COUNTY OF SAN MATEO

Inter-Departmental Correspondence

 

Health Department

 

DATE:

November 28, 2005

BOARD MEETING DATE:

December 13, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

   

FROM:

Charlene A. Silva, Director of Health

 

Gale Bataille, Director of Mental Health Services

   

SUBJECT:

Agreement with 7th Avenue Center, LLC

   

RECOMMENDATION:

Adopt a resolution:

1)

Waiving the Request for Proposal process;

2)

Authorizing the President of the Board to execute an agreement with 7th Avenue Center, LLC to provide locked psychiatric care for clients of Mental Health Services for the period July 1, 2005 through June 30, 2008, for a maximum obligation of $1,049,968; and

3)

Authorizing the Director of Health to execute subsequent amendments and minor modifications not to exceed $25,000 in aggregate and to make minor changes in the types of services and activities provided under the agreement.

 

VISION ALIGNMENT:

Commitment: The Agreement with 7th Avenue, LLC keeps the commitment to 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 locked psychiatric care for San Mateo County adults with serious and persistent mental illness.

 

Performance Measure(s):

Measure

FY 2004-05
Actual

FY 2005-06
Projected

Maximum percentage of discharges to an acute psychiatric level of care.

28%*

10%

* Clients acuity resulted in a greater frequency of hospitalization than anticipated.

 

BACKGROUND:

Mental Health Rehabilitation Centers (MHRC) such as 7th Avenue Center, LLC, provide locked psychiatric care for 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.

 

Mental Health Services has contracted continuously with 7th Avenue for MHRC services since 2002.

 

DISCUSSION:

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

 

7th Avenue will provide up to 5 beds for San Mateo County residents. Use of services by this Contractor has increased 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). Efforts to decrease the length of stay at Napa State Hospital and at Cordilleras have resulted in an increased use of community placements like 7th Avenue.

 

Beginning October 1, 2005, 7th Avenue is also providing Monitored Housing Program services, which provide clients with daily life management skills in a community housing setting. The goal of this program is to help clients build confidence, community re-entry skills, and improve management of their symptoms so that they may return to their own communities and successfully live independently.

 

Since 1999 Mental Health Services has contracted for unique services under its plan for contracting, which excludes these services from the Request for Proposals (RFP) requirement. County Counsel has advised that our plan should be updated and presented to your Board for approval, which we will do early in 2006. This contractor provides gender specific services for seriously and persistently mentally ill clients who are discharged from the State Hospital. The unique MHRC services provided by this contractor are both difficult to find and necessary for clients who might otherwise require hospital placement. We are requesting a waiver of the RFP requirement for this agreement.

 

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

 

FISCAL IMPACT:

The term of this Agreement is July 1, 2005 through June 30, 2008.

 

The Agreement maximum is $1,049,968 for the three-year term. The maximum for FY 2005-06 is $349,670, which has been included in the approved FY 2005-06 Mental Health Services budget. Of that amount, sales tax through Realignment will pay $313,829. The remaining $35,841 represents the Net County Cost as maintenance of effort for Realignment. Similar arrangements will be in place for FY 2006-07 and FY 2007-08.