COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

August 4, 2003

BOARD MEETING DATE:

August 12, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Second Amendment to the Agreement with Rashmi Garg, M.D.

Recommendation

Adopt a resolution authorizing:

1.

the President of the Board to execute a second amendment to the agreement with Rashmi Garg, M.D.

2.

the Director of Health Services to execute minor amendments and adjustments up to an aggregate of $25,000 for the term of the agreement.

Background

There has been a shortage of child psychiatrists in California and in the nation for the past several years. Mental Health has found it extremely difficult to fill child psychiatrist positions. Physicians are exempt from the requirement for a Request for Proposals process, and Mental Health Services Division runs advertisements for specialty psychiatric services on a regular basis in the Northern California Psychiatric Newsletter and other venues as needed. Dr. Garg was selected from candidates who responded to those advertisements.

On September 11, 2001, your Board approved an agreement with Rashmi Garg, M.D., for the provision of child psychiatric services for the Receiving Home and children and youth served under SB 933. Her duties include: child and youth medication evaluation and treatment; psychotherapy and family consultation; case consultation to staff; and other duties as assigned.

Discussion

The agreement maximum is being increased and the term of the agreement is being extended through FY 2004-05. In addition, cost of living increases are being provided equal to the salary increases that were recently negotiated for San Mateo County physicians. Required HIPAA compliance language has been included in the amended agreement.

We request that the Director of Health Services be given signing authority to execute minor amendments and adjustments up to an aggregate $25,000 for the term of the agreement.

Vision Alignment

This amended agreement 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 amended agreement contributes to this commitment and goal by providing psychiatric services and consultation for children and youth in San Mateo County.

Fiscal Impact

The term of the amended agreement is July 1, 2001 through June 30, 2005. This amendment has been reviewed and approved by Risk Management and County Counsel.

The agreement with this contractor provided a 6% cost of living increase for FY 2002-03. In October of 2002 your Board approved an additional 10% increase for contracted child psychiatrists in order to address the extreme difficulties faced by the County in recruiting child psychiatrists. That increase matched the increase provided child psychiatrists employed by the County, and allowed Mental Health to maintain competitive rates for these providers. The net increase for FY 2002-03 was 16.6%.

For FY 2003-04 the negotiated COLA is 4%. A 3% COLA has been included for FY 2004-05.

The new contract maximum is $575,918 and includes an increase of $315,448 for the 2-year extension. The Agreement maximum for FY 2003-04 is $155,392 has been included in the Mental Health Services’ budget. State and Federal Medi-Cal is expected to fund 51% or $79,250 of the cost. A total of 3.5% or $5,439 is reimbursed under SB90 claims and $18,111 is funded through Human Service Agency’s out-of-home placement fund, a Children’s System of Care match. The remaining $52,592 is funded through sales tax through realignment. A similar arrangement has been made for FY2004-05. There is no net county cost.