COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

September 6, 2007

BOARD MEETING DATE:

September 25, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health

Gale Bataille, Interim Director, Behavioral Health & Recovery Services

Lisa Mancini, Director of Aging and Adult Services

SUBJECT:

Agreement with Crestwood Behavioral Health, Inc.

RECOMMENDATION:

Adopt a Resolution:

1) Authorizing the President of the Board to execute an Agreement with Crestwood Behavioral Health, Inc. for residential rehabilitation and long-term care services for the term July 1, 2007 through June 30, 2010, for a maximum obligation of $5,245,530; and

2) Authorizing the Director of Health or the Director's designee to execute contract amendments which modify the County's maximum fiscal obligation by no more than $25,000 (in aggregate) and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions.

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.

This Agreement with Crestwood Behavioral Health, Inc. keeps the commitment to ensure basic health and safety for all by providing residential rehabilitation and long-term care for this vulnerable population of adults suffering from serious mental illness.

Performance Measures:

Measure

FY 2006-07
Actual

FY 2007-08
Projected

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

35%*

10%

Percentage of clients with decrease in number of hospital bed days in comparison with year prior to admission.

79%**

66%

*Mental Health will work with contractor to improve outcomes for FY 2007-08.

**FY 2006-07 performance exceeded target, which is unchanged for FY 2007-08.

BACKGROUND:

Mental Health Services has contracted with Crestwood Behavioral Health, Inc. since 1988 to provide long-term care for County residents. Some of these individuals are Lanterman, Petris and Short (LPS) conservatees, and some are conserved under the Probate dementia laws.

DISCUSSION:

To accommodate specialized treatment care needs and to distinguish between the LPS conserved mentally ill clients and the Probate dementia conservatees, this contract has a Mental Health Services component and an Aging and Adult Services (AAS) component. The Mental Health Program provides services for up to 50 clients who are seriously mentally ill and in need of mental health rehabilitation, treatment and long-term care. The Aging and Adult Services Program provides services for up to eight clients who are Probate dementia conservatees and who require a locked, long-term treatment setting.

Services provided through this Agreement offer an alternative to use of more costly emergency services (i.e. Psychiatric Emergency Services, inpatient administrative days, and Corrections). Under the B-1 Administrative Memorandum, the selection of providers for these long-term locked facility services is exempt from the Request for Proposals requirement.

Prior agreements with Crestwood have included services at their Idylwood – Sunnyvale facility, which is now owned by Helios Healthcare. An Agreement with Helios for services at Idylwood will be presented to your Board separately.

The Agreement has been reviewed and approved by County Counsel and Risk Management. 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. The Agreement with Crestwood is on the Continuing Resolution.

FISCAL IMPACT:

The contract total is $5,245,530 for the term July 1, 2007 through June 30, 2010. The three-year maximum obligation for Mental Health Services is $4,774,530. The three-year maximum obligation for AAS is $471,000. It is estimated that the cost for Mental Health Services for the first year will be $1,700,000, which is included in Mental Health Services tentatively Adopted FY 2007-08 Budget. Sales tax provided through realignment is estimated to fund 89% or $1,569,070. The remaining $130,930 represents the Net County Cost for the Mental Health Program. It is estimated that the cost for AAS for the first year will be $157,000, which is funded through client reimbursements and is included in the AAS Tentatively Adopted FY 2007-08 Budget. There is no Net County Cost associated with the AAS component of this Agreement. Similar arrangements will be made for FY 2008-09 and FY 2009-10.