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Approve three contract amendments to provide subacute residential mental health treatment: a first contract amendment with Telecare Corporation for $387,661 for a total contract amount of $536,661 for the current period through June 30, 2025; a first contract amendment with Merced Behavioral Health, LLC for $248,576 for a total contract amount of $1,075,300 for the current period through June 30, 2025, and a third contract amendment with Canyon Manor for $180,000 for a total contract amount of $1,426,068 for the current period through June 30, 2024; and Delegate authority to the County Administrator to execute the three contract amendments 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 (H&SS) recommends that the Board of Supervisors approve three contract amendments to provide subacute residential mental health treatment: a first contract amendment with Telecare Corporation for $387,661 for a total contract amount of $536,661 for the current period through June 30, 2025; a first contract amendment with Merced Behavioral Health, LLC for $248,576 for a total contract amount of $1,075,300 for the current period through June 30, 2025, and a third contract amendment with Canyon Manor for $180,000 for a total contract amount of $1,426,068 for the current period through June 30, 2024; and Delegate authority to the County Administrator to execute the three contract amendments and any subsequent amendments, with County Counsel concurrence, up to an aggregate of $74,999.
SUMMARY:
Throughout the past year, Solano County Behavioral Health has seen an increase in the complex psychiatric and specialized treatment needs of clients, necessitating higher levels of care in both locked and unlocked settings. The three contract amendments are recommended due to the need for additional psychiatric skilled nursing facility beds to continue care for current clients placed in these specialized treatment programs.
Telecare Corporation provides specialized skilled nursing facilities with locked and unlocked settings for neurocognitive and geropsychiatric programs that provide intensive services to support the ongoing needs of high acuity clients with co-occurring psychiatric and medical conditions.
Merced Behavioral Health, LLC is a long-term locked mental health treatment program that provides intensive services to support the ongoing needs of high acuity subacute clients. Individuals placed in Merced Behavioral Health cannot be stabilized in an acute inpatient setting and require a longer period of time in a locked setting for their own safety or the safety of others.
Canyon Manor is a 24-hour mental health rehabilitation center and locked treatment program that provides intensive rehabilitation treatment programming and nursing care for gravely disabled and severely mentally ill clients.
FINANCIAL IMPACT:
The contract with Telecare is funded with 1991 Realignment. Appropriations for the amendment are included in the Department’s FY2023/24 Working Budget. There is no impact to the County General Fund.
The contracts with Merced Behavioral Health and Canyon Manor are funded with 1991 Realignment and County General Fund. Anticipated underspending in other contracted services will provide the additional appropriations for these agreements. No additional County General Fund is being requested for these amendments.
DISCUSSION:
Obtaining available psychiatric skilled nursing facility and Institutions for Mental Disorder (IMD) beds has become a greater challenge each year as overall demand has increased while the number of beds across the state has significantly decreased. These limited resources are further reduced for those clients with co-occurring complex psychiatric and medical conditions.
Locked psychiatric skilled nursing facilities and IMDs are 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 individual rights. Mental health conservatorships, sometimes called LPS conservatorships because they are governed by the Lanterman-Petris-Short Act, can involve confinement in a locked psychiatric facility to achieve the goal of ameliorating symptoms of grave disability, improving functional impairment, and increasing independence through recovery-based treatment.
Telecare Corporation provides specialized skilled nursing facilities with locked and unlocked settings for neurocognitive and geropsychiatric programs that provide intensive services, including medication management and monitoring for both medical and psychiatric diagnoses, neurobehavioral/cognitive care, and residential care treatment to support the ongoing needs of high acuity clients with co-occurring psychiatric and medical conditions. Telecare is one of the few organizations in California that accepts individuals who have both a neurobehavioral and mental illness requiring a secure environment with structured services.
Solano Behavioral Health entered a two-year contract with Telecare for $149,000 for the period of July 1, 2023 through June 30, 2025. This first amendment is necessary as the increased service demand for this specialized treatment program is on pace to exceed the current contract amount.
Merced Behavioral Health, LLC is a long-term locked mental health treatment program that provides intensive services to support the ongoing needs of high acuity subacute clients, including 24-hour mental health nursing care, personalized treatment plan, structured living environment, mental health education, medication management, residential care treatment, and regular progress evaluations with a psychiatrist and an interdisciplinary treatment team. Individuals placed in Merced Behavioral Health cannot be stabilized in an acute inpatient setting and require a longer period of time in a locked setting for their own safety or the safety of others. The cost of services in this treatment setting is $226.39 per client per day. The contract amendment reflects the recent placement of five (5) additional clients, bringing the total to nine beds for Solano County Behavioral Health clients for the remainder of the contract. This increase will provide for approximately 1,098 additional bed days.
The Merced Behavioral Health contract for $826,724 was approved by the Board as part of the H&SS FY2023/24 master list of contracts on June 27, 2023. The contract amendment is necessary for the continued care of current clients placed in this facility as the current cost of services is on pace to exceed the current contracted amount by $248,576 for the current period through June 30, 2025.
Canyon Manor is a 24-hour mental health rehabilitation center and locked treatment program that provides intensive rehabilitation treatment programming and nursing care for gravely disabled and severely mentally ill clients. In this setting, Canyon Manor supports the ongoing needs of subacute care clients with a personalized treatment plan, structured living environment, mental health education, medication management, and regular evaluation of progress with a psychiatrist and an interdisciplinary treatment team. The cost of services in this treatment setting is $384.36 per client, per day. The third contract amendment reflects an increase in the daily rate and the placement of two (2) additional clients, bringing the total to seven (7) beds for Solano County Behavioral Health clients for the remainder of the contract. This increase will provide for approximately 445 additional bed days.
On June 28, 2022, the Board approved a contract with Canyon Manor for $540,448 for the period of July 1, 2022 through June 30, 2024. On June 27, 2023, the Board approved a first amendment for $705,620 for a total contract amount of $1,246,068 for the continued care of current clients placed in this Mental Health Rehabilitation Center. The second amendment, entered on October 27, 2023, reflected bed rate increases and had no impact on the total contract amount. The third contract amendment is necessary for the continued care of current clients placed in this facility as the current cost of services is on pace to exceed the current contracted amount by $180,000 for the current period through June 30, 2024.
ALTERNATIVES:
The Board may choose not to approve these contract amendments. This is not recommended as it would limit the available skilled nursing facilities that offer treatment programs for Behavioral Health clients with co-occurring complex psychiatric and medical needs and/or chronic grave disabilities and would result in having to move up to four (4) clients currently receiving treatment from Telecare, six (6) clients receiving treatment from Merced Behavioral Health, and five (5) clients receiving treatment from Canyon Manor.
OTHER AGENCY INVOLVEMENT:
None.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION