Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Adopt and authorize the Chair to sign Resolution 230-2024, which will repeal and replace Resolution 028-2020, which delegates authority to the HHSA Director, or Chief Assistant Director, to execute Specialty Mental Health Services Short-Term Residential Treatment Program (STRTP) Single Case Agreements with other counties and out-of-county STRTP-certified providers, utilizing the County Counsel and Risk Management approved contract templates attached in the Resolution, when urgent out-of-County client placements are needed, as follows:
a) Authorizes the use of the STRTP Single Case Agreement (SCA) template for use with other counties to place a client in need of services (attachment A of the Resolution) and the STRTP Admission Agreement (AA) template for use with out-of-County STRTP providers to place a client in need of services (attachment B of the Resolution);
b) Authorizes the term of the STRTP SCA and AA Agreements to be effective one-year from execution by all parties, with the start date to begin effective on the client’s admission date into the STRTP, allowing a retroactive start date (if needed) based upon a client’s need for emergency placement, with the option to extend the agreement’s term an additional six-months if needed for continued client care, for an initial not to exceed amount of $200,000 for the one-year term, and a total maximum obligation not to exceed $300,000 if the six-month extension is granted, for the total term not to exceed 18-months; and
c) Authorizes the HHSA Director, or Chief Assistant Director, to execute the finalized agreements utilizing the STRTP SCA and STRTP AA agreement templates, including any amendments, which do not increase the maximum dollar amount of the agreements beyond $300,000 or term of the agreements beyond 18-months, and any administrative, and fiscal documents relating to these agreements, contingent upon approval of any template changes by County Counsel and Risk Management, as applicable; and
2) Make findings in accordance with Procurement Policy C-17 Section 3.4(3) exempting the competitive bidding process for the resulting STRTP SCA and AA Agreements, with Purchasing Agent concurrence, as competitive bidding would produce no economic benefit to the County.
FUNDING: Federal Medi-Cal and State Mental Health Service Act (MHSA) funding.
Body
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 Specialty Mental Health Services (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 Section 14717.1, which established presumptive transfer, requiring 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.
Consequently, to allow HHSA to meet this mandate, on March 10, 2020, the Board adopted Resolution 028-2020, approving the use a Short-Term Residential Treatment Program Short-Form boilerplate agreement for the term of 90 days and a maximum obligation of $9,999, and approved the HHSA Director to execute such agreements utilizing this template on an “as needed” basis in order to place foster youth and children in need of SMHS into an out-of-county accredited STRTP facility (Legistar file 20-0012). This template was designed to cover the immediate cost of the client placement over a short time frame while HHSA processed a longer-term agreement.
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. 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.
HHSA recommends the Board approve these recommendations to enable HHSA to expedite the processing of the STRTP agreements necessary for the County to contract with other counties and STRTP facility providers for placements of clients. HHSA is requesting the Board authorize retroactive start dates on these agreements when needed, based on a client’s admission date into an out-of-county accredited STRTP, to ensure timely delivery of mandated SMHS services, and enable the County to meet its MHP service requirements. Board approval of the proposed Resolution presented in this agenda item will repeal and replace Resolution No. 028-2020.
In accordance with Board of Supervisors Procurement Policy C-17, HHSA recommends that agreements utilizing these STRTP templates be exempt from competitive bidding, with Purchasing Agent concurrence, as “competitive bidding would produce no economic benefit to the County” as HHSA contracts with as many counties and certified STRTP providers throughout the State as possible to allow HHSA’s Behavioral Health Division to meet its obligations for the provision of these mandated services, as required through the County’s Medi-Cal Mental Health Plan contract with the DHCS. Because the need for STRTP services outweighs the availability of beds, other counties or qualified providers are not anticipated to respond to any competitive solicitation.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA as the County MHP may have difficulty placing eligible foster youth and children in an out-of-County STRTP when the needs arise, thus delaying timely delivery of services, which may result in non-compliance with County’s MHP service requirements.
PRIOR BOARD ACTION:
03/10/2020, 20-0012, HHSA Short-Term Residential Treatment Program Short-Form Template/Resolution
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management. The Auditor Controller was notified of these templates per Policy B-12.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Funding for the STRTP Single Case Agreements with other counties and the STRTP Admission Agreement with out-of-County STRTP providers are covered through the federal Medi-Cal program or 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 the resulting agreements and will be included in future budgets for the terms of future agreements.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain the signature of Chair on one (1) original Resolution; and
2) Clerk of the Board to provide HHSA with a certified copy of the adopted Resolution.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency