DATE: March 28, 2023
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment to Agreement with BAART Behavioral Health Services, Inc.
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment I to Agreement with BAART Behavioral Health Services, Inc. to increase Narcotic Treatment Program services to in-custody individuals at the County’s Detention Facilities, effective upon execution with no change to the term of July 1, 2018 to June 30, 2023 and increasing the maximum compensation by $95,000 to a total of $845,000.
REPORT
There is no additional Net County Cost associated with the recommended action, which will allow BAART Behavioral Health Services, Inc. (BAART) to continue delivering mandated and medically necessary Narcotic Treatment Program (NTP) services to more in-custody individuals at County detention facilities. The proposed Amendment will be funded with Behavioral Health Realignment. This item pertains to services provided at the County’s Detention Facilities in District Three.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If the Board does not approve the recommended action, BAART will be unable to continue providing in-custody individuals with medically necessary NTP services once the current maximum compensation is reached, and the County will be out of compliance with State regulations.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Approval of the recommended amendment will increase the maximum compensation for Fiscal Year (FY) 2022-23 by 63.3% or $95,000, from $150,000 to $245,000. The full contract maximum compensation will increase from $750,000 to $845,000. The increase is fully funded with Behavioral Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2022-23 Adopted Budget. Total expenditures are based on actual services provided.
DISCUSSION:
NTP services are provided to individuals diagnosed by a physician as having an addiction to opioids and for whom the treatment has been deemed to be a medical necessity. On June 5, 2018, the Board approved Agreement No. 18-292 with BAART, a licensed community-based NTP provider, to deliver services to in-custody individuals who jail medical staff have identified as potentially needing such services, or to individuals who were receiving these services prior to incarceration.
On February 1, 2022, the Board approved Amendment IV to Agreement No. A-18-169 with California Forensic Medical Group, Inc. to add a Medication Assisted Treatment (MAT) Care Coordinator to identify opioid use disorder (OUD) individuals upon intake and enroll them in MAT services while incarcerated. The addition of the MAT Care Coordinator has increased utilization of MAT services for individuals who were not enrolled with a community-based NTP provider prior to incarceration. The MAT Care Coordinator works with BAART in acquiring an individual’s medication and treatment plan, facilitates intake with BAART, and provides linkage to community-based NTP providers upon release into the community.
The number of in-custody individuals receiving NTP services increased during FY 2022-23 in comparison to FY 2021-22, along with an increase in Buprenorphine-Naloxone dosing. Buprenorphine-Naloxone dosing is provided as it is easier for individuals to continue treatment after release or transfer to out-of-county detention facilities. The average daily number of persons served increased 117% from 11.16 during FY 2021-22 to 24.08 during FY 2022-23 as of December 31, 2022. Buprenorphine-Naloxone dosing is estimated to increase from 1,149 doses administered in FY 2021-22 to 4,219 in FY 2022-23. It is anticipated that the jail service treatment provider will continue to ramp up their ability to deliver NTP services and rely on the contract with the licensed NTP community-based provider to only deliver services that require licenses and certifications not in place at the County’s Detention Facilities.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of the recommended Amendment at its March 2023 meeting.
REFERENCE MATERIAL:
BAI #16, February 1, 2022
BAI #44, June 5, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment to Agreement No. 18-292
CAO ANALYST:
Ron Alexander