To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Behavioral Health Services Agreements - Additional Delegated Authority for Fiscal Year 2022-2023
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute an extension of the current agreement for Patient Rights Advocate services with The SmithWaters Group through June 30, 2023.
B) Authorize the Director of Health Services, or designee, to execute an extension of current agreements with five providers of Temporary Clinical Staffing services, including psychiatry and nursing, through June 30, 2023 and an increase in delegated authority of $2,586,799 for Fiscal Year 2022-23.
C) Authorize an increase of $288,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with providers of Behavioral Health services that are the result from Beneficiary Requests for Services for Adults.
D) Authorize a total increase of $216,000 to the Director of Health Services’, or designee’s, delegated authority to execute agreements and amendments for Administrative Hearing Officer services with California Hearing Officers, with a term ending no later than June 30, 2025.
E) Authorize an increase of $500,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with California Psychiatric Transitions to provide rehabilitative care for adults with serious mental illness.
F) Authorize an increase of $500,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with service providers of outpatient telehealth services to supplement current providers in their ability to schedule and provide treatment within the mandated timeframes for timeliness and availability requirements.
G) Adopt a budget resolution adjusting the fiscal year 2022-2023 revised budget to increase expenditures by $2,208,570 financed with use of $2,208,570 of 1991 Mental Health Realignment Fund Balance. (4/5th vote required).
(4/5th Vote Required)
end
Executive Summary:
The Department contracts with a broad range of providers of mental health and substance use disorder services. Because the term of the identified agreements expires on 12/31/2022, to deliver timely access to services, Department staff requests both term extension to 6/30/2023 and increased expenditure delegated authority so that staff can execute agreements for mental health and substance use disorder treatment, as well as related support services provided by partner agencies.
The Department is requesting additional delegated (contracting) authority of $4,090,799. This Board item requests additional delegated (contracting) authority in the amount of $3,946,799 for Fiscal Year 2022-2023 and $144,000 for future fiscal years (Fiscal Years 2023-2024 and 2024-2025).
The Fiscal Year 2022-2023 Adopted Budget includes contract expenditures for behavioral health services of $68,174,680; of which $68,174,680 is estimated to be incurred/obligated by 6/30/2023. This Board item requests additional budget appropriations for Fiscal Year 2022-2023 for the identified contract service expenditures in the amount of $2,208,570; which is less than the total additional delegated authority amount by $1,882,229 due to redirecting current appropriations from salary savings and costs to be incurred in future fiscal years.
Included in the requested additional delegated authority for behavioral health services are several agreements for Temporary Clinical Staffing services, service agreements that are the result of Beneficiary Requests for Service (BRS) for adults, Administrative Hearing Officer services, rehabilitative care for adults with serious mental illness, and emergency outpatient telehealth services.
The current services agreements included in this Board item are funded with a combination of Medi-Cal/Federal Financial Participation, Mental Health Services Act, 1991 Mental Health Realignment, 2011 Behavioral Health Realignment, Measure O sales tax, reimbursements from other County departments and other agencies, and County General Funds.
Discussion:
The Department contracts with a broad range of licensed providers to provide timely access to high-quality mental health and substance use disorder services. Many of the Department’s behavioral health services contracts are managed within a medical network of care as mandated by federal and state regulations. Consistent with state requirements for mental health plans, the Department must maintain an adequate network of service providers based on client need, geographic coverage, culturally-based needs and language capabilities. Mental Health Services Act programs and service needs are vetted annually through a community planning and input process that includes posting of the Mental Health Services Act plan for comment and a public hearing.
Attachment 1 provides a list of behavioral health and support service providers for which the Department is requesting additional delegated authority (or a transfer of existing delegated authority from other categories). Individual contract amounts may be different as final agreements are negotiated, but the total amount for each delegated authority category will not exceed its total without further Board action.
Recommended Action A
This action requests authority for the Director of Health Services, or designee, to execute an extension of the current agreement for Patient Rights Advocate services with The SmithWaters Group through June 30, 2023. The current vendor provides the following services:
• Oversight of Patients’ Rights and Certification hearing process, insuring compliance with all Patients’ Rights laws and regulations.
• Investigates all reports of rights violations as well as abuse and neglect in the system related to both inpatient and outpatient facilities where Mental Health Plan beneficiaries are receiving services.
• Conducts regular trainings with Behavioral Health Division staff related to 5150, patients’ rights, 5270, rights denials, etc.
The Department is currently in the process of competitively procuring the Patient Rights Advocate services. The vendor currently has a six-month contract for $130,060 through 12/31/2022. In order to maintain continuity of services while the Request for Proposals (RFP) process takes place, this action seeks to extend the existing contract through June 30, 2023. The contract that is awarded as a result of the RFP will begin July 1, 2023.
Recommended Action B
Temporary staffing contracts support maintenance of a pool of psychiatrists and other psychiatric professionals to provide services in the event the County is unable to recruit and retain staff, or to provide for the specialized needs of Mental Health Plan clients. The Department contracts with staffing agencies, locum tenens, or other providers as needed.
This action requests authority for the Director of Health Services, or designee, to execute extensions of current agreements with five providers of Temporary Clinical Staffing services, including psychiatry and nursing, through June 30, 2023, including an increase in delegated authority of $2,586,799 for Fiscal Year 2022-2023 as detailed below.
The Department is currently in the process of competitively procuring the Temporary Clinical Staffing services. The five vendors currently have six-month contracts. In order to maintain continuity of services while the Request for Proposals (RFP) process takes place, this action seeks to extend existing contracts through June 30, 2023. Contracts that are awarded as a result of the RFP will begin July 1, 2023.
Brabetz, Inc. currently has a six-month contract for $127,518 for Temporary Nursing services. This action seeks to extend this existing contract through June 30, 2023.
Maxim Healthcare currently has a six-month contract for $62,914 for Temporary Nursing services. This action seeks to extend this existing contract through June 30, 2023.
Siyan Clinical Corporation currently has a six-month contract for $109,701 for Temporary Psychiatry services. This action seeks to extend this existing contract through June 30, 2023.
Jackson & Coker currently has a six-month contract for $264,329 for Temporary Psychiatry services. This action seeks to extend this existing contract through June 30, 2023. The sum of $912,410 in new delegated authority is requested for Fiscal Year 2022-2023. $188,217 in new budget appropriations are also requested, funded by existing 1991 Mental Health Realignment fund balance. In addition, the department will utilize. In addition, the department will utilize $724,193 in Behavioral Health psychiatrist and medical director salary savings to fund the contract.
LocumTenens.com currently has a six-month contract for $482,309 for Temporary Psychiatry services. This action seeks to extend this existing contract through June 30, 2023. The sum of $1,674,389 in new delegated authority is requested for Fiscal Year 2022-2023. $660,353 in new budget appropriations are also requested, funded by existing 1991 Mental Health Realignment fund balance. In addition, the department will utilize $910,117 in Behavioral Health psychiatrist salary savings and $103,919 in reimbursements from the Public Health Division through a memorandum of understanding with the Probation Department to fund the contract.
Recommended Action C
Under current regulations, Medi-Cal beneficiaries who receive specialty mental health services from county mental health plans have the right to make certain requests for services. There are two types of Beneficiary Requests for Service:
• Continuity of Care (COC) - The California Department of Health Care Services states that “beneficiaries with pre-existing provider relationships who make a continuity of care request to the county mental health plan must be given the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider.”
• Extended Network Provider (ENP) - If the Department of Health Services Behavioral Health Division (DHS-BHD) is unable to provide necessary services, they will find an Extended Network Provider (ENP) who can deliver the services to the beneficiary.
Due to a projected increase in these types of requests for Fiscal Year 2022-2023, this action requests an increase of $288,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with providers of Behavioral Health services that are the result from Beneficiary Requests for Services for Adults. The department also requests an increase in appropriations of $288,000 for these expenses, funded by existing 1991 Mental Health Realignment fund balance.
Recommended Action D
Individuals who are a danger to themselves or others and/or who are gravely disabled can be detained against their will for up to 72 hours pursuant to Welfare and Institutions Code (“WIC”) sections 5150 and 5585 (minors). When individuals require extended involuntary mental health care beyond 72 hours, the Lanterman-Petris-Short (LPS) Act mandates a hearing for all persons certified for an additional period of involuntary mental health treatment pursuant to WIC 5250 and WIC 5270.15. The County of Sonoma uses the services of a contractor as a qualified Certification Review Hearing Officer as defined by section 5256.1 of the Welfare and Institutions Code.
Due to a projected increase in the number of needed Certification Review Hearings, this action requests a total increase of $216,000 to the Director of Health Services’, or designee’s, delegated authority to execute agreements and amendments for Administrative Hearing Officer services with California Hearing Officers, with a term ending no later than June 30, 2025. The department also requests an increase of $72,000 in appropriations for Fiscal Year 2022-2023, funded by existing 1991 Mental Health Realignment fund balance.
Recommended Action E
For Fiscal Year 2022-2023, the Department anticipates the need to increase the existing contract amount with California Psychiatric Transitions, a facility that serves individuals whose serious mental illness contributes to violent behavior. State hospital facilities have traditionally served this population. However, the Department of State Hospitals does not have adequate resources to meet the need.
This action requests an increase of $500,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with California Psychiatric Transitions to provide rehabilitative care for adults with serious mental illness that are experiencing high levels of acuity. The department also requests an increase in $500,000 in appropriations, funded by existing 1991 Mental Health Realignment fund balance, to Fiscal Year 2022-23.
Recommended Action F
For Fiscal Year 2022-2023, the Department has identified an immediate need for contracts with service providers of outpatient telehealth services to supplement current providers in their ability to schedule and provide treatment within the mandated timeframes for timeliness and availability requirements outlined by both the Department of Health Care Service (DHCS) and reported quarterly in the Network Adequacy Certification Tool (NACT) as well as Mental Health Plan network adequacy for both children/youth and adults consistent with Information Notice 18-011. Current demand for these mandated services is greater than the current network can support.
This action requests an increase of $500,000 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to execute agreements and amendments with service providers of outpatient telehealth services to supplement current providers in their ability to schedule and provide treatment within the mandated timeframes for timeliness and availability requirements. The department also requests an increase in $500,000 in appropriations, funded by existing 1991 Mental Health Realignment fund balance, to Fiscal Year 2022-23.
Recommended Action G
The Department is requesting use of 1991 Mental Health Realignment Fund balance in the amount of $2,208,570. The current estimated available Fund Balance is $14,719,039.
Strategic Plan:
N/A
Prior Board Actions:
On June 13, 2022, the Board approved:
1) An increase of $13,691,995 to the Director of Health Services’, or designee’s, Fiscal Year 2022-2023 delegated authority to extend or renew agreements and amendments with providers of Behavioral Health services for terms ending no later than June 30, 2025.
2) The Director of Health Services, or designee, to execute new agreements and amendments with providers of Behavioral Health services, competitively procured during Fiscal Year 2021-2022 and 2022-2023, in an amount not to exceed $18,550,173, for terms ending no later than June 30, 2027, including $4,093,103 in Fiscal Year 2022-2023.
3) An increase by $194,349 to the Director of Health Services’, or designee’s, delegated authority to execute an agreement with Sonoma County Office of Education for mental health services for children and youth, resulting in a new not-to-exceed amount of $3,248,270.
4) The Director of Health Services, or designee, to execute an agreement with Aurora Behavioral Healthcare for reimbursement of associated administrative costs incurred by the County for the term July 1, 2022, through June 30, 2023, resulting in revenue of $250,000.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$68,174,680 |
|
|
|
Additional Appropriation Requested |
$2,208,570 |
|
|
|
Total Expenditures |
$70,383,250 |
0 |
0 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$41,393,599 |
|
|
|
Fees/Other |
$26,781,081 |
|
|
|
Use of Fund Balance |
$2,208,570 |
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$70,383,250 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
The Fiscal Year 2022-2023 budget includes $68,174,680 for service provider contracts, including treatment services, for Fiscal Year 2022-2023. Additional delegated authority is being requested in the amount of $3,946,799 [$2,586,799 for Temporary clinical staffing (Recommended Action A), $288,000 for Behavioral Health Services (Recommended Action B), $72,000 Administrative Hearing Officers (Recommended Action C)], $500,000 for Behavioral Health Services [Recommended Action E], and $500,000 for Behavioral Health Services [Recommended Action F]. The department is requesting $2,208,570 in additional expenditure appropriations and use of 1991 Mental Health Realignment Fund balance (Estimated fund balance $14,719,000).
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Additional Delegated Authority by Provider
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None