Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Agreement with American Medical Response West - San Mateo County Mental Assessment and Referral Team for Assessment and Transportation of Behavioral Health and Recovery Services Clients
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with American Medical Response West- San Mateo County Mental Assessment and Referral Team for assessment and transportation of Behavioral Health and Recovery Services clients, for the term of May 1, 2023 through June 30, 2025, in an amount not to exceed $1,176,676.
body
BACKGROUND:
The San Mateo County Mental Assessment and Referral Team (SMART) program was established by County Health’s Emergency Medical Services (EMS) division and American Medical Response West (AMR) in 2005. SMART provides a specially trained paramedic response team to 911 emergency requests for individuals experiencing behavioral health emergencies who would otherwise be transported by a police car or ambulance. The SMART paramedic is trained to de-escalate behavioral health crises and transport clients in a specially equipped sport utility vehicle, which is less intimidating for clients than a police car.
In July 2018, the County Procurement Department released a Request for Proposals (RFP) for emergency ambulance services with advanced life support. AMR, the County’s current ambulance vendor, submitted a proposal and was recommended as the provider for these services.
DISCUSSION:
Through the SMART program, AMR provides medical clearance in the field, facilitates appropriate referral and resolution, and reduces the time spent by local law enforcement on these cases. Since the program’s inception, 4,254 County residents have been served, with 373 residents (8.8% of the total) served more than once. Prior to SMART, all clients would have been transported directly to a hospital emergency department or to jail. Instead, SMART can transport an individual to an alternative location, such as a residential facility or a treatment provider, which also contributes to a lower overall cost for SMART; for transport alone, an ambulance ride would have been $1,746 versus $574 for SMART. In April 2014, with Measure A funds, a second SMART team was added to extend coverage to 12 hours a day, 7 days a week.
According to EMS requirements, the persons providing SMART program services must be County-accredited paramedics. By definition, such paramedics have to be employed by a County-recognized provider, i.e., AMR (the County’s current provider of emergency ambulance services) or one of the local fire departments. Because these fire departments do not have a mental health program, the only entity in the County with the ability to staff the SMART program is AMR. Under administrative Memorandum B-1, the SMART services would be exempt from the RFP process as they are provided by a sole source.
The resolution contains the County’s standard provisions allowing amendments of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
This agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 75% of behavioral health emergency calls to EMS that meet the SMART criteria will be handled by the AMR SMART vehicle. It is also anticipated that SMART will divert 10% of patients from Psychiatric Emergency Services (PES) who have not already been put on a 5150 hold when SMART is called to respond for mental health support and services.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Percentage of behavioral health emergency calls to EMS that meet the SMART criteria that are handled by the AMR SMART vehicle |
70% 228/325 calls |
75% 244/325 calls |
|
Percentage of patients diverted from PES for mental health support and services |
N/A* |
10% |
*This is a new performance measure
FISCAL IMPACT:
The term of the agreement is May 1, 2023, through June 30, 2025. The amount of the agreement is not to exceed $1,176,676 for the two-year term. Funds in the amount of $90,514 are included in the BHRS FY 2022-23 Adopted Budget.
Of this amount, $44,267 will be funded by Mental Health Services Act (MHSA), and $46,247 will be funded by 1991 Realignment. Funds in the amount of $543,081 are included in BHRS FY 2023-24 Recommended Budget.
Of this amount, it is expected that $98,714 will be funded by Measure K, $134,529 by Mental Health Services Act funds, and $309,838 by 1991 Realignment. There is no Net County Cost associated with this agreement. Similar arrangements will be made for FY 2024-25 Recommended Budget.