COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

 

DATE:

March 19, 2004

BOARD MEETING DATE:

April 6, 2004

 

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Gale Bataille, Director of Mental Health Services

SUBJECT:

Agreement with State Department of Mental Health

 

Recommendation

 

Adopt a resolution authorizing the President of the Board to execute an Agreement with the State Department of Mental Health (DMH) for the purchase of services at Napa State Hospital for FY 2003-04.

 

Background

 

The 1991-92 State budget changed mental health funding from a state allocation system to sales tax funding with more local control. Realignment legislation required that DMH develop a performance agreement replacing all previous agreements used between counties and the State. That agreement included various administrative assurances, performance outcome requirements, maintenance of effort requirements, and had up until FY 2002-03, identified the number of beds reserved for the County at Napa State Hospital. As of FY 2002-03 the DMH has used a separate agreement for State Hospital services. Napa State Hospital provides the highest level of care for Mental Health clients. These services are reserved for seriously mentally ill clients with the most severe behavioral issues, for whom there is no lower level of care available.

 

Discussion

 

This Agreement establishes dedicated capacity for Napa State Hospital services and stipulates that the County will pay for a specific number of beds regardless of whether the beds are occupied. The County manages this resource carefully and assures utilization matches the number of beds contained in the Agreement. The County may negotiate "bed trades" with other counties as needed. Mental Health Services recommends that the County purchase seven beds in the State Hospital system for FY 2003-04. This represents no change from the prior year number of beds and reflects the County's consistent use of 7 beds since FY 2001-02. The number, type, and cost of Napa State Hospital beds for FY 2003-04 compared to FY 2002-03 are as follows:

 
 

Napa Beds

Cost

Change

Type of Service

2002-03

2003-04

2002-03

2003-04

Beds

Cost

Subacute

7

7

$844,249

$885,658

(0)

$41,409

TOTAL

7

7

$844,249

$885,658

(0)

$41,409

 

In addition to the dedicated capacity of seven beds, the County is also financially responsible for its use of Napa State Hospital resources resulting from conversion of Penal Code commitments to Murphy Conservatorships. Murphy clients are individuals accused of a serious crime, but who have been deemed incompetent to stand trial. In such cases, the criminal justice system transfers financial responsibility for their hospitalization from the California Department of Corrections to the Mental Health agency of the county in which the crime was committed. Payment for use of Napa State Hospital is withheld from the State payment of realignment funds to the County. As a result, there are no direct payments for services provided at Napa State Hospital.

 

Vision Alignment

 

This contract with DMH 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 mental health services at Napa State Hospital to appropriate clients.

 

Fiscal Impact

 

This Agreement is effective from July 1, 2003, through June 30, 2004, and has been reviewed and approved by County Counsel. The late submission of this Agreement occurred because it was not received from the DMH until February of this year.

 

The Napa State Hospital Agreement amount is $885,658 for FY 2003-04. The State Hospital expense for the seven beds is included in the FY 2003-04 Mental Health Services budget and is completely funded through state realignment funds. Adjustments for bed use in excess of the contracted amount are made twice a year in February and August. The February 2004 adjustment identified an additional $70,707 County responsibility for Murphy Conservatorships. The FY 2003-04 cost for the Murphy Conservatorships is estimated at $141,414. The realignment revenue estimate for the FY 2003-04 budget anticipated the entire amount to be withheld for payment of Napa State Hospital. There is no net County cost.