DATE: November 5, 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 Wraparound and Super Wraparound Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a Master Agreement with providers for Wraparound and Super Wraparound services, effective upon execution through June 30, 2029, which includes two optional one-year extensions, total not to exceed $44,784,643.
REPORT
There is no additional Net County Cost associated with the recommended action, which will allow contracted vendors to continue to provide Wraparound and add Super Wraparound services. Wraparound services are highly individualized and family-based, provided by a team of professionals, and serve as an alternative to congregate care for youth/families by providing services in the least restrictive setting possible. Super Wraparound services are more intensive Wraparound services for high acuity needs youth enrolled in the Children’s Well Being Continuum (CWBC), the continuum developed by the County for participation in the State Children’s Crisis Continuum Pilot Program (CCCPP). This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board choose not to approve the recommended action, dependent children and their families will no longer receive intensive, family-centered, Wraparound services. Additionally, the $8.5 million CCCPP Grant awarded by California Department of Social Services (CDSS) would be impacted, as both Wraparound and Super Wraparound services are included in the proposal, final work plan, and grant award, which was approved for acceptance by your Board on August 6, 2024.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum cost of the agreement ($44,784,643) will be offset with Medi-Cal revenue ($14,321,542), Early and Periodic Screening, Diagnostic, & Treatment (EPSDT) funds ($11,457,233), CCCPP Grant funds ($750,933), and SB 163 Trust Funds ($18,254,935). Sufficient appropriations and estimated revenues are included in the Department of Social Services Org 5610 FY 2024-25 Adopted Budget and the Department of Behavioral Health Org 5630 FY 2024-2025 Adopted Budget. Sufficient appropriations and estimated revenues will be included in all subsequent budget requests.
DISCUSSION:
The Department of Social Services (DSS), in partnership with the County's Departments of Behavioral Health (DBH) and Probation, have contracted with vendors to provide Wraparound services in Fresno County since 2005. Wraparound services have been provided in an effort to improve outcomes for foster and probation youth at risk of escalating into, or remaining in, higher level placements, such as congregate care or Short-Term Residential Treatment Programs (STRTPs). Last fiscal year, a total of 115 youth received between two to ten months of services, which supported them staying in a home-based setting. Wraparound services are highly coordinated, individualized, unconditional, and assist youth/families in addressing identified needs through services such as mental health services, Intensive Care Coordination (ICC), Intensive Home-Based Services (IHBS), case management, crisis intervention, and more. The Departments work collaboratively to ensure optimal service delivery that aligns with, and positively impacts, the safety, permanency, and well-being of children and families.
On May 1, 2018, the Board approved an agreement with Central Star Behavioral Health for provision of Wraparound services in Fresno County. On June 20, 2023, your Board approved a supersede agreement with this vendor to continue providing Wraparound services under the new State-mandated California Advancing and Innovating Medi-Cal (CalAIM) Behavioral Health Payment Reform.
Following your Board’s approval on August 6, 2024, of the Retroactive CCCPP grant application and signing of the Standard Agreement with the State, DSS, DBH, and Probation, have officially become part of CDSS’ Pilot Program. The Pilot Program is intended to provide a framework for a highly integrated continuum of care for foster youth with high acuity needs by addressing perceived gaps in services and appropriate placements within the continuum to ensure that the complex behavioral, developmental, and physical needs of these youth are better met.
The CWBC, the County’s design for the Pilot Program, aims to eliminate the identified gaps in the continuum by fully integrating the System of Care (SOC) by providing stabilization and treatment for high acuity needs youth in crisis who require short-term, intensive stabilization in a trauma-focused residential treatment setting, coupled with ongoing, timely, and seamless transition support between levels of care, all in the least restrictive setting possible. The Wraparound program will have a key role in ensuring consistency as youth move throughout the continuum. Additionally, Super Wraparound services are being introduced in the recommended agreement to provide more intensive Wraparound services to youth who have more complex needs and require additional support, including in times of crisis, as they transition between service levels within the continuum. Super Wraparound teams will provide immediate intervention to assist with crisis stabilization, placement and permanency support and promotion, and reduction in unnecessary psychiatric hospitalizations.
On January 23, 2023, the County released Request for Proposal (RFP) #23-021 seeking proposals, from one or more vendors, that presented comprehensive strategies to provide an array of high-fidelity Wrap and Super Wrap services to eligible foster and probation youth, including but not limited to, ICC, IHBS, case management, crisis intervention, mental health assessments, facilitation of the service planning process, community resource development, and development of parent advocacy and support networks. The RFP also requested services in relationship to CCCPP and the creation of 24/7, rapid response Super Wrap teams to work with the highest acuity needs youth and serve as the single point of care management to ensure seamless coordination for youth moving through the crisis continuum. These services are in compliance with Katie A. Settlement Agreement (Katie A.) mandates and will allow for consistency with a family-centered practice model designed to improve outcomes for youth. The RFP was sent to vendors registered in Public Purchase as well as a bidders list consisting of 34 organizations. Four (4) proposals were received and accepted by Purchasing and all four were reviewed by the RFP review committee: Central Star Behavioral Health, Aspiranet, Inc., Kings View, and Pacific Clinics. The review committee was comprised of a DSS Deputy Director, DSS Program Manager, Probation Officer, DBH Clinical Supervisor and the Chief Executive Officer of a Community-Based Organization. All four proposals were reviewed on the following criteria: company information that demonstrates experience and capacity to provide services, a comprehensive response to all areas of the Scope of Work requirement section of the RFP, demonstrated organizational readiness to provide the requested services, provision of all requested Cost Proposal information, and a proposed budget in the County’s best interest. Aspiranet, Inc. and Central Star Behavioral Health received the highest rankings and the review committee unanimously recommended both bidders’ proposals for funding. Further, consistent with the RFP, it was recommended that the County negotiate with both providers to share all or part of Wrap and Super Wrap service components.
Since May 1, 2018, an average of 122 Fresno County youth and their families received Wraparound services each year. Each youth was a foster or probation youth at risk of escalating into, or remaining in, a higher-level placement. Currently, Wraparound services are provided by Central Star Behavioral Health. Under the recommended agreement, the two vendors will provide Wraparound services to 50 youth each, for a total of 100 youth, and Super Wraparound services to 4 youth each, for a total of 8 youth. The recommended agreement will supersede the existing Agreement No. 23-272 with Central Star Behavioral Health, Inc.
As this is a pilot program with new services, the payment structure of the recommended agreement deviates from the standard. The payment structure of the recommended agreement will be cost reimbursement for the first two years of the contract term. The expectation is that both the Contractor(s) and the County will work in collaboration over the first two years in tracking and monitoring the SMHS to develop an informed understanding of the quantity of Medi-Cal billable and non-Medi-Cal billable services provided. The experience gained from this will be leveraged for the development of a hybrid payment structure model that will ensure maximum Medi-Cal revenue. With your Board’s approval of an amendment, the remaining years of the contract term will be a hybrid payment structure in which Specialty Mental Health Services (SMHS), which are Medi-Cal billable service, are billed on a fee-for-service basis, while the remaining, non-Medi-Cal billable services remain billed as cost reimbursement.
If approved, the recommended agreement will become effective upon execution through June 30, 2027, with two optional one-year extensions and may be terminated by the County 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
BAI #44, June 20, 2023
BAI #18, May 1, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Master Agreement
CAO ANALYST:
Ronald Alexander