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File #: 2021-0293   
Type: Consent Calendar Item Status: Agenda Ready
File created: 3/18/2021 In control: Health Services
On agenda: 6/8/2021 Final action:
Title: Behavioral Health Services Agreements - Delegated Authority
Department or Agency Name(s): Health Services
Attachments: 1. Summary Report, 2. Attachment 1 - MH and SUD Treatment Services Providers, 3. Attachment 2 - MH and SUD Services Providers - Total Amount Per Provider, 4. Attachment 3 - Service Categories Receiving Measure O Funding
Date Action ByActionResultAction DetailsMeeting DetailsVideo
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To: Board of Supervisors of Sonoma County

Department or Agency Name(s): Department of Health Services

Staff Name and Phone Number: Bill Carter, 565-5157

Vote Requirement: Majority

Supervisorial District(s): Countywide

 

Title:

Title

Behavioral Health Services Agreements - Delegated Authority

End

 

Recommended Action:

Recommended action

A)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for Mental Health Services Act (MHSA) Prevention and Early Intervention programs, competitively procured during fiscal year 2020-2021, with a term beginning in fiscal year 2021-2022 and ending no later than June 30, 2025, for a not to exceed amount of up to $1,132,246 annually.

B)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for Administrative Hearing Officers, competitively procured during fiscal year 2020-2021, with a term beginning in fiscal year 2021-2022 and ending no later than June 30, 2025, for a not to exceed amount of up to $100,000 annually.

C)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments to fulfill First Episode Psychosis program requirements in the Mental Health Block Grant (MHBG), competitively procured during fiscal year 2020-2021, with a term beginning in fiscal year 2021-2022 and ending no later than June 30, 2025, for a not to exceed amount of up to $238,000 annually.

D)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for Substance Use Disorder Services, including the extension of current agreements through September 30, 2021 and those competitively procured during fiscal year 2020-2021, with terms beginning in fiscal year 2021-2022 and ending no later than June 30, 2024, for a not to exceed amount of up to $7,707,988 annually.

E)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for specialty mental health services for youth in foster care for which competitive procurement is not feasible with a term ending no later than June 30, 2024, for a not-to-exceed amount of up to $4,227,410 annually.

F)                     Authorize the Director of Health Services, or designee, to execute support services agreements and amendments for behavioral health services with a term ending no later than June 30, 2022, for a fiscal year 2021-2022 not to exceed amount of $691,848.

G)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for mental health and substance use disorder services, for which delegated authority is not otherwise requested, with a term ending no later than June 30, 2022, for a fiscal year 2021-2022 not-to-exceed amount of $12,203,778.

H)                     Authorize 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, 2021 through June 30, 2022, resulting in revenue of $250,000.

I)                     Authorize the Director of Health Services, or designee, to execute agreements and amendments for Mental Health Services Act (MHSA) Innovation Projects, for which a community-based solicitation was performed, with a term ending no later than June 30, 2024, for a not-to-exceed amount of up to $1,216,356 annually.

J)                     Authorize an increase of $1,143,188 to the Director of Health Services’, or designee’s, fiscal year 2020-2021 delegated authority, initially approved by the Board on August 4, 2020 in the amount of $16,042,142, and increased by Board on April 6, 2021 to $17,358,361 to execute agreements and amendments for Residential Care Facilities, Long-Term Care Facilities, Inpatient Hospitals, and Independent Contractors providing behavioral health services for which competitive procurement is not feasible with a term ending no later than June 30, 2023, resulting in a new not-to-exceed amount of $18,501,549, to provide for increased service needs and costs.

end

 

Executive Summary:

The Department of Health Services requests authority to execute agreements for mental health and substance use disorder treatment services and related support services provided by agencies documented in Attachment 1. The Department contracts with a broad range of providers to provide timely access to high-quality mental health and substance use disorder services.

During the fiscal year 2020-2021 budget hearings, the Department presented a budget to the Board with contract expenditures for behavioral health services of $43,130,831. On April 6, 2021 the Board approved additional contract expenditures of $1,963,524. Total requested contracting authority for fiscal year 2021-2022 is $14,932,040, which includes $14,240,192 for mental health and substance use disorder services and $691,848 for behavioral health support services.

Included in the requested contracting authority for mental health services are several agreements for Mental Health Services Act (MHSA) Prevention and Early Intervention programs, administrative hearing officers, and to fulfill First Episode Psychosis program requirements in the Mental Health Block Grant (MHBG), and that were competitively procured during fiscal year 2020-2021, with a corresponding funding amount of up to $1,470,246 annually for the next four years. In addition, multiple agreements for substance use disorder and recovery services are in the process of being competitively procured, with a corresponding funding amount of $7,707,988, annually.

The Department is seeking authority to receive revenue of $250,000 from Aurora Behavioral Healthcare for services provided by the County to Aurora patients having a residence outside of Sonoma County. For the County to be reimbursed by Aurora for these costs, the Department is requesting approval to enter into an agreement with Aurora. In consideration of the associated costs, Aurora will reimburse the County with an administrative fee in the amount of $250,000 for fiscal year 2021-2022.

The service agreements 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, Substance Abuse and Mental Health Services Administration grants, Investment in Mental Health Wellness Act of 2013 grants, reimbursements from other County departments, and approximately $2.7 million in County General Funds which primarily support residential care facilities and substance use disorder services.

 

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 mental health and substance use disorder treatment services providers as well as support services providers. Attachment 2 provides a list of proposed funding amounts per-contractor. These amounts may be different as final agreements are negotiated, but total amount for each section will not exceed its total without further Board action.

Behavioral Health Services

Proposed fiscal year 2021-2022 contract expenditures include $53,254,011 for mental health and substance use disorder treatment services. The Department contracts for services to access expertise not available internally, to expand existing services to match consumer needs to provider expertise, and to address staff shortages for specialized client needs. Contracts include a full range of specialty behavioral health services, and provide consumers broad access to culturally-, age-, and gender-appropriate services within an integrated network of care. Consumers served by the Department’s contracted network of behavioral health providers include Medi-Cal beneficiaries, medically indigent, underinsured, and uninsured individuals. Each year, behavioral health services providers implement outreach, prevention, mental health, and substance use disorder services to over 15,000 consumers.

The Department of Health Services works to maintain a consistent level of healthcare provision to ensure continuity of care and that the delivery of services are geographically accessible throughout Sonoma County. Contracted providers must be licensed by the state and comply with certification requirements and all regulatory and fiscal reporting requirements specific to the services and treatment provided. Because individuals experiencing a serious behavioral health crisis often require an immediate referral to a qualified contracted provider, Board authority to execute and amend agreements is needed to facilitate timely and appropriate access to services.

The Department contracts for the following types of mental health and substance use disorder treatment services as part of the Department of Health Services treatment system. In some instances, the needs of clients dictate a pattern of contract utilization that may be different than what was originally planned at the beginning of a fiscal year. The ability to maximize and move funding between contracts (within the overall budget authority granted by the Board and through typical contract amendment processes) increases opportunities to provide for the varying needs of clients with the most appropriate and effective level of care. Contracts are executed in counsel-approved templates, include language that obligates the Department only to the extent funding is available, and allows for termination of the contract in the event that any anticipated funding is reduced or eliminated.

Acute Inpatient and Short-Term Crisis Services ($5,595,483)

Individuals in crisis may require a structured setting that provides 24-hour supervision and support. Acute inpatient psychiatric hospitals serve those clients who require a locked facility. Others are able to receive services in a residential setting in the community with intensive 24-hour support and supervision. The Department plans to contract with two providers for these services for a total amount of $3,537,218. In addition, $2,058,265 is budgeted for inpatient stays in multiple out-of-county hospitals.

Community Services & Supports - Mental Health Services Act ($1,139,797)

The Department provides funds and consultation services to community-based health care and substance abuse organizations, enabling these organizations to work more effectively with their clients who have mental illness. These collaborations facilitate access to primary care for individuals with mental illness, and assist the Behavioral Health Division to identify new clients needing services. In addition, these organizations are the providers of choice for many in the Latino and Native American populations. The Department plans to contract with seven providers for these services in amounts ranging from $81,040 to $238,587.

Consumer, Family Peer Support and Recovery Services ($1,654,099)

Through contracts with several community-based organizations, clients and/or their families may access a variety of services designed to foster self-reliance and maximize overall quality of life. The services include provision of general health information and referral, assistance navigating the mental health systems of care, recreation and socialization, consumer and family support groups, peer counseling training, peer counseling, telephone support, advocacy training and consultation, benefits counseling, vocational training, community based informational events, and consumer-operated employment opportunities. The contracts also provide opportunities for individuals in recovery from mental illness and/or family members to be trained to take peer support positions in the system. A request for proposals was completed in February 2020. The Department plans to contract with one provider for the competitively procured services, West County Community Services, for a total amount of $1,342,606. West County Community Services is also providing services in the amount of $166,000 that were not part of the competitive procurement process. In addition, the Department plans to contract with Buckelew Programs in the amount of $77,993 and the County of Sonoma Human Services Department’s Job Link Program in the amount of $67,500 for services in this category.

Independent Specialty Mental Health Services Providers ($1,018,478)

Independent Specialty Mental Health Providers are psychiatrists and other psychiatric professionals to provide services in the event the County is unable to recruit and retain staff within internally-based programs, to provide for the specialized needs of clients in the community, and to provide services to Mental Health Plan clients in Long Term Care and Residential Care facilities. Continued challenges with recruiting appropriate staff has resulted in an increased need for these services, as well as new federal and state regulations regarding beneficiary continuity of care. The Department plans to contract with multiple currently unidentified providers for these services, based on client need.

Long-Term Care Facilities ($6,463,329)

Long-term care facilities provide services to improve the daily functioning of adults with serious and persistent mental illness. Facilities also serve clients who require short- to medium-term intensive treatment in a secure, highly structured therapeutic environment in order to return to the community. The Department has identified and plans to contract with an estimated 9 providers for these services, based on client need and the availability of beds, in amounts ranging from $49,640 to 2,684,283.

Prevention and Early Intervention - Mental Health Services Act ($1,548,306)

Our community partners provide 1) prevention based services to individuals prior to the development of serious mental illness or serious emotional disturbances and to alleviate the need for additional mental health services or extended mental health treatment; 2) build capacity for mental health prevention and early intervention services at sites where people access other services such as health providers, education facilities, and community organizations; and 3) ensure earlier access to mental health services in order to lower the incidence of mental illness and suicide, to enhance wellness and resilience, and to reduce stigma and discrimination in Sonoma County. The Department plans to contract with approximately eight providers for these services based on the request for proposals that was completed in FY 20-21. In addition, the Department plans to contract with County of Sonoma Human Services Department’s Older Adult Collaboration and California Mental Health Services Authority.

Innovation Projects - Mental Health Services Act ($1,216,356)

In the fall of 2019, the Department conducted a community-based solicitation for MHSA Innovation Projects. The Innovation Component of the Mental Health Services Act (MHSA) requires counties to design, pilot, assess, refine, and evaluate a “new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges” (Welfare and Institutions Code Section 5830, subdivision (c)). The eventual goal is for counties to implement successful practices without Innovation Funds after a maximum of five years and to disseminate successful practices to other counties. Counties can expend Innovation Funds for a specific Innovative Project only after the Mental Health Services Oversight and Accountability Commission approves the funds for that Innovative Project. The Department plans to contract with approximately 12 providers in amounts ranging from $51,987 to $412,569.

Residential Care Facilities ($7,280,767)

Support services provided to adults in licensed community care facilities fall into two broad categories. Contractors provide an organized treatment program with a daily schedule of activities designed to help clients learn daily living skills, understand their mental illness, and/or deal with substance use disorder issues in preparation for moving into a more independent living situation, if possible. The remaining contracts are with licensed board and care providers that offer limited supervision of clients, assistance with managing medications, and help with the activities of daily living. The Department plans to contract with approximately 17 providers for these services, based on client need, in amounts ranging from $37,230 to $1,516,932.

Specialty Mental Health Services for Adults ($5,005,972)

Includes both residential and outpatient specialty mental health services to ensure that individual’s treatment, counseling, and case management needs are addressed. These community-based programs provide for the specialized needs of clients and provide services to Mental Health Plan clients in residential care facilities. The Department plans to contract with five providers for these services, based on client need, for a total amount of up to $5,005,972, in amounts ranging from $205,443 to $1,294,588. The Department plans to contract with currently unidentified providers, based on client need, for a total amount of up to $295,669.

Specialty Mental Health Services for Youth and Families (4,491,100)

Includes outpatient mental health youth and family services to ensure that individual/family counseling and case management needs are addressed. A majority of services in this category were competitively procured in early 2019 and four-year contracts with three providers were executed for services beginning July 1, 2019, in the amount of up to $4,438,489 annually. $647,389 of this amount has been shifted to county staff costs to increase the number clients seen in the child full-service partnership, FASST. Additional services may be required for specialized placements that the identified providers do not have the ability to serve, such as a very young child or a child with very specialized needs such as eating disorders. The Department plans to contract with currently unidentified providers, based on client need, for a total amount of up to $700,000.

Specialty Mental Health Services for Youth in Foster Care ($4,227,410)

Partnerships with agencies that provide specialty mental health services to ensure that the mental health treatment needs of youth in foster care (or other placements) are appropriately met. Services are available to children who have been assessed and identified as requiring specific levels of mental health intervention, and may also be eligible for services in Short-Term Residential Therapeutic Programs, Intensive Services Foster Care programs and Wraparound. The Department plans to contract with six providers for these services in amounts ranging from $150,000 to $2,050,000. Various additional services may be required for specialized placements that the identified providers do not have the ability to serve, such as a very young child or a child with very specialized needs such as eating disorders. Use of additional providers will result in a decreased cost of identified providers.

Substance Use Disorder Services (SUDS) ($7,707,988)

Consistent with state requirements for providing substance use disorders services through the Drug Medi-Cal program, the Department maintains an open provider network and any licensed provider may submit a request to contract to provide behavioral health services. Requests are reviewed on an ongoing basis and approved as needed.

A competitive recruitment for substance use disorder services is currently underway for agreements starting October 1, 2021 and ending no later than June 30, 2023. To allow for continuity and transition, if needed, of services as a result of this process, the Department will be extending current agreements for these services by three months (July 1 - September 30, 2021). In summary, the Department plans to extend current contracts for three months with six providers in the amount of $2,019,982 and for the remaining nine months in FY 21-22 with an undetermined amount of providers in the amount of $5,688,006. In FY 22-23, the contracts awarded through the request for proposal process will be for the full annual total of $7,653,238.

                     Narcotic Treatment Programs

This program provides outpatient therapeutic substance use disorder treatment in the form of Narcotic Replacement Therapy (such as methadone) and draws down Drug Medi-Cal federal financial participation dollars. While awaiting the results of the competitive procurement process, the Department plans to extend current contracts with two providers for three months in the amount of $693,122.

                     SUDS Outpatient

Therapeutic outpatient substance use disorder treatment services may be provided in lieu of incarceration for inmates of the Main Detention Facility and North County Detention Facility, or to residents of the community in need of therapeutic outpatient substance use disorder treatment. While awaiting the results of the competitive procurement process, the Department plans to extend current contracts with three providers for three months in the amount of $381,490.

                     SUDS Perinatal & Parenting Residential & Outpatient

Perinatal substance use disorder treatment services are designed to support pregnant and parenting women through intensive outpatient treatment programs and residential treatment. These services can be accessed through community partner referrals, criminal justice system referrals, or self-referral. Both the residential and outpatient services include on-site child care and transportation for clients. While awaiting the results of the competitive procurement process, the Department plans to extend current contracts with two providers for three months in the amount of $225,914.

                     SUDS Residential Non-Medical Detoxification

Drug Abuse Alternatives Center provides 10 residential non-medical detoxification beds at the Orenda Center. While awaiting the results of the competitive procurement process, the Department plans to extend current its contract with this single provider for three months in the amount of $116,228.

                     SUDS Residential Treatment

Residential treatment services provides therapeutic inpatient substance use disorder treatment. Services may be provided in lieu of incarceration for inmates of the Main Detention Facility and North County Detention Facility. Services may be provided to residents of the community in need of therapeutic residential substance use disorder treatment. While awaiting the results of the competitive procurement process, the Department plans to extend current contracts with two providers for three months in the amount of $603,228.

Supportive Services to Adults in Independent Living Settings ($1,549,766)

The treatment goal for all mental health clients is for them to live in the community as independently as possible. A variety of living arrangements are available to clients including single or shared apartments, and homes shared by a small number of individuals. Contract providers send staff to clients’ homes to teach and assist them in accomplishing all the tasks necessary to live independently, including menu planning, grocery shopping, budgeting and paying bills, taking medications as prescribed, etc. The Department plans to contract with two providers for these services in amounts ranging from $236,398 to $1,313,368.

Temporary Specialty Mental Health Service Agency Providers ($1,701,969)

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. The Department plans to contract with five identified providers for these services in amounts ranging from $124,800 to $588,121.

Support Services

The proposed budget for fiscal year 2021-2022 includes $2,422,271 for services to support the delivery of client and program related services. Following is a description of proposed support service contracts. A list of support services providers is presented in Attachment 1.

Netsmart Technologies Inc. ($1,032,034) Ongoing development, support, and implementation of the Avatar electronic health record for mental health services. The Avatar application was selected and approved by the Board in January of 2012 based upon a Statewide California Behavioral Health Systems coalition, comprised of 27 California Counties which reviewed 44 software products. The Avatar system will be used to submit claims to Medi-Cal and Medicare for services in fiscal year 2013-2014 and beyond, and perform related clinical, accounting and reporting functions. The software developer, Netsmart, is the sole source for this maintenance agreement.

Counties of Contra Costa, Marin and San Mateo ($151,832) The County of San Mateo contracts with Optum to provide after-hours phone coverage to the 1-800 numbers that are accessible to residents and Medi-Cal beneficiaries of San Mateo, Marin, Sonoma, and Contra Costa Counties seeking behavioral health services. This agreement funds Sonoma County’s portion of the contract with Optum.

The SmithWaters Group ($208,000) Oversight of Patient’s 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.

Revenue Agreement with Aurora Behavioral Healthcare

Aurora Behavioral Healthcare provides inpatient psychiatric hospitalization for Medi-Cal clients under the age of 21 and over 65. In addition, the Department contracts with Aurora to provide inpatient hospitalization and associated psychiatric professional fees for Medi-Cal Mental Health Plan clients who fall between those ages. Aurora clients needing acute inpatient psychiatric hospitalization and having a residence outside of Sonoma County may require services provided by the County. For the County to be reimbursed by Aurora for these costs, the Department is requesting approval to enter into an agreement with Aurora. In consideration of the associated costs, Aurora will reimburse the County with an administrative fee in the amount of $250,000 for fiscal year 2021-2022.

Competitive Procurement

During fiscal year 2018-2019, the Department assessed the various types of contracted behavioral health services and embarked on a contracting reform effort to enhance the process of procuring services through a competitive process and to ensure that contracts have performance requirements for quality outcomes. In addition to the 2019 Behavioral Health Services for Sonoma County Youth and 2020 Consumer Peer Support/Recovery and Training Services requests for proposals, the Department released a request for proposals in March 2021 for Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) Services; in April 2021 for Administrative Hearing Officer Services and Mental Health Block Grant (MHBG) First Episode Psychosis (FEP) Services; and in May 2021 for Substance Use Disorder & Recovery Services. This competitive procurement exemplifies Department efforts to align with the contracting principles for safety net programs adopted by the Board in April 2019. Alignment with the contracting principles promotes fair and open competition in selecting vendors and helps to ensure that behavioral health services are provided equitably and fairly across all regions of the County.

In the fall of 2019, the Department conducted a community-based solicitation for MHSA Innovation Projects that will initiate in FY 20-21. The Department worked with diverse stakeholders on the MHSA Steering Committee and the Committee’s Innovation Subcommittee to develop a process that successfully solicited Innovation project applications from the community. A total of 16 Innovation applications were received. The Innovation Subcommittee reviewed and scored all of the applications. The top five scoring applications were presented to the MHSA Steering Committee and the Department for review and approval. The following five proposals were approved to be sent to the Mental Health Services Oversight and Accountability Commission (MHSOAC) for final approval:

                     Early Psychosis Learning Health Care Network (EP LHCN) - Buckelew Programs, Aldea Children and Family Services, and UC Davis

                     Nuestra Cultura Cura Social Innovations Lab - On the Move, La Plaza, Humanidad, Raizes Collective, and Latino Service Providers

                     New Parent TLC - First 5 Sonoma County

                     Instructions Not Included - Early Learning Institute

                     Collaborative Care Enhanced Recovery Project (CCERP) - Sonoma County Human Services Department and Santa Rosa Community Health Clinics

The Department will continue its phased approach for competitive procurement of behavioral health services in fiscal year 2021-2022, as planned with planned release of requests for proposals for Behavioral Health Services for Sonoma County Adults; Mental Health Services Act (MHSA) Community and Service Supports (CSS) programs; Supportive Services for Adults in Independent Living Settings; and professional temporary service agencies (including locum tenens).

By competitively procuring additional types of behavioral health services, the Department seeks to identify the most capable, responsive, and responsible providers to deliver necessary services. As competitive procurement of behavioral health services continues, existing and potential providers will gain familiarity with the process and better understand how to obtain funding from the County. Further, through implementation of enhanced contract management and monitoring in alignment with the contracting principles, the Department and Board will have an enhanced ability to evaluate program effectiveness to ensure that County resources are being spent effectively.

Through the assessment of the various types of contracted behavioral health services, the Department has identified a number of service types that are not feasible for competitive procurement.

1)                     Services provided by Residential Care Facilities, Long-Term Care Facilities, and Inpatient Hospitals are purchased for specific individual clients based on the client’s unique needs and are not appropriate to competitively procure. The Department selects a vendor for each client according to the vendor’s ability to meet the clients’ needs and expectations, and availability. As such, services are purchased at the rate offered by the provider. Other services identified as not being suitable for competitive procurement include certain services for psychiatry, eating disorder specialty treatment, and electroconvulsive therapy as well as services to be provided under the County’s responsibility to meet State Continuity of Care requirements (i.e., beneficiaries may request to continue services with a provider outside of contracted services), which are purchased from individual providers/Independent Contractors. In FY 20-21, the Department is given authority to enter into contracts for services identified in this paragraph for up to three years in a not to exceed amount of $16,042,142. Additional authority was requested and granted by the Board on April 6, 2021 to increase the not to exceed amount to $17,358,361. An additional $1,143,188 increase is requested in this Board item.

2)                     Specialty Mental Health Services provided to youth in Foster Care

The department enters into multiple agreements with agencies that provide specialty mental health Sonoma County’s youth in foster care. These providers are approved and referred to by the Human Services Department. Under the County of Sonoma Mental Health Plan, we are mandated to pay for any specialty mental health services that are provided to the youth while they are with the provider. As such, these agreements are not suitable for competitive procurement. Through this board item, the department is requesting authority to enter into contract for these services for up to three years in a not-to-exceed amount of $4,227,410, annually.

 

Prior Board Actions:

The Board annually authorizes the Director of Health Services to execute agreements for mental health and substance use disorder services and support services agreements for behavioral health services.

On April 6, 2021 the Board approved execution of agreements and amendments for mental health and substance use disorder services and related support services, increasing the fiscal year 2020-2021 not-to-exceed amount to $45,094,355, including authorization to execute agreements and amendments for Residential Care Facilities, Long-Term Care Facilities, Inpatient Hospitals, and Independent Contractors providing behavioral health services for which competitive procurement is not feasible with a term ending no later than June 30, 2023, for a not-to-exceed amount of up to $17,358,361 annually.

On August 4, 2020 the Board approved 1) execution of agreements and amendments for mental health and substance use disorder services and related support services, including agreements for fiscal year 2020-2021 in an amount not-to-exceed $43,130,831; 2) execution of agreements and amendments for Residential Care Facilities, Long-Term Care Facilities, Inpatient Hospitals, and Independent Contractors providing behavioral health services for which competitive procurement is not feasible with a term ending no later than June 30, 2023, for a not-to-exceed amount of up to $16,042,142 annually; 3) execution of an agreement with NetSmart Technologies, Inc. for a software license and services agreement to provide an integrated information system with clinical decision support for behavioral health services for a term beginning July 1, 2020 and ending no later than June 30, 2023, for a not to exceed amount of up to $1,032,034 annually; 4) execution of agreements and amendments for Peer Support/Recovery and Training Services, competitively procured during fiscal year 2019-2020, with a term beginning in fiscal year 2020-2021 and ending no later than June 30, 2024, for a not to exceed amount of up to $1,431,150 annually.

On July 9, 2019 the Board approved execution of agreements and amendments for mental health services for youth, competitively procured during fiscal year 2018-2019, with a term beginning July 1, 2019 and ending no later than June 30, 2023 for a not to exceed amount of $4,438,489 annually.

 

Fiscal Summary

 Expenditures

FY 20-21 Adopted

FY 21-22 Proposed

FY 22-23 Projected

Budgeted Expenses

43,130,831

53,254,011

53,254,011

Additional Appropriation Requested

 

 

 

Total Expenditures

43,130,831

53,254,011

53,254,011

Funding Sources

 

 

 

General Fund/WA GF

5,661,125

2,815,792

2,815,792

State/Federal

37,469,706

40,835,752

40,835,752

Fees/Other

 

9,602,467

9,602,467

Use of Fund Balance

 

 

 

Contingencies

 

 

 

Total Sources

43,130,831

53,254,011

53,254,011

 

Narrative Explanation of Fiscal Impacts:

The fiscal year 2021-2022 budget includes $50,831,740 for provider treatment services contracts and $2,422,271 for support services contracts, totaling $53,254,011. Of the total amount, delegated authority is being requested in the amount of $45,964,425. Contract authority of $2,585,682 is for various services providers, primarily providers of medically necessary behavioral health services from both existing and not yet identified providers as the need is identified.

The mental health and substance use disorder treatment and support services contracts are funded by Medi-Cal/Federal Financial Participation, Mental Health Services Act, 1991 Mental Health Realignment, 2011 Behavioral Health Realignment, Measure O sales tax, Substance Abuse and Mental Health Services Administration grants, Investment in Mental Health Wellness Act of 2013 grants, reimbursements from other County departments, and approximately $2.7 million in County General Funds which primarily supports residential care facilities and substance use disorder services. Attachment 3 provides a list of service categories receiving Measure O funding.

 

Staffing Impacts:

 

 

 

Position Title (Payroll Classification)

Monthly Salary Range (A-I Step)

Additions (Number)

Deletions (Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

Narrative Explanation of Staffing Impacts (If Required):

N/A

 

Attachments:

Attachment 1 - Mental Health and Substance Use Disorder Treatment Services Providers

Attachment 2 - Mental Health and Substance Use Disorder Services Providers - Total Amount Per Provider

Attachment 3 - Service Categories Receiving Measure O Funding

 

Related Items “On File” with the Clerk of the Board:

None