COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

November 29, 2004

BOARD MEETING DATE:

December 14, 2004

TO:

Honorable Board of Supervisors

FROM:

Charlene Silva, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Agreement with 7^th Avenue Center, LLC

Recommendation

Adopt a resolution:

A)

Authorizing the President of the Board to execute an Agreement with 7^th Avenue Center, LLC; and

B)

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

Background

Mental Health Rehabilitation Centers (MHRC) such as 7^th Avenue Center, LLC (7^th Avenue) provide locked psychiatric care for San Mateo County adults with serious and persistent mental illness.

Counties are required by the State Department of Mental Health to pay a “basic rate” for skilled nursing/basic care for adults 18-64 years of age who are housed in MHRC 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 rate, selected San Mateo County clients at MHRC facilities may be authorized for supplemental payments, often referred to as “patches” or “enhanced rates” in order to provide augmented services based on the severity of an individual’s illness.

Discussion

For severely mentally ill clients, 7^th Avenue is an alternate and less expensive placement than Napa State Hospital. The daily rate at the State Hospital is $346.68 versus $165 at 7^th Avenue. In addition, 7^th Avenue has been willing to work with clients with very difficult behavioral problems who are placed directly from the State Hospital. This facility has a women’s wing with all female staff for female clients in need of a gender specific program.

7^th Avenue will provide up to 5 beds for San Mateo County residents. We have increased use of these services as a result of the philosophy of moving severely and persistently mentally ill people to less restrictive environments (i.e. from locked facilities back into the community). Decreasing the length of stay at Napa State Hospital, and decreasing the length of stay at Cordilleras, has resulted in an increased use of community placements like 7^th Avenue.

The Agreement has been reviewed and approved by Risk Management and County Counsel.

The performance objectives are as follows:

Performance Measure

2003-04 Objectives

2003-04 Actuals

2004-05

Objectives

Percentage of patients to be discharged to a less restrictive, more independent level of care, which shall include all community-based supported housing

50%

0%*

40%

* There were only three discharges from this facility, all of which were to a hospital. Due to the severity of behavioral issues in clients seen by this provider, the objective may need to be revised downward following this FY.

Vision Alignment

The Agreement with 7^th Avenue, LLC 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 locked psychiatric care for San Mateo County adults with serious and persistent mental illness.

Fiscal Impact

The term of this Agreement is July 1, 2004 through June 30, 2005.

The Agreement maximum for FY 2004-05 is $301,125, which has been included in the approved FY 2004-05 Mental Health Services budget, and is the same as the FY 2003-04 maximum agreement amount. County shall pay Contractor at a rate of $165 per bed, per day, the same as FY 2003-04. Of that amount, sales tax through realignment will cover 81% or $243,911. The remaining $57,214 represents the net County cost as maintenance of effort for realignment.