DATE: September 24, 2024
TO: Board of Supervisors
SUBMITTED BY: John Zanoni, Sheriff-Coroner-Public Administrator
SUBJECT: Amendment to Agreement with California Forensic Medical Group, Incorporated
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment XI to Agreement with California Forensic Medical Group, Incorporated (CFMG) for Jail medical and behavioral health care services for the Sheriff-Coroner-Public Administrator’s Office detention facilities, extending the term by two months and three days, commencing on October 1, 2024, to December 3, 2024, and increasing the maximum by $6,650,001, to a total of $190,196,899.
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will extend the County’s agreement with CFMG for medical and behavioral health care services provided at the Jail for an additional two months and three days. Approval of the recommended action will provide sufficient time to continue to negotiate and develop a new agreement or an amendment with a longer term for Jail medical and behavioral health care services. This item is countywide.
ALTERNATIVE ACTION(S):
There is no practical alternative under the circumstances. If the recommended action is not approved, the Sheriff’s Office will be without a Jail medical and behavioral health care agreement.
FISCAL IMPACT:
There is no additional Net County Cost associated with the recommended action. The Sheriff’s Office has sufficient appropriations included in the Department’s Org 3111 FY 2024-25 Adopted Budget. Approval of the recommended action will increase the Sheriff’s agreement maximum by $6,650,001, for a total of $190,196,899. Staff will monitor appropriations within Org 3111 and adjustments will be brought to your Board if needed.
The recommended amendment provides that during the two month and three-day extension the County will pay for:
• all skilled nursing costs for adult inmates who are cared for at off-site facilities (commonly called “congregate care” costs) at approximately $385,000; and
• all waived liquidated damages provided in Section VII of the Agreement as the Department estimates that the liquidated damages that would potentially be assessed against CFMG during the extension, based on prior liquidated damages assessments, would be approximately $337,500.
On August 4, 2020, the Board approved Amendment II to Agreement A-18-169 to increase staffing for CFMG from 120 to 159.6. The additional staffing provided COVID screening, testing and other medical services related to COVID. The additional staffing costs was funded by CARES/ARPA funding. Amendment III, Amendment V, and Amendment VI, also approved by the Board, extended the continuation of the additional staffing and funding associated with CFMG’s COVID related services. Amendments VIII, IX, and X included the COVID-related medical services and extended the agreement terms to conduct negotiations for a new contract.
DISCUSSION:
On April 3, 2018, the Board approved Agreement No. A-18-169 with CFMG, to provide medical and behavioral health care services to the adult incarcerated individuals detained in the County Sheriff Adult Detention Facilities identified as North Annex, Main, and South Annex Jails (Jail).
On April 28, 2020, the Board approved Amendment I to Agreement No. A-18-169-1 with CFMG to allow the Sheriff’s Office to approve pre-payments and accept a 1% discount for the months of May, June, July, and August of 2020.
On August 4, 2020, the Board approved Amendment II to Agreement No. A-18-169-2 with CFMG for additional temporary staffing from July 16, 2020, to December 30, 2020 for medical services to address the need for testing and treatment(s) for Jail inmates due to the COVID-19 pandemic and the ongoing spread of COVID-19 in the Jail.
On March 23, 2021, the Board approved Amendment III to Agreement No. A-18-169-3 with CFMG to increase the maximum compensation provided under the Agreement by $5,261,182, to a total of $129,627,204, to pay for an additional six months of COVID-19 testing and treatment(s) for jail inmates due to the COVID-19 pandemic (January 1, 2021, to June 30, 2021), and provide for pharmaceutical costs.
On February 1, 2022, the Board approved Amendment IV to Agreement No. A-22-038 with CFMG to increase the maximum compensation provided under the Agreement by $120,000, to a total of $129,747,205 to pay for a Medication Assisted Treatment (MAT) Care Coordinator to identify Opioid Use Disorder (OUD) inmates upon intake and enroll them in MAT services while incarcerated in the Fresno County Jail.
On March 22, 2022, the Board approved Amendment V to Agreement No. A-22-094 with CFMG to increase the maximum compensation provided under the Agreement by $6,702,382 to a total of $136,449,588 to pay for an additional twelve months (July 1, 2022, to June 30, 2023) of COVID-19 testing and treatment(s) for jail inmates and pay COVID-19 related pharmaceutical and congregate living costs, with no change to the term of July 1, 2018, to June 30, 2023.
On November 29, 2022, the Board approved Amendment VI to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $6,147,900 to a total of $142,597,488 to continue to provide COVID-19 testing and treatment through June 30, 2023, provide reimbursement for COVID-19 related pharmaceutical costs in excess of the pharmaceutical cap discussed in Section VI of the Agreement, and allow for the reimbursement of COVID-19 related staffing and treatment of inmates within the congregate living system. Due to the Omicron variant surge, services related to detection and treatment of COVID-19 were not being reduced, and staff estimated there would be an additional cost of $6,147,900 for the remainder of FY 2022-23.
On May 23, 2023 (retroactive to February 1, 2023) the Board approved Amendment VII to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $53,125 to a total of $142,650,613 to extend funding to pay for a MAT Care Coordinator to identify OUD inmates upon intake and enroll them in MAT services while incarcerated in the Jail.
On June 20, 2023, the Board approved Amendment VIII to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $16,358,514 to a total of $159,009,127 and extend the term of the Agreement to December 31, 2023. Under a second recommended action the Board also approved Amendment I to Agreement No. A-18-170 to increase the maximum compensation provided under the Agreement by $1,806,996 to a total of $18,854,547 and extend the term of the Agreement to December 31, 2023.
On November 28, 2023, the Board approved Amendment IX to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $16,358,514 to a total of $175,367,641 and extend the term of the Agreement to June 30, 2024.
On June 18, 2024, the Board approved Amendment X to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $8,179,257 to a total of $183,546,898 and extend the term of the Agreement to September 30, 2024.
Approval of the recommended action will further extend the term of Agreement A-22-528 and approve an increase in compensation $6,650,001 to a total compensation of $190,196,899, to pay for the additional two-month and 3-day term for Jail medical and behavioral health care services. The recommended amendment provides that during the two month and three-day extension, the County will pay for all skilled nursing costs for adult inmates who are cared for at off-site facilities (commonly called “congregate care” costs). The recommended amendment provides that any new referrals to such off-site skilled nursing facilities shall be made by Contractor with the concurrence of County’s medical staff. CFMG is currently responsible for these costs under the Agreement. The Department estimates that the cost to the County to pay for these services during the two month and three-day extension would be approximately $385,000.
The recommended amendment also provides that the liquidated damages provided in Section VII of the Agreement, which would be assessed against CFMG for failure to meet the performance standards, and/or failure or delay in providing or maintaining minimum staffing levels, shall be waived during the two month and three-day extension, while the parties complete negotiations. The Department estimates that the liquidated damages that would potentially be assessed against CFMG during the two month and three-day extension, based on prior liquidated damages assessments, would be approximately $337,500.
The recommended amendment provides that despite entering into the amendment, the County may still terminate negotiations with CFMG and engage in a competitive request for proposal process, in accordance with the County’s purchasing procedures, and that CFMG would continue to provide these services until a successor contractor commences providing these services.
Staff will return to your Board on December 3, 2024 with a new multi-year agreement.
REFERENCE MATERIAL:
BAI #23, June 18, 2024
BAI #40 November 28, 2023
BAI #30 June 20, 2023
BAI #22 May 23, 2023
BAI #25 November 29, 2022
BAI #35 March 22, 2022
BAI #16 February 1, 2022
BAI #23 March 23, 2021
BAI #5, August 4, 2020
BAI #30.1, April 28, 2020
BAI #8.1, April 3, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment XI with CFMG (Jail)
CAO ANALYST:
Fine Nai