Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  19-000810

 

MEETING DATE:

09/10/19

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):

Anna Peters (714) 834-5150 

 

 

Richard Sanchez (714) 834-2830

 

 

Subject:  Renewal of Master Agreement for Professional 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: $3,331,777

Annual Cost: FY 2020-21 $1,110,592

 

 

 

    Staffing Impact:

No

# of Positions:

Sole Source: No

    Current Fiscal Year Revenue: N/A

  Funding Source: See Financial Impact Section

County Audit in last 3 years: No

 

 

    Prior Board Action: 04/09/2019 #11, 8/28/2018 #20, 9/12/2017 #20, 9/13/2016 #23

 

RECOMMENDED ACTION(S):

 

 

1.

Approve the renewal of Master Agreement with various licensed clinical providers for provision of Professional Services, for the period September 29, 2019, through September 28, 2020, with an amount not to exceed $4,442,369.

 

2.

Authorize the Health Care Agency Director, or designee, to execute the Master Agreement and selection of individual Agreements with various licensed clinical providers as referenced in the Recommended Action above.

 

 

 

 

SUMMARY:

 

Approval of the renewal of Master Agreement with various licensed clinical providers for provision of Professional Services will provide a mechanism to flexibly adjust vital medical staffing in various locations, including jails and clinics and adapt to changing caseload requirements.

 

 

 

 

 

BACKGROUND INFORMATION:

 

On April 9, 2019, your Honorable Board of Supervisors (Board) approved the addition of Contract Psychiatrist – Institutional (Correctional) classification and rate to the Board-Approved Rate Chart effective April 10, 2019. On August 28, 2018, the Board approved the current Master Agreement for Professional Services, for the period of September 29, 2018, through September 28, 2019. Previous Master Agreements for Professional Services were approved by the Board on September 12, 2017, and September 13, 2016.

 

The Health Care Agency (HCA) provides essential medical, dental, behavioral and other support services through its Public Health, Behavioral Health, Regulatory Medical Services and Correctional Health Services programs. HCA has historically contracted with health care professionals to augment essential services provided to clients. The availability of contracting for these services provides the flexibility needed to maintain levels of services required by state and other mandates, as well as conditions of eligibility for state and federal funding. It provides a mechanism to flexibly adjust vital medical staffing in various locations, including the jails and clinics, and to adapt to changing caseload requirements. These Professional Services Contractors (PSC) help to fill gaps in assignments, such as weekend schedules and unexpected vacancies, augment base staffing levels in times of increased demand and to meet caseloads for court-ordered clients. In addition, many of these providers are actively working in the Orange County medical community assisting HCA in meeting community standards for health care.

 

The current individual agreements under the Master Agreement expire on September 28, 2019. The rates approved by the Board on April 9, 2019, for all classifications are listed below. The rates for all PSC classifications were previously approved by the Board on September 13, 2016. Maintaining competitive rates is critical in order to recruit and retain licensed medical staff, particularly for the Correctional Health Services positions.

 

The current contract hourly rates in the Master Agreement for FY 2018-19, by category, are as follows:

 

 

TITLE

 

RATE

Contract Registered Nurse

 $   50.18

Contract Clinical Psychologist- Intern

$   48.05

Contract Registered Nurse - Institutional (Correctional)

$   56.53

Contract Pharmacist

 $   62.51

Contract Nurse Practitioner - Institutional (Correctional)

$   74.61

Contract Dentist

 $   82.47

Contract Physician I

 $   92.15

Contract Physician I - Board Eligible Specialist

$   99.97

Contract Physician I - Board Certified Specialist

$ 105.55

Contract Physician I - Correctional

$ 105.55

Contract Physician I - Correctional Board Eligible Specialist

$ 114.49

Contract Physician I - Correctional Board Certified Specialist

$ 120.87

Contract Psychiatrist

 $  150.00

Contract Psychiatrist - Institutional (Correctional)

$  225.00

Contract Nurse Practitioner

 $   59.77

Contract Clinical Psychologist - Licensed

 $   50.71

 

HCA appropriations for PSC services for FY 2019-20 have increased by approximately $532,000 from FY 2018-19, primarily related to the approved Budget Augmentation to expand mental health care in the jails in FY 2019-20.

 

These positions provide direct clinical patient care, and because there is a wide variety of classifications involved (Medical Doctor, Registered Nurse, Pharmacist, etc.), there are varying expectations for each classification based upon their specific professional licensure. Qualitative internal monitoring of clinical performance is ongoing, as each Professional Service Contractor is assigned to a supervisor/manager, and clinical performance issues are addressed and documented per County guidelines. Annually, each individual contracted provider’s performance is reviewed by the program service area in order to determine whether individual contract renewal or termination is warranted.

 

Approving the Master Agreement and authorizing the execution of individual agreements with contracting providers will allow for the continuity of services to vulnerable client populations. The list of anticipated professional services providers for FY 2019-20 is noted in Attachment E. HCA may execute agreements with additional contracting providers to meet service needs. This item is coming to the Board with less than 30 days due to a delay in finalizing the contract document, and is brought to the Board at the earliest date available to expedite the implementation.

 

The County has historically indemnified these health care professionals from any and all claims resulting from acts or omissions while acting on HCA's behalf, pursuant to the terms of the Master Agreement. CEO/Office of Risk Management has approved the indemnification provision and determined the risk to be acceptable for these services. Please see Attachment F for a Risk Assessment or Modification of Insurance Terms Form.

 

The contractors’ performance have been confirmed as satisfactory. HCA has verified there are no concerns that must be addressed with respect to Contractor’s ownership/name, litigation status or conflicts with County interests. This contract does not currently include subcontractors or pass through to other providers. See Attachment C for Contract Summary Form.

 

HCA requests that the Board approve the Master Agreement for provision of Professional Services as referenced in the Recommended Actions.

 

 

 

FINANCIAL IMPACT:

 

Appropriations for this Master Agreement are included in Budget Control 042 FY 2019-20 Budget and will be included in the budgeting process for future years. This Master Agreement does not have individual maximum obligations, as the Professional Services Contract individuals are paid through the County's payroll system, rather than by invoice.

 

The Professional Services Contract has provisions that allow for immediate termination of the Agreement by either party without cause. 

 

Funding Sources

GF: 37%

State: 51%

Federal: 5%

Fees/Other: 7%

 

The funding percentages are aggregate of funding sources within multiple programs anticipated to utilize this agreement.

 

 

 

STAFFING IMPACT:

 

N/A

 

 

 

ATTACHMENT(S):

 

Attachment A - Master Agreement for Provision of Professional Services
Attachment B - Redline Version to Attachment A
Attachment C - Contract Summary Form
Attachment D - PSC Rate Chart
Attachment E - List of Anticipated Contracting Providers
Attachment F - Risk Assessment Form