COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

September 30, 2004

BOARD MEETING DATE:

October 19, 2004

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health Services

Gale Bataille, Director of Mental Health Services

Lisa Mancini, Director of Aging and Adult Services

SUBJECT:

Agreement with Crestwood Behavioral Health, Inc.

Recommendation

Adopt a resolution:

A) Authorizing the President of the Board to execute an agreement with Crestwood Behavioral Health, Inc.

B) Authorizing the Director of the Health Services Agency to execute subsequent amendments and minor modifications not to exceed $25,000 and to make minor changes in the type of services and activities provided under the Agreement.

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 these levels 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 could not 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,” that vary based upon the severity of an individual’s illness and the additional services needed.

Discussion

In October 2000 the gero-psychiatric unit at San Mateo County Medical Center was closed, and some of these patients were transferred to Crestwood facilities. As a result the number of our clients served by Crestwood increased from 31 to 62. Some of these individuals are LPS conservatees, and some are conserved under the Probate dementia laws.

To accommodate specialized treatment care needs and to distinguish between the LPS conserved mentally ill clients and the Probate dementia conservatees, this contract has a Mental Health Services component and an Aging and Adult Services component. The Mental Health Program provides services for up to 50 clients who are seriously mentally ill and in need of mental health rehabilitation, treatment and long term care. The Aging and Adult Services Program provides services for up to 12 clients who are Probate dementia conservatees and who require a locked, long-term treatment setting.

This component of the housing continuum allows a cost efficient alternative to using more costly emergency services (i.e. Psychiatric Emergency Services, inpatient administrative days, and Corrections). Placement in this and other Mental Health adult residential service facilities is managed within the budget for these services, which is $3,233,844 in the recommended budget for FY 2004-05.

Consistent with the Mental Health Services’ Policy for Contracts and Requests for Proposals (RFP), providers of unique services and contracts for long-term locked facilities without specialized treatment programs are exempt from the RFP process. Crestwood’s service and facilities fall under one or both of these categories.

The performance objectives are as follows:

Performance Measure

2003-04 Objectives

2003-04 Actuals

2004-05 Objectives

Maximum percentage of discharges to an acute psychiatric level of care

10%

3%

10%

Minimum percentage of MHRC discharged clients who will be discharged to a less restrictive, more independent level of care, which shall include all community-based supported housing

40%

84%

75%

Minimum percentage of client survey respondents who shall rate services as good or better*

92%

*N/A

92%

* The State DMH discontinued required use of their data collection tool for this measure. Mental Health is in the process of establishing a new required collection tool, which will be used for this measure for 2004-05.

Vision Alignment

This agreement 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 agreement contributes to this commitment and goal by providing residential rehabilitation and long-term care for this vulnerable population of adults suffering from serious mental illness.

Fiscal Impact

The term of this agreement is from July 1, 2004, through June 30, 2007. The agreement has been reviewed and approved by Risk Management and County Counsel.

The contract total is $7,145,413 for three years. The three-year maximum obligation for Mental Health Services is $6,185,413. The three-year maximum obligation for Aging and Adult Services is $960,000. It is estimated that the cost for Mental Health Services for the first year will be $1,981,488, which is included in the FY 2004-05 Mental Health Services’ budget. Sales tax provided through realignment is estimated to fund 89% or $1,763,524. The remaining $217,964 represents the net County cost for the Mental Health Program. Similar arrangements will be made for FY 2005-06 and FY 2006-07.