Title
a. Approve and authorize the Director of Health Services or designee to execute a Letter of Agreement with the County of Riverside for the provisions of Short-Term Residential Therapeutic Program (STRTP) treatment services including Case Management, Mental Health Services, Medication Support, and Crisis Intervention for children/youth for a retroactive term of July 1, 2025, through June 30, 2028.
b. Approve and adopt a Letter of Agreement (LOA) boilerplate to contract with County-to-County Short-Term Residential Therapeutic Programs (STRTPs) to ensure timely access to specialty mental health services for children and youth in and out of county placement.
c. Approve and authorize the Director of Health Services or designee to execute a boilerplate Letter of Agreement (LOA) with Short-Term Residential Therapeutic Program (STRTP) providers during Fiscal Year (FY) 2025-2028, where the contract amount for each Letter of Agreement (LOA) with each provider does not exceed $200,000 per fiscal year and where the aggregate for all contracts with providers does not exceed $2,000,000, subject to approval by County Counsel, County Risk Management, and County Auditor-Controller; and
d. Approve and authorize the Director of Health Services or designee to execute up to three future amendments for Letters of Agreement (LOAs) with Short-Term Residential Treatment Programs (STRTPs) that in total does not exceed 10% of the initial Letter of Agreement (LOA) amount specified in each Letter of Agreement (LOA) and does not significantly change the scope of services, subject to approval by County Counsel, County Risk Management, and County Auditor-Controller.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and authorize the Director of Health Services or designee to execute a Letter of Agreement with the County of Riverside for the provisions of Short-Term Residential Therapeutic Program (STRTP) treatment services including Case Management, Mental Health Services, Medication Support, and Crisis Intervention for children/youth for a retroactive term of July 1, 2025, through June 30, 2028.
b. Approve and adopt a Letter of Agreement (LOA) boilerplate to contract with County-to-County Short-Term Residential Therapeutic Programs (STRTPs) to ensure timely access to specialty mental health services for children and youth in and out of county placement.
c. Approve and authorize the Director of Health Services or designee to execute a boilerplate Letter of Agreement (LOA) with Short-Term Residential Therapeutic Program (STRTP) providers during Fiscal Year (FY) 2025-2028, where the contract amount for each Letter of Agreement (LOA) with each provider does not exceed $200,000 per fiscal year and where the aggregate for all contracts with providers does not exceed $2,000,000, subject to approval by County Counsel, County Risk Management, and County Auditor-Controller; and
d. Approve and authorize the Director of Health Services or designee to execute up to three future amendments for Letters of Agreement (LOAs) with Short-Term Residential Treatment Programs (STRTPs) that in total does not exceed 10% of the initial Letter of Agreement (LOA) amount specified in each Letter of Agreement (LOA) and does not significantly change the scope of services, subject to approval by County Counsel, County Risk Management, and County Auditor-Controller.
SUMMARY:
Short-Term Residential Programs (STRTPs) are residential facilities operated by a public agency or a private organization and must be licensed by the California Department of Social Services (CDSS) pursuant to California Health and Safety Code section 1562.01. The statute requires that an integrated program of specialized and intensive care, services and supports, treatment, and short-term 24-hour care and supervision be provided to children and youth who are Wards and Dependents of the Court and/or Non-Minor Dependents (NMDs). The program's goal is to move the youth to a less restrictive environment within six months. The care and supervision STRTPs provide are nonmedical, except as otherwise permitted by law. STRTPs are designed primarily for youth aged 12 to 20. These programs may be operated by private organizations, which must be organized and operated on a not-for-profit basis. Only state-licensed, county-contracted agencies may provide STRTP services.
STRTPs provide short-term, specialized, and intensive behavioral health treatment to Wards and Dependents of the Court and NMDs whose needs cannot be safely met initially in a family setting. These core Specialty Mental Health Services (SMHS) are provided by STRTP staff through an agreement with the County of Monterey Health Department, and include, at a minimum, medication support services, case management, crisis intervention, and mental health services (e.g., assessment, individual and group therapy).
DISCUSSION:
Effective July 1, 2017, AB 1299 added Welfare & Institutions Code section 14717.1, which established presumptive transfer to ensure that Wards and Dependents of the Court and Non-Minor Dependents (NMDs) receive timely Specialty Mental Health Services (SMHS), regardless of where they are placed. When a child or youth from one county (called “county of original jurisdiction”) is placed in another county, presumptive transfer places responsibility for the provision and payment of SMHS on the county in which the youth is placed (called “county of residence”).
Effective July 1, 2024, AB 1051 implemented changes to presumptive transfer when a NMD is placed outside of the county of original jurisdiction in a community treatment facility, group home, Short-Term Residential Therapeutic Program (STRTP), or a children’s crisis residential program. In these specific placement settings, the county of original jurisdiction will now be responsible for the provision and payment of SMHS, unless very specific exceptions apply.
AB 1051 requires the placing agency (Child Welfare or Probation) to notify Monterey County Health Department of the placement. Monterey County Health Department must then enter into an agreement for SMHS. County-to-county agreements require this within 30 days. Direct STRTP agreements have a mutually agreed timeframe. STRTPs will often not accept placement of a child or youth without a SMHS agreement in place or a specific timeline for entering into an agreement, as these are often small facilities that rely upon consistent funding for operations.
There are over 300 licensed STRTPs in California, meaning Monterey County placing agencies may place youth in any of these facilities that may meet that individual’s needs. With the changes implemented under AB 1051, the Monterey County Health Department must be able to expeditiously enter into agreements with a county or STRTP once notified of a potential placement by a Monterey County placing agency. These placements typically do not occur with a significant amount of time for planning and sometimes are done on an urgent basis. Monterey County Health Department is able to utilize existing agreements with some STRTPs to ensure timely service provision for children and youth in placement. However, several STRTPs are not willing to contract directly with the County of Monterey and require a County-to-County agreement. Monterey County Health Department has developed the attached Letter of Agreement (LOA) template for County-to-County STRTP options to ensure timely access to specialty mental health services for children and youth in out-of-county placement.
The County of Monterey Health Department, Behavioral Health Bureau is seeking the Monterey County Board of Supervisors to adopt and approve the County of Monterey Health Department Behavioral Health Bureau County-to-County Short-Term Residential Treatment Program LOA boilerplate template to contract with STRTPs seeking a County-to-County agreement. The template has been drafted in accordance with the requirements for contract payment reimbursement and cost and revenue reporting of the California Advancing and Innovating Medi-Cal (CalAim) program, a multi-year California Department of Health Care services (DHCS) initiative to improve the quality of life and health outcomes of our population by implementing broad delivery system, program, and payment reform across the Medi-Cal program. The County-to-County LOA template contains the County’s standard 30-day “no cause” provision (Section V, B) and an additional defunding provision (Section V, D), which provides the County the ability to amend or terminate the Agreement in the event of a reduction and/or termination of funding.
As AB 1051 did not include a template agreement, counties have taken different approaches to meeting the statute’s requirements. Riverside University Health System - Behavioral Health has developed a master LOA to utilize with any county seeking to address AB 1051 requirements for SMHS for children and youth placed in Riverside County facilities to which AB 1051 applies. Riverside University Health System - Behavioral Health indicated they would sign the agreement after the County of Monterey Health Department Behavioral Health Bureau staff receives approval of the agreement from the Monterey County Board of Supervisors. Being that Riverside County is home to several STRTPs that Monterey County placing agencies place with the County of Monterey Health Department Behavioral Health Bureau is seeking authority for the Director of Health Services or designee to enter into this Master LOA for SMHS with Riverside University Health System - Behavioral Health.
OTHER AGENCY INVOLVEMENT:
The Office of the County Counsel and Auditor-Controller have reviewed and approved this agreement as to legal form and fiscal provisions, respectively.
FINANCING:
These Agreements are funded by 2011 Realignment (50%) and Federal Financial Participation (50%). The funds for these Agreements are included in the Health Department’s Behavioral Health (HEA012, Unit 8410) Fiscal Year (FY) 2025-2026 Adopted Budgets. The funds for Fiscal Years (FYs) 2026-2027 and 2027-2028 will be included in the Department’s (HEA012, Unit 8410) Requested Budgets, respectively.
BOARD OF SUPERVISORS STRATEGIC PLAN GOALS:
This work supports the Board of Supervisors Strategic Plan Goal(s) by providing exceptional Person-Centered Care through Accessible, Community-Focused Health Services to provide service enhancements to support well-being and quality of life.
Mark a check next to the related Board of Supervisors Strategic Plan Goals:
_x_ Well-Being and Quality of Life
___ Sustainable Infrastructure for the Present and Future
___ Safe and Resilient Communities
___ Diverse and Thriving Economy
___ Administrative
Prepared by: Laura Henderson, Management Analyst II, 235-7548
Approved By: Elsa Mendoza Jimenez, Director of Health Services, 755-4526
Attachments:
Board Report
Attachment A- Letter of Agreement between Monterey County Health Department, Behavioral Health Bureau and Riverside University Health System - Behavioral Health
Attachment B - Letter of Agreement Boilerplate