DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreement with JDT Consultants, Inc. for the provision of Therapeutic Behavioral Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with JDT Consultants, Inc. for the provision of Therapeutic Behavioral Services to Fresno County Medi-Cal Persons Served as mandated pursuant to the permanent injunction issued by the United States District Court in the case of Emily Q. v. Bonta, effective August 5, 2025, through June 30, 2030, which includes a contract and two optional one-year extensions, total not to exceed $22,744,716.
REPORT
There is no Net County Cost associated with the recommended action. Approval of the recommended action would allow JDT Consultants, Inc. to provide Therapeutic Behavioral Services (TBS) to eligible Fresno County Medi-Cal beneficiaries who are under 21 and can benefit from one-to-one therapeutic contact with a mental health specialist to maintain placement at the lowest appropriate level. The proposed agreement would be funded by Mental Health Realignment and Short/Doyle Medi-Cal Federal and State funds with no Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There are no alternative actions. Should the recommended action not be approved, the County will not be able to provide TBS as mandated by the judgment and permanent injunction issued in Emily Q. v. Bonta (C.D. Cal. 2001) 208 F.Supp.2d 1078 and will impact compliance with the federal court order. Without approval of this recommended action, children and families in need of these services may experience a gap and/or delay in receiving essential mental health services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Services will be fully funded with Medi-Cal Federal Financial Participation (FFP) and Mental Health Realignment in the amount of $22,744,716. Sufficient appropriations and estimated revenues are included in DBH’s Org 5630 FY 2025-2026 Recommended Budget and will be included in subsequent budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On December 11, 2018, the Board of Supervisors approved Agreement A-18-699 for the continued provision of Therapeutic Behavioral Services.
On November 8, 2022, the Board of Supervisors approved Amendment No. 1 (No. 18-699-1) to allow for an increase in “per minute” rates with no increase to the overall compensation or net county cost.
On June 20, 2023, the Board of Supervisors approved Superseding Agreement No. A-23-281 to add the Department of Health and Care Services (DHCS) California Advancing in Medi-Cal (CalAIM) initiative requirements. The Superseding Agreement extended the Agreement term for two additional years.
On June 24, 2025, your Board approved Amendment No. 1 (No. 25-290) to the Agreement to extend the term for three months, with an optional additional three-month extension, to prevent a gap in services in anticipation for the implementation of a new Agreement.
The Department released a Request for Proposals (RFP) on March 13, 2025, for the provision of Therapeutic Behavioral Services for Medi-Cal beneficiaries under the age of 21. Addendum No. 1 to the RFP was published on April 1, 2025, to respond to potential bidder questions. The RFP closed on April 17, 2025. Two bids were received: McKinley Children’s Center (did not provide a five-year maximum compensation proposal) and JDT Consultants, Inc. ($21,321,405). An evaluation panel reviewed all bids and recommended entering into an Agreement with JDT Consultants, Inc.
JDT Consultants, Inc. was selected as the best fit for the County’s needs. The bid demonstrated a vast understanding of the requested services and a substantial history in the provision of these services, while additionally highlighting the bidder’s success with this program through their excellent outcomes for persons served.
In 1999, the U.S. District Court issued a preliminary injunction requiring the State Department of Health Care Services (DHCS) to provide TBS to children/youth under 21 years of age, through the Medi-Cal Early and Periodic, Screening Diagnosis and Treatment (EPSDT) benefit (California Code of Regulations Title 9, Chapter 11). On May 10, 2001, a judgement and permanent injunction in Emily Q. v. Bonta was issued requiring all Behavioral Health Plans to ensure access to and provide or arrange for the provision of TBS. As Fresno County’s Behavioral Health Plan, the Department of Behavioral Health (DBH) has been providing TBS since November 2000.
TBS is an intensive, individualized, one to one behavioral coaching program between a mental health specialist and the person served for a specified and limited period. TBS can help the person served learn strategies and skills to increase the kinds of behavior that will allow them to be successful in their current environment and learn new ways of reducing and managing challenging behaviors. TBS focus on behaviors and symptoms, which may jeopardize existing placements, or act as barriers to a lower level of placement or the completion of specific treatment goals. The TBS coach meets with persons served at their home, school, or a place where the person served is most comfortable, during times most therapeutic and when interventions are most needed. Persons served are referred by the County’s Department of Social Services, DBH, contracted mental health providers, families, care givers, and courts.
TBS is not a standalone service and must be delivered as an adjunct to regular specialty mental health services already in place. TBS is only available to those children and youth with full scope Medi-Cal benefits who are receiving ongoing mental health services and meet medical necessity and class certification criteria as outlined in the TBS documentation manual.
The maximum compensation for the agreement was calculated by using historical data from Fiscal Years 2023-2024 and 2024-2025, staffing, and Fee-For-Service reimbursement rates. Through the current Agreement, 367 persons served were served in Fiscal Year 2023-24 at a cost of $3,853,330 and 350 persons served cost were served in Fiscal Year 2024-25 at a projected cost of $4,069,450.
Approval of the recommended action will execute the Agreement with JDT Consultants, Inc. for the provision of Therapeutic Behavioral Services, for a five-year term, total not to exceed $22,744,716.
The modification and budget modification clauses of the agreement delegate the Board’s authority to the DBH Director to make non-material changes, that will not result in any change to the maximum compensation payable to the Contractor, to the agreement during the term of the agreement, as further described in Article 15, Sections 1 and 2 of the agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this agreement at the July 2025 meeting.
REFERENCE MATERIAL:
BAI #51, June 24, 2025
BAI #44, June 20, 2023
BAI #24, November 8, 2022
BAI #36, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with JDT Consultants, Inc.
CAO ANALYST:
Ronald W. Alexander, Jr.