DATE: September 23, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan Holt, Director, Department of Behavioral Health
SUBJECT: Amendment No. 1 to Master Agreement for Eating Disorder Services
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34), determine that an exception to the competitive bidding requirement under AP 34 is satisfied and a suspension of competition is warranted due to unusual or extraordinary circumstances due to the non-competitive nature of Master Agreements; and
2. Approve and Authorize the Chairman to execute Amendment No. 1 to Master Agreement No. 25-383 for Eating Disorder Services, to add Discovery Practice Management, Inc. d.b.a. Center for Discovery and BHC Alhambra Hospital, Inc. d.b.a. BHC Alhambra Hospital, with no change to the term of August 5, 2025, through June 30, 2030, or compensation maximum of $6,500,000.
REPORT
There is no increase in Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the Department to add Discovery Practice Management, Inc. d.b.a. Center for Discovery (CFD) and BHC Alhambra Hospital, Inc. d.b.a. BHC Alhambra Hospital (BHC) onto the Master Agreement for the provision of required medically necessary behavioral health eating disorder treatment services for all County persons served requiring these services at the appropriately designated level of care. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department will not be able to maintain its network of providers, possibly resulting in the Department falling out of compliance with the Department of Heath Case Services (DHCS) and the requirement of providing behavioral health treatment for persons living with an eating disorder. Both CFD and BHC are currently contracted through Master Agreement A-23-283, which is scheduled to expire on September 30, 2025.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under AP No. 34 that an exception to the competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or extraordinary circumstances as the Department will contract with any vendor who meets the requirements of the Master Agreement. The General Services Department - Purchasing concurs with the Department’s assessment that this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of the recommended Agreement ($6,500,000) will be funded with Mental Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department of Behavioral Health’s Org 5630 FY 2025-2026 Adopted Budget and will be included in future budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On August 20, 2019, the Board approved Master Agreement No. A-19-406 with licensed and credentialed facilities to provide specialized residential mental health services for County persons served, as mandated by the Welfare and Institutions Code (WIC) and California Code of Regulations (CCR) Title 22.
On June 30, 2023, the Board approved Superseding Agreement No. A-23-283 to include new California Advancing and Innovating Medi-Cal (CalAIM) requirements set by the Department of Health Care Services including payment reform requirements. The Agreement was amended four times to revise rates and add additional providers.
On June 24, 2025, the Board approved Amendment No. 5 No. 25-291 to the Master 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.
On August 5, 2025, the Board approved Master Agreement No. 25-383 with one licensed and credentialed facility to provide eating disorder services for County persons served.
Eating disorders are complex conditions involving both physical and psychological components. As such, effective treatment of eating disorders involves a combination of physical and mental health interventions, often provided through an integrated therapeutic modality, program, or setting. County through the Department of Behavioral Health (DBH) is a Behavioral Health Plan (BHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), section 1810226. BHPs are required to cover all medically necessary treatment services including residential and day treatment intensive services to treat the eating disorder. The number of individuals requiring eating disorder services for such conditions is increasing while options for placement remain limited.
One eating disorder provider is currently contracted with the County of Fresno under the Eating Disorder Master Agreement. This provider does not offer adult and youth inpatient or residential services for eating disorder treatment. The DBH eating disorder team has identified a continued need for this level of care for County persons served. CFD is able to provide Residential Treatment Center (RTC) eating disorder treatment services for individuals ages 10+. BHC offers RTC treatment for adults and additionally provides Inpatient level eating disorder treatment for both adolescents and adults.
Master Agreement No. A-23-283, as amended most recently by Agreement No. A-25-291, ends its term on September 30, 2025. Adding these eating disorder treatment providers onto Master Agreement A-25-383 for Eating Disorder Services will ensure no lapse in treatment for County persons served. CFD and BHC are both familiar and in compliance with all requirements for eating disorder treatment programs, making their addition a seamless transition that will prevent any interruptions or delays in the provision of services. Due to the compatibility of the scope of work and requirements for this Master Agreement, along with the need for the available levels of services offered by these providers to maintain network adequacy, it is recommended that CFD and BHC be added to the Eating Disorder Services Master Agreement, effective September 23, 2025.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this recommended amendment at the September 2025 meeting.
REFERENCE MATERIAL:
BAI #47, August 5, 2025
BAI #51, June 24, 2025
BAI #27, May 6, 2025
BAI #31, August 20, 2024
BAI #30, March 5, 2024
BAI #26, August 22, 2023
BAI #44, June 20, 2023
BAI #26, August 20, 2019
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Amendment No. 1 to Master Agreement
CAO ANALYST:
Ronald Alexander Jr.