Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Lisa Mancini, Interim Director, Behavioral Health and Recovery Services
Subject: Agreement with Addiction Research and Treatment, Inc. for Narcotic Replacement Therapy Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Addiction Research and Treatment, Inc. for narcotic replacement therapy services, for the term of July 1, 2022, through June 30, 2023, in an amount not to exceed $2,223,104.
body
BACKGROUND:
Since July 2015 Addiction Research and Treatment, Inc. (ART) has provided 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 this 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. As a result, BHRS contracted with ART for the terms of July 1, 2016, through June 30, 2018, and July 1, 2018, through June 30, 2019.
In April 2016, the California Department of Health Care Services (DHCS) and the federal government approved the DMC-ODS waiver.
In October 2019, BHRS requested and was granted approval from this Board to waive the RFP process for NRT services for two years because additional time was needed to finalize the implementation of DHCS’s changes in the delivery and reporting requirements. As a result, BHRS contracted with ART for the term of July 1, 2019, through June 30, 2021.
DHCS continues to require changes in service delivery and reporting requirements of substance use disorder treatment services through the CalAIM waiver (formally DMC-ODS waiver). Due to these changes, BHRS is requesting that this Board waive the RFP process for substance use disorder treatment services for another year, allowing BHRS time to finalize the implementation of CalAIM waiver-related changes to this and all other BHRS substance use related contracts. In early 2023, BHRS plans to release an RFP for substance use disorder treatment services to start on July 1, 2023.
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 and adult clients that are not eligible for Drug Medi-Cal or other health care insurance 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.
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 is coming to this Board late due to prolonged contract negotiations and is on the path of a continuing resolution.
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
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 within 24 hours.
PERFORMANCE MEASURE:
|
Measure |
FY 2021-22 Actual |
FY 2022-23 Estimated |
|
Percentage of clients requesting methadone services who receive treatment within 24 hours |
90% 194 clients |
90% 194 clients |
FISCAL IMPACT:
The term of the agreement is July 1, 2022, through June 30, 2023. The amount of the agreement is not to exceed $2,223,104 for the one-year term. Funds in the amount of $2,223,104 are included in the BHRS FY 2022-23 Recommended Budget. Of this amount, $1,046,610 will be funded by Federal Financial Participation for Drug Medi-Cal, $1,046,610 will be funded by 2011 Realignment, and $10,500 will be funded by AB 109. The Net County Cost is $119,384.