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: Amendment to the Agreement with A&A Health Services, LLC for Residential and Transitional Care Services
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the agreement with A&A Health Services, LLC for residential and transitional care services, extending the term of the agreement through December 31, 2026, and increasing the amount of the agreement by $662,875 to an amount not to exceed $991,375.
body
BACKGROUND:
On December 10, 2024, this Board approved an agreement with A&A Health Services, LLC, authorizing expenditures for residential care facilities in Contra Costa County to provide residential care services for adults living with a mental illness and who may have histories of homelessness, substance abuse, or forensic histories. These services enhance successful community living and avoid a more costly, higher level of care. The term of the agreement is January 1, 2025, through December 31, 2025, in an amount not to exceed $328,500.
Behavioral Health and Recovery Services (BHRS) has a need to house clients who are at risk of arrest and being found incompetent to stand trial, with the goal of diverting them from placement under the Department of State Hospitals (DSH) care. To support this effort, A&A Health Services, LLC will begin serving these clients, necessitating this amendment and extension of the existing agreement.
Out-of-county Board and Care (B&C) facilities serve a critical role in the care of BHRS clients. These facilities provide long-term placements and care for a population of clients that are often stigmatized and perceived as having too many complex issues. The facilities provide clients with meals, assistance attending to activities of daily living, medication support, and social skills development. These facilities are needed due to the limited number of beds available at in-county B&C facilities.
In recent years, the San Mateo County B&C market has been struggling. Established B&C contractors have been retiring and closing their operations, and new facilities are not being opened to succeed them. BHRS attempted to engage with B&C operators who are not contracted with San Mateo County, but these operators are not interested in serving clients with severe mental illness or contracting for relatively low expected revenue.
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 B&C beds. In response, BHRS has had to contract with out-of-county providers to address the loss of in-county B&C beds.
This agreement is exempt from the competitive procurement process due to the particular needs of the clients served by B&C facilities, the uniqueness of the local B&C market, and the B-1 Administrative Memo exception for Housing Services and Related Supports. A waiver request was reviewed by County Procurement, which recommended for submission to this Board for approval.
DISCUSSION:
This agreement increases the number of beds able to be provided by A&A Health Services, LLC by 50%, from four to six beds, in order to accommodate additional BHRS clients. (Please note that BHRS only pays for actual clients placed.)
A&A Health Services, LLC shall continue to provide beds for difficult-to-place clients and augmented services for adults with a severe mental illness who require a higher level of care and supervision. These services include supplemental intensive mental health services, social skills training, and assistance with daily living activities.
The resolution contains the County’s standard provisions allowing amendments of the County’s fiscal obligation by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 67% of clients will be discharged to an acute (i.e. lower) psychiatric level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of clients that will be discharged to an acute (i.e. lower) psychiatric level of care |
67% 4 out of 6 clients |
67% 4 out of 6 clients |
COMMUNITY IMPACT:
This agreement will positively impact a critically underserved community of BHRS clients who have severe mental illness and need a residential placement. Residential providers such as A&A Health Services, LLC are a vital resource for housing such individuals. This agreement with A&A Health Services, LLC affords these individuals an ability to step down from higher acute, more costly levels of care to a community placement. This provider is committed to serving this population and supporting them with being successful while living in a community setting.
FISCAL IMPACT:
The term of the amended agreement is January 1, 2025 through December 31, 2026. The amount of the amended agreement is not to exceed $991,375. The amendment increases the contract amount by $662,875. Funds in the amount of $662,875 are included in the BHRS FY 2025-26 Adopted Budget. Of that amount, 1991 Realignment will fund $492,752, and $170,125 is from the California Department of State Hospitals. There is no Net County Cost associated with this agreement.