AGENDA STAFF REPORT

Agenda Item AGENDA STAFF REPORT ASR Control 16-001459
MEETING DATE:	03/28/17
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):	Jeff Nagel (714) 834-7024
	Mary Hale (714) 834-6032

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 2017-18 $11,481,800
FY 2018-19 $11,871,456

Staffing Impact:

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: GF: 12%, State: 88% (Mental Health Realignment, Vehicle License Fee and Managed Care)	County Audit in last 3 years: No

Prior Board Action: 5/24/2016 #57, 5/6/2014 #24

RECOMMENDED ACTION(S):

1.	Approve the Master Agreement for Provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the period of July 1, 2017, through June 30, 2019, for a total maximum obligation of $22,655,742.
2.	Approve the Agreement with Anne Sippi Clinic Treatment Group for Provision of Adult Mental Health Intensive Residential Services for the period of July 1, 2017, through June 30, 2019, for a total maximum obligation of $697,514.
3.	Authorize the Health Care Agency Director, or designee, to exercise a contingency contract cost increase in an amount not to exceed 10% of Period One funding for the Agreements as referenced in the Recommended Actions above, for the entire term and within the scope of work set forth in the Agreements, in accordance with section 3.3-113 of the County Contract Policy Manual.
4.	Authorize the Health Care Agency Director, or designee, to execute the Agreements, as referenced in the Recommended Actions above.

SUMMARY:

The Health Care Agency requests 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 for provision of Adult Mental Health Intensive Residential Services to Orange County residents with a diagnosis of a mental disorder.

BACKGROUND INFORMATION:

On May 6, 2014, the 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% 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. The current Agreements will end June 30, 2017, and the proposed Agreements will allow services to continue through June 30, 2019. The SNF Master Agreement has a maximum obligation of $11,133,043 for FY 2017-18 and $11,522,699 for FY 2018-19, for a total maximum obligation of $22,655,742. The Anne Sippi Agreement has an annual maximum obligation of $348,757 for FY 2017-18 and FY 2018-19, for a total maximum obligation of $697,514.

Intensive Residential Services

The Health Care Agency (HCA) currently contracts with Anne Sippi to provide Intensive Residential Services in two unlocked licensed Community Care Facilities. These services provide a recovery-based, structured psycho-social rehabilitative program that assists consumers to move along the rehabilitative continuum. In addition to one-to-one interaction between staff and consumers, there is a minimum of five planned and structured group activities each week as well as medication services. The performance of the provider under the current Agreement is satisfactory.

The proposed annual maximum obligation of $348,757 for Intensive Residential Services allows for total utilization of 2,143 bed days annually.

Psychiatric SNF Services

HCA currently contracts with six organizations to provide 24-hour, seven days per week Psychiatric SNF Services for Orange County residents with a diagnosis of a mental disorder and who are residing in locked and unlocked Skilled Nursing Facilities. These programs provide recovery-based mental health services including medication management and a minimum of 27 hours per week of structured therapeutic group activities.

During FY 2016-17, 7,331 annual bed days were added via the Second Amendment to meet the need for additional Psychiatric SNF Services for consumers. The overall numbers of referrals received in Long Term Care Services has increased 32% in the last year. Of the referrals currently being processed for these services, the average wait time is 68 days. The proposed Agreement reflects a 3.5% rate increase each year, consistent with the State mandated rate setting for these types of services and allowing utilization to remain the same at approximately 33,160 bed days annually.

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 and persistent mental illness that requires long-term residential care. No lesser restrictive services exist that matches their clinical needs. The performance of the providers under the current Agreements are satisfactory.

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 outcomes for these programs are to:

Provide an alternative to the use of state hospital and acute psychiatric hospitalizations as evidenced by an increased number of consumers being served in this less restrictive environment

Improve consumer functioning level and decrease symptoms as evidenced by discharging consumers to a lower level of care

The most current data available is for the period covering July 1, 2016, through December 31, 2016, and shows 85 consumers being served and having a discharge to lower level of care rate of 41%. In comparison, during FY 2015-16 there were 171 participants served, and a discharge to lower level of care rate of 36%.

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

HCA requests that the Board authorize the HCA Director or designee, to amend, as needed, the maximum obligation of the proposed Agreements by an amount not to exceed 10% of the Period One funding over the entire term of the Agreements and within the scope of work set forth in the Agreements. The contingency provision would be exercised in the event of an unanticipated increase in the need for services within the scope of work of the proposed Agreements.

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

FINANCIAL IMPACT:

Appropriations for this Agreement 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 - Redline Version to Attachment A
Attachment D - Redline Version to Attachment B
Attachment E – Contract Summary to Attachment A
Attachment F – Contract Summary to Attachment B