Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Scott Gilman, Director, Behavioral Health and Recovery Services
Subject: Agreement with Addiction Research and Treatment, Inc. for Narcotic Replacement Therapy Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Addiction Research and Treatment, Inc. for narcotic replacement therapy services, for the term July 1, 2019 through June 30, 2021, in an amount not to exceed $4,105,930.
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BACKGROUND:
Addiction Research and Treatment, Inc. (ART) provides narcotic replacement therapy (NRT) services for San Mateo County adults with histories of opioid dependency and comorbid health related issues. Specifically, ART provides methadone maintenance, counseling and case management services, primarily to Medi-Cal beneficiaries.
In October 2015, Behavioral Health and Recovery Services (BHRS) requested and was granted approval from your Board to waive the Request for Proposals (RFP) process for NRT services for two years, pending approval of the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver.
In April 2016, the California Department of Health Care Services (DHCS) and the federal government approved the DMC-ODS waiver. DHCS continues to require changes in service delivery and reporting requirements of substance use disorder treatment services through the DMC-ODS waiver. Due to these changes, BHRS is requesting that your Board waive the RFP process for substance use disorder treatment services for another two years, allowing BHRS time to finalize the implementation of DMC-ODS waiver-related changes to this and all other BHRS substance use related contracts. In early 2020, BHRS will release a RFP for substance use disorder treatment services to start on July 1, 2021.
DISCUSSION:
The demand for Medication Assisted Therapy (which includes NRT services) has nearly doubled since June 2014, due to San Mateo County’s successful implementation of the Affordable Care Act (ACA) and the expansion of Medi-Cal eligibility. More people are covered under ACA and are aware of Medication Assisted Therapy (MAT) service availability, resulting in a much higher demand for services.
Through this agreement, ART will continue to operate and manage NRT services for San Mateo County adult Medi-Cal clients with complex needs. These services include daily methadone dosing, appropriate MAT services, urine screening, addiction education and intervention, aftercare planning, patient follow-up, and follow-up with referring partners. Research has validated the effectiveness of methadone treatment for opiate-dependent patients.
On June 25, 2019, your Board approved BHRS’ FY 2019-20 recommended budget. This budget included a 4% Cost-of-Living Adjustment for Community-Based Organizations - including ART - that BHRS contracts with for various mental health and substance abuse services.
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 County Counsel as to form. This agreement is late due to prolonged contract negotiations and is on the Continuing Resolution.
Approval of this agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing individuals and families with prevention and treatment services to support recovery, which in turn contributes to the health and safety of communities throughout the county. Success for services under this agreement is measured by sustained abstinence over a one-year period and is verified by a rigorous regime of testing for alcohol, methadone, methadone metabolites, heroin, opium, other opioids, cocaine, amphetamine, methamphetamine, and other substances. Each patient is randomly tested once a month. It is anticipated that 90% of clients requesting methadone services will receive treatment with 24 hours.
PERFORMANCE MEASURE:
|
Measure |
FY 2018-19 Actual |
FY 2019-2020 Projected |
|
Percentage of clients requesting methadone services that receive treatment within 24 hours |
90% 194 clients |
90% 194 clients |
FISCAL IMPACT:
The term of the agreement is July 1, 2019 through June 30, 2021. The amount of the agreement is not to exceed $4,105,930 for the two-year term. Funds in the amount of $2,012,711 are included in the BHRS FY 2019-20 Adopted Budget. Of this amount, $1,006,355.50 will be funded by Federal Financial Participation for Drug Medi-Cal and $1,006,355.50 will be funded by 2011 Realignment. There is no Net County Cost. The payment provisions and levels of service remain essentially the same as those of the prior agreement. Similar arrangements will be in place for FY 2020-21.