Agenda Item AGENDA STAFF REPORT ASR Control 19-000911
MEETING DATE:	09/24/19
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	3
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Annette Mugrditchian (714) 834-5026
	Jeff Nagel (714) 834-7024

Subject: Agreement for Adult Residential Drug Medi-Cal Treatment Services

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Consent Calendar

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: N/A

Staffing Impact:

No

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: N/A

County Audit in last 3 years: No

Prior Board Action: 05/21/2019 #46

RECOMMENDED ACTION(S):

1.	Approve the selection of and Agreement with The Teen Project, Inc., for provision of Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services under the existing Master Agreement for the period October 1, 2019, through June 30, 2022.
2.	Authorize the Health Care Agency Director or designee, to execute the Agreement with The Teen Project Inc., as referenced in the Recommended Action above.

SUMMARY:

Approval of the selection of and Agreement with The Teen Project, Inc. under the existing Master Agreement for the provision of Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services will increase options for Orange County adult females seeking residential substance use disorder treatment.

BACKGROUND INFORMATION:

On May 21, 2019, your Honorable Board of Supervisors (Board) approved the Master Agreement for the provision of Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services for the period of July 1, 2019, through June 30, 2022, with an annual maximum obligation of $6,493,650 for FY 2019-20. On the same Agenda Staff Report, the Board approved two individual agreements with Straight Talk Clinic, Incorporated and Woodglen Recovery Junction.

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, for residents of Orange County. DHCS approved the plan in December 2016 and on May 8, 2018; the Board approved the DMC Waiver with the State. As a result, HCA has been seeking agreements with various DMC certified treatment providers in Orange County. The proposed Agreement is essential to meet the need of the Drug Medi-Cal Organized Delivery System (DMC-ODS).

On March 12, 2018, HCA re-released the solicitation seeking qualified DMC organizations to provide SUD Residential Services for adults and adolescents. One additional qualified Adult DMC organization was identified and selected, The Teen Project, Inc. The site is located at Vera's Sanctuary in Trabuco Canyon. Services will commence on October 1, 2019. Negotiations with the bidder to determine acceptable rates for services have occurred. The Teen Project, Inc. will provide up to 18 beds for females, bringing the total number of female adult residential beds in Orange County to 40. HCA will return to the Board for approval of any new provider or location. Each agreement will share the annual maximum obligation and funding among Board-approved providers, which will vary based on utilization. Due to a critical need for this service, HCA is proposing this agreement with a recently identified provider to the Board with less than the required 30 days' advanced notice.

HCA staff have conducted due diligence on The Teen Project Inc. Reference checks were satisfactory and completed with Healthright 36, the California Community Foundation and Long Beach Police Departments regarding similar projects.

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. Only two non-continuous 90-day regimens for adults will be authorized in a one-year period. 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 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 for Adult Residential programs 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. The CEST is a self-administered survey completed at the midpoint of treatment (minimum of 45 days post-admission) and at discharge.

· 75 percent of clients completing treatment will report their life is more manageable than it was when they entered treatment.

Table 1 below indicates the results of CEST for FY 2017-18 and preliminary FY 2018-19

Period		Average Scores on Subscales
	Desire for Help		Treatment Readiness	Counseling Rapport	Treatment Participation	Peer Support	Social Support
HCA Adult Residential (Preliminary FY 2018-19	43.7		39.2	45.0	45.2	42.8	43.2
HCA Adult Residential (FY 2017-18)	44.1		42.1	45.2	45.6	44.2	43.4
National Norm	39.9		38.8	40.0	40.9	36.7	39.5

HCA worked collaboratively with providers to develop a good neighbor policy that will be in effect for all adult residential DMC agreements. To date, HCA has not received any negative feedback from cities and continue to work with both cities and providers to support the policy.

The Agreements will include subcontractors. See Attachment B for information regarding subcontractors and Contract Summary Form.

HCA requests that the Board approve the selection of and Agreement with The Teen Project, Inc. for the provision of Adult Residential DMC SUD Treatment Services as referenced in the Recommended Actions.

FINANCIAL IMPACT:

N/A

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 Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services
Attachment B - Agreement for Provision of Adult Residential Drug Medi-Cal Substance Use Disorder Treatment Services with The Teen Project, Inc.
Attachment C - Contract Summary Form