DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreement with Central Star Behavioral Health, Inc. for Transitional Age Youth Continuum of Care
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with Central Star Behavioral Health, Inc. for a Transitional Age Youth (TAY) Continuum of Care program including Full-Service Partnership (FSP) for TAY ages 16-25 with serious emotional disturbance (SED) or serious mental illness (SMI) who qualify for Specialty Mental Health Services, and Intensive Case Management (ICM) and Outpatient (OP) levels of care for TAY ages 16-25 years who qualify for Specialty Mental Health Services, effective October 1, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $24,949,819.
REPORT
There is no Net County Cost associated with the recommended action. Approval of the recommended action would allow Central Star Behavioral Health, Inc. (Central Star) to provide specialty mental health services to TAY ranging from 16-25 years of age through the TAY Continuum of Care program and ensure Fresno County Department of Behavioral Health meets mandated network adequacy time and distance standards and Mental Health Services Act (MHSA) requirements as set by the Department of Health Care Services (DHCS). The proposed agreement will be funded by MHSA Community Systems and Supports (MHSA-CSS) funds, Mental Health Realignment, and Medi-Cal Federal and State funds with no Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There are no alternative actions. Should the recommended action not be approved, mental health services for high acuity TAY and their families would be eliminated, which would impact compliance with network adequacy time and distance requirements, and MHSA requirements set by the DHCS.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum amount of the agreement ($24,949,819) will be funded with MHSA-CSS, Medi-Cal Federal Financial Participation (FFP), and Mental Health Realignment funds. Sufficient appropriations and estimated revenues are included in DBH’s Org 5630 FY 2025-2026 Recommended Budget and will be included in subsequent budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On October 9, 2018, the Board approved Agreement 18-576 between the County and Central Star to provide Mental Health Services Act (MHSA) Transition Age Youth (TAY) Mental Health Services and Supports program to deliver integrated mental health and supportive housing services to the TAY population, ages 16 to 25 years of age who have a serious mental illness and are at risk of being hospitalized, homeless, and/or incarcerated. The agreement was amended once to delegate authority to the Department Director to make changes to expense category subtotals in the contracted budgets, so long as they did not exceed twenty percent of the maximum compensation, through written approval.
On June 20, 2023, the Board approved Superseding Agreement A-23-278, between the County and Central Star to include new California Advancing and Innovating Medi-Cal (CalAIM) requirements set by the Department of Health Care services (DHCS) including payment reform requirements. The Superseding Agreement extended the term of the Agreement for two additional years. The Agreement was amended twice to correct the rate sheet to reflect the correct rate category for Full-Service Partnership programs and include Supplemental/ Add On service codes, and to expand services for the target population by adding Intensive Case Management and Outpatient levels of care.
On June 24, 2025, your Board approved Amendment No. 3 (No. 25-289) to the Agreement to extend the term for three months, with an optional additional three-month extension, to prevent a gap in services in anticipation of the implementation of a new Agreement.
The Department released a Request for Proposals (RFP) on March 19, 2025, for the provision of a TAY Continuum of Care program including FSP, ICM, and OP mental health services for TAY ages 16-25 who qualify for Specialty Mental Health Services. Addendum No. 1 to the RFP was issued on April 1, 2025, to update reimbursement rates for the new fiscal year. The RFP closed on April 17, 2025. 4 bids were received: Central Star Behavioral Health, Inc ($30,225,890), Kings View ($29,501,000), North Star Wellness Center ($22,821,689), and Pacific Clinics ($26,699,834). An evaluation panel reviewed all bids and recommended entering into an Agreement with Central Star Behavioral Health, Inc.
Central Star was selected as the best fit for the County’s needs. The bid demonstrated a high degree of understanding of the level of service being requested and of applicable laws, regulations, and funding requirements. Out of the submitted bids, Central Star demonstrated the greatest understanding of the needs and service requirements of the target population. Central Star’s bid also proposed the greatest volume of services for the FSP level of care out of the submitted bids.
Under the MHSA, also known as Proposition 63, county behavioral health departments receive funding to assist in providing services to underserved and unserved populations. Following a mandated local community stakeholder process to identify the highest service needs of the county, MHSA-CSS funds were allocated by the Department to provide FSP services for TAY ages 16-25 who have SED or SMI.
The recommended TAY Continuum of Care Agreement would serve TAY ages 16-25. In addition, siblings, relatives, caregivers, and other significant support persons of the FSP enrolled person served, may receive specialty mental health services through this program.
FSP services encompass a unified team approach, in which the provider commits to do “whatever-it-takes” to assist the person served in reaching their recovery, resiliency, and wellness goals and reduce the number of days of hospitalization, homelessness, and juvenile justice or criminal justice system involvement. Persons served at this level meet the State-defined FSP criteria and require higher intensity services to meet their needs. This level of care has an increased focus on engagement, collaboration with the person served/family and stabilization to achieve mutually agreed upon treatment goals. These services are accessible 24 hours per day, 7 days per week via a support line where a staff member known to the family is available by phone. Persons served are provided three contacts per week with at least one being face to face.
ICM provides persons served with regularly scheduled case management, individual rehabilitation and/or individual therapy. These services are accessible during standard office hours. Persons served are provided one or two contacts per week with at least one being face to face. OP provides persons served with therapeutic appointments for individual/group treatment, case management, and medication services, as needed. These services are accessible during standard office hours. Persons served are provided at least one contact per week, with at least one of those contacts being face to face each month.
Services under the recommended agreement will be offered in the office, at home, within the community, as preferred by the person served and their guardian, and will include, assessment, care planning/goal setting, psychiatry/medication support, individual/family therapy, group therapy, targeted case management, peer support services, rehabilitation, intensive care coordination, intensive home-based services, and linkage to additional services and support. Evidence Based Practice models recognized as effective in improving functioning of the target population will be utilized in the programs. These models include and are not limited to; Dialectical Behavior Therapy, Trauma Informed Care, Trauma-Focused Cognitive Behavioral Therapy, Motivational Interviewing, and Eye Movement Desensitization and Reprocessing.
The maximum compensation for the agreement was adjusted from the proposed amount to align with expectations for needed capacity and was calculated using historical data from Fiscal Year 2023-24 and Fiscal Year 2024-25. The program served 140 individuals in Fiscal Year 2023-24 at a cost of $2,385,998. The program served 168 individuals in Fiscal Year 2024-25 at a projected cost of $3,006,631. The maximum compensation for Fiscal Year 25-26 has been prorated to account for funds budgeted to the three-month extension of the current agreement.
Approval of the recommended action will execute the Agreement with Central Star Behavioral Health, Inc for the provision of Transitional Age Youth Continuum of Care services, for a five-year term, total not to exceed $24,949,819.
The modification and budget modification clauses of the agreement delegate the Board’s authority to the DBH Director to make non-material changes to the agreement, that will not result in any change to the maximum compensation payable to the Contractor, during the term of the agreement, as further described in Article 15, Sections 1 and 2 of the agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this agreement at the July 2025 meeting.
REFERENCE MATERIAL:
BAI #51, June 24, 2025
BAI #40, June 18, 2024
BAI #36, October 24, 2023
BAI #44, June 20, 2023
BAI #31.1, April 28, 2020
BAI #33, October 9, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Central Star
CAO ANALYST:
Ronald W. Alexander Jr.