Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings in accordance with County Ordinance 3.13.030(F) that contracting out for Patients’ Rights Advocate services is necessary to protect against a conflict of interest or to ensure independent and unbiased findings where there is a need for an outside perspective;
2) Approve and authorize the Chair to sign competitively procured Agreement for Services 10337 with The SmithWaters Group, with an amount not to exceed $386,715 for the initial term, effective upon final execution, covering the period beginning the first of the month following final execution through June 30, 2029, with the option to extend the Agreement for one additional year through June 30, 2030, adding an additional $145,860.75 for the extended term if that option is exercised, for a total maximum obligation of $532,575.75;
3) Authorize the Purchasing Agent to execute amendments relating to Agreement 10337, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amount or term of the Agreement; and
4) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 10337.
FUNDING: 75% Behavioral Health Services Act, 25% Realignment.
Body
DISCUSSION / BACKGROUND
On November 10, 2025, on behalf of HHSA, the Chief Administrative office (CAO) Procurement and Contracts Division released Request for Qualifications (RFQ) 2025-0155 to solicit qualified Respondents to provide PRA services at the County-owned Psychiatric Health Facility (PHF) located in Placerville. Three responses were received and evaluated. As a result of the evaluative process, The SmithWaters Group was deemed qualified for award of this RFQ and selected by HHSA to contract for these services.
The California Welfare and Institutions Code (WIC) sections 5325, 5370.2, 5521, and 5520-5550 establish the County’s mandate to safeguard the statutory rights of individuals receiving behavioral health services, including inpatients, individuals subject to involuntary holds or medication capacity determinations, and persons filing rights-based grievances within the County’s Behavioral Health system. Because these functions require independence and impartiality, providing PRA services using County staff would create an inherent conflict of interest. Accordingly, the County is required to contract with an external provider to ensure these duties are carried out by a qualified and independent entity.
The proposed Agreement 10337 with The SmithWaters Group will provide comprehensive PRA services consistent with State requirements. These services include representation and support during certification review hearings (including 5250 proceedings), Riese medication capacity hearings upon request, and advisement on rights such as the writ of habeas corpus. The SmithWaters Group will also assist with grievance and problem-resolution processes, conduct education and outreach for clients, families, and providers, perform facility visits and compliance monitoring, coordinate with the Department of Health Care Services and other partners, and maintain all required logs, records, and reports. Collectively, these activities promote the protection of client rights, ensure timely hearings and grievance resolution, support compliance with State and federal regulations, and enhance overall system accountability and client experience.
HHSA recommends the Board approve Agreement 10337 to obtain PRA services from an external provider. Reliance on internal staff could limit the County’s ability to ensure timely hearings, grievance investigations, and compliance monitoring, thereby increasing the risk of delays or non-compliance with State mandates. Contracting with an independent provider mitigates these risks by ensuring impartiality, strengthening regulatory compliance, and maintaining the independence required for effective PRA functions.
ALTERNATIVES
Should the Board decline to approve this recommendation, HHSA would continue providing PRA services through existing in-house staff, however, this arrangement presents an inherent conflict of interest because the County is both the service provider and the entity whose actions are subject to rights review.
PRIOR BOARD ACTION
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel, Human Resources, and Risk Management.
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 (FY) 2026-27 budget and will be included in future budgets for the terms of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain signature of Chair on one original Agreement for Services 10337.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency