DATE: November 8, 2022
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Memorandum of Understanding with California Department of State Hospitals and CalMHSA and Participation Agreement with CalMHSA
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Memorandum of Understanding with the California Department of State Hospitals and the California Mental Health Services Authority for mandated state psychiatric hospital beds and services, effective July 1, 2022, through February 28, 2023, which includes one optional 60-day extension ($425,000); and
2. Approve and authorize the Chairman to execute a retroactive Participation Agreement (No. 1498-SHB-2022-FC) with the California Mental Health Services Authority for purchase of state psychiatric hospital beds on behalf of the County, effective July 1, 2022, through June 30, 2023 ($2,804).
REPORT
Approval of the first recommended action will allow for a six-month Memorandum of Understanding (MOU) with the California Department of State Hospitals (DSH). Pursuant to Welfare & Institutions Code (W&IC), section 5000 and following, the MOU will provide mandated beds and services for Lanterman-Petris Short (LPS) Conservatees, who are adults with severe mental illness and are gravely disabled, as ordered by the Fresno County Superior Court (Court). The agreement will be funded with Mental Health Realignment funds, with no additional Net County Cost. Approval of the second recommended action will allow for a one-year Participation Agreement with the California Mental Health Services Authority (CalMHSA) to contract for state hospital beds on the County’s behalf, along with all other counties under the agreement. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternatives. Non-approval of the recommended actions will prevent the Department from authorizing state psychiatric hospital placement and services through the DSH/CalMHSA MOU and the Participation Agreement with CalMHSA for adults with severe mental illness deemed by the Court to require a higher level of care in a locked facility.
RETROACTIVE AGREEMENT:
The recommended MOU and Participation Agreement are retroactive to July 1, 2022, as the Department received the final approved MOU from CalMHSA on October 4, 2022. CalMHSA has historically provided the documents to the Department late.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum compensation allocated for the MOU for FY 2022-23 is $425,000, fully offset with Mental Health Realignment funds. The cost of the MOU is based upon a dedicated hospital bed rate structure. The cost is based on amounts provided to the California State Controller’s Office per the County Actual Use statement reflecting actual bed usage by the County. The cost of the recommended Participation Agreement is $2,804 ($1,402 per bed) offset by Mental Health Realignment funds. The actual cost for the FY 2021-22 agreement was $574,042.00. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2022-23 Adopted Budget.
DISCUSSION:
Pursuant to W&IC, Section 5600, counties are mandated to provide treatment options for adults with severe mental illness, including 24-hour treatment services at locked inpatient psychiatric hospitals. Sections 4330 through 4335 establish the process by which counties contract with DSH for a specified number of hospital beds, services, and the reimbursement method.
On September 14, 2010, the Board approved Agreement No. 10-489 with CalMHSA, authorizing the Department to join the CalMHSA Joint Powers Authority (JPA) to develop, implement, administer, and provide fiscal oversight of Mental Health Services Act statewide projects. The County has received membership benefits including cost reductions and the related efficiencies of sharing resources and knowledge. On June 18, 2013, the Board approved an amendment to the agreement, which broadened the scope including the authority to jointly contract with other counties for state hospital beds and services. The amendment was a product of the Department’s JPA membership and delineated that CalMHSA is an administrative agent for the County.
With your Board’s approval of the MOU, the County will continue to utilize state psychiatric hospital placement and services for adults with severe mental health illness that require a higher level of care within a locked facility through December 31, 2022. Services include, but are not limited to, psychiatric and ancillary services, health care, expert testimony, and therapy. Department staff closely monitor each individual placed at a state hospital for services. As the individual’s mental health improves, placement staff may transition them to less restrictive and less costly mental health facilities such as Mental Health Rehabilitation Centers and Skilled Nursing Facilities.
Additionally, with your Board’s approval of the recommended actions, the state hospital bed rates for the period of July 1, 2022, through December 31, 2022, are as follows:
• Acute $753/bed/day
• Intermediate Care Facility $728/bed/day
• Skilled Nursing Facility $806/bed/day.
The CalMHSA State Hospitals Program authorizes CalMHSA to contract with DSH for state hospital bed utilization on behalf of the County. The recommended Participation Agreement includes an annual maximum payment of $2,804 ($1,402/per bed with a maximum of two beds) to CalMHSA to cover administrative charges associated with their procurement of state hospital beds.
As this is state-drafted agreement language, the County’s traditional insurance language and hold harmless language is not present in the recommended Participation Agreement. The MOU does contain a mutual indemnification clause for both County and the state (page 12, Section III, Subsection C).
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of these recommended action items during the September 21, 2022, meeting.
REFERENCE MATERIAL:
BAI# 36, May 17, 2022
BAI# 30, May 11, 2021
BAI# 57, June 18, 2013
BAI# 39, September 14, 2010
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Memorandum of Understanding with DSH and CalMHSA
On file with Clerk - Participation Agreement with CalMHSA
CAO ANALYST:
Ronald Alexander