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Agenda Item
ASR
Control 22-000309 |
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MEETING DATE: |
05/24/22 |
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legal entity taking action: |
Board of Supervisors |
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board of supervisors
district(s): |
All Districts |
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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 Psychiatric Skilled
Nursing Facility and Intensive Residential Services
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ceo CONCUR |
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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 2022-23 $14,572,507 |
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Staffing Impact: |
No |
# of Positions:
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Sole Source:
No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 5/21/2019
#44, 3/28/2017 #16, 5/6/2014 #24 |
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RECOMMENDED ACTION(S):
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1. |
Approve Amendment No. 1 to renew the Master Agreement with various contractors for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024, in an aggregate amount not to exceed $29,524,384, for a revised cumulative aggregate total amount not to exceed $66,531,097. |
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2. |
Approve Amendment No. 1 to renew the Contract with Downey Community Health Care for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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3. |
Approve Amendment No. 1 to renew the Contract with KF Community Care, LLC for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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4. |
Approve Amendment No. 1 to renew the Contract with Landmark Medical Services, Inc. for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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5. |
Approve Amendment No. 1 to renew the Contract with Riverside Sanitarium, LLC for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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6. |
Approve Amendment No. 1 to renew the Contract with Sylmar Health and Rehabilitation Center, Inc. for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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7 |
Approve Amendment No. 1 to renew the Contract with Vista Woods Health Associates LLC DBA Vista Knoll Specialized Care Facility for the provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services for the term of July 1, 2022, through June 30, 2024. |
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8. |
Approve Amendment No. 1 to renew the Contract with Anne Sippi Clinic Treatment Group for the provision of Adult Mental Health Intensive Residential Services for the term of July 1, 2022, through June 30, 2024, in an amount not to exceed $900,000 for a revised cumulative total amount not to exceed $2,021,235. |
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9. |
Authorize the County Procurement Officer or Deputized designee to execute Amendment No. 1 to Master Agreement and Amendment No. 1 to individual contracts with Downey Community Health Care, KF Community Care, LLC, Landmark Medical Services, Inc., Riverside Sanitarium, LLC, Sylmar Health and Rehabilitation Center, Vista Woods Health Associates, LLC and Anne Sippi Clinic Treatment Group as referenced in the Recommended Actions above. |
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SUMMARY:
Approval of the Master Agreement and individual Amendments No. 1 with various providers for Adult Mental Health Psychiatric Skilled Nursing Facility Services and Amendment No. 1 with Anne Sippi Clinic Treatment Group for Adult Mental Health Intensive Residential Services will provide psychiatric skilled nursing facility and intensive residential treatment services to severely mentally ill residents of Orange County.
BACKGROUND INFORMATION:
Your Honorable Board of Supervisors (Board) approved
the Master Agreement for provision of Adult Mental Health Psychiatric Skilled
Nursing Facility (SNF) Services and the Contract with Anne Sippi Clinic
Treatment Group (Anne Sippi) for provision of Adult Mental Health Intensive
Residential Services for period of July 1, 2019, through June 30, 2022. The
proposed Amendments represent the final renewal term. Prior to contract
expiration, the Health Care Agency (HCA) plans to issue a solicitation to
continue services.
Prior Board
Actions
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Board Date |
Contract/Amendment |
Action |
Term |
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May 6, 2014 |
Contracts |
Board Approved Contracts |
July 1, 2014 – June 30, 2017 |
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March 28, 2017 |
Contracts |
Board Approved Contracts |
July 1, 2017 – June 30, 2019 |
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May 21, 2019 |
Contracts |
Board Approved Master Agreement |
July 1, 2019 – June 30, 2022 |
HCA released a Request for Proposals on December 18, 2018. Seven proposals were received for Adult Mental Health Psychiatric SNF Services. One proposal was determined to be non-responsive. The remaining six proposals were evaluated by an evaluation panel and all six were recommended for award. Anne Sippi was the only bidder for Adult Mental Health Intensive Residential Services. The proposed amendments will allow services to continue from July 1, 2022, through June 30, 2024.
Each individual Contract shares the annual maximum obligation and funding between the individual providers, which will vary based on utilization.
Psychiatric SNF
Services
Scope of Services
HCA currently contracts with six organizations to provide Psychiatric SNF Services for Orange County clients living with severe mental illness. These services take place in locked Skilled Nursing Facilities with Special Treatment Programs (STP) for individuals whose symptoms prevent them from living in the community.
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Provider |
City |
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Downey Community Health Care |
Downey, CA |
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KF Community Care, LLC |
Duarte, CA |
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Landmark Medical Services, Inc. |
Pomona, CA |
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Riverside Sanitarium, LLC |
Riverside, CA |
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Sylmar Health and Rehabilitation Centers, Inc. |
Sylmar, CA |
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Vista Woods Health Associates LLC DBA 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 Amendments reflect a six percent rate increase the first year of this renewal, and a three and a half percent increase for the final year of the contract. A three and a half percent increase each year is consistent with the State mandated rate setting for these types of services. The initial six percent increase is to bring Orange County SNF/STP rates to be consistent with other County rate increases in order to secure beds for Orange County conservatees requiring this level of care. Rate increases are needed and competitive as a result of increase costs of food and salaries of SNF/STP staff, which include licensed nurses and certified nurse assistants (CNAs). Utilization increased to 54,780 bed days in FY 2020-21 and remains high with 53,434 bed days used in the first three quarters of FY 2021-22, leading to a projection of 57,305 bed days for FY 2022-23. The majority of clients placed in these programs are Lanterman-Petris Short (LPS) conservatees, referred from either the State hospital system or acute care hospitals, with a long history of serious mental illness and high level of acuity of symptoms that requires intensive services within a long-term care setting.
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.
Performance
Outcomes
The contracted providers performance has been confirmed as satisfactory with no identified issues. Utilization of these highly intensive services are as follows:
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Fiscal Year |
Number of
Clients Served |
Total Number
of Bed Days Utilized |
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2020 - 21 |
123 |
53,842 |
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2021 - 22 (July thru March) |
117 |
53,434 |
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. The rate of discharges to both lower and higher levels of care remains low due to challenges with quarantine, isolation protocols, and unit closures as a result of COVID-19 during the last two fiscal years.
Intensive
Residential Services
Scope of Services
HCA currently contracts with one organization, Anne Sippi, to provide Intensive Residential Services in a licensed Board and Care Facility. 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 intervention between clinical staff and clients, there is a minimum of 10 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 six percent increase for the initial year of the renewal to again be consistent with other County rate increases in order to secure beds for Orange County conservatees requiring this level of care. Rate increases are needed and competitive as a result of increase costs of food and salaries of Board and Care staff. The second and last year of the renewal period includes a three and a half percent negotiated increase and allows for approximately seven clients per day or a maximum utilization of 2,555 bed days annually.
Performance Outcomes
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Fiscal Year |
Number of clients
served |
Percent of
Clients Discharged to a Lower Level of Care |
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2020-21 |
8 |
50% |
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2021-22 (July thru March) |
6 |
50% |
The length of stay (LOS) for clients completing the
program typically ranges between nine months and three and a half years. Over
the last two fiscal years, discharges have decreased significantly as a result
of unit closures, isolation protocols, and quarantines due to COVID-19,
however, half of these individuals are still able to discharge to a lower level
of care. 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.
HCA staff have conducted due diligence on the Contractors’ performance which has been confirmed as satisfactory. All contractors are 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. Orange County Preference Policy is not applicable to the Amendment.
The proposed Amendment with Anne Sippi does not have any subcontracts or pass through to other providers. See attachment Q for Contract Summary Forms.
HCA requests that the Board approve the Amendments to Master Agreement and to individual contracts with Downey Community Health Care, KF Community Care, LLC, Landmark Medical Services, Inc., Riverside Sanitarium, LLC, Sylmar Health and Rehabilitation Center, Inc., Vista Woods Health Associates, LLC DBA Vista Knoll Specificialized Care Facility and Anne Sippi Clinic Treatment Group as referenced in the Recommended Actions.
FINANCIAL IMPACT:
Appropriations for these Amendments will be included in Budget Control 042 FY 2022-23 Budget and will be included in the budgeting process for future years.
The Contracts include provisions allowing HCA to terminate the Contracts, 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 1. to Master Agreement
MA-042-20010215 for Provision of Adult Mental Health Psychiatric Skilled
Nursing Facility Services between County of Orange and various providers
Attachment B - Amendment No. 1 to the Contract MA-042-20010215 with Downey
Community Health Care for the provision of Adult Mental Health Psychiatric
Skilled Nursing Facility Services
Attachment C - Amendment No. 1 to the Contract MA-042-20010215 with KF
Community Care, LLC for the provision of Adult Mental Health Psychiatric
Skilled Nursing Facility Services
Attachment D - Amendment No. 1 to the Contract MA-042-20010215 with Landmark
Medical Services, Inc. for the provision of Adult Mental Health Psychiatric
Skilled Nursing Facility Services
Attachment E - Amendment No. 1 to the Contract MA-042-20010215 with Riverside
Sanitarium, LLC for the provision of Adult Mental Health Psychiatric Skilled
Nursing Facility Services
Attachment F - Amendment No. 1 to the Contract MA-042-20010215 with Sylmar
Health and Rehabilitation Center, Inc. for the provision of Adult Mental Health
Psychiatric Skilled Nursing Facility Services
Attachment G - Amendment No. 1 to the Contract MA-042-20010215 with Vista Woods
Health Associates LLC DBA Vista Knoll Specialized Care Facility for the
provision of Adult Mental Health Psychiatric Skilled Nursing Facility Services
Attachment H - Amendment No. 1 to Contract MA-042-20010216 for provision of
Adult Mental Health Intensive Residential Services between County of Orange and
Anne Sippi Clinic Treatment Group
Attachment I - Redlined to Attachment A
Attachment J - Redlined to Attachment B
Attachment K - Redlined to Attachment C
Attachment L - Redlined to Attachment D
Attachment M - Redlined to Attachment E
Attachment N - Redlined to Attachment F
Attachment O - Redlined to Attachment G
Attachment P - Redlined to Attachment H
Attachment Q - Contract Summary Form