DATE: June 22, 2021
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Amendments to Extend Five Behavioral Health System of Care Agreements
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment I to Master Agreement No. 17-006 with various contractors to provide an integrated screening process linking individuals and families facing behavioral, social, health and other related challenges to supportive services, effective July 1, 2021, extending the term by one year from July 1, 2021 to June 30, 2022, and increasing the contract maximum by $1,000,000 to a total of $8,500,000;
2. Approve and authorize the Chairman to execute Amendment I to Agreement No. 16-692 with Bitwise Industries Inc. dba Shift3 Technologies, effective July 1, 2021, extending the term by one year from July 1, 2021 to June 30, 2022, and increasing the contract maximum by $48,000 to a total of $563,500;
3. Approve and authorize the Chairman to execute the Amendment III to Agreement No. 15-317 with Kings View Behavioral Health for Crisis Intervention Team Services - Rural Triage Mental Health Services, effective July 1, 2021, extending the term by one year from July 1, 2021 to June 30, 2022, and increasing the contract maximum by $2,681,876 to a total of $17,545,391;
4. Approve and authorize the Chairman to execute the retroactive Amendment II to Agreement No. 15-594 with Exodus Recovery, Inc. for the operation of the adult acute inpatient psychiatric health facility effective July 1, 2020, extending the term by one year from July 1, 2021 to June 30, 2022 and increasing the maximum by $5,302,954 to a total of $28,075,237; and,
5. Approve and authorize the Chairman to execute the First Amendment to Facility Use Agreement No. 15-595 with Exodus Foundation, Inc. for usage of county owned space at 4411 E. Kings Canyon Rd., Fresno, CA 93702, Building 319 (14,318 square feet) to provide acute inpatient psychiatric health facility services to adults, effective July 1, 2021 extending the term by one year from July 1, 2021 to June 30, 2022 ($0).
REPORT
There is no Net County Cost associated with the recommended actions. Approval of the recommended actions will ensure that necessary behavioral health services continue uninterrupted through the COVID-19 pandemic (pandemic) and will allow the various contractors the ability to continue providing services while the related competitive bid processes are finalized. The amendments will also update the agreements’ insurance language and are funded with Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI), Federal Financial Participation (FFP) Medi-Cal Revenue and Realignment funds. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, services will be reduced for individuals with serious mental illness and the Department of Behavioral Health would be unable to provide mandated adult acute inpatient psychiatric services to county residents.
RETROACTIVE AGREEMENT:
The recommended amendment with Exodus Recovery, Inc, action is retroactive to July 1, 2020 due to an increase in funding for FY 2020-21 as a result of increased capacity and services necessary due to the pandemic.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions.
• The first recommended action will increase the total compensation from $7,500,000 to $8,500,000 ($1,000,000) using MHSA-PEI funds.
• The second recommend action will increase the total compensation from $515,500 to $563,500 ($48,000) using MHSA-PEI funds.
• The third recommended action will increase the total compensation from $14,863,515 to $17,545,391 ($2,681,876) using MHSA-PEI funds and FFP Medi-Cal Revenue.
• The fourth recommended action will increase the total compensation from $22,772,283 to $28,075,237 ($5,302,954) using Realignment funds.
• The fifth recommended action does not include compensation or funding amounts.
Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2020-21 Adopted Budget and will be included in the FY 2021-22 Recommended Budget.
DISCUSSION:
Due to the challenges presented by the pandemic, most county and contracted provider staff have been experienced unanticipated staff shortages and accommodations to meet the new requirements and safety precautions. Furthermore, the contractors in these agreements have had an increase in services as they have either had an influx of individuals seeking services due to the impacts of the pandemic, as other service providers have not been available, and/or have provided additional support in pandemic response related activities such as vaccinations.
On January 10, 2017, the Board approved Master Agreement No. 17-006 for an integrated screening process linking individuals and families facing behavioral, social, health and other related challenges to supportive services. The pandemic and various factors have impacted services. As other service providers have scaled back in-person services, Multi-Agency Access Program (MAP) service providers have continued to provide in-person services as well incorporate not physical services.
On December 13, 2016, the Board approved Agreement No. 16-692 with Bitwise Industries Inc. dba Shift3 Technologies to develop and implement an electronic integrated information system to manage clients, services and providers at MAP Points in the County. The Department is working to secure a database that will enhance data reporting, increase efficiency for the screening tool and comply with reporting requirements mandated by MHSA-PEI. As a new database is being secured, the amendment would allow Bitwise to continue to provide maintenance and support for the current database and not disrupt services at the MAP Points.
On July 14, 2015, the Board approved Agreement No. 15-317 with Kings View Behavioral Health (Kings View) for Rural Mental Health Triage Services in the east and west cities of the County. On July 10, 2018, the Board approved the first amendment to extend the term for two additional years from July 1, 2018 to June 30, 2020 and increase the maximum compensation to include two, optional one-year extensions. On April 28, 2020, your Board approved the second amendment to extend the term for an additional year from July 1, 2020 to June 30, 2021 and increase the maximum compensation due to the pandemic. The recommended amendment will extend the term one-year to allow sufficient time for the procurement process as review of appropriate CIT models for the community is completed and to bring alignment with Metro CIT services as currently contracted under Agreement No. 18-688 and approved by your Board on December 11, 2018.
On November 17, 2015, the Board approved Agreement No. 15-594 with Exodus Recovery, Inc. (Exodus) for mandated adult acute inpatient psychiatric health facility (PHF) services to residents of the County. On June 18, 2019, your Board approved the first amendment to retain and add both Exodus and subcontracted positions. The need for services has increased due to the pandemic and the PHF added four beds during FY 2020-21, requiring an increase to the maximum compensation. The recommended amendment will extend the term one-year because the possibility of changing over to a different provider as a result of a competitive bid process in the middle of the pandemic could risk the stable environment of the patients currently in crisis. The recommended Facility Use Agreement amendment with Exodus Foundation, Inc. (Exodus’ non-profit organization) will allow the adult acute inpatient psychiatric health facility services to continue to be provided on county-owned property located at 4411 E Kings Canyon Road in the City of Fresno (14,318 square feet).
The four recommended amendments to existing Agreement will provide flexibility with term deadlines and payment structures to maintain the current services levels provided to the individuals served throughout the Behavioral Health System of Care. The amendments will also update the agreements’ insurance language.
The identified agreements are in their final year with June 30, 2021 expiration date. Approval of the recommended actions will allow for a one-year extension period to June 30, 2022 and increase maximum compensation for program services to continue while competitive bidding processes and contract negotiations can be completed.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of the recommended amendments on March 17, 2021.
REFERENCE MATERIAL:
BAI #31.1, April 28, 2020
BAI #38, June 18, 2019
BAI #32, December 11, 2018
BAI #47, July 10, 2018
BAI #28, January 10, 2017
BAI #27, December 13, 2016
BAI #35, November 17, 2015
BAI #35, July 14, 2015
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Agreement No. 17-006
On file with Clerk - Amendment I to Agreement No. 16-692
On file with Clerk - Amendment III to Agreement No. 15-317
On file with Clerk - Amendment II to Agreement No. 15-594
On file with Clerk - First Amendment to Facility Use Agreement No. 15-595
CAO ANALYST:
Sonia M. De La Rosa