DATE: June 24, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan Holt, Director, Department of Behavioral Health
SUBJECT: Amendment to Extend Central Star Behavioral Health Inc. Adolescent and Youth Psychiatric Health Facility, Crisis Residential Treatment, and WestCare California Inc. Supervised Overnight Stay Services Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment No. 2 to Agreement No. 24-618 with Central Star Behavioral Health Inc. for operation of the adolescent youth psychiatric health facility, extending the term by one year, which includes a six-month base term and an optional six-month extension, from July 1, 2025, through June 30, 2026, and increasing the maximum by $7,292,195 to a total of $36,224,407;
2. Approve and authorize the Chairman to execute Amendment No. 1 to License Agreement No. FL-120 with Central Star Behavioral Health Inc. to extend use of County leased space at 3115 N. Millbrook Ave, Fresno CA 93703, for one-year, which includes a six-month base term and an optional six-month extension, from July 1, 2025, through June 30, 2026 ($0);
3. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 23-275 with Central Star Behavioral Health Inc. for adult crisis residential treatment services, extending the term by one year, which includes a six-month base term and an optional six-month extension, from July 1, 2025, through June 30, 2026, and increasing the maximum by $3,295,565 to a total of $8,795,565;
4. Approve and authorize the Chairman to execute Amendment No. 2 to License Agreement No. 23-297 with Central Star Behavioral Health Inc. to extend use of the County’s Crisis Residential Unit, 496 S. Barton, Fresno CA 93702, for one-year, which includes a six-month base term and an optional six-month extension, from July 1, 2025, through June 30, 2026 ($0); and
5. Approve and authorize the Chairman to execute Amendment No. 3 to Agreement No. 24-293 with WestCare California Inc. for operation of the supervised overnight stay services, extending the term by one year, from July 1, 2025, through June 30, 2026, and increasing the maximum by $956,427 to a total of $8,559,995.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of recommended actions one, three and five will extend the term of the Agreement by one year and increase the maximum compensation for each to continue to provide adolescent youth psychiatric health facility, crisis residential treatment services and supervised overnight stay services. Recommended action two and four will extend the corresponding license agreements by one year. These recommended amendments will allow the Department to utilize services provided by the contractors until new contracts are adopted. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. If your Board does not approve the recommended actions 1 through 4, the Department would not be in compliance with DHCS mandated services. Furthermore, individuals actively experiencing a behavioral health crisis will not receive the care they need and adolescents who meet medical necessity for acute psychiatric inpatient services would be sent out of county for care. If recommended action 5 is not approved, the Department would not be able to provide Supervised Overnight Stay services to Fresno County adult residents.
For all recommended actions, your Board may direct the Department to assume operations of any of these services; however, the decision will result in added costs to the County and a delay in services as the Department obtains the required staff and licensure.
FISCAL IMPACT:
The first recommended action increases the maximum compensation by $7,292,195, for the extension of the agreement and brings the total maximum compensation to $36,224,407. The maximum amount of the agreement will be fully offset with Medi-Cal Federal Financial Participation (FFP) and Mental Health Realignment funds. Approval of the second recommended action has no cost associated and will allow Central Star to continue to provide services in the county leased building.
The third recommended action increases the maximum compensation by $129,648, for the Fiscal Year 2024-2025, and by $3,165,917 for the extension of the agreement and brings the total maximum compensation to $8,795,565. The maximum amount of the agreement will be fully offset with Medi-Cal FFP and Mental Health Realignment funds. The fourth recommended action has no cost associated and will allow Central Star to continue to provide services in the county owned licensed building.
Approval of the fifth recommended action increases the maximum compensation by $956,427, for the extension of the Agreement and brings the maximum compensation to $8,559,995. The maximum amount of the agreement will be fully offset with Mental Health Realignment and Opioid Settlement funds and will allow WestCare to continue to provide services.
Sufficient appropriations and estimated revenues are included in the Department of Behavioral Health Org 5630 FY 2024-25 Adopted Budget and FY 2025-26 Recommended Budget.
DISCUSSION:
Adolescent Youth Psychiatric Health Facility
On June 23, 2020, your Board approved Agreement No. 20-238 with Central Star to provide 24 hours a day/7 day a week adolescent inpatient psychiatric health facility services, and a License Agreement for County-owned property located within the University Medical Center (UMC) Campus at 4411 E Cesar Chavez Blvd (previously known as Kings Canyon Road).
On December 3, 2024, the Board approved Amendment No 1. 24-618 to Agreement No. 20-238 and a new License Agreement, for facility relocation and associated budget modifications as the Kings Canyon UMC Campus has been sold and requires services to relocate.
On March 25, 2025, a Request for Proposal (RFP) No. 25-067 for Adolescent and Youth Psychiatric Facility Services was issued, on April 8, 2025, Addendum No. 1 to County’s RFP No. 25-067 was issued, and on April 11, 2025 Addendum No. 2 to County’s RFP No. 25-067 was issued. The RFP closed on April 23, 2025. No bids were received.
Approval of the first recommended action will allow mandated inpatient psychiatric services to continue with the current vendor until a new contract is adopted. Approval of the second recommended action will allow Central Star Behavioral Health to continue to utilize the County leased building. DBH is mandated to provide inpatient psychiatric services, and approval of the first and second recommended actions will allow youth and adolescents to receive services in county.
In FY 2023-24, 199 individuals were served with an average monthly census of 12. For the period of July 2024 through December 2024, 137 unique individuals were served.
Crisis Residential Treatment
On June 20, 2023, the Board approved Agreement No. 23-275 with Central Star Behavioral Health, Inc., for a sixteen (16) bed crisis residential treatment facility (CRT) which provides a residential structured therapeutic program as an alternative to hospitalization. The therapeutic and rehabilitative services are provided as defined in California Code of Regulations (CCR), Title 22, 1810.208.
On June 20, 2023, the Board also approved Amendment No. 1. 23-297 to License Agreement No.17-581 to extend the term to June 30, 2025.
On March 7, 2025, RFP 25-066 for Crisis Residential Treatment Services was issued. Addendums were published on March 27, April 4, and April 9, 2025. The RFP closed April 22, 2025. The Department received four bids. The selected bidder will have to seek certification and licensure through DHCS in accordance with 9 CCR § 1840.334 to operate a CRT. DHCS licensure can take up to 6 months. Certification and licensure are required before services can be provided.
Approval of the third recommended action will allow mandated crisis residential services to continue as the selected bidder completes all required steps to assume service provision. Approval of the fourth recommended action will allow Central Star Behavioral Health to utilize the County operated building. The recommended action also includes an increase to the FY 2024-25 Maximum Compensation. The increase is needed to make salary adjustments to include overtime costs market changes.
In FY 2023-24, 191 unique individuals were served, with an average monthly census of 12. For the period July 2024 through December 2024, 93 unique individuals were served.
Supervised Overnight Stay
On December 11, 2018, the Board approved Agreement No. 18-686 with WestCare California, Inc. to provide supervised overnight stay services to Fresno County.
On June 20, 2023, the Board approved Amendment No. 1, 23-302 to include the implementation DHCS’s California Advancing and Innovating Medi-Cal (CalAIM), and to extend the contract term for an additional twelve (12) month period.
On June 18, 2024, the Board approved Amendment No. 2, 24-293 to modify the billing structure and to extend the contract term for an additional twelve (12) month period.
On March 17, 2025, RFP No. 25-068 for Supervised Overnight Stay Services was issued and on March 27, 2025 Addendum No. 1 to the County’s RFP No. 25-067 was issued. The RFP closed April 11, 2025. No bids were received.
Approval of the fifth recommended action will allow WestCare to continue providing supervised overnight stay services to Fresno County persons served until a new agreement is adopted.
In FY 2023-24, 504 unique individuals were served. For the period of July 2024 through December 2024, 335 referrals were received and 90% of those referrals were for unhoused individuals.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this item at the June 2025 meeting.
REFERENCE MATERIAL:
BAI #46, December 3, 2024
BAI #36, June 18, 2024
BAI #46, June 20, 2023
BAI #44, June 20, 2023
BAI #36, June 23, 2020
BAI #30, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment No. 2 to Agreement No. 24-618 with Central Star
On file with Clerk - Amendment No. 1 to License Agreement No. FL-120 with Central Star
On file with Clerk - Amendment No. 1 to Agreement No. 23-275 with Central Star
On file with Clerk - Amendment No. 2 to License Agreement No. 23-297 with Central Star
On file with Clerk - Amendment No. 3 to Agreement No. 24-293 with WestCare California
CAO ANALYST:
Ron Alexander