Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings that the provision of Specialty Mental Health Services (SMHS) children and youth services provided by the contractors are in the public's best interest and that there are specialty skills, qualifications, and equipment not expressly identified in County classifications involved in the performance of the work in accordance with El Dorado County Ordinance Code, Chapter 3.13.030(B);
2) Make findings to waive the competitive bid process for the five specified SMHS HHSA Agreements for Services (7928, 7937, 7938, 7940 and 7944) in accordance with County’s Procurement Policy Section 3.4.2(f), Exemption from Competitive Bidding, as the Providers of these Agreements possess critical knowledge, including the required staff, facilities, and level of care certifications and facility licenses, to ensure continuity of these mandated services;
3) Authorize the Chair to execute Agreement for Services 7928 with New Morning Youth and Family Services, Inc., for the provision of SMHS, in the amount of $775,008, with an 18-month term, for the retroactive term start date of July 1, 2023, through December 31, 2024, to ensure that HHSA can meet the Department of Health Care Services (DHCS) required implementation date of this new agreement, in compliance with the California Advancing and Innovating Medi-Cal (CalAIM) contract change requirements for these services;
4) Authorize the Chair to execute Agreement for Services 7937 with Summitview Child and Family Services, Inc., for the provision SMHS Short-Term Residential Treatment Program (STRTP) services, in the amount of $2,325,000, with an 18-month term, for the retroactive term start date of July 1, 2023, through December 31, 2024, to ensure that HHSA can meet the DHCS required implementation date of this new agreement, in compliance with the CalAIM contract change requirements for these services;
5) Authorize the Chair to execute Agreement for Services 7938 with Summitview Child and Family Services, Inc, for the provision of SMHS, in the amount of $2,092,500, with an 18-month term, for the retroactive term start date of July 1, 2023, through December 31, 2024, to ensure that HHSA can meet the DHCS required implementation date of this new agreement, in compliance with the CalAIM contract change requirements for these services;
6) Authorize the Chair to execute Agreement for Services 7940 with Sierra Child & Family Services, Inc., for the provision of SMHS, in the amount of $3,255,000, with an 18-month term, for the retroactive term start date of July 1, 2023, through December 31, 2024, to ensure that HHSA can meet the DHCS required implementation date of this new agreement, in compliance with the CalAIM contract change requirements for these services;
7) Authorize the Chair to execute Agreement for Services 7944 with Stanford Youth Solutions doing business (dba) as Stanford Sierra Youth & Families, for the provision of SMHS, with a not-to-exceed amount of $2,015,004, with an 18-month term, for the retroactive term start date of July 1, 2023, through December 31, 2024, to ensure that HHSA can meet the DHCS required implementation date of this new agreement, in compliance with the CalAIM contract change requirements for these services;
8) Authorize the Purchasing Agent to execute amendments relating to these SMHS Agreements, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amounts or terms of the agreements; and
9) Authorize the HHSA Director or the HHSA Behavioral Health Director to execute programmatic, administrative, and fiscal documents relating to these agreements.
FUNDING: Federal and State Funding: 50% Federal Medi-Cal, 13% Realignment, and 37% Mental Health Services Act.
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DISCUSSION / BACKGROUND:
The Mental Health Plan (MHP) in each county is responsible for providing or arranging for the provision of SMHS to local residents that are Medi-Cal beneficiaries. Medi-Cal is California’s Medicaid program that provides public health insurance to low-income people, including families with children, seniors, persons with disabilities, foster care, pregnant women, and low-income individuals diagnosed with specific diseases to cover needed health care services. Beneficiaries become eligible for SMHS when an identified mental health condition has a significant impact on the individual’s life functioning.
The HHSA Behavioral Health Division (BHD) acts as the MHP for the County of El Dorado and thereby has the obligation to provide eligible children, youth, and young adult residents with access to designated SMHS, in accordance with California Welfare and Institutions Code (WIC) Section 5600 et seq., 5775 et seq., 14000 et seq., and 17000 et seq. Mandated SMHS programs include outpatient mental health services such as medication therapeutic services, inpatient services such as acute psychiatric hospitalizations, and certain types of residential placements. Beginning in early 2023, DHCS developed program and payment reform across the Medi-Cal program, called the California Advancing and Innovating Medi-Cal (CalAIM) initiative. CalAIM is the State’s comprehensive plan to transform the Medi-Cal program and enable it to work more seamlessly with other social services. Under CalAIM, DHCS will add new programs and make important reforms to many existing Medi-Cal programs, including SMHS, Substance Use Disorder (SUD), and Residential Treatment Programs, to improve the quality of life and health outcomes of Medi-Cal eligible individuals.
CalAIM is transitioning Mental Health programs from a cost-based reimbursement model to a fee-for-service-based reimbursement model. DHCS established July 1, 2023, as the California counties’ deadline for achieving said documentation and payment reforms. Consequently, as HHSA BHD contracts with multiple licensed providers to deliver most of the SMHS for County residents, all of the existing SMHS contracts require new CalAIM contract language and new Medi-Cal billing rates, resulting in new agreements to be developed by this deadline.
In April 2023, HHSA BHD received a SMHS contract boilerplate template and new Medi-Cal reimbursement rates from the State and has diligently worked to review and implement these changes to create new service agreements with the providers of these services to meet this due date.
The SMHS County Agreements impacted by the CalAIM, that required renewal agreements to be developed and retroactively executed by July 1, 2023, are as follows:
1. New Morning Youth and Family Services, Inc., Agreement 7928, the renewal of Agreement 5615 for youth SMHS services which expired June 30, 2023, approved by the Board on June 8, 2021 (File ID 21-0543);
2. Summitview Child and Family Services, Inc., Agreement 7937, the renewal of Agreement 5619 for youth SMHS STRTP services which expired June 30, 2023, approved by the Board on June 8, 2021 (File ID 21-0546);
3. Summitview Child and Family Services, Inc., Agreement 7938, the renewal of Agreement 5617 for youth SMHS services which expired June 30, 2023, approved by the Board on June 22, 2021 (21-0545);
4. Sierra Child & Family Services, Inc., Agreement 7940, the renewal of Agreement 5495 for youth SMHS services which expired June 30, 2023, approved by the Board on May 18, 2021 (File ID 21-0301); and
5. Stanford Youth Solutions doing business (dba) as Stanford Sierra Youth & Families Agreement 7944, the renewal of Agreement 5616 for youth SMHS services which expired June 30, 2023, approved by the Board on June 8, 2021 (File ID 21-0543).
Due to DHCS’ mandate for CalAIM implementations coupled with the short turn-around time frame to meet July 1, 2023, targeted date, HHSA BHD is recommending the Board authorize the Chair to execute these renewal agreements. Due to this CalAIM implementation demand, HHSA BHD is requesting the Board authorize the retroactive service start date for these CalAIM-impacted contracts. These agreements ensure compliance with all Federal and State requirements and will continue to uphold parameters such as consistency in service delivery expectations, performance measures and outcomes, productivity, and funding.
SMHS require a specialized skill set and treatment approach and are not effectively remediated by a general provider in the field of mental health. Consequently, to ensure continuity of SMHS among the existing providers, who possess the qualified staffing and Drug Medi-Cal certified facilities to provide these services, HHSA, in concurrence with the County Chief Administrative Office Contracts and Procurement Division, is requesting the Board approve the non-competitive bid exemption for these agreements.
ALTERNATIVES:
Should the Board decline to approve these recommendations, HHSA would not have providers under contract to provide the mandated SMHS. Consequently, HHSA would not fulfill the obligations required of serving as the MHP and will be out of compliance with the County's responsibilities as the MHP and with the State's new CalAIM requirements.
PRIOR BOARD ACTION:
1) 01/12/22, 22-0157, HHSA CalAIM Presentation and Overview
2) 06/22/21, 21-0545, HHSA Summitview Child & Family 5617
3) 06/08/21, 21-0543, HHSA New Morning Youth & Family, 5615
4) 06/08/21, 21-0544, HHSA Stanford Sierra Youth & Family 5616
5) 06/08/21, 21-0546, HHSA Summitview Child & Family - STRTP 5619
6) 05/18/21, 21-0301, HHSA Sierra Child & Family 5495
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management reviewed and approved that boilerplate agreement. Chief Administrative Office Procurement and Contracts Division approved the Non-Competitive Bid Forms. The Auditor-Controller was notified of these agreements in accordance with Policy B-12.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda item. Sufficient appropriations for SMHS for Federal Medi-Cal, Realignment, and Mental Health Services Act were included in the Fiscal Year 2023-24 Budget and will be included in future budgets for the term of the agreements, as well as Medi-Cal reimbursement as appropriate.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on Agreements for Services 7928, 7937, 7937, 7940 and 7944.
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Interim Director, Health and Human Services Agency