Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Authorizing the Chief of San Mateo County Health or Designee to Execute Amendments to the Agreements with Essential Local Community-Based Organizations for Board and Care Services
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health or designee(s) to execute amendments to the agreements with each contractor listed in Attachment A to provide board and care services, increasing the amount by $101,050, to an amount not to exceed $3,563,050 with no change to the agreement terms.
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BACKGROUND:
Since 1985, this Board has approved resolutions authorizing expenditures for residential board and care (B&C) facilities serving clients with severe mental illness by providing residential care services. Local in-County B&C facilities serve a critical role in the care of Behavioral Health and Recovery Services (BHRS) clients. B&C facilities provide long-term placements and care for a population of clients that are often stigmatized and perceived as having too many complex issues. B&C facilities provide clients with meals, assistance with daily living activities, medication support, and social skills development. Additionally, being placed in an in-County B&C means that a client is close to and receives support from their family, friends, and community. The alternative to in-County B&C placement would be a more costly placement out of County and away from a client’s community and support network.
In recent years, the County B&C market has been struggling. Established B&C contractors have been retiring and closing down their operations, and new facilities are not being opened to succeed them. BHRS has attempted to engage with B&C operators based in-County who are not contracted with the County, but these operators are not interested in serving clients with severe mental illness or relatively low expected revenue resulting from these services.
As a result, over the past few years, BHRS has lost six in-County contracted B&C facilities, resulting in a total loss of 41 beds. The needs of the clients served by B&C facilities, as well as the uniqueness of the local B&C market, inform the procurement approach that the County has adopted for these contracts, in addition to the B-1 Administrative Memorandum exception for Housing Services and Related Supports.
DISCUSSION:
Attachment A of the resolution lists eight contractors that operate B&C facilities, along with the agreement amounts for each contractor. The not-to-exceed aggregate amount of $3,563,050 will authorize the Chief of San Mateo Health, or designee(s), to execute the amendments to the agreements with the contractors listed in Attachment A. The amended agreement amounts listed in Attachment A reflect a change in the daily bed rates for FY 2025-26.
All eight local contractors operate B&C facilities and provide an augmented service for seriously mentally ill clients who require intensive support services, as described in the Background section above. These services are needed to support clients living in the community in the least restrictive level of care.
Under the B-1 Administrative Memorandum, the selection of providers of residential services for mental health clients is exempt from the Request for Proposals requirement.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The agreements and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 100% of B&C clients will remain in an acute psychiatric level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25
Actual |
FY 2025-26
Estimated |
|
Percentage of B&C clients that remain in an acute psychiatric level of care |
100%
72 clients |
100%
72 clients |
COMMUNITY IMPACT:
These agreements will positively impact a critically underserved community of BHRS clients who have severe mental illness and will benefit from a secured placement to support their stabilization and recovery. These B&C providers are vital placement resources for such individuals. These agreements with the B&C providers afford these individuals an ability to step down from higher acute, more costly levels of care to a placement that can address their behavioral health needs. These providers are committed to serving this population and supporting them with achieving their recovery goals.
FISCAL IMPACT:
The term of all the agreements is July 1, 2023 through June 30, 2026. The total amount of the agreements is not to exceed $3,563,050 in aggregate for the three-year term. Funds in the amount of $1,211,700 will be included in the BHRS FY 2025-26 Recommended Budget. Of that amount, it is anticipated that $387,744, or 32%, will be funded by the Mental Health Services Act; $739,137, or 61%, will be funded by 1991 Realignment and $84,819, or 7%, will be funded by Net County Cost.
The payment provisions and levels of service in the agreements are essentially the same as the prior agreements.