DATE: February 4, 2020
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Retroactive Amendment I to Master Agreement for Temporary Staffing
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Amendment I to the Master Agreement No. 18-666 with various Temporary Staffing Agencies, effective February 1, 2020, with no change in the term to June 30, 2023 and increasing the maximum by $94,060,779 to a total of $106,194,112.
2. Adopt Budget Resolution increasing the FY 2019-20 appropriations and estimated revenues for Department of Behavioral Health Org 5630 in the amount of $11,470,827 (4/5 vote).
REPORT
Approval of the recommended actions will allow the Department of Behavioral Health (DBH) to utilize Temporary Staffing Agencies to provide staffing qualified to deliver services to adults with severe mental illness and youth with serious emotional disturbances when gaps in qualified County staff coverage is identified, including Licensed Marriage and Family Therapists (LMFT), Licensed Clinical Social Workers (LCSW), Licensed Professional Clinical Counselors (LPCC), Licensed Vocational Nurses (LVN), Registered Nurses (RN), Nurse Practitioners (NP), a Quality Improvement Coordinator (QIC), a Medical Records Coordinator (MRC), and Registered Health Information Technicians (RHIT) through a Master Agreement. Approval of the recommended budget resolution will allow for sufficient appropriations and estimated revenues for the remainder of FY 2019-20 to allow for adequate funding for staffing needs, as mandated by the Department of Health Care Services, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended actions, individuals receiving mental health services will be subject to the negative consequences of inadequate staffing. Optimal staffing is critical for DBH operations and ongoing services to clients. Given the current vacancies, it is crucial that appropriate staffing levels are maintained. The requested classifications in need of recruitment are essential in the operation of DBH to continue to provide services to seriously mentally ill clients, which helps deter decompensation of the individuals and also aids in preventing costly hospitalization. Periods of inadequate staffing may cause gaps in services received which may pose a danger to clients. Additionally, the State of California mandated staffing ratios must be maintained at all times.
RETROACTIVE AGREEMENT:
If approved, this Amendment will be retroactive to February 1, 2020 in order to meet DHCS requirements for staffing effective at the beginning of the month.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The annual contract maximum for FY 2019-20 is $14,070,827 (an increase of $11,470,827) and the annual maximum for FY 2020-21 for the remaining base contract year is $30,129,984 (an increase of $27,529,984), for all providers combined. The maximum compensation for the remaining two subsequent years, if the Agreement is extended for satisfactory performance, will be $30,129,984 per year for a total of $106,194,112 for the entire 5-year contract term (an increase of $94,060,779). The costs will be fully funded by Medi-Cal Federal Financial Participation, Mental Health Realignment funds, and funds available due to salary savings from the vacant positions, which will be filled by this staffing agreement.
Approval of the recommended Budget Resolution will increase the FY 2019-20 appropriations and estimated revenues in the Behavioral Health Org 5630 in the amount of $11,470,827 to fund costs associated to staffing needs. Ongoing costs will be included in future fiscal year requested budgets for the duration of the contract term.
DISCUSSION:
In 2018, DBH solicited the services of temporary staffing agencies via a competitive bid process, Request for Statement of Qualifications (RFSQ #18-053) specializing in the recruitment of the following licensed positions: Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), Licensed Professional Clinical Counselor (LPCC), Licensed Vocational Nurse (LVN), Registered Nurse (RN), and Nurse Practitioner (NP) to provide services to the individuals with serious mental illness in the County of Fresno. Respondents were to identify and recruit qualified candidates who satisfy the criteria as established by DBH pertaining to each respective staff classification.
There continues to be a shortage of qualified applicants for LMFT, LCSW, LPCC, LVN, RN and NP recruitments. There has also been an identified need in DBH’s Quality Improvement Division for the following positions as well: Quality Improvement Coordinator (QIC), Medical Records Coordinator (MRC), and Registered Health Information Technicians (RHIT). As a result, DBH continues to struggle with filling these positions through the County of Fresno recruitment process. DHCS implemented the Final Rule in 2018 which included mandated requirements for Network Adequacy Standards. If DBH does not meet the prescribed number of staffing, the Department may be fined or funds withheld until the standards are met. The requirement for the adequate staffing (as defined by DHCS) must be available for a period up to one year. To meet DHCS’ requirements, capacity must be achieved through utilization of staff available through contracted temporary staffing agencies via this Agreement. Therefore, the maximum compensation for this Agreement must be increased to accommodate the level of staffing required. The maximum compensation increase was calculated utilizing the number of FTEs that DHCS has indicated that DBH is currently short: 192 FTEs.
Upon your Board’s approval, the proposed Amendment will become effective February 1, 2020 to avoid gaps in staffing coverage, as mandated by DHCS.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of this item at their January 15, 2020 meeting.
REFERENCE MATERIAL:
BAI #38, December 4, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Master Agreement
On file with Clerk - Budget Resolution (Org 5630)
CAO ANALYST:
Ronald Alexander