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Agenda Item
ASR
Control 21-000169 |
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MEETING DATE: |
05/11/21 |
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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): |
Annette Mugrditchian (714) 834-5026 |
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Jeff Nagel (714) 834-7024 |
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Subject: Amendments to Drug Medi-Cal
Residential Treatment Master Agreements
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ceo CONCUR |
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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 2021-22 $1,298,730 |
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Staffing Impact: |
No |
# of Positions:
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Sole Source:
N/A |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 12/15/2020
#16, 09/29/2020 #10, 05/05/2020 #5, 01/28/2020 #17 |
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RECOMMENDED ACTION(S):
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1. |
Approve Amendment No. 3 to the Contract with various providers for the provision of Adult Residential Drug Medi-Cal Withdrawal Management Services. |
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2. |
Approve Amendment No. 4 to the Contract with various providers for the provision of Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services to increase the contract amount by $1,298,730, effective July 1, 2021, through June 30, 2022, for a revised cumulative total amount not to exceed $21,429,045. |
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3. |
Approve Amendment No. 3 to the Contract with various providers for the provision of Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services. |
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4. |
Authorize the County Procurement Officer or authorized Deputy to execute individual Amendments with various providers as needed throughout the term of the Master Agreements. |
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5. |
Authorize the County Procurement Officer or authorized Deputy to execute individual Contracts with various providers as needed throughout the term of the Master Agreements. |
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6. |
Authorize the County Procurement Officer or authorized Deputy to execute the Amendments as referenced in the Recommended Actions above. |
SUMMARY:
Approval of the Amendments to the Contracts for the provisions of Adult Residential Drug Medi-Cal Withdrawal Management, Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services and Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services will maintain options for Orange County adults seeking residential treatment services.
BACKGROUND INFORMATION:
Your Honorable Board of Supervisors (Board) approved the Master Agreement for provision of Adult Residential Drug Medi-Cal (DMC) Withdrawal Management Services with various providers and the below additional actions have been executed pursuant to appropriate authorities. Approval of Amendment No. 3 will allow for the modification of the method of reimbursement and other various administrative changes to Exhibit A.
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Board Date |
Contract/Amendment |
Action |
Term |
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May 21, 2019 |
Contract |
Board Approved Master Agreement |
July 1, 2019 – June 30, 2022 |
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Amendment No. 1 |
Deputy Purchasing Agent (DPA) Authority Administrative Revisions - Modified Exhibit A to incorporate unfunded population |
July 1, 2019 – June 30, 2022 |
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September 29, 2020 |
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Provider Added |
November 1, 2020 - June 30, 2020 |
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Amendment No. 2 |
DPA Authority Administrative Revisions - Updated sanction screening and insurance requirements |
November 1, 2020 – June 30, 2022 |
Scope of Service:
Services for withdrawal management include: intake, observation, medication services, discharge services and linkage to continuing care. Each treatment program is expected to have a collaborative relationship with community, for-profit, private and public non-profit providers, community-based organizations and governmental and non-governmental agencies to facilitate linkage to an appropriate continuum of care at the time of discharge. Individuals will be encouraged to continue treatment at a lower level of care including residential treatment services or outpatient treatment. The target population is adult DMC beneficiaries, 18 years and older, that experience moderate withdrawal symptoms and need 24-hour support to safely withdraw from substances. Clients must be enrolled in Orange County Medi-Cal, reside in Orange County and meet medical necessity criteria per American Society of Addiction Medicine (ASAM) standards and as determined by a licensed physician or Licensed Practitioner of the Healing Arts.
Performance Outcomes:
Provider shall be required to meet the following performance objective for Withdrawal Management Treatment:
- Increase quality of life as measured by 75 percent of clients reporting that their “life is more manageable than it was when they entered treatment” at 30 days after completion.
The current DMC Withdrawal Management Providers had the following outcomes:
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At least 75
percent of clients will report their life is more manageable at 30 days after
completion than when they entered treatment |
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Provider |
2019-20 |
2020-2021 (July to February) |
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Woodglen Recovery Junction, Inc. |
59% |
65% |
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Roque Center, Inc. |
74% |
74% |
Adult
Residential Drug Medi-Cal Substance Use Disorder Treatment Services
The Board approved the Master Agreement for provision of Adult Residential DMC Substance Use Disorder (SUD) Treatment Services with various providers and the below additional actions have been executed pursuant to appropriate authorities. Approval of Amendment No. 4 will allow for the increase of funding, modification of the method of reimbursement and other various administrative changes to Exhibit A. This Amendment will increase funding for FY 2021-22 bringing the revised cumulative total contract amount to $21,429,045. The current providers have now reached capacity and funds will allow the providers to fill additional beds with the additional funds. This will help cover costs.
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Board Date |
Contract/Amendment |
Action |
Term |
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May 21, 2019 |
Contract |
Board Approved Master Agreement |
July 1, 2019 – June 30, 2022 |
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Amendment No. 1 |
DPA Authority Administrative Revisions – Modified programmatic requirements in Exhibit A |
August 9, 2019 – June 30, 2022 |
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September 24, 2019 |
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Provider Added |
October 1, 2019 - June 30, 2022 |
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January 28, 2020 |
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Provider Added |
March 1, 2020 - June 30, 2022 |
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May 5, 2020 |
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Providers Added |
July 1, 2020 - June 30, 2022 |
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Amendment No. 2 |
DPA Authority Administrative Revisions - Updated sanction screening and insurance requirements |
September 1, 2020 – June 20, 2022 |
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December 15, 2020 |
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Provider Added |
February 1, 2020 - June 30, 2022 |
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Amendment No. 3 |
DPA Authority Contingency Increase |
March 4, 2021 – June 20, 2022 |
Scope of Service:
Clients must be enrolled in Orange County Medi-Cal, reside in Orange County and meet medical necessity criteria per ASAM standards and as determined by a licensed physician or Licensed Practitioner of the Healing Arts.
For adults, the average length of residential services for all levels will be 90-days maximum, unless medical necessity authorizes a one-time extension of up to 30 days on an annual basis. Only two non-continuous 90-day regiments for adults will be authorized in a single year. Providers must transition clients to the appropriate level of care as medical necessity dictates.
In the residential treatment environment, there is a daily regimen of structured activities that are intended to build positive behavioral patterns within a community. Residential Treatment Services provide client-centered treatment, which is based on mutually agreed upon goals/objectives between the clinician and client. Components include intake, treatment planning, individual and group counseling, educational sessions, collateral services, relapse prevention and case management. Common issues that are addressed at the beginning of treatment include planning and preparing for housing, a safe living environment and education and employment so that clients have a specific plan at the time of discharge.
Performance Outcomes:
Provider shall be required to meet the following performance objective for Residential Treatment:
- Increase quality of life as measured by 75 percent of clients reporting that their “life is more manageable than it was when they entered treatment” at 30 days after completion.
The current DMC residential providers had the following percentages:
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At least 75
percent of clients will report their life is more manageable at 30 days after
completion than when they entered treatment |
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Provider |
2019-20 |
2020-2021 (July to February) |
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CleanPath Recovery, LLC |
71% |
83% |
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Straight Talk Clinic, Inc. |
89% |
100% |
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Hope House Corporation |
98% |
99% |
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Phoenix House |
61% |
48% |
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The Teen Project, Inc. |
83% |
100% |
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Woodglen Recovery Junction, Inc. |
78% |
65% |
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G And C Swan, Inc. |
N/A |
100% |
Residential Treatment Services acknowledges that two providers did not meet the expected objective. Individual meetings with the provider will be used to address the particular issues that clients may report. Despite the two providers, Phoenix House and Woodglen Recovery, not meeting the objective, there is an overwhelming need to have this service for this population. Both providers reported that COVID-19 played a significant role in their clients’ abilities to cope with and during the pandemic. HCA has worked with both providers to identify the coping challenges and will be working with them to address those challenges.
Perinatal Drug Medi-Cal Substance Use
Disorder Residential Treatment Services
The Board approved the Master Agreement for provision of Perinatal DMC SUD Residential Treatment Services with various providers and the below additional actions have been executed pursuant to appropriate authorities. Approval of Amendment No. 3 will allow for the modification of the method of reimbursement for SABG to be actual cost for the bed day and other various administrative changes to Exhibit A.
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Board Date |
Contract/Amendment |
Action |
Term |
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July 16, 2019 |
Contract |
Board Approved Master Agreement |
August 1, 2019 – June 30, 2022 |
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Amendment No. 1 |
DPA Authority Administrative Revisions - Modified programmatic requirements in Exhibit A |
October 17, 2019 – June 30, 2022 |
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Amendment No. 2 |
DPA Authority Administrative Revisions - Updated sanction screening and insurance requirements |
January 12, 2021 – June 20, 2022 |
Scope of Service:
Perinatal services shall address treatment and recovery issues specific to pregnant and postpartum women, such as relationships, sexual and physical abuse and development of parenting skills. The length of residential services for all levels ranges 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. Only two non-continuous 90-day regimens for each adult will be authorized in a one-year period. If determined to be medically necessary, perinatal clients may receive longer lengths of stay than those described above, in accordance with state perinatal guidelines. Providers must transition clients to the appropriate level of care as medical necessity dictates.
In the residential treatment environment, 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 that is based on the client’s and clinician’s mutually agreed goals/objectives. Components include: intake, treatment planning, individual and group counseling, mother/child habilitative and rehabilitative services that may include cooperative child care, educational sessions, collateral services, relapse prevention and case management. Common issues that are addressed at the beginning include planning and preparing for housing, a safe living environment, education and employment so that clients have a specific plan at the time of discharge.
Performance
Outcomes:
Provider shall be required to meet the following performance objective for Residential Treatment:
· 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. The CEST is a self-administered survey completed at midpoint of treatment (minimum of 45 days post admission) and at discharge.
· Seventy-five percent of clients completing treatment will report their life is more manageable than it was when they entered treatment.
Current DMC Perinatal residential providers had the following percentages:
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At least 75
percent of clients will report their life is more manageable at 30 days after
completion than when they entered treatment |
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Provider |
2019-20 |
2020-2021 (July to February) |
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CleanPath Recovery, LLC |
71% |
80% |
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Vera’s Sanctuary |
83% |
100% |
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The performance of all Contractors has been confirmed as satisfactory. HCA has verified there are no concerns that must be addressed with respect to the Contractors’ ownerships/names, litigation status or conflicts with County interests. These Contracts include subcontractors. See Attachment D for the Contract Summary Form.
HCA has developed a Good Neighbor Policy that is included in Residential Program contracts wherein contractor provides services to County residents and the services may have a potential impact on 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.
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Contractor |
Facility
Location |
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Coastal Addiction Center, Inc. |
Anaheim |
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Clean Path Recovery, LLC |
Santa Ana |
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G And C Swan, Inc. |
Colton, Upland |
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Hope House Corporation |
Anaheim |
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Roque Center, Inc. |
Stanton |
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Straight Talk Clinic, Inc. |
Santa Ana |
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The Teen Project, Inc. |
Trabuco Canyon |
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Woodglen Recovery Junction, Inc. |
Fullerton |
HCA requests that the Board approve the Amendments to the Contracts with various providers for the provisions of Adult Residential DMC Withdrawal Management, Adult Residential DMC SUD Treatment Services and Perinatal DMC SUD Treatment Services and requests the authority to add new providers or locations without returning to the Board for approval as referenced in the Recommended Actions.
FINANCIAL IMPACT:
Appropriations for these Contracts are included in the Budget Control 042 FY 2021-22 Recommended Budget.
Funding
Sources:
FED: 26% (Substance Abuse Prevention and Treatment Block Grant)
Fees/Other: 37% (Federal Financial Participation Drug Medi-Cal)
State: 37% (Drug Medi-Cal State General Fund)
Should services need to be reduced or terminated due to lack of funding, these contracts contain language that allows HCA to give 30-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 - Amendment No. 3 to Contract MA-042-20010222 for Provision
of Adult Residential Drug Medi-Cal Withdrawal Management Services
Attachment B - Amendment No. 4 to Contract MA-042-20010248 for Provision of
Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services
Attachment C - Amendment No. 3 to Contract MA-042-20010246 for Provision of
Perinatal Drug Medi-Cal Substance Use Disorder Treatment Services
Attachment D - Contract Summary Form
Attachment E - Redline to Attachment A
Attachment F - Redline to Attachment B
Attachment G - Redline to Attachment C