DATE: May 23, 2023
TO: Board of Supervisors
SUBMITTED BY: John Zanoni, Sheriff-Coroner-Public Administrator
SUBJECT: Amendment VII to Agreement with California Forensic Medical Group, Incorporated
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute retroactive Amendment VII to Agreement with California Forensic Medical Group, Incorporated for payment of 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), effective February 1, 2023 through June 30, 2023 and increasing the maximum by $53,125, to a total of $142,650,613;
2. Adopt Budget Resolution increasing FY 2022-23 appropriations for Sheriff-Coroner-Public Administration’s Org 3111 in the amount of $53,125 to allow for the payment for MAT Care Coordinator expenses (4/5 vote);
3. Adopt Budget Resolution increasing FY 2022-23 appropriations for Special Revenue Fund Sheriff-Coroner-Public Administrator Incarcerated Person’s Welfare Fund Org 1500 in the amount of $17,708 (4/5 vote);
4. Retroactively approve and authorize the Sheriff’s, or his authorized representative’s, previous submittal of a grant application and award acceptance, to the California Department of Health Care Services (DHCS) to pay for a MAT Care Coordinator; and
5. Approve and authorize the Sheriff, or his 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 February 9, 2023. 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 (SOR) 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 are no viable alternative actions. 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 on December 29, 2022 and awarded on February 9, 2023. The recommended amendment is retroactive to February 1, 2023; however, there are no pending invoices.
FISCAL IMPACT:
There is no Net County Cost associated with these recommended actions, as costs for the temporary MAT Care Coordinator in the amount of $127,500 through January 31, 2024 will be covered with funding from DHCS, under Federal funding for the State Opioid Response MAT Expansion Project 2.0 and the Incarcerated Person’s Welfare Fund (IPWF) as follows:
MAT IPWF Total
FY 2022-23 $35,417 $17,708 $53,125
FY 2023-24 $49,583 $24,792 $74,375
$127,500
Approval of the first recommended action will increase the agreement maximum by $53,125, for a total of $142,650,613. Approval of the second and the third recommended actions will increase FY 2022-23 appropriations and estimated revenues for Sheriff-Coroner-Public Administrator Org 3111 to facilitate payment for the MAT Care Coordinator.
It should be noted, the $85,000 award is based on population and covers a full year; however, the current Jail Medical agreement will expire on June 30, 2023. Staff will return to your Board with a new agreement with the California Forensic Medical Group and will include costs associated with the MAT Coordinator.
Should DHCS funding become unavailable, the MAT coordinator will be funded by IPWF. It should be noted that since the current grant period ends January 31, 2024, sufficient appropriations and estimated revenues in the amount of $74,375 will be included in the FY 2023-24 budget request.
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-18-169-1 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-18-169-2 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-18-169-3 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.
On February 1, 2022, the Board approved Amendment IV to Agreement No. A-22-038 with CFMG 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.
On March 22, 2022, the Board approved Amendment V to Agreement No. A-22-094 with CFMG to increase the maximum compensation provided under the Agreement by $6,702,382 to a total of $136,449,588 to pay for an additional twelve months (July 1, 2022, to June 30, 2023) of COVID-19 testing and treatment(s) for jail inmates and pay COVID-19 related pharmaceutical and congregate living costs, with no change to the term of July 1, 2018, to June 30, 2023.
On November 29, 2022 the Board approved Amendment VI to Agreement No. A-22-528 with CFMG to increase the maximum compensation provided under the Agreement by $6,147,900 to a total of $142,597,488 to continue to provide COVID-19 testing and treatment through June 30, 2023, provide reimbursement for COVID-19 related pharmaceutical costs in excess of the pharmaceutical cap discussed in Section VI of the Agreement, and allow for the reimbursement of COVID-19 related staffing and treatment of inmates within the congregate living system. Due to the Omicron variant surge, services related to detection and treatment of COVID-19 are not being reduced, and staff estimates there will be an additional cost of $6,147,900 for the remainder of FY 2022-23.
The DHCS, under 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 OUD and Stimulant Use Disorder through jails, drug courts, and the local justice system.
The grant application was submitted on December 29, 2022, the application was accepted on February 1, 2023, and awarded on February 9, 2023.
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).
The FCJ system incarcerates between 2500 and 3000 adult persons (Incarcerated Persons) who are awaiting trial or serving local sentences. Among the Incarcerated Persons, there is a high degree of substance use disorders (SUD), including those with an OUD. Fresno County currently contracts with a community vendor (BAART) to assist in treating Incarcerated Persons who are enrolled in the MAT program prior to incarceration. Currently, those Incarcerated Persons who become incarcerated and are not enrolled in a MAT program in the community are not provided MAT services while incarcerated. Incarcerated Persons 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 Incarcerated Persons in the FCJ. The services provided through SOR grant funding will provide support and services for Incarcerated Persons 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 Incarcerated Persons upon intake and enroll them in MAT services while they are incarcerated in the FCJ. Services will include enrolling Incarcerated Persons 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 continuous and safe medication management when re-introduced into the community.
Currently, it is estimated that 71 Incarcerated Persons suffering from an OUD come into the custody of the FCJ per month. Most of these Incarcerated Persons are not enrolled in an OUD program prior to their incarceration and must medically detox from opioids while in jail. Upon release, these Incarcerated Persons 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 assist Incarcerated Persons and provide long term solutions to Incarcerated Persons 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. A total of $85,000 was awarded to the County of Fresno; the County of Fresno is requesting an amendment of $53,125 for the duration of the agreement.
Approval of the second and the third recommended actions will increase FY 2022-23 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 his authorized representative, of the previous submittal of a grant application to DHCS to pay for MAT Care Coordinator.
Approval of the fifth recommended action will allow the Sheriff’s Office to execute a Memorandum of Understanding with Health Management Associates, Inc. for distribution of the DHCS Opioid Crisis Grant.
REFERENCE MATERIAL:
BAI #25 November 29, 2022
BAI #35 March 22, 2022
BAI #16 February 1, 2022
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 VII to Agreement with CFMG
On file with Clerk - MOU for MAT Coordinator
On file with Clerk - DHCS MAT Grant Application/Award
CAO ANALYST:
Samantha Buck