Approve fourth amendment to ratification Agreement No. 24-47 with American Medical Response to extend the term of the Agreement through December 31, 2024 and add funding in the amount of $365,130 for 2024-25 for a new contract maximum of $1,338,810 for the period of December 31, 2023 through December 31, 2024, for the provision of mobile crisis response services. (No general fund impact) (Sullivan)

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.

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 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.

On or about February 14, 2024, the County issued the optional extension to extend services through June 30, 2024, with no increase to the contract maximum.

On or about March 12, 2024, the parties amended the agreement via the first amendment which added funding in the amount of $243,420 for a new contract maximum of $486,840.
 
On or about May 21, 2027, the parties amended the agreement to add funding in the amount of $121,710 for 2023-24 for a new contract maximum of $608,550.

On or about August 27, 2024, the parties amended the agreement to extend the term of the agreement through September 30, 2024, and added funding for 2024-25 in an amount of $365,130 for a new contract maximum of $973,680.

Approval of this fourth amendment will allow the term of the agreement to be extended through December 31, 2024 and add funding for 2024-25 in an amount of $365,130 for a new contract maximum of $1,338,810. HHSA is also requesting delegated authority to the Yolo County Procurement Manager or designee to execute financial amendments to Agreement No. 24-47 in an amount not to exceed $2,069,070, if needed to prevent a contract lapse, ensure continued compliance with federal and state regulations, and avoid any interruption in services.

Approval of this fourth amendment will allow for the continuation of services and will allow the County be in compliance with DHCS and avoid any potential sanctions.

Performance Measures included in this Agreement are as follows:
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 has performed satisfactorily under this agreement to date and is coordinating with HHSA staff to further develop the program. AMR has responded to 43 mobile crisis service requests during the first three months of this FY, and the average response time of 30 minutes which meet the DHCS time requirement for mobile crisis services.

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, included but were not limited to:
1) Based on the 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 has been a county vendor for over five years providing successful performance; 3) competitive pricing/cost savings; and 4) Without sole source approval the County would not be providing Medi-Cal Mobile Crisis Services to Yolo County residents. 5) The County risks being in violation of State requirements and being sanctioned if services as required in BHIN 23-025 were not provided.