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Approve a second contract amendment with Crestwood Behavioral Health for $217,000 for a total contract amount of $10,871,860 to provide acute psychiatric inpatient services for the current period through June 30, 2024; and Delegate authority to the County Administrator to execute the amendment and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services recommends that the Board of Supervisors approve a second contract amendment with Crestwood Behavioral Health, Inc. for $217,000 for a total contract amount of $10,871,860 to provide acute psychiatric inpatient services for the current period through June 30, 2024; and delegate authority to the County Administrator to execute the amendment and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999.
SUMMARY:
Crestwood Behavioral Health operates a locked acute psychiatric health facility for treating adults 18 years of age and older. The facility has 16 beds, of which 14 are designated as guaranteed beds for Solano County Behavioral Health clients. Contract utilization is on pace to exceed the current contract amount prior to contract expiration on June 30, 2024 due to a higher client census and placement of indigent clients. The recommended contract amendment is needed for the continued care of current clients placed in the psychiatric health facility.
FINANCIAL IMPACT:
The contract is funded by Medi-Cal federal financial participation (FFP), State General Fund (SGF), and 2011 Realignment. Appropriations are available in the FY2023/24 Working Budget for this amendment. There is no impact on the County General Fund.
DISCUSSION:
Locked psychiatric hospitals are used when a client is psychiatrically evaluated and placed on a Welfare and Institutions Code (WIC) section 5150 as a danger to self, danger to others, and/or gravely disabled. Obtaining an available hospital bed has become a greater challenge each year as overall demand has increased, yet the number of psychiatric beds across the State has dramatically decreased. The scarcity of beds routinely results in a client waiting many hours, or sometimes days, for an available bed and subsequent transfer to an appropriate treatment facility. This waiting period is deleterious to client care and causes census problems in the County’s Crisis Stabilization Unit (CSU) and hospital emergency departments. When clients are waiting for transfer to a hospital, they remain in a bed that is thus not available for another client.
Crestwood operates a local psychiatric health facility in Vallejo, the most frequently used facility for the County’s most psychiatrically acute clients. The County has 14 designated and guaranteed treatment beds available and has developed protocols and a strong collaborative relationship with the Crestwood psychiatric health facility staff. County staff are routinely at the psychiatric health facility to engage clients in outpatient services and to facilitate proper discharge placement either to a facility or home.
The County pays for 14 bed days whether they are occupied or not. However, if beds are at risk of being vacant due to fluctuations in demand, the County maintains an arrangement to delegate available beds and their daily costs to Napa County as needed.
When the existing 14 beds are full, clients are admitted to alternative psychiatric hospital facilities in the greater Bay Area and Sacramento and sometimes farther, posing a challenge for families to visit their loved ones. In addition, a significant drawback to most of these alternate hospitals is that they are not eligible for Medi-Cal billing due to the federal “IMD (institution for mental disease) exclusion” that prohibits Medi-Cal billing for adults ages 21-64 years in facilities with greater than 16 beds. Therefore, when placements must be made to alternate facilities, the cost of the admission must be fully covered by county funds (Behavioral Health Realignment and County General Fund). An adult inpatient stay at an alternative hospital averages $1,660 per day, whereas an admission at the psychiatric health facility is $1,074 per day, or $1,124 per day for indigent clients, allowing for Medi-Cal billing and federal financial participation. The County saves approximately $536 per day when clients are placed at the psychiatric health facility, or $5,360 per stay based upon the average 10-day admission.
On June 28, 2022, the Board of Supervisors approved a contract with Crestwood Behavioral Health to continue operating their Psychiatric Health Facility (PHF) in Vallejo. Psychiatric health facilities are licensed by the State Department of Health Care Services. Care includes, but is not limited to, the following essential services: psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration, and appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or outpatient setting. A first amendment, executed on March 3, 2023, modified rates for FY2023/24 without changing the total contract amount.
ALTERNATIVES:
The Board could choose not to approve this contract amendment. This is not recommended as the County is mandated to provide psychiatric services for clients served in the County mental health system who need mental health care for their own safety and the safety of the community. This second amendment will ensure continued acute inpatient psychiatric services are provided to these clients.
OTHER AGENCY INVOLVEMENT:
None.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION