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: Amendment to the Agreement with Cielo House, Inc. for Comprehensive Treatment Services for Clients Diagnosed with Eating Disorders
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Cielo House, Inc. for comprehensive treatment services for clients diagnosed with eating disorders, increasing the amount by $850,000 to an amount not to exceed $1,250,000, with no change to the term of the agreement.
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BACKGROUND:
In 2018, the California Department of Health Care Services added eating disorders to the conditions that County Specialty Mental Health Services like Behavioral Health and Recovery Services (BHRS) are mandated to treat. It was at this time that BHRS identified a need to fill a service gap for Severely Mentally Ill (SMI) adult clients diagnosed with moderate to severe eating disorders, as defined in the DSM-5, that require a more specialized and intensive level of treatment. No BHRS clinic or program could effectively address the comprehensive behavioral, dietary, and medical needs associated with moderate/severe eating disorders. Given this lack of in-house expertise, BHRS reached out to several local providers. Cielo House Inc. (Cielo House) was the only in-county provider that met BHRS’ requirements to provide comprehensive and specialized treatment for clients diagnosed with eating disorders such as anorexia, bulimia, binge eating disorder, and eating disorders not otherwise specified. Since then, Cielo House has been providing eating disorders comprehensive treatment services.
In September 2022, this Board authorized an agreement with Cielo House for the term July 1, 2022, through June 30, 2024, in an amount not to exceed $400,000.
DISCUSSION:
Through this amendment, Cielo House will continue to provide Intensive Outpatient, Partial Hospitalization Program, outpatient treatment services, and residential treatment services for SMI adult clients with moderate to severe eating disorders who need specialized treatment. Ongoing services include nutritional assessments, comprehensive treatment plans, close supervision, dietary counseling, psychiatry, and individual/family counseling. There is a continued need for these specialized services to support clients with eating disorders in their recovery. Additional funds are needed due to the increased utilization for intensive outpatient and residential treatment services.
This amendment will increase the maximum amount by $850,000, the additional funds needed to cover the increase in utilization.
In San Mateo County, BHRS has seen little motivation for providers to offer eating disorder treatment services at a reduced rate for the publicly insured, since providers can receive higher reimbursement on a cash basis in the private market, with none of the required paperwork or payment wait times. Until now, Cielo House has been the only in-county provider that covers eating disorder treatment services. However, two new providers have opened offices in San Mateo County. In order to maintain an adequate provider network, we are negotiating with these providers to bring them under contract in addition to Cielo House. This will allow us to provide eating disorder treatment services in the communities in which our clients reside, consisting of outpatient, intensive outpatient, partial hospitalization programs, and residential treatment services.
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 agreement and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 50% of clients receiving services will not require hospitalization and no more than one Psychiatric Emergency Services (PES) visit.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Actual |
FY 2023-24 Estimated |
|
Percentage of clients receiving services that will not require hospitalization and will have no more than one PES visit |
50% 5 clients |
50% 5 clients |
FISCAL IMPACT:
The term of the amended agreement is July 1, 2022, through June 30, 2024. This amendment increases the agreement amount by $850,000 to an amount not to exceed $1,250,000 for the two-year term. Funds in the amount of $500,000 are included in the BHRS FY 2022-23 Adopted Budget. Similar arrangements will be made in future years. Of the FY 2023-24 amount, it is anticipated that $450,000 will be funded by Mental Health Services Act and $300,000 will be funded by 1991 Realignment. There is no Net County Cost associated with this amendment.