Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings pursuant to Section 3.13.030 (B) of the El Dorado County Ordinance Chapter 3.13, Contracting Out, that the Specialty Mental Health Services Short-Term Residential Treatment Program services provided by the County of Fresno requires specialty skills and qualifications not expressly identified in County classifications are involved in the performance of the work;
2) Make findings in accordance with Procurement Policy C-17 Section 3.4(3) exempting the competitive bidding process, with Purchasing Agent concurrence, because “competitive bidding would produce no economic benefit to the County”;
3) Approve and authorize the Chair to sign Agreement for Services 9405 with County of Fresno, with a $15,000,000 million obligation that includes other California counties use of the Agreement, HHSA is only anticipating expending $600,000 under this Agreement, and for the term of execution through June 30, 2027, with the option to extend the agreement for no more than two one-year periods, for a term not to exceed five years; and
4) Authorize the Purchasing Agent to execute further documents relating to Agreement 9405, contingent upon approval by County Counsel and Risk Management, including amendments which do not increase the maximum dollar amount or term of the Agreement.
FUNDING: 50% State Mental Health Services Act and 50% State Realignment.
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DISCUSSION / BACKGROUND:
HHSA contracts with the California Department of Health Care Services (DHCS) to be the Mental Health Plan (MHP) in El Dorado County. As the MHP, HHSA is required to provide SMHS to qualified individuals, including foster youth and children receiving services through its Child Welfare Service Program and Behavioral Health Division, or County Probation Department Juvenile Services.
Effective July 1, 2017, Assembly Bill (AB) 1299 (Statutes of 2016) added California Welfare and Institutions Code (WIC) Section 14717.1, which established presumptive transfer. This provision mandates that when a child or youth in foster care is placed outside of their county of original jurisdiction, the responsibility to provide or arrange and pay for that child or youth’s SMHS transfers from the county of original jurisdiction to the county where the child or youth resides (also referred to as the “county of residence”) to ensure that foster children/youth are able to access mental health services in a timely manner.
Effective July 1, 2024, AB 118 (Statute of 2024) enacted changes to the prior presumptive transfer requirements by mandating that because certain residential placements are intended to be short-term based on medical necessity, the responsibility to provide and arrange for SMHS for youth and children shall remain with the child/youth’s county of residence and enforces that out-of-county placements should not disrupt continuity of care or adversely impact timely payment to providers. On June 28, 2024, DHCS distributed Behavioral Health Information Notice (BHIN) 24-025 clarifying these new regulations and outlined that it is expected that the county of original jurisdiction shall be proactive in establishing contracts with STRTP facilities and other counties in order to provide SMHS in a timely manner to clients living outside a county’s jurisdiction.
Currently, HHSA only has only one STRTP contract in place with a local community provider which is used for in-County client placements. In December 2024, to meet the need for out-of-County STRTP placements and meet statutes for timely out-of-County client placements, HHSA worked with County Counsel to develop two new STRTP contract templates to include: (a) the STRTP Single Case Agreement template to allow HHSA to quickly enter into contracts with other counties to place a client in need of services, and (b) the STRTP Admission Agreement template to allow HHSA to quickly enter into contracts with out-of-County STRTP providers. On December 10, 2024, the Board approved Resolution 230-2024 which approved the use of these two contract templates for STRTP Single Case Agreements with other counties and out-of-county STRTP-certified providers when urgent out-of-County client placements are needed (Legistar file 24-2106). Subsequently, other counties took the same action which resulted in most counties having their own slightly different template for the same services. Agreement 9405 is using Fresno County’s template approved by their board and as such cannot be changed without their board’s approval.
The agreement presented in this agenda item arranges for reimbursement between Fresno County and participating counties for the provision of SMHS to out of county youth who meet criteria for services, as established by WIC Section 14184.402. El Dorado County (EDC) will utilize this agreement when youth in EDC’s jurisdiction reside in Fresno County and have been determined to be in need of STRTP services and are referred by HHSA to a Fresno County STRTP. Execution of this agreement will allow EDC youth to be placed immediately. This agreement also arranges for the reverse, so that EDC may be reimbursed for SMHS provided to Fresno County youth residing in an EDC STRTP. It is important to note that while the maximum obligation of the County of Fresno Agreement 9405 is $15 million, this obligation includes other California counties usage of said agreement, and HHSA is only anticipating an amount not to exceed $600,000 for these services. Medi-Cal will pay a large portion of the service costs up front and then the counties will bill each other only for their match cost which El Dorado pays using MHSA and State Realignment funds.
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(3) which states “competitive bidding would produce no economic benefit to the County.” EDC contracts with as many SMHS licensed STRTP providers as possible throughout the state to meet regulatory guidelines, therefore competitive bidding would produce no economic benefit.
ALTERNATIVES:
Should the Board decline to approve this recommendation and HHSA does not contract with the County of Fresno, the County will continue to be severely limited in its access to out-of-County STRTP facilities. With only one contracted STRTP provider, the availability of a bed cannot be guaranteed. As a result, the County has diminished capacity to provide mandated SMHS services and risks being out of compliance with timely access requirements pursuant to Title 9 Section 1810.405 CCR. Additionally, BHIN 24-025 is clear that out-of-county placements should not disrupt continuity of care for the youth or adversely impact timely payment to providers.
PRIOR BOARD ACTION:
12/10/24, 24-2106, HHSA Out-of-County Short-Term Residential Treatment Program (STRTP) Single Case Templates and Resolution.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources, Procurement and Contracts, and Risk Management. Auditor Controller was notified 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 funding for STRTP agreements with other counties is covered through the federal Medi-Cal program and have been included in HHSA's Board adopted MHSA-Year Expenditure Plan. Sufficient Medi-Cal and MHSA appropriations have been included in HHSA’S Fiscal Year 2024-25 Budget to cover the cost of this agreement and will be included in future budgets for the terms of this agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on original Agreement for Services 9405.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency