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Agenda Item
ASR
Control 25-000698 |
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MEETING
DATE: |
04/14/26 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Veronica
Kelley (714) 834-7024 |
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Ian
Kemmer (714) 834-2160 |
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Subject: Renewal of Behavioral Health
Service Short-Term Residential Therapeutic Program
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ceo CONCUR |
County Counsel Review |
Clerk of the Board |
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Concur |
Approved
Agreement to Form |
Discussion |
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3
Votes Board Majority |
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Budgeted: N/A |
Current Year
Cost: N/A |
Annual Cost: FY 2026-27 $12,000,000 |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 5/7/2024 # 10 |
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RECOMMENDED
ACTION(S):
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1. |
Approve Amendment No. 2 to renew the
Master Contract for the provision of Behavioral Health Services in Short-Term
Residential Therapeutic Programs, for the term of July 1, 2026, through June
30, 2029, in an amount not to exceed $36,000,000, for an aggregate amount not
to exceed $60,000,000. |
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2. |
Approve Amendment No. 4 to renew the
individual contract with Mary’s Shelter dba Mary’s Path for the provision of
Behavioral Health Services in Short-Term Residential Therapeutic Programs,
for the term of July 1, 2026, through June 30, 2029. |
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3. |
Approve Amendment No. 2 to renew the
individual contract with New Alternatives, Inc. for the provision of
Behavioral Health Services in Short-Term Residential Therapeutic Programs,
for the term of July 1, 2026, through June 30, 2029. |
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4. |
Approve Amendment No. 2 to renew the
individual contract with Olive Crest for the provision of Behavioral Health
Services in Short-Term Residential Therapeutic Programs, for the term of July
1, 2026, through June 30, 2029. |
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5. |
Approve Amendment No. 3 to renew the
individual contract with Rite of Passage Adolescent Treatment Centers and
Schools, Inc. for the provision of Behavioral Health Services in Short-Term
Residential Therapeutic Programs, for the term of July 1, 2026, through June
30, 2029. |
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6. |
Authorize the County Procurement Officer
or Deputized designee to execute contracts with new providers under the
Master Contract or to add locations to current providers, without returning
to the Board for approval. |
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7. |
Authorize the County Procurement Officer
or Deputized designee to execute Amendments to the Master Contract and
Individual Amendments, as referenced in the Recommended Actions above. |
SUMMARY:
Approval of Amendment No. 2 to the
Master Contract and the individual amendments with various providers allows for
the continued delivery of intensive Specialty Mental Health Services to youth
in foster care or juvenile justice placements, ages six to 17, and Non-Minor
Dependents, ages 18 to 20, who are placed in licensed Short-Term Residential
Therapeutic Programs in Orange County and in programs located in other counties
when Orange County remains responsible for their mental health care.
BACKGROUND
INFORMATION:
On May 7, 2024, your Honorable
Board of Supervisors (Board) approved the Master Contract for the provision of
Behavioral Health Services in Short-Term Residential Therapeutic Programs
(STRTP) with various providers. The Orange County Preference Policy is not
applicable to these Contract amendments.
The below additional actions
related to the Master Contract were executed pursuant to appropriate
authorities.
Table
1: Prior Actions related to the Master Contract
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Board
Date |
Contract
/ Amendment |
Action |
Term |
Amount
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May 7, 2024 |
Master Agreement |
Board Approved Master
Agreement |
July 1, 2024 – June 30,
2026 |
$24,000,000 |
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N/A |
Amendment No. 1 |
Deputy Purchasing Agent
(DPA) Delegated Authority Administrative Revisions; Actual Cost to Fee-for-
Service to Master and individual Contracts |
July 1, 2025 – June 30,
2026 |
N/A |
Scope
of Services
Behavioral health services provided
in STRTPs support youth in foster care or juvenile justice placements who have
complex behavioral health needs and require a short-term residential level of
care. In some cases, youth are placed in STRTPs outside Orange County when
appropriate placements are not available locally, and Orange County remains
responsible for their mental health care. STRTPs were established under
California’s Continuum of Care Reform (CCR) to replace traditional group homes
with a more clinically intensive and treatment-focused model.
STRTPs are licensed by the
California Department of Social Services (CDSS) and are required to contract
with the County Behavioral Health Plan, which in Orange County is the Health
Care Agency (HCA), to become certified Medi-Cal providers and receive Mental
Health Program approval from the Department of Health Care Services (DHCS).
This contractual framework allows HCA to deliver behavioral health services to
eligible youth placed in STRTPs. While the Social Services Agency (SSA) is
responsible for residential care and supervision, HCA provides the clinical
mental health services necessary to stabilize youth and support their
transition to lower levels of care.
All STRTP providers currently operating in
Orange County have obtained permanent licensure and are under contract with
HCA. The total number of available beds is sufficient to meet current local
demand for this level of care. In accordance with DHCS regulations, STRTPs
provide intensive behavioral health services seven days a week, during both
daytime and evening hours, based on each youth’s individualized treatment plan.
Services may include crisis intervention, medication support, individual,
group, and family therapy, intensive care coordination and targeted case
management, as well as intensive home-based services and rehabilitation. As the
County Behavioral Health Plan, Orange County is required under State and
federal Medi-Cal requirements to ensure access to medically necessary
behavioral health services for eligible youth placed in STRTPs.Providers are
required to follow Medi-Cal regulations and bill their services to Medi-Cal in
addition to adhering to HCA standards for quality, cultural responsiveness, and
family engagement.
Performance
Outcomes
HCA currently contracts 100 STRTP
beds across four providers operating at 14 facilities throughout Orange County.
During Fiscal Year (FY) 2024-25, 170 unduplicated youth received services in
STRTPs. The average length of stay was approximately 9.2 months, which exceeds
the intended six-month timeframe. This reflects the significant clinical and
behavioral health needs of the youth served and the time required to safely
stabilize them and transition them to family-based or lower levels of care.
STRTP mental health providers use
the Child and Adolescent Needs and Strengths (CANS) assessment, a
State-mandated tool that measures clinical needs, treatment priorities, and
strengths for youth involved in multiple systems of care. Over the past two FY's,
providers have met or exceeded HCA's performance targets across all measured
outcome areas.
As shown in the outcome data in
Table 2, a majority of youth maintained or improved their functioning in mood
symptoms, behavior regulation, adjustment to trauma, and suicide risk during
treatment. While FY 2024-25 outcomes remained within target ranges, there were
declines compared to the prior year in mood symptoms and trauma-related
adjustment. These trends suggest that youth entering STRTPs are presenting with
increasingly complex needs, requiring more intensive and sustained treatment
interventions.
HCA establishes performance targets
using historical and current CANS data trends across all STRTP providers.
Performance targets were increased, and indicators were revised after recent
evaluation of data trends to ensure they remain appropriate and clinically
meaningful.
Table 2: FY 2023-24 and FY 2024-25
Outcomes:
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Symptom
Area |
%
Youth Maintaining or Improving Clinical Outcomes During Treatment |
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Target
Range |
FY
2023-24 |
FY
2024-25 |
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Mood Symptoms |
60-65% |
75% |
61% |
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Behavior Regulation |
55-60% |
60% |
56% |
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Suicide Risk |
80-85% |
88% |
82% |
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HCA requests the authority to
execute contracts with new providers under the Master Contract or to add
locations to current providers, without returning to the Board for approval, as
referenced in the Recommended Actions. Returning to the Board for approval of
new providers may result in a delay that would compromise critical bed
availability. The ability to add new qualified providers is time-sensitive due
to the instability and needs of the at-risk population served under the Master
Contract. The STRTPs are contracted with the County Child Welfare Agency for
residential care and supervision, and per CCR requirements, therefore, HCA will
need to contract in a timely manner with new providers who are licensed by CDSS
and contracted with SSA in order to ensure the STRTP beds may be promptly
utilized to serve this high-risk population.
The overall goal of the STRTP is to
stabilize families, reduce the need for higher levels of care, avoid foster
care or juvenile justice placements, and support youth in achieving long-term
stability in a family setting.
Due to the nature of the services,
the individual contracts could require the addition of subcontractors. To add
subcontractor(s) to the contract(s), the provider/contractor must seek express
consent from HCA. Should the addition of a subcontractor affect the scope of
work and/or contract amount, HCA will bring the item back to the Board for
approval. See Attachment B regarding subcontracts and Contract Summary Form.
The Contractors’ performances have
been confirmed as satisfactory. HCA has verified that there are no concerns
that must be addressed with respect to Contractors’ ownership/name, litigation
status or conflicts with County interests.
HCA has developed a Good Neighbor
Policy that is included in Residential Program contracts wherein the contractor
provides services to Orange County residents, and the services may potentially
impact the surrounding neighborhood(s), including but not limited to
environment, safety, and congregation. HCA has not received any negative
feedback from the community and will continue to work with the contractor(s)
and the community to ensure positive community relations.
HCA requests that the Board approve the
Amendment to the Master Contract and the Amendments to the individual Contracts
with Mary’s Shelter dba Mary’s Path, New Alternatives, Inc., Olive Crest and
Rite of Passage Adolescent Treatment Centers and Schools, Inc. for Behavioral
Health Services in Short-Term Residential Therapeutic Programs, as referenced
in the Recommended Actions.
FINANCIAL
IMPACT:
Appropriations for these Amendments
will be included in Budget Control 042 FY 2026-27 and in the budgeting process
for future years.
Funding
Sources:
State: 10% (Behavioral Health
Services Act)
Other: 90% (Federal Financial
Participation Medi-Cal)
The proposed Contract Amendments
include provisions allowing HCA to terminate the Contracts, reduce the level of
services, and/or renegotiate the levels of services provided, as necessary.
This includes a notice that allows HCA adequate time to transition or terminate
services to clients, if necessary.
STAFFING
IMPACT:
An analysis was completed to verify
the contracts provide HCA with persons specially trained, experienced, expert
and competent to perform the special services in accordance with the law.
REVIEWING
AGENCIES:
Social
Services Agency
ATTACHMENT(S):
Attachment
A – Amendment No. 2 to the Master Contract MA-042-24011001 for Behavioral
Health Services in Short-Term Residential Therapeutic Programs
Attachment B – Contract Summary Form
Attachment C – Amendment No. 4 to Contract MA-042-24011001 for Behavioral
Health Services in Short-Term Residential Therapeutic Programs with Mary's
Shelter dba Mary's Path
Attachment D – Amendment No. 2 to Contract MA-042-24011001 for Behavioral
Health Services in Short-Term Residential Therapeutic Programs with New Alternatives,
Inc.
Attachment E – Amendment No. 2 to Contract MA-042-24011001 for Behavioral
Health Services in Short-Term Residential Therapeutic Programs with Olive Crest
Attachment F – Amendment No. 3 to Contract MA-042-24011001 for Behavioral
Health Services in Short-Term Residential Therapeutic Programs with Rite of
Passage Adolescent Treatment Centers and Schools, Inc.