DATE: February 1, 2022
TO: Board of Supervisors
SUBMITTED BY: Margaret Mims, Sheriff-Coroner-Public Administrator
SUBJECT: Amendment IV to Agreement with California Forensic Medical Group, Incorporated
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment IV to agreement with California Forensic Medical Group, Incorporated effective February 01, 2022 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 (FCJ), with no change to the term of July 1, 2018 through June 30, 2023;
2. Adopt Budget Resolution increasing FY 2021-22 appropriations for Sheriff-Coroner-Public Administration’s Org 3111 in the amount of $120,000 to allow for the payment for MAT Care Coordinator expenses (4/5 vote);
3. Adopt Budget Resolution increasing FY 2021-22 appropriations for Special Revenue Fund Sheriff-Coroner-Public Administrator Inmate Welfare Fund Org 1500 in the amount of $40,000 (4/5 vote);
4. Retroactively approve and ratify the execution by the Sheriff, or her authorized representative, of the previous submittal of a grant application to the California Department of Health Care Services (DHCS) to pay for MAT Care Coordinator; and
5. Approve and authorize the Sheriff, or her authorized representative, to execute the Memorandum of Understanding with Health Management Associates, Inc. for distribution of the DHCS Opioid Crisis Grant.
REPORT
There is no Net County Cost associated with the recommended actions. The DHCS, under its federal funding for the State Opioid Response “Medication Assisted Treatment Expansion Project 2.0” has provided funds to be distributed to all county teams participating in the project Expanding Access to MAT in County Criminal Justice Settings. Funds are intended to expedite program maturation and sustainability of local access to MAT and other treatments for Opioid Use Disorder and Stimulant Use Disorder through jails, drug courts, and the local justice system. The grant application was submitted, accepted, and awarded on November 3rd, 2021. A Memorandum of Understanding (MOU) is required to be executed between Health Management Associates, Inc. and the Sheriff’s Office, as Health Management Associates, Inc. will distribute grants from the State Opioid Response Grant to participating California counties, for the purpose of implementing specific and approved strategies to expand access to medication assisted treatment of opioid addiction in the county’s jails and drug courts. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If the recommended actions are not approved, the Sheriff’s Office will not be able to pay for the MAT Care Coordinator; accordingly, the Sheriff’s Office will not be able to identify OUD inmates upon intake and enroll them in the MAT services while incarcerated in the FCJ.
RETROACTIVE AGREEMENT:
The grant application was submitted, accepted and awarded on November 3rd, 2021. Final award will be made subsequent to your Board’s approval.
FISCAL IMPACT:
There is no Net County Cost associated with these recommended actions as costs for the temporary MAT Care Coordinator will be covered with funding from DHCS, under its federal funding for the State Opioid Response “Medication Assisted Treatment Expansion Project 2.0” ($80,000) and the remaining ($40,000) will be funded from the Inmate Welfare FUND (IWF). Approval of the first recommended action will increase the agreement maximum by $120,000 for a total of $129,747,205. Approval of the second and the third recommended action will increase FY 2021-22 appropriations and estimated revenues for Sheriff-Coroner-Public Administrator Org 3111 to facilitate payment for the MAT Care Coordinator. Approval of the fourth recommended action will retroactively approve and ratify the execution by the Sheriff, or her authorized representative, of the previous submittal of a grant application to the California Department of Health Care Services (DHCS) to pay for MAT Care Coordinator. Approval of the fifth recommended action will allow the Sheriff’s Office to complete the grant process with the DHCS to pay for MAT Care Coordinator services.
DISCUSSION:
On April 3, 2018, the Board approved Agreement No. A-18-169 with California Forensic Medical Group Incorporated (“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 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 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 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.
The DHCS, under its federal funding for the State Opioid Response “Medication Assisted Treatment (MAT) Expansion Project 2.0” has provided funds to be distributed to all county teams participating in the project Expanding Access to MAT in County criminal justice settings. Funds are intended to expedite program maturation and sustainability of local access to MAT and other treatments for OUD and Stimulant Use Disorder through jails, drug courts, and the local justice system.
The grant application was submitted, accepted, and awarded on November 3rd, 2021.
An MOU is required to be executed between Health Management Associates, Inc. and the Sheriff’s Office. Health Management Associates, Inc. is a subrecipient of the State Targeted Response to the Opioid Crisis Grant awarded by the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (“SAMHSA”) to DHCS (the “State Opioid Response Grant”) pursuant to an agreement between DHCS and Health Management Associates, Inc. (“DHCS Agreement”). Under the DHCS Agreement, Health Management Associates, Inc. will distribute grants from the State Opioid Response Grant to participating California counties, for the purpose of implementing specific and approved strategies to expand access to medication assisted treatment of opioid addiction in the county’s jail(s) and drug court(s).
50% of the awarded grant funds will be paid upon receipt of the fully executed MOU. The remainder of the grant award will be paid on receipt of satisfactory interim report as specified in the MOU, and contingent on submittal of quarterly Jail MAT data, which is due January 15, 2022. Grant funds must be spent by August 31, 2022.
The FCJ system incarcerates between 2500 and 3000 adult inmates who are awaiting trial or serving local sentences. Among the inmates, there is a high degree of substance use disorder (SUD), including those with an OUD. Fresno County currently holds a contract with a community vendor (BAART) to assist in treating jail inmates who are enrolled in the MAT program prior to incarceration. Currently, those inmates who become incarcerated and are not enrolled in a MAT program in the community are not provided MAT services while incarcerated. Inmates who enter the jail with an opioid SUD are detoxified under medical supervision while in jail and are not provided linkage to services upon discharge into the community.
It is the objective of the FCJ, through the SOR grant, to increase the availability of MAT services to justice-involved inmates in the FCJ. The services provided through SOR grant funding will provide support and services for incarcerated inmates in the FCJ with OUD. Services will be provided from intake into the FCJ and continue with a discharge plan, including linkage to community OUD providers, upon their release into the community.
The SOR grant funds will allow the FCJ, through its medical and mental health provider Wellpath, to hire a MAT Care Coordinator. The MAT Care Coordinator will be responsible to identify OUD inmates upon intake and enroll them in MAT services while they are incarcerated in the FCJ. Services will include enrolling inmates into the MAT program, linkage to jail providers for medication administration, induction in SUD programming, and providing discharge planning and a “warm hand-off” to community OUD providers post release.
The MAT Care Coordinator in the FCJ will be responsible for connecting patients in need with experienced medical providers for diagnosis, medication initiation and/or continuation, medication compliance, creating and tracking patient’s treatment plan and progress throughout their incarceration within the facility. In addition, the MAT Care Coordinator will introduce the patient into SUD programming, and create a plan for the patient’s safe discharge from the facility. The MAT Care Coordinator will also be responsible for completing a “warm hand-off” with community partners in the Department of Behavioral Health, to ensure patients have continuation and safe medication management when re-introduced into the community.
Currently, it is estimated that 71 inmates per month come into the custody of the FCJ suffering from an OUD. Most of these inmates are not enrolled in an OUD program prior to their incarceration and must medically detox from opioids while in jail. Upon release, these inmates are at a substantially higher risk to reuse opioids, overdose, and die. The grant funds through the SOR grant will allow the FCJ to develop a robust solution to justice-involved inmates and provide long term solutions to inmates who live with OUD, including linkage to services upon release into the community.
Approval of the first recommended action will approve an increase to the agreement maximum for CFMG to pay for the MAT Care Coordinator.
Approval of the second and the third recommended action will increase FY 2021-22 appropriations and estimated revenues for Sheriff-Coroner-Public Administrator Org 3111 to facilitate payment for the MAT Care Coordinator.
Approval of the fourth recommended action will retroactively approve and ratify the execution by the Sheriff, or her authorized representative, of the previous submittal of a grant application to the California Department of Health Care Services (DHCS) to pay for MAT Care Coordinator.
Approval of the fifth recommended action will allow the Sheriff’s Office to submit the grant application to the DHCS to pay for the MAT Care Coordinator.
REFERENCE MATERIAL:
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 - Budget Resolution (ORG 1500)
On file with Clerk - Budget Resolution (ORG 3111)
On file with Clerk - Amendment IV to Agreement with CFMG
On file with Clerk - MOU for MAT Coordinator
On file with Clerk - DHCS MAT Grant Application
CAO ANALYST:
Yussel Zalapa