Approve seventh amendment to Agreement No. 24-47 with American Medical Response to extend the term of the Agreement through December 31, 2025, and add funding in the amount of $255,000 for 2025-26 for a new contract maximum of $2,193,810 for the period of December 31, 2023 through December 31, 2025; and update rates and the effective dates, for the provision of mandated Medi-Cal mobile crisis services for Medi-Cal beneficiaries. (No general fund impact) (Morales)

Approve seventh amendment to Agreement No. 24-47 with American Medical Response to extend the term of the Agreement through December 31, 2025, and add funding in the amount of $255,000 for 2025-26 for a new contract maximum of $2,193,810 for the period of December 31, 2023 through December 31, 2025; and update rates and the effective dates, for the provision of mandated Medi-Cal mobile crisis services for Medi-Cal beneficiaries. 

The County has entered into agreements with the State of California, Department of Health Care Services (DHCS), to provide mental health services to County of Yolo residents and State Managed Care Mental Health Plan (MHP) Agreement.

The American Rescue Plan Act of 2021 section 9813 (42 U.S.C. section 1396w–6) allowed states to add qualifying community-based mobile crisis intervention services as a covered Medi-Cal benefit for a five-year period, beginning April 1, 2022, and ending March 31, 2027. The Medi-Cal Mobile Crisis Benefit became a federal mandate on January 1, 2024. Mobile crisis services are intended to provide community-based crisis resolution and reduce unnecessary law enforcement involvement and emergency department utilization. These services are provided 24 hours per day to ensure County residents, including Medi-Cal beneficiaries, have continuous access to coordinated crisis care.

DHCS, as a part of its California Advancing and Innovating Medi-Cal (CalAIM) initiatives, amended its State Plan to include community-based mobile crisis intervention services. Per Behavioral Health information Notice (BHIN) 23-025, county MHPs, DMC counties, and DMC-ODS counties (collectively, “Medi-Cal behavioral health delivery systems”) shall provide, or arrange for the provision of, qualifying mobile crisis services in accordance with the requirements set forth in this BHIN. Mobile crisis services are an integral part of California’s efforts to strengthen the continuum of community-based care for individuals who experience behavioral health crises.  

On or about December 29, 2023, the County entered into ratification Agreement No. 24-47 with American Medical Response to provide mobile crisis response services in the amount of $243,420 for the period of December 31, 2023 through February 28, 2024. The Agreement included an optional extension through June 30, 2024, with no additional funding. Since then, the Agreement has been revised several times to extend the term and add funding.

In the past six months, HHSA has twice unsuccessfully solicited a vendor through the RFP process to ensure the County’s continued compliance with the requirement to provide the Medi-Cal Mobile Crisis Benefit.  The multiple extensions to this contract have been necessary to avoid a disruption in mandated services and to avoid any potential sanctions with federal and state regulations.  Approval of this seventh amendment will allow the term of the agreement to be extended through December 31, 2025; and add funding for 2025-26 in an amount of $255,000 for a new contract maximum of $2,193,810; and update rates and the effective dates. Approval of this amendment is needed to prevent a contract lapse while a third  Request for Proposal (RFP) is finalized and a new vendor is chosen. Approval of this seventh amendment will prevent a disruption in services and ensure the County’s continued compliance with provision of the Medi-Cal Mobile Crisis Benefit while a new vendor is sought.

County Counsel has approved this Amendment as to form.
General Services Department, Procurement Division

On December 15, 2023, the Yolo County Procurement Manager or designee approved a sole/single source procurement for these services. Without sole source approval of the agreement, the County would be out of compliance with the requirements of Behavioral Health Information Notice (BHIN) 23-025 and may face sanctions from DHCS. Factors considered, in approving the sole source included but were not limited to: 1) Pursuant to DHCS Info Notice BHIN 23-025 the County is required to implement a 24/7 operational Medi-Cal Mobile Crisis response team; 2) the vendor was a long standing (5+ years) county vendor with successful performance; 3) competitive pricing/cost savings; 4) without sole source approval the County would not be providing mandated Medi-Cal Mobile Crisis Services to Yolo County residents; and 5) the County risked being in violation of State requirements and being sanctioned if services as mandated in BHIN 23-025 were not provided.

Vendor Performance:
The Performance Measures were included in the underlying Agreement and are not being revised at this time (See Att. B. Performance Measures).

HHSA confirms American Medical Response is performing satisfactorily under this agreement to date and is coordinating with HHSA staff to further develop the program. AMR has responded to one hundred and thirty-five (135) mobile crisis service requests, an average of fifteen (15) mobile crisis responses a month, during the past nine months of 2024-25, with an average response time of thirty (30) minutes, meeting the DHCS timeliness requirement for mobile crisis services.