DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreement with Central Star Behavioral Health, Inc. for Youth Continuum of Care
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with Central Star Behavioral Health, Inc. for a Youth Continuum of Care program including; Full-Service Partnership (FSP) for youth ages 11-18 with serious emotional disturbance who qualify for specialty mental health services, and Intensive Case Management (ICM), and Outpatient (OP) levels of care for youth ages 11-18 years who qualify for 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 $22,039,066.
REPORT
There is no Net County Cost associated with the recommended action. Approval of the recommended action would allow Central Star Behavioral Health Inc. (Central Star) to provide specialty mental health services to youth ages 11-18 years through the Youth Continuum of Care program and ensure Fresno County Department of Behavioral Health meets mandated network adequacy time and distance standards and Mental Health Services Act (MHSA) requirements as set by the Department of Health Care Services (DHCS). The proposed agreement would be funded by MHSA Community Systems and Supports (MHSA-CSS) funds, Mental Health Realignment, and 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, mental health services for high acuity youth and their families would be eliminated, which would impact compliance with network adequacy time and distance requirements, and MHSA requirements set by the DHCS.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended agreement will be funded with MHSA-CSS, Medi-Cal Federal Financial Participation (FFP) and Realignment funds in the amount of $22,039,066. 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 approved Agreement No.18-689 for the continued provision of Assertive Community Treatment mental health and community supports for youth ages 10-18 and their families. The agreement was amended once to increase the maximum compensation to help the provider reduce high staff turnover rates by increasing wages.
On June 20, 2023, the Board approved Superseding Agreement No. A-23-280 to include new California Advancing and Innovating Medi-Cal (CalAIM) requirements set by the Department of Health Care services (DHCS) including payment reform requirements. The Amendment also extended the Agreement for two additional years. The agreement was amended once to expand services by adding Intensive Case Management and Outpatient levels of care, allowing youth to transition to a lower level of care with minimal disruption to services.
On June 24, 2025, your Board approved Amendment No. 2 (No. 25-288) 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 14, 2025, for the provision of a Youth Continuum of Care program including FSP, ICM, and OP mental health services for Youth ages 11-18 with serious emotional disturbances who qualify for Specialty Mental Health Services. Addendum No. 1 to the RFP was issued on April 1, 2025, to respond to questions from potential bidders and update reimbursement rates for the new fiscal year. The RFP closed on April 14, 2025. Five bids were received: Central Star Behavioral Health Inc. ($35,009,070), Hope and Healing Family Therapy Center, Inc. ($25,577,683), North Star Wellness Center ($40,606,502), Pacific Clinics ($22,832,993), and Victor Community Support Services ($28,024,690). An evaluation panel reviewed all bids and recommended entering into an Agreement with Central Star Behavioral Health, Inc.
Central Star was selected as the best fit for the County’s needs. The bid demonstrated a high degree of understanding of the County’s service requirements, their expansive experience and clear understanding the needs of the target population, their knowledge of MHSA and DHCS requirements, their demonstrated outcomes measurements, and the volume of services proposed.
Under the MHSA, also known as Proposition 63, County mental health departments receive funding to assist in providing services to underserved and unserved populations. Following a mandated local community stakeholder process to identify the highest service needs of the County, MHSA-CSS funds were allocated by the Department to provide FSP services for youth ages 11 - 18 who have serious emotional disturbances (SED).
The recommended Youth Continuum of Care agreement would serve Youth ages 11-18. In addition, siblings, relatives, caregivers, and other significant support persons of the FSP enrolled person served, may receive specialty mental health services through this program.
FSP services encompass a unified team approach, in which the provider commits to do “whatever-it-takes” to assist the individual in reaching their recovery, resiliency, and wellness goals and reduce the number of days of hospitalization, and juvenile justice involvement. Persons served at this level meet the State-defined FSP criteria and require higher intensity services to meet their needs. This level of care has an increased focus on engagement, collaboration with the youth/family and stabilization to achieve mutually agreed upon treatment goals. These services are accessible 24 hours per day, 7 days per week via a support line where a staff member known to the family is available by phone. Persons served are provided three contacts per week with at least one being face to face.
ICM provides persons served with regularly scheduled case management, individual rehabilitation and/or individual therapy. These services are accessible during standard office hours. Youth are provided one or two contacts per week with at least one being face to face. OP provides persons served with therapeutic appointments for individual/group treatment, case management, and medication services, as needed. These services are accessible during standard office hours. Persons served are provided at least one contact per week, with at least one of those contacts being face to face each month.
Services under the recommended agreement will be offered in the office, at home, within the community, as preferred by the person served and their guardian, and will include, assessment, care planning/goal setting, psychiatry/medication support, individual/family therapy, group therapy, targeted case management, peer support services, rehabilitation, intensive care coordination, intensive home-based services, and linkage to additional services and support. Evidence Based Practice models recognized as effective in improving functioning of the target population will be utilized in the programs. These models include and are not limited to; Dialectical Behavior Therapy, Trauma Informed Care, Trauma-Focused Cognitive Behavioral Therapy, Meaning and Purpose, Motivational Interviewing, and Eye Movement Desensitization and Reprocessing.
The maximum compensation for the agreement was calculated using historical data from Fiscal Years 2023-2024 and 2024-2025. Through the current agreement, 156 individuals were served in Fiscal Year 2023-24 at a cost of $2,408,813 and 118 individuals have been served in Fiscal Year 2024-25 at a projected cost of $1,921,138. The maximum compensation for Fiscal Year 2025-26 has been prorated to account for funds budgeted to the three-month extension of the current agreement.
Approval of the recommended action will execute the Agreement with Central Star Behavioral Health, Inc for the provision of Youth Continuum of Care services, for a five-year term, total not to exceed $22,039,066.
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 #23, February 2, 2024
BAI #44, June 20, 2023
BAI #33, August 9, 2022
BAI #27, June 8, 2021
BAI #30, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Central Star
CAO ANALYST:
Ronald W. Alexander Jr.