|
DATE: |
November 15, 2022 |
28 |
SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATIONS AND AMENDMENTS TO EXTEND EXISTING BEHAVIORAL HEALTH SERVICES CONTRACTS (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services provides a comprehensive array of mental health and substance use services to people of all ages. These services are delivered through County-operated programs, as well as contracts with local agencies. Those served include vulnerable populations, including individuals who are experiencing homelessness, individuals with justice involvement, and children and youth with complex behavioral health conditions.
Approval of today’s recommended actions authorizes competitive solicitations and amendments to extend existing behavioral health services contracts, including single source contracts, to sustain critical behavioral health services, with the goal of building a better behavioral health services delivery system for San Diego County communities. These recommended actions support the continuation of critical work to advance the Behavioral Health Continuum of Care.
These items support the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by upholding practices that align with community priorities and improve transparency and trust while maintaining good fiscal management. Additionally, the programs and services outlined provide critical treatment and housing services to individuals with complex behavioral health conditions, including those who are experiencing homelessness and justice involvement, aligning with the Services, Treatment and Outreach and Emergency/Interim Housing/Resources domains of the County’s Framework for Ending Homelessness.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue competitive solicitations for behavioral health services listed below, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed; and to amend the contracts to reflect changes in program, funding or service requirements, subject to the availability of funds and the approval of the Agency Director, Health and Human Services Agency.
a. Behavioral Health Support Services
b. Behavioral Health Collaborative Court
c. Bio-Psychosocial Rehabilitation Services
d. Central Region Urgent Walk-In Program
e. Recuperative Services Treatment for Transition Age Youth
f. Substance Use Outpatient Treatment Program
2. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to amend the contracts listed below to extend the contract term and expand services, subject to the availability of funds; and amend the contracts as required in order to reflect changes to services and funding allocations, subject to the approval of the Agency Director, Health and Human Services Agency.
a. Extend the contract term up to June 30, 2023, and up to an additional six months, if needed:
• Assertive Community Treatment, Substance Use and Housing Services
o Mental Health Systems, Inc., dba TURN Behavioral Health Services (Contract #555095)
o Mental Health Systems, Inc., dba TURN Behavioral Health Services (Contract #554865)
b. Extend the contract term up to December 31, 2023, and up to an additional six months, if needed:
• Case Management Services
o NAMI San Diego (Contract #549938)
• Mental Health Outpatient Treatment Services
o Exodus Recovery, Inc. (Contract #549560)
c. Extend the contract term up to June 30, 2024, and up to an additional six months, if needed:
• Assertive Community Treatment Services
o Community Research Foundation (Contract #559397)
o Community Research Foundation (Contract #559398)
o Community Research Foundation (Contract #559488)
o Pathways Community Services, LLC (Contract #559971)
• Consultant Services
o Public Consulting Group, LLC (Contract #566147)
• Mental Health Outpatient Treatment Services
o Union of Pan Asian Communities (Contract #557827)
• Mental Health Residential Treatment Services
o Crestwood Behavioral Health, Inc. (Contract #558255)
• Strength-Based and Institutional Case Management
o Telecare Corporation (Contract #559490)
d. Extend the contract term up to June 30, 2027, and up to an additional six months, if needed:
• Mental Health Outpatient Treatment Services
o Exodus Recovery, Inc. (Contract #549564)
3. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to amend the single source contracts listed below to extend the contract term and expand services, subject to the availability of funds; and amend the contracts as required in order to reflect changes to services and funding allocations, subject to the approval of the Agency Director, Health and Human Services Agency.
a. Extend the contract term up to June 30, 2023, and up to an additional six months, if needed:
• Augmented Services Program and Enhanced Augmented Services
o Casa El Cajon (Contract #562384)
b. Extend the contract term up to June 30, 2024, and up to an additional six months, if needed:
• Long Term Care Services
o Vista Woods Health Association, LLC (Contract #558327)
• Substance Use Outpatient Treatment Services
o Interfaith Community Services (#559501)
• Substance Use Residential Treatment Services
o CRASH, Inc. (Contract #553456)
o Crossroads Foundation (Contract #553466)
o House of Metamorphosis, Inc. (Contract #553455)
o Metropolitan Area Advisory Commission (Contract #553460)
o Pathfinders of San Diego, Inc. (Contract #553467)
o Stepping Stone of San Diego, Inc. (Contract #553454)
o Tradition One, Inc. (Contract #553462)
o Turning Point Home of San Diego, Inc. (Contract #553457)
o Twelfth Step House, Inc. (Contract # 553464)
o Veterans Village of San Diego (Contract #553463)
o The Way Back, Inc. (Contract #553465)
• Substance Use Perinatal Residential Treatment Services
o New Entra Casa (Contract #560535)
o HealthRight 360 (Contract #550907)
o McAlister Institute for Treatment and Education (Contract #553432)
o Mental Health Systems, Inc. (Contract #553434)
• Substance Use Teen Residential Treatment Services
o McAlister Institute for Treatment and Education (Contract #553433)
• Crisis Services
o New Alternatives, Inc. (Contract #533821)
EQUITY IMPACT STATEMENT
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services (BHS) serves as the specialty mental health plan for Medi-Cal eligible residents within San Diego County who are experiencing serious mental illness or serious emotional disturbance, and the service delivery system for Medi-Cal eligible residents with substance use care needs. As a steward of public health for the region, BHS must ensure that the services offered through County-operated and contracted programs address the social determinants of health by being accessible, capable of meeting the needs of diverse populations, and with the intent to equitably distribute services to those most in need.
In support of these efforts, BHS utilizes a population health approach to identify need and design services that are impactful, equitable, and yield meaningful outcomes for those served. This includes facilitating ongoing engagement and input from the community, stakeholders, consumers, family members, community-based providers, and healthcare organizations through formal and informal convenings, along with cross-collaboration with other County departments and community partners. Additionally, through the establishment of the Community Experience Partnership and the recent launch of the Behavioral Health Equity Index, in collaboration with the University of California San Diego, BHS is leading the development of a tool for measuring behavioral health equity which will be used to inform program planning, siting of services, and allocation of resources in a way that supports community needs.
If approved, today's action will award contracts for services that improve access to treatment and care for populations who are underserved by social and behavioral health resources, including individuals experiencing homelessness, individuals with justice involvement, as well as children and youth with complex behavioral health needs.
SUSTAINABILITY IMPACT STATEMENT
The proposed action to provide services that improve access to treatment and care for populations who are underserved by social and behavioral health resources, will result in sustainability enhancements in terms of health/wellbeing, equity, economy, and environment. Awarding contracts for these services will contribute to County of San Diego Sustainability Goal #2 to provide just and equitable access to County services by providing a wider availability and range of supportive, inclusive, and stigma-free options. Services will first improve the overall health of communities, reducing the demand of associated care services, while then increasing effectiveness of care providers and lowering operating costs of facilities, thus reducing emissions and waste generated within the care sector.
FISCAL IMPACT
Funds for these requests are included in the Fiscal Year (FY) 2022-24 Operational Plan in the Health and Human Services Agency (HHSA). If approved, today’s recommendations will result in approximate costs and revenue of $5.3-7.1 million in FY 2022-23 and $131.3-$175.0 million in FY 2023-24. There will be no change in net General Fund cost and no additional staff years.
Recommendation #1: Authorization to Issue Competitive Solicitations
If approved, this request will result in estimated costs and revenue of $50-$66.7 million in FY 2023-24. The funding sources are Mental Health Services Act (MHSA), Realignment, Short Doyle Medi-Cal, and Drug Medi-Cal (DMC). There will be no change in net General Fund cost and no additional staff years.
Recommendation #2: Authorization to Amend and Extend Contracts
If approved, this request will result in estimated costs and revenues of $5.2-$6.9 million in FY 2022-23 and $31.3-$41.7 million in FY 2023-24. The funding sources are MHSA, Realignment, Short Doyle Medi-Cal, DMC, and Assembly Bill 109. There will be no change in net General Fund cost and no additional staff years.
Recommendation #3: Authorization to Amend and Extend Single Source Contracts
If approved, this request will result in estimated costs and revenues of $0.1-$0.2 million in FY 2022-23 and $50-$66.6 million in FY 2023-24. The funding sources are MHSA, Realignment, Short Doyle Medi-Cal, California Work Opportunity and Responsibility to Kids (CalWORKs), Substance Abuse Block Grant, DMC, and Project for Assistance in Transition from Homelessness. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
At their meeting on November 3, 2022, the Behavioral Health Advisory Board voted to approve these recommendations.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services (BHS) provides a comprehensive array of community-based behavioral health services to vulnerable populations, including individuals who are experiencing homelessness, individuals with justice involvement, and children and youth with complex behavioral health conditions. Services are provided through County-operated programs as well as contracts with local public and private agencies. Approval of today’s recommended actions authorizes competitive solicitations to sustain critical behavioral health services and amendments to extend existing behavioral health services contracts.
These recommended actions support the continuation of critical work to advance the ongoing transformation of the Behavioral Health Continuum of Care. Additionally, the programs and services outlined provide critical treatment and housing services to individuals with complex behavioral health conditions, including those who are experiencing homelessness and justice involvement, aligning with the Services, Treatment and Outreach, and Emergency/Interim Housing and Resources domains of the County’s Framework for Ending Homelessness. All contracts are contingent upon the availability of funding, successful negotiations, and determination of a fair and reasonable price.
Recommendation #1: Authorization to Issue Competitive Solicitations
a. Behavioral Health Support Services
On January 26, 2021 (11), the Board authorized the procurement of behavioral health support services (BHSS) at new housing developments in the Central Region. BHSS programs provide onsite services and permanent supportive housing to adults, ages 18 and older, who reside at San Diego Housing Commission’s housing developments, who may have a mental health and/or substance use condition and need behavioral health support services. Services include screening, outreach and engagement, case management, housing stabilization, crisis intervention, and care coordination.
The BHSS programs utilize Housing First principles and adhere to housing stability metrics that reflect the community standards for permanent supportive housing programs and are reflective of national best practices. If approved, services will be provided in the Central and North Central Regions. In Fiscal Year (FY) 2021-22, BHSS programs served a total of 386 unduplicated residents, with 95.3% of residents receiving onsite behavioral health support services.
Today’s action requests the Board to authorize a competitive solicitation for the procurement of two BHSS programs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
b. Behavioral Health Collaborative Court
On September 23, 2014 (9), the Board authorized the procurement of the Behavioral Health Collaborative Court (BHCC) program designed to provide clinical case management and mental health, substance-induced psychiatric rehabilitation treatment, and recovery services to adults with serious mental illness (SMI). Subsequently, on November 16, 2021 (5), the Board authorized the contract term extension of this program up to June 30, 2023, and up to an additional six months, if needed. Furthermore, on May 24, 2022 (22), the Board authorized an amendment of the contract with the California Department of State Hospitals to increase grant funds for its mental health diversion program for BHCC. BHCC is a Full-Service Partnership and Assertive Community Treatment team that provides clinical case management and mental health, substance-induced psychiatric rehabilitation treatment, and recovery services to adults who have been incarcerated and are referred by the San Diego County Superior Court. Services include intensive court services and community supervision by the Superior Court and Probation Department, mental health, and co-occurring treatment services, including medication prescription and management, case management, and support in attaining stable housing and employment.
The BHCC program is based on a collaborative court model, which has shown effectiveness in increasing success and decreasing recidivism as participants transition from custody to community. The collaborative court model includes a team consisting of a Judge, Defense Attorney, Public Defender, Probation Officer, and treatment provider, designed to address public safety issues presented by misdemeanor and non-violent offenders and restore them as accountable and productive community members. The program helps participants effectively manage SMI and co-occurring conditions. It also helps prevent future criminal activity while also reducing the burden and costs of repeatedly processing individuals with low-level, non-violent offenses through the Nation’s courts, jails, and prisons. Services are provided countywide. In FY 2021-22, the program served a total of 142 unduplicated clients. Of those served by the program, 76% remained the same or showed improvement in their functional status and 48% remained the same or showed improvement in their clinical status.
Today’s action requests the Board authorize a competitive solicitation for the procurement of the BHCC program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
c. Bio-Psychosocial Rehabilitation Services
On January 7, 2014 (9), the Board authorized the procurement of Bio-Psychosocial Rehabilitation (BPSR) services for the Chaldean and Middle Eastern Community in the East Region and subsequently, on November 16, 2021 (5), the Board authorized a contract term extension of this program up to June 30, 2023, and up to an additional six months, if needed. On June 20, 2017 (13), the Board authorized the procurement of BPSR services in the East and Central Regions. BPSR programs provide treatment, rehabilitation, and recovery services to adults who have SMI, including those who may have co-occurring substance use conditions. The BPSR programs include urgent walk-in services, psychiatric evaluation, medication management, individual and group therapy, and crisis management.
BPSR services are provided for underserved communities, including the Asian American and Pacific Islander, Hispanic/Latino, and Middle Eastern populations. In FY 2021-22, the four BPSR clinics in the Central and East Regions served a total of 1,866 unduplicated clients. In FY 2021-22, the Mental Health Outcomes Management System reported that 78.1% of these clients showed clinical improvements and 70.3% showed functional improvements.
Today’s action requests the Board authorize a competitive solicitation for the procurement of four BPSR programs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed. If approved, these four programs will provide services to the Middle Eastern (with programming located in the East Region), Hispanic/Latino (with programming located in the Central Region), and Asian American Pacific Islander population (with programming located in the Central Region), along with an East Region-specific outpatient mental health clinic which will complement the County Operated BPSR in the East Region. Culturally specific programming and best practices will be included to support the needs of community members.
d. Central Region Urgent Walk-In Program
On June 20, 2017 (13), the Board authorized the procurement of the Central Region Urgent Walk-In Program. This program provides urgent mental health services that are consistent with psychosocial rehabilitation and recovery principles for adults with persistent SMI and/or co-occurring mental health and substance use conditions, who are eligible for Medi-Cal funded services or are indigent. Services include screening and behavioral health assessment, medication services, referrals, and linkage to ongoing care.
The Central Region Urgent Walk-In Program assists in reducing the number of individuals going to emergency rooms or emergency psychiatric units solely to access medication and services. In FY 2021-22, the program screened a total of 3,207 unduplicated clients to determine if they meet program criteria, of which 2,023 were assessed for mental health needs. Of those assessed, 749 clients were successfully connected to ongoing care, thus, achieving 92.5% of the program goal of connecting 809 clients to ongoing services in the system of care.
Today’s action requests the Board authorize a competitive solicitation for the procurement of the Central Region Urgent Walk-In Program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
e. Recuperative Services Treatment for Transition Age Youth
On April 25, 2017 (5), the Board authorized the procurement of Recuperative Services Treatment (ReST) Recuperative Housing program. This program is designed to improve the mental health and quality of life outcomes of transition age youth (TAY) with SMI who are experiencing or at risk of homelessness, and who repeatedly utilize acute or emergency mental health services but are otherwise unconnected to services. Services include short-term housing that incorporates innovative, recuperative, and habilitative housing and supportive services. The program innovatively engages and connects TAY to all needed services, including ongoing behavioral health treatment. The program also provides a supportive environment which includes whole-health services targeting healthy eating, exercise, sleep, and a range of holistic interventions coupled with occupational therapy supports to help teach skills needed to encourage recovery, promote healthy social connections, and accomplish personal goals. Services are provided countywide.
In FY 2021-22, the program served a total of 52 unduplicated TAY and 100% of these clients were linked to employment, education, housing, improved health and social connectedness, connection to ongoing mental health treatment, and access to behavioral health services. According to the FY 2020-21 University of California San Diego Evaluation Report, ReST participants showed a reduction in the use of Psychiatric Emergency Response Team services from 22.4% to 6.1%, crisis stabilization services from 24.5% to 4.1%, inpatient services from 34.7% to 10.2%, and crisis residential treatment services from 26.5% to 8.2% during their time in the program and 180 days after leaving the program.
Today’s action requests the Board to authorize a competitive solicitation for the procurement of the ReST for TAY program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
f. Substance Use Outpatient Treatment Program
On September 23, 2014 (9), the Board authorized the procurement of Regional Recovery Services for adults. On March 27, 2018 (2), the Board authorized the implementation of the Drug Medi-Cal Organized Delivery System designed to improve care for those who are experiencing substance use issues and the procurement and amendment of contracts to support and expand the substance use provider network capacity. Subsequently, on November 16, 2021 (5), the Board authorized the contract term extension of the six Regional Recovery Centers up to June 30, 2023, and up to an additional six months, if needed.
Regional Recovery Centers provide non-residential substance use treatment and recovery services to TAY, adults, and older adults with substance use conditions, including those with co-occurring mental health needs. Services are provided in the Central, East, North Central, North Coastal, North Inland, and South Regions. Regional Recovery Centers incorporate evidence-based treatment and recovery approaches. This level of treatment includes outpatient withdrawal management, intensive outpatient substance use treatment, case management, connection to medication assisted treatment, recovery services, and client support in attaining the appropriate level of care, employment, and stable housing.
In FY 2021-22, clients in the six substance use outpatient treatment programs have demonstrated an increase in housing stability, with an average of 83% of those experiencing homelessness at intake being housed at the end of treatment. Additionally, an average of 77% of clients who completed treatment were enrolled in an eligibility program at the end of treatment or employed either in a structured employment preparation program or in a formal educational setting. Furthermore, clients in these programs have reported no new arrests, successful assessment completion, and the provision of recovery services. In FY 2021-22, the Regional Recovery Centers served a cumulative total of 3,738 unduplicated clients.
Today’s action requests the Board to authorize competitive solicitations for the procurement of the six Substance Use Outpatient Treatment Programs, Regional Recovery Centers, for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
Recommendation #2: Authorization to Amend and Extend Contracts
The Board authorized the competitive solicitation for the programs listed in Attachment A, Tables 1-4. Most of the contracts listed in Attachment A, Tables 1-4 expire by the end of FY 2022-23 and require an amendment to extend to ensure continuity of critical behavioral health treatment services. These contracts will be competitively re-procured and the extensions support strategically spreading the re-procurements over time to allow for maximum competition from potential offerors. Additionally, these extensions will support improved service delivery by ensuring similar services are aligned and evaluated through clinical design.
If approved, today’s actions would authorize an amendment and extension as follows:
a. Table 1 - extend the contract term up to June 30, 2023, and up to an additional six months, if needed.
b. Table 2 - extend the contract term up to December 31, 2023, and up to an additional six months, if needed.
c. Table 3 - extend the contract term up to June 30, 2024, and up to an additional six months, if needed.
d. Table 4 - extend the contract term up to June 30, 2027, and up to an additional six months, if needed. The County invested time and resources to obtain site licensure and conduct facility improvements of the Vista Crisis Stabilization Center. This site has been operational for less than one year; extending this contract would prevent disruption in services.
Additional details of these programs can be found in Attachment A, Tables 1-4.
Recommendation #3: Authorization to Amend and Extend Single Source Contracts
The Board authorized the single source procurement of the programs listed in Attachment A, Tables 5-6. Most of the contracts listed in Attachment A, Tables 5-6 expire by the end of FY 2022-23 and require an amendment to extend to ensure continuity of critical behavioral health treatment services. Most of these contracts will be competitively re-procured and the extensions support strategically spreading the re-procurements over time to allow for maximum competition from potential offerors. Additionally, these extensions will support improved service delivery by ensuring similar services are aligned and evaluated through clinical design.
If approved, today’s actions would authorize an amendment and extension as follows:
a. Table 5 - extend the contract term up to June 30, 2023, and up to an additional six months, if needed.
b. Table 6 - extend the contract term up to June 30, 2024, and up to an additional six months, if needed.
The Director of the Department of Purchasing and Contracting awarded the contracts listed in Attachment A, Tables 5-6 based on the following Board Policy A-87, Competitive Procurement exceptions:
• Section 1.D.3: the procurement is for services from a provider with unique knowledge, skill, or ability not available from other sources.
• Section 1.D.6: the procurement is for goods and/or services where continuity of providers will provide efficiency or critical knowledge, and other providers of the good and/or services cannot provide similar efficiencies or critical knowledge.
Additional details of these programs can be found in Attachment A, Tables 5-6.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s (County) 2022-2027 Strategic Plan Initiatives of Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision of healthy, safe, and thriving communities. This is accomplished by reducing disparities and disproportionality of individuals with mental health and substance use conditions and ensuring access to a comprehensive continuum of behavioral health services administered through accessible behavioral health programs.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Behavioral Health Services List of Contracts