AGENDA STAFF REPORT

Agenda Item AGENDA STAFF REPORT ASR Control 19-000843
MEETING DATE:	09/24/19
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):	Joanne Lim (714) 647-6048
	Erin Winger (714) 647-4510

Subject: Retroactive Agreement for Correctional Health Psychiatry and Telepsychiatry

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: Yes

Current Year Cost: $2,500,000

Annual Cost: N/A

Staffing Impact:

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: See Financial Impact	County Audit in last 3 years: No

Prior Board Action: 05/22/2018 #31

RECOMMENDED ACTION(S):

Approve retroactive Agreement with Orbit Health, DBA Orbit Health Telepsychiatry for provision of Psychiatry and Telepsychiatry Services for Correctional Health Services Programs for the period August 26, 2019, through June 30, 2020, with an amount not to exceed $2,500,000.

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

SUMMARY:

Approval of the retroactive Agreement with Orbit Health, DBA Orbit Health Telepsychiatry for the provision of Psychiatry and Telepsychiatry Services for Correctional Health Services programs will expand telepsychiatry and on-site mental health services to persons in the County's custody at its detention facilities.

BACKGROUND INFORMATION:

The County of Orange is mandated to provide medical care to persons in the County's custody pursuant to State of California Penal Code Sections 4011 and 4015 and Government Code Section 29602. The Health Care Agency's (HCA) Correctional Health Services (CHS) division is the designated provider of health care to adult persons in-custody on behalf of the Orange County Sheriff's Department. In 2018, CHS was responsible for providing mental health services to an average daily population of 1,798 inmates with a mental health diagnosis. These services include, but are not limited to, psychiatric evaluation, development of treatment plans, medication management and crisis intervention and management. HCA has a continuous open recruitment for psychiatrists and mental health nurse practitioners, but recruitment for these classifications has proven to be difficult due to the competitive market and required lengthy and extensive background process.

On December 22, 2017, HCA released a Request for Proposal (RFP) for Psychiatry and Telepsychiatry Services for CHS. As the respondent with the highest score, Aligned Telehealth was selected and approved by your Honorable Board of Supervisors (Board) on May 22, 2018, for the provision of Psychiatry and Telepsychiatry Services for the period of July 1, 2018, through June 30, 2020.

As of January 2019, the average daily population of individuals requiring mental health services has increased to 1,870, which is a four percent increase from 2018. There is also an increasing trend in the acuity of the illness of the patients. The change in population and needs created a demand for additional resources. In order to continue meeting mental health care mandates and service demand, expanded hours for psychiatry and telepsychiatry services are required immediately.

To respond to the increased need for psychiatric services and the extensive time required for security clearances, HCA has entered into an emergency Agreement with Orbit Health, DBA Orbit Health Telepsychiatry (Orbit Health) effective August 26, 2019, through June 30, 2020, for the provision of Psychiatry and Telepsychiatry services in the amount not to exceed $2.5 million. Costs are incurred as fee-for-service for psychiatry and telepsychiatry services by a psychiatrist or mental health nurse practitioner. Orbit Health has extensive experience in correctional telepsychiatry currently serving eight county jails. CHS has previously worked successfully with Orbit Health through a subcontract with the existing vendor for Specialty Physician Services. Having a second vendor for psychiatry and telepsychiatry services will provide CHS with enhanced options in staffing these difficult to recruit positions as the number of inmates with mental illness continues to rise. HCA intends to release a RFP for additional Psychiatry and Telepsychiatry Services by winter 2019.

Department staff have conducted due diligence on the vendor. Reference checks were satisfactory and completed with Los Angeles County Jail, Telecare Corporation and Imperial County Behavioral Health regarding similar contracts.

This Agreement does not currently include subcontractors or pass through to other providers. See Attachment B for Contract Summary Form.

HCA requests that the Board ratify the Agreement with Orbit Health for the provision of Psychiatry and Telepsychiatry Services as referenced in the Recommended Actions.

FINANCIAL IMPACT:

Appropriations for this Agreement are included in Budget Control 042 FY 2019-20 Budget.

Funding Source:

FED: 2% (U.S. Marshal)

State: 57% (1991 Mental Health Realignment Reserves, 2011 Realignment, AB 109)

GF: 41%

Should services need to be reduced or terminated due to lack of funding, this Agreement contains language that allows HCA to give 30 calendar days' notice to either terminate or renegotiate the level of services to be 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 - Agreement for the Provision of Psychiatry and Telepsychiatry Services
Attachment B - Contract Summary Form
Attachment C - California Government Code Section 29602
Attachment D - California Penal Code Section 4011
Attachment E - California Penal Code Section 4015
Attachment F - California Department of Corrections and Rehabilitation Title 15 Article 11 Ver.2010-12
Attachment G - Performance-Based National Detention Standards 2008