DATE: June 16, 2026
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendments to Various Full-Service Partnership Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment No. 3 to Agreement No. 25-616 with Turning Point of Central California, Inc. effective July 1, 2026 with no change to the term of July 1, 2023 through June 30, 2027 and increasing the maximum compensation by $140,000 to a total of $29,195,243; and
2. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-380 with Mental Health Systems, Inc. effective July 1, 2026 with no change to the term of August 5, 2025 through June 30, 2030 and increasing the maximum compensation by $2,776,124 to a total of $32,131,247; and
3. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-413 with Mental Health Systems, Inc. effective July 1, 2026 with no change to the term of August 19, 2025 through June 30, 2030 and increasing the maximum compensation by $27,326,291 to a total of $50,306,859; and
4. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-381 with Central Star Behavioral Health, Inc. effective July 1, 2026 with no change to the term of August 5, 2025 through June 30, 2030 and decreasing the maximum compensation by $10,389,720 to a total of $34,170,854; and
5. Approve and authorize the Chairman to execute Amendment No. 2 to Agreement No. 25-412 with The Fresno Center effective July 1, 2026 with no change to the term of August 19, 2025 through June 30, 2030 and decreasing the maximum compensation by $7,718,522 to a total of $21,190,758; and
6. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-414 with Turning Point of Central California, Inc., effective July 1, 2026 with no change to the term of August 19, 2025 through June 30, 2030 and decreasing the maximum compensation by $11,825,628 to a total of $58,527,904; and
7. Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-382 with Turning Point of Central California, Inc. effective July 1, 2026 with no change to the term of August 5, 2025 through June 30, 2030 and increasing the maximum compensation by $20,547,008 to a total of $53,973,723.
REPORT
There is no additional Net County Cost associated with the recommended actions. The recommended actions will allow the Department to align Full-Service Partnership (FSP) services with the requirements of the Behavioral Health Services Act (BHSA) and offer incentives to persons served to encourage enrollment in Community Assistance, Recovery and Empowerment (CARE) Act services. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department would be unable to implement the State-mandated requirements of BHSA, including the County’s three-year Integrated Plan and the associated FSP program regulations. Current Agreements would remain in effect; however, the current Mental Health Services Act (MHSA) funding will no longer be available. Additionally, CARE Act incentives would not become available to encourage enrollment in these services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. Attachment A includes the contract amounts for the period of July 1, 2026 through June 30, 2027, the total maximum compensation amounts through June 30, 2030, and funding sources of each amendment herein. Sufficient appropriations and estimated revenues are included in the Department of Behavioral Health’s Org 5630 FY 2026-2027 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 June 20, 2023, the Board approved Superseding Agreement No. 23-296 with Turning Point of Central California, Inc. (TPOCC) for Forensic Continuum of Care Services and to include new California Advancing and Innovating Medi-Cal (Cal-AIM) requirements set by the Department of Health Care Services including payment reform requirements.
On October 8, 2024, the Board approved Amendment No. 1 (24-533) to Agreement No. 23-296 with TPOCC to increase Department of State Hospital (DSH) Diversion Program funds for one additional year to continue services for the Felony Incompetent to Stand Trial (FIST) population.
On December 9, 2025, the Board approved Amendment No. 2 (25-616) to Agreement No. 23-296 with TPOCC to increase DSH Diversion Program funds and continue services for the FIST population for the remainder of the contract term.
In March and April 2025, the Department released two (2) Requests for Proposals (RFPs) for Full-Service Partnership (FSP) Continuum of Care (CoC) services which includes: FSP, Intensive Case Management (ICM) and Outpatient (OP) levels of care. Language in the RFPs notified bidders to be prepared for contract amendments to include changes specific to the implementation of the BHSA requirements. The changes include formally defining the FSP Assertive Community Treatment (ACT) and FSP ICM services, removing MHSA funds, and adding BHSA funds. Outpatient services will continue to be available with no significant changes.
On August 5, 2025, the Board approved Agreement No. 25-380 with Mental Health Systems, Inc., Agreement No. 25-381 with Central Star Behavioral Health, Inc. and Agreement No. 25-382 with Turning Point of Central California, Inc. for Adult FSP CoC services. Agreement No. 25-380 with Mental Health Systems, Inc. also includes Assertive Outreach Treatment (AOT) and CARE Act services.
On August 19, 2025, the Board approved Agreement No. 25-413 with Mental Health Systems, Inc. for Co-Occurring Adult FSP CoC services, Agreement No. 25-414 with Turning Point of Central California, Inc. for Rural FSP CoC services and Agreement No. 25-412 with The Fresno Center for Culturally Specific Adult FSP CoC services. Agreement No. 25-412 was amended May 12, 2026 (26-192) to reallocate funds between service levels.
In March 2026, the State released new accountability measures for counties implementing CARE Act. The new measure of success is petitions per capita with the current State average being 6.2 petitions per capita. Fresno County fell under the average by 0.2 petitions. As a result, the Department is ramping up CARE Act activities and including an incentives budget line item to meet the new measurement of success. Incentives are small tokens utilized during the outreach and engagement period to build initial rapport and trust with individuals petitioned to CARE. Incentives are a tool to enhance the effectiveness of assertive outreach and engagement efforts and improve the success of the program.
Additionally, no later than July 1, 2026, the Department must implement Proposition 1, which was passed by California voters in March 2024. Proposition 1 proposed statewide reform and expansion of California’s behavioral health system, effectively replacing the Mental Health Services Act (MHSA) of 2004 with the Behavioral Health Services Act (BHSA). The impacts of the BHSA include changes to the FSP programs including carving out housing support funds into a separate, distinct service and formally delineating the FSP services into distinct levels which includes FSP Forensic Assertive Community Treatment (FACT), FSP Assertive Community Treatment (ACT) and FSP Intensive Case Management (ICM).
The Department held a series of meetings with the Purchasing Manager to discuss the scope of work changes required to align these Agreements with BHSA. The Purchasing Manager concurs with the determination that amending the scope of work remains consistent with the RFP.
Through a series of meetings with the current contractors, all were offered the opportunity to include an FSP FACT or FSP ACT team in their programs. Turning Point of Central California, Inc. Sunrise and First Street Center programs and Mental Health Systems, Inc. IMPACT program opted to provide this level of care. Three Contractors, Central Star Behavioral Health, Inc., The Fresno Center and Turning Point of Central California, Inc. Rural Mental Health, will not have ACT services, resulting in a reduction to their contract maximums.
AB 339 noticing has occurred and the Human Resources Department approved execution of the recommended amendments.
Attachment A includes information for seven (7) recommended amendments to implement the BHSA and the new CARE Act provisions, including the original Agreement and any amendment numbers, dates of previous Board actions, contractor names, service description, modality, contract effective date, contract maximums, funding sources and the entire contract term for each recommended amendment.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board will be notified of this agreement at the June 2026 meeting.
REFERENCE MATERIAL:
BAI #27, May 12, 2026
BAI #39, August 19, 2025
BAI #46, August 5, 2025
BAI #49, December 9, 2025
BAI #31, October 8, 2024
BAI #45, June 20, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
Attachment A
On file with Clerk - Amendment No. 3 with Turning Point of Central California, Inc.
On file with Clerk - Amendment No. 1 with Mental Health Systems, Inc.
On file with Clerk - Amendment No. 1 with Mental Health Systems, Inc.
On file with Clerk - Amendment No. 1 with Central Star Behavioral Health, Inc.
On file with Clerk - Amendment No. 2 with The Fresno Center
On file with Clerk - Amendment No. 1 with Turning Point of Central California, Inc.
On file with Clerk - Amendment No. 1 with Turning Point of Central California, Inc.
CAO ANALYST:
Ronald Alexander