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Approve two contracts to provide acute psychiatric inpatient treatment services with St. Helena Hospital and St. Helena Hospital Center for Behavioral Health for $620,136 and with Sierra Vista Hospital for $100,000 for the period beginning October 1, 2016 through June 30, 2018; and Authorize the County Administrator to execute the contracts and any amendments that remain within budgeted appropriations
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Published Notice Required? Yes ___ No _X_
Public Hearing Required? Yes ___ No _ X_
DEPARTMENTAL RECOMMENDATION:
The Department of Health & Social Services (H&SS) recommends that the Board of Supervisors approve two contracts to provide acute psychiatric inpatient treatment services with St. Helena Hospital and St. Helena Hospital Center for Behavioral Health for $620,136 and with Sierra Vista Hospital for $100,000 for the period beginning October 1, 2016 through June 30, 2018; and Authorize the County Administrator to execute the contracts and any amendments that remain within budgeted appropriations.
SUMMARY:
St. Helena and Sierra Vista Hospitals provide acute psychiatric inpatient treatment. Inpatient services include a 24-hour secure setting for assessment, diagnosis, and treatment of individuals in an acute psychiatric crisis. Clients are typically admitted when placed on a Welfare and Institutions (W&I) Code 5150, indicating that the individual is a danger to self, others, or gravely disabled due to a mental illness. Inpatient care includes 24-hour psychiatric and nursing care, crisis intervention services, administration and supervision of the clinical use of psychotropic medications, individual and group psychotherapy, and psychological services.
The contracts with St Helena and Sierra Vista hospital are utilization-based, with H&SS making payments for actual usage as this occurs. These Hospital contracts have been prepared and negotiated in accordance with County purchasing policies and provide for continuous provision of mandated mental health services.
FINANCIAL IMPACT:
The costs associated with the St. Helena Hospital and St. Helena Hospital Center for Behavioral Health and Sierra Vista Hospital contracts are included in the Department’s FY2016/17 Recommended Budget. There is no additional financial impact to the County General Fund.
The County is mandated to provide inpatient services to stabilize an acute psychiatric condition in order for individuals to return to the community or other appropriate placement. Sierra Vista and St. Helena’s Center for Behavioral Health are considered Institutions for Mental Disease (IMD). Due to federal law, Medi-Cal only reimburses the cost of services for youth under the age of 21 and adults over 64 at these facilities. Individuals are placed at these two facilities when the County’s principal inpatient facility contractor, Crestwood, has no beds available, or if they are under 21. Inpatient hospitalizations at these facilities are paid with County General Fund and utilization of these hospital beds is kept to a minimum to reduce fiscal exposure.
DISCUSSION:
As part of maintaining an effective system of inpatient psychiatric care, H&SS contracts with hospitals and psychiatric health facilities that flexibly accept and treat individuals who are placed under a Welfare & Institutions Code 5150 hold. The primary focus is to find the most appropriate level of care for clients with persistent mental illness, and inpatient admissions are usually brief, averaging 7-10 days.
St. Helena Center for Behavioral Health is one of two in-county providers used by Solano County. The Children’s unit is one of the few available child-serving facilities in the region, but its adult units are also used by Solano County when no other beds can be found with its primary inpatient contractor. The current requested amount reflects the fact that it is no longer a principal source of inpatient care for Solano clients due to the inability to recover federal reimbursement. St. Helena Deer Park in Napa and Sierra Vista Hospital in Sacramento provide additional inpatient access when local capacity has been exceeded, in order to maintain the appropriate level of care and preserve the safety of the individual and community. These facilities provide timely access to WIC 5150 beds that allow the County to remain in compliance with lawful mandates for individuals who pose a danger to themselves, others, or are gravely disabled, and to preserve community safety and the safety of the individuals.
On August 26, 2014, the Board approved a contract with St. Helena for $641,200 for the period beginning July 1, 2014 through June 30, 2016. On June 23, 2016, an amendment for $50,000 was approved, increasing the total contract to $691,200.
On June 23, 2015, the Board approved a contract with Sierra Vista for $185,908 for the period beginning July 1, 2015 through June 30, 2016.
These requested contract approvals will maintain continuation of the vital services provided by the contractor.
ALTERNATIVES:
The Board could choose not to approve the contracts with St. Helena and Sierra Vista Hospitals. This is not recommended as it could result in failure to meet mandated requirements and pose risk to individuals requiring inpatient psychiatric hospitalization.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed the contracts for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION