To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Single Case Agreements for Specialty Mental Health Services with Other County Jurisdictions
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE two (2) forms of Single Case Agreements for Specialty Mental Health Services to govern the provision and payment of Specialty Mental Health Services for youth placed into congregate care facilities by county agencies pursuant to California Welfare and Institutions Code Section 14717.25; AUTHORIZE the Health Services Director, or designee, to execute the form agreement with other county jurisdictions, in an amount not to exceed $200,000, to place Contra Costa County clients outside the county; and AUTHORIZE the Health Services Director, or designee, to execute the form agreement with other county jurisdictions to receive funding for non-county clients placed within Contra Costa County.
FISCAL IMPACT:
There is no fiscal impact for this action.
BACKGROUND:
AB 1299, effective July 1, 2017, added Welfare & Institutions Code section 14717.1, establishing Presumptive Transfer, which requires that the responsibility for provision and payment of Specialty Mental Health Services (SMHS) promptly transfers from the county of original jurisdiction (COJ) to the county in which a foster child resides or is being placed in, the county of residence (COR), subject to any exceptions established pursuant to that section. AB 1051, effective July 1, 2024, was enacted to correct AB 1299 in the instances of placements into Short Term Residential Therapeutic Programs (STRTPs) and Crisis Residential programs which are designed to be short term in nature and occur on very short notice. Under AB 1299, counties are allowed to Presumptively Transfer or to contract with and pay STRTPs directly, and also allowed placing counties the ability to pay their own Medicaid match. Under AB 1051 counties are required to retain jurisdictional responsibility when placing a youth out of county (for STRTP or Crisis Residential). This complicated the process and led many STRTP providers to not accept direct county contracts. This combination of not being able to Presumptively Transfer, and in most instances not being able to directly contract with the STRTP/Crisis Residential provider, has led to counties being required to directly contract with each other to pay the county in which the child is placed. Counties are requiring this agreement between the jurisdiction county and the residence county in order to ensure the residence county is not left with the jurisdiction county’s related costs.
By their nature, STRTP and Crisis Residential placements are urgent and occur on an as needed basis without sufficient time to bring them individually to obtain prior approval from the Board of Supervisors. Approval of this action would allow Contra Costa Health Services to enter into single case agreements on a per client basis or multi-case jurisdictional agreements with other counties to both receive their funds if their clients are placed in Contra Costa County or to be able to provide funding for Contra Costa County clients being placed outside the county.
Contra Costa Health Services has drafted the attached templates for Single Case Agreements (aka Letters of Agreement- LoA) to address arrangement and payment of Specialty Mental Health Services (SMHS) for youth admitted into out-of-county Children’s Crisis Residential Programs (CCRP) or placed out of county into congregate care facilities (Short Term Residential Therapeutic Programs - STRTPs, Community Treatment Facilities - CTFs, and Group Homes) by placing agencies (Child Welfare or Probation). Under those circumstances, arrangement and payment of SMHS falls under AB 1051. See BHIN 24-025 ACL 24-23 Presumptive Transfer Policy, also attached. AB 1051 was implemented statewide, however no statewide template contract was adopted for use among participating counties. Many counties developed and approved templates of this kind.
There are two versions of the LoA to address whether a Contra Costa County (CCC) youth is placed out of county, or whether a youth from another county is placed into Conta Costa. The LoA labeled CCC=COJ covers the situation when CCC is the County of Jurisdiction (COJ) and places a minor into another county, the LoA labeled CCC=COR covers the opposite, when other county placed a youth into CCC. The County of Residence (COR) pays for the mental health services provided at a contracted residential facility within its boundaries, and the COJ reimburses the COR the local share of medically necessary SMHS.
Under each Single Case Agreement, both COR and COJ will defend, indemnify, save, and hold harmless each party and its officers and employees from any and all claims, demands, losses, costs, expenses, and liabilities for any damages, fines, sickness, death, or injury to person(s) or property, including any and all administrative fines, penalties or costs imposed as a result of an administrative or quasi-judicial proceeding, arising directly or indirectly from or connected with the services provided hereunder that are caused, or claimed or alleged to be caused, in whole or in part, by the negligence or willful misconduct of the other party, its officers, employees, agents, contractors, subcontractors, or any persons under its direction or control. If requested by either party, the indemnifying party will defend any such suits at its sole cost and expense. If the indemnified party elects to provide its own defense, the other party will reimburse the indemnified party for any expenditures, including reasonable attorney’s fees and costs.
Each party’s indemnification obligations exist regardless of concurrent negligence or willful misconduct on the part of the other party or any other person; provided, however, that COR and COJ are not required to indemnify each other for the proportion of liability a court determines is attributable to the sole negligence or willful misconduct of the other party. This provision will survive the expiration or termination of the Agreements.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, Contra Costa County Health Services would not have approved templates for Single Case Agreements for Specialty Mental Health Services, which will impact the County’s ability to quickly address the, often, urgent arrangement and payment of Specialty Mental Health Services youth placement.
CHILDREN’S IMPACT STATEMENT:
The recommendation supports the following children’s outcomes: Children Ready for and Succeeding in School; Children and Youth Healthy and Preparing for Productive Adulthood; and Communities that are Safe and Provide a High Quality of Life for Children and Families.