Authorize the Chair to execute a renewal agreement with BHC Heritage Oaks Hospital to provide After-Hours Access and Crisis Services in compliance with the new California Advancing and Innovating Medi-Cal (CalAIM) initiative in an amount not-to-exceed $355,025 for the period of July 1, 2023 through December 31, 2023. (No general fund impact) (Sullivan)

On December 20, 2017, the County issued a formal request for proposal (2017 RFP) to solicit a provider for after-hours access and crisis services. (Please find details regarding the 2017 RFP in the Competitive Bid Process section below). Crisis navigation services provide 24/7 clinician response to local hospital emergency rooms and law enforcement. Since then, the crisis continuum in Yolo County has continued to evolve. Now, local ER staff have taken over crisis assessments in their hospitals while Yolo County Health and Human Services Agency (HHSA)/contractor staff, act as Crisis Navigators, providing service eligibility and medical necessity review, as well as appropriate acute inpatient psychiatric placement arrangements for Yolo County beneficiaries. County staff manage the daytime Navigation response and Heritage Oaks Hospital Access Line staff manage the after-business hours’ Navigation response. Law enforcement crisis response is now subsumed within the Co-Responder Project.

The resulting agreement from the 2017 RFP was awarded to BHC Heritage Oaks and on October 9, 2018, the County and BHC Heritage Oaks entered into Agreement No. 18-218, which provided an initial term of July 1, 2018 through June 30, 2020, with two optional extensions for FY’s 2020-21 ($750,900), and 2021-22 ($750,900). Agreement No. 18-218 was subsequently extended to allow time from the Crisis Now program implementation. On June 29, 2022, Yolo County issued a formal request for proposal (2022 RFP) to solicit a provider for a Crisis Now Program, which included the provision of a high-tech 24/7 Crisis & Access Call Center. The 2022 RFP did not result in the selection of a new vendor and Agreement No. 18-218 was extended through FY 2022-23.

California Advancing and Innovating Medi-Cal (CalAIM) Initiative
In January 2022, California Department of Health Care Services (DHCS) rolled out the CalAIM initiative that aims to provide broad delivery system program and payment reform across the Medi-Cal system. The goal is transformation of the Medi-Cal delivery system, moving it towards a population health approach that prioritizes prevention and whole person care. Focus shifts from compliance to quality and performance metrics. Specialty Mental Health Services (SMHS) requirements and policies pursuant to the CalAIM initiative were updated, and as a result of these updates, the County is required to revise the terms and conditions in the provider agreements for these services.  In preparation for this system-wide change, the County has been working closely with CalMHSA who has been providing the County and other SMHS Medi-Cal counties with technical assistance around the CalAIM initiative. The County has received new boilerplate templates from CalMHSA for both DMC/SUD treatment services and SMHS Medi-Cal services that include updated programmatic regulatory requirements and updated billing/claiming requirements. County is working on finalizing a new Yolo County SMHS Medi-Cal boilerplate that is in compliance with these changes, a draft of which is attached hereto as Att. A. Draft Yolo County SMHS boilerplate.

The renewal agreement requested in this staff report will be drafted and executed on the finalized Yolo County SMHS boilerplate. County Counsel and the Procurement Division are participating in the review and finalization of the Yolo County SMHS boilerplate. However, due to the timeliness in which the County has been receiving information from DHCS, especially regarding rates, final boilerplate language is still pending.  Approval of this request herein will enable HHSA to expedite processing and approval of the renewal agreement to minimize any lapse in services once we have all of the information from DHCS and have negotiated final rates with our providers.

Due to the significant regulatory and claiming changes driven by the CalAIM initiative, the current agreement cannot be extended on the same terms and conditions and must be replaced by a renewal agreement. HHSA now requests BOS approval of a 6-month extension of the agreement with BHC Heritage Oaks Hospital to provide After-Hours Access and Crisis Services in an amount not-to-exceed $355,025 for the period of July 1, 2023 through December 31, 2023, and delegate signing authority to the Yolo County Board Chair to assist with expediting execution of the renewal agreement. This renewal agreement will also include one (1) 6-month optional extension through June 30, 2024, in an amount not-to-exceed $355,025. A formal solicitation for these services is planned to be released in FY 2023-24.

Performance Measures included in this Agreement are as follows:
Performance measures were included in Agreement No. 18-218 See Att. B. Performance Measures. These performance measures or similar performance measures will also be included in the renewal agreement.

County Counsel - review and approval of the Yolo County SMHS boilerplate
County Counsel - review and approval of the resulting renewal agreements as to form
Department of General Services, Procurement Division
CalMHSA - technical assistance with CalAIM Initiative

On December 20, 2017, the County issued a Request for Proposals (2017 RFP) from qualified community-based organizations to provide After Hours Access and Crisis Services through Bidsync. The 2017 RFP was open for six (6) weeks, and staff offered potential bidders an opportunity to ask questions during a Mandatory Bidders’ Conference on January 3, 2018.  Bidders were also offered the opportunity to submit proposals by dropping off a paper proposal directly at HHSA's Bauer Building

The County received two proposals from this solicitation. A Proposal Review Committee was formed that included three HHSA employees from different branches, and two members from outside entities. The two proposals were evaluated, and because scoring results were very close, it was recommended that individual interviews be conducted to determine the best qualified bidder. Ultimately, the proposal submitted by BHC Heritage Oaks Hospital was selected as the top choice by all members of the Proposal Review Committee.

Additional information regarding the Competitive Bid Process is provided below, including a summary of the RFP evaluation criteria.

Evaluation Criteria Included in RFP

 

On or about June 29, 2022, the County issued a formal request for proposal (2022 RFP) to solicit a provider for a Crisis Now Program which included the provision of a High Tech 24/7 Crisis & Access Call Center. Only two proposals were received and after review, neither proposal was awarded the contract. Since, the 2022 RFP did not result in the selection of a new vendor, services were continued with BHC Heritage Oaks Hospital under Agreement 18-218. HHSA confirms BHC Heritage Oaks Hospital has performed satisfactorily under Agreement No. 18-218. Thus, pursuant to the authority provided to the County Procurement Manager as the County Purchasing Agent under the current Yolo County Procurement Policy, the County Procurement Manager has determined that it is in the best interest of the County to enter into a 6-month renewal agreement, based on satisfactory service and to avoid the interruption of County business. A formal solicitation for these services is planned to be released in FY 2023-24 and a resulting agreement will be issued for FY2024-25.