DATE: January 7, 2020
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director of Behavioral Health
SUBJECT: Retroactive Agreement with Mental Health Systems, Inc. for a Co-Occurring Disorders Full Service Partnership Program
RECOMMENDED ACTION:
TITLE
Approve and authorize the Chairman to execute a retroactive Agreement with Mental Health Systems, Inc. for the provision of a Co-Occurring Disorders Full Service Partnership Program for adult and older adult mentally ill and substance use disorder individuals, effective January 1, 2020, not to exceed four and a half consecutive years, which includes a two and a half year base contract and two optional one-year extensions, total not to exceed $12,355,363.
REPORT
The provision of Co-Occurring Disorder FSP services includes mental health services, housing, and substance abuse treatment for 158 Fresno County adults and older adults who are seriously and persistently mentally ill with substance use disorders. Approval of the recommended action will allow the Department to continue these services for the existing 158 individuals. This Agreement term is for two (2) years and six (6) months, and may be extended for two (2) additional twelve month periods based on satisfactory performance outcomes and available funding.
RETROACTIVE AGREEMENT:
The proposed Agreement is retroactive to January 1, 2020, due to extended contract negotiations.
ALTERNATIVE ACTION:
If the recommended action is not approved, the seriously and persistently mentally ill individuals would not receive the Co-Occurring Disorder FSP Services they require in a timely manner. The lack of timely services may directly impact the demand for more costly mental health and substance abuse services, leaving existing mentally ill individuals with substance abuse issues without adequate services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The first six months of the contract ($1,370,133) will be financed with Mental Health Services Act ($771,558), Federal Financial Participation ($546,961), consumer rent revenue ($50,000), and other health coverage ($1,614). Costs for each subsequent fiscal year ($2,714,824) will be financed with Mental Health Services Act ($1,537,398), Federal Financial Participation ($1,075,812), consumer rent revenue ($100,000), and other health coverage ($1,614). Sufficient appropriations and estimated revenues are included in the FY 2019-20 DBH Org 5630 Adopted Budget and will be included in subsequent fiscal years.
DISCUSSION:
On May 20, 2014, your Board approved an Agreement with MHS, Inc. (Agreement No. 14-276) for Co-Occurring Disorders Program FSP Services to County adults:
• with serious and persistent mental illness and substance abuse disorders;
• who are also homeless or at risk of homelessness;
• frequent users of crisis services; and/or,
• at risk of incarceration.
The MHS Co-Occurring FSP Program has successfully increased access to services for seriously and persistently mentally ill County individuals with substance abuse issues. Some of areas and ways MHS has been able to implement changes include:
• To address limited housing resources
MHS has worked collaboratively with community partners to establish appropriate housing for individuals receiving services. Additional collaborations including efforts in master leasing and managing appropriate housing in locations that ensure safety for the Fresno County individuals.
• To address the lack of board and care services
Accommodations have been made for individuals who have a lower level of functioning due to lack of board and care access.
• To improve the quality of program services
Interns were implemented to accommodate for the staff to consumer ratio.
• To address Discharge planning for consumers who refuse services or self-discharge before goals are met
To address this barrier, several strategies were implemented. As a precaution, consumers who are refusing/self-discharging services are scheduled to meet with the Program Manager and their wellness team to discuss barriers, gaps in treatment and reason for refusal/self-discharge. During the discharge meeting, consumers are provided resources within the community and information on how to continue services.
• To combat stigma and decrease barriers around Substance abuse treatment programs with lack of knowledge on severe mental illnesses
MHS provides psychoeducation on the severe mentally ill population and offers trainings on Co-Occurring and Crisis Management to Substance Abuse treatment facilities.
These are just some of the ways MHS has been able to enhance some of their services to ensure that the services that they are providing makes an impact for the needs of the individuals served.
On September 22, 2015, your Board approved Amendment I to Agreement No. 14-276 with MHS for the expansion of the Co-Occurring FSP Program services to further address the needs of County of Fresno Behavioral Health individuals.
On June 18, 2019, your Board approved Amendment II to Agreement No. 14-276 with MHS to allow for extension of program services from July 1, 2019 through December 31, 2019. The extension allowed the Department to complete a new RFP and complete the competitive bidding process.
On September 20, 2019, RFP No. 20-014 For Co-Occurring Disorders FSP services was released by the Internal Services Department - Purchasing (ISD - Purchasing). The RFP sought bidders that would provide FSP services to individuals with co-occurring disorders and symptoms (severe mental illness and substance use disorders) to adults and older adults for Fresno County residents. Addendum No. 1 was issued on October 4, 2019 following a Bidders’ Conference on September 26, 2019. The RFP closed on October 16, 2019.
A total of three proposal were received and evaluated 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 one Clinical Supervisor, two Utilization Review Specialists, a Fresno County Behavioral Board Member and a Staff Analyst, was able to reach a consensus and develop a recommendation that would best meet the co-occurring disorders FSP service needs of the County’s population.
Approval of the recommended Agreement would allow the Department to continue providing uninterrupted services with MHS IMPACT Co-Occurring Disorder FSP Program and will allow provision of new modalities of services including direct services to individuals with Substance Use Disorders (SUD) and Assertive Community Treatment (ACT) model like services. The Department requires MHS to sign on to the Departments’ existing Drug Medi-Cal (DMC) Master Agreement No. 18-690, and Non-DMC Agreement No. 18-691 to serve all individuals with SUD service needs.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was advised of the proposed Co-Occurring FSP Program Agreement at its November 13, 2019 Meeting.
REFERENCE MATERIAL:
BAI #40, June 18, 2019 - Amendment II to 14-276-2
BAI #45, September 22, 2015 - Amendment I to 14-276-1
BAI #56, May 20, 2014 - Agreement No. 14-276
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with MHS
CAO ANALYST:
Ronald Alexander