DATE: April 28, 2020
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
Delfino Neira, Director, Department of Social Services
SUBJECT: Contract Amendments due to COVID-19 Pandemic
RECOMMENDED ACTION(S):
TITLE
1. Approve and Authorize the Chairman to execute the following Amendments to existing Agreements with various contractors (Attachment 1) for contract term extensions with increases to the maximum compensations for FY 2020-21, effective upon execution:
A. Amendment I to Agt. No. 18-685 with Beacon Health Options for 24/7 Substance Use Disorder (SUD) Access Line, SUD Residential Authorizations, Mental Health Inpatient Concurrent Reviews, effective upon execution
B. Amendment III to Agt. No. 16-430 with California Health Collaborative for SUD Prevention Services: Performing Above the High and Lock It Up, effective upon execution
C. Amendment I to Agt. No. 15-318 with Envolve Pharmacy Solutions for Pharmacy Benefit Management: Prescription Services, effective upon execution
D. Amendment I to Agt. No. 15-210 with Housing Authority of the City and County of Fresno for Shelter Plus Care Program: Rental Assistance Vouchers to Qualified Homeless Individuals, effective upon execution
E. Amendment III to Agt. No. 15-257 with Kings View Corporation for Homeless Outreach, Engagement and Linkage Services and Specialty Mental Health Services (PATH Grant), effective upon execution
F. Amendment II to Agt. No. 15-317 with Kings View Behavioral Health for Crisis Intervention Team Services - Rural Triage Mental Health Services in East and West Cities, effective upon execution
G. Amendment II to Agt. No. 15-248 with Master Agreement - Translation Services for Verbal Interpreting and Written Translation Services, effective upon execution
H. Amendment I to Agt. No. 20-071 with San Diego State University Research Foundation for Community Planning Process Around Transition Aged Youth (TAY) Innovation Programs, effective upon execution
I. Amendment III to Agt. No. 16-431 with Youth Leadership Institute for SUD Prevention Services: Friday Night Live & Alcohol Initiative, effective upon execution
2. Approve and Authorize the Chairman to execute Amendments to the following existing Agreements with various contractors (Attachment 2) for increased budget modification request allowances for FY 2019-20, effective retroactive to March 1, 2020 through June 30, 2020.
A. Amendment III to Agt. No. 14-704 with Central Star Behavioral Health, Inc. for Adolescent Psychiatric Health Facility, effective retroactive to March 1, 2020
B. Amendment I to Agt. No. 17-580 with Central Star Behavioral Health, Inc. for Crisis Residential Treatment Services, effective retroactive to March 1, 2020
C. Amendment I to Agt. No. 18-576 with Central Star Behavioral Health, Inc. for Full Service Partnership Services to Transitional Age Youth, effective retroactive to March 1, 2020
D. Amendment I to Agt. No. 17-579 with Clinica Sierra Vista for Integrated Mental Health and Substance Use Disorder Services at Primary Care Clinics, effective retroactive to March 1, 2020
E. Amendment I to Agt. No. 20-014 with Mental Health Systems, Inc. for Full Service Partnership Co-occurring Services; Program Name: "IMPACT", effective retroactive to March 1, 2020
F. Amendment I to Agt. No. 18-327 with Turning Point of Central California, Inc. for Full Service Partnership Services; Program Name: "VISTA", effective retroactive to March 1, 2020
G. Amendment II to Agt. No. 15-215 with Turning Point of Central California, Inc. for Outpatient, Intensive Case Management, and Full Service Partnership Services to Rural Areas, effective retroactive to March 1, 2020
3. Approve and Authorize the Chairman to execute a Retroactive First Amendment to Agreement No. 18-233 with Central Star Behavioral Health Inc. for wraparound services to provide for a compensation structure change for FY 2019-20, effective March 1, 2020 through June 30, 2020.
REPORT
Approval of the recommended actions will allow for modifications to current contract language that will allow flexibility to continue to provide necessary behavioral health and/or substance use disorder services to existing clients during the current COVID-19 pandemic. The first recommended action will extend the current contract terms and increase the maximum compensation amounts to allow the various contractors the ability to continue while the ongoing competitive bid processes are finalized. The second recommended action will allow for modification from the allowance of up to a 10% budget modification to a 20% budget modification, as needed for unexpected needs during the COVID-19 pandemic. The third recommended action will allow for modification to the current contract language for Central Star Behavioral Health, Inc. (Central Star), a fee-for-service contract, to provide additional flexibility in payment structure to allow them to continue to serve the high intensity needs clients. All recommended actions will be applied only to contracts identified to be affected by the COVID-19 pandemic, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, existing individuals served will be subjected to negative consequences of inadequate staffing and resources available. If not approved, individuals served with serious mental illness and/or substance use disorders may face potential reduction in services from their existing service provider.
RETROACTIVE AGREEMENT:
The three recommended actions are recommended to be retroactive to March 1, 2020 in order to cover the time period when COVID-19 became a national emergency in early 2020 and reached the Central Valley by March 2020. In order to allow for complete flexibility for providers to determine how to continue to provide services due to all the rapidly changing requirements and safety precautions, all amendments need to become retroactive to March 1, 2020.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The first recommended action will increase the total maximum compensation amount for the individual contracts identified in Attachment 1 by no more than 3% over the contracted FY 2019-20 maximum compensation. The combined total of the increases equal $6,697,223. The second and third recommended actions will not increase the maximum compensations of the contracts identified. Each of the contracts identified within this agenda item will be fully funded by their existing funding sources including, but not limited to: Medi-Cal Federal Financial Participation, Mental Health Realignment funds, and Mental Health Services Act funds (Community Services and Supports and/or Prevention and Early Intervention). Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2019-20 Adopted Budget and will be included in the FY 2020-21 Recommended Budget.
DISCUSSION:
Due to the unexpected COVID-19 pandemic, most County staff and contracted provider’s staff have been affected by unanticipated staffing shortages and accommodations to meet the new requirements and safety precautions, including allowing individuals to work from home. The Department is presenting your Board with these three recommended actions for amendments to existing contracts for a variety of reasons in order to provide flexibility with term deadlines and payment structures to maintain the current service levels provided to the individuals served throughout the Behavioral Health System of Care.
For the first recommended action, all of the agreements identified are currently in their final year with a June 30, 2020 expiration date. Approval of the recommended action will allow for a one-year extension period to June 30, 2021 in order for program services to continue while competitive bidding processes and contract negotiations can be completed. The requested term extensions will provide an adequate transition period to allow potential new contractors identified from the competitive bid processes to ramp up necessary resources to successfully assume responsibility with minimum impact to existing individuals served.
The Department is expediting its competitive bid process for the applicable contracted services identified in the first recommended action. The RFPs for the services identified have been or will be released to the public within the next few months. County Purchasing has agreed to postpone closing deadlines for some RFPs already in process and will extend out the deadlines for RFPs soon to be submitted to Purchasing. The resulting new agreements from each RFP will be presented to your Board for approval and are anticipated to include a new 3-year term with the possibility of two one-year renewals upon satisfactory performance.
Attachment 1 includes the information for nine contracts requiring a one-year term extension including: contractor name, services provided, Board agreement # (including any related amendments), requested compensation for FY 2020-21, and resulting new total maximum compensation amount.
Approval of the second recommended action will modify current contract language in the identified contracts listed in Attachment 2 to adjust the current allowance of budget modification requests from 10% of the maximum compensation to 20% of the maximum compensation. This change will allow contracted providers who were required to purchase additional technological items or personal protective equipment for their staff and who may have already expended all funds in a specific line item or expense category to have more flexibility with the budget modification process, without an increase to the maximum compensation. The requested modification will apply to expenses incurred between March 1, 2020 and June 30, 2020.
Attachment 2 includes information for seven contracts with amended modification language and includes: contractor name, services provided, Board agreement # (including any related amendments), existing maximum compensation for FY 2019-20.
Approval of the third recommended action will modify current contract language regarding payment structure in the Central Star Agreement No. 18-233 for wraparound services (Wrap) provided to youth in the foster care system. The requested modification will be retroactive to March 1, 2020 through June 30, 2020. Central Star Wrap is structured as a fee-for-service contract which does not allow for flexible movement to purchase necessary technological or personal protective equipment, due to this shift in focus during the COVID-19 pandemic.
OTHER REVIEWING AGENCIES:
The regularly scheduled April 15, 2020 meeting of the Behavioral Health Board was canceled due to the COVID-19 pandemic, but they were informed of the recommended Amendments on April 22, 2020 via email communication.
REFERENCE MATERIAL:
Recommended Action 1:
BAI #29, December 11, 2018 - Agt. No. 18-685 with Beacon Health Options (formerly ValueOptions of California, Inc.)
BAI #37, July 12, 2016 - Agt. No. 16-430 with California Health Collaborative
BAI #43, June 20, 2017 - Agt. No. 16-430-1 with California Health Collaborative
BAI #47, May 7, 2019 - Agt. No. 16-430-2 with California Health Collaborative
BAI #36, July 14, 2015 - Agt. 15-318 with Envolve Pharmacy Solutions (formerly US Script, Inc.)
BAI #27, June 2, 2015 - Agt. 15-210 with Housing Authority of the City and County of Fresno
BAI #45, June 16, 2015 - Agt. 15-257 with Kings View Corporation
BAI #39, June 6, 2017 - Agt. 15-257-1 with Kings View Corporation
BAI #31, October 22, 2019 - Agt. 15-257-2 with Kings View Corporation
BAI #35, July 14, 2015 - Agt. 15-317 with Kings View Behavioral Health
BAI #47, July 10, 2018 - Agt. 15-317-1 with Kings View Behavioral Health
BAI #38, June 16, 2015 - Agt. 15-248 with Master Agreement - Translation Services
BAI #35, April 26, 2016 - Agt. 15-248-1 with Master Agreement - Translation Services
BAI #38, February 25, 2020 - Agt. No. 20-071 with San Diego State University Research Foundation
BAI #37, July 12, 2016 - Agt. No. 16-431 with Youth Leadership Institute
BAI #43, June 20, 2017 - Agt. No. 16-431-1 with Youth Leadership Institute
BAI #47, May 7, 2019 - Agt. No. 16-431-2 with Youth Leadership Institute
Recommended Action 2:
BAI #32, June 2, 2015 - Agt. No. 14-704 with Central Star Behavioral Health, Inc.
BAI #17, February 2, 2016 - Agt. No. 14-704-1 with Central Star Behavioral Health, Inc.
BAI #34, November 14, 2017 - Agt. No. 17-580 with Central Star Behavioral Health, Inc.
BAI #33, October 9, 2018 - Agt. No. 18-576 with Central Star Behavioral Health, Inc.
BAI #33, November 14, 2017 - Agt. No. 17-579 with Clinica Sierra Vista
BAI #22, January 7, 2020 - Agt. 20-014 with Mental Health Systems, Inc.
BAI #9, December 2, 2014 - Agt. 15-215 with Turning Point of Central California, Inc.
BAI #40, May 24, 2016 - Agt. 15-215-1 with Turning Point of Central California, Inc.
BAI #33, June 12, 2018 - Agt. 18-327 with Turning Point of Central California, Inc.
Recommended Action 3:
BAI #18, May 1, 2018 - Agt. No. 18-233 with Central Star Behavioral Health, Inc.
ATTACHMENTS INCLUDED AND/OR ON FILE:
Attachment 1
Attachment 2
On file with Clerk - Amendment I to Agt. No. 18-685 with Beacon Health Options
On file with Clerk - Amendment III to Agt. No. 16-430 with California Health Collaborative
On file with Clerk - Amendment I to Agt. No. 15-318 with Envolve Pharmacy Solutions
On file with Clerk - Amendment I to Agt. No. 15-210 with Housing Authority
On file with Clerk - Amendment III to Agt. No. 15-257 with Kings View Corporation
On file with Clerk - Amendment II to Agt. No. 15-317 with Kings View
On file with Clerk - Amendment III to Agt. No. 15-248 with Master Agreement - Translation Services
On file with Clerk - Amendment I to Agt. No. 20-071 with San Diego State
On file with Clerk - Amendment III to Agt. No. 16-431 with Youth Leadership Institute
On file with Clerk - Amendment III to Agt. No. 14-704 with Central Star Behavioral Health
On file with Clerk - Amendment I to Agt. No. 17-580 with Central Star Behavioral Health
On file with Clerk - Amendment I to Agt. No. 18-576 with Central Star Behavioral Health
On file with Clerk - Amendment I to Agt. No. 17-579 with Clinica Sierra Vista
On file with Clerk - Amendment III to Agt. No. 20-014 with Mental Health Systems
On file with Clerk - Amendment II to Agt. No. 15-215 with Turning Point
On file with Clerk - Amendment I to Agt. No. 18-327 with Turning Point
On file with Clerk - Amendment I to Agt. No. 18-233 with Central Star Behavioral Health
CAO ANALYST:
Ronald Alexander