Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Scott Gilman, Director, Behavioral Health and Recovery Services
Subject: Agreement with American Medical Response West - SMART for Assessment and Transportation of Behavioral Health and Recovery Services Clients
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with American Medical Response West -SMART for assessment and transportation of Behavioral Health and Recovery Services clients for the term of July 1, 2019 through June 30, 2022, in an amount not to exceed $1,342,527.
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BACKGROUND:
The San Mateo County Mental Assessment and Referral Team (SMART) program was established by the County Health’s Emergency Medical Services division (EMS) 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 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.
On July 18, 2018, a Request for Proposals (RFP) was released 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%) served more than once. Prior to SMART, all clients would have been transported to a hospital emergency department or to jail. The costlier 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 obligation by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by County Counsel as to form. This agreement is coming to your board late due to prolonged negotiations and is in the Continuing Resolution.
Approval of this agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing emergency services to people experiencing behavioral emergencies. It is anticipated that 75% of behavioral emergency calls to EMS will be handled by the AMR SMART vehicle, instead of the costlier ambulance ride.
PERFORMANCE MEASURE:
|
Measure |
FY 2019-20 Estimated |
FY 2020-21 Projected |
|
Percentage of behavioral health emergency calls handled by AMR SMART vehicle |
70% |
75% |
FISCAL IMPACT:
The term of the agreement is July 1, 2019 through June 30, 2022. The amount of the agreement is not to exceed $1,342,527. Funds in the amount of $436,275 are included in the BHRS FY 2019-20 Approved Recommended Budget. Of this amount, it is expected that $89,468 will be funded by Measure K; $96,938 will be funded by the Mental Health Medi-Cal Administrative Activities program; $145,000 by Mental Health Services Act funds; and $104,869 by 1991 Realignment. There is no Net County Cost associated with this agreement. The payment provisions and levels of service in the agreement are essentially the same as the prior agreement.