Are County Community Based Organizations (CBOs) Contracts Administered Properly?

Agree. No recommendation,

- Once a contract is awarded, renewing it without going through the process of competitive bidding iswidespread. MHD Response: Disagree (in Part) Explanation: The Mental Health Department executes over 300 contracts annually ina variety of categories (service agreements, CBO contracts, fee-for-service contracts, residential care facility contracts, Skilled Nursing Facilities, inpatient hospitals, state and federal grants, and avariety ofMOUs and interagency agreements). In addition the Department executes approximately 150amendments to these contracts each fiscal year in order to reflect changes in service or funding levels. Of those, 60 contracts are with CBO's for approximately 60 specific programs for adults, older adults and children. This group of providers, along with County operated outpatient clinics, and fee-for-service providers, comprise the provider network that delivers service to approximately 22,000 eligible mental health clients each year. The services are primarily professional mental health treatment services that must be delivered in compliance with State and Federal Medi-Cal Mental Health Managed Care requirements. In 1998,the Board of Supervisors approved the Mental Health Department's proposal to develop a plan and protocol for monitoring the ShortlDoyle agreements with CBO' s utilizing evaluation criteria that included specific performance measures. It was further proposed that the performance evaluation system be applied to county operated programs and that performance oversight be addressed during contract negotiations, in lieu of re bidding. The argument for this model of contract oversight was that ongoing provider continuous quality improvement and participation inquality improvement activities was a more effective method of assuring quality consumer services. Itwas also understood that new program funding would bemade available through an RFP process, thus allowing for new providers to have opportunities tojoin the MHD provider network. With Board of Supervisor approval, the MHD has conducted annual performance reviews of county and contracted (CBO) organizations using the Annual Performance Evaluation process in lieu of rebidding. This method of contract oversight has been effective in supporting providers to continually improve the quality of service and to adapt service improvements that emerge inthe field of mental health. The MHD agrees, however, that it isprudent and in alignment with County policy that all contracts should be subject to periodic rebidding, inaddition to the annual review process. MHD Grand Jury Report Response 7/23/2010 - Many of the current CBO providers have had MHD contracts for many years; and many have multiple programs under their master contract with the MHD. All new programs over the past decade are the result ofan RFP process or a specific alternative process presented to the Board of Supervisors for approval (seeAttachment A). For example, during recent budget reductions, proposals have been made to transfer CBO contracts from other Departments, orto modify current programs as aresult of aredesign process. It is accurate that the MHD has not routinely rebid CBO contracts for specific levels of care (e.g., age-based outpatient, day treatment, residential, crisis). The Mental Health CBO contracts provide 31unique adult and older adult programs, and 31 unique youth programs. Many of these programs are linked sothat they support the goals of a specific MHSA funded work-plan. In addition, we have contracts that are the result of other County agency's programs such as SSA, Probation, Office of Education and DADS. Many ofthese arrangements were made inorder to develop a more effective collaborative program between departments or agencies orto enhance revenue.