COUNTY OF SAN MATEO

Health Department

DATE:

May 27, 2008

BOARD MEETING DATE:

June 17, 2008

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors
Acting as the In-Home Supportive Services Public Authority

FROM:

Charlene A. Silva, Director, Health Department
Lisa Mancini, Director, Aging and Adult Services

SUBJECT:

Amendment I to the Agreement with Addus HealthCare, Inc.

RECOMMENDATION:

Adopt a Resolution authorizing the President of the In-Home Supportive Services Public Authority to execute the First Amendment to the Agreement with Addus HealthCare, Inc., for the administration of contracted provider components of In-Home Supportive Services, decreasing the maximum number of service hours from 182,000 to 172,500 and the fixed rate from $19.54 to $19.02 in FY 2008-09 and FY 2009-10, and adding an Administrative Services component to the Agreement for FY 2008-09 and 2009-10 with no change to the three-year term of July 1, 2007 through June 30, 2010 or the total amount of $10,668,840.

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 Amendment contributes to this commitment and goal through the continuation of contracted in-home provider services throughout the County.

Aging and Adult Services (AAS) has continued to make the provision of services which help maintain at-risk individuals in a least restrictive setting a division-wide performance measure. With services provided by Addus Healthcare, Inc., AAS has met this measure as a division.

Performance Measure:

Measure

FY 2006-07
Actual

FY 2007-08
Estimated

Percent of at-risk individuals maintained in a least restrictive setting through case management

94%

95%

BACKGROUND:

In December 2006 AAS, acting on behalf of the Public Authority (PA), issued a Request for Proposals for In-Home Supportive Services (IHSS) contract services for a three-year period beginning July 1, 2007. On June 26, 2007, the Board adopted Resolution 68839 approving an Agreement with Addus HealthCare, Inc., (Addus) in the amount of $10,668,840 for the term of July 1, 2007 through June 30, 2010, to provide IHSS to individuals who are unable to remain safely in their own homes without this assistance and who are unable to hire, supervise, or fire their own providers due to the type or severity of their disabilities.

DISCUSSION:

AAS utilizes the contract mode for our most difficult to serve IHSS clients. The contractor also provides additional administrative services that are beyond the scope of the PA, such as direct provider supervision. San Mateo County’s current state-approved Maximum Allowable Contract Rate (MACR) for IHSS contract services is $19.02 per hour. The current Agreement with Addus includes a contract rate of $19.54 per hour. This original Agreement was approved by the Board with the understanding that AAS would continue to request an increase in the MACR to $19.54; a request that was first made to the state in May 2006 but has been denied. AAS is reducing the contract rate with Addus to $19.02 for provider-related services to be consistent with the MACR. AAS is also separating the additional administrative services provided by Addus from the service provider wages in this Amendment.

On September 25, 2007, the Board approved a wage increase of $1.00 per hour for IHSS Independent Providers effective October 1, 2007, bringing their rate of pay to $11.50 per hour; equal to the wage the state participates in. The wage currently paid to Addus providers under the existing agreement is $10.50 per hour. In order for Addus to provide a comparable wage to its service providers, this Amendment includes a wage increase to $11.50 per hour. AAS was able to pay for this wage increase by decreasing the number of service hours from 182,000 to 172,500 annually, and by separately purchasing administrative services.

FISCAL IMPACT:

The term of this Agreement remains July 1, 2007 through June 30, 2010. The maximum hours that can be purchased under this Agreement for FY 2007-08 is 182,000 at a rate of $19.54. The maximum hours that can be purchased under this Agreement for FY 2008-09 and 2009-10 is 172,500 annually at a rate of $19.02 for a total annual amount of $3,280,950. The annual amount for administrative support services in FY 2008-09 and 2009-10 is $272,387 annually. The maximum amount payable under the Agreement for the three-year term is not to exceed $10,668,840. State and Federal funds pay $8,641,760 approximately 81% of the cost of this Agreement. The remaining 19% ($2,027,080) represents the required County obligation for the Agreement and will be paid through Realignment funds. The amounts necessary for reimbursement of this Amendment are included in the Recommended Budgets for FY 2008-09 and 2009-10.