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DATE: |
January 28, 2025 |
03 |
SUBJECT
Title
AUTHORIZE A SINGLE SOURCE CONTRACT WITH SHARP HEALTHCARE FOR HOSPITAL-BASED CRISIS STABILIZATION SERVICES WITHIN SHARP CHULA VISTA MEDICAL CENTER (DISTRICTS: ALL)
Body
OVERVIEW
Under the leadership of the San Diego County Board of Supervisors (Board), the County of San Diego Health and Human Services Agency, Behavioral Health Services (BHS) has made key investments over the last several years to enhance community-based behavioral health services including the establishment of several crisis stabilization units (CSUs). CSUs provide immediate mental health support and treatment services in a therapeutic setting to people with serious behavioral health needs who require urgent care beyond what an outpatient clinical service can provide. Services typically last less than 24 hours and include crisis intervention, ongoing assessment and stabilization, medication administration, consultation with family and outpatient providers, and linkage and/or referral to follow-up community-based services and resources.
In January 2024, Sharp HealthCare (Sharp) received one-time grant funding to support the design and development of a new Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) CSU within the Sharp Chula Vista Medical Center. Similar to a traditional CSU, an EmPATH CSU offers care for people experiencing a psychiatric crisis through crisis stabilization services. The EmPATH model differs as it is co-located in an emergency department (ED), thus enabling people with behavioral health needs to transition smoothly to a CSU without being discharged. Sharp will establish approximately six EmPATH CSU recliners adjacent to the ED that are anticipated to provide care for a large proportion of people with serious behavioral health conditions who are eligible for Medi-Cal. As the specialty mental health plan for people with serious mental illness, the County can receive Medi-Cal reimbursement for these services through the California Department of Health Care Services.
Today’s item seeks authority to establish a single source contract with Sharp for approximately six CSU recliners within the Sharp Chula Vista Medical Center that serve people with behavioral health conditions who are eligible for Medi-Cal. Sharp Chula Vista Medical Center will be the only hospital providing CSU services co-located within an ED through the new EmPATH unit, which uniquely positions it to facilitate quicker connections to behavioral health crisis care for people entering the ED.
Today’s action supports the County 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 through further strengthening the continuum of behavioral health services by advancing crisis care in San Diego County and expanding capacity in the South Region.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
In accordance with Board Policy A-87, Competitive Procurement, approve and authorize the Director, Department of Purchasing and Contracting, to enter into negotiations with Sharp HealthCare for hospital-based crisis stabilization services, co-located within the Sharp Chula Vista Medical Center emergency department, and subject to successful negotiations and determination of a fair and reasonable price, award a contract 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 Deputy Chief Administrative Officer, Health and Human Services Agency.
EQUITY IMPACT STATEMENT
The County of San Diego (County) Health and Human Services Agency (HHSA), Behavioral Health Services (BHS) functions as the specialty mental health plan for Medi-Cal eligible residents within San Diego County with serious mental illness, and the service delivery system for Medi-Cal eligible residents with substance use disorder care needs. As a regional steward of public health, BHS must ensure that services address the social determinants of health by being accessible, capable of meeting the needs of a diverse population, and equitably distributed to those most in need. BHS utilizes a population health approach, evidence-based practices, robust data analysis, and input from consumers, community-based providers, healthcare organizations, and other stakeholders to identify community needs and design services that are impactful, equitable, and yield meaningful outcomes for clients.
According to 2023 data from the County Medical Examiner's Office, residents in South Region had the third-highest rate of drug overdose deaths among all HHSA regions, with a staggering 117% increase from 2018 to 2023-the largest growth of any region. In 2022, South Region residents had an average of 22 emergency department (ED) encounters per week with substance use disorder (SUD) indicated as the primary diagnosis, with more than half among Medi-Cal recipients. Additionally, South Region residents had an average of 260 ED encounters per week for serious mental illness (SMI), accounting for 15% of all SMI-related ED visits in the county, 29% of which were among Medi-Cal recipients. Establishing crisis stabilization services will increase capacity of critical behavioral health care in South Region and will expand inpatient care to Medi-Cal eligible adults and others, improving access to critical crisis care for vulnerable adults who are experiencing a behavioral health crisis.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed action aligns with County Sustainability Goal #2, to ensure equitable access to County services. Establishing inpatient care services within the South Region prioritizes equitable access to essential behavioral health inpatient services for Medi-Cal eligible adults, enabling those in need of higher levels of care to be connected to care in close proximity to where they reside.
FISCAL IMPACT
Funds for these requests are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, today’s recommendations will result in approximate costs and revenue of approximately $3.0 million in FY 2024-25 and $9.1 million in FY 2025-26. The funding sources are Mental Health Services Act (MHSA) and Short-Doyle Medi-Cal. 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 regular meeting on December 5, 2024, the Behavioral Health Advisory Board voted to approve this item.
BACKGROUND
In California, counties are responsible for administering specialty mental health and substance use services for residents eligible for Medi-Cal. In this capacity, the County of San Diego (County) Health and Human Services Agency (HHSA), Behavioral Health Services (BHS) serves as the specialty mental health plan for San Diego County. To ensure access to quality care that meets the needs of Medi-Cal beneficiaries in San Diego County, BHS is required to maintain a local network of behavioral health services and providers. To optimize the local behavioral health system of care, the San Diego County Board of Supervisors has made key investments over the last several years to enhance community-based behavioral health services and develop critical behavioral health infrastructure that is regionally distributed in alignment with population health needs, which have included the establishment of several CSUs.
CSUs provide immediate mental health support and treatment services in a therapeutic setting to people with serious behavioral health needs who require urgent care beyond what an outpatient clinical service can provide. CSUs can help to deescalate a person’s level of distress, prevent or treat a behavioral health crisis, and reduce acute symptoms of a mental health condition. Services typically last less than 24 hours and include crisis intervention, ongoing assessment and stabilization, medication administration, consultation with family and outpatient providers, and linkage and/or referral to follow-up community-based services and resources. These services reduce unnecessary hospitalizations by diverting individuals from emergency departments and inpatient care, whenever possible, stabilizing them and connecting them to community-based behavioral health services for ongoing care.
Since 2018, BHS has continued to build on the two existing CSUs by establishing four new CSUs, including three in North County and one in South County, to support regional access to crisis mental health care so people can receive treatment in close proximity to where they reside. In late 2025, a seventh new CSU will become operational in East County. Since the expansion of CSUs, the San Diego County Psychiatric Hospital has seen nearly a 40% reduction in inpatient admissions, demonstrating the effectiveness of CSUs in diverting people from unnecessary inpatient care.
In January 2024, Sharp HealthCare (Sharp) received one-time grant funding from the California Department of Health Care Services (DHCS) to support the design and development of a new Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) crisis stabilization unit within the Sharp Chula Vista Medical Center. Similar to a traditional CSU, an EmPATH crisis stabilization unit offers care for people experiencing a psychiatric crisis through crisis stabilization services. The EmPATH model differs from the other CSUs with which the County contracts in that it is co-located in an emergency department (ED), thus enabling people with behavioral health needs to transition smoothly to a CSU without being discharged. Sharp will establish six new CSU recliners adjacent to the ED, which are anticipated to provide care for a large proportion of people with serious behavioral health conditions who are eligible for Medi-Cal. As the specialty mental health plan for people with serious mental illness, the County contracts for and receives Medi-Cal reimbursement from DHCS for CSU services provided locally.
Today’s item seeks authority to establish a single source contract with Sharp for approximately six new CSU recliners within the Sharp Chula Vista Medical Center that will serve people with behavioral health conditions who are eligible for Medi-Cal. Sharp qualifies for a single source contract for these services based on Section 1D-3 of Board Policy A-87, Competitive Procurement: The procurement is for services from a provider with unique knowledge, skill, or ability not available from other sources. Sharp Chula Vista Medical Center will be the only hospital providing CSU services co-located within an ED through the new EmPATH unit, which uniquely positions it to facilitate quicker connections to behavioral health crisis care for people entering the ED. The estimated cost for CSU services at Sharp is determined to be fair and reasonable as it aligns with behavioral health payment reform rates set by the State and offered locally for contracted hospital-based CSU services. Approval of this action will advance crisis care in San Diego County and expand capacity in South Region.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the County of San Diego 2025-2030 Strategic Plan initiatives of Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision. This is accomplished by reducing disparities and disproportionality of individuals experiencing a behavioral health crisis by ensuring access to a comprehensive continuum of regionally distributed services.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
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