Agenda Item

AGENDA STAFF REPORT

 

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ASR Control 19-000600

 

MEETING DATE:

07/16/19

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

1

SUBMITTING Agency/Department:

Health Care Agency†† (Approved)

Department contact person(s):

Annette Mugrditchian (714) 834-5026

 

 

Jeff Nagel (714) 834-7024

 

 

Subject: Master Agreement for Perinatal Drug Medi-Cal Treatment Services

 

††††† ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

 

 

3 Votes Board Majority

 

 

 

††† Budgeted: N/A

Current Year Cost: $2,847,420

Annual Cost: FY 2020-21 $2,847,420
FY 2021-22 $2,847,420

 

 

 

††† Staffing Impact:

No

# of Positions:

Sole Source: N/A

††† Current Fiscal Year Revenue: N/A

Funding Source: See Financial Impact Section

County Audit in last 3 years: No

 

 

††† Prior Board Action: 05/08/2018 #26

 

RECOMMENDED ACTION(S):

 

 

1.

Approve the Master Agreement with various providers for provision of Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services for the period of August 1, 2019, through June 30, 2022, for a total maximum obligation not to exceed $8,542,260.

 

2.

Approve the selection of Clean Path LLC for provision of Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services for the period August 1, 2019, through June 30, 2022.

 

3.

Pursuant to Contract Policy Manual Section 3.4-114, authorize Health Care Agency Director or designee to exercise a contingency contract cost increase, not to exceed a total of 10 percent of the contract amount for the first year of the contract, for the entire term of the contract, including renewals, and within the scope of work set forth in the contract.The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer. The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

 

4.

Authorize the Health Care Agency Director or designee to execute the Agreement with Clean Path LLC as referenced in the Recommended Actions above.

 

 

 

 

SUMMARY:

 

Approval of the Master Agreement with various providers and selection of Clean Path LLC for the Provision of Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services will provide Drug Medi-Cal perinatal substance use disorder treatment for women living in Orange County.

 

 

 

BACKGROUND INFORMATION:

 

The Department of Health Care Services (DHCS) received a Federal 1115 waiver to develop a five-year demonstration project that expands Substance Use Disorder (SUD) services funded by Drug Medi-Cal (DMC) in California. In 2016, the Health Care Agency (HCA) submitted a plan to DHCS to provide a continuum of SUD services, reimbursable under DMC. On May 8, 2018, your Honorable Board of Supervisors (Board) approved the Drug Medi-Cal Waiver with the state. As a result, HCA has been seeking agreements with various DMC certified treatment providers in Orange County. Perinatal residential treatment is a required service and will be a new service under the DMC waiver.

 

On March 12, 2018, HCA re-released a solicitation seeking qualified DMC organizations to provide SUD Residential Services for adults and adolescents, which included Perinatal services because there were no respondents to the first solicitation that occurred on November 15, 2017. One qualified DMC organization was identified to provide DMC Perinatal Residential Services: Clean Path LLC (Clean Path). Negotiations with Clean Path to determine acceptable rates for services have been conducted and this provider has been selected to contract for these services. Clean Path had initially received DMC certification for a different location and had requested approval from the state for a transfer of this certification to their location in Santa Ana. HCA was unable to move forward with a proposed contract until the completion of this transfer. Because of the critical need for this new service, and because the provider only recently received approval of this transfer by the state on March, 29, 2019, HCA is presenting this agreement to the Board with less than the standard 30 days advanced notice.

 

Clean Path is a residential treatment facility that can serve up to 30 clients. There is an agreement to dedicate six beds to children and the remaining 24 beds to adults. Clean Path is located in a Santa Ana neighborhood. For adults, the length of residential services for all levels range from one to 90 days with a 90-day maximum unless medical necessity authorizes a one-time extension of up to 30 days on an annual basis. Perinatal beneficiaries may receive a length of stay for the duration of their pregnancy, plus 60 days postpartum based on medical necessity. Only two non-continuous residential episodes of care for adults will be authorized in a one-year period. Providers must transition clients to the appropriate level of care as medical necessity dictates.

 

HCA staff have conducted due diligence on Clean Path. Reference checks were satisfactory and completed with Intervention911, Cardoso Consulting and SC Technology. HCA worked collaboratively with cities to develop a good neighbor policy, found in the Agreement, that is in effect for all DMC agreements. To date, HCA has not received any negative feedback from cities and HCA will continue to work with both cities and providers to support the policy.

 

HCA will return to the Board for approval of any new provider or location. Each individual Agreement will share the annual maximum obligation and funding among Board-approved providers, which will vary based on utilization.

 

In Drug Medi-Cal Organized Delivery System (DMC-ODS), the American Society of Addiction Medicine categorizes residential treatment in distinct levels of care identified as Level 3.1 Clinically Managed Low-Intensity Residential Services and Level 3.5 Clinically Managed High-Intensity Residential Services. The County sought providers that provided treatment at the levels of 3.1 and 3.5 for residential treatment for adults, adolescents and perinatal services.Clean Path LLC will provide both 3.1 and 3.5 level treatment.

 

Perinatal residential services will address treatment and recovery issues specific to pregnant and postpartum women, such as relationships, sexual and physical abuse and development of parenting skills. There is a daily regimen and structured patterns of activities that are intended to build positive behavioral patterns within a community. Residential treatment services provide client-centered treatment, which is based on the clientís and clinicianís mutual agreed upon goals/objectives. Components include: intake, treatment planning, individual and group counseling, educational sessions, collateral services, relapse prevention and case management. Common issues that will be addressed at the beginning of treatment are planning and preparing for housing, a safe living environment, education and employment so that clients have a specific plan at the time of discharge. Childcare is provided onsite through a cooperative arrangement between the mothers. There will be supervision by a staff member that has expertise in child development.

 

Contract providers are expected to perform effective residential substance abuse assessment, treatment and counseling to clients with identified alcohol and/or drug problems. Performance outcomes include:

 

         Client Evaluation of Self and Treatment (CEST) scores will be higher than national norms in the areas of perception of social support, peer support, counseling rapport and treatment participation. CEST is a national tool and self-administered survey that measures and monitors participant needs and performance in treatment. The CEST is completed at midpoint of treatment (minimum of 45 days post admission) and at discharge.

 

CEST National Norms (mean scores range from 10-50):

Desire for Help

39.9

Treatment Readiness

38.8

Counseling Rapport

40.0

Treatment Participation

40.9

Peer Support

36.7

Social Support

39.5

 

        Seventy-five percent of clients completing treatment will report their life is more manageable than it was when they entered treatment. 

 

        One-hundred percent of pregnant clients served will deliver drug-free babies. 

 

This Agreement includes subcontractors. See Attachment B for information regarding subcontractors and Contract Summary Form.

 

Pursuant to Contract Policy Manual Section 3.4-114, HCA seeks Board authorization for the HCA Director, or designee, to exercise a contingency agreement cost increase in an amount not to exceed 10 percent of the contract amount for the first year of the contract, for the entire term of the Contract, including renewals, and within the scope of work set forth in the contract. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer.The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

 

HCA requests that the Board approve the Master Agreement with various providers for provision of Perinatal DMC SUD Treatment Services and the selection of Clean Path LLC as referenced in the Recommended Actions.

 

 

 

FINANCIAL IMPACT:

 

Appropriations for this Agreement are included in the FY 2019-20 Budget and will be included in the budgeting process for future years.

 

Funding Sources:

Fed: 34% (Substance Abuse Prevention and Treatment Block Grant)

Fees/Other: 33% (Federal Financial Participation Drug Medi-Cal)

State: 33% (Drug Medi-Cal Realignment)

 

Should services need to be reduced or terminated due to lack of funding, these agreements contain language that allows HCA to give 90-day notice to either terminate or renegotiate the level of services provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.

 

 

 

STAFFING IMPACT:

 

N/A

 

 

ATTACHMENT(S):

 

Attachment A - Master Agreement for Provision of Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services
Attachment B - Contract Summary Form