Agenda Item AGENDA STAFF REPORT ASR Control 22-000953
MEETING DATE:	05/23/23
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	5
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Annette Mugrditchian (714) 834-5026
	Veronica Kelley (714) 834-7024

Subject: Renewal of Contract for Crisis Stabilization Unit 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 2023-24 $6,203,232

Staffing Impact:

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: State: 50% (Mental Health Services Act/Prop 63), Fees/Other: 50% (Medi-Cal Federal Financial Participation)	County Audit in last 3 years: No
Levine Act Review Completed: Yes

Prior Board Action: 5/24/2022, #38, 3/9/2021 #S27E, 2/11/2020 #6, 3/26/2019 #27

RECOMMENDED ACTION(S):

Approve Amendment No. 6 to renew the Contract with CSU LLC dba College Hospital Crisis Stabilization Unit for provision of Crisis Stabilization Services for the term of July 1, 2023, through June 30, 2024, for an increased amount not to exceed $6,203,232, for a revised cumulative Contract total amount not to exceed $27,509,565.

Authorize the County Procurement Officer or Deputized designee to execute Amendment No. 6 to the Contract with CSU LLC dba College Hospital Crisis Stabilization Unit, as referenced in the Recommended Action above.

SUMMARY:

Approval of Amendment No. 6 with CSU LLC dba College Hospital Crisis Stabilization Unit for Crisis Stabilization Services will allow Orange County to maintain the current resources and capacity for Crisis Stabilization Services for residents experiencing mental health crises and continue to allow residents to be treated in less restrictive and more appropriate levels of care versus inpatient psychiatric hospitalization and emergency department visits.

BACKGROUND INFORMATION:

Your Honorable Board of Supervisors (Board) approved the contract with CSU LLC dba College Hospital Crisis Stabilization Unit (College Hospital CSU) for the provision of Crisis Stabilization Unit Services (CSU) and the below additional actions have been executed pursuant to appropriate authorities. Prior to contract expiration, the Health Care Agency (HCA) plans to issue a solicitation to continue services. The Orange County Preference Policy is not applicable to this Amendment.

Board Date	Contract/Amendment	Action	Term
March 26, 2019	Contract	Board Approved Contract	July 1, 2019 - June 30, 2022
September 1, 2019	Amendment No. 1	Deputy Purchasing Agent (DPA) Authority Revised Tax ID	July 1, 2019 – June 30, 2022
December 1, 2019	Amendment No. 2	DPA Authority Revised Tax ID and modified Budget	July 1, 2019 – June 30, 2022
February 11, 2020	Lanterman-Petris-Short (LPS) designation approval requested to Department of Health Care Services	Board Approved Designation submission by HCA	July 1, 2019 - June 30, 2022
June 1, 2020	Amendment No. 3	DPA Authority Modified Budget	July 1, 2019 - June 30, 2022
March 9, 2021	Amendment No. 4	Board Approved Budget Modification	April 1, 2021 - June 30, 2022
May 24, 2022	Amendment No. 5	Board Approved Budget Modification	July 1, 2023 - June 30, 2024

The proposed increase will allow College Hospital CSU to increase staffing salaries. Additionally, salary adjustments will contribute to College Hospital CSU being able to recruit and retain staff in a very competitive job market and maintain consistent service levels for Orange County residents. The proposed Amendment No. 6 will allow the services to continue through June 30, 2024.

Scope of Services

The College Hospital Crisis Stabilization Unit (CSU) provides emergency mental health evaluations and crisis stabilization services 24 hours a day, seven days a week and 365 days a year basis. Crisis stabilization services include, yet are not limited to, psychiatric evaluations, counseling/therapy services, nursing assessments, collateral services and consultations with significant others and outpatient providers, individual and family education, peer support and crisis intervention services. College Hospital CSU also provides coordination of referrals to continuing care and emergency housing, post discharge planning and facilitation of transfer of individuals to inpatient treatment facilities when clinically appropriate and indicated.

The target population is Orange County residents 18 years and over who are experiencing mental health emergencies, may have a co-occurring disorder, are at risk of hospitalization and need urgent psychiatric care. The CSU will provide services to all persons meeting criteria who present on a walk-in basis, by police transport and emergency department referral regardless of payor. As a LPS designated outpatient facility, treatment is limited to no longer than 23 hours and 59 minutes. The CSU has an affiliation with College Hospital Costa Mesa, Inc. dba Costa Mesa Medical Center Hospital that provides the facility with access to medical, laboratory and pharmaceutical support. This outpatient Crisis Stabilization Service provides 12 reclining chairs and is expected to serve an average daily census of 18 persons.

Performance Outcomes

Over the past two years, College Hospital CSU was required to achieve, track and report Performance Outcome Metrics, on a quarterly basis. Outcomes are shown below for FY 2021-22 and FY 2022-23 (through end of March 2023):

Performance Outcomes	FY 2021-22	FY 2022-23 (through end of March)
Total Admissions	1790	1322
At least 55 percent of individuals admitted shall be successfully stabilized and returned to the community.	65%	68%
Contractor shall provide timely evaluations as measured by completing 95 percent of CSU admissions within one hour of individual’s arrival on a monthly basis.	99%	100%
Contractor shall provide the least restrictive alternatives and an effective medication approach that results in seclusion and restraint use of 1.6 percent or less of admissions per month.	1.28%	0.37%
At least 75 percent of individuals returned to the community shall successfully link (keep appointment) to ongoing mental health services within 14 days of discharge.	93%	94%

The CSU has seen 35-40 percent of clients admitted to the CSU that are on involuntary Welfare & Institutions Code 5150 psychiatric holds. Follow up phone calls are made to all clients whom are discharged to the community within seventy-two hours post discharge to confirm linkage. The linkage rate of 75 percent is held at a high standard to reduce readmissions and College Hospital CSU is currently exceeding this metric. College Hospital CSU is performing satisfactorily in all other areas of the performance outcome metrics.

College Hospital CSU's performance has been confirmed as satisfactory with no identified issues. HCA has verified there are no concerns that must be addressed with respect to College Hospital CSU’s ownership/name, litigation status or conflicts with County interests.

The proposed Amendment No. 6 with College Hospital CSU does not include subcontractors or pass through to other providers. See Attachment B for Contract Summary Form.

HCA requests the Board approve Amendment No. 6 to renew the contract with College Hospital CSU for provision of Crisis Stabilization Services as referenced in the Recommended Action.

FINANCIAL IMPACT:

Appropriations for this Contract will be included in Budget Control 042 FY 2023-24 Budget.

The Contract includes provisions allowing HCA to terminate the Contract, reduce the level of services, and/or renegotiate the levels of services provided, as necessary. This includes a notice that allows HCA adequate time to transition or terminate service to clients, if necessary.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A - Amendment No. 6 to contract MA 042-20010244 for Crisis Stabilization Services with CSU LLC dba College Hospital Crisis Stabilization Unit
Attachment B - Contract Summary Form
Attachment C - Redline version of Attachment A
Attachment D - Welfare and Institutions Code 5150