DATE: May 7, 2019
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Master Agreement for Locum Tenens Psychiatrist Services
RECOMMENDED ACTION(S):
TITLE
1. Approve and Authorize the Chairman to execute a Master Agreement with various locum tenens vendors to provide recruitment services for qualified psychiatrists, which will supersede Master Agreement 18-112, effective upon execution through June 30, 2023, which includes a three-year and six-month base contract and two optional one year extensions, not to exceed $37,500,000.
2. Authorize the Director, Department of Behavioral Health, to add vendors as needed by the Department to the Master Agreement and to renegotiate and approve rates based upon the prevailing market.
REPORT
Approval of the first recommended action will modify language in the agreement in sections including HIPAA, obligations of the contractors, compensation, compliance and assurances to better suit the needs of contractors and allow the Department of Behavioral Health to continue to deliver psychiatric services when gaps in qualified psychiatrist coverage are experienced.
Approval of the second recommended action will allow the Director to modify the agreement to add psychiatrists as needed to the master agreement and renegotiate their rates based upon the prevailing market. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative options. The non-approval of the recommended actions would prevent the Department from providing psychiatric services to severely mentally ill adult individuals and seriously emotionally disturbed children within the County when gaps in psychiatrist coverage are experienced.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of the recommended superseding master agreement ($37,500,000) will be financed with Mental Health Realignment and Short Doyle/Medi-Cal revenue. Maximum compensation for each fiscal year is $7,000,000. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2018-19 Adopted Budget and will be included in subsequent budget requests for the duration of the recommended master agreement. Actual cost will be determined by actual services provided.
DISCUSSION:
There continues to be a significant shortage of psychiatrists in the Central Valley and in the State of California. On May 1, 2018, your Board approved agreement 18-234 with Central California Faculty Medical Group (CCFMG) for psychiatric services by licensed psychiatrists serving Department of Behavioral Health Clients. CCFMG is still in the process of recruiting permanent, full time psychiatrists and is not expected to reach the goal of 26.5 full-time equivalent (FTE) Adult/Child Psychiatrists until FY 2022-2023. The Department will still utilize locum tenens physicians on an as-needed basis until staffing needs are met. Other contributing factors include aggressive recruitment tactics implemented by the California Department of Corrections and the Department of State Hospitals.
To navigate through the recruitment challenges and potential negative impacts to medication services for County mental health clients, your Board approved a master agreement 13-241 for locum tenens psychiatrists on May 7, 2013. The agreement was amended on February 2, 2016 to increase the contract maximum to $1,800,000; however, the need for locum tenens psychiatrists continued to increase. Your Board Approved Master Agreement 18-112 for locum tenens psychiatrists on March 20, 2018, which increased the contract maximum to $37,500,000. This agreement has been successful in the provision of psychiatrist services to outpatient clients, and ensuring timely and effective services to meet wellness and recovery needs of adult mental health clients.
After discussion with several vendors, it was decided that language in the master agreement should be modified to better meet the needs of current and future vendors. Modification of contract language will allow the department to continue the relationship with our current and future vendors to deliver the services as needed. Failure to make these language modifications may result in loss of contractors.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of this item at its March 20, 2019 meeting.
REFERENCE MATERIAL:
BAI # 13, May 1, 2018
BAI #35, March 20, 2018
BAI #18, February 2, 2016
BAI #44 May 7, 2013
BAI #42 August 24, 2010
BAI #39 August 26, 2008
BAI #58 June 17, 2008
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Supersede Agreement
CAO ANALYST:
Ron Alexander