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: Authorizing the Chief of San Mateo County Health or Designee to Execute Three Separate Agreements with Essential Local Community-Based Organizations for Full Service Partnership Services Programs
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health, or designee(s) to execute agreements and negotiate amendments with each contract listed in Attachment A to provide Full Service Partnership Services, for the term of June 1, 2025 through June 30, 2027, in an aggregate amount not to exceed $66,707,856.
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BACKGROUND:
The cornerstone of the County’s Mental Health Services Act (MHSA) Community Services and Supports plan is the delivery of Full Service Partnership (FSP) services for the highest-risk consumers with serious mental illness. FSP programs for both Youth and Adult clients are designed to allow consumers to remain living in the community and decrease their hospitalizations and/or incarcerations by providing case management, medication management, therapy, social activities, and 24/7 response capability to mitigate an evolving situation.
FSP programs have been shown to decrease psychiatric emergency service visits, hospitalizations, homelessness, active substance use, and arrests by providing case management, medication management, therapy, social activities, and 24/7 crisis response capability to mitigate evolving situations with participants in the program.
The California Department of Health Care Services (DHCS) requires that counties include specific language related to the implementation of the CalAIM system in all contracts with FSP providers. Specifically, all FSP contracts covering Medi-Cal services must include mandated program requirements and fee-for-service (FFS) language going forward.
Behavioral Health and Recovery Services (BHRS) has continued to engage our FSP providers affected by the new CalAIM requirements, advising them of the considerable changes this will bring to their claims, reporting, and payment processes. BHRS and our FSP providers have had to work closely together to determine the effect of CalAIM on each individual contract to ensure that services can continue to our clients through these changes.
DISCUSSION:
In order to meet this new contracting requirement, BHRS is requesting that this Board authorize the Chief of San Mateo County Health or designee to execute agreements for these FSP contracts that are currently in the process of incorporating the CalAIM language and FFS Schedule. This signature authority will streamline the approval process for the CEO, Health, BHRS, the Board, and our contract agencies, allowing the time needed to execute the contract renewals.
Attachment A of the resolution lists contractors that provide FSP services, along with the contract amounts for each contractor. The not-to-exceed aggregate amount of $66,707,856 will authorize the Chief of San Mateo County Health, or designee(s), to execute agreements and associated amendments with the contractors listed in Attachment A.
These contracts will provide comprehensive FSP services, with separate programs for Youth FSP services and Adult FSP services. Youth FSP services target children, youth, and transition age youth (TAY). Youth FSP services are for severely emotionally disturbed clients who are either returning from out-of-home placements or are at risk for out-of-home placements. These services enable clients to maintain placements in their respective communities. While services are open to all at-risk clients, they are specifically targeted to clients from underserved communities.
Adult FSP Programs are designed for adults and older adults who have been diagnosed with a severe mental illness. These programs assist with housing, employment, and education as well as mental health services and integrated treatment for individuals who have co-occurring mental health and substance abuse disorder.
In August 2022, BHRS released a Request for Proposals (RFP) for the Children, Youth, and TAY FSP Services where Edgewood Family Services was recommended to provide services because of their extensive history of providing FSP services and their collaboration with colleges and vocational programs for TAY.
In July 2023, BHRS released an RFP for the Adult and Older Adult FSP Services where Telecare and Caminar were recommended to provide services because of their diverse and established community collaborations, with peer organizations, and with housing providers.
These agreements will be approved by the County Attorney as to form, and by Risk Management if necessary, and will comply with applicable County ordinances.
The resolution has been reviewed and approved by the County Attorney as to form.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
BHRS provides a range of services to promote wellness and recovery to support consumers remaining in the lowest possible level of care. It is anticipated that the percentage of FSP clients who receive FSP services that are maintained at a current or lower level of care will be 80%.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of FSP clients who receive FSP services that are maintained at a current or lower level of care |
80% 410 of 513 participants |
80% 410 of 513 participants |
COMMUNITY IMPACT:
This agreement will positively impact a critically underserved community of behavioral health clients who have severe mental illness and who will benefit from higher levels of care/wraparound services to support their stabilization and recovery. FSP services are a vital resource in our community. Having these agreements will help us to keep clients out of high-cost services such as the emergency room, psychiatric emergency services, inpatient psychiatric units, and out of locked settings such as jail and our mental health rehabilitation centers. FSP services are designed to meet the unique needs of underserved populations, emphasizing trauma, and using culturally informed and evidence-based practices to promote long-term well-being.
FISCAL IMPACT:
The term of the agreements is June 1, 2025 through June 30, 2027. The total amount of the agreements is not to exceed $66,707,856 for the 25-month term. Funds in the amount of $33,353,928 will be included in the BHRS FY 2025-26 Recommended Budget. Of this amount, the MHSA will fund $15,232,335, Federal Medi-Cal will fund $8,316,218, 2011 Realignment will fund $2,110,262, AB109 will fund $541,830, 1991 Realignment will fund $3,307,387, and Net County Cost will be $3,845,896. Similar arrangements will be made in subsequent years for FY 2026-27. 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 FFS 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 20, 2025, Board agenda. There will be no pre-pays in subsequent fiscal years.