DATE: November 17, 2026
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment No. 1 to Master Agreement for Inpatient Psychiatric Hospital Professional 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 due to the non-competitive nature of inpatient psychiatric hospital professional services; and
2. Approve and authorize the Chairman to execute Amendment No. 1 to Master Agreement No. 25-295, for Inpatient Psychiatric Hospital Professional Services, to add Sarah M. Hunter to the Agreement effective upon execution, with no change to the term of July 1, 2025 through June 30, 2030, or compensation maximum of $12,000,000.
REPORT
There is no additional Net County Cost associated with the recommended actions. The recommended actions will allow the Department to add Sarah M. Hunter to the existing Master Agreement to provide inpatient psychiatric hospital professional services. DBH, in its role as the County Behavioral Health Plan (BHP), is obligated to provide and reimburse for inpatient psychiatric hospital services, which include professional services. Approval of the recommended action will ensure the Department remains in compliance with the Department of Health Care Services (DHCS). This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department would be unable to add Sarah M. Hunter to the Master Agreement to continue providing inpatient psychiatric hospital professional services for persons served in need of this level of care.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under AP 34 that an exception to the competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or extraordinary circumstances due to the non-competitive nature of the services. Professional services are a part of Inpatient Psychiatric Hospital services, and the Department does not have control over the referral process to hospitals by local emergency departments but are required to pay for these services. 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 approved Master Agreement ($12,000,000) will be funded with Mental Health Realignment and Medi-Cal Federal Financial Participation (FFP). Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2026-27 Adopted Budget and will be included in future budget requests for the duration of the term of the Agreement. Actual cost will be determined by actual services provided.
DISCUSSION:
On May 23, 2023, the Board authorized reimbursement to non-contracted mental health providers and psychiatric inpatient hospitals for services provided to County Medi-Cal beneficiaries receiving services in other counties, in accordance with Title 9 of the California Code of Regulations. Under this authorization, reimbursement of up to $200,000 may be issued to each provider or inpatient hospital. Providers for inpatient hospitals that exceed the $200,000 reimbursement threshold are required to enter an agreement with the County to continue receiving reimbursement. On June 2, 2026, the Board approved updating and extending the authorization an additional three years through June 30, 2029.
On June 24, 2025, the Board approved Master Agreement No. 25-295 for the provision of Inpatient Hospital Professional Services with Bio-Behavioral Medical Clinics, Inc. and Precision Psychiatric Services, Inc. as these providers exceeded the $200,000 reimbursement limitation. The Master Agreement is intended to provide a mechanism for timely payment processing for County residents in need of inpatient psychiatric care.
Sarah M. Hunter provided 104 inpatient professional fee services in FY 2025-26 and 12 inpatient professional fee services in FY 2026-27 to Fresno County beneficiaries admitted to an inpatient psychiatric hospital. The provider’s total reimbursement is $135,580, which is nearing the $200,000 limit thus requiring the proposed amendment adding Ms. Hunter to Master Agreement No. 25-295 to be reimbursed for continued services provided.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the Amendment at the November 2026 meeting.
REFERENCE MATERIAL:
BAI #28, June 2, 2026
BAI #53, June 24, 2025
BAI #28, May 23, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Amendment No. 1 to Master Agreement 25-295
CAO ANALYST:
Ronald Alexander