COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

December 23, 2002

BOARD MEETING DATE:

January 7, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Gale Bataille, Director of Mental Health Services

SUBJECT:

Agreements with Mills-Peninsula Hospitals, Mt. Diablo Medical Pavilion, Sequoia Hospital and Medical Center, and St. Mary's Hospital and Medical Center

Recommendation

Adopt a resolution authorizing the President of the Board:

1. To execute agreements with Mills-Peninsula Hospitals, Mt. Diablo Medical Pavilion, Sequoia Hospital and Medical Center, and St. Mary's Hospital and Medical Center collectively totaling $1,217,000, and

2. To delegate signing authority for the Health Services Director or her designee to execute amendments to the agreements.

Background

In March 1995, your Board approved the acceptance of state and federal funds to implement the San Mateo County Mental Health Managed Care Plan (MHP). As part of this plan, the Mental Health Services Division offered agreements to all the major hospitals within the Bay Area that serve San Mateo County Medi-Cal clients.

Discussion

The FY 2002-03 agreements for hospitals in the MHP have negotiated rates for Medi-Cal clients. Medi-Cal rates are all-inclusive except for professional fees for doctors, which are paid separately. Inpatient daily rates are included for Medi-Cal covered and indigent adults and youth at Mills-Peninsula Hospitals, Medi-Cal covered and indigent adults at Sequoia Hospital and Medical Center, and Medi-Cal covered and indigent youth at Mt. Diablo Medical Pavilion, and St. Mary's Hospital and Medical Center. In addition, crisis intervention services for Medi-Cal covered and indigent adults and youth will be provided at Mills-Peninsula, one-to-one supervision will be provided at Mt. Diablo and St. Mary's, and adolescent day treatment services will be provided at Mills-Peninsula Hospitals. Administrative day rates will be reimbursed at all four hospitals. The total maximum agreement amount for all the hospitals, collectively, is $1,217,000, and there are no separate contract maximums for individual hospitals.

We are requesting signing authority be granted to the Health Services Director or her designee for amendments or minor modifications up to an aggregate of $25,000 for the term of these agreements.

The negotiated daily rate schedule is below:

Hospital

Daily IP Medi-Cal Rate

Daily IP Indigent Rate

Crisis Intervention Rate

One-to-one supervision

Day Treatment Services

Admin. Day Rate

Adult

Youth

Adult

Youth

Adult

Youth

Mills-Peninsula

$563.10

$592.56

$591.43

$620.88

$72/hr, $563.10 cap

$72/hr, $592.56 cap

n/a

$280 day

$289.13

Mt. Diablo

n/a

$600

n/a

$700

n/a

$25/hr, $600 cap

n/a

$289.13

Sequoia

$563.10

n/a

591.43

n/a

$289.13

St. Mary's

n/a

$695

n/a

$862

n/a

$472

n/a

$289.13

The objectives and actual performance for FY 2001-02 and objectives for FY 2003-03 are as follows:

Performance Measure

Hospital

2001-02 Objective

2001-02 Actual

2002-03 Objective

Percent of clients who need to be re-admitted within 30 days of a completed episode of care

· Mills-Peninsula - adult and youth

10%

15%*

10%

· Mt. Diablo - youth

10%

0%

10%

· Sequoia - adult

10%

24%*

10%

· St. Mary's - youth

10%

5%

10%

* These facilities had a significant increase in usage from the previous year (27%). As SMMC has decreased its inpatient psychiatric beds, usage is expected to remain high for 2002-03. Mental Health will work with these providers to decrease the frequency of readmissions.

Vision Alignment

These managed care contract agreements keep the commitment to Ensure 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. These agreements contribute to this commitment and goal by providing mental health services for San Mateo County youth and adults.

Fiscal Impact

The agreements are effective July 1, 2002 through June 30, 2003 and carry a 60-day termination clause for both parties. County Counsel has reviewed and approved the agreements and Risk Management has approved the insurance coverage. These agreements are delayed due to the late return of agreements from the contractors to the County.

These agreements are structured on the basis of fee-for-service negotiated rates. Only services authorized by San Mateo County Mental Health Services will be paid. The collective agreement maximum amount is $1,217,000. It is anticipated that 90% of these costs will be funded with Federal Financial Participation (FFP) and state matching funds through managed care allocation of realignment funds. The remaining $121,700 is the net County cost. The funding for these agreements has been included in the FY 2002-03 approved Mental Health Services budget.