Nurses and Social Work staff provide culturally sensitive Case Management services. The program has language-certified staff who speak Spanish, Cantonese, Mandarin, and Tagalog. All the MSSP forms and documents are translated into the following languages:
Chinese (Simplified and Traditional)
Spanish.
The MSSP also serves other non-English monolingual elders through the City of Oakland Equal Access Language Line interpreter service.
ACTION REQUESTED OF THE CITY COUNCIL
Staff Recommends That The City Council Adopt A Resolution:
1. Authorizing The City Administrator To Accept And Appropriate An Estimated $1,976,364 Reimbursement For Fiscal Year 2024 -2025 From The State O f California Department Of Aging (CDA) For The Crucial Multipurpose Senior Services Program (MSSP) Standard Agreement Number Ms-2425-01;
Jestin D. Johnson, City Administrator
Subject: MSSP Agenda Report FY 24-25
Date: June 13, 2024 Page 8
Life Enrichment Committee
July 9, 2024
2. Authorizing The City Administrator To Accept And Appropriate Additional Reimbursement Funds From C DA For Subsequent Program Years 2025 -2026, 2026- 2027, 2027 -2028, 2028 -2029, Anticipated Standard Agreement Numbers M S-2526-01, MS-2627-01, MS-2728-01, MS-2829-01;
3. Authorizing Contributions From The Gene ral Purpose Fund In An Estimated Amount Of $472,971 Per Year Through Fiscal Year 2028 -2029 For Departmental And Central Services Overhead Charges As Direct Offset;
4. Authorizing The City Administrator To Procure MSSP Related Goods And Award Professional Services Agreements To Bay Area Vital Link, Lifeline Systems, Community Care Services And Home Instead For Five -year Agreements Within The Limits Of MSSP Funding; And
5. Authorizing The City Administrator To Take All Actions Necessary To Accept And Appropriate The MSSP Agreements And Amendments From Fiscal Years 2024 -2025 Through Fiscal Year 2028-2029.
For questions regarding this report, please contact Ana Bagtas, Aging and Adult Services Manager, at 510-238-6794.
Respectfully submitted,
SCOTT MEANS
Interim Director, Human Services
Prepared by:
Karyl Eckels, Sr. Services Supervisor,
Multipurpose Senior Services Program