Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings that the provision of County-wide residential Substance Use Disorder (SUD) services provided by providers are in the public's best interest and that there are specialty skills, qualifications, and equipment not expressly identified in County classifications involved in the performance of the work in accordance with El Dorado County Ordinance Code, Chapter 3.13.030(B);
2) Make findings in accordance with Procurement Policy C-17 Section 3.4(3) exempting the competitive bidding process for the SUD contracts identified below (Agreements 9954, 9955, 9956, 9957, 9958 and 9959) with Purchasing Agent concurrence, because “competitive bidding would produce no economic benefit to the County”;
3) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9954 with Aegis Treatment Centers, LLC (Aegis) for provision of SUD services, similar in form and scope to the County Counsel approved Drug Medi-Cal Organized Delivery System (DMC-ODS) template agreement attached (Attachment C), in the amount of $1,875,000 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $1,250,000 if the extension is granted, for a total maximum obligation of $3,125,000;
4) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9955 with Bi-Valley Medical Clinic, Inc. doing business as (dba) BAART Programs Carmichael for provision of SUD services, similar in form and scope to the County Counsel approved DMC-ODS template agreement attached (Attachment C), in the amount of $75,000 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $50,000 if the extension is granted, for a total maximum obligation of $125,000;
5) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9956 with Granite Wellness Centers for provision of SUD services, similar in form and scope to the County Counsel approved DMC-ODS template agreement attached (Attachment C), in the amount of $1,500,000 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $1,000,000 if the extension is granted, for a total maximum obligation of $2,500,000;
6) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9957 with Shamanic Living Center dba Recovery in Action (RIA) for provision of SUD services, similar in form and scope to the County Counsel approved DMC-ODS template agreement attached (Attachment C), in the amount of $825,000 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $550,000 if the extension is granted, for a total maximum obligation of $1,375,000;
7) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9958 with Recover Medical Group, P.C. (Recover) for provision of SUD services, similar in form and scope to the County Counsel approved DMC-ODS template agreement attached (Attachment C), in the amount of $450,000 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $300,000 if the extension is granted, for a total maximum obligation of $750,000;
8) Authorize the Purchasing Agent to execute the finalized Agreement for Services 9959 with Wellspace Health (Wellspace) for provision of SUD services, similar in form and scope to the County Counsel approved DMC-ODS template agreement attached (Attachment C), in the amount of $1,432,500 for the initial term effective upon final execution to cover the period beginning the first of the month following final execution, through June 30, 2027, with the option for a one-year term extension through June 30, 2028, and an additional $955,000 if the extension is granted, for a total maximum obligation of $2,387,500;
9) Authorize the Purchasing Agent to execute amendments relating to Agreements 9954, 9955, 9956, 9957, 9958, and 9959, contingent upon approval by County Counsel and Risk Management, which do not increase the maximum dollar amounts or terms of the Agreements; and
10) Authorize the HHSA Director or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreements 9954, 9955, 9956, 9957, 9958, and 9959.
FUNDING: 77% Federal Drug Medi-Cal, 14% State Behavioral Health Realignment, 3% Substance Use Block Grant, and 6% Other Sources.
Body
DISCUSSION / BACKGROUND:
The mission of the HHSA Behavioral Health Division (BHD) SUD Program is to provide an array of evidence-based services designed to prevent and reduce alcoholism and drug addiction through the provision of education, prevention, treatment, and counseling services offered directly through the HHSA BHD SUD Program as well as through contracts with community agencies.
In August 2015, California Department of Health Care Services (DHCS) announced approval of California’s DMC-ODS Waiver Program, enacted to provide a continuum of care for SUD treatment services. The DMC-ODS Program enables more local control and accountability, provides greater administrative oversight, creates utilization controls to improve care and efficient use of resources, implements evidence-based practices in substance abuse treatment, and coordinates with other systems of care. DMC-ODS waiver program participating counties administer or arrange for SUD treatment for DMC beneficiaries. On May 23, 2017, the Board authorized the County to “opt in” to the DMC-ODS Waiver Program (Legistar file 17-0525).
The DMC-ODS in each county is responsible for providing or arranging for the provision of SUD services to local residents that are Medi-Cal beneficiaries. Medi-Cal is California’s Medicaid program that provides public health insurance to low-income people, including families with children, seniors, persons with disabilities, foster care, pregnant women, and low-income individuals diagnosed with specific diseases to cover needed health care services. Beneficiaries become eligible for SUD services when an identified substance use disorder has a significant impact on the individual’s life functioning.
The six providers presented in this agenda item will provide SUD services for County residents that are Medi-Cal beneficiaries and are eligible to receive SUD services. These clients will be provided high-level treatment interventions and supportive services to reach their treatment goals.
On April 1, 2025, HHSA was notified by DHCS of the early cancellation of Intergovernmental Agreement (IA) 21-1002, with the termination date effective June 30, 2025, and DHCS informed HHSA that a renewal DMC-ODS IA, with the effective start date of July 1, 2025, would be issued. DHCS later informed DMC-ODS participating counties of the states' plan to remove the maximum obligation in the renewal agreements notating the change in agreement structure from a prior maximum obligation funding-in contract model to a reimbursement-based service model titled a "zero-dollar" maximum obligation agreement. This IA change is to enable DMC-ODS counties to not need multiple amendments to accept increased reimbursement as the state has elected to not set a cap on maximum obligation. Agreement 25-50096 (Fenix 9726) was executed on August 12, 2025, with a retroactive start date of July 1, 2025 (Legistar file 25-1227).
Subsequently, HHSA staff began developing new provider agreements for SUD services, which are similar in form and scope to the attached DMC-ODS template agreement (Attachment C), which has been approved by both County Counsel and Risk Management. The updated template agreement (Attachment C) has been developed to align with all applicable provisions of DHCS Agreement 25-50096.
To ensure continuity of mandated SUD services that align with the DHCS IA 25-50096 (Fenix 9726) and to ensure the finalized agreements can be executed effective on January 01, 2026, HHSA recommends the Board authorize the Purchasing Agent to execute the finalized Agreements 9954, 9955, 9956, 9957, 9958, and 9959 utilizing the template attached to this agenda item. HHSA currently contracts with all six providers for SUD services. The current agreements with said providers for DMC-ODS services, which were approved by the Board on August 15, 2023, will be terminated and superseded by said finalized agreements once executed (Legistar file 23-1370).
In accordance with the Board Procurement Policy C-17, HHSA recommends these agreements be exempt from competitive bidding, with Purchasing Agent concurrence, per Section 3.4(3) as “competitive bidding would produce no economic benefit to the County” due to the lack of providers, as HHSA BHD contracts with as many DMC-certified providers as possible to meet SUD network adequacy standards required by DHCS.
This DMC-ODS template agreement is being presented to the Board as the finalized agreements could not be processed in time to bring before the Board in this agenda item. Should modifications to the template agreements be necessary (e.g., updates to the rates, minor changes to the scope to align with state requirements, standard articles, or other changes suggested by County Counsel, etc.), they will be reviewed and approved by County Counsel and Risk Management but will not require Board approval. The final agreements will not exceed the maximum obligation or alter the terms as outlined in this item.
ALTERNATIVES:
Should the Board decline to approve these recommendations, HHSA would be unable to maintain compliance with DMC-ODS IA 25-50096 Agreement (Fenix 9726) executed between the County and DHCS which could lead to fiscal sanctions.
PRIOR BOARD ACTION:
1) 05/23/17, 17-0525, 05/23/17 HHSA Federal 1115 Waiver for DMC ODS
2) 08/15/23, 23-1370, HHSA New CalAIM Drug Medi-Cal Organized Delivery System (DMC-ODS) Agreements
3) 08/12/25, 25-1227, HHSA DMC-ODS Funding In 25-50096 (Fenix 9726)
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with the agenda item. There are sufficient appropriations for the DMC-ODS program with funding from Federal Medicaid, Behavioral Health Realignment, Federal SUBG, and other sources, which are included in the current Fiscal Year (FY) 2025-26 Budget and will be included in subsequent FY budgets, upon approval of these agreements.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
N/A
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency