A. Approve delegation of signing authority for medical provider agreements to the Health Services Director for up to $350,000 per provider per fiscal year and to the County Administrator for up to $500,000 per provider per fiscal year.

B. Direct the department to return annually with a report listing a summary of provider agreements that have been established utilizing this delegation of authority.

The Department of Health Services, division of Alcohol, Drug and Mental Health (ADMH), is responsible for the provision of residential (24/7) care to children, youth, and adults living with serious emotional disturbance, serious mental illness, and/or substance use disorders. The nature of these illnesses necessitates placements at a wide variety of facilities. Therefore, ADMH engages numerous contracts every year with residential facilities to meet the varied needs of these clients. Accordingly, numerous contracts are required to manage the individual needs. Further, frequent amendments are necessary due to shifting locations of placement, differing complexity of the medical needs for patients, and the availability (or lack thereof) of willing and licensed service providers.

Rather than using a competitive bid process resulting in a singular provider to the exclusion of all others these residential service agreements are secured using an "any willing provider" process where any licensed/qualified/appropriate and willing provider of such services can each be engaged with a contract for service. Adequate delivery of this level of care truly takes the entire community of licensed service providers, and significant shortfalls in availability persist.

In order to improve the quality of care delivered to clients, maintain positive vendor relations, and increase the speed at which providers can be paid for services delivered to clients, the department proposes a higher signing authority at the department and CAO levels for these agreements. Specifically, authority for the Health Services Director for up to $350,000 per provider per fiscal year, and authority for the County Administrator for up to $500,000 per provider per fiscal year. This will allow the department to engage service providers, pay claims more quickly, and have greater flexibility in matching clients with the most appropriate and cost effective provider. It will also help in addressing challenges presented by the current space/bed availability at the provider level, and the complexity of the medical/psychiatric care required for clients. All services delivered to clients will continue to be reviewed and authorized in advance for medical necessity by county staff.

A sample listing of service providers is attached as an exhibit, but the network of providers will expand and contract frequently based on current availability.

Department of Financial Services, ADMH Providers and County Counsel

There is no direct fiscal impact from this delegation of signing authority. Payments will be made to medical service providers based on care delivered to clients which has been authorized by county staff based on medical necessity.