DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreements for Adult Full-Service Partnership Continuums of Care
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute an Agreement with Mental Health Systems, Inc. dba TURN Behavioral Health to provide Adult Full-Service Partnership Continuum of Care specialty mental health, Assisted Outpatient Treatment and CARE Act services, effective September 1, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $29,355,123;
2. Approve and authorize the Chairman to execute an Agreement with Central Star Behavioral Health, Inc. to provide Adult Full-Service Partnership Continuum of Care specialty mental health services, effective August 5, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $44,560,574; and
3. Approve and authorize the Chairman to execute an Agreement with Turning Point of Central California, Inc. to provide Adult Full-Service Partnership Continuum of Care specialty mental health services, effective September 1, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $33,426,715.
REPORT
There is no additional Net County Cost associated with the recommended actions, which will allow the Department of Behavioral Health (Department) to provide mandated Adult Full-Service Partnership (FSP) Continuum of Care services, including FSP, Outpatient (OP), Intensive Case Management (ICM), Assisted Outpatient Treatment (AOT), and Community Assistance, Recovery, and Empowerment (CARE) Act services to persons served. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, mandated Adult FSP Continuum of Care services will not be available to persons served and the Department will be out of compliance with State network adequacy requirements.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of the recommended Agreements ($107,342,412) will be funded with Federal Financial Participation (FFP) funds, Mental Health Services Act Community Services and Supports (MHSA-CSS) funds, Realignment funds, and Department of Healthcare Services CARE Act Administrative funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2025-26 Recommended Budget and will be requested in subsequent fiscal year budgets for the duration of the contract term. Actual costs will be determined by actual services provided.
DISCUSSION:
The Department has determined the need to contract for Adult Full-Service Partnership Continuum of Care services for up to three (3) sites and for Adult Continuum of Care services that include Full-Service Partnership (FSP), Outpatient (OP) and Intensive Case Management (ICM) services to person diagnosed with a severe mental illness (SMI)/serious emotional disturbance (SED). The FSP level has a maximum capacity of 180 persons served per site and provides comprehensive mental health treatment services, including housing, education and community supports. Additionally, the Department has determined the need to provide Community Assistance, Recovery, and Empowerment (CARE) Act and Assisted Outpatient Treatment (AOT) services. These services are civil court processes designed to connect individuals with specific mental health diagnoses with needed services and support coordinated and/or provided by county behavioral health departments under the oversight of a judge.
On June 20, 2023, the Board approved Master Agreement No. 23-287, which superseded Agreement No. 20-216 approved on June 9, 2020 for FSP and AOT services to incorporate California Advancing and Innovating Medi-Cal (CalAIM) required updates including payment structure changes. On November 5, 2024, the Board approved Master Agreement No. 24-594 as an Amendment I to Master Agreement No. 23-287 to add the Community Assistance, Recovery and Empowerment (CARE) Act to the Scope of Services to comply with Welfare and Institutions Code Section 5970.5(b). On January 28, 2025, the Board approved Amend No. 25-034 to increase housing funds in the direct client supports budgets. On June 24, 2025, the Board approved Amendment No. 25-283 as an Amendment II to Master Agreement No. 23-287 to extend the term for three (3) months with one optional three-month period to provide sufficient time to complete the procurement process, including transitioning persons served to a new provider should a new vendor be awarded. The Agreement, originally scheduled to expire June 30, 2025, will expire no later than December 31, 2025. Under the current Agreement, a total of 1,127 persons were served during the two-year term.
On March 18, 2025, a Request for Proposals (RFP) No. 25-078, for Adult Full-Service Partnership Continuum of Care was issued, and on April 7, 2025, Addendum No. One (1) to County’s RFP No. 25-078 was issued. The Department requested three (3) qualified providers to offer all services in an Adult FSP Continuum of Care program, including FSP, OP and ICM levels of care for adults 18 and older with a severe impairment resulting from a diagnosis of serious mental illness (SMI)/serious emotional disturbance (SED). Upon the closing of the RFP on April 17, 2025, the Department received three (3) responses.
Responses were received from Mental Health Systems, Inc dba TURN Behavioral Health for a total of $29,069,430, Central Star Behavioral Health, Inc for a total of $45,431,870 and Turning Point of California, Inc for a total of $34,579,360. The bid responses from Mental Health Systems, Inc. and Central Star Behavioral Health, Inc. were determined to be responsive and were evaluated by the Bid Review Committee consisting of three (3) Staff Analysts and two (2) Utilization Review Specialists. The County selected both bidders, awarding one Adult FSP Continuum to each. The selected bidders demonstrated experience and knowledge of the FSP, ICM and OP services, described their capabilities to provide sufficient and appropriately trained staff who have experience working with person with SMI/SED, and described how they will incorporate “whatever it takes” and “meet the person where they are” into their program design to ensure persons served receive the services as outlined in the RFP.
Turning Point of Central California, Inc. was determined to be nonresponsive, therefore, not evaluated by the Bid Review Committee. Following consultation with and approval from the Purchasing Manager, the Department engaged in contract negotiations with Turning Point to operate the third program site which is needed to ensure there is sufficient capacity to address the needs of persons served in Fresno County. Turning Point, as one of the incumbent providers, has demonstrated experience and knowledge of Adult FSP Continuums of Care.
On March 17, 2025, an RFP No. 25-077, for CARE Act and AOT Services was issued and on April 8, 2025, Addendum No. One (1) to County’s RFP No. 24-077 was issued. The Department requested one (1) qualified provider to offer CARE Act services, AOT services, and FSP Continuum of Care services, including FSP, OP, and ICM levels of care for adults 18 and older with a severe impairment resulting from a diagnosis of SMI/SED. Upon the closing of the RFP on April 18, 2025, the Department received no bid responses.
After the award notice was posted for the Adult FSP Continuum of Care RFP, the Department approached Mental Health Systems, Inc. dba TURN Behavioral Health, one of the selected bidders for the Adult FSP Continuum of Care RFP, to provide CARE Act and AOT services. Mental health Systems, Inc. dba TURN Behavioral Health is the current incumbent for CARE Act services for Fresno County and has experience providing AOT services in other counties. Mental Health Systems, Inc. dba TURN Behavioral Health agreed to provide the services and agreed to a maximum total compensation of $500,000 for AOT services and $750,000 for CARE Act services. The provider will be reimbursed by rates for actual service hours completed. The rates are set by the Department of Health Care Services.
Since the start of the current AOT services agreement in October 2022, a total of 62 individuals have been served over the three-year period. Based on the referral trends observed in FY 2024-25 and the typical number of service interactions required to engage individuals, it is projected that approximately 900 unique service encounters will be provided annually, at an estimated cost of $90,000 per fiscal year.
Following the implementation of the CARE Act on December 1, 2024, twenty (20) individuals have been petitioned and received services to date. Recently, the Department has been receiving an average of six (6) petitions per month. Drawing from the experiences of other counties, this number is expected to steadily increase as more members of the community become aware of the CARE Act process. Although the program is still in its early stages and available data is limited, the Department anticipates continued growth in petition volume. Given that the CARE Act process typically involves two (2) to three (3) months of assertive outreach and engagement per individual, the Department estimates an annual cost of $132,000 to support these services.
Approval of the recommended Agreements will allow the Department to provide mandated Adult Continuum of Care programs, including FSP, OP and ICM services, CARE Act services, and AOT services to meet the wellness and recovery needs of behavioral health persons served.
Article 15, section 2 of each agreement delegates the board’s authority to the DBH Director to make non-material changes to the agreement during the term of the agreement, as further described in the modification clause of the agreement. These changes shall not result in any change to the maximum compensation amount.
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 #34, January 28, 2025
BAI #9, November 5, 2024
BAI #45, June 20, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Mental Health Systems, Inc.
On file with Clerk - Agreement with Central Star Behavioral Health, Inc.
On file with Clerk - Agreement with Turning Point of Central California, Inc.
CAO ANALYST:
Ronald Alexander