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Approve a second contract amendment with Crestwood Behavioral Health, Inc. for $2,230,000 for a total contract amount of $12,345,457 to provide intensive psychiatric services for the current period through June 30, 2025; 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; and Approve an Appropriation Transfer Request in the amount of $713,378 (4/5 vote required)
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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 second contract amendment with Crestwood Behavioral Health, Inc. for $2,230,000 for a total contract amount of $12,345,457 to provide intensive psychiatric services for the current period through June 30, 2025; 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; and approve an Appropriation Transfer Request (ATR) in the amount of $713,378 (4/5 vote required).
SUMMARY:
On June 27, 2023, the Board approved a $10,115,457 contract with Crestwood Behavioral Health, Inc. (CBH) for the period of July 1, 2023 through June 30, 2025, to provide intensive psychiatric services for seriously and persistently mentally ill persons referred by the County, including subacute inpatient residential treatment and rehabilitation and/or stabilization services. Due to increases in both current service utilization and trend in number of individuals being referred for conservatorship, an amendment with CBH is needed to increase the contract by $2,230,000 for a total contract amount of $12,345,457. This increase will provide for the continuing treatment and program placements of County clients.
CBH is one of the largest providers of Institutions of Mental Disorders (IMD) programs throughout the State and 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 the facility locations identified within this contract increased by 29% (from 66 to 85) between FY2022/23 and FY2023/24. 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.
FINANCIAL IMPACT:
Current 1991 Realignment receipts and projected FY2025/26 rollover of 1991 Realignment revenue will fund this amendment. An ATR for $713,378 is recommended as current budget appropriations are unavailable to cover this amendment amount. As this increase relies on future projected rollover funding to cover current-year operations, H&SS is exploring current uses of 1991 Realignment and determining if other funding sources are available to cover expenses. No new County General Fund is being requested with this action; however, if other revenue sources are not identified and expenses outpace revenue receipts for 1991 Realignment, H&SS may return to the Board for a request for additional funding.
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 individual 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 acuity needs show the demand outpacing service availability with the number of IMD beds offered/available across the State decreasing as the number of clients requiring this higher care level of care 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 impacts inpatient care caseload.
The first contract amendment, dated April 4, 2024, was to update service rates in FY2024/25. The contract with CBH is utilization-based and payment is for actual bed usage or services as they occur.
ALTERNATIVES:
The Board may choose not to approve this second contract amendment with Crestwood Behavioral Health. However, this action 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 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