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DATE: |
October 11, 2022 |
14 |
SUBJECT
Title
AUTHORIZE APPROPRIATIONS FOR THE TRI-CITY PSYCHIATRIC HEALTH AND THE EAST REGION COMMUNITY-BASED CARE FACILITIES; ACCEPT GRANT FUNDING FOR THE EDGEMOOR ACUTE INPATIENT UNIT; SHIFT FUTURE SERVICES AT THE SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL FACILITY AND THE VACANT COUNTY-OWNED PROPERTY AT 4307 THIRD AVENUE; AND ISSUE COMPETITIVE SOLICITATIONS FOR PROFESSIONAL SERVICES, PRECONSTRUCTION SERVICES, AND THE DEVELOPMENT OF THE CENTRAL REGION AND EAST REGION COMMUNITY-BASED CARE FACILITIES (DISTRICTS: ALL) (4 VOTES)
Body
OVERVIEW
Under the leadership of the San Diego County Board of Supervisors (Board), behavioral health care in San Diego County is in the midst of a profound transformation. The County of San Diego (County) is taking action and making strategic investments to move the local behavioral health care delivery system from a model of care driven by crises to one centered on continuous, coordinated care and prevention. These efforts, broadly referred to as the Behavioral Health Continuum of Care (Continuum of Care), are guided by data, focused on equity, and designed to engender collaborative work within and outside of government.
Today’s recommended actions will continue to advance the County Health and Human Services Agency, Behavioral Health Services’ (BHS) work across the Continuum of Care within three strategic domains, including Crisis and Diversionary Services, Inpatient Hubs and Care Coordination, and Residential and Long-Term Care, by establishing critical infrastructure and services dedicated to support people with behavioral health conditions who are Medi-Cal eligible.
Building on Continuum of Care efforts underway, BHS developed the Behavioral Health Continuum of Care Optimal Care Pathways (OCP) model, a data-informed algorithm that quantifies optimal utilization across service areas within the system. The OCP model proposes to recalibrate and expand services, along with the addition of new service types to remove barriers to care, reduce per capita cost, and connect individuals to the care they need, when they need it to ensure wellness over the long-term.
Today’s recommended actions will advance the County toward the optimal state of the OCP model by establishing new capital infrastructure for subacute and community-based care services dedicated to supporting individuals with behavioral health conditions who are Medi-Cal eligible. Establishing additional capacity within these service categories will ensure proper care pathways are available to divert individuals from unnecessary utilization of expensive acute 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 unserved and underserved, as well as the ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by working across systems to support better care of individuals, better health for local populations, and more efficient health care resourcing.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Find that the proposed activities are exempt from the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(3), 15061(b)(3), and 15262 of the State CEQA Guidelines.
2. Establish appropriations of up to $7.0 million in the County Health Complex Fund for Capital Project 1023557, Tri-City Healthcare District Psychiatric Health Facility, based on Realignment and Intergovernmental Transfer revenues. (4 VOTES)
3. Authorize the acceptance of $4.4 million of one-time Behavioral Health Continuum Infrastructure Program Launch Ready Grant funding from the California Department of Health Care Services for Fiscal Year (FY) 2022-23 through FY 2026-27, for total awarded grant funding of $16.8 million, for the construction of a new 12-bed Acute Psychiatric Unit within the existing Edgemoor Distinct Part Skilled Nursing Facility campus and authorize the Agency Director, Health and Human Services Agency, or designee to execute all required documents, upon receipt, including any annual extensions, amendments, or revisions that do not materially impact or alter the services or funding level.
4. Authorize the department to formally shift future services at the San Diego County Psychiatric Hospital facility from psychiatric acute inpatient care and emergency psychiatric unit services to a new optimal array of services to be informed through a Request for Information, which may include a small psychiatric acute inpatient unit and subacute care. The final service array will be informed by revenue modeling to determine availability of funding to sustain operations.
5. Establish appropriations of up to $5.0 million in the County Health Complex Fund, Capital Project 1025925, San Diego County Psychiatric Hospital Facility for planning and design related to facility improvements to support future programming, based on Realignment and Intergovernmental Transfer revenues. (4 VOTES)
6. Authorize the Director, Purchasing and Contracting to advertise and award an architectural and engineering contract and to take any action authorized by Article XXIII, Section 401, et seq. of the Administrative Code, with respect to contracting for the design of the San Diego County Psychiatric Hospital Facility. Designate the Director, Department of General Services as the County of San Diego Officer responsible for administering the awarded architectural and engineering contract.
7. Authorize the Director, Department of Purchasing and Contracting to take any action authorized by Article XXIII, Section 401, et seq. of the Administrative Code and Public Contract Code Section 20146 to advertise and award a single Construction Manager at Risk contract for the San Diego County Psychiatric Hospital capital project, to authorize Phase 1 of the contract for preconstruction services, and to return to the Board for appropriations and authority to execute the option for Phase 2, construction.
8. Authorize the formal shift of the approved capital development and subsequent provision of services slated for the vacant parcel of County-owned land located on Third Avenue, Capital Project 1023736, from acute inpatient, crisis stabilization, and intensive outpatient services to community-based care services, which may include an adult residential facility, residential care facility for the elderly, recuperative care services, and other services, as needed, to support the development of the Central Region Community-Based Care Facility on Third Avenue, and authorize the Director, Department of General Services, to issue, and to take any related actions necessary to issue a request or requests for proposals for development and operation of a Central Region Community-Based Care Facility and/or related services. The final service array will be informed by revenue modeling to determine availability of funding to sustain operations.
9. Establish appropriations of $1.0 million in the County Health Complex Fund for Capital Project 1025926, East Region Community-Based Care Facility for planning and design to support construction, which may include an adult residential facility, residential care facility for the elderly, recuperative care services, and other services, as needed, based on Realignment and Intergovernmental Transfer Revenues, and authorize the Director, Department of General Services, to issue, and to take any related actions necessary to issue, a request or requests for proposals for development and operation of an East Region Community-Based Care Facility and/or related services. The final service array will be informed by revenue modeling to determine availability of funding to sustain operations. (4 VOTES)
EQUITY IMPACT STATEMENT
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services (BHS) serves as the specialty behavioral 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 disorder care needs. As a steward of public health for the region, BHS must ensure that the resources and services offered through County-operated and contracted programs promote equitable outcomes, advance wellness across the continuum of need, and are equitably distributed based on the needs of the region’s diverse communities.
In support of these efforts, BHS utilizes a population health approach, incorporating evidence-based practices and robust data analysis, to identify need and design services that are impactful, equitable, and yield meaningful outcomes for clients. This includes facilitating ongoing engagement and input from 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, in collaboration with the University of California San Diego, BHS is leading the development of the Behavioral Health Equity Index, a tool to help measure behavioral health equity that will inform program planning, siting of services, and allocation of resources in a way that supports the most pressing community needs.
If approved, today's actions will set a course for the region’s behavioral health system by expanding crisis services and advancing the vision of the Optimal Care Pathways model to build dedicated subacute and community-based care capacity that connects individuals who are Medi-Cal eligible to care in the least restrictive setting to meet their unique needs long term. The model establishes new care pathways that divert people from unnecessary utilization of expensive acute care and thereby reduces per capita cost.
These actions will ultimately aim to reduce behavioral health inequities among the region, advancing services that will impact vulnerable populations including individuals experiencing homelessness and those with justice involvement.
SUSTAINABILITY IMPACT STATEMENT
Transforming the Behavioral Health Continuum of Care in San Diego County supports the County of San Diego’s (County) Sustainability Goal #2 to provide just and equitable access through the regional distribution of services that allows chronically underserved communities and individuals with behavioral health conditions to receive care in close proximity to where they live. Today’s actions will establish dedicated crisis services, subacute care, and community-based care in locations that are geographically dispersed throughout the region to support individuals who are Medi-Cal eligible.
The historic inequity and lack of parity within long-term care has resulted in individuals who remain stuck in higher levels of care, an endless cycle of visits to emergency services, chronic homelessness for people with behavioral health conditions, and individuals who are unable to get care, which has resulted in a higher risk of poor health outcomes. According to the State’s Community Care Licensing Division, since 2017, 146 of the 781 licensed adult residential facilities in San Diego County, or 19%, have closed and 138 of the 719 unique residential care facilities for the elderly, or 19%, have closed leaving people unable to step down out of higher levels of care.
Today’s actions support Sustainability Goal #4 to protect the health and wellbeing of individuals with behavioral health conditions who are Medi-Cal eligible by establishing dedicated long-term care infrastructure, inclusive of community-based care and subacute care, that supports them in the least restrictive setting thereby removing historical barriers to care.
County Health and Human Services Agency, Behavioral Health Services will continue to explore thoughtful and sustainable building design for the Capital projects and facility improvements outlined in today’s actions.
FISCAL IMPACT
Recommendation #1: Exemption from CEQA
There is no fiscal impact associated with this recommendation.
Recommendation #2: Tri-City Psychiatric Health Facility
Funds for this request are partially included in the Fiscal Year (FY) 2022-24 Operational Plan in the County Health Complex Fund for Capital Project 1023557, Tri-City Healthcare District Psychiatric Health Facility. If approved, this will result in estimated costs and revenues of up to $7.0 million for the Tri-City Healthcare District Psychiatric Health Facility. The funding source is Realignment and Intergovernmental Transfer revenues. Current project appropriations are $20.6 million General Fund fund balance ($17.4 million) and Realignment and Intergovernmental Transfer revenues ($3.2 million). The new total project cost is estimated at $27.6 million, inclusive of current approved appropriations ($20.6 million) and new appropriations ($7.0 million).
Recommendation #3: Accept Additional Behavioral Health Continuum Infrastructure Program Launch Ready Grant Funding
Funds for this request are partially included in the FY 2022-24 Operational Plan in HHSA. If approved, this request will result in estimated costs and revenues of $8.8 million in FY 2022-23 through FY 2026-27 for the Edgemoor Psychiatric Unit Capital project appropriated in the County Health Complex Fund. The estimated revenue of $8.8 million is inclusive of $4.4 million associated with the Behavioral Health Continuum Infrastructure Program Launch Ready Grant allocation funded by State Fiscal Recovery Funds established by the American Rescue Plan Act to cover 50% of the estimated overage cost for the project ($8.8 million), and a $4.4 million County match funded by Realignment. The total grant funding conditionally awarded for this capital project is $16.8 million. The total estimated cost for this project is still being finalized and staff will return to the Board to establish appropriations for this project and with other recommended actions in the future.
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Recommendations #4 - #7: Facility Improvements for Future Services at the San Diego County Psychiatric Hospital Facility
Funds for this request are not included in the FY 2022-24 Operational Plan for the County Health Complex Fund. If approved, this request will result in estimated costs and revenues of $5.0 million in Capital Project 1025925, San Diego County Psychiatric Hospital project for costs related to planning, design, project management, consultant, and other costs. The funding source is Realignment and Intergovernmental Transfer revenues. The total estimated cost is under development and will include substantial infrastructural improvements, maintenance, and major systems upgrades. The department will return to the Board to establish appropriations for this project and with other recommended actions in the future.
Recommendation #8: Central Region Community-Based Care Facility
Funds for this request are included in the FY 2022-24 Operational Plan for the County Health Complex Fund. Capital Project 1023736, Central Region Community-Based Care Facility current project appropriations are $32.0 million. Funding sources are Intergovernmental Transfer revenues ($12.0 million) and Behavioral Health Realignment ($20.0 million). The department will return to the Board to establish additional appropriations and with other recommended actions in the future. The County will continue to pursue any new federal and State funding, grants, or other funding sources, including the use of securitized Tobacco Settlement Funds.
Recommendation #9: East Region Community-Based Care Facility
Funds for this request are not included in the FY 2022-24 Operational Plan for the County Health Complex Fund. If approved, this request will result in estimated costs and revenues of $1.0 million in Capital Project 1025926, East Region Community-Based Care Facility for costs related to planning and design. The funding source is Realignment and Intergovernmental Transfer revenues. The estimated total facility development and construction costs are being developed, and the department will return to the Board to establish appropriations for this project and with other recommended actions in the future. The County will continue to pursue any new federal and State funding, grants, or other funding sources, including the use of securitized Tobacco Settlement Funds.
There will be no change in net General Fund cost and no additional staff years resulting from any of today’s recommendations.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The Behavioral Health Advisory Board received this Board letter as an informational item at their regular meeting on October 6, 2022.
BACKGROUND
Under the leadership of the San Diego County Board of Supervisors (Board), behavioral health care in San Diego County is in the midst of a profound transformation. The County of San Diego (County) is taking action and making strategic investments to move the local behavioral health care delivery system from a model of care driven by crises to one centered on continuous, coordinated care and prevention. These efforts, broadly referred to as the Behavioral Health Continuum of Care (Continuum of Care), are guided by data, focused on equity, and designed to engender collaborative work across silos, within and outside of government.
The County Health and Human Services Agency (HHSA), Behavioral Health Services (BHS) has advanced Continuum of Care efforts by addressing the immediate needs and setting a more appropriate care trajectory for individuals experiencing behavioral health crises, which has resulted in major investments in:
• Psychiatric acute inpatient beds to support the increasing number of people in need of hospitalization;
• Regionally distributed crisis stabilization units to divert individuals experiencing a behavioral health crisis from unnecessarily utilizing emergency departments; and
• The implementation of mobile crisis response teams countywide to respond in the field to individuals who are experiencing a behavioral health crisis.
Tri-City Psychiatric Health Facility
On January 14, 2020 (11), the Board approved agreements between the County and Tri-City Healthcare District for the development and operation of a 16-bed psychiatric health facility (PHF) at the Tri-City Medical Center. The Board also approved establishing appropriations of $17.4 million to fund the construction of the Tri-City PHF. On December 7, 2021 (26), the Board approved additional appropriations of $3.2 million for the project which is anticipated to begin in Fall 2022 and be completed by late 2023.
Today’s recommendation will establish appropriations up to $7.0 million for the Tri-City PHF project for increased costs of construction related to current market conditions. Construction of the project is anticipated to begin Fall 2022 and be completed by late 2023.
Accept Additional Grant Funding for Edgemoor Acute Inpatient Unit
On January 31, 2022, the Department of Health Care Services (DHCS) released a Request for Application for the Behavioral Health Continuum Infrastructure Program (BHCIP) round 3 funding cycle, BHCIP Launch Ready Grant, which provides funding to construct, acquire, and rehabilitate real estate assets to expand the behavioral health continuum of treatment and service resources in settings serving Medi-Cal beneficiaries. Proposed behavioral health infrastructure projects must demonstrate they have been through a planning process and are ready for implementation.
In March 2022, BHS submitted a BHCIP Launch Ready Grant application totaling $12.4 million for the Edgemoor Acute Psychiatric Unit capital project to support the expansion of the Continuum of Care infrastructure within San Diego County and on June 21, 2022, BHS received a notice of conditional award of approximately $12.4 million. On August 16, 2022 (7), the Board authorized acceptance of these funds.
On September 13, 2022, DHCS notified BHS that additional BHCIP Launch Ready grant funding was conditionally awarded for the Edgemoor Acute Inpatient Unit capital project increasing the total grant funding awarded to the County from $12.4 million to $16.8 million, inclusive of the initial allocation awarded ($12.4 million) plus 50% ($4.4 million) of the estimated overage cost for the project ($8.8 million) based on initial rough estimates for the project, due to increasing costs of construction. When completed, this capital project will add a new 12-bed acute psychiatric unit within the existing Edgemoor Distinct Part Skilled Nursing Facility (Edgemoor) campus, allowing residents to continue to receive the appropriate specialty psychiatric care without requiring them to transfer out of their residence at Edgemoor. This facility will have the capacity to serve residents countywide, as needed, and will increase accessibility to vulnerable individuals within the East Region which currently has limited behavioral health infrastructure.
Today’s recommended action is to accept the increased BHCIP Launch Ready grant funding of $4.4 million for the development and construction of the Edgemoor Acute Inpatient Unit within the existing Edgemoor campus. This project will support access to individuals experiencing a behavioral health crisis in the East Region. The total estimated cost of the capital project is under development and recommended actions will be brought before the Board in the future.
Optimal Care Pathways Model
On September 27, 2022 (23), BHS introduced the Optimal Care Pathways (OCP) model, a data-informed algorithm that quantifies optimal utilization across three distinct service areas, including community crisis diversion, sub-acute services, and community-based care. The OCP model outlines the need to recalibrate and nearly double current utilization levels across these three service categories by adding new services, developing innovative payment models, and establishing dedicated infrastructure that is centered around connecting clients to the care they need in the least restrictive setting to meet their unique needs long term. The model also removes barriers to care by establishing new care pathways that divert people from unnecessary utilization of expensive acute care and thereby reduces per capita cost. In alignment with the optimal state of the OCP model, recommendations are included today that will establish dedicated capacity within sub-acute services and community-based care dedicated to supporting individuals with behavioral health conditions who are Medi-Cal eligible.
Establishing Subacute Care at the San Diego County Psychiatric Hospital Facility
On August 30, 2022 (16), to further advance regional distribution of services and to enhance capacity for critical crisis and inpatient services, the Board approved recommendations to establish 44 new dedicated psychiatric inpatient beds at Alvarado Hospital for individuals who are Medi-Cal eligible, along with emergency psychiatric unit and crisis stabilization unit services, thereby establishing the Central Region Behavioral Health Hub at Alvarado Hospital (Central Region Hub). The agreement with Alvarado Hospital will establish a bed reservation system that guarantees bed availability for Medi-Cal eligible individuals thereby increasing regional capacity for critical inpatient services that serve adults experiencing a behavioral health crisis.
Establishing the Central Region Hub at Alvarado Hospital will shift the provision of acute inpatient care from the San Diego County Psychiatric Hospital (SDCPH), an Institution of Mental Disease (IMD) revenue-excluded facility, to Alvarado Hospital, a General Acute Care Hospital, will allow the County to realize operational efficiencies, and optimize available revenues. This opportunity has allowed BHS to explore options for future services within the SDCPH facility, including establishing subacute care, to meet urgent needs, as outlined in the OCP model.
Subacute care is provided to individuals who are stepping down from acute psychiatric care or for individuals whose acuity may have intensified and therefore they need a higher level of care. Services are provided on a 24/7 basis in a secured setting to adults who are unable to live safely in the community, and include room and board, health monitoring, medication therapy, individual, group and/or family therapy, case management, and discharge planning. Services offered provide structured daily programming to assist clients in improving functioning so they can return to live in the community. As outlined in the OCP model, subacute services demonstrated an increased bed day utilization need of nearly 65% in the optimal future state.
Planning is underway, in partnership with the County’s Department of General Services (DGS) and consultants, to identify the new array of services for the SDCPH facility, which will likely include subacute care, along with considerations such as licensing, facility capacity, revenue modeling, and infrastructure limitations, to identify the optimal array of new services that will be developed within the SDCPH property, and may include:
• A small psychiatric acute inpatient unit, which would be of a relatively smaller scale when compared with existing psychiatric acute inpatient services provided currently;
• Skilled Nursing Facility (SNF) Specialized Treatment Program beds, which are IMDs that provide mental health services for patients who have a diagnosed chronic psychiatric condition and whose adaptive functioning is moderately impaired;
• SNF Neurobehavioral Health beds, which provide specialized neurobehavioral treatment and care to individuals who are Medi-Cal eligible and diagnosed with traumatic brain injury or neuro-cognitive impairment and serious mental illness;
• SNF Medical beds, similar to services at the County’s Edgemoor Distinct Part SNF, which provide long-term skilled nursing care for individuals with complex medical needs who require skilled nursing care under the direction of physicians and supervision of registered nurses; and/or,
• Other subacute services.
Establishing dedicated new subacute capacity for specialized beds designed to meet the needs of individuals with complex conditions who have serious mental illness would provide vital support to individuals in stepping down from acute inpatient care and stepping up from lower levels of care to ensure they are connected to the right level of care at the right time. The new subacute services at the SDCPH facility would not commence until the new acute inpatient unit within Alvarado Hospital is completed and operational, subsequently followed by the transition of existing services out of the SDCPH, and finally the completion of facility improvements within the SDCPH facility. Additionally, the facility may require licensure by the State, which will be dependent on the final array of services outlined.
Today’s action recommends formally shifting future services at the SDCPH facility from psychiatric acute inpatient care and emergency psychiatric unit services to a new optimal array of services to be informed through a Request for Information, which may include a small psychiatric acute inpatient unit and subacute care.
Additionally, today’s action requests authorization to establish appropriations up to $5.0 million and to commence planning and design work related to facility improvements, in partnership with DGS and consultants, for the SDCPH facility to support future programming. The total project cost is under development and will include substantial infrastructural improvements, maintenance, and major systems upgrades. The department will return to the Board to establish appropriations for this project and with other recommended actions in the future.
Reimagining the Third Avenue Property as Community-Based Care
On October 29, 2019 (5), the Board approved the County-owned property at Third Avenue for the development and construction of the Central Region Behavioral Health Hub, to include acute inpatient, crisis stabilization, and intensive outpatient services. The County now has an opportunity to establish acute inpatient psychiatric services and crisis services at the Central Region Hub at Alvarado Hospital; this can be accomplished in a more expedient and efficient manner when compared to development of a standalone acute care hospital. This also allows the County to pivot toward a new strategy for the vacant County-owned property on Third Avenue, to include community-based care dedicated for individuals with behavioral health conditions who are Medi-Cal eligible.
Community-based care pathways are cost-effective and create step-down pathways from higher levels of care, along with diversion and prevention, when clinically appropriate, from unnecessary acute and subacute care, which is more expensive and often not the appropriate level of care. Offering a full array of client-centered services will provide individuals with the care they need to support positive health outcomes over their lifetime.
The new scope of services being recommended for the Central Region Community-Based Care Facility on Third Avenue site include adult residential facilities and residential care facilities for the elderly that offer 24/7 care and supervision to Medi-Cal eligible individuals with various levels of clinical and social care to support recovery and rehabilitation within the community. Also recommended is recuperative care, which supports individuals stepping down from secure settings by offering a welcoming environment that sustains stabilization and prevents the likelihood of readmission by providing whole person care interventions. The OCP model projects a need to increase community-based care bed utilization days by nearly 150% in the optimal state.
Today’s recommendation requests Board approval to formally shift the approved scope of services and capital development of the Third Avenue property from acute inpatient, crisis stabilization, and intensive outpatient services to community-based care services, inclusive of an adult residential facility, a residential care facility for the elderly, recuperative care services, and other services, as needed. If approved, planning and design activities will shift scope to support the development and construction of the Central Region Community-Based Care Facility. DGS intends to issue a Request for Information to determine industry interest in and feasibility of a developer-led approach to development and operation of a Central Region Community-Based Care Facility, to be followed by a Request for Proposals depending on the results of the Request for Information.
Upon completion, the Central Region Community-Based Care Facility is expected to result in new capacity dedicated to support individuals with behavioral health conditions who are Medi-Cal eligible. The estimated total cost of this capital project is under development as the County drafts a development and operations request for proposal for this facility. Staff will return to the Board to establish appropriations for this project and with other recommended actions in the future.
To support the construction of the Central Region Community-Based Care Facility, the County plans to apply for Community Care Expansion (CCE) - Capital Expansion grant funding available through the California Department of Social Services. CCE grant funds may be utilized for the acquisition, construction, and rehabilitation of adult and senior care facilities serving Supplemental Security Income/State Supplementary Payment and Cash Assistance Program for Immigrants applicants and recipients, including those who are experiencing or at risk of homelessness.
East Region Community-Based Care Facility
Also aligning with the optimal future state outlined in the OCP model, is an opportunity to design and construct a new community-based care facility in the East Region that would include an adult residential facility, a residential care facility for the elderly, recuperative care, and other services, as needed, dedicated to providing services to Medi-Cal eligible individuals with behavioral health conditions. As noted in the OCP model, San Diego County has a critical need for dedicated community-based care to support individuals with behavioral health conditions in the least restrictive setting long term. DGS intends to issue a Request for Information to determine industry interest in and feasibility of a developer-led approach to development and operation of an East Region Community-Based Care Facility, to be followed by a Request for Proposals depending on the results of the Request for Information.
If approved, today’s recommendation would establish appropriations of $1.0 million for HHSA and DGS in collaboration with other key partners to initiate planning and design activities for an East Region Community-Based Care Facility. The estimated total cost of the capital project would be informed by this work. County staff will return to the Board to establish appropriations for this project and with other recommended actions in the future.
ENVIRONMENTAL STATEMENT
Today’s actions for authorizing the procurement of design professional services and the issuance of requests for proposals for the East and Central Region Community-Based Care Facilities are exempt from CEQA pursuant to Sections 15060(c)(3), 15061(b)(3), and 15262 of the State CEQA Guidelines. The proposed actions to authorize requests for proposals for development of the East and Central Region Community-Based Care Facilities are not subject to review under the CEQA pursuant to CEQA Guidelines section 15060(c)(3) because the action is not a project as defined in Section 15378 of the CEQA Guidelines. The proposed actions are administrative activities that will not result in direct or indirect physical changes in the environment. Section 15061(b)(3) is applicable because it can be seen with certainty that this action has no potential to cause a significant effect on the environment. At this time, the Board is only authorizing the procurement of architect/engineering and preconstruction services for the San Diego County Psychiatric Hospital. Staff will return to the Board for direction and approval to potentially move forward, make changes to, or not move forward with the project, at which time the appropriate CEQA review will accompany any future Board actions. Section 15262 is equally applicable because the actions before the Board include a feasibility analysis and design for possible future actions that do not commit the County to any definitive course of action. Subsequent actions would be reviewed pursuant to CEQA and presented to the Board as required for consideration prior to implementation.
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, by reducing disparities and disproportionality of individuals with mental illness and substance use disorders 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)
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