COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

June 20, 2002

BOARD MEETING DATE:

July 9, 2002

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Brian Zamora, Director of Public Health and Environmental Protection

SUBJECT:

Agreement with Rehab Resource Group

Recommendation

Adopt a resolution authorizing the President of the Board of Supervisors to execute an agreement with Rehab Resource Group (RRG) for physical therapy (PT) and occupational therapy (OT) services for medically eligible California Children Services (CCS) clients and to waive the Request for Proposals (RFP) process.

Background

The Medical Therapy Unit (MTU) at CCS provides direct physical and occupational therapy services to children with severe disabilities. This state-mandated program has eligibility requirements for medical conditions. When those conditions are met, it is the responsibility of Public Health to provide appropriate therapy services to the children.

Beginning in 1992, the CCS/MTU caseload increased to such an extent that more than 40 children were placed on a waiting list. In 1994, this number reached 100. Delay of treatment seriously interferes with the child's ability to gain maximum functional independence during critical development years. State CCS guidelines provide a mechanism for contract services when there is a proven shortage of therapy staff. The number of clients referred to CCS/MTU continues to increase (i.e., former clients are being reactivated to improve independence of daily living skills, premature infant survival rate is increasing which at times requires ongoing therapy, and there is an increase in the number of clients moving from other counties). In 2000-01, the number of MTU cases has grown to 393. This growth, combined with increasing therapy needs due to the severity of the medical conditions, require the continued use of outside therapy services.

Discussion

Rehab Resource Group is the only local therapy registry that accepts the state reimbursement rate. Without this agreement, children in need of therapy services will be placed on a waiting list.

Performance Indicator

FY 2000-01

Actual

FY 2001-02

Estimated

FY 2002-03 Projected

Percentage of MTU clients with non-progressive disorders who make documented functional gain using the Therapy Improvement Scale (TIS) for evaluation

90%

90%

90%

Based on the initial assessment, recommended medical therapy and home program and goals are established and implemented. Periodic evaluations (six months) are performed with regards to the treatment plan and the child's status. These evaluations are submitted to the child's parent and physician. From these evaluations, the determination is made to either: 1) continue medical therapy and home programs (using existing or modified treatment plan and goals), or 2) discontinue MTU treatment and continue home programs with MTU staff consulting with parents.

Beginning in 1995, San Mateo County has had a formal agreement with Discharge Resource Group (DRG) to provide occupational and physical therapy services. Last year, DRG reorganized; Rehab Resource Group is now a subsidiary of Discharge Resource Group, and RRG is the entity that provides OT and PT services. The CCS/MTU continues to use RRG to augment onsite services on an as-needed basis. A waiver of the RFP process for this service is requested because DRG is the only local therapy registry that will perform onsite therapy services at the current state reimbursement rate.

Vision Alignment

The agreement with Rehab Resource Group keeps the commitment of ensuring basic health and safety for all and goal number 8: Help vulnerable people - the aged, disabled, mentally ill, at-risk youth and others - achieve a better quality of life. The agreement contributes to this commitment and goal by providing occupational and physical therapy to severely disabled children in San Mateo County.

Fiscal Impact

The term of the agreement is July 1, 2002 through June 30, 2004. The maximum amount of the contract is $452,000 over two years, FY 2002-03 and FY 2003-04; $226,000 is included in the recommended budgets for each of those two years. The cost of the agreement is reimbursed 50% from the state CCS program. Because RRG is only used on an as-needed basis, final charges will be based on actual utilization of therapist services. Likewise, the net county cost will be directly based on actual use. The maximum net county cost is $226,000 over two years.