objection? without objection? without objection. thank you, without objection. item 3. >> clerk: the agreement between health rights 360 or intermediary service for the amount of $16.2 million not to exceed $79 million and an agreement of january 1, 2014 through december 31, 2023. >> it's providing intermediary services through 2023. colleagues, you may remember we heard a similar item back in october for intermediary service for adults an older adults. thank you for coming back to explain this to you. my question to you is why does this need to be a different contract? >> i think that the contract we may have brought last time was for check writing. so this contract and in the

future they probably could be it's a different mechanism and it's more common other contract paid per check. i think it's $3 or something per check and so this is continuing a service and allows us to pay for things which are difficult to pay for using the normal process. so it allows that ability. >> supervisor: thank you. is there any other cliff fiction -- clarification you'd like to offer? it's straightforward. supervisor fewer. >> supervisor fewer: it was chezzen for a it was chosen for a one-year contract without amendments.

this doesn't seem like a good practice. can you respond on that? >> based on -- >> supervisor fewer: we continue with amendment after amendment. >> the solicitation allows for a 10-year contract. it has an initial contract and then options to extend the contract. if we're happy with the contract and this is true for almost all the contracts and specifically speaking for behavioral health services, we have many long-time vendors and so not per se, exactly this, but we have long-term vendors and so if they're doing a good job and we're happy with them, we do annual monitoring. so typically we'll exercise the option because when we do go out to bid and we just finished 20 solicitations in behavioral health services, there's not a lot change -- a significant

amount of change among the vendors interested in doing business with us. so we make adjustments. if there's under spending we'll move money around. it's not that a vendor has the exact same contract through the duration but for business purpose, we tend not to go out to bid unless there's a need to and we're still within the allowable time period. >> sure, so i think my question is also, so we never had a contract before with health 360? >> the contract before that had been awarded to asian american recovery services and we merged and went out to bid again and hr360 got it and that's how it's continued. >> supervisor fewer: are you saying to me after a 10-year period because you said we have an option to renew within a 10-year period we'd be looking at a new contract for longer

than one year so we wouldn't have continual amendment to keep on contracting with health right 360? >> we're exercising more options to extend it. if approved it maximizes the 10-year period for whatever the solicitation period was and then we gout to bid and select a vendor. it may or may not be this ver vernd -- vendor and go into contract and return to the board. >> supervisor: let's go to the budget legislative analyst. item 3. >> the original contract was for $9.7 million and extended from 2014 to 2018 by previous resolution of the board and increase the contract amount to $62.8 million. i want to point out because i don't think it came up in the

discussion the original r.f.p. was for 10 years and the contract was set up. what's previously been approved is the five years with the five-one-year extensions. this would exercise all the contract option to extend through 2023 and increase the amount by $16.3 million from $62 million to $79 million. there's one other issue in the contract the cost of living adjustment that has not -- it would have to be subject to board of supervisors' approval but the number is in the contract and we do recommend approval. >> supervisor: thank you for the recommendation. public comment. no public comment. public comment is closed. i think we got what we need. i'll make a motion to approve and seems the full board with a positive recommendation and send it as a committee record. we'll see this on tuesday's

agenda. thank you. without objection. madame clerk, item 4. >> the resolution approving the amendment to increase the agreement amount by approximately $84.9 million not to exceed approximately $94.5 million from july 1, 2018 through december 31, 2022. >> we have the department of health. >> it's an example of a contract long-term 20-plus years. we bid under two solicitations. one for the residential treatment and one for the out patient treatment in their housing co-op environment. we brought this into a contract. we are now coming back.

we did an initial shorter term negotiating the changes we needed and they wanted to discuss what to put in place. so now we're proposing this contract until december 31, 2022 at which time we'd return to exercise options assuming everything is going okay. >> supervisor: is this a new provider to san francisco? >> no, it's a long term called progress foundation. they've been doing the job 35 years. they're an important part of the behavioral health system of care. they have 133 residential treatment beds they provide with range from acute diversion units to longer term residential

treatment and run an acute care respite instead of having go into psych emergency services can come to the door to stabilize and then be referred to acute diversion unit or residential treatment. it's a very key part of our system of care and has been for years. >> supervisor: how many people do they serve? >> i don't know. they have 133 residential treatment beds and i think the rotation -- here's our person from the director of adult system of care who can speak to that. >> hi, i'm the director for adult behavioral health services. and in terms of the number of people served, our residential treatment episodes run anywhere from three, six, to nine months.

on average the turnover would be 1.5 or so. so 1.5 times the numbers of beds would be the estimated number of clients. >> supervisor: okay. old -- hold on, 1.5 times the number of beds. >> 1.9 is my rough in the moment estimation. >> supervisor: you're supposed to be presenting information to me. >> the number of beds i think is 131 beds. -- 190 beds. -- 133 beds. >> supervisor: interesting i ask a simple question about how many people you serve and i can't get a straightforward answer. >> i can get the answer. >> supervisor: great. what do you look when you

evaluate whether to extend a new contract like this one? i don't know if you want to -- what due to -- do you look to and what are your qualifiers when you're extend new contract similar to this? >> well, there's a lot of indicators that are included in the solicitation. they get selected through the solicitation process. the reason this one we would want to extend, well, first of all, they have to be doing okay in their annual monitoring and meeting all the compliance measures that we have but they have a 133 residential treatment beds which is a significant part of our system. it's not they're licensed in all those facilities so it would not be easy to replace that capacity and we rely on that capacity.

they also have a very robust system of co-ops and supportive housing locations where clients are placed and they provide the wrap-around service to ensure their stability. so what we're looking for in extending them is the knowledge that they're meeting all the requirements both county and state they're meeting their performance objectives, which they are. >> supervisor: performance objectives such as what? can you give an example? >> such as we keep track of residdivism rates, 30 days from when someone leaves, recidivism rates and discharge and treatment and there's also a tool that's used to measure a client's stability and remeasured to compare how they're improving in their own stability. and ability to manage their

day-to-day functioning. there's different measures that measure both the individual client improvement as well as the agency's ability to how they're doing and if the recidivism is high maybe the client was discharged before they were stable and there's a number of compliance items that we measure as well. >> supervisor: all right. i'm going back to my original question, how many people do you serve? >> i have a list of all the programs and the numbers served by programs it will take me a minute to add them all up. >> supervisor: okay. supervisor fewer has a general

question. >> supervisor fewer: the contract states over 10 years or over $10 million goes to the supervisor for approval what if it take over 10 years? >> deputy city attorney, john gibner. the 10-year question whether the $10 million question is whether the city anticipates the contract will cost $10 million over its term. your question about a five-year contract with multiple extensions, if there are extensions built into the contract when it's first signed and the term is going to be over 10 years, that contract comes to the board for approval. if there's a five-year contract without extensions or options to

extend built in goes to the board but if it extends by two years and in year nine wants another two-year extension the department must come to the board that the point to approve because that's when it goes over 10 years. >> supervisor: okay. thank you very much. >> the target numbers and it comes out to 1,300 clients for the beds. >> supervisor: thank you. so my question is just to pivot off this, are we increasing our reach or meeting 1300 this year, how many last year and how many the year before? i'm trying to understand more a little bit more clearly how we're reaching our target. >> i understand. the beds are used very much. they're part of our step-downs

from the psychiatric and patient hospitals and some are stabilization units and we make use of the beds. >> supervisor: i want to ask the budget legislative analyst about bed utilization. in your analysis, dit , does it capture the dollars we're spending are a good return on our investment? >> for this type of analysis we look to see what they have been spending and how the contract -- in this case it was a new contract so we look at the process to see that the process was legitimate. it was a competitive and open process and the contract itself reflects what the r.f.p. says and doesn't have different terms from what was publicly advertised and don't look at

make sure it corresponds to the contract for an amendment we look at see what happened in the original or prior amendments or the original contract to see where they were with that. i would like to say in terms of a deeper look at it we completed and had a hearing and audit report looking at behavioral services an progress foundation was a contract we looked at as part of the audit. so in that purview we did actually did look more closely at the performance and utilization. >> supervisor: what did that audit yield? >> we had several findings. we had an audit yesterday on it. we looked at how we took samples of behavior health contracts and looked at the performance indicators and how it had consistently been looked at and we focus on the performance indicators that were about

client utilization and client outcomes because we were concerned to see how each of the nonprofits and the city civil service clinics were dealing with patients an progress foundation was one of the non-profit contractors we looked at and we looked at city wide utilization and looked at the behavioral health needs and utilization. >> supervisor: and your recommendation is to auto -- is to approve this? if there's any members of the public to comment come up. seeing none, public comment is closed and i'll accept the recommendation and send it to the board with a positive recommendation and send it as a committee report. can i take it without objection? without objection. please, item 5. >> clerk: reading item 5.

>> supervisor: so we've got item 5 is a contract amendment between the department of public health and toyon associates for medicaid and medical. can you tell me what is toyon associates? what kind of a business is this? >> reimbursement services in general. >> supervisor: welcome. >> it's a medicare, medical reimbursement private company that have files medicare and medicaid cost reports to both federal and state regulatory

agencies in order to recoup any uncompensated funds from the programs. >> supervisor: is toyon played a flat fee or the a money they recover? >> both. in certain instances they're paid for a fee-for-service where an hourly rate is paid and for appeal services they perform. >> supervisor: describe to me the instances where they are paid when they recoup? >> generally speaking, there are instance where's regulation is passed down from a federal perspective or from federal regulators that counties or counties who are operating hospitals disagree with and instances where multiple hospitals have a similar issue or take on a similar case, what's created is called group appeals where the zuckerberg

general hospital or hospitals in san francisco are able to participate as a group on an appeal case taken to the administrators and for those cases, it's difficult or the practice that it will receive a percentage for successful appeals. >> >> supervisor: thank you. mr. mario marino, please make your presentation. >> good morning, supervisors. first of all, i'd like to acknowledge the contract is brought to you late due to a staff absence during the time the contract was to have been continued. we've since then addressed staff fully primarily my hire. the proposed resolution would approve a second amendment to the contract to provide

regulatory reporting and reimbursement maximization of medicare and medical programs. the proposed resolution increases the contract amount by $5,555,360. we're exercising the option to extend the term for four years due to the solicitation process as described was the structure and the basis of toyon's services. it's essentially supporting reimbursement services for san francisco general hospital and laguna hospital and health home agency to review and file required regulatory documents with federal and state agencies to maximize revenue to the city.