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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings pursuant to Section 3.13.030 (C) of the El Dorado County Ordinance, Contracting Out, that the provision of as-needed public health nursing and Behavioral Health staffing services provided by Amergis Healthcare Staffing, Inc. (Amergis) is in the public’s best interest due to the limited timeframes, temporary or occasional nature, or schedule for the project or scope of work to be performed is not sufficient to warrant addition of permanent staff;
2) Make findings in accordance with Procurement Policy C-17 Section 3.4(2f) exempting the competitive bidding process, with Purchasing Agent concurrence, because “the procurement is for services where the continuity of providers will provide efficiency or critical knowledge, and other providers of the services cannot provide similar efficiencies or critical knowledge”;
3) Approve and authorize the Chair to sign Amendment II to Agreement for Services 7954 with Amergis, to update various contract provisions, include optional associate level classifications and rates, increasing the as-needed contract value by $1,400,000 for the initial two year term ending on December 31, 2025, for a new total amount of $2,000,000, and adding an optional one year extension through December 31, 2026, with an additional obligation of $1,000,000 for the extension, for a total not-to-exceed amount of $3,000,000, if the extension is granted;
4) Authorize the Purchasing Agent to execute amendments relating to Agreement 7954, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amount or term of the Agreement; and
5) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 7954.
FUNDING: 50% Federal and State, 40% Mental Health Services Act, 10% Behavioral Health Realignment.
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DISCUSSION / BACKGROUND:
On December 5, 2023, the Board authorized the Chair to execute Agreement 7954 with Maxim Healthcare Staffing Services, now known as Amergis, for the term of December 5, 2023, through December 31, 2025, with a maximum obligation of $200,000 to address HHSA Public Health Division's (PHD) critical nursing staffing needs (Legistar file 23-1757). Subsequently, the Board approved the First Amendment to this Agreement on September 24, 2024, to address significant staffing shortages in the HHSA Behavioral Health Division (BHD), increasing the maximum obligation to $600,000 (Legistar file 24-1324).
HHSA BHD has been facing significant staffing shortages, impacting both temporary and permanent positions, including critical vacancies in the role of Mental Health Clinicians. Notably, this position has sustained a 40% vacancy rate for over a year, intensifying the strain on the BHD's ability to deliver essential services. To address these shortages, Amergis staff have been strategically assigned to key areas within the County’s BHD system of care for adult beneficiaries, ensuring continuity and quality of care. As the Medi-Cal Mental Health Plan (MHP) in the County, HHSA BHD is mandated to provide specialty mental health services (SMHS) to Medi-Cal beneficiaries in accordance with Title 9, California Code of Regulations, Section 1810.100. This responsibility underscores the importance of addressing BHD’s existing staffing needs to meet regulatory obligations and deliver comprehensive mental health care to the community.
HHSA recommends that the Board approve Amendment II to Agreement 7954 with Amergis to address its staffing shortages and better meet County resident’s behavioral health related needs. Amendment II updates various contract provisions, includes optional associate level classifications and rates, increases the as-needed contract value by $1,400,000 for the initial two year term ending on December 31, 2025, and adds an optional one year extension through December 31, 2026, with an additional obligation of $1,000,000 for the extension. Behavioral Health has utilized a significant portion of the current not-to-exceed (NTE) amount under the existing agreement, primarily to support critical temporary staffing placements. Between January and April, the program maintained approximately four to six temporary placements, with three additional priority positions identified for assignment following this amendment. The proposed amendment includes an option to extend the agreement term, allowing any unexpended funds as of December 31, 2025, to remain available through December 31, 2026. This structure provides added flexibility enabling continued alignment of temporary staffing with operational needs and available budget. HHSA hopes that current vacancy rates improve for Behavioral Health resulting in a slower rate of utilizing this contracted service.
In accordance with Board of Supervisors Procurement Policy C-17, the contractor is exempt from competitive bidding, with Purchasing Agent concurrence, per Section 3.4 (2)(f), as the procurement is for services where the continuity of providers will provide efficiency or critical knowledge, and other providers of the services cannot provide similar efficiencies or critical knowledge. Through this Agreement, Amergis has provided as-needed staffing services for both Public Health and Behavioral Health positions. Public Health staffing includes nursing and non-nursing roles, while Behavioral Health staffing covers specialty mental health services and crisis intervention. The acquisition is restricted to this vendor because they have a unique capability to provide both Public Health and Behavioral Health staffing services in response to the critical staffing shortages for both divisions. Amergis’ reliable performance and familiarity with the agency's specific needs make them uniquely qualified to expand services for increased Behavioral Health staffing.
ALTERNATIVES:
Should the Board decline to approve this recommendation, hard-to-fill HHSA BHD clinical positions are likely to continue remaining vacant for extended periods of time. These vacancies greatly impact the County's ability to provide quality of care, reduce staffing shortage, and remain in compliance with California Regulation and could put the County at risk for fines, sanctions or penalties.
PRIOR BOARD ACTION:
1) 08/25/20, 20-1024, HHSA Maxim Healthcare Staffing Svcs, 5061
2) 01/26/21, 21-0031, HHSA Maxim Healthcare Staffing Services, 5061 A2
3) 11/16/21, 21-1008, HHSA #5061-A3 Maxim Healthcare Staffing Services, Inc.
4) 12/05/23, 23-1757, HHSA Maxim Healthcare Staffing Services, 7954
5) 09/24/24, 24-1324, HHSA Amergis Staffing Services (Maxim), 7954 A1
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources, and Risk Management. The Auditor-Controller has been notified per Policy B-12.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Sufficient appropriations were included in the Fiscal Year 2024-25 Budget, the FY 2025-26 Budget request and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Amendment II to Agreement for Services 7954.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency