DATE: June 18, 2019
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Amendments to Agreements with Exodus Recovery, Inc.
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute the following Amendments with Exodus Recovery, Inc. to update Agreement language that allows Exodus Recovery, Inc. greater access to the Department of Behavioral Health’s client Electronic Health Record (EHR) mental health information system and address staffing changes with increases to the maximum compensations, effective upon execution with no change in term to June 30, 2021:
1. Amendment I to Agreement No. 16-221, an increase of $1,075,491 ($22,772,283); and
2. Amendment I to Agreement No. 15-594, an increase of $3,432,964 ($53,626,998).
REPORT
Approval of the recommended action will increase the maximum compensation amounts to allow Exodus Recovery, Inc, (Exodus) the ability to record, maintain, and manage their electronic health records via the Department of Behavioral Health (DBH) integrated mental health information system, known as Avatar. Avatar is provided through an agreement between DBH and Netsmart Technologies. Exodus will reimburse DBH for the cost of its users. Additionally, the increase in funding will allow Exodus to retain and add positions, both personnel and sub-contracted, at the Adult Psychiatric Health Facility (PHF) and the Adult and Youth Crisis Stabilization Centers (CSCs). The proposed Amendments will be funded with Mental Health Realignment, Behavioral Health Realignment and Medi-Cal Federal Financial Participation revenue, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
If your Board does not approve the recommended action, the County will not benefit from an opportunity to provide greater consistency in client treatment through the use of a shared electronic health system. Exodus will also be unable to cover their actual staffing costs to continue providing mandated inpatient psychiatric services and crisis stabilization services to County residents once they reach the current maximum compensation.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The cost for access to Avatar includes a monthly hosting fee per user, an annual maintenance licensing fee per user with a three percent (3%) fee increase each fiscal year, an annual licensing fee per user for access to OrderConnect module, and an annual fee per user for utilization of DBH Reaching Recovery tools. Exodus’s access to the system will be upon implementation and the total estimated cost for each fiscal year is included. DBH will invoice Exodus for reimbursement of the access fees.
The recommended amendment for the Adult PHF will increase the FY 18-19 maximum compensation by 9.3% or $365,144, from $3,926,201 to $4,291,345. The full contract maximum will increase from $21,696,792 to $22,772,283. The recommended amendment for the CSCs will increase the combined FY 18-19 maximum compensations by 9.1% or $887,576, from $9,726,579 to $10,614,156. The full contract maximum will increase from $50,194,034 to $53,626,998. The increases are fully funded by Mental Health Realignment, Behavioral Health Realignment and Medi-Cal revenues. Sufficient appropriations and estimated revenues are available in the Department’s Org 5630 FY 2018-19 Adopted Budget and will be included in future budget requests for the terms’ duration. Total expenditures are based on actual services provided.
DISCUSSION:
On February 2017, your Board approved Agreement No. 17-039 with Netsmart to continue to supply DBH with the Integrated Mental Health Information System (IMHIS), referred to as Avatar. In July 2017, Exodus contacted DBH and requested the utilization of Avatar in order to record, maintain, and manage their electronic health records. Currently, Exodus does not have an electronic health record system and maintains paper-based health records. Their access to Avatar is currently limited to billing purposes of their contracted agreements.
As a DBH contracted provider, Exodus’ contracted programs are part of the Fresno County Mental Health Plan. In providing greater access to this agency, treatment information for clients who utilize both DBH and Exodus programs, or transfer between the two, will be kept in a central repository and help facilitate greater consistency in client treatment. These records will begin with intake and include client authorization forms, assessments, treatment plans, progress notes, as well as other documents approved by DBH. Costs for Avatar will be approximately $14,457 annually at the Adult PHF and approximately $45,248 at the Crisis Stabilization Centers.
The recommended action will also allow Exodus to continue to provide 24/7 acute inpatient and crisis services by employing and contracting with behavioral health provider staff in the following ways:
• Adult PHF
o Incorporate the following positions previously added during prior budget modifications that did not exceed the maximum compensation and provide salary adjustments for the current fiscal year at the stated cost:
§ 6.2 Full-Time Equivalent (FTE) Mental Health Worker positions (total 14.59 FTE) and increase average cost from $34,868 to $43,138, which includes salaries and benefits;
§ 0.60 FTE Licensed Marriage Family Therapist/Licensed Clinical Social Worker positions (total 1.6 FTE) and increase average cost from $71,000 to $73,625; and
§ 0.91 FTE Peer Advocate/Counselor position (total 1.91 FTE);
o Reclassify 11.01 FTE Nurses, including Registered Nurses, Licensed Vocational Nurses and Licensed Psychiatric Technicians, from subcontracted services to personnel at a cost of $759,525; and
o Increase the contracted psychiatrist hourly rate from $185 to $240 to meet market adjustments.
• Adult and Youth CSCs
o Incorporate the following positions previously added during prior budget modifications that did not exceed the maximum compensation and provide salary adjustments for the current fiscal year at the stated cost:
§ 8.9 FTE Mental Health Worker positions (total 34.14 FTE) and increase average cost from $34,868 to $43,138;
§ 0.9 FTE Program Nurse positions (total 21.9 FTE) and increase average cost from $60,000 to $68,985;
§ 0.9 FTE Social Service Coordinators positions (total 4.8 FTE) and increase average cost from $69,237 to $70,167; and
§ 0.70 FTE Peer Counselor positions (total 2.70 FTE);
o Add a 1 FTE mid-shift Program Nurse position (total 22.9 FTE) at an average cost of $68,985; and
o Increase the contracted psychiatrist hourly rate from $185 to $240 to meet market adjustments.
These staffing changes will result in aligning program services with program needs. Increased client acuity at the Adult PHF that has required more one-on-one interventions and at extended periods. Additional services have been provided to client overstays while placement at appropriate levels of care were being secured. During the period of February 1, 2018 through January 31, 2019, the CSCs served 17,830 clients, which is a 1.5% (272) increase from the prior period.
The proposed amendments also update the Modification clauses of the Agreements by allowing changes over 10% of the budgets in expense category subtotals to be reviewed and approved by the Director of Behavioral Health, County Counsel, and the Auditor. These provisions increase the Director’s contracting authority and deviate from the County contract template. Any changes permitted under these Agreements will not result in any change to the maximum compensation amount allowed under these Agreements. No extension/change to the term is included in the proposed amendments.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of the recommended Amendments at its May 2019 meeting.
REFERENCE MATERIAL:
BAI #21, February 7, 2017 - Agreement No. 17-039
BAI #38, May 24, 2016 - Agreement No. 16-221
BAI #35, November 17, 2015 - Agreement No. 15-594
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Agreement No. 16-221
On file with Clerk - Amendment I to Agreement No. 15-594
CAO ANALYST:
Ronald Alexander