HomeMy WebLinkAboutBAI - Exodus CSU.pdfBoard Agenda Item 38
DATE:May 24, 2016
TO:Board of Supervisors
SUBMITTED BY:Dawan Utecht, Director, Department of Behavioral Health
Robert W. Bash, Director of Internal Services/Chief Information Officer
SUBJECT:Agreement with Exodus Recovery, Inc. for the Provision of Crisis Stabilization Services
RECOMMENDED ACTIONS:
1.Approve and authorize the Chairman to execute an Agreement with Exodus Recovery, Inc., for
the operation of a crisis stabilization center and Access Line answering services, effective July 1,
2016, not to exceed five consecutive years, which includes a three-year base contract and two
optional one-year extensions, not to exceed $50,194,034.
2.Approve and authorize the Chairman to execute a Facility Use Agreement with Exodus
Foundation, Inc., effective July 1, 2016 through June 30, 2021, for County-owned space located at
4411 E. Kings Canyon Road, Fresno, CA 93702, Building 319 (10,450 square feet) to be used by
Exodus Recovery, Inc. to provide crisis stabilization center and Access Line answering services.
Approval of the recommended actions will allow for the provision of adult and youth crisis stabilization services
for clients who may be admitted on a voluntary or involuntary basis. The crisis stabilization centers operate in
separate areas within the County-owned building located at 4411 E. Kings Canyon Road, Fresno, CA 93702.
Additionally, approval will allow for the operation of the County’s State-mandated toll-free answering service
(Access Line) in accordance with State and Federal regulations. The cost of this Agreement will be offset by
Medi-Cal Federal Financial Participation and Behavioral Health Realignment revenues, with no increase in Net
County Cost.
ALTERNATIVE ACTION(S):
On June 30, 2016, the existing crisis stabilization center and Access Line answering service contracts will
expire. If the recommended actions are not approved, the Department of Behavioral Health will be unable to
provide the mandated services. Your Board may direct the Department to assume operation of the crisis
stabilization center and operate the answering service; resulting in added costs to the County and a delay in
services as the Department obtains the required staff and licensure.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum cost for this
Agreement ($50,194,034) will be funded as follows:
·Adult Crisis Stabilization Center: $34,656,897 - funding through Medi-Cal Federal Financial Participation
(FFP) and Behavioral Health Realignment
·Youth Crisis Stabilization Center: $14,018,427 - funding through Medi-Cal FFP and Behavioral Health
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Realignment
·Access Line answering service: $1,518,710 - funding through Mental Health Realignment
Although there is no cost associated with the Facility Use Agreement for lease of County Building 319, the fair
market value for leasing this space for a twelve-month period is estimated to be $156,750; and $783,750 for the
term of the Agreement. This calculation is based on a monthly rent of $1.25 per square foot for 10,450 square
feet. The Internal Services Department - Lease Services concurs with this rate. Sufficient appropriations and
estimated revenues are included in the Department of Behavioral Org 5630 FY 2016-17 Recommended Budget
($9,735,707) and will be included in future requested budgets for the duration of the contract term.
DISCUSSION:
The Adult Crisis Stabilization Center (Adult CSC) has operated from the Kings Canyon Campus since March
2012 and the Youth Crisis Stabilization Center (Youth CSC) has operated from an adjacent location since April
2014. These facilities provide immediate therapeutic response on a short-term basis (lasting less than 24
hours) to stabilize acute mental health crises and to prevent acute psychiatric inpatient hospitalizations. Both
the Adult and Youth CSC serve male and female clients who are exhibiting acute psychiatric symptoms and
either have been placed on Welfare and Institutions Code (W&IC), section 5150 designation or request
admittance to the CSC on a voluntary status. The Youth CSC will also serve foster children and youth who
reside in the County but remain under the original jurisdiction of another county.
On December 10, 2015, the Department released a request for proposal (RFP) for the operation of a 20-bed
Adult and an 8-bed Youth Crisis Stabilization Center (CSC) which closed on January 26, 2016. In addition, the
selected bidder would operate the County’s State-mandated toll-free answering service (Access Line). One
response was received by the incumbent vendor, Exodus Recovery, Inc. (Exodus). On February 8, 2016, an
evaluation panel consisting of staff from the Department of Behavioral Health, a member of the Behavioral
Health Board, and a representative from the Mental Health Patient’s Rights Advocacy Program met to discuss
the merits of the bid and recommended Exodus for the award based on the following:
·Experience operating and maintaining successful Crisis Stabilization Units;
·Strong community ties with clients as well as both medical and mental health agency providers;
·Strong understanding of and commitment to providing quality care to clients in need of crisis stabilization
services; and,
·Willingness to work with the Department to provide quality Access Line answering services.
The current contract for the Adult and Youth CSCs operated by Exodus will terminate on June 30, 2016. Upon
your Board’s approval, the recommended Agreement will become effective July 1, 2016. As the incumbent
vendor, there will be no service disruption or need for client transition. Additionally, all necessary licensing and
staff acquisition has taken place.
Between July 1, 2015 and March 31, 2016, 4,795 total admissions were recorded at the Adult CSC and 1,422
total admissions were recorded at the Youth CSC. Of these admissions, there were 2,590 unique adult clients
and 909 unique youth clients with 15% of the adults and 13% of the adolescents identified as clients with three
or more visits to the CSCs. The average length of stay for these clients was approximately 22 hours with 72%
of the clients discharged to a home, shelter, or other residential facility (an increase from 68.4% in the last
reporting period) and 27% of the clients discharged to a hospital or other inpatient facility.
Clients at both CSCs will include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries,
privately insured and indigent/uninsured clients who are referred by the Department, contract providers with the
Department, hospital emergency departments, law enforcement, or Emergency Medical Services (EMS).
Clients may also be family or self-referred. It is projected that there will be approximately 500 clients referred to
the CSCs monthly.
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Additionally, the Department is State-mandated to maintain a log of all requests for mental health services. This
service is to be provided via a toll-free, 24 hours a day, 7 days a week answering services, in accordance with
Title 9 of the California Code of Regulations. The answering service provides information to callers regarding
access to specialty mental health services, including information about the grievance and appeals processes
and the State’s fair hearing system. Currently, this service is provided through a Purchasing Agreement with
Professional Exchange Service Corporation, whose contract terminates June 30, 2017. Upon your Board’s
approval, transition of Access Line services to Exodus will begin July 1, 2016. After an initial ramp-up period,
the Access Line will be fully operated by Exodus with a September 1, 2016 commencement date and will be in
operation 24 hours a day, 7 days a week.
The recommended Agreement allows the Director to approve changes to the line items within the budget that do
not exceed 10% of the maximum compensation and do not result in any change to the maximum compensation
amount. Language is also included which allows the Director, County Counsel, and Auditor to review and
approve changes in budget line items which exceed 10% of the annual maximum compensation but do not
result in any change to the annual maximum compensation amount. Additionally, Agreement language allows
the Director to approve changes to the volume of units of service/types of service units as well as changes
required due to changes in the law related to mental health treatment, substance use disorder treatment, and
Access Line services. These changes are not to result in any change to the annual maximum compensation.
Also, the recommended Agreement includes language for termination by Exodus, the County, or their designees
upon the giving of sixty (60) days advance written notice. Additional language included allows for the
termination of the Agreement due to non-allocation of funds upon the giving of thirty (30) days advance written
notice to Exodus
Approval of the recommended Facility Use Agreement with Exodus Foundation, Inc. (Exodus’ non-profit
organization) will allow these services to be provided on County-owned property located at 4411 E. Kings
Canyon Road in Fresno (10,450 square feet) and utilize private janitorial and security staff. There is no cost to
Exodus Foundation for use of the County-owned space. The County will provide building maintenance,
landscaping, and utilities. The Facilities Planning Committee discussed and approved the recommended Facility
Use Agreement on April 15, 2016.
OTHER REVIEWING AGENCIES:
During the May 2016 meeting, the Behavioral Health Board was notified of the recommended Agreement and
Actions.
Facilities Planning Committee, April 15, 2016, Agenda Item No. 12
REFERENCE MATERIAL:
BAI Addendum A, March 13, 2012
BAI #39, April 24, 2012
BAI #42 and #44, May 21, 2013
BAI #39, June 17, 2014
BAI #24, March 10, 2015
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Exodus, Inc.
On file with Clerk - Facility Use Agreement
CAO ANALYST:
Sonia De La Rosa
Page 3 County of Fresno File Number: 16-0464