AGENDA STAFF REPORT

Agenda Item AGENDA STAFF REPORT ASR Control 17-001070
MEETING DATE:	10/31/17
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):	Jeff Nagel (714) 834-7024
	Mary Hale (714) 834-6032

Subject: Master Agreement for Short-Term Residential Therapeutic Programs

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: Yes

Current Year Cost: $2,333,333

Annual Cost: FY 2018-19 $4,000,000
FY 2019-20 $4,000,000

Staffing Impact:

# 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: N/A

RECOMMENDED ACTION(S):

Approve the Master Agreement for various providers for the provision of Behavioral Health Services in Short-Term Residential Therapeutic Programs for the period December 1, 2017, through June 30, 2020, for a total aggregate maximum obligation of $10,333,333.

Authorize the Health Care Agency Director or designee, to exercise a contingency contract cost increase in an amount not to exceed $400,000, which is 10% of the original amount of the first year of funding for the Master Agreement, as referenced in the Recommended Action above, for the entire term and within the scope of work set forth in the Master Agreement, pursuant to County Contract Policy Manual Section 3.3-113.

Authorize the Health Care Agency Director or designee, to execute the Agreements with various providers as referenced in the Recommended Action above.

SUMMARY:

The Health Care Agency requests approval of the Master Agreement for various providers for the provision of intensive specialty mental health services to Wards and Dependents of the Court, ages 12-17, and Non-Minor Dependents, ages 18-20, placed in licensed Short-Term Residential Therapeutic Programs in Orange County, and in other counties where a waiver has been established.

BACKGROUND INFORMATION:

During their 2015-16 session, the California Legislature made a major shift in how children in the foster care system are served. Assembly Bills (AB) 403 and (AB) 1997 established the Continuum of Care Reform (CCR), which was designed to reform of congregate care for youth in California. Most Wards and Dependents of the Court and Non-Minor Dependents (NMDs) are successfully placed in homes with relatives or resource families. However, some Wards and Dependents remain in group home placements for extended periods of time, two thirds for over two years and one third for more than five years. These long stays are associated with negative outcomes such as increased likelihood of involvement in the criminal justice system and youth who leave the child welfare system without the skills they need to succeed in the adult world. CCR proposes a new continuum of care setting for Wards and Dependents of the Court and NMDs. Its overarching goal is to reduce reliance on congregate care as long-term placements by narrowly defining the purpose of group care while intensifying services. CCR simultaneously increases the capacity of home-based family care settings. Consequently, CCR established, as of January 1, 2017, a new community care licensure category for residential treatment programs called a Short-Term Residential Therapeutic Program (STRTP).

STRTPs are residential facilities operated by a public agency or a private organization and are licensed by the California Department of Social Services (CDSS) pursuant to Section 1562.01 of the Health and Safety Code. They will provide an integrated program of specialized intensive care and supervision with the aim of moving the youth to less restrictive environments within six months. Private STRTPs are organized and operated on a nonprofit basis and are designed primarily for youth ages 12-20.

The key to STRTP’s success is the provision of short-term, specialized and intensive behavioral health treatment to Wards and Dependents of the Court and NMDs whose needs cannot be safely met initially in a family setting. These core behavioral health services will be provided by STRTP staff through a required Medi-Cal contract with the Health Care Agency (HCA). Behavioral health services will include, at a minimum, medication support services, case management, crisis intervention and mental health services (e.g., assessment, individual and group therapy).

In the process of the State’s rollout and transition of group homes to STRTPs, standards and timelines have been established to ensure successful implementation. Potential STRTPs must submit a Plan of Operation and Program Statement to CDSS after having received local approval from County placing agencies (i.e., Social Services Agency (SSA) and Probation). Once STRTPs have received initial licensure (provisional), STRTPs have 12 months to negotiate a contract with the local Mental Health Plan (i.e., HCA) to provide intensive services and bill for them through the Medi-Cal claiming system.

Presently, no Orange County group home provider has completed the STRTP licensure process; however, the following entities have initiated Plans of Operation and Program Statements: New Alternatives, Inc.; Hart Community Homes, Inc.; Olive Crest Treatment Centers, Inc.; South Coast Children’s Society, Inc.; Florence Crittenton Services of Orange County, Inc.; Rite of Passage Adolescent Treatment Centers and Schools, Inc.; Child Help Orange County; and Mary's Shelter.

The legislation provides that once licensed by CDSS, STRTPs can take the next step of becoming a STRTP certified Medi-Cal provider. To become certified, the STRTP must first secure a mental health contract with the local Mental Health Plan (i.e., HCA). This Master Agreement is being submitted at this time to allow HCA to respond promptly to STRTPs that will soon become licensed, allowing each STRTP to fully implement the mandated behavioral health services for the Wards and Dependents of the Court and NMDs placed in STRTPs. The proposed Master Agreement will have an aggregate maximum obligation of $10,333,333.

On October 17, 2017, SSA appeared before the Board to obtain approval for a Master Agreement for the provision of Group Home Services or STRTP Services by qualified providers. HCA will contract with all such providers who have been approved by SSA and are in the process of becoming fully licensed by the CDSS. This Master Agreement addresses the provision of the state mandated Behavioral Health Services. SSA’s action covers the residential portion of the STRTPs.

HCA has included outcome measures in the proposed Master Agreement, which will include the Outcome Questionnaire (OQ). The OQ will be administered periodically during the course of treatment. It provides ongoing data regarding the client's level of distress and sense of well-being. Additional outcome measures will be developed in tandem with Probation and SSA as the STRTP program develops and data collection is refined.

The proposed Agreements may include subcontracts or pass-throughs to other providers. See Attachment B for the Contract Summary Form. As providers become licensed and individual contracts are executed pursuant to this Master Agreement, HCA will report back to the Board with an updated list of providers, including information related to any subcontracts or pass-throughs to other providers.

HCA requests that the Board authorize the HCA Director, or designee, to exercise a contingency contract cost increase in an amount not to exceed $400,000, which is 10% of the original amount of the first year of funding for the Master Agreement for the entire term and within the scope of work set forth in the Master Agreement, pursuant to County Contract Policy Manual Section 3.3-113. 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 for various providers for the provision of Behavioral Health Services in Short-Term Residential Therapeutic Programs, as referenced in the Recommended Action.

FINANCIAL IMPACT:

Appropriations for this Agreement are included in HCA's FY 2017-18 Adopted Budget and will be included in the budgeting process for future years.

Funding Sources:

State: 50% (Mental Health Services Act/Prop 63)

Fees/Other: 50% (Federal Financial Participation Medi-Cal)

Should services need to be reduced or terminated due to lack of funding, this Agreement contains language that allows HCA to give a 30 days' notice to either terminate or renegotiate the level of services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.

STAFFING IMPACT:

N/A

REVIEWING AGENCIES:

Probation Department
Social Services Agency

ATTACHMENT(S):

Attachment A - Agreement for Provision of Behavioral Health Services in Short-Term Residential Therapeutic Programs
Attachment B - Contract Summary Form
Attachment C - Analysis of Assembly Bill 403
Attachment D - Analysis of Assembly Bill 1997
Attachment E - Health and Safety Code, Section 1562.01