DATE: November 14, 2017
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
Robert W. Bash, Director of Internal Services/Chief Information Officer
SUBJECT: Mental Health Crisis Residential Treatment Services
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute an Agreement with Central Star Behavioral Health, Inc., for adult mental health crisis residential treatment services, effective December 1, 2017, not to exceed five years and seven months consecutively, which includes a seven-month ramp-up and implementation phase followed by a three-year base contract and two optional one-year extensions, total not to exceed $11,667,380; and,
2. Approve and authorize the Chairman to execute a Facility Use Agreement with Star View Children and Family Services, Inc., effective May 1, 2018 through June 30, 2023, for County owned space at 496 S. Barton, Fresno, CA 93702, Building 337 (11,655 square feet), to be used by Central Star Behavioral Health, Inc. to provide adult mental health crisis residential treatment services.
REPORT
Approval of the recommended actions will allow for a seven-month ramp-up and implementation of the Adult Mental Health Crisis Residential Treatment Program (CRT) followed by a three-year base contract and two optional one-year service extensions for CRT services for adults. Central Star Behavioral Health, Inc. (Central Star) was selected following a Request for Proposal (RFP) process. Central Star will begin acquiring all the necessary licensing and staff prior to implementation on May 1, 2018, with no increase in Net County Cost. The CRT Facility is new and was the result of a grant that was awarded from the California Health Facilities Financing Authority (CHFFA). The services will be funded with Mental Health Realignment and Short/Doyle Medi-Cal Federal Financial Participation funds.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. If the recommended actions are not approved, the Department of Behavioral Health would be unable to provide CRT services to adult residents. Your Board may direct the Department to assume operation of the CRT Facility and provide related services; however, the decision will result in added costs to the County and a delay in services as the Department obtains the required staff and licensure.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The FY 2017-18 maximum compensation for the ramp-up and implementation phase (December 1, 2017 through June 30, 2018) is $775,196. The five-year recommended agreement has provisions for a three-year base contract and two optional one-year extensions through June 30, 2023. The maximum compensation for the five-year recommended agreement is $10,892,184. The annual maximum compensation will be as follows:
FY 2018-19 $2,065,608
FY 2019-20 $2,121,453
FY 2020-21 $2,174,889
FY 2021-22 $2,234,895
FY 2022-23 $2,295,339
The combined maximum for FY 2017-18 and the proposed five-year agreement is $11,667,380. The recommended actions will be financed with Mental Health Realignment and Short/Doyle Medi-Cal Federal Financial Participation funds.
In addition, there is no cost associated with the recommended Facility Use Agreement for lease of County Building 337. The fair market value for leasing this space is estimated to be $149,652 for a 12-month period. This calculation is based on a monthly rental rate of $1.07 per square foot. Internal Services Department - Lease Services Division (ISD - Lease Services) was contacted and concurs with the rate. Over the term of the recommended agreement, the total value of the lease is estimated to be $773,202. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2017-18 Adopted Budget and will be included in the future budget requests for the term’s duration.
DISCUSSION:
Senate Bill 82: Investment in Mental Health Wellness Act of 2013 (Chapter 34, Statutes of 2013), was enacted to provide counties with funding to increase their capacity and access to community based mental health crisis services that are wellness, resiliency, and recovery oriented in the least restrictive manner possible. On July 15, 2014, your Board approved the retroactive (January 22, 2014) submittal of a grant application to CHFFA, and on June 2, 2015, your Board approved the grant agreement in the amount of $3,100,714 for construction of the CRT Facility. The construction is scheduled to be complete by February 2018.
On August 16, 2017, RFP No. 18-005 for Crisis Residential Treatment (CRT) services was released by the ISD - Purchasing Division (ISD - Purchasing). The RFP sought bidders that would provide CRT services to adult County residents. Addendum No. 1 was issued on August 30, 2017, following a Bidders’ Conference on August 25, 2017. The RFP closed on September 20, 2017.
A total of three proposals were received and ranked according to ISD - Purchasing guidelines based on a combination of proposal content, quality of proposed services, and experience in delivering treatment services to the target population. The review committee, consisting of a senior analyst, two clinical supervisors and a peer support specialist from the Department, and a senior analyst from the Department of Social Services, was able to reach a consensus and develop a recommendation that would best meet the critical needs of the County’s population.
Central Star was selected due to their demonstrated strength and knowledge in the provision of CRT services to mental health clients. Their proposal demonstrated an understanding of, and commitment to, providing individualized services based on the needs of clients. Central Star has strong community collaborations, and presents the best service delivery model to the clients that will be served. In addition, Central Star included an implementation plan in their proposal demonstrating their readiness to begin providing services upon completion of construction of the CRT Facility.
Central Star is in its 29th year of operation and annually throughout California at 32 different sites with nearly 50 programs, serves over 20,000 individuals including adults, children, youth, and their family members. They are also the current provider of youth psychiatric health facility (PHF) services in the County through Agreement No. 14-704.
The CRT program will serve adults for up to 30 days by providing therapeutic and/or rehabilitative services, in a non-institutional residential setting, through a structured program, as an alternative to hospitalization for clients experiencing an acute psychiatric episode or crisis, without medical complications requiring nursing care. The adult clients will typically have existing co-occurring physical health concerns and/or trauma-related experiences, and may occasionally have undiagnosed physical disorders that are not the cause of their mental symptoms but nonetheless will require evaluation and treatment. Culturally-attuned services will include crisis intervention and stabilization strategies, screening for medical complications, diagnosis formulation, medication education and monitoring, clinical assessment, individual treatment and/or rehabilitation plans, and discharge planning with linkage resources, such as permanent housing, pre-vocational and vocational programs, substance abuse treatment services and other supports based on the clients’ individual needs.
The proposed agreement allows for the adjustment of the ramp-up and implementation period by the Department Director, or designee, if the construction of the new CRT Facility is not completed within the estimated timeframes as it result in a service delay. The recommended agreement includes language for termination by Central Star, County, or their designees, upon a 60-day advanced written notice and allows for the termination due to non-allocation of funds upon the giving a 30-day advanced written notice to Central Star.
With your Board’s approval, the Department Director, or designee, may approve the following changes as needed:
• services, staffing, and contractor(s)’ responsibilities to accommodate changes in laws relating to mental health treatment;
• budgets that do not exceed 10% of the maximum annual compensation payable to the contractors;
• volume of service or type of service units;
• rates of service; and
• written notice of non-renewal not later than sixty (60) days prior to the close of the current Agreement term.
Changes to the budget that exceed 10% of the maximum annual compensation payable to the contractor would require an amendment with signed written approval by the contractor, County Counsel, the Auditor-Controller/Treasurer-Tax Collector’s Office, and the Department Director, or designee.
The proposed agreement deviates from the standard five-year agreement of a three-year base with two one-year extensions to allow Central Star to hire and train staff, to complete necessary staff credentialing, licensing and site certification of the CRT.
Approval of the recommended Facility Use Agreement with Star View Children and Family Services, Inc. (Central Star’s non-profit organization) will allow the CRT services to be provided on County-owned property located at 496 S. Barton Avenue in Fresno (11,655 square feet) and utilize private janitorial and security staff.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended agreement and actions at their October 2017 meeting.
REFERENCE MATERIAL:
BAI #13, September 13, 2016
BAI #7, October 13, 2015
BAI #7, September 1, 2015
BAI #31, June 2, 2015
BAI #9, December 2, 2014
BAI #63, July 15, 2014
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Central Star
On file with Clerk - Facility Use Agreement with Star View Children and Family Services, Inc.
CAO ANALYST:
Sonia De La Rosa