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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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Health Department
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DATE:
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March 2, 2007
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BOARD MEETING DATE:
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March 13, 2007
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Charlene A. Silva, Director of Health
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Gale Bataille, Director of Mental Health Services
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SUBJECT:
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Agreement with State Department of Mental Health for State Hospital Beds
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RECOMMENDATION:
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Adopt a resolution authorizing the President of the Board to execute an Agreement with the State Department of Mental Health for the purchase of services at State Hospitals for the term July 1, 2006 through June 30, 2007, for a total obligation not to exceed $952,821.
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VISION ALIGNMENT:
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Commitment: Ensure basic Health and Safety for all.
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Goal 8: Help vulnerable people-the aged, disabled, mentally ill, at risk youth and others-achieve a better quality of life.
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This Agreement contributes to this commitment and goal by providing mental health services at Napa and Metropolitan State Hospitals for appropriate clients.
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Performance Measure(s):
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Measure
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Number of bed days utilized
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Percentage of bed days utilized
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BACKGROUND:
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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 the State Department of Mental Health (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.
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DISCUSSION:
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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. This Agreement is for the purchase of seven beds in the State Hospital system for FY 2006-07. This represents no change from the prior year number of beds and reflects the County’s consistent use of seven beds since FY 2001-02. The number, type, and cost of State Hospital beds for FY 2006-07 compared to FY 2005-06 are as follows:
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Beds
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Cost
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Changes
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Type of Service
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2006-07
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2005-06
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2006-07
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Beds
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Subacute (Napa)
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5
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6
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$653,825
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$804,956
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--
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Medical – Skilled Nursing Facility (Metropolitan & Napa)
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2
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1 (Napa)
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$271,509
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$147,865
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--
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($123,644)
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TOTAL
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7
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7
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$925,334
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$952,821
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--
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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.
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Payment for use of all 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. Actual costs for use of the State Hospital beds are established in Exhibit B of the Agreement.
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The term of the Agreement is July 1, 2006 through June 30, 2007. The Agreement has been reviewed and approved by County Counsel and Risk Management. This Agreement was not received from DMH until January of this year.
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The contractor has assured compliance with the County's Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.
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FISCAL IMPACT:
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The term of this Agreement is July 1, 2006 through June 30, 2007. The Agreement maximum is $952,821 for FY 2006-07, which is included in the Mental Health Services FY 2006-07 Adopted Budget. Adjustments for bed use in excess of the contracted amount are made twice a year in February and August. This Agreement is completely funded through State Realignment funds. There is no Net County Cost associated with this Agreement.
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