Agenda Item AGENDA STAFF REPORT ASR Control 09-000445
MEETING DATE:	05/05/09
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Mary Hale (714) 834-7024

Subject: Master Agreement for MH Outpatient Services

ceo Concur	County Counsel Review		Clerk of the Board
Concur	Approved Agreement to Form		Discussion
			3 Votes Board Majority
Budgeted: Yes		Current Year Cost: FY 2009-10: $4,700,000		Annual Cost: N/A
Staffing Impact: No		# of Positions:		Sole Source: N/A
Current Fiscal Year Revenue: N/A
Funding Source: FED: 54% (Individuals with Disabilities Education Act), State: 46% (Senate Bill 90)
Prior Board Action: N/A

RECOMMENDED ACTION(S)

1.	Approve the Master Agreement for the provision of Mental Health Outpatient Services with various providers for the period July 1, 2009 through June 30, 2010.
2.	Authorize the Health Care Agency Director, or designee, on behalf of the Board of Supervisors, to execute the Agreements with contracting providers.

SUMMARY:

The Health Care Agency requests approval of the Master Agreement for Mental Health Outpatient Services with various providers.

BACKGROUND INFORMATION:

The Health Care Agency (HCA) currently contracts with twenty-two (22) out-of-state residential facilities through a Master Agreement for the provision of Mental Health Outpatient Services for Orange County children and adolescents, pursuant to Chapter 26.5 of the Government Code (referred to as the AB 3632 program). The current agreements for these services will expire on June 30, 2009, and the proposed new agreements will continue services through June 30, 2010.

Outpatient services include individual and group therapy, crisis intervention, medication support, case management, and therapeutic behavioral services. These services are provided to children and adolescents who qualify for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program because they are eligible for full-scope Medi-Cal, or who qualify for the special education program under the rules and regulations of AB 3632. Contract providers under this Master Agreement provide services only to AB 3632 clients.

As of March 2009, there were 112 Orange County children and adolescents placed in out-of-state residential facilities. The placement of Orange County clients in these facilities is necessary because they have either failed in multiple local Orange County residential programs or have been refused admission by multiple programs in California, leaving no alternative to out-of-state placement. The facilities are certified by the California Department of Education as a nonpublic, nonsectarian school or agency (EC 56366.1) and are also nonprofit and licensed in their own state by their department of social services. Facilities at considerable distances are used because they meet the very unique needs of certain children (i.e. deafness, services to dually diagnosed mentally retarded/severely emotionally disturbed, etc.). These facilities provide a more secure environment than is available in state due to the California prohibition against locked facilities.

These facilities charge a public daily rate that is uniform for all California AB 3632 clients and that is set by their home state. These daily all-inclusive rates include individual, group and family therapy, medication evaluation and monitoring, crisis intervention and case management.

The estimated cost for FY 2009-10 of services to be provided under the Master Agreement is $4,700,000 which is $200,000 more than the current fiscal year. The increase is due to higher monthly utilization of these services and rate increases for some of the providers. If the costs for these services exceed this amount, HCA will manage the additional costs within its existing budget.

Outcomes focus on educational achievement and accomplishment of Individualized Education Plan goals and objectives. Measured outcomes are designated by a desired discharge, which includes: discharge from the facility due to graduation from high school, or discharge from the facility due to the need for a less restrictive setting including return to home.

To date for FY 2008-09 there were 67 discharges, of which 35 client discharges (or 52%) were a result of graduation from high school and 24 client discharges (or 36%) were a result of the need for a less restrictive setting. This results in a 88% desired outcome. The goal for FY 2009-10 is to maintain or improve the current rates.

Currently, the individual agreements under the Master Agreement have no subcontracts.

The twenty-two (22) individual providers currently under this Master Agreement are:

Name	Location
Alpine Academy	Erda, Utah
Aspen Solutions (Aspen Ranch and Youth Care)	Lao and Salt Lake City, Utah
Cathedral Home for Children	Laramie, Wyoming
Chileda Institute, Inc.	La Crosse, Wisconsin
Cinnamon Hills Youth Crisis Center	St. George, Utah
Colorado Boys Ranch Youth Connect	La Junta, Colorado
Daystar Residential, Inc.	Manvel, Texas
Devereux Arizona	Scottsdale, Arizona
Devereux Cleo Wallace	Westminster, Colorado
Devereux Florida	Orlando, Florida
Devereux Texas Treatment Network	League City, Texas
Excelsior Youth Centers, Inc.	Aurora, Colorado
Griffith Centers For Children, Inc.	La Crosse, Winconsin
Heritage Schools, Inc. dba Residential Treatment Center	Provo, Utah
Kids Behavorial Health (Cooper Hills)	West Jordan, Utah
Intermountain Restoring Hope to Children	Helena, Montana
Mental Health Systems (Logan River)	Logan, Utah
Mental Health Systems (Provo)	Orem, Utah
Red Rock Canyon School	St. George, Utah
The Learning Clinic, Inc.	Brooklyn, Connecticut
The Pathway School	Norristown, Pennsylvania
Yellowstone Boys and Girls Ranch	Billings, Montana

The Health Care Agency requests your Honorable Board approve the Master Agreement for the provision of Mental Health Outpatient Services as referenced in the Recommended Actions.

FINANCIAL IMPACT:

This Agreement is included in the Health Care Agency’s FY 2009-10 Requested Budget.

Services under this Master Agreement have multiple contractors that share an aggregate maximum funding amount. Funding for these contractors will vary depending upon referrals and utilization of services. Should services need to be reduced or terminated due to lack of funding, these Agreements contain language that allows Health Care Agency to give 30 days notice to either terminate or renegotiate the level of services to be provided. The notice will allow Health Care Agency adequate time to transition or terminate services to clients, if necessary. Health Care Agency staff has reviewed each contractor's financial documentation, including their most recent financial statements. At this time, there appears to be no issues that would impact the contractor's ability to perform the services.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

A. Master Agreement for provision of Mental Health Outpatient Services

B. Redline Version to Attachment A