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COUNTY OF SAN MATEO
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Inter-Departmental Correspondence
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Health System
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DATE:
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January 16, 2009
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BOARD MEETING DATE:
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February 10, 2009
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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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Jean S. Fraser, Chief, Health System
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Louise Rogers, Director, Behavioral Health and Recovery Services
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SUBJECT:
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Rates for Mental Health Services
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RECOMMENDATION:
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Adopt a Resolution setting mental health services rates for the Behavioral Health and Recovery Services Division of the Health System.
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VISION ALIGNMENT:
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Commitments: Ensure basic health and safety for all; and responsive, effective, and collaborative government.
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Goals 8 and 20: Help vulnerable people–the aged, disabled, mentally ill, at-risk youth, and others–achieve a better quality of life; and government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.
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The approval of these rates contributes to these commitments and goals by authorizing rates for billing mental health services for clients of Behavioral Health and Recovery Services (BHRS), who have private third-party insurance coverage, who do not have insurance coverage, or who have Medicare insurance coverage that is not provided through the Health Plan of San Mateo (HPSM).
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Performance Measure:
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Measure
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Percent change in third party revenues and client fees over prior year
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BACKGROUND:
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BHRS bills the State and the HPSM for various forms of publicly funded insurance, including CareAdvantage (Medicare), Medi-Cal, Healthy Families, HealthyKids and HealthWorx. The rates for billing for these services are set through various participation agreements. BHRS also bills clients who have private third-party insurance coverage, who do not have insurance coverage, or who have Medicare insurance coverage other than through the HPSM. Your Board has the authority to approve these rates.
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DISCUSSION:
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The rates presented in Exhibit A of the Resolution are recommended for your Board’s approval. These rates will be used to bill clients who have private third-party insurance, who do not have insurance coverage, or who have Medicare coverage that is not provided through the HPSM. Rates have been calculated separately for each contractor provider based upon actual costs for services as determined by the contractors’ most recent cost reports. The BHRS billing rates are limited to actual cost of services by provider and by service mode and service function. The distinctions complicate these rates, but are required by the State Department of Mental Health. Administrative fees have been added to these rates.
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BHRS also has numerous contracts with service providers for mental health services. The rates set for billing are different from the amounts that the County pays to its contractors. Rates paid to providers through those agreements are negotiated specific to each contractor and are approved in the County’s contract approval process. When BHRS negotiates renewal contracts for such services, rates are usually based upon the actual costs of the provider as identified in prior annual cost reports submitted to BHRS.
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FISCAL IMPACT:
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Billing for clients with private third-party insurance, without insurance, and with Medicare coverage other than through the HPSM yielded total revenue of approximately $282,000 in FY 2007-08. It is expected that approximately $279,000 will be generated in FY 2008-09. That amount is included in the BHRS FY 2008-09 Adopted Budget.
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