|
Agenda Item
ASR
Control 23-000793 |
||
|
MEETING
DATE: |
05/07/24 |
|
|
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): |
Annette
Mugrditchian (714) 834-5026 |
|
|
|
Veronica
Kelley (714) 834-7024 |
|
Subject: Approval of Contracts 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: N/A |
Current Year
Cost: N/A |
Annual Cost: FY 2024-25 $12,000,000 |
||||||||
|
|
|
|
||||||||
|
Staffing Impact: |
No |
# of Positions: |
Sole Source: No |
|||||||
|
Current Fiscal Year Revenue: N/A
|
||||||||||
|
Prior Board Action: 4/26/2022 #16 |
||||||||||
RECOMMENDED
ACTION(S):
|
1. |
Approve the Master Contract with various
providers for the provision of Behavioral Health Services in Short-Term
Residential Therapeutic Programs for the term of July 1, 2024, through June
30, 2026, for an aggregate amount not to exceed $24,000,000, renewable for
three additional one-year terms. |
|
2. |
Pursuant to Contract Policy Manual
Section 3.4-114, authorize the Health Care Agency Director or designee, to
exercise a contingency contract cost increase in an amount not to exceed
$1,200,000, which is 10 percent of the contract amount for the first year of
the contract, for the entire term of the Contract, including renewals, and
within the scope of work set forth in the contract. The use of this
contingency contract cost increase is subject to approval requirements
established by the County Procurement Officer. |
|
3. |
Authorize the
County Procurement Officer or Deputized designee to execute Master Contract
as referenced in the Recommended Actions and individual Contracts with
various providers as needed throughout the term of the Master Contract. |
SUMMARY:
Approval of the Master Contract and
individual Contracts with various providers for the provision of Behavioral
Health Services in Short-Term Residential Therapeutic Programs will provide
intensive Specialty Mental Health Services to Wards and Dependents of the
Court, ages six to 17, and Non-Minor Dependents, ages 18 to 20, placed in
licensed Short-Term Residential Therapeutic Programs in Orange County and in
other counties where a Presumptive Transfer waiver has been established.
BACKGROUND
INFORMATION:
On April 26, 2022, your Honorable
Board of Supervisors (Board) approved the current Master Contract for the
provision of Behavioral Health Services in Short-Term Residential Therapeutic
Programs (STRTP) with various providers. The below additional actions related
to the Master Contract were executed pursuant to appropriate authorities. A
Request for Proposal for these services was not conducted or required as it is
a state-mandated program under Continuum of Care Reform (CCR), enacted by the
passage of Assembly Bill 403 in 2015. Statutory requirements direct counties to
obtain Program Statements and Plans of Operation from those providers who would
like to operate an STRTP. Program Statements and Plans of Operation are
submitted to Social Services Agency (SSA) who convenes an interagency group
consisting of representation from SSA, Probation, and Health Care Agency (HCA)
to review the Program Statements and Plans of Operation to determine if the
proposed STRTP will meet the County’s needs. The STRTP Master Contracts for
both HCA and SSA will go before the Board concurrently as done in previous
years.
Table 1: Prior Actions related to the Master Contract:
|
Board
Date |
Contract
/ Amendment |
Action |
Term |
|
April 26, 2022 |
Master Agreement |
Board Approved Master Agreement |
July 1, 2022 – June 30, 2024 |
|
N/A |
Amendment No. 1 |
Deputy Purchasing Agent Delegated
Authority Administrative Revisions; Added state-mandated performance outcome
language (effective December 1, 2023) |
July 1, 2022 – June 30, 2024 |
Scope
of Services
Behavioral Health Services in
STRTPs for Wards and Dependents of the Court and Non-Minor Dependents (NMD)
were designed to reform congregate care for youth in California. As of January
1, 2017, CCR established STRTP as a new Community Care Licensure category for
residential treatment programs. To
continue providing services to children under the jurisdiction of the Juvenile
Court, all facilities previously licensed as group homes were required to
transition to this new facility type by December 31, 2018. The California
Department of Social Services (CDSS) processes the licenses for an existing
group home to become a STRTP or for any new providers applying to become a
STRTP.
The legislation provides that once
provisionally licensed by CDSS, STRTPs have 12 months to obtain the permanent
license and two years to become fully accredited. The transition process for
STRTPs requires that they secure a mental health contract with the local Mental
Health Plan (i.e., Health Care Agency) in order to become a certified Medi-Cal
provider and obtain Mental Health Program approval from the Department of
Health Care Services (DHCS). This Master Contract allows HCA to respond
promptly to STRTPs that are provisionally 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. SSA provides the residential
care and supervision for the youth placed at the STRTPs, whereas HCA provides
the Specialty Mental Health Services (SMHS) for these youth.
Since the approval of the Master
Agreement, all six current group home providers in Orange County that applied
for STRTP licensure have obtained permanent STRTP licenses. All six providers
are also contracted with HCA for SMHS, and the total aggregate number of beds
is sufficient for the number of youth needing STRTP level of care placements in
Orange County. Per DHCS STRTP Interim Regulations, the STRTPs provide intensive
SMHS in the day and evening, seven days a week, according to the youth’s
individual needs as indicated in the youth’s treatment plan. Intensive SMHS may
include Crisis Intervention, Medication Support Services, Individual, Group,
and Family Therapy, Intensive Care Coordination/Targeted Case Management, and
Intensive Home-Based Services/Individual Rehabilitation.
Performance
Outcomes
HCA is contracted for 121 beds with
six STRTP providers at 18 different facilities throughout Orange County. In FY
2022-23, there were 211 unduplicated clients served in STRTPs. The average length
of stay for these youth is 335.52 days (11.00 months), much longer than the
intended six-month timeline for the STRTPs. This is indicative of the intensive
clinical needs of the youth served in the STRTPs and the need for extended
intensive treatment in order to stabilize and transition them to lower levels
of care and longer-term family-based placements.
The STRTPs use State-mandated
performance outcomes measures, which are currently the Child and Adolescent
Needs and Strengths (CANS) and Pediatric Symptom Checklist-35 (PSC), to
demonstrate reduction in client symptom distress. The program’s targets and
outcomes for FY 2022-23 are provided in the table below.
In FY 2022-23, the proportion of
youth who required active intervention for various symptoms reduced after
receiving services in the STRTPs. Reductions were within the established target
ranges for two symptom domains and just outside the established target range by
one percent for the remaining two.
Table 2: FY 2022-23 Outcomes:
|
Domain |
Target
Range |
FY
2022 - 23 Rate |
|
Adjustment to Trauma |
20-25% |
19% |
|
Anger Control |
30-35% |
32% |
|
Anxiety |
20-25% |
21% |
|
Suicide Risk |
65-70% |
71% |
The data was determined by utilizing past and current
data trends across all STRTPs. At this time, the targets will remain the same
for FY 2024-25.
HCA now requests that the Board
approve the Master Contract and individual contracts with various providers for
the provision of Behavioral Health Services in STRTP, as referenced in the
Recommended Actions.
HCA requests the authority to add
new providers or locations without returning to the Board for approval, as
referenced in the Recommended Actions. Returning to the Board for approval of
new providers may result in a delay that would compromise critical bed
availability. The ability to add new, qualified providers is time-sensitive due
to the instability and needs of the at-risk population served under the Master
Contract. The STRTPs are contracted with the County Child Welfare Agency for
residential care and supervision, and per CCR requirements, also contracted
with the County Mental Health Plan for SMHS; therefore, HCA will need to
contract in a timely manner with new providers who are licensed by CDSS and
contracted with SSA in order to ensure the STRTP beds may be promptly utilized
to serve this high-risk population.
Pursuant to Contract Policy Manual Section
3.4-114, authorize the HCA Director or designee, to exercise a contingency
contract cost increase in an amount not to exceed $1.2 million, which is 10
percent of the contract amount for the first year of the contract, for the
entire term of the Contract, including renewals, and within the scope of work
set forth in the contract. The use of this contingency contract cost increase
is subject to approval requirements established by the County Procurement
Officer.
Due to the nature of the services,
the individual contracts could require the addition of subcontractors. To add
subcontractor(s) to the contract(s), the provider/contractor must seek express
consent from HCA. Should the addition of a subcontractor affect the scope of
work and/or contract amount, HCA will bring the item back to the Board for
approval. See Attachment B regarding subcontracts and Contract Summary Form.
The Contractors’ performances have
been confirmed as satisfactory. HCA has verified that there are no concerns
that must be addressed with respect to Contractors’ ownership/name, litigation
status or conflicts with County interests.
The Orange County Preference Policy
is not applicable to this contract award.
HCA has developed a Good Neighbor Policy
that is included in Residential Program contracts wherein the contractor
provides services to County residents and the services may potentially impact
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.
FINANCIAL
IMPACT:
Appropriations for this Contract
will be included in Budget Control 042 FY 2024-25 Budget and in the budgeting
process for future years.
The Contract includes provisions
allowing HCA to terminate the Contract, reduce the level of services, and/or
renegotiate the levels of services provided, as necessary. This includes a
notice that allows HCA adequate time to transition or terminate services to
clients, if necessary.
STAFFING
IMPACT:
N/A
REVIEWING
AGENCIES:
Social
Services Agency
ATTACHMENT(S):
Attachment
A - Master Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs
Attachment B - Contract Summary Form
Attachment C - Assembly Bill 403
Attachment D - Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with Hart Community Homes, Inc.
Attachment E - Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with Mary's Shelter dba Mary's Path
Attachment F - Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with New Alternatives, Inc.
Attachment G - Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with Olive Crest
Attachment H- Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with Rite of Passage Adolescent
Treatment Centers and Schools, Inc.
Attachment I - Contract MA-042-24011001 for Behavioral Health Services in
Short-Term Residential Therapeutic Programs with South Coast Children's
Society, Inc.