DATE: June 10, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment III to Master Agreement for Specialized Supplemental Board and Care Home Services
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34), determine that an exception to the competitive bidding requirement under AP 34 is satisfied and a suspension of competition is warranted due to unusual or extraordinary circumstances, and that the best interests of the County would be served by entering into the Master Agreement given the non-competitive nature of the Master Agreement; and
2. Approve and authorize the Chairman to execute Amendment III to Master Agreement No. 22-230, to add Ever Well Health Systems, LLC, effective July 1, 2025, for Supplemental Board and Care Home services with no change to the term of July 1, 2022 to June 30, 2027, or compensation maximum of $54,000,000.
REPORT
There is no additional Net County Cost associated with the recommended actions, which will waive the competitive bidding process and allow the Department to expand the network of care for severely and persistently mentally ill conserved adult persons served by adding Ever Well Health Systems, LLC (Ever Well) to the Master Agreement. This item is countywide.
ALTERNATIVE ACTION(S):
Should the recommended actions not be approved, the provision of services for County persons served currently residing in Ever Well facilities would be interrupted and the Department would not be able to continue utilizing the services of Ever Well until a new agreement is approved, due to the expiration of the current Master Agreement A-23-283, on June 30, 2025.
SUSPENSION OF COMPETITION CONTRACT:
It is requested that the County find under AP 34 that an exception to the competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or extraordinary circumstances due to the non-competitive nature of the Master Agreement. Qualified, licensed, and interested vendors will be added to the Master Agreement to meet the Department’s placement needs as assessed by clinical staff and in accordance with all terms and conditions specified in the contract will be able to participate as a contracted provider. The General Services Department - Purchasing concurs with the Department’s assessment that this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum compensation for Fiscal Year 2025-26 is $10,800,000 and will be funded with Mental Health Realignment and Community Mental Health Block Grant. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2025-2026 Recommended Budget and will be included in future budget requests. Actual costs will be determined by actual services provided.
DISCUSSION:
The Department, pursuant to Welfare and Institutions Code, section 5801 and the California Code of Regulations, Title 22, provides placements for conserved severely and persistently mentally ill adult persons served in secured certified/licensed facilities with the appropriate level of care and services. Specialized Supplemental Board and Care Homes are Adult Residential Facilities (ARF) or Residential Facilities for the Elderly (RCFE) licensed and monitored by Community Care Licensing (CCL), a division of the California Department of Social Services. They are the least restrictive level of care for conserved persons that provide structured supportive and therapeutic housing that supports a seamless transition in preparing persons served to return to independence in the community free of institutional restrictions. The range of services in these facilities focus on the persons served wellness and recovery, working to facilitate returning or continuing to live in the community, and include medication management/education and self-care. Contracted ARF and RCFE facilities possess care exemptions from CCL, which allows them to provide services to persons served with mental health disorders and a wide variety of specialized medical and behavioral needs.
On August 20, 2019, the Board approved Master Agreement No. 19-406 with licensed and credentialed facilities to provide specialized residential mental health services for County persons served, as mandated by the WIC and CCR Title 22.
On June 7, 2022, the Board approved Master Agreement No. 22-230 for the provision of Specialized Supplemental Board and Care Home Services.
On June 20, 2023, the Board approved Amendment I to the Master Agreement, No. A-23-269, to add contractors, revise the compensation language, define bed holds, and add HR-Risk required revised clauses.
On July 9, 2024, the Board approved Amendment II to the Master Agreement, No. A-24-367, to increase the Supplemental Services Rate for providers and revise the Scope of Work to add a list of services that may be provided by Contractor(s). Additionally, monitoring language was added to the Scope of Work to increase accountability of services provided.
On June 20, 2023, the Board approved Superseding Master Agreement No. A-23-283 with licensed residential facilities to provide specialized residential mental health services. This master agreement allowed Fresno County to contract with various mental health treatment providers and made necessary changes required by the implementation of California Advancing and Innovating Medi-Cal (CalAIM), including a new billing structure for Medi-Cal services.
On August 22, 2023, the Board retroactively approved Amendment I (No. 23-415) to the Master Agreement to revise the rates for Star View Behavioral Health, Inc.
On March 5, 2024, the Board approved Amendment II (No. 24-100) to the Master Agreement, adding provider BHC Alhambra Hospital, Inc. d.b.a. BHC Alhambra Hospital.
On August 20, 2024, the Board approved Amendment III (No. 24-441), which added provider Central Star Behavioral Health, Inc and removed Crestwood Behavioral Health, Inc.
On May 6, 2025, your Board approved Amendment IV (No. 25-169), which modified the rate sheet for Psynergy Programs, Inc. to allow for the inclusion of a payment mechanism for basic services for non-benefited persons served.
As Master Agreement No. A-23-283 ends its term on June 30, 2025, it has been decided by the Department to split this agreement into various master agreements, each designed for a specific level of care. Ever Well is licensed and monitored through CCL, making their addition to the Supplemental Board and Care Home Services Master Agreement a seamless transition that will prevent any interruptions or delays in the provision of services. Due to the compatibility of the scope of work and requirements for this Master Agreement with the services offered by this provider, it is recommended that Ever Well be added to the Specialized Supplemental Board and Care Home Services Master Agreement, effective July 1, 2025.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended Amendment during the May 2025 meeting.
REFERENCE MATERIAL:
BAI #27 May 6, 2025
BAI #31 August 20, 2024
BAI #27 July 9, 2024
BAI #30 March 5, 2024
BAI #26 August 22, 2023
BAI #44, June 20, 2023
BAI #41 June 20, 2023
BAI #48, June 7, 2022
BAI #26 August 20, 2019
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request Form
On file with Clerk - Amendment III to Master Agreement
CAO ANALYST:
Ronald Alexander Jr.