DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan Holt, Director, Department of Behavioral Health
SUBJECT: Master Agreement for Eating Disorder Services
RECOMMENDED ACTION:
TITLE
Approve and authorize the Chairman to execute a Master Agreement for Eating Disorder Services for youth with serious emotional disturbance (SED) and adults with severe mental illness (SMI), effective August 5, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $6,500,000.
REPORT
There is no Net County Cost associated with the recommended action. Approval of the recommended action will allow the Department to enter into a master agreement for the provision of required medically necessary behavioral health eating disorder treatment services for all County persons served requiring these services at the appropriately designated level of care. This item is countywide.
ALTERNATIVE ACTION:
There is no viable alternative action. Should the Board not approve the recommended actions, this will result in youth with SED and adults with SMI not being placed within the appropriate treatment settings to receive adequate services to treat their eating disorder diagnoses and the Department not being able to fulfill the Department of Health Care Services (DHCS) requirement of providing behavioral health treatment for persons living with an eating disorder.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum cost of the recommended Agreement ($6,500,000) will be funded with Mental Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department of Behavioral Health’s Org 5630 FY 2025-2026 Recommended Budget and will be included in future budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On August 20, 2019, the Board approved Master Agreement No. A-19-406 with licensed and credentialed facilities to provide specialized residential mental health services for County persons served, as mandated by the Welfare and Institutions Code (WIC) and California Code of Regulations (CCR) Title 22.
On June 30, 2023, the Board approved Superseding Agreement No. A-23-283 to include new California Advancing and Innovating Medi-Cal (CalAIM) requirements set by the Department of Health Care Services including payment reform requirements. The Agreement was amended four times to revise rates and add additional providers.
On June 24, 2025, your Board approved Amendment No. 5 (No. 25-291) to the Master Agreement to extend the term for three months, with an optional additional three-month extension, to prevent a gap in services in anticipation for the implementation of a new Agreement.
The Department released a Request for Service Qualifications (RFSQ) on April 24, 2025, for the provision of eating disorder treatment services. The purpose of the RFSQ is to establish a master agreement that included all qualified bidders with the ability to provide eating disorder treatment for County youth and adult persons served diagnosed with eating disorders, as required by Behavioral Health and Information Notice (BHIN) 22-009. The response period closed on May 15, 2025, and one response was received from Oasis Eating Disorder Recovery, A Professional Psychology Corporation.
Eating disorders are complex conditions involving both physical and psychological components. As such, effective treatment of eating disorders involves a combination of physical and mental health interventions, often provided through an integrated therapeutic modality, program, or setting. County through the Department of Behavioral Health (DBH) is a Behavioral Health Plan (BHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), section 1810226. BHPs are required to cover all medically necessary treatment services including residential and day treatment intensive services to treat the eating disorder. The number of individuals requiring eating disorder services for such conditions is increasing while options for placement remain limited.
The Department has reached out to several facilities that deliver eating disorder services to secure placement for at least ten (10) individuals within the past several months. Most facilities that treat severe and complex conditions such as eating disorders are reluctant to contract with counties because such facilities prefer to treat individuals that are capable of financing their own care (private pay). However, there are facilities throughout the State that are willing to serve Fresno County Medi-Cal beneficiaries as long as they are not held to the rules and regulations of the Medi-Cal program. The recommended Master Agreement includes provisions that will ensure that facilities that are not willing to participate in the Medi-Cal program will be willing to enter into the recommended Master Agreement. The Department is seeking approval of the recommended Master Agreement with such provisions to maintain a sufficient network of mental health facilities providing eating disorder services to meet the growing demands for such services for Fresno County residents.
The maximum compensation for this Master Agreement was determined based on several factors including the expenditures of the past three (3) FY for eating disorder treatment and the number of persons treated for these services. During FY 2024-25, the Department has compensated a total of $942,494 for eating disorder services, with $252,117 for Oasis Eating Disorder Recovery, A Professional Psychology Corporation. The maximum compensation amount will ensure the Department will be able to add additional providers to increase the network of eating disorder services due to the growing needs for these services. In the past FY, the Department has placed over 18 persons served in various facilities for eating disorder services with ten (10) of those persons served placed within Oasis Eating Disorder Recovery, A Professional Psychology Corporation.
If the recommended Master Agreement is approved, it will provide a mechanism to ensure individuals can be placed within facilities that deliver the appropriate level of care for eating disorder services as timely as possible while also providing a mechanism for expeditious payment of such services. The recommended Master Agreement also includes provisions to ensure that the Department will appropriately monitor the quality of the care provided to all Fresno County residents that will be placed within such facilities. If approved, the recommended Master Agreement will become effective upon execution and may be terminated by the County, DBH Director, or designee, or the contractor(s), upon providing a 60-day advanced written notice. The Department continually searches for facilities that provide SHMS eating Disorder services to meet the needs of persons living with an eating disorder. If the Department locates a vendor who meets the needs of the Department, the Department will return to your Board to amend the recommended agreement.
The modification and rate modification clauses of the agreement delegate the Board’s authority to the DBH Director to make non-material changes to the agreement, that will not result in any change to the maximum compensation payable to Contractor(s), during the term of the agreement, as further described in Article 15, Sections 1 and 2 of the agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended actions at the July 2025 meeting.
REFERENCE MATERIAL:
BAI #51, June 24, 2025
BAI #27, May 6, 2025
BAI #31, August 20, 2024
BAI #30, March 5, 2024
BAI #26, August 22, 2023
BAI #44, June 20, 2023
BAI #26, August 20, 2019
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Master Agreement
CAO ANALYST:
Ronald Alexander Jr.