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Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings pursuant to El Dorado County Ordinance Chapter 3.13, Contracting Out, that the provision of State Hospital Beds provided by California Mental Health Services Authority (CalMHSA) will be performed by another governmental entity or agency;
2) Approve and authorize the Chair to sign Amendment I to Participation Agreement 8132 with CalMHSA, to increase the contract value by $1,402, for an updated amount of $4,206, and update contract provisions and extend the term for one additional year through June 30, 2026;
3) Approve and authorize the Chair to sign Memorandum of Understanding (MOU) 9597 with CalMHSA and California Department of State Hospitals, for the provision of state hospital beds on an “as requested" basis, for a term of July 1, 2025, through June 30, 2027, with a variable maximum obligation dependent on County’s usage of state hospital beds;
4) Authorize the Purchasing Agent (PA) to execute amendments relating to Participation Agreement 8132 and MOU 9597, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amount or term of the Agreement beyond PA authority; and
5) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Participation Agreement 8132 and MOU 9597.
FUNDING: 100% State Behavioral Health Realignment.
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DISCUSSION / BACKGROUND:
In 2011, the Board authorized the County to become a participating member of the California Mental Health Services Authority (CalMHSA) Joint Powers Authority (JPA) through Resolution 024-2011. This resolution led to the County entering into a Participation Agreement that granted CalMHSA JPA the authority to negotiate with the State and other hospital bed providers (Legistar file 10-1324).
In 2015, the County joined the “CalMHSA State Hospital Bed Program,” which allowed the County to no longer bear the cost of unoccupied state hospital beds. The County also entered into further Participation Agreements with CalMHSA JPA to maintain its participation in the program (Legistar file 15-1386). The State Hospital Program is designed to improve coordination between DSH and counties/cities, facilitating access to essential psychiatric services for individuals with serious mental illnesses. Specifically, it serves adults in El Dorado County who have not responded to treatment at lower levels of care, in accordance with California Welfare and Institutions Code (WIC) Section 4100 et seq.
CalMHSA serves as the primary point of contact and lead negotiator for psychiatric bed utilization terms and rates with the DSH. In this capacity, CalMHSA collaborates with its member counties to assess and explore the feasibility of local infrastructure projects that could serve as alternatives to DSH hospitals.
In December 2023, the Board approved Agreement 8132 which authorized CalMHSA to continue contracting for state hospital beds on behalf of the County (Legistar file 23-1852). Through Agreement 8132, CalMHSA is able to explore alternative facilities for patient placement. This agreement is designed to ensure compliance with all applicable legal requirements, improve efficiency, control costs, and maintain consistent quality of care. Furthermore, it supports the identification and development of alternative resources for special populations requiring secure, 24-hour treatment services.
To continue the program’s benefits, a proposed Amendment I to Participation Agreement 8132 will extend the County's participation for another year, ensuring continued access to psychiatric bed services and alternative placement options. It is important to note that the reason this amendment is being presented to the Board is due to an error in the prior approved board action staff report which authorized the PA to execute amendments that did not increase the maximum obligation of the agreement, versus within the PA’s authority allowed under Board Policy C-17. This agenda item corrects this language.
The current Tri-Party MOU 8134, approved by the Board on December 5, 2023, governs the County’s participation in the State Hospital Program, establishes negotiated rates and bed utilization terms with DSH (Legistar file 23-1852). This MOU is the resulting agreement from those negotiations with DSH and includes the bed rates negotiated by CalMHSA on behalf of member counties. MOU 8134 is set to expire on July 1, 2025. The proposed MOU 9597 is a renewal of MOU 8134 and will provide similar benefits, ensuring the County only pays for beds used by County residents, and helping to control mental health care costs while ensuring necessary services.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA would be out of compliance with WIC 4330, which requires the County to reimburse the DSH for bed usage.
PRIOR BOARD ACTION:
1) 02/15/11, 10-1324 V. 1, CalMHSA JPA Resolution and Agreement
2) 12/10/13, 10-1324 V.2, CalMHSA JPA Resolution Adoption and JPA Agreement
3) 12/15/15, 15-1386, HHSA State Hospital Bed MOUs
4) 12/05/23, 23-1852, HHSA MOU 8134 and Participation Agreement 8132
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with this agenda item. MOU 9597 has no stated not-to-exceed (NTE) amount, as the NTE is variable depending on usage. The State Hospital Bed rate is established annually and depends on the type of service required, which is related to patient acuity. No invoices are issued by DSH; instead the Behavioral Health Realignment amount allotted to the County is reduced by the number of beds used. Sufficient appropriations were included in the Fiscal Year (FY) 2024-25 Budget and FY 2025-2026 Budget, 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 of Amendment I to Participation Agreement 8132 and one original of MOU 9597.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency