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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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November 18, 2009
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BOARD MEETING DATE:
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December 15, 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 & Recovery Services
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SUBJECT:
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Agreement with State Department of Mental Health for State Hospital Beds
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RECOMMENDATION:
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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, 2008 through June 30, 2009, for a maximum obligation not to exceed $1,149,341.
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BACKGROUND:
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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. Since 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.
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DISCUSSION:
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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 2008-09. For several months this fiscal year BHRS purchased one additional bed. Additional bed usage is not expected for FY 2009-10.
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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.
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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. This Agreement was not received from DMH until the end of May, and was further delayed due to delay in fiscal review in BHRS. The Agreement has been reviewed and approved by Risk Management and the Agreement and the Resolution have been reviewed and approved by County Counsel.
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The Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing mental health services at Napa and Metropolitan State Hospitals for appropriate clients. 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 State Hospital Beds is the highest established level of care. The services provided through this Agreement contribute to this measure. It is anticipated that 100% of available beds will be used.
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Performance Measures:
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Measure
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FY 2007-08
Actual
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FY 2008-09
Actual
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Maximum percentage of bed days utilized
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100%
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100%
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FISCAL IMPACT:
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The term of the Agreement is July 1, 2008 through June 30, 2009. The Agreement maximum is $1,149,341 for FY 2008-09, which is included in the BHRS FY 2008-09 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.
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The number, type and cost of State Hospital beds for FY 2008-09 compared to FY 2007-08 are as follows.
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Beds
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Costs
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Changes
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Type of Service
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2007-08
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2008-09
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2007-08
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2008-09
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Bed
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Cost
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Subacute (NAPA)
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6
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7
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813,091
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1,149,341
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+1
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336,250
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Medical – Skilled Nursing Facility (Metropolitan & Napa)
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1
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0
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149,357
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0
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-1
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(149,357)
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TOTAL
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7
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7
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962,448
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1,149,341
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0
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186,893
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