DATE: September 10, 2024
TO: Board of Supervisors
SUBMITTED BY: Sanja Bugay, Director, Department of Social Services
Susan Holt, Director, Department of Behavioral Health
Kirk Haynes, Chief Probation Officer, Probation Department
SUBJECT: Master Agreement for Enhanced Intensive Services Foster Care and Emergency Enhanced Intensive Services Foster Care
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34, determine that an exception to the requirements for competitive bids or requests for proposals is satisfied due to unusual or extraordinary circumstances, and that the best interest of the County would be served by entering into a Master Agreement with Aspiranet, Inc. and Promesa Behavioral Health, as the only qualified providers that meet specified requirements for Enhanced Intensive Services Foster Care and Emergency Enhanced Intensive Services Foster Care; and
2. Approve and authorize the Chairman to execute a Master Agreement with authorized providers for Enhanced Intensive Services Foster Care services and Emergency Enhanced Intensive Services Foster Care, effective upon execution through June 30, 2026 and two optional one-year extensions, total not to exceed $39,364,924.
REPORT
There is no additional Net County Cost associated with the recommended actions, which will allow selected Foster Family Agencies (FFAs) to provide safe, supportive, and highly individualized treatment for foster youth with high acuity needs within the context of a loving home with skilled and caring resource parents. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, intensive, individualized services for high acuity foster youth will not be provided, resulting in continued reliance on the transitional shelter currently in place.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department of Social Services (DSS) contacted all FFAs operating in Fresno County and received responses from Aspiranet, Inc., Promesa Behavioral Health, Transitions Children’s Services, and Pacific Clinics. DSS determined that Promesa Behavioral Health and Aspiranet were the only qualified providers able to provide the unique services required. DSS requests to suspend the competitive bidding process consistent with Administrative Policy No. 34 and finds that it is in the best interest of the County to enter into a Master Agreement with Promesa Behavioral Health and Aspiranet, Inc. for Enhanced Intensive Services Foster Care (E-ISFC) and Emergency Enhanced Intensive Services Foster Care (E-E-ISFC). The Internal Services Department - Purchasing Division concurs with DSS’ request to suspend the competitive bidding process.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of the recommended agreement ($39,364,924) will be offset with Medi-Cal Federal Financial Participation (FFP) revenue ($10,141,275), Early and Periodic Screening, Diagnostic, & Treatment (EPSDT) funds ($8,113,020), Children’s Crisis Continuum Pilot Program (CCCPP) Grant ($5,015,318), Complex Care Capacity Building (CCCB) Allocation ($699,992), Title IV-E funds ($4,685,535), and SB 163 Trust Funds ($10,709,784). Sufficient appropriations and estimated revenues are included in DSS Org 5610 FY 2024-25 Recommended Budget and will be included in subsequent budget requests.
DISCUSSION:
On August 6, 2024, your Board approved the retroactive submission of the grant Application and Standard Agreement with CDSS to support the expansion and implementation of the Child Well-Being Continuum (CWBC) in Fresno County.
On December 1, 2022, DSS, in partnership with the County’s Departments of Behavioral Health (DBH) and Probation, responded to a Request for Proposal (RFP) released by the California Department of Social Services (CDSS) for the CCCPP. The pilot program aims to deliver highly integrated, trauma-focused care for foster youth with high acuity needs. This program addresses youth mental health crises and ensures seamless transitions between varying levels of care without delays due to arranging appropriate supportive services.
The Departments have identified several gaps within the existing crisis continuum. Youth in crisis have been required to stay overnight in County offices and hospital emergency departments due to a lack of bed availability and/or a lack of more appropriate crisis services. Through the pilot program and in collaboration with DBH and Probation, DSS seeks to increase and enhance available ISFC levels of care through the implementation of sixteen (16) E-ISFC homes (8 per vendor) and eight (8) E-E-ISFC homes (4 per vendor) for supporting youth with intensive needs between thirty (30) days and one (1) year of stabilizing placement. E-ISFC and E-E-ISFC are two components of the CWBC. These programs provide intensive, individualized supports in licensed facilities for youth who do not require treatment in locked, inpatient facilities but who are not yet ready to step-down into lower levels of care, such as ISFC homes or Short-Term Residential Treatment Programs.
The E-ISFC and E-E-ISFC programs provide a structured and safe setting promoting stabilization and the development of therapeutic relationships with both specialized resource parents and staff, allowing the multidisciplinary team to complete an accurate assessment of the youth’s needs, engage the youth in intensive treatment services, and recommend next steps toward permanency and healing. E-ISFC provides placement and services from thirty (30) days to twelve (12) months, whereas E-E-ISFC provides placement and a more intensive level of services for up to thirty (30) days. Notably, the most significant difference is that E-E-ISFC homes will accept children on an urgent basis for a shorter period of time.
If the recommended agreement is approved, Promesa Behavioral Health and Aspiranet, Inc. will provide E-ISFC and E-E-ISFC services to foster and probation youth between the ages of 6 and 17 years old who are in between longer-term placements and present complex mental or behavioral health needs. Additionally, each provider will recruit, train, and support E-ISFC/E-E-ISFC Specialized Resource Parents who are dedicated to ensuring eligible youth meet their treatment goals in a nurturing, affirming, and supportive home. E-ISFC/E-E-ISFC Specialized Resource Parents differ from traditional ISFC Resource Parents in several critical ways, including capacity for 24/7 availability to respond to youth needs with at least one parent with no competing responsibilities outside the home, commitment to providing care for the youth regardless of any behavioral challenges that emerge, and successful completion of rigorous supplemental training and continuing education.
Program outcomes include transition to a less restrictive placement including legal or emotional/relational permanency, increased family and natural supports, and improved behavioral/emotional needs. These outcomes will meet the complex needs of high acuity foster youth and reduce the reliance on the transitional shelter currently in place while promoting safe, stable, and permanent placements.
Since these are new program models, the payment structure of the recommended agreement will be cost reimbursement for the first two years with the expectation that billing and invoicing will be managed and monitored as if fee-for-service (FFS) for the Specialty Mental Health Services (SMHS) costs. An amendment will be brought to the Board to transition completely into FFS model for the SMHS for subsequent contract terms, based on budget structures and informed by hands-on experience and monitoring. The recommended agreement also allows for the DSS Director and DBH Director or designees to approve changes in service sites, budget expense category subtotals that do not exceed 10% of the individual contractor’s total annual maximum compensation, volume of units of services/types of service units to be provided, and service rates.
If approved, the recommended agreement will become effective upon execution through June 30, 2026 with two, optional one-year extensions and may be terminated by the DBH or DSS Directors, or designees, or the contractor(s), upon providing a 30-day advanced written notice. The services and maximum compensation amounts provided in the recommended agreement are contingent upon the availability of funds and can be amended to reduce the maximum compensation at any time during the contract period.
REFERENCE MATERIAL:
BAI #55, August 6, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request for Promesa Behavioral Health
Suspension of Competition Acquisition Request for Aspiranet, Inc.
On file with Clerk - Master Agreement for Enhanced Intensive Services Foster Care and Emergency Enhanced Intensive Services Foster Care
CAO ANALYST:
Dylan McCully