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Agenda Item
ASR
Control 23-000973 |
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MEETING
DATE: |
02/06/24 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
5 |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Annette
Mugrditchian (714) 834-5026 |
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Veronica
Kelley (714) 834-7024 |
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Subject: Renewal of Contract for Inpatient
Behavioral Health Services
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ceo CONCUR |
County Counsel Review |
Clerk of the Board |
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Concur |
Approved
Agreement to Form |
Discussion |
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3
Votes Board Majority |
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Budgeted: N/A |
Current Year
Cost: N/A |
Annual Cost: FY 2024-25 $16,695,000 |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: N/A |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 12/20/2022 #17, 12/14/2021 #S39N |
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RECOMMENDED
ACTION(S):
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1. |
Approve Amendment No. 2 to renew the
Contract with Aliso Ridge Behavioral Health, LLC for provision of Inpatient
Behavioral Health Services for the term July 1, 2024, through June 30, 2026,
for an amount not to exceed $33,390,000, for a revised cumulative contract
total amount not to exceed $62,005,000. |
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2. |
Authorize the County Procurement Officer
or Deputized designee to execute Amendment No. 2 to the Contract with Aliso
Ridge Behavioral Health, LLC, as referenced in the Recommended Action above. |
SUMMARY:
Approval of Amendment No. 2 with
Aliso Ridge Behavioral Health, LLC, for the provision of Inpatient Behavioral
Health Services will provide services to mentally ill youth and adults to
assist them in successfully reaching psychiatric stabilization to be discharged
or transferred to a lower level of care.
BACKGROUND
INFORMATION:
On December 14, 2021, your
Honorable Board of Supervisors (Board) approved the contract with Aliso Ridge
Behavioral Health, LLC (Aliso Ridge) for the provision of Inpatient Behavioral
Health Services. The term of this contract started upon execution of all
authorized signatures, February 12, 2022, through June 30, 2024.
On December 20, 2022, the Board
approved Amendment No. 1 to increase the amount not to exceed due to the
unanticipated volume of services being provided to adults, ages 22 – 64 years
old, experiencing a mental health crisis being admitted to Aliso Ridge. This
Amendment will allow services to continue for the term of July 1, 2024 through
June 30, 2026. Prior to contract expiration, the Health Care Agency (HCA) plans
to issue a solicitation to continue services.
Part of the Contract with Aliso
Ridge is compensated directly from the Department of Health Care Services
(DHCS), as indicated in the table below under Pay Source. There are two
separate rates for acute psychiatric inpatient hospitalization: 1) a negotiated
rate for Acute hospitalization days, and 2) an Administrative Day Rate, which
is set by DHCS. Administrative days are inpatient stay days for clients who no
longer require acute psychiatric hospital care and are awaiting placement in
subacute or post-acute care.
As noted in the table below, DHCS
does not cover acute inpatient hospitalization costs in Institute for Mental
Disease (IMD) facilities for individuals ages 22 – 64 years old. Therefore,
this client population is compensated by the County of Orange (County) through
HCA.
Bed Rates
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Age
Served |
Negotiated Acute
Bed Rate |
Administrative
Day Rate |
Pay Source |
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12-17 years old |
$1300 |
Set by DHCS |
DHCS |
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18-21 years old |
$1200 |
Set by DHCS |
DHCS |
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22-64 years old |
$1200 |
Set by DHCS |
HCA |
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65 + years old |
$1200 |
Set by DHCS |
DHCS |
Scope
of Services
Aliso Ridge provides Inpatient
Behavioral Health Services to seriously emotionally disturbed and/or acute
mentally ill youth aged 12 – 17 years, adults aged 18 – 64 years and/or older
adults aged 65 and older, who may experience co-occurring medical/substance use
diagnoses and who are experiencing a behavioral health crisis. These
individuals may be deemed a danger to themselves and/or others, or gravely
disabled and require this highly restrictive level of care to ensure the safety
of themselves and/or others. Aliso Ridge provides services to any individual
experiencing a behavioral health crisis requiring acute psychiatric
hospitalization, either on an involuntary or voluntary status. Aliso Ridge
accepts referrals from anywhere in Orange County, including the County Crisis
Assessment Teams, County and contracted outpatient clinics, Full-Service
Partnerships, Law Enforcement, Emergency Departments, County and contracted
Crisis Stabilization Units (CSUs) and self-referred walk-ins. Referrals from
County and County-contracted CSUs are prioritized for admission.
These inpatient services are
recovery oriented, and trauma informed. The staff engage clients in a
non-coercive way and focus on assisting clients to reach psychiatric
stabilization to be discharged or transferred to a lower level of care as
appropriate. Services include, but are not limited to, the following: a series
of medical, physical, and psychiatric assessments to determine the individual’s
treatment needs, psychiatric medication evaluation and ongoing monitoring;
individual, group and collateral therapies, supportive services,
psychoeducational support, continuing care and discharge planning and referral
and linkage to aftercare behavioral health providers for continued treatment.
Performance
Outcomes
The following data is reported to DHCS
during yearly audits of the HCA Mental Health and Recovery Services system of
care. While DHCS monitors acute psychiatric hospital utilization, performance
objectives for this measure are not set. Aliso Ridge hospital utilization will
continue to be monitored through monthly reporting of hospital admissions and
rates of re-hospitalization within seven and thirty days of discharge.
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Medi-Cal Beneficiary Admissions |
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FY 2021-22* |
FY 2022-23 |
FY 2023-24 (YTD**) |
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Youth
(12- 21 years) |
25 |
614 |
219 |
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Adult
(22 – 64 years) |
93 |
675 |
336 |
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Older
Adult (65 + years) |
0 |
0 |
0 |
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Total
Admissions |
118 |
1,289 |
555 |
*Services began on February 12, 2022
** YTD is July – October
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FY
2021-22* |
FY
2022-23 |
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Total Admissions |
118 |
1,289 |
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Total Readmissions within 7 Days
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8 (7.3%) |
133 (10.7%) |
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Total Readmissions within 30 Days
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15 (13.6%) |
272 (21.8%) |
*Services began on February 12, 2022
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FY
2023-24 YTD (July – October) |
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July |
August |
September |
October |
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Total Admissions Per Month |
132 |
136 |
124 |
163 |
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Readmissions within 7 Days |
6 (7.4%) |
12 (8.7%) |
20 (14.9%) |
13 (8.6%) |
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Readmission within 30 Days |
9 (11.1%) |
20 (14.5%) |
36 (26.9%) |
32 (21.2%) |
After opening in February 2022, Aliso
Ridge continued hiring licensed staff to allow to continue to open beds until
max bed capacity was reached in FY 2022-23. Since all beds have been opened,
the expectation is for admissions numbers to remain stable.
The Contract does not currently
include subcontractors or pass through to other providers. See Attachment B for
Contract Summary form. The Orange County Preference Policy is not applicable to
this Amendment.
Contractor’s performance has been
confirmed as satisfactory. HCA has conducted due diligence on Contractor and
has verified there are no concerns to address with respect to Contractor’s
ownership/name, litigation status or conflicts with County interests.
HCA requests that the Board approve
Amendment No. 2 with Aliso Ridge Behavioral Health, LLC, for the provision of
Inpatient Behavioral Health Services, as referenced in the Recommended Actions.
FINANCIAL
IMPACT:
Appropriations for this Amendment
will be included in Budget Control 042 FY 2024-25 Budget and will be included
in the budgeting process for future years.
Should services need to be reduced
or terminated due to lack of funding, these Contracts contain language that
allows HCA to give 30 days’ notice to either terminate or renegotiate the level
of services provided. The notice will allow HCA adequate time to
transition or terminate services to clients, if necessary.
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A – Amendment No. 2 to Contract MA-042-22010732 for the Provision of Inpatient
Behavioral Health Services
Attachment B - Contract Summary Form
Attachment C - Redline version of Attachment A