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: Amendment to the Agreement with Addiction Research and Treatment, Inc. for Narcotic Replacement Therapy Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Addiction Research and Treatment, Inc. for narcotic replacement therapy services, extending the term by nine months through March 31, 2024, and increasing the amount by $1,667,328 to an amount not to exceed $3,890,432.
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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 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 Drug Medi-Cal waiver 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.
In November 2021, DHCS continued to require changes in service delivery and reporting requirements of substance use disorder treatment services through the new CalAIM waiver. Due to these changes, BHRS requested 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. As a result, BHRS contracted with ART for the term of July 1, 2021, through June 30, 2022.
In October 2022, BHRS requested and was granted approval from this Board to waive the RFP process for NRT services for another year because additional time was needed to implement the CalAIM waiver-related changes. As a result, BHRS contracted with ART for the term of July 1, 2022, through June 30, 2023, in an amount not to exceed $2,223,104.
DISCUSSION:
The demand for Medication Assisted Therapy (MAT) (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 MAT service availability, resulting in a much higher demand for services.
Through this amendment, 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.
BHRS will release an RFP for NFT services in Fall 2023. This nine-month extension will provide additional time for the RFP process to be completed and allow ART to continue providing services throughout the proposed extension of the contract term.
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 amendment 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 one year and is verified by a rigorous regimen 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 2022-23 Estimated |
FY 2022-23 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 amended agreement is July 1, 2022 through March 31, 2024. The amount of the amended agreement is not to exceed $3,890,432 for the 21-month-term. Funds in the amount of $1,667,328 are included in the BHRS FY 2023-24 Recommended Budget. Of this amount, $833,664 will be funded by Federal Financial Participation for Drug Medi-Cal, and $833,664 will be funded by 2011 Realignment. There is no Net County Cost associated with this amendment.