COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

April 16, 2008

BOARD MEETING DATE:

May 6, 2008

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health

Louise Rogers, Director, Behavioral Health & Recovery 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 for the purchase of services at State Hospitals for the term July 1, 2007 through June 30, 2008, for a total obligation not to exceed $962,448.

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 contributes to this commitment and goal by providing mental health services at Napa and Metropolitan State Hospitals for appropriate clients.

Performance Measures:

Measure

FY 2006-07 Actual

FY 2007-08 Projected

Maximum number of bed days utilized

2,555

2,555

Maximum percentage of bed days utilized

100%

100%

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 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 Behavioral Health and Recovery Services (BHRS) clients. These services are reserved for seriously mentally ill clients with the most severe behavioral issues, for whom there is no appropriate lower level of care.

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. This Agreement is for the purchase of seven beds in the State Hospital system for FY 2007-08. 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 2007-08 compared to FY 2006-07 are as follows:

Beds

Costs

Changes

Type of Service

2006-07

2007-08

2006-07

2007-08

Beds

Cost

Subacute (NAPA)

6

6

$804,956

$813,091

--

$8,135

Medical – Skilled Nursing Facility (Metropolitan & Napa)

1 (NAPA)

1 (NAPA)

$147,865

$149,357

--

$1,492

TOTAL

7

7

$952,821

$962,448

--

$9,627

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 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. This Agreement was not received from DMH until January of this year and needed changes were not received until March.

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

FISCAL IMPACT:

The term of this Agreement is July 1, 2007 through June 30, 2008. The Agreement maximum is $962,448 for FY 2007-08, which is included in the Behavioral Health and Recovery Services FY 2007-08 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.