COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

April 19.2002

BOARD MEETING DATE:

May 7, 2002

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Charlene A. Silva, Director of Aging and Adult Services

SUBJECT:

Appropriation Transfer Request for Clients of Public Guardian at Crestwood Behavioral Health, Inc.

Recommendation

Approve an Appropriation Transfer Request (ATR) adding $320,000 in revenues and appropriation to Aging and Adult Services (AAS) budget (4/5 vote required)

Background

Institutes for Mental Disease, (IMDs) Mental Health Rehabilitation Centers (MHRCs) and Skilled Nursing Facilities (SNFs) with specialized treatment programs (STPs) are all programs that provide locked care for adults suffering from serious mental illness. Approximately thirty-five percent (35%) of AAS conservatees who require this level of care are treated at Cordilleras (MHRC). However, Cordilleras is unable to serve some individuals because of special needs. San Mateo County has contracted with Crestwood Behavioral Health, Inc., since 1988 to serve those residents whom Cordilleras is unable to serve due to their special needs.

Counties are required by the State Department of Mental Health to pay a "basic rate" for skilled nursing/basic care for adults 18 to 64 years of age at Crestwood and other similar facilities. The rates vary by geographic region and are set annually by the State Department of Health Services. Medi-Cal provides basic rate funding for individuals in locked facilities who are age 65 years and older. In addition to the basic rates, selected San Mateo County clients at Crestwood facilities may be authorized for additional supplemental payments, often referred to as "patches," that vary based upon severity of an individual's illness and the additional services needed.

Discussion

In October 2000 the gero-psychiatric unit at San Mateo County General Hospital was closed, and some AAS clients who are Lanterman Petris Short (LPS) conservatees and some who are conserved under the Probate dementia law were transferred to Crestwood Behavioral Health, Inc., facilities. AAS contracts with Crestwood for services for up to twelve clients per year who require a locked, long-term treatment setting.

Vision Alignment

The approval of the ATR for the long-term care of Public Guardian clients supports the commitment of ensuring basic health and safety for all and goal number 8: People- Help vulnerable people- the aged, disabled, mentally ill, at-risk youth and others-achieve a better quality of life.

Fiscal Impact

This ATR adds $320,000 in appropriation to pay the cost of patches for AAS clients at Crestwood. This cost will be paid with $320,000 in Public Guardian fees, which will be added to the AAS budget for 2001-02. There is no impact on the county General Fund as a result of approval of this ATR.