Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Agreement with Our Common Ground, Inc. for Substance Use Disorder Treatment Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Our Common Ground, Inc. for substance use disorder treatment services, for the term June 1, 2025, through June 30, 2027, in an amount not to exceed $18,552,817.
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BACKGROUND:
Behavioral Health and Recovery Services (BHRS) has contracted with Our Common Ground, Inc. (OCG) for over 20 years to provide substance use disorder (SUD) outpatient and residential treatment services to San Mateo County adults with substance abuse and addiction problems.
Behavioral Health and Recovery Services launched the Drug Medi-Cal Organized Delivery System (DMC-ODS) in February 2017, greatly expanding the continuum of care and increasing levels of care targeting substance use disorders. BHRS is now part of CalAIM, a multi-year initiative by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of our population by implementing a broad delivery system and program and payment reform across the Medi-Cal program. The behavioral health components of CalAIM are designed to support whole-person, integrated care; move the administration of Medi-Cal behavioral health to a more consistent and seamless system by reducing complexity and increasing flexibility; and improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through improvements to behavioral health policies and the launch of behavioral health payment reform.
DISCUSSION:
In December 2023, BHRS released a Request for Proposals for the provision of SUD outpatient treatment services. OCG was recommended based on their continued successful treatment program providing services to vulnerable and underserved youth and their established collaboration with community partners.
Through the DMC-ODS waiver, OCG continues to provide outpatient and residential treatment services to adult County residents. These services encompass a comprehensive approach, including individualized residential and outpatient treatment, family group therapy, alcohol and drug testing, recovery services and relapse prevention, and recovery residence. OCG’s treatment approach is a strength-based Modified Therapeutic Community Model, which values relationships and views the clients in light of their competencies rather than their deficiencies. Success is based upon individual progress in treatment, while concentrating on academic and vocational pursuits.
Effective September 1, 2024, OCG has become Incidental Medical Services, Residential Withdrawal Management certified within Drug Medi-Cal. The OCG Residential Withdrawal Management program is a six-bed male facility with established expertise in serving clients who have SUD. OCG began providing services in this program effective November 4, 2024.
Residential withdrawal management services are defined by DHCS as urgent. Clinically managed residential withdrawal management services, such as those offered by OCG, provide 24-hour support for moderate withdrawal symptoms that are not manageable in an outpatient setting. The services are medically necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. BHRS is required to provide these services per the DMC-ODS regulations.
Under the B-1 Administrative Memorandum, the selection of providers delivering housing and related support services for mental health clients is exempt from the Request for Proposal requirement. In order to improve service capacity, BHRS may contract for housing and related support services with any willing, qualified provider. Residential treatment programs like OCG have established expertise in serving clients who have SUD. There continues to be a shortage of facilities in San Mateo County that specialize in residential services for SUD.
Through the Mental Health Diversion Grant Program, OCG shall provide residential treatment services to San Mateo County residents who are not eligible for Drug Medi-Cal or other health care insurance but are in need of services. These services include individual therapy, individual counseling, group therapy, anger management, family therapy, and room and board.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
Successful treatment discharge occurs when a program participant completes his/her treatment/recovery plan or when a participant is transferred to the next appropriate level of care. It is anticipated that 95% of program participants will achieve a successful treatment discharge.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Estimated |
|
Percentage of program participants who achieve a successful treatment discharge |
95% 352 of 371 participants |
95% 352 of 371 participants |
COMMUNITY IMPACT:
This contract will positively impact the behavioral health of low-income residents in need of SUD treatment services. OCG offers bilingual and bicultural substance use treatment services in convenient locations across San Mateo County with the aim of helping residents to achieve long-term wellness and recovery. This provider is essential to assure equitable access to quality care for underserved and vulnerable people in San Mateo County. Most clients have co-occurring mental health needs and other complex needs, including homelessness, justice system involvement, and other physical health conditions.
To advance health equity, improve quality, and help eliminate health disparities, the County requires providers to comply with National Culturally and Linguistically Appropriate Services Standards. Each provider is required to submit an annual cultural competence plan that details current and future efforts to address the diverse needs of clients, families, and the workforce in San Mateo County.
FISCAL IMPACT:
The term of the agreement is June 1, 2025 through June 30, 2027. The amount of the agreement is not to exceed $18,552,817 for the 25-month term. For FY 2025-26, the maximum amount is $8,447,067 and will be included in the BHRS FY 2025-26 Recommended Budget. Of this amount, the Mental Health Services Act will fund $19,532, Federal Financial Participation for Drug Med-Cal will fund $5,332,191, Substance Abuse Prevention, Treatment, and Recovery Services Block Grant will fund $1,097,012, Realignment will fund $34,842, and Assembly Bill 109 will fund $348,454. The Net County Cost is $1,615,036.
BHRS is changing the methodology used to pay contracted providers that are currently paid on a 1/12th monthly advance. Specifically, BHRS is changing the payment methodology for most contracts to fee-for-service and payments will be made in arrears. Additionally, in previous fiscal years, BHRS was granted an exception to pay providers during the accounting “blackout period” in July and August. This exception will no longer be available.
To facilitate these changes, BHRS has agreed to one three-month “pre-pay” for July-September of FY 2025-26 to qualifying providers. This payment will be reconciled in November. This payment must be made in June 2025. However, to make this payment, an ATR is needed. One ATR for all the impacted contracts will be submitted on the May 6, 2025 Board agenda. There will be no pre-pays in subsequent fiscal years.
Attachments:
RFP Matrix