Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Adopt and authorize the Chair to sign Resolution 065-2026, which will supersede and replace Resolution 230-2024, which delegates authority to the HHSA Director, or Chief Assistant Director, to execute Short-Term Residential Therapeutic Program (STRTP) agreements for the provision of Specialty Mental Health Services (SMHS), when urgent youth client placements are needed, using the other counties STRTP agreement when necessary, or using one of the three County Counsel and Risk Management-approved contract templates with county Mental Health Plans (MHPs) or out-of-County STRTP facility providers, and any amendments approved by County Counsel and Risk Management that do not increase the maximum obligation or extend the term of the agreements, as follows:
a) STRTP Provider Agreement (PA) template for contracting with out-of-county STRTP facility providers for placement of youth clients, for a total term not to exceed five years, effective on the date the first youth was admitted to the facility (with retroactive start dates permitted for urgent cases), for a maximum obligation of $600,000 per agreement;
b) STRTP County MHP Agreement template for contracting with other county MHPs, which allows placement of multiple youth clients into the contracting county’s STRTP, for a total term not to exceed five years, effective on the date the first youth was admitted to the facility (with retroactive start dates permitted for urgent cases), for a maximum obligation of $600,000 per agreement;
c) STRTP Reciprocal Agreement template for use with other county MHPs for placement of County youth in an out-of-county STRTP, or allowing acceptance of out-of-county youth in the County’s contracted STRTP, for a term of three years effective on the date the first youth is admitted to the facility (retroactive start permitted for urgent cases), and a maximum obligation not to exceed $600,000 per agreement; and
d) Other counties’ STRTP Agreements, when necessary, with other county MHPs using the other counties’ template when the scope of work is similar to STRTP SMHS services shown in Attachment C, and is approved by County Counsel and Risk Management, for a term of three years effective on the date the first youth is admitted (with retroactive start dates permitted for urgent cases), for a maximum obligation of $600,000 per agreement; and
2) Make findings in accordance with Procurement Policy C-17 Section 3.4(3) exempting the competitive bidding process for the resulting STRTP agreements, with Purchasing Agent concurrence, as competitive bidding would produce no economic benefit to the County.
FUNDING: Federal Medi-Cal, Realignment and State Mental Health Service Act funding.
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DISCUSSION / BACKGROUND:
HHSA contracts with the California Department of Health Care Services (DHCS) to be the MHP in El Dorado County. As the MHP, HHSA is required to provide SMHS, which includes STRTP to qualified individuals, including foster youth and children receiving services through its Child Welfare Service Program and Behavioral Health Division (BHD), or County Probation Department Juvenile Services. A STRTP is a residential facility licensed by the State of California’s Community Care Licensing Division and operated by a public agency or private organization. STRTPs provide a structured program of specialized, intensive care and 24-hour supervision to children and non-minor dependents. SMHS provided in STRTPs are designed to stabilize the youth's current crisis with the goal of returning home. The care and supervision provided by a STRTP is non-medical, except as otherwise permitted by law.
Effective July 1, 2024, Assembly Bill (AB) 1051 (Statute of 2024) mandated that because certain residential placements are intended to be short-term, the responsibility to provide and arrange for SMHS for eligible youth who are placed in an out-of-county STRTP shall remain with the youth’s County of Original Jurisdiction, rather than transferring to the County of Residence as it had prior to AB 1051. On June 28, 2024, DHCS distributed Behavioral Health Information Notice (BHIN) 24-025 further clarifying that counties are expected to be proactive in establishing the contracts necessary to provide STRTP services in a timely manner, and that out-of-county placements should not disrupt the youth’s continuity of care or adversely impact timely payment to providers. On December 10, 2024, to enable HHSA BHD to comply with AB 1051, the Board adopted Resolution 230-2024 which superseded Resolution 028-2020 (Legistar files 24-2106 and 20-0012). This resolution delegated authority to the HHSA Director or Chief Assistant Director to execute out-of-county STRTP agreements using either the STRTP PA template for contracting with out-of-county STRTP providers, or the STRTP single case agreement template for contracting with other counties or MHPs.
HHSA BHD requests to replace Resolution 230-2024, as the department has worked with County Counsel to amend the prior two Board-approved STRTP templates (one with other county MHPs and the other with out-of-County STRTP facility providers) to allow for the placement of multiple clients (rather than a single client), extend the contract term from a maximum of 18-months to a term that does not exceed five years per agreement, and increase the maximum obligation of each agreement from $300,0000 to $600,000. Additionally, HHSA BHD seeks to add a third template, the STRTP Reciprocal Agreement (Attachment C), which would authorize HHSA BHD to contract with other county MHPs for STRTP services and accept out-of-county youth into the County’s STRTP contracted facilities, thereby receiving revenue for providing reciprocal services.
As a result of AB 1051, other counties created their own STRTP templates and HHSA is also requesting the Board authorize HHSA to enter into other counties’ STRTP agreements with a similar scope of work, contingent upon County Counsel and Risk Management approval, to enable timely placement and acceptance of youth clients in need.
HHSA recommends the Board approve these recommendations to enable HHSA BHD to expedite the processing of the STRTP agreements necessary for the County to ensure the timely delivery of mandated SMHS services and meet its service requirements as the MHP. Board approval of the proposed Resolution presented in this agenda item will replace and supersede Resolution No. 230-2024.
In accordance with Board Procurement Policy C-17, HHSA recommends that agreements utilizing the included STRTP templates be exempt from competitive bidding, with Purchasing Agent concurrence, as “competitive bidding would produce no economic benefit to the County” because the State-wide need for STRTP services outweighs the availability of beds and qualified providers are not anticipated to respond to any competitive solicitation. As such, to meet its obligations for the provision of these mandated services, as required through the County’s Medi-Cal MHP contract with the DHCS, HHSA seeks to contract with as many counties and certified STRTP providers as necessary to allow HHSA’s BHD to meet its service obligations, as required by the County’s Medi-Cal MHP contract with the DHCS.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA as the MHP may have difficulty placing eligible youth in an out-of-county STRTP when the need arises, delaying the timely delivery of services, which may result in non-compliance with County’s MHP service requirements.
PRIOR BOARD ACTION:
1) 12/10/24, 24-2106, HHSA Out-of-County Short-Term Residential Treatment Program (STRTP) Single Case Templates and Resolution
2) 03/10/20, 20-0012, HHSA Short-Term Residential Treatment Program Short-Form Template/Resolution
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Funding for the STRTP SMHS services with other counties or facility providers are covered through the federal Medi-Cal program or have been included in HHSA's Board adopted MHSA Expenditure Plan, or future BHSA Plan. Sufficient Medi-Cal and MHSA appropriations have been included in HHSA’S Fiscal Year 2025-26 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:
Clerk of the Board to obtain the signature of Chair on one original Resolution.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency