REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 29, 2022
FROM
GEORGINA YOSHIOKA, Interim Director, Department of Behavioral Health
SUBJECT
Title
Amendment to Contract with Crestwood Behavioral Health, Inc. for Mental Health Rehabilitation Center Adult Residential Treatment Services
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 3, effective March 29, 2022, to Contract No. 19-589 with Crestwood Behavioral Health, Inc. to provide adult residential treatment services within a locked Mental Health Rehabilitation Center, increasing access to 10 additional beds for a total of 41 beds and increasing the total contract amount by $7,722,336, from $22,854,475 to $30,576,811, with no change to the contract period of August 20, 2019 through August 19, 2024.
(Presenter: Georgina Yoshioka, Interim Director, 388-0801)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
This item does not impact Discretionary General Funding (Net County Cost). The increase in the amount of $7,722,336 for the adult residential treatment services will be funded by 1991 Mental Health Realignment. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2021-22 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Crestwood Behavioral Health, Inc. (Crestwood) provides DBH consumers adult residential treatment services within its two locked Mental Health Rehabilitation Centers (MHRC). MHRCs provide a high level of care to consumers transitioning from a State Hospital or acute psychiatric inpatient facility. These consumers have achieved some stabilization but still require the next level of care to ensure community integration and stabilization. Currently, Crestwood provides DBH access to 1 bed at its Bakersfield facility and 30 beds at its Fallbrook facility, for a total of 31 beds, as there are no MHRCs in San Bernardino County. The recommended amendment will increase access to 10 additional beds at Crestwood’s Fallbrook facility, from 30 beds to 40 beds, for a combined total of 41 beds. It is anticipated approximately 41 to 81 DBH consumers will be served annually for a total of 14,965 bed days, with an average length of stay being nine to sixteen months, at an estimated annual cost per consumer ranging from $76,396 to $152,792, dependent upon the individual need for services.
MHRCs are locked, long term residential facilities categorized as an Institution for Mental Disease and considered a step towards a least restrictive placement. MHRCs provide services to consumers who suffer from a severe and chronic behavioral health condition and whose functioning is improving enough to move from a State Hospital or acute psychiatric inpatient hospital but still too low to be maintained in a licensed board and care facility, including social rehabilitation home-like facilities, or augmented board and care. MHRCs maintain a stable environment and benefits the consumer as it affords the opportunity for increased stabilization.
During 2020-21, Crestwood MHRC facilities served a total of 40 consumers, providing the appropriate and required treatment options as a stepdown from higher, more restrictive and costly levels of care. At this time, all DBH contracted beds are at full capacity, resulting in the need to increase access to additional beds to ensure current and future needs are met. MHRC services include comprehensive, organized therapeutic activities, such as skill building, small therapy groups, individual therapy, physical and recreational activities; and various types of supervised outings that include passes and special events designed to promote improved functionality in daily living and social skills in order to prepare the consumer to return to a less structured facility when appropriate.
PROCUREMENT
On August 20, 2019 (Item No. 18), the Board of Supervisors (Board) approved non-competitive Contract No. 19-589 with Crestwood for MHRC residential services, in the amount of $11,001,100, for the period of August 20, 2019 through August 19, 2024. Purchasing continues to concur with the non-competitive justification of specialized mental health treatment services. DBH does not procure for these services as there are a limited number of state licensed MHRC facilities with available beds willing to provide services to DBH clients. DBH would be willing to facilitate future solicitations providing resources should they become available.
On November 5, 2019 (Item No. 17), the Board approved Amendment No. 1 with Crestwood, increasing access to 15 additional beds for a total of 31 beds and increasing the contract amount by $11,853,375, from $11,001,100 to $22,854,475, with no change to the contract period of August 20, 2019 through August 19, 2024.
On March 23, 2021 (Item No. 23), the Board approved Amendment No. 2 with Crestwood, updating the fiscal provisions with no change to the contract amount of $22,854,475 or contract period of August 20, 2019 through August 19, 2024.
DBH will monitor contract performance on a regular basis to ensure performance and compliance standards are met by reviewing monthly reports, ongoing site visits to review consumer progress, as well as an annual program review. Crestwood’s invoices will be reviewed and approved by DBH Programs to ensure clients and bed count are accurate prior to being forwarded to Fiscal for payment. Fiscal will verify signatures, bed rate and total cost prior to issuing payment.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health Contracts (Ellayna Hoatson, Contracts Supervisor, 388-0858) on December 28, 2021; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on March 14, 2022; Purchasing (Bruce Cole, Supervising Buyer, 387-2148) on January 14, 2022; Finance (Christopher Lange, Administrative Analyst, 386-8393) on January 6, 2022; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on January 10, 2022.