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Agenda Item
ASR
Control 23-000663 |
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MEETING
DATE: |
03/26/24 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
2 |
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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 Amendment No. 2 for
Inpatient Mental Health Services for Youth
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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 $1,500,000 |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: Yes |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 3/28/2023 #17, 5/24/2022 #36 |
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RECOMMENDED
ACTION(S):
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1. |
Approve Amendment No. 2 to renew the
Contract with Children's Hospital of Orange County DBA CHOC Children's for
provision of Inpatient Mental Health Services for Youth, for the term of July
1, 2024, through June 30, 2025, in an amount not to exceed $1,500,000, for a
revised cumulative contract total amount not to exceed $2,500,000. |
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2. |
Authorize the County Procurement Officer
or Deputized designee to execute Amendment No. 2 to the Contract with
Children's Hospital of Orange County DBA CHOC Children's for Inpatient Mental
Health Services for Youth, as referenced in the Recommended Action above. |
SUMMARY:
Approval of Amendment No. 2 to
renew the Contract with Children's Hospital of Orange County DBA CHOC
Children's for provision of Inpatient Mental Health Services for Youth will
continue to allow for Inpatient Mental Health Services for children and youth
from three through 17 years of age.
BACKGROUND
INFORMATION:
On May 24, 2022, your Honorable
Board of Supervisors (Board) approved the selection of and Contract with
Children's Hospital of Orange County DBA CHOC Children's (CHOC) for provision
of Inpatient Mental Health Services for Youth for the term of July 1, 2022,
through June 30, 2023, in an amount not to exceed $500,000. On March 28, 2023,
the Board approved a one-year renewal for the term of July 1, 2023, through
June 30, 2024, in an amount not to exceed $500,000 for a revised cumulative
contract amount not to exceed $1 million. The Orange County Preference Policy
is not applicable to this Amendment.
The proposed Amendment will allow
for Inpatient Mental Health services for children who are ages three through 17
to continue for the term of July 1, 2024, through June 30, 2025. The Bed Day
Rate for this contract will primarily be funded by Department of Health Care
Services (DHCS), with the remainder being paid by Health Care Agency
(HCA). Most, if not all, patients served
by this contract are anticipated to be Medi-Cal eligible. The breakdown of
reimbursement rates are as follows:
Bed Rates for Medi-Cal eligible
patients:
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Pay
Source |
Administrative
Day Rate |
Negotiated
Acute Bed Rate |
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DHCS |
Set by DHCS |
$1,387.60 |
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HCA |
N/A |
$ 296.40 |
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Bed Day Rate
Total: |
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$ 1,684.00 |
Bed Rates for uninsured patients:
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Pay
Source |
Administrative
Day Rate |
Negotiated
Acute Bed Rate |
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HCA |
N/A |
$1,684.00 |
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Bed Day Rate
Total: |
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$1,684.00 |
Although this contract serves ages
three through 17, CHOC operates the only inpatient unit for youth in Orange
County that serves children under the age of 10 and, in 2018, CHOC was the
first new inpatient unit for this population in Orange County in 25 years. CHOC
has the unique capacity to allow parents to stay in the unit with their
children.
Scope
of Services
CHOC provides services to youth
that are actively experiencing mental health crisis events and in need of
involuntary or voluntary psychiatric hospitalization. CHOC inpatient
psychiatric services are provided 24 hours a day, seven days a week, and 365
days a year. CHOC provides services that include, but are not limited to,
therapy, group therapy, case management, medication management and psychiatric
services. CHOC focuses on working in collaboration with parents and/or
caretakers to achieve the youth’s wellness and resiliency goals. CHOC collaborates
with outpatient providers in the community and with HCA programs to ensure that
ongoing treatment needs are met for the youth and families they served.
Performance
Outcomes
CHOC experienced an increase in the
total bed days in Fiscal Year (FY) 2022-23. Outcomes are as follows:
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Fiscal Year |
Bed Days |
Occupancy Rate
(Percent) |
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FY
2021-22 |
2,176 |
99% |
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FY
2022-23 |
2,584 |
100% |
Outcomes for these services are
measured by a seven day and 30-day readmission rate of clients discharged from
the contracted facility. The target goal of the CHOC inpatient unit is to have
less than 10 percent of clients hospitalized seven days post discharge and less
than 20 percent of clients hospitalized 30 days post-discharge for FY 2024-25.
Re-admissions outcomes data for FY 2021-22 and FY 2022-23 are as follows:
|
Fiscal
Year |
Total
Medi-Cal Unfunded
Clients Served |
Readmissions
(%) 7 days Post
Discharge < 10% |
Readmission
(%) 30 Days Post Discharge < 20% |
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FY 2021-22 |
450 |
3.3%* |
6% |
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FY 2022-23 |
382** |
3.5% |
12% |
*Outcome
data tracking started November of 2021.
**378 Medi-Cal youth and four
unfunded youth.
CHOC’s performance has been
confirmed as satisfactory. HCA has verified there are no concerns that must be
addressed with respect to CHOC’s ownership/name, litigation status or conflicts
with County interests.
The proposed Amendment with CHOC
for provision of Inpatient Mental Health Services for Youth does not currently
include subcontractors or pass through to other providers. See Attachment B for
Contract Summary Form.
This Amendment No. 2 to renew the
contract contains a mutual indemnification provision, which varies from the
County standard of sole indemnification. Risk Management has approved the
indemnification provision and determined the risk to be acceptable for these
services. See Attachment D for Risk Assessment Form.
HCA requests the Board approve Amendment
No. 2 with CHOC as referenced in the Recommended Actions.
FINANCIAL
IMPACT:
Appropriations for this Amendment
will be included in Budget Control 042 FY 2024-25 Budget.
HCA estimates the County share of
cost under this Amendment No. 2 to renew the Contract will be approximately
$1.5 million for fiscal year 2024-25. The amount of $1.5 million is only an
estimate and it may differ from actuals based on the number of patients served
within the fiscal year.
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 services to clients, if
necessary.
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A - Amendment No. 2 MA-042-22011507 for Inpatient Mental Health Services for
Youth with Children's Hospital of Orange County
Attachment B - Contract Summary Form
Attachment C - Redline to Attachment A
Attachment D - Risk Assessment Form