Adopt budget resolution to amend and adjust the Health and Human Services Agency budget for Fiscal Year 2024-25 to reflect an increase of $246,935 for the Adult Outpatient Mental Health Cost Center in the Adult & Aging Branch; and approve sixth amendment to Agreement No. PO 4385 with LocumTenens.com to extend the term of the Agreement through June 30, 2026; add funding in the amount of $331,935 for 2024-25; add funding in the amount of $715,000 for 2025-26 for a new contract maximum of $2,573,690 for the period of July 1, 2022 through June 30, 2026; and increase option year funding, for the provision of adult psychiatric staffing services. (No general fund impact) (4/5 vote required) (Sullivan)

Resolution for Budget Amendment
On or about September 24, 2024, the Board of Supervisors for the County of Yolo adopted a budget for fiscal year 2024-25 for the Health and Human Services Agency (“HHSA”). During the adopted budget process, HHSA Fiscal staff were unaware of an increase to the Mental Health Services Act (“MHSA”) budget for fiscal year 2024-25 as the MHSA budgeting tool was not yet complete and approved; therefore, the additional funds were not included in the adopted budget process.

For reference, on or about August 29, 2023, the County approved HHSA’s MHSA Three-Year Program and Expenditure Plan for fiscal years 2023-2026. The services provided by LocumTenens were approved as part of HHSA’s MHSA 3-Year Plan.

Approval of the request herein will enable HHSA to add the amount of $246,935 to the Health and Human Services Agency adopted budget for fiscal year 2024-25 and subsequently amend to increase the LocumTenens contract.

Contract Amendment
On or about June 22, 2022, the County entered into Agreement Legacy PO No. 4385 (the Agreement) with LocumTenens.com for the provision of adult psychiatric services for eligible Yolo County clients including County residents conserved under the Lanterman-Petris-Short (LPS) Act. County Behavioral Health programs rely on short-term contracted psychiatric providers to augment their county staffing as recruitment and retention of such staff (i.e., psychiatrists and psychiatric nurse practitioners) is very difficult in this field. Contracting with LocumTenens.com provides professional staffing augmentation, recruitment, presentation, and management which is the best option as this is a challenging process for the County.

On or about February 21, 2023, the parties amended the Agreement via the first amendment (Agreement No. 23-48) to add funding in the amount of $295,000 for 2022-23 to account for the ongoing inability to recruit and retain psychiatry staff who wish to fill a vacant County position.

On or about May 9, 2023, the parties amended the Agreement via the second amendment (Agreement No. 23-86) to add funding in the amount of $200,000 for 2023-24 and $215,000 for 2024-25 to account for the continued ongoing inability to recruit and retain psychiatry staff who wish to fill a vacant County position.

On or about July 25, 2023, the parties amended the Agreement to add funding to account for the continued ongoing inability to recruit and retain psychiatry staff. In FY23/24, HHSA had three consistent locum tenens staff that covered vacancies and helped meet the current need. The second amendment also increased the maximum hourly rate for Psychiatry/Telepsychiatry effective July 1, 2023.

On or about June 4, 2024, the parties amended the agreement to add funding to account for the continued ongoing inability to recruit and retain psychiatry staff and fill vacant County positions.

On or about September 10, 2024, the parties amended the agreement via the fifth amendment to add additional funding needed to cover 2023-24 invoices.

Locum Tenens.com Providers continue to be used at a higher level than planned at the start of the fiscal year due to ongoing prescriber employee vacancies. The additional funding is needed as there has been an overall increase in prescriber utilization.

Performance Measures included in this Agreement are as follows:
Performance Measures are not associated with this Agreement. As HHSA does not directly supervise Locum Tenens psychiatric providers and each provider’s contract is secured in three-month increments, the development of an RBA for this contract has not yet occurred. Additionally, the contracted staff schedules vary widely as they may provide temporary and/or fill-in services when HHSA loses an HHSA staff prescriber. Each quarter, a rudimentary prescriber capacity versus need comparison is undertaken to inform ongoing contracted provider arrangements.

County Counsel has approved the Resolution and Sixth Amendment as to form.
Department of General Services, Procurement Division

On April 26, 2022, the then acting Yolo County Procurement Manager or designee approved a sole/single source procurement for these services. Without sole source approval of the agreement with the vendor, the County would lose the staffing of two psychiatrists and one nurse practitioner, resulting in devastating impacts to the County’s ability to provide mandated psychiatric care for County mental health clients. Factors considered, included but were not limited to:

1) the County’s ongoing difficulty in recruiting psychiatrists and nurse practitioners (prescribers) due to statewide staffing shortages; 2) satisfactory vendor performance–the vendor has been a County vendor for over five years providing competitive rates and documented successful performance in recruiting high quality locum tenens providers; 3) competitive pricing/cost savings; and 4) loss of three locum tenens providers from the vendor, who are actively on the HHSA clinic psychiatric staff contingent, carrying a combined case load of hundreds of County mental health clients.