COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

December 5, 2003

BOARD MEETING DATE:

December 16, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Amendment One to the Agreement with Crestwood Behavioral Health, Inc.

Recommendation

Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with Crestwood Behavioral Health, Inc.

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. In San Mateo County, approximately seventy-five percent (75%) of adults who require this level of care are treated at Cordilleras (MHRC). There are, however, some individuals who are unable to be served at Cordilleras because of special needs. San Mateo County has contracted with Crestwood Behavioral Health, Inc. since 1988 to provide long term care for San Mateo County residents who were unable to be served at Cordilleras 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 basic 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 a "patch" or enhanced rate, that vary based upon severity of an individual's illness and the additional services needed.

Discussion

This agreement is being amended to reflect FY 2002-03 and FY 2003-04 rate increases for the Mental Health Program, and to include the new Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Sections specific to the Aging and Adult Services Program remain unchanged.

The County cost for dementia clients placed at Crestwood is a result of closing the San Mateo Medical Center's (SMMC) geropsychiatric program several years ago. Due to the behavioral issues of the clients housed at Crestwood, and current admission criteria of the new SMMC/Burlingame Long Term Care facility, it is unclear if and/or when these clients may be able to be transferred to the Burlingame facility. Mental Health staff and Aging and Adult staff are working with the SMMC to address training, safety, and security issues for these clients who have dementia and behavioral problems.

Vision Alignment

This amendment with Crestwood Behavioral Health, Inc. 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 amendment contributes to this commitment and goal by providing mental health rehabilitation, treatment and long-term care for seriously mentally ill adults, and by providing services to clients who are probate dementia conservatees and who require a locked, long-term treatment setting.

Fiscal Impact

The term of this amended agreement remains July 1, 2001 through June 30, 2004. The amendment has been reviewed and approved by Risk Management and County Counsel.

The agreement maximum remains unchanged at $6,360,420 for the three-year term. The three-year maximum obligation for the Mental Health Program is $5,400,420. The three-year maximum obligation for the Aging and Adult Services program is $960,000.

The FY 2003-04 maximum amount for the Mental Health Program is $2,174,616 and is included in the FY 2003-04 Mental Health Services' budget. Sales tax provided through realignment will cover $1,774,616. The remaining $400,000 represents the net County cost which covers the cost of dementia clients placed at Crestwood as a result of closing the SMMC geropsychiatric program several years ago.

The FY 2003-04 maximum amount for Aging and Adult Services is $320,000, which will be paid out of Public Guardian conservator fees.