Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  19-000374

 

MEETING DATE:

05/21/19

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

Annette Mugrditchian (714) 834-5026 

 

 

Jeff Nagel (714) 834-7024

 

 

Subject:  Psychiatric Skilled Nursing Facility and Intensive Residential Services

 

      ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

 

 

3 Votes Board Majority

 

 

 

    Budgeted: N/A

Current Year Cost: N/A

Annual Cost: FY 2019-20 $12,274,690
FY 2020-21 $12,704,304
FY 2021-22 $13,148,955

 

 

 

    Staffing Impact:

No

# of Positions:

Sole Source: No

    Current Fiscal Year Revenue: N/A

  Funding Source: GF: 12%, State: 88% (Mental Health Realignment, Vehicle License Fee, Managed Care, Purpose Restrict Rev-Int)

County Audit in last 3 years: No

 

 

    Prior Board Action: 03/28/2017 #16, 05/24/2016 #57, 05/06/2014 #24

 

RECOMMENDED ACTION(S):

 

 

1.

Approve the Master Agreement with various providers for provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the period of July 1, 2019, through June 30, 2022, for a total aggregate maximum obligation not to exceed $37,006,714.

 

2.

Approve the selection of and the Agreement with Anne Sippi Clinic Treatment Group for provision of Adult Mental Health Intensive Residential Services for the period of July 1, 2019, through June 30, 2022, for a total maximum obligation not to exceed $1,121,235.

 

3.

Pursuant to Contract Policy Manual Section 3.3-114, authorize the Health Care Agency Director, or designee, to exercise a contingency contract cost increase not to exceed $1,191,372 which is 10 percent of the contract amount for the first year of the contract, for the entire term of the Agreement in Recommended Action #1, including renewals, and within the scope of work set forth in the contract. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer. The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

 

4.

Pursuant to Contract Policy Manual Section 3.3- Health Care Agency Director, or designee, to exercise a contingency contract cost increase, not to exceed a total of 10 percent of the contract amount for the first year of the contract, for the entire term of the Agreement in Recommended Action #2, including renewals, and within the scope of work set forth in the contract. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer. The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

 

5.

Authorize the Health Care Agency Director, or designee, to execute the Agreements, as referenced in the Recommended Actions above.

 

 

 

 

SUMMARY:

 

Approval of the Master Agreement for provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services and the Agreement with Anne Sippi Clinic Treatment Group will provide psychiatric skilled nursing facility and intensive residential treatment services to severely mentally ill residents of Orange County.

 

 

 

BACKGROUND INFORMATION:

 

On May 6, 2014, your Honorable Board of Supervisors (Board) approved the Master Agreement for provision of Adult Mental Health Psychiatric Skilled Nursing Facility (SNF) Services and the Agreement with Anne Sippi Clinic Treatment Group (Anne Sippi) for provision of Adult Mental Health Intensive Residential Services for period of July 1, 2014, through June 30, 2017.  During FY 2015-16, a First Amendment to the Master Agreement was executed to exercise the 10 percent contingency increase to meet the need for additional SNF services. On May 24, 2016, the Board approved a Second Amendment to the Master Agreement to increase funding for FY 2016-17. On March 28, 2017, the Board approved Master Agreement for provision of Adult Mental Health Psychiatric SNF Services, and the Agreement with Anne Sippi for the provision of Adult Mental Health Intensive Residential Services for the period of July 1, 2017, through June 30, 2019. The current Agreements will end June 30, 2019.

 

The Health Care Agency (HCA) released a solicitation on December 18, 2018.  Seven bids were received for provision of Adult Mental Health Psychiatric SNF Services.  One bid was determined to be non-responsive.  The remaining six bids were evaluated by the panel and all six are recommended for services.  Anne Sippi was the only bidder for provision of Adult Mental Health Intensive Residential Services.

 

No new qualified providers were identified through the solicitation, and the proposed Agreements will allow services to continue July 1, 2019, through June 30, 2022.

 

The Contractor's performance has been confirmed as satisfactory. HCA has verified there are no concerns that must be addressed to Contractor's ownership/name, litigation status or conflicts with County interests.

 

Each individual Agreement will share the annual maximum obligation and funding between the Board approved providers, which will vary based on utilization. HCA requests that the Board approve the selections and the Agreements for the provision of Adult Mental Health Psychiatric SNF Services and Adult Mental Health Intensive Residential Services.

 

Psychiatric SNF Services

 

HCA currently contracts with six organizations to provide Psychiatric SNF Services for severely mentally ill Orange County clients who are residing in locked and unlocked Skilled Nursing Facilities.

 

Provider

City

Downey Community Health Care

Downey, CA

KF Community Care, LLC dba Community Care Center

Duarte, CA

Landmark Medical Services Incorporated

Pomona, CA

Riverside Sanitarium, LLC dba Riverside Health Care Center

Riverside, CA

Sylmar Health and Rehabilitation Centers Incorporated

Sylmar, CA

Vista Woods Health Associates, LLC Vista Knoll Specialized Care Facility

Vista, CA

 

These programs operate 24 hours per day, seven days per week, and provide recovery-based mental health services including medication management and a minimum of 27 hours per week of structured therapeutic group activities. 

 

The proposed Agreement reflects a 3.5 percent rate increase each year, consistent with the State mandated rate setting for these types of services. Utilization has increased to 54,780 beds days in FY 2017-18 and remains high with 41,145 used in the first 3 quarters of FY 2018-19 leading to a projection of 55,395 bed days for FY 2018-19. The majority of consumers placed in these programs are Lanterman-Petris Short conservatees, referred from either the State hospital system or acute care hospitals, with a long history of serious mental illness that requires long-term care.

 

HCA staff have conducted due diligence on the Contractor's performance which has been confirmed as satisfactory.  Contractor is currently under a contract with HCA.  HCA has verified there are no concerns that must be addressed with respect to the Contractor's name/ownership, litigation status or conflicts with County interests. 

 

In addition to the services outlined above, the County provides supplemental rates for specialized services which include programming tailored for those with hearing impairments, medical co-morbidities, and dangerous behaviors which require more intensive behavioral interventions and supervision.

 

The proposed performance outcomes for these programs are to improve client functioning levels and decrease symptoms as evidenced by discharging clients to a lower level of care. 

 

Fiscal Year

Number of Clients Served

Number of Bed Days Utilized

Percent Discharged to Lower Level of Care

Percent Discharged to Higher Level of Care

2017-2018

207

54,780

54%

11%

2018-2019 (July thru March)

188

41,145

50%

23%

 

The rate of discharges to lower levels has risen significantly as reflected in the chart.  In comparison, during FY 2015-16 there were 171 participants served, and a discharge to lower level of care rate of 36 percent. Approximately 25-35 percent of clients are discharged to other locations not considered higher or lower levels of service, usually for treatment of medical comorbidities in general acute hospitals or medical skilled nursing facilities.

 

Intensive Residential Services

 

HCA currently contracts with one organization, Anne Sippi, located in Los Angeles and Bakersfield to provide Intensive Residential Services in two unlocked licensed Board and Care Facilities. The target population for these services are high acuity clients, often from the state hospital or other acute settings who have complex symptoms and are difficult to place in alternate settings.  These services provide a recovery-based, structured psycho-social rehabilitative program that assists clients to move along the rehabilitative continuum.  In addition to one-to-one interaction between clinical staff and clients, there is a minimum of five planned and structured group activities each week provided by psychologists and other clinical staff as well as medication services.

 

The proposed annual maximum obligation for Intensive Residential Services reflects a 3.5 percent negotiated increase in rates for each year and allows for approximately seven clients per day or a maximum utilization of 2,555 bed days annually.

 

Fiscal Year

Number of clients served

Average Length of Stay (LOS) for Clients Completing Program

Percent of Clients Discharged to a Lower Level of Care

2017-18

12

16 Months

37%

2018-19 (July thru March)

13

11 months

17%

 

The LOS for clients completing the program ranges between nine months and 3.5 years.  Those clients discharged to a higher level of care, usually for psychiatric stabilization, have an average LOS of 32 days, and often will readmit to the facility, being given the opportunity to succeed in the program multiple times. However, this may affect the measured outcomes for the program. This program also admits clients directly from the State hospital system and are treating a fragile population.

 

The proposed Agreement with Anne Sippi will not have any subcontracts or pass through to other providers.  See attachment C and D for Contract Summary Forms.  

 

Pursuant to Contract Policy Manual Section 3.3-114, authorize the Health Care Agency Director, or designee, to exercise a contingency contract cost increase not to exceed $1,227,469 which is 10 percent of the contract amount for the first year of the contract, for the entire term of the Agreement including renewals, and within the scope of work set forth in the contract. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer. The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

 

HCA requests that the Board approve the Agreements as referenced in the Recommended Actions.

 

 

 

FINANCIAL IMPACT:

 

Appropriations for this Agreement are included in the FY 2019-20 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, the Agreements contain language that allows the Health Care Agency to give a 30-day notice to either terminate or renegotiate the level of services to be provided.  The notice will allow the Health Care Agency adequate time to transition or terminate services to clients, if necessary.

 

 

 

STAFFING IMPACT:

 

N/A

 

 

ATTACHMENT(S):

 

Attachment A - Master Agreement for Provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services between County of Orange and various providers
Attachment B - Agreement for Provision of Adult Mental Intensive Residential Services between County of Orange and Anne Sippi Clinic Treatment Group
Attachment C - Contract Summary to Attachment A
Attachment D - Contract Summary to Attachment B