COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

December 22, 2004

BOARD MEETING DATE:

January 4, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health Services

Gale Bataille, Director of Mental Health Services

SUBJECT:

Agreement with State Department of Mental Health for State Hospital beds

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 State Hospitals for FY 2004-05, for a total obligation not to exceed $911,974.

VISION ALIGNMENT:

Commitment: Ensure Basic Health and Safety for All

Goal 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 mental health services at Napa and Metropolitan State Hospitals for appropriate clients.

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 up until FY 2002-03, had identified the number of beds reserved for the County at Napa State Hospital. As of FY 2002-03 DMH has used a separate agreement for State Hospital services. State Hospitals provide 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 services at Napa and Metropolitan State Hospitals and stipulates that the County will pay for a specific number of beds regardless of whether the beds are occupied. The County manages these resources carefully and assures that 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 2004-05. 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 State Hospital beds for FY 2004-05 compared to FY 2003-04 are as follows:

Beds

Cost

Change

Type of Service

2003-04

2004-05

2003-04

2004-05

Beds

Cost

Subacute (Napa)

7

6

$885,658

$784,589

(1)

($101,069)

Medical – SNF (Metropolitan)

0

1

$127,385

1

$127,385

TOTAL

7

7

$885,658

$911,974

--

$26,316

The County is also financially responsible for its use of State Hospital resources resulting from conversion of Penal Code commitments to Murphy Conservatorships. Murphy conservatees are individuals who were charged with serious crimes and were committed to a state hospital as incompetent to stand trial under a Penal Code hold. These Penal Code commitments can be transferred to Murphy Conservatorships after approximately three years of Penal Code Commitment, if DMH determines that the individual is unlikely to regain competency. The county where the crime was committed becomes financially responsible for hospitalization costs when the Murphy Conservatorship is instituted. Payment for use of State Hospital beds is withheld from the State payment of realignment funds to the County. As a result, there are no direct payments for services provided at the State Hospitals.

County Counsel and Risk Management have reviewed and approved the Agreement. This Agreement was received from DMH in November of this year.

FISCAL IMPACT:

The term of this Agreement is July 1, 2004, through June 30, 2005. The Agreement maximum is $911,974 for FY 2004-05, which is included in the FY 2004-05 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. There is no net County cost.