DATE: November 4, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Master Agreement for Locum Tenens Psychiatric Services
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34) determine that an exception to the competitive bidding requirement under AP 34 is satisfied and a suspension of competition is warranted due to unusual or extraordinary circumstances as the identified vendors are the only agencies that are able and willing to provide licensed psychiatric professionals available to provide services to individuals in Fresno County on a non-permanent employment basis; and
2. Approve and authorize the Chairman to execute a Master Agreement with various vendors to provide locum tenens psychiatric services, effective January 1, 2026, which includes a six month and two-year base contract and two optional one-year extensions, total not to exceed $60,000,000.
REPORT
There is no increase in Net County Cost associated with the recommended actions. The recommended actions allow the Department of Behavioral Health to place non-permanent psychiatrists and psychiatric nurse practitioners within County-operated facilities to provide psychiatric services to individuals with behavioral health needs. The agreement will ensure that the service population will have timely and appropriate access to psychiatric care until permanent psychiatric professionals can be recruited, hired, and onboarded. This item is countywide.
ALTERNATIVE ACTION(S):
If your Board does not approve the recommended actions, individuals living in Fresno County who currently receive psychiatric care will experience delays in essential services and access to needed medication. Furthermore, the Department will be noncompliant with Federal and State mandated requirements for access to psychiatric services. The Department would be severely inadequately staffed with licensed psychiatrists and psychiatric nurse practitioners despite continuous efforts to recruit and hire qualified providers.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under Administrative Policy No. 34 that an exception to the competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or extraordinary circumstances, as the vendors identified on this Master Agreement are the only vendors able and willing to provide Psychiatrist and Psychiatric Nurse Practitioners to provide essential and mandated medication management services to adults and youth with moderate to severe mental health diagnosis. Due to the nature of this Master Agreement the Department will return to your Board if any other vendors are identified and vetted to request to add them to the Master Agreement. The General Services Department - Purchasing concurs with the Department’s assessment that this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of the Agreement is $60,000,000 and will be funded with Mental Health Realignment and Short/Doyle Medi-Cal revenue. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5630 FY 2025-26 Adopted Budget and in subsequent budget requests for the duration of the term of the Agreement. Actual cost will be determined by actual services provided.
DISCUSSION:
The County of Fresno continues to face challenges in retaining long-term psychiatric service providers who are local to Fresno County or are willing to relocate to Fresno County. In general, there continues to be a significant shortage of psychiatric service providers in the Central Valley and in the State of California.
The Department of Health Care Services (DHCS) has established network adequacy standards for access to services and distance from services that the Department is required to meet. Locum tenens providers help to increase the Department’s capacity to provide appropriate psychiatric services by expanding the provider network to include local as well as remote psychiatric providers located throughout the United States. The option for telehealth treatment mitigates barriers to access to timely services, as well as proximity to services, as individuals are required to be seen in-person every six months, at minimum.
Psychiatrists and Psychiatric Nurse Practitioners provide essential and mandated medication management services to adults and children with moderate to severe mental health diagnoses. Psychiatric providers are necessary for the Department to maintain appropriate levels of service. The Department has experienced ongoing challenges to fill vacant psychiatric services positions through traditional recruitment and hiring practices and partnered with Central California Faculty Medical Group, Inc. (CCFMG) in 2018 to fulfill that purpose.
On May 7, 2019, the Board approved master agreement 19-200 for in-person locum tenens (non-permanent) providers. On January 7, 2020 the Board approved master agreement 20-015 for remote/telehealth locum tenens providers. These agreements were executed to bridge the gap in services until CCFMG could fill all vacancies. Currently, there are 15 permanent providers hired through CCFMG, and a total of 32 onsite and remote locum tenens providers hired through the master agreements to deliver psychiatric services to individuals living in Fresno County. Although the number of permanent CCFMG psychiatrists is steadily increasing, there is still need for non-permanent providers to meet the needs of the County. Over the term of the in-person locum tenens Master Agreement A-19-200 was amended five times to add providers, modify rates, and extend the term. Over the term of the telemedicine Master Agreement A-20-015 was amended four times add providers, modify rates, and to extend the term.
The current master agreements for locum tenens onsite and telehealth providers have been very successful in meeting the needs of the County as well as the people we serve, and most of the current providers have worked within the Department’s system of care for several years, building good professional rapport with County staff and persons served.
The recommended master agreement would combine the services of the two master agreements into one agreement with two modes of service delivery: onsite and remote. Contractors will have the option to offer one or both service modalities. Changes to the master agreement such as reimbursement rates, vendor service modalities, and additions or deletions of vendors will be presented to the Board for approval.
The modification clause of the agreement delegates the Board’s authority to the DBH Director to make non-material changes to the agreement during the term of the agreement, as further described in the modification clause of the Agreement. These changes shall not result in any changes to the maximum compensation amount.
The recommended agreement does not automatically guarantee placement of a locum tenens professional to provide services in a County of Fresno facility. The Department has made the decision, after consultation with County Risk Management, to allow Contractors to obtain Molestation Liability prior to placement of any locum tenens professional. This decision was made to allow businesses, both large and small, to not be unduly burdened without a guarantee of a placement in Fresno County. Once a placement has been made, the Contractor will be required to keep the Molestation Liability in effect for the term of the agreement plus another five years as stated in the insurance language, even if no further placements are given. The Department has implemented controls to ensure this process is followed.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this agreement at the November 2025 meeting.
REFERENCE MATERIAL:
BAI# 51 - June 24, 2025
BAI# 43 - December 3, 2024
BAI# 45 - November 7, 2023
BAI# 46 - June 20, 2023
BAI# 35 - February 28, 2023
BAI# 36 - February 28, 2023
BAI# 23 - January 7, 2020
BAI# 48 - May 7, 2019
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Master Agreement for Locum Tenens Psychiatric Services
CAO ANALYST:
Ronald Alexander