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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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June 3, 2010
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BOARD MEETING DATE:
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June 29, 2010
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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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BACKGROUND:
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Behavioral Health & Recovery Services (BHRS) bills the State and the Health Plan of San Mateo (HPSM) for various forms of publicly funded insurance, including CareAdvantage (Medicare), Medi-Cal, Healthy Families, Healthy Kids and HealthWorx. The rates for billing for these services are set through various participation agreements. BHRS also bills for 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 the rates for these clients.
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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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County Counsel has reviewed and approved this Resolution.
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The setting of rates for Mental Health Services contributes to the Shared Vision 2025 outcome of a Healthy Community by providing reimbursement of the cost of care for residents with Healthy Families, Healthy Kids and HealthWorx insurance coverage. The revenue generated will contribute to the total volume of third party revenues and client fees collected. It is anticipated that there will be a 0% increase in these revenues for FY 2010-11, which is consistent with the BHRS goal to maintain the total volume of third party revenues and client fees collected and not experience a decrease during the current fiscal climate.
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Performance Measure:
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Measure
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FY 2009-10
Estimate
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Percent change in third party revenues and client fees over prior year
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0%
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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 2009-10. That amount is included in the BHRS FY 2010-11 tentatively Adopted Budget. It is expected that approximately $279,000 will be generated in FY 2011-12.
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