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Board Agenda Item 36
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DATE: February 28, 2023
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment I to Master Agreement with Licensed Providers for the Provision of
Telemedicine Services
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute Amendment I to Master Agreement with Licensed
Providers for Telemedicine Services to revise service reimbursement rates for contractors Dr.
John L. Schaeffer, Inc. and Thomas Milam MD, Inc., and to add Traditions Psychology Group, Inc. as
a contractor,with no change to term of January 1, 2020 through June 30, 2024 and no change to the
contract maximum of$33,101,120.
Approval of the recommended actions will revise service reimbursement rates for Dr. John L. Schaeffer, Inc.
and Thomas Milam MD, Inc. as well as add one additional contractor, Traditions Psychology Group, Inc. to
the master agreement. These actions will allow the Department of Behavioral Health (Department)to
competitively recruit through the contractors and retain qualified and experienced psychiatrists and
psychiatric nurse practitioners to provide psychiatry services through telemedicine. This item is countywide.
ALTERNATIVE ACTION(S):
If your Board were not to approve the recommended actions, the Department would continue to struggle to
meet essential needs for psychiatric services for severely mentally ill adults and seriously emotionally
disturbed children and adolescents.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost of
the master agreement is $33,101,120 and will be financed with Mental Health Realignment, Mental Health
Services Act funds, and Medi-Cal funds. Actual costs will be determined by actual services provided and
will not exceed $7,525,440 for fiscal year 2022-23. Sufficient appropriations and estimated revenues are
included in the Department's Org 5630 FY 2022-23 Adopted Budget and will be included in subsequent
budget requests for the duration of the recommended master agreement.
DISCUSSION:
On May 1, 2018, your Board approved agreement 18-234 with Central California Faculty Medical Group
(CCFMG)for psychiatric services by licensed psychiatrists serving Department of Behavioral Health clients.
CCFMG would recruit and fill full-time on-site psychiatrist positions; however, the continued shortage of
psychiatrists in the Central Valley and in the state of California resulted in major challenges in recruitment.
On January 18, 2022, your Board approved agreement 22-023, Amendment I to agreement 18-234, to revise
employment incentives and approve a salary resolution to improve the Department's ability to meet the
County of Fresno Page I File Number.23-0097
File Number:23-0097
needs for psychiatry services in Fresno County.
While CCFMG recruits full-time psychiatrists and psychiatric nurse practitioners, the Department continues
to utilize locum tenens psychiatrists to provide onsite psychiatry services and telemedicine psychiatrists to
provide remote psychiatry services. On May 7, 2019, your Board approved master agreement 19-200 for
locum tenens onsite psychiatry services. On January 7, 2020, your Board approved agreement 20-015 for
psychiatry services via telemedicine to serve Department of Behavioral Health clients.
Due to the highly competitive environment for psychiatry services, it is increasingly difficult to attract and
retain qualified and experienced locum tenens psychiatry providers. As a result, it is necessary to, on
occasion, review and moderately revise existing reimbursement rates to be competitive enough to attract
quality providers while not inflating the market unnecessarily.
Although the original agreement authorizes the Department's Director or designee to modify the agreement
and add or delete contractors, your Board has assumed the sole authorization to approve any changes to
the agreement, including additions and deletions of contractors. This Amendment would revise the rates for
existing contractors Dr. John L. Schaeffer, Inc. and Thomas Milam MD, Inc., and add new contractor
Traditions Psychology Group, Inc. The rates for Dr. John L. Schaeffer, Inc. would increase from $234-$244
per hour for psychiatrists to$250-$261. The rates for Thomas Milam MD, Inc. would increase from $213 per
hour to $250-$260 per hour for psychiatrists.
REFERENCE MATERIAL:
BAI #17, January 18, 2022
BAI #48, May 7, 2019
BAI #23, January 7, 2020
BAI #13, May 1, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment I to Master Agreement
CAO ANALYST:
Ron Alexander
County of Fresno page 2 File Number.23-0097