Title
Health and Human Services Agency, Sheriff’s Office and Probation Department recommending the Board:
1) Find, in accordance with County Ordinance Section 3.13.030, it is more economical and feasible to engage an independent contractor to provide licensed healthcare professionals trained in correctional medicine;
2) Approve and authorize the Chair to sign Amendment 1 to Agreement for Services 2989 with California Forensic Medical Group for the provision of health services in the County detention facilities for the term of January 1, 2019 through December 31, 2023, with a reduction in Fiscal Year 2019-20 by $87,154 retroactively effective July 1, 2019 due to the closure of the Placerville Juvenile Hall, and continuing for the remaining term of the Agreement (total reduction over five year term $418,096), thereby reducing the maximum contractual obligation of $21,967,666 to $21,549,570;
3) Approve and authorize the attached Budget Transfer Request to increase the General Fund contribution for Fiscal Year 2019-20 CFMG budget by $195,846, and decrease the General Fund contribution to the County Medical Services Program budget by $195,846; and
4) Authorize the Purchasing Agent, or designee, to execute further documents relating to Agreement for Services 2989, including amendments which do not increase the maximum dollar amount or term of the Agreement, and contingent upon approval by County Counsel and Risk Management.
FUNDING: General Fund.
Body
DISCUSSION / BACKGROUND:
Effective June 30, 2019 the County discontinued operations at the Placerville Juvenile Hall located at 299 Fair Lane, Placerville, CA 95667. In preparation for this event, HHSA facilitated a conversation between County representatives and Wellpath (formerly California Forensic Medical Group) to identify a reasonable reduction in the annual contracted amount for healthcare services in the remaining juvenile detention facility (JDF) in South Lake Tahoe.
The CFMG Agreement has an annual amount divided into adult services for the jail(s), juvenile services for the JDFs, and a per diem amount if the average daily population (ADP) for any of the four facilities exceeds the agreed-upon ADP. The annual amounts are divided into twelve equal monthly flat-rate payments for billing. There is an annual escalator of 3.6 percent. For fiscal year 2019-20 the annual amount for the two JDFs was $625,709.
Staffing in the four facilities is defined in Exhibit E of the Agreement, and prior to the closure of the Juvenile Detention facility in Placerville included 25 hours a week of nursing time in each of the two JDFs, plus two hours on one day each weekend of available nursing for each JDF.
As a result of these negotiations, an annual reduction of $87,154 was agreed upon. This amount was predicated on elimination of the 0.625 full-time equivalent (FTE) nurse on the West Slope.
The County initially anticipated a reduction closer to one-half of the annual amount of $625,709 for juvenile healthcare services, and HHSA's budget for the FY 2019-20 payment was reduced by $283,000 in anticipation of the negotiations. Fixed administrative costs are distributed between each of the calculated rates for the facilities. The revised agreement does not redistribute these costs and the fixed costs were not reduced due to the overall reduction in service levels. A review of the combined ADP for both the West Slope and South Lake Tahoe from January 2019 through June 30, 2019 (ADP 20.23), compared to a review of the ADP for the South Lake Tahoe JDF (ADP 20.15) since closure of the JDF in Placerville, indicated that the ADP in South Lake Tahoe since July 1, 2019 has increased commensurate to the ADP for both facilities prior to the closure.
ALTERNATIVES:
1) The Board could decline to approve Amendment 1 to Agreement for Services 2989, whereupon the County would pay the original amount for services in the JDF.
2) The Board could decline to authorize the attached Budget Transfer, whereupon insufficient funds would be available to pay the CFMG agreement invoices.
PRIOR BOARD ACTION:
18-1793; December 18, 2019, Agreement for Services 2989 with California Forensic Medical Group.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Human Resources and Risk Management; Sheriff’s Office; and Probation Department.
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
This reduction in the CFMG Agreement of $87,154 for fiscal year 2019-20 creates a General Fund gap of $195,846 between the budgeted amount of $342,709 and the negotiated amount of $538,555 for juvenile healthcare services. To cover the gap, HHSA is recommending the use of $195,846 of General Fund currently budgeted to pay the County Medical Services Program (CMSP) Participation Fee. HHSA received notice from CMSP that for fiscal year 2019-20 the Participation Fee is being waived, thereby allowing use of these funds for the CFMG payments.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on two (2) original Amendments 1 to Agreement for Services 2989.
2) Clerk of the Board to return one (1) fully executed Amendment 1 to Agreement 2989 to Health and Human Services Agency -Contracts Division.
STRATEGIC PLAN COMPONENT:
“Good Governance: Approach large, complex and/or system-wide matters as one organization - Departments will collaborate on projects and efforts that have cross-departmental impacts.”
CONTACT
Donald Semon, Director, Health and Human Services Agency