Inter-Departmental Correspondence

Health System



April 8, 2009


May 5, 2009







Honorable Board of Supervisors



Jean S. Fraser, Chief, Health System


Louise Rogers, Director, Behavioral Health & Recovery Services



Agreement with SYMED



Adopt a Resolution:

1) Authorizing the President of the Board to execute an Agreement with SYMED for the period of July 1, 2009 through June 30, 2012 for a maximum obligation of $150,000 for the provision of outpatient psychiatric mental health services for San Mateo County youth and adults; and


2) Authorizing the Chief of the Health System or 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.



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.


The Agreement contributes to this commitment and this goal by providing outpatient psychiatric mental health services within skilled nursing facilities.


Behavioral Health and Recovery Services (BHRS) provides a range of services to promote wellness and recovery and to support consumers remaining in the lowest possible level of care. The provision of outpatient psychiatric mental health services to clients within a skilled nursing facility is one established level of care. The services provided through this Agreement contribute to this measure.


Performance Measure:


    FY 2008-09

    FY 2009-10

Percentage of clients maintained at current or lower level of care.





In March 1995 your Board approved the acceptance of State and Federal funds to implement the San Mateo County Mental Health Managed Care Plan (MHP). Subsequently, the Private Provider Network (PPN) was established to provide outpatient psychiatric mental health services. The services were designed to treat individuals who could benefit from selected outpatient services as opposed to the more intense and comprehensive level of treatment offered in the County clinics. Since 2006 SYMED has contracted with the County to provide outpatient psychiatric mental health services. These services are used to accommodate clients throughout San Mateo County who reside in skilled nursing facilities and are unable to travel to see a psychiatrist for medication management.


Since 2006 BHRS has seen a decline in the number of psychiatrists who are willing to contract to become members of the PPN. The skilled nursing facilities within the County have been adversely impacted by the lack of psychiatrists and have sought assistance from County clinics. The County clinics have subsequently experienced strain on their capacity to treat the increasing number of clients.



In response to the service gap created by the limited availability of psychiatrists, SYMED emerged as an alternative by offering nurse practitioners who (with the oversight of SYMED’s staff psychiatrist) can evaluate, prescribe, and manage medications for BHRS clients in skilled nursing facilities. SYMED will provide services to BHRS clients at Burlingame Health Care Center and at other skilled nursing facilities in the County, which will reduce the need for client services by County clinics.


The Agreement and Resolution have 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 term of the Agreement is July 1, 2009 through June 30, 2012. The Agreement maximum is $150,000 for the three-year term. The budgeted maximum for FY 2009-10 is $50,000. Of that amount, $5,000 is funded by Medicare, $22,500 is from Medi-Cal, and $22,500 is from sales tax through realignment. The revenues and expenditures are included in the BHRS FY 2009-10 Recommended Budget. There is no Net County Cost. Similar arrangements will be made for subsequent years.