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Approve 2 contracts, one with Medmark Treatment Centers - Fairfield, Inc. for $1,416,432 and the other with Successful Alternatives for Addiction and Counseling Services, Inc. for $1,226,366, to provide narcotic treatment services beginning on October 1, 2018 through June 30, 2019; Authorize the County Administrator to execute contract amendments that are within budgeted appropriations; Authorize the Director of Health and Social Services to execute any amendments which are technical or administrative in nature and have no fiscal impact; and Approve an Appropriation Transfer Request in the amount of $1,930,297 (4/5 vote required)
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Published Notice Required? Yes ___ No _X__
Public Hearing Required? Yes ___ No _X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors approve two contracts, one with Medmark Treatment Centers - Fairfield, Inc. for $1,416,432 and the other with Successful Alternatives for Addiction and Counseling Services, Inc. for $1,226,366 to provide narcotic treatment services beginning on October 1, 2018 through June 30, 2019; Authorize the County Administrator to execute contract amendments that are within budgeted appropriations; Authorize the Director of Health and Social Services to execute any amendments which are technical or administrative in nature and have no fiscal impact; and Approve an Appropriation Transfer Request in the amount of $1,930,297 (4/5 vote required).
SUMMARY:
NTP services have been offered in Solano County through direct contracts between the providers and the State; however, the California Department of Healthcare Services (DHCS), on May 3, 2018, notified the County that under the Drug Medi-Cal program, the County must “provide, arrange, or subcontract” all required services which includes NTP services. The notice indicated the County was not in compliance with one or more services required in the Drug Medi-Cal program, specifically Narcotic Treatment Programs (NTP), in which individuals are prescribed methadone to address their opioid addiction
In response to the notice of non-compliance from DHCS, H&SS submitted a Plan of Correction to DHCS for full compliance with the Drug Medi-Cal program by October 1, 2018. The proposed contracts with the two providers brings Solano into compliance with the requirement that NTP services be direct contracts with the County. The amounts for each contract for NTP services is set based upon prior year claims, as reported by DHCS. Under these contracts, H&SS anticipates serving approximately 550 individuals, a number similar to 2017 when the contracts were held by DHCS.
DISCUSSION:
Background:
NTP services are associated with a 1994 federal court decision, Sobky vs. Smoley (855 F. Supp. 1123), which required the “State to assure that all eligible categorically needy individuals receive methadone maintenance treatment services that are equal in amount, duration, and scope; that all eligible categorically needy persons receive methadone maintenance treatment services that are at least equal in amount, duration, and scope to services provided to medically needy persons; and that no persons eligible for Medi-Cal funded methadone maintenance treatment services will be placed on waiting lists for such services due to budgetary constraints.” This court case addressed the lack of uniformity among California counties in the availability of methadone treatment in that services were available in some counties but were not in others which was viewed as a violation of the federal Medicaid program. At the time of the court decision counties were allowed to implement any part of the Drug Medi-Cal program that they wanted. To finance Drug Medi-Cal programs and other substance treatment programs, the State allocated a fixed amount of funds that could be split between Drug Medi-Cal and other program at the discretion of the counties. Medium and small counties objected based on the inadequacy of the state allocated funds. In response to the objections, the State allowed the NTP providers to contract directly with the state agency which administered drug and alcohol programs at the time. Locally, Baymark Corporation branches, including Med Mark Treatment Centers - Fairfield, Inc. and Successful Alternatives for Addiction and Counseling Services, Inc. sought and received direct contracts with DHCS.
Today, 2018, the access to NTP services are structured across the State with the exception of who holds the treatment contracts. The recommended Board action will address the remaining State requirement that the County hold the contracts for the services. The cost of the NTP services is funded between federal, State and local funds, and he County share is paid from use of 2011 Realignment.
FINANCIAL IMPACT:
Federal Financial Participation, State General Fund, and 2011 Realignment fund NTP services. The FY2018/19 Adopted Budget currently includes $950,000 in appropriation that was associated with the County’s responsibility to provide DHCS the 50% nonfederal share for these services under the State’s management of the agreements. An ATR in the amount of $1,930,297 is recommended to appropriate the unanticipated costs and revenue associated with executing these agreements for the 9-month contract term (4/5 vote required). The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2018/19 Adopted Budget.
ALTERNATIVES:
The Board could choose not to approve the contracts, but that will continue the County’s non-compliance with its Drug Medi-Cal contract. As stated in the DHCS-county contract for Drug Medi-Cal, DHCS has the right to withhold funds in the event of non-compliance.
OTHER AGENCY INVOLVEMENT:
No other County agencies are involved.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION