Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Horizon Services, Inc. for Residential Substance Use Disorder Detoxification Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Horizon Services, Inc. for residential substance use disorder detoxification services for the term of July 1, 2023 through June 30, 2024, in an amount not to exceed $3,051,472.
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BACKGROUND:
For over 35 years, Palm Avenue Detox (Palm Avenue), a program of Horizon Services, Inc. (Horizon), has been serving residents of San Mateo County. Horizon assists clients in connecting to ongoing substance use disorder treatment programs, primary and psychiatric care, housing, and other health-related services.
In April 2016, the California Department of Health Care Services (DHCS) and the Federal Government approved the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver for substance use disorder treatment services.
In July 2019, Horizon began providing services under the DMC-ODS waiver, allowing Horizon and other providers to bill for many more services than they were previously able.
In early 2021, DHCS investigated a client death that occurred at Palm Avenue in September 2020 and found widespread documentation fraud and practices that were putting clients’ safety at risk.
In March 2021, DHCS issued an Immediate Temporary Suspension Order on Palm Avenue’s license to operate, for violations of the Health and Safety Code and applicable regulations and rules. Class A deficiencies were found to “present an imminent danger” to client safety.
In June 2021, DHCS and Horizon executed a Stipulated Settlement Agreement (SSA) to resolve all the issues pertaining to the Order. In the SSA, Palm Avenue agreed to remain closed through August 14, 2021, and could reopen thereafter under a probationary status for three years.
During the closure of Palm Avenue, Horizon completed an extensive re-organization, and hired all new staff, from line staff to their Executive Director and Medical Director. Horizon created new standard operating procedures, implemented new training requirements, increased staffing levels to ensure client safety, and has become Incidental Medical Services certified within Drug Medi-Cal, so that it can provide a higher quality of services to clients.
DISCUSSION:
Through the DMC-ODS waiver, Horizon has provided detoxification, stabilization, and assessment for clients who have co-occurring substance use and mental health disorders, by providing extended assessment and linkages to medication assisted treatment and other identified substance use services to support recovery. DHCS continues to require changes in service delivery and reporting requirements of substance use disorder treatment services through the DMC-ODS waiver. BHRS requests the Board waive the Request for Proposal (RFP) process to allow BHRS to finalize the implementation of DMC-ODS waiver-related changes to this and all other BHRS substance use related contracts and allow Horizon to continue providing services for one year. BHRS will release an RFP for substance use disorder treatment services in Fall 2023.
The resolution contains the County’s standard provisions allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
This agreement has been delayed due to prolonged contract negotiations with the provider.
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
Successful discharge occurs when a program participant completes detoxification services and is in transition to the next appropriate level of care. Research shows that the longer participants are retained in an appropriate level of treatment, the more likely they are to achieve long-term recovery. A participant’s willingness to continue in treatment is a key element to successful stabilization and progress towards sustained recovery. It is anticipated that 90% of program participants will achieve a successful detoxification discharge.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Actual |
FY 2023-24 Estimated |
|
Percentage of program participants that achieve a successful detoxification discharge |
90% 135 of 150 participants |
90% 135 of 150 participants |
FISCAL IMPACT:
The term of the agreement is July 1, 2023 through June 30, 2024. The amount of the agreement is not to exceed $3,051,472 for the one-year term. Funds in the amount of $3,051,472 are included in the BHRS FY 2023-24 Recommended Budget. Of this amendment $207,368 is funded with Federal Financial Participation Medi-Cal revenue, $2,202,093 with 2011 Realignment, $172,807 with Substance Abuse Block Grant and $469,204 with Net County Cost.