DATE: April 3, 2018
TO: Board of Supervisors
SUBMITTED BY: Margaret Mims, Sheriff-Coroner
Dawan Utecht, Director, Department of Behavioral Health
Philip Kader, Interim Chief Probation Officer, Probation Department
David Pomaville, Director, Department of Public Health
Jean M. Rousseau, County Administrative Officer
SUBJECT: Agreements with California Forensic Medical Group for Comprehensive Medical and Behavioral Health Care Services at County Detention Facilities
RECOMMENDED ACTIONS:
TITLE
1. Approve and authorize the Chairman to execute an Agreement with California Forensic Medical Group, Inc., for comprehensive medical and behavioral health care, including substance use disorder, services to inmates at Sheriff-Coroner’s Office Adult Detention Facilities, effective upon execution, not to exceed five years and three months consecutively, which includes a three-month ramp-up and implementation phase followed by a three-year base contract and two optional one-year extensions, total not to exceed $121,109,052;
2. Authorize the County Administrative Officer, or designee, to modify the inmate annual contract maximums up to $150,000 during the three-year base contract, for pharmaceutical expenses, without exceeding the total contract maximum of $121,109,052; and
3. Approve and authorize the Chairman to execute an Agreement with California Forensic Medical Group, Inc., for comprehensive medical and behavioral health care services to wards at the County Probation Department Juvenile Justice Campus, effective upon execution, not to exceed five years and three months consecutively, which includes a three-month ramp-up and implementation phase followed by a three-year base contract and two optional one-year extensions, total not to exceed $17,047,551.
REPORT
Approval of the first and third recommended actions will allow for a three-month ramp-up and implementation of two separate comprehensive medical and behavioral health care service agreements for adult inmates (inmates) and juvenile wards (wards). California Forensic Medical Group, Inc. (CFMG) was selected following a Request for Proposal (RFP) process. CFMG will begin acquiring all necessary licensing and staff prior to implementation on July 1, 2018 to provide the mandated services to incarcerated individuals. The proposed agreement for services to inmates will be administered by the Sheriff-Coroner’s Office (Sheriff-Coroner), the proposed agreement for services to wards will be administered by the Probation Department and the Department of Public Health (DPH). Both agreements include an annual $25,000 pharmacy cap per inmate/ward. In addition, the inmate agreement includes an annual aggregate of $150,000 for costs in excess of the $25,000 cap per inmate. The agreements will be funded with a combination of Health Realignment, Assembly Bill (AB) 109, Mental Health Realignment, Substance Abuse and Mental Health Services Administration, and Net County Cost monies.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. If the recommended actions are not approved, the County would be unable to provide health care services to incarcerated individuals as mandated by Title 15 and Title 24 of the California Code of Regulations - Minimum Standards for Local Detention Facilities.
FISCAL IMPACT:
During FY 2017-18 the ramp-up and implementation phase will take place from April 3, 2018 through June 30, 2018, with no increase in Net County Cost. The five-year recommended agreements have 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 agreements are $121,109,052 for services to inmates, $17,047,551 for services to wards. The annual maximum compensation will be as follows:
Services to Inmates Services to Wards
FY 2018-19 $22,814,355 $3,210,984
FY 2019-20 $23,497,286 $3,307,314
FY 2020-21 $24,200,704 $3,406,533
FY 2021-22 $24,925,225 $3,508,729
FY 2022-23 $25,671,482 $3,613,991
The proposed agreements will be offset with a combination of Health Realignment, Assembly Bill (AB) 109, Mental Health Realignment, Substance Abuse and Mental Health Services Administration, and Net County Cost monies. The services to inmates include medical, behavioral health, and substance use disorder (SUD). The services to wards include medical and behavioral health; SUD is not a part of the services to wards but will be provided through a separate agreement.
Sufficient appropriations and estimated revenues will be included in the Sheriff-Coroner’s Org 3111 and Probation Department’s Org 3440 budget requests for the duration of the terms.
DISCUSSION:
Title 15 and Title 24 of the California Code of Regulations - Minimum Standards for Local Detention Facilities requires that the County provide State and Federal mandated medical and behavioral health care to individuals incarcerated in the County’s detention facilities, the Jail and Juvenile Justice Campus (JJC).
On March 25, 2014, the Board approved Agreement No. 14-118 for comprehensive medical and behavioral health care services for inmates and wards housed within County detention facilities. On December 6, 2016, the Board implemented one of the two one-year extensions (July 1, 2017 to June 30, 2018). On August 18, 2017, RFP No. 18-006 for Comprehensive Medical and Behavioral Health Care Services, was released by Internal Services Department - Purchasing Division (ISD-Purchasing), with Addendum One issued on October 9, 2017. The RFP closed on November 9, 2017.
The RFP notice was sent to approximately 550 potential vendors through the County Public Purchase system and ISD-Purchasing received four bids for the Jail: CFMG, Corizon Health, Correct Care Solutions, and Wexford Health Care, Inc., three bids were received for the JJC: CFMG, Corizon Health, and Correct Care Solutions. The seven-member review committee consisted of personnel from DPH, Department of Behavioral Health, County Counsel, County Administrative Office, Probation Department, Sheriff-Coroner’s Office, and a representative from a community based organization.
Three review committee members conducted site visits at locations served by the two highest ranked bidders (CFMG and Corizon). The members visited jails in Alameda County, Monterey County, and Tulare County. In conjunction with the site visits, reference checks and legal review were conducted.
The committee was able to reach a consensus and develop a recommendation that would best meet the medical and behavioral health mandated services. CFMG was selected due to the following:
• strong staffing plan which guaranteed coverage of all shifts;
• impressive coordinated case management system, unique from other bidders’ options;
• only bidder committed to obtaining United States Drug Enforcement Administration (DEA) licensure to provide methadone maintenance treatment;
• complete responsiveness to the RFP; and,
• demonstrated experience and knowledge in working and complying with the California and Federal rules, regulations, and requirements, as they apply to health care provision to inmates and wards in California detention facilities.
• Collaborative Correctional Care model, which assesses patient needs, ensures correct treatment protocols, and monitors care progress and outcomes during the entire length of incarceration providing continuity of care from facility intake through release to the community.
• Care Manager assistance with inmates re-entering the community.
The proposed agreements include a three-month ramp up period to allow CFMG to hire and train staff, to complete necessary staff credentialing, licensing and site certifications.
The recommended agreements differ from the prior Comprehensive Medical and Behavioral Health Care Services agreement as follows:
• Two separate agreements.
One agreement for medical and behavioral health plus SUD services at the Jail and one agreement for medical and behavioral health services at the JJC. SUD services at JJC will continue to be provided through a separate agreement.
• Pharmacy Cap.
The two agreements include a new pharmacy “cap” of $25,000 per year per inmate/ward. Additionally, the inmate services recommended agreement, includes a $150,000 annual aggregate for any pharmacy costs over $25,000 per inmate. The County is responsible for any costs beyond the $150,000 annual aggregate.
REFERENCE MATERIAL:
BAI #36.1, December 6, 2016
BAI #6, March 25, 2014
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with CFMG for the Jail
On file with Clerk - Agreement with CFMG for the JJC
CAO ANALYST:
Jeannie Z. Figueroa