DATE: December 11, 2018
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Agreement with JDT Consultants, Inc. for the provision of Therapeutic Behavioral Services (TBS)
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Amendment V to Agreement No. 13-398 with JDT Consultants, Inc., effective June 1, 2018 for the provision of therapeutic behavioral services to Fresno County Medi-Cal beneficiaries, increasing the 2017-2018 fiscal year maximum by $310,000 to a total of $17,635,000.
2. Approve and authorize the Chairman to execute a service Agreement with JDT Consultants, Inc. for the provision of therapeutic behavioral services to Fresno County Medi-Cal Beneficiaries as mandated pursuant to the permanent injunction issued by the United States District Court in the case of Emily Q. v. Bonta, effective January 1, 2019 through June 30, 2023, which includes a two and a half-year base contract and two optional one-year extensions, total not to exceed $18,300,000.
REPORT
Approval of the recommended actions would allow for continued Therapeutic Behavioral Services (TBS) to be provided to Fresno County Medi-Cal beneficiaries who are under 21 and are eligible and can benefit from one-to-one therapeutic contact with a mental health specialist to maintain residential placement at the lowest appropriate level. The proposed agreement would be funded by Short/Doyle Medi-Cal Federal and State funds with no Net County Cost.
ALTERNATIVE ACTION(S):
There are no viable alternatives. If your Board does not approve the recommended actions, the County will not be able to receive continuing services. Without approval of these recommended actions, children and families in need of these services may experience a gap and/or delay in receiving essential mental health services.
RETROACTIVE AGREEMENT:
The recommended amendment is retroactive to June 1, 2018 in order to pay outstanding expenses rendered during FY 2017-2018. The increasing need for these services were beyond those projected.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended amendment will increase the FY 2017-18 maximum compensation by $310,000 to a total of $3,710,000. The recommended agreement ($18,300,000) and recommended amendment will be fully funded with Medi-Cal Federal Financial Participation (FFP), Behavioral Health realignment, and Mental Health realignment. Sufficient appropriations and estimated revenues are available in the Department’s Org 5630 FY 2018-19 Adopted Budget and will be included in subsequent budget requests for the duration of the contract term.
DISCUSSION:
In 1999, the U.S. District Court issued a preliminary injunction requiring the State Department of Health Services to provide TBS services to children/youth under 21 through the EPSDT benefit in the Medi-Cal program (California Code of Regulations Title 9, Chapter 11). The Fresno County Mental Health Plan (FCMHP) has been providing TBS since November 2000. TBS are one-to-one therapeutic contacts between a mental health specialist and the client for a specified and limited period. TBS focus on behaviors and symptoms, which may jeopardize existing placements, or act as barriers to a lower level of residential placement or the completion of specific treatment goals. The TBS coach meets with clients at their home, school, or a place where the client is most comfortable, during times most therapeutic and when interventions are most needed. Clients are referred by the County’s Department of Social Services, the County’s Department of Behavioral Health, contracted mental health providers, families, care givers, and courts.
Request for Proposal (RFP) 18-033 was released on March 19, 2018 for the provision of Therapeutic Behavioral Services. Upon the bid closing date, three bids were received from Aspiranet, Mental Health Systems, Inc., and JDT Consultants. The evaluation panel consisted of three participants from the Department of Behavioral Health (one Staff Analyst, two Clinical Supervisors, and a Senior Staff Analyst), and one participant from the Department of Social Services (a Staff Analyst). All five evaluators recommended JDT Consultants, Inc. for the award.
JDT Consultants, Inc. was recommended based on extensive experience working with the TBS program and specifically Fresno’s diverse and unique population, a good performance record, complete proposal received, experience providing TBS throughout the state, providing concrete outcome measurements, strong internal policy regarding opening cases in a timely manner, having provided assistance to the State in developing TBS, and cost considerations(they only charge the County for face-to-face services versus charging for face-to-face time, collateral services, and travel time).
During FY 2015-2016, 300 clients received TBS from JDT Consultants, Inc. After care, 87.4% were prevented from degrading into more intensive services or were even able to upgrade to less restrictive care. During FY 2016-2017, 321 clients received TBS from JDT Consultants, Inc. 91.8% of those clients have shown similar success. To date in FY 2017-18 of the 366 clients that received TBS from JDT Consultants, Inc. 89.4% are currently reporting successful results.
An increase in clients receiving TBS was mandated by the Court in 2004 and implemented through the Nine-Point Plan to increase TBS access and utilization in 2008. It is expected that this growth trend will continue and JDT Consultants, Inc. has proven prepared to provide TBS to increasing numbers of clients. The recommended amendment would provide a retroactive increase to provide a mechanism for reimbursing JDT Consultants for the higher than anticipated volume of services they provided in FY 2017-18.
Amendment IV to Agreement No. 13-398 extended the agreement from June 30, 2018 to December 31, 2018 and provided a max budget of $1,700,000.00, half of the previous year’s budget. Amendment V to Agreement No. 13-398 increases the Fiscal Year 2017-2018 budget by $310,000 to a total of $3,710,000 and a total contract max of $17,635,000.
REFERENCE MATERIAL:
BAI #32, June 12, 2018 - Agt.13-398-4
BAI #41, May 24, 2016 - Agt. 13-398-3
BAI #34, April 21, 2015 - Agt. 13-398-2
BAI #53, May 20, 2014 - Agt. 13-398-1
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended Amendment and Agreement at its November 28, 2018 Board meeting.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment V to Agt. 13-398
On file with Clerk - Agreement
CAO ANALYST:
Ron Alexander