LAKEPORT >> At the Board of Supervisors meeting Tuesday an appeal to approve extending a third party contract between the Community Behavioral Health Department and Lake County stimulated push back because of a high price tag and whether same service could be done in-house.
The Behavioral Health Department requested extending an ongoing contract for $1 million to a contractor client for a substance use disorder medication for behavioral health patients in treatment for fiscal year 2025/26. Lake County Behavioral Health Director Elise Jones noted she was delighted to bring the agreement forward because it was a significant step forward and represents implementing the department’s organized drug/medical delivery system. “We do not have any Medical Assisted Treatment (MAT) programs, or very few, ” she explained to the BOS. “Not enough for these services so, we’re thrilled we now have one in health. It initially started with our own (department) so, our contractor provider clients can have access so, we hope we can expand MAT availability across the community.”
Yet District 2 Supervisor Bruno Sabatier explained he struggled with this item since the county already has a relationship with Behavioral Health and that is for mental health services. He wondered, however, is this contract for substance use or is it a new contract for what was already started up in the first place. Jones clarified that they already had a long relationship with Behavioral Health, which started in ’21/’22/’23. “We issued a Request For Proposal, for our Specialty Mental Health Services, for Psychiatry and Nurses Staff and they’ve been filling those Full-Time Equivalent needs for some time and now this is a newer relationship, with staffing for MAT, specifically prescribing for a nursing staff.”
Yet Sabatier recalled a prior contract that the county had for specialty mental health services because he approved it and since he reviewed it again, it brings up concerns. “Not about the needs and not about the services, but they (contractor clients) are using our facilities, but I don’t see any lease agreement and how that functions,” he said. “How does that function? Are we paying for janitorial and electricity? But the cost of each of those services are high.” Additionally, the county contracts for individuals who carry out the services, such as an LVN, an RN and a doctor. Meanwhile these are positions the county could possibly hire for. “We need a conversation about what the labor union would say,” he remarked. “There is still an outstanding loan currently and adding more services in an atmosphere of a complete unknown as to what is going to happen with Medicaid.”
Jones noted the rates of service are billed as fee for service when delivered. “They bill us at 65% of the rate, so those rates listed on the sheet of 100% yet we retain 35% for administrative burdening. We used our percentage of retaining and support of our facility.” She went on to note as per the lease agreement, fees for service are charged at Medicaid rates. So, it means Medicaid is fully reimbursable. “To date, Medicaid continues to flow and we have not seen any impact to the Medicaid system. And the loan doesn’t pertain to the DMC, ODS or SUDT budget, it pertains to Special Mental Health so, it is a different budget.”
Yet since the opioid crisis, there is more concern about how MAT services are dispensed. So, the county is working on convening with other health care providers to get everybody on the same page about MAT. And for anyone who walked into an Emergency Department could receive MAT. “What we do is offer MAT combined with outpatient counseling so, it is programmatically based.” And for people who participated in a MAT program and feel they have achieved a sustained level of progress, they could transition to their primary care provider, who would resume care.” So there are a lot of different scenarios, according to Jones.
“We have a lot of great individual MAT prescribers in the community but having a specialized MAT Clinic, where it’s embedded within a program of outpatient counseling and services is something that has not been a strong offering in Lake County to date,” she said.
District 4 Supervisor Brad Rasmussen asked about the lack of a lease agreement. Jones replied they have not had such an agreement to date but maintained a business agreement. “We’ve done a bit of risk analysis to ensure contractors are not supervising employees or ever ask them to pay for space they utilize in county clinics since they provide services to the county’s beneficiaries.” A motion was called for and seconded and a vote was called. The board passed approval for the contract 3-2 with Sabatier and Owen opposed.
