To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Psychiatric Health Facility Update and Revenue Agreements
End
Recommended Action:
Recommended action
A) Receive an update on the Department of Health Services’ efforts related to the establishment of a regional psychiatric health facility in Sonoma County.
B) Authorize the Director of Health Services to execute revenue agreements with Kaiser Foundation Hospitals, Sutter Medical Center of Santa Rosa, and St. Joseph Health/Santa Rosa Memorial Hospital to accept revenue that will fund first-year operating costs of a psychiatric health facility for a total amount not to exceed $624,999.
end
Executive Summary:
The Department of Health Services is working with Crestwood Behavioral Health, a Northern California based provider of mental health services, to establish of a 16-bed regional psychiatric health facility in Sonoma County. The establishment of a psychiatric health facility will improve access to inpatient psychiatric services and will improve the mental health continuum of care in Sonoma County. Under the proposed model, Health Services will contract with Crestwood for fourteen of the Crestwood-operated facility’s sixteen beds, and Marin County will contract with Crestwood for the two remaining beds.
This item includes a request for authorization to enter into agreements with Kaiser Foundation Hospitals, Sutter Medical Center of Santa Rosa, and St. Joseph Health/Santa Rosa Memorial Hospital for the County to accept a total of $624,999 in one-time revenue that will be used to fund first year operating costs of the psychiatric health facility.
Discussion:
The Department of Health Services is working with Crestwood Behavioral Health, a Northern California based provider of mental health services, to establish of a regional psychiatric health facility in Sonoma County. This report provides an update on the status of the Department’s efforts related to the establishment of the regional psychiatric health facility and requests approval to execute agreements with local hospitals for the County to accept revenue that will be used to fund first-year operating costs of the facility.
The planned psychiatric health facility will have a 16-bed capacity and will provide 24-hour acute inpatient mental health treatment and services in a non-hospital setting. Psychiatric health facility services may include evaluation and stabilization of individuals in acute psychiatric crisis, psychiatric consultation services, 24-hour nursing care, medication monitoring, and referrals to appropriate community supports and services.
The Department’s goal is to establish a regional psychiatric health facility operated by Crestwood that will include fourteen beds dedicated to Sonoma County clients and two beds dedicated to Marin County clients. Under the proposed model, Crestwood will lease or own the facility and the Department will enter into a professional services agreement with Crestwood to serve Sonoma County clients. As the operator of the facility, Crestwood will be responsible for identifying an appropriate facility, managing the permit/approval process, construction and renovation of the site, and hiring and training staff. Crestwood is currently conducting due diligence related to a proposed site with a projected opening in summer 2020. Closer to the opening, the Department will return to the Board with a recommendation that the Board designate the facility under the Lanterman-Petris-Short Act, which will allow the facility to accept involuntary as well as voluntary patients.
The need for a psychiatric health facility in Sonoma County is driven by the lack of access to inpatient psychiatric services and the need to improve the mental health continuum of care. The number of psychiatric inpatient beds in California has declined by 29 percent since 1995. During this time, the population of California has grown by 23 percent. The number of psychiatric beds per 100,000 population has declined by 43 percent in that time. (Source: California Hospital Association)
In Sonoma County, the impact of inadequate psychiatric bed capacity is felt throughout the health care system, and specifically in local hospital emergency departments and in the County’s Crisis Stabilization Unit. The Crisis Stabilization Unit is designed to stabilize clients for up to 23 hours, after which clients may be transferred from the facility as appropriate, with one option being a transfer to a more intensive therapeutic psychiatric facility. Placements in intensive therapeutic psychiatric facilities can be challenging to find, which often results in strains on the health care system, including the Crisis Stabilization Unit.
During the June 2018 budget hearings the Board of Supervisors approved $500,000 in funding to support the operations of the psychiatric health facility. Our three major hospital systems (Kaiser, Sutter, St. Joseph) recognize the importance of a psychiatric health facility in strengthening the behavioral health system of care and have agreed to partner with the County to support the establishment of a psychiatric health facility. Kaiser Foundation Hospitals, Sutter Medical Center of Santa Rosa, and St. Joseph Health/Santa Rosa Memorial Hospital have agreed to make a one-time contribution of $624,999 ($208,333 each) to be used as funding for first year operating costs of the psychiatric health facility. This item requests approval to execute agreements with the above hospitals to accept this revenue.
Based on a daily bed rate of $1172, the Department estimates the ongoing annualized cost to fund 14 beds in the psychiatric health facility will be approximately $6.0 million, of which $3.0 million will be reimbursed through claiming of federal financial participation. The remaining costs will be funded with existing behavioral health funding streams (e.g., realignment, etc.). Through the budgetary process the Department will prioritize allocation of behavioral health funding to cover the ongoing costs of the psychiatric health facility.
In addition, the ongoing costs of the facility will be funded with savings generated by the transfer of clients from more expensive inpatient psychiatric facilities. Under the current system, the lack of adequate bed capacity results in clients being placed in treatment settings for which the Department does not receive any federal reimbursement and therefore must cover 100 percent of the cost of the service (e.g., Crisis Stabilization Unit after 23 hours, Institute for Mental Disease, etc.). With the addition of the 14 psychiatric beds, clients will be transferred to the psychiatric health facility, which costs approximately $200 to $400 less per day and is subject to fifty percent federal financial participation reimbursement.
Strategic Plan Alignment - The establishment of a psychiatric health facility in Sonoma County supports the County’s goal of a safe, healthy, and caring community by providing access to additional inpatient psychiatric beds and improving the local continuum of mental health care services available to residents of our community.
Prior Board Actions:
None
Fiscal Summary
|
Expenditures |
FY 19-20 Adopted |
FY 20-21 Projected |
FY 21-22 Projected |
|
Budgeted Expenses |
|
624,999 |
|
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
0 |
624,999 |
0 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
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Fees/Other |
|
624,999 |
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
0 |
624,999 |
0 |
Narrative Explanation of Fiscal Impacts:
Revenue from hospital agreements and associated expenditures will be included in the FY 20-21 budget.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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|
|
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|
|
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
None
Related Items “On File” with the Clerk of the Board:
None