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Approve a third contract amendment with Crestwood Behavioral Health, Inc. for $192,000 for a total contract amount of $12,537,457 to provide intensive psychiatric services from July 1, 2023 through June 30, 2025
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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 (H&SS) recommends that the Board of Supervisors approve a third contract amendment with Crestwood Behavioral Health, Inc. for $192,000 for a total contract amount of $12,537,457 to provide intensive psychiatric services from July 1, 2023 through June 30, 2025.
SUMMARY:
Crestwood Behavioral Health, Inc. (CBH) is one of the largest providers of Institutions of Mental Disorders (IMD) programs throughout the State. The organization has demonstrated the ability to provide specialized levels of care to meet the needs of Solano County’s most vulnerable behavioral health clients. In addition, CBH consistently manages 33% of the County’s clients in its subacute care program who reside at various treatment locations. The number of unduplicated clients served across facility locations identified within this contract increased by 29% (from 66 to 85) between FY2022/23 and FY2023/24, and 38% (from 85 to 118) between FY2023/24 and FY2024/25. During the last year, Solano County Behavioral Health has seen an overall increase in the complex psychiatric and specialized treatment needs of clients, necessitating a higher level of care in both locked and unlocked settings.
Due to the increase in service utilization and number of individuals referred for conservatorship, a third amendment is needed to increase the contract to $12,537,457 to provide for the treatment and program placements of County clients in FY2024/25.
FINANCIAL IMPACT:
The contract amendment will be funded with 1991 Realignment. The need for this third amendment was not anticipated for FY2024/25; therefore, FY2025/26 appropriations will be used as the date has passed by which departments can utilize prior year funding. Health and Social Services will assess the impact of this third amendment on current year appropriations as part of the Midyear reporting process and will adjust appropriations at that time if needed. There is no additional financial impact to the County General.
DISCUSSION:
Institutions of Mental Disorders (IMDs) are locked treatment programs used when a client is psychiatrically evaluated to be chronically gravely disabled and placed under a mental health conservatorship by an order of the court. The purpose of mental health conservatorships is to provide individualized treatment, supervision, and living arrangements for people who are seriously mentally ill while still protecting their rights. Mental health conservatorships are governed by the Lanterman-Petris-Short Act, also known as LPS conservatorships and can involve confinement in a locked psychiatric facility to achieve the goal of ameliorating the symptoms of grave disability, improving functional impairment, and increasing independence through recovery-based treatment.
Obtaining an available IMD bed has become a greater challenge each year as mental health clients’ needs are outpacing service availability and the number of IMD beds offered/available across the State decreasing as the number of clients requiring this higher care level is increasing. Moreover, the growth in the number of clients being referred for LPS conservatorship from local inpatient psychiatric hospitals is partly due to changes in legislation that now give courts more latitude in ordering LPS conservatorship evaluations for misdemeanants who present with behavioral health symptoms. This change in LPS investigation orders has also resulted in an increase in conserved clients, requiring both augmented board and care and IMD placements. Additionally, the Kaiser Medi-Cal specialty mental health services’ clients transitioning from Kaiser to County Behavioral Health also increased inpatient care caseload.
On June 27, 2023, the Board approved a $10,115,457 contract with Crestwood Behavioral Health, Inc. for the period of July 1, 2023 through June 30, 2025. On April 4, 2024, the contract was amended to capture rate changes without affecting the contract amount or term. However, due to increases in both service utilization and number of individuals being referred for conservatorship, the Board approved a second amendment on December 10, 2024 to increase the contract by $2,230,000. A third amendment for $192,000 is now needed as the second amendment was not sufficient to cover the actual cost of treatment services provided and program placements of conserved County clients for FY2024/25. The third amendment provided for an additional 530 bed days at an average cost of $360 per bed day.
ALTERNATIVES:
The Board may choose not to approve this third contract amendment. However, 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 third amendment will ensure continued intensive psychiatric services are provided to these clients.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION