COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

December 4, 2003

BOARD MEETING DATE:

December 16, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director, Health Services Agency

Gale Bataille, Director, Mental Health Services

Brian Zamora, Director, Public Health Services

SUBJECT:

Agreement with Telecare Corporation for services at Cordilleras Mental Health Center and Gladman Center

Recommendation

Adopt a resolution authorizing the President of the Board:

1) To approve a waiver of the request for proposal requirement; and

2) To execute an agreement with Telecare Corporation.

Background

Telecare Corporation has provided inpatient and residential psychiatric treatment services for San Mateo County residents at two locations, Cordilleras Mental Health Center in Redwood City, and Gladman Mental Health Rehabilitation Facility in Alameda County. It also provides a direct observation therapy program for non-adherent Tuberculosis patients at Cordilleras. Telecare has operated Cordilleras Center since 1982, treating up to 110 seriously mentally ill San Mateo County residents through the operation of a locked Mental Health Rehabilitation Center (MHRC) and residential care services supported by an assertive treatment team. In addition, it provides locked psychiatric skilled nursing specialty beds at Gladman Psychiatric Health Facility located in Alameda County.

Under the Mental Health Services Division's plan for contracted services, services provided at Cordilleras are on a five-year cycle for Requests for Proposals. In 1998 Mental Health services conducted a full Request for Proposal process that resulted in the selection of Telecare to provide these services. The five-year agreement with Telecare, which extended through June 30, 2003, is currently on Continuing Resolution.

Discussion

There are a total of 110 beds at Cordilleras dedicated to San Mateo County residents. The first and second floors of Cordilleras provide 49 residential beds for San Mateo County clients. On the first floor Magnolia and Edgewood Suites provide 29 residential beds. Willow Suites on the second floor provides 20 residential beds with intensive case management services. The third floor has 68 beds and is licensed as a locked Mental Health Rehabilitation Center (MHRC). This program serves 61 San Mateo County residents and reserves 9 beds for the Veterans Administration and other counties. Telecare also provides peer counseling for clients discharged from Cordilleras, as part of Mental Health's Resource Management team.

Gladman is a regional MHRC program located in Oakland that is designed for clients who are mentally ill and who have significant cognitive and behavioral problems. This facility is a cost-effective alternative to the state hospital.

Mental Health Services is requesting a two-year waiver of the RFP requirement for services at Cordilleras. This request is based on the critical role of the Cordilleras MHRC in achieving planned savings for fiscal years 2003-04 and 2004-05 in Mental Health and at San Mateo Medical Center. Development of an RFP would have diverted staff from making program changes to achieve the necessary cost reduction. Instead, staff worked with Telecare to increase its capacity to serve San Mateo clients at Cordilleras. Telecare has committed to shorten the average length of stay in its MHRC program, permitting reductions in spending for beds in out-of-county psychiatric skilled nursing facilities, and in the number of administrative days in the San Mateo Medical Center's psychiatric inpatient unit. This program development has taken place through our work with Telecare during the course of the current contract. There are no other local vendors immediately capable of providing the specialized treatment and level of care currently provided by Telecare. Issuance of a RFP at this time would severely limit the Mental Health Division's ability to work with this agency to implement planned savings for the 2003-04 and 2004-05 fiscal years. Mental Health Services will conduct a formal RFP process to select a contractor for these specialized mental health services in FY 2004-05.

Consistent with contract approval level limitations in County Administrative Memorandum B-1, the Director of Health Services will be authorized to execute amendments and modifications to this agreement, not to exceed $25,000 in aggregate.

Performance Measure

2002-03 Objectives

2002-03 Actual

2003-04 Objectives

Community Discharges will increase by 50% (MHRC)

N/A

89

132

Admissions (MHRC)

N/A

59

89

Client Satisfaction (MHRC)

80%

82%

80%

Client Satisfaction (Residential Care)*

80%

N/A

80%

Clients will be discharged to a lower level of care (MHRC)

65%

66%

65%

Clients will be discharged to a lower level of care (Residential)

65%

74%

65%

* Satisfaction data for this population were not required by the State DMH last year. It is required this year and will be collected.

Vision Alignment

This contract with Telecare Corporation keeps 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. The contract contributes to this commitment and goal by providing residential treatment, case management, rehabilitation services and community support services for mentally ill clients.

Fiscal Impact

The term of this agreement is July 1, 2003 through June 30, 2005. The agreement maximum for the two-year period is $12,945,519, with the maximum amount for FY 2003-04 being $6,397,769.

For Mental Health Services the agreement maximum is $12,737,184 for the two-year term. $6,293,459 has been included in the approved Mental Health Services budget for FY 2003-04, of which Federal and State Medi-Cal will fund 5.2% or $327,260. The balance will be funded with sales tax provided through realignment. For FY 2004-05 the Mental Health maximum will be $6,443,725, which includes a 3% COLA in order to fund negotiated labor agreements and to sustain critical staffing required for intensive services to clients who would otherwise require out-of-county skilled nursing facility or state hospital placements. There is no net County cost.

Public Health is required to pay a flat rate of $91 per day to reserve the TB bed for a client regardless of whether or not the bed is filled, or $33,215 per year. If the bed is filled, the day rate doubles to $182. If medications are required, an additional $103 per day may be charged to Public Health. The total amount included in the agreement for FY 2003-04 is $104,310; this amount is enough to cover maximum charges for one TB client for 366 days. The State TB Control Branch has awarded Public Health $33,215 for FY 2003-04 to cover the flat day rate. If the bed is filled, the State will reimburse Public Health for the additional charges for the day rate. If medications are required, Medi-Cal, Medicare or the State will reimburse Public Health 100% of the charges.

The total amount included in the Public Health FY 2003-04 approved budget is $66,430. It is anticipated that the entire $104,310 will not be required during this fiscal year. If the amount exceeds $66,430, we will execute an ATR to cover the additional amount.

The total agreement amount for Public Health for the two-year term is $208,335. Similar revenue and expenditures will be included in the Public Health FY 2004-05 recommended budget. There is no net county cost.