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  Consent-Health & Human Services   # 14.       
Board of Supervisors Adult & Aging  
Meeting Date: 03/26/2024  
Brief Title:    Seventh Amendment to Agreement No. 19-230 with BHC Sierra Vista Hospital
From: Nolan Sullivan, Director, Health and Human Services Agency
Staff Contact: Samantha Fusselman, Adult and Aging Branch Director, Health and Human Services Agency, x2492
Supervisorial District Impact: Countywide

Subject
Approve seventh amendment to Agreement No. 19-230 with BHC Sierra Vista Hospital to add funding in the amount of $869,712 for 2023-24 for a new contract maximum of $3,495,963 for the period of July 1, 2019 through June 30, 2024, for the provision of Acute Psychiatric Inpatient Services. (No general fund impact) (Sullivan)
Recommended Action
Approve seventh amendment to Agreement No. 19-230 with BHC Sierra Vista Hospital to add funding in the amount of $869,712 for 2023-24 for a new contract maximum of $3,495,963 for the period of July 1, 2019 through June 30, 2024, for the provision of Acute Psychiatric Inpatient Services.
Strategic Plan Goal(s)
Thriving Residents
Safe Communities
Reason for Recommended Action/Background
California state law mandates the County to provide psychiatric inpatient hospital services to eligible Medi-Cal and non-Medi-Cal mental health consumers.  Woodland Memorial Hospital is the designated and responsible hospital to provide these services to Yolo County resident adults (age 18 or older), who meet California Welfare and Institutions Code criteria and/or who are a danger to self, others or are gravely disabled and require inpatient acute psychiatric services.

When no adult bed space is available at Woodland Memorial Hospital, or when a child or adolescent needs services, the patient must be treated by another qualified psychiatric hospital facility in the surrounding area.  BHC Sierra Vista Hospital, being such a facility, is equipped to provide appropriate services to meet our clients’ needs.

The County is responsible for serving all Yolo County Medi-Cal beneficiaries regardless of age.  BHC Sierra Vista Hospital is not certified to bill Medi-Cal for services provided to Yolo County Medi-Cal beneficiaries whose age is between 21 and 64 years. Thus, federal financial participation (FFP) is not available for these services. The stated contract amount will be used for funding the services related to this group.

For services provided to Yolo County Medi-Cal beneficiaries whose age is either 20 or younger, or 65 or older, the payment to the service provider for this population is not paid directly via the County.  The service provider bills Medi-Cal directly to receive funding via FFP and the County’s mental health realignment funds.  The State then reduces the amount used for this purpose from the monthly realignment apportionment to the County. 

On or about November 5, 2019, the County entered into an Agreement with BHC Sierra Vista Hospital with an initial term of July 1, 2019 through June 30, 2022 with a contract maximum of $1,410,000. The Agreement also included 2 optional extensions for FY 2022-23 and 2023-24.

On or about January 12, 2021, the Parties amended the Agreement via the first amendment to reduce funding in the amount of $120,000 for FY 2020-21 and $120,000 for FY 2021-22 for a new contract maximum of $1,170,000.

On or about June 29, 2021, the Parties further amended the Agreement via the second amendment to add funding in the amount of $150,000 for FY 2020-21 for a new contract maximum of $1,320,000.

On or about October 26, 2021, the Parties further amended the Agreement via the third amendment to add funding in the amount of $70,000 for FY 2020-21 for a new contract maximum of $1,390,000.

On or about March 24, 2022, the County exercised the option to extend the Agreement through FY 2022-23 under the same terms and conditions and added $400,000 for FY 2022-23.

On or about June 7, 2022, the Parties further amended the Agreement via the fourth amendment to add funding in the amount of $82,000 for FY 2020-21 and $70,000 for FY 2021-22 for a new contract maximum of $1,942,000.

On or about January 10, 2023, the Parties further amended the Agreement via the fifth amendment to add funding in the amount of $62,650 for FY 2021-22 for a new contract maximum of $2,004,650 and to update contract language.

On or about June 7, 2023, the County exercised the option to extend the Agreement through FY 2023-24 under the same terms and conditions and added $400,000 for FY 2023-24.

On or about August 29, 2023, the Parties further amended the Agreement via the sixth amendment to add funding in the amount of $221,600 for FY 2022-23 for a new contract maximum of $2,626,250.

Approval of this seventh amendment is necessary as additional funding is needed for FY 2023-24 as actual costs each year have surpassed previously planned annual budgets and resulted in repeated contract budget amendments.

Performance Measures included in this Agreement are as follows:
The Performance Measures were included in the underlying Agreement and are not being revised at this time (See Att. B. Performance Measures)

HHSA confirms BHC Sierra Vista Hospital has performed satisfactorily under this agreement. BHC Sierra Vista Hospital has served 27 unduplicated clients and provided them 369 services in FY 2022-23. The average time of stay for the clients was 12.3 days. 100% of clients did not experience a psychiatric re-admission within 7 days of discharge, and 100% of clients did not experience a psychiatric re-admission within 30 days of discharge.
Collaborations (including Board advisory groups and external partner agencies)
County Counsel has approved this amendment as to form.
Competitive Bid Process/Vendor Performance
This agreement was sought through a Sole Source, which was approved by the Procurement Manager on May 2, 2019.

Procurement reviewed HHSA’s request and determined that it was in the best interest of the County, based on satisfactory service/reasonable prices and to avoid the interruption of County business, to approve the sole source. Without sole source approval of the agreement with BHC Sierra Vista Hospital, the County would be unable to meet the state mandate standards. Factors considered, included but were not limited to:
1) BHC Sierra Vista Hospital has bed availability and is close in proximity to Yolo County for when the in-County facility has no bed space; 2) satisfactory vendor performance-- BHC Sierra Vista Hospital has been a County vendor for over five years; 3) competitive pricing, BHC Sierra Vista Hospital charges the County Medi-Cal rate which is standard and reasonable; and 4) reduced ability to care for residents in acute crisis who need psychiatric inpatient service for stabilization, which would put consumers, their loved ones and the community as a whole at risk.

Fiscal Impact
Fiscal impact (see budgetary detail below)
Fiscal Impact (Expenditure)
Total cost of recommended action:    $   869,812
Amount budgeted for expenditure:    $   869,812
Additional expenditure authority needed:    $  
One-time commitment     Yes
Source of Funds for this Expenditure
$869,812
Explanation (Expenditure and/or Revenue)
Further explanation as needed:
No general funds are required by this action.  These services will be funded by Realignment. The action increases the contract maximum by $869,812 for a total of $3,495,962 for the period of July 1, 2019 through June 30, 2024. The amount of $869,812 is included in the HHSA adopted budget for fiscal year 2023-24.

The following is the breakdown of funding for this agreement.
FY 2019-20
July 1, 2019
through
 June 30, 2020
FY 2020-21
July 1, 2020
through
 June 30, 2021
FY 2021-22
July 1, 2021
through
 June 30, 2022
FY 2022-23
July 1, 2022
through
 June 30, 2023
FY 2023-24
July 1, 2023
through
 June 30, 2024

Total
$470,000 $652,000 $482,650 $621,600 $1,269,712 $3,495,962
Attachments
Att. A. Seventh Amendment
Att. B. Performance Measures

Form Review
Inbox Reviewed By Date
Karleen Jakowski Karleen Jakowski 03/07/2024 08:31 PM
Nolan Sullivan Nolan Sullivan 03/11/2024 02:10 PM
Financial Services Matt Robertson 03/11/2024 02:37 PM
County Counsel Hope Welton 03/11/2024 02:39 PM
Cindy Perez Cindy Perez 03/11/2024 04:32 PM
Form Started By: Kimberly Mayfield Started On: 01/18/2024 09:13 AM
Final Approval Date: 03/11/2024

    

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