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HomeMy WebLinkAboutMINUTES - 02141989 - 1.34 Pq 1-®3 To: BOARD OF SUPERVISORS Mark Finucane , Health Services Director FROM; ra t co By : Elizabeth A. Spooner , Contracts Administrator G�^��} DATE; February 2, 1989 Costa SUBJECT; Authorization for Retroative Payment to Providers County and Approval of Policy and Procedures for Obtaining Acute Psychiatric Inpatient Treatment for Minors in Separate Facilities From Adults SPECIFIC REQUEST(S) OR RECOMMENDATION(.S) & BACKGROUND AND JUSTIFICATION I . RECOMMENDED ACTION : 1 . Ratify purchase of services from various psychiatric treat- ment and diagnostic service providers as set forth in the attached list , and authorize the County Auditor-Controller to pay the outstanding balance , not to exceed a total of $ 128 , 416 for provision of said services through December 31., 1988 , upon approval of provider payment demands by the Health Services Director or his designee ( Stuart McCullough) . 2 . Authorize the Health Services Department to continue its efforts to obtain acute psychiatric inpatient .' treatment ser- vices for minors in public and private hospitals which pro- vide separate inpatient facilities for minors and approve the Department ' s proposed operating plan as set forth in the attached Policy and Procedure Statement for Prohibiting the Inpatient Psychiatric Treatment of Minors on the Same Treatment Wards as Adults . 3 . Authorize the Health Services Director or his designees ( Stuart McCullough and Ruth Ormsby) to negotiate purchase of service contracts with the following hospitals to obtain separate acute psychiatric inpatient treatment from January 1 , 1989 , through June 30 , 1989 , for minors with no alter- native financial coverage , subject to _the limitations of the Health Services Department Budget for FY 1988-89 : a . CPC Walnut Creek Hospital , Walnut Creek b. First Vallejo Hospital , Vallejo c . Oak Grove Psychiatric Center For Adolescents , Concord d. Gladman Memorial Hospital , Oakland e . Langely Porter Psychiatric Institute/Hospital (UCSF ) , San Francisco f . McAuley Neuropsychiatric Institute , San Francisco g . East Bay Hospital , Richmond h. Alta Bates-Herrick, Berkeley CONTINUED ON ATTACHMENT; X YES SIGNATURE: O'er RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATIN OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S)' TTTACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Cc: Health Services (Contracts) ATTESTED FEB 14 1989 _ Auditor-Controller (Accounts Payable) PHIL BATCHELOR, CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR M382i7-83 BY- _ DEPUTY BOARD ORDER Retroactive Payment and Policy and Procedures for Obtaining Psychiatric Treatment for Minors Page 2 4 . Direct the Health Services Director to report to the Board monthly on the cost of providing separate acute psychiatric inpatient treatment services for minors , including related costs for physician services , admitting history and physical exams , special diagnostic or testing services ., and incidental medical or health. care costs related to non-psychiatric illnesses . II . FINANCIAL IMPACT : The amount of $ 128 ,416 has been included in the 1988-89 Fiscal Year expenditure projection for the Alcohol/Drug Abuse/Mental Health Division of the Health Services Department . This amount was not included in the Department ' s approved 1988-89 budget . This expenditure will reduce the availability of a carry-over fund balance for 1989-90 . Lack of a sufficient fund balance for the next fiscal year may necessitate program modifications in the Department . III . REASONS FOR RECOMMENDATION/BACKGROUND : 1 . Background . Under the Statutes of 1987 (Assembly Bill 1362 , Bronzan) , Welfare and Institutions Code Section 5751 . 7 establishes a prohibition against minors being admitted for psychiatric treatment into the same treatment ward as certain adults which might present a threat to the physical safety of minors , except when a waiver has been granted by the State under special circumstances . On April 25 , 1988 , the Mental Health Advisory Board delivered their 1987 report to your Board . Following this report , your Board discussed the issue of separating mentally ill children from mentally ill adults in County facilities and directed the Mental Health Director to report back "on the feasibility and implications of a policy relative to the separation of mentally ill children and adults in County facilities . " The report of the Health Services Director was accepted by the Board on June 7 , 1988 . 2 . Contract Negotiations and Provider Payments . At the time of the June report and in response to your Board 's concern , the Department was meeting with various psychiatric hospitals and private psychiatrists to explore contract options for acute care alternatives in lieu of Merrithew Memorial Hospital . Protracted negotiations are still going on in an effort to find a permanent , cost- effective solution for caring for mentally ill children and adolescents in our County , separately from mentally ill adults . In the meanwhile , there are and have been mentally ill children and adolescents (many of these on an emergency basis ) in need of immediate inpatient psychiatric treatment , and Alcohol/Drug Abuse/Mental Health staff have put forth their best efforts to obtain quality care for these patients . As a temporary solution , the Department arranged for admission of said child and adolescent patients to various psychiatric hospitals in the area and for psychiatrists and psychologists on staff at those hospitals to treat these patients . BOARD ORDER Retroactive Payment and Policy and Procedures for Obtaining Psychiatric Treatment for Minors Page 3 In the course of arranging for these urgent (and often, emergent ) psychiatric , services , staff made verbal agreements with inpatient facilities and mental health professionals . However , written contracts with these providers were not exe- cuted , and even though the facilities and mental health pro- fessionals provided the services in good faith, they cannot be paid for their services without proper County authorization. The Alcohol/Drug Abuse/Mental Health Division now has a new Child and Adolescent Services Program Chief who is in the pro- cess of setting up a permanent system for expediting provision of inpatient psychiatric services for children and ado- lescents , with requisite billing and payment components . In the meantime , the Department is requesting that the past due amounts , set forth on the attached list , be paid in a one-time effort to clear up these accounts . This can be accomplished by the Board of Supervisors ratifying the actions of County employees in obtaining provi- sion of inpatient psychiatric services for its child and ado- lescent patients . This will create a valid obligation on the part of the County , retroactively authorizing , through December 31 , 1988 , said inpatient psychiatric services requested by the County, and authorizing the Auditor-Controller to pay these providers , not to exceed the amounts specified on the attached list . 3 . Management Responsibility and Detailed Operating Plan. The Alcohol /Drug Abuse/Mental Health Division has now established a proposed operating plan which is set forth in the attached Policy and Procedure Statement for Prohibiting the Inpatient Psychiatric Treatment of Minors on the Same Treatment Wards as Adults . This plan designates the County ' s Child and Adolescent Services Program Chief as the person in charge of the Department ' s system for providing acute psychiatric inpatient treatment services for minors and inclu- des a system for maintaining management and financial controls . The Division will make every effort possible to ensure that no further verbal agreements are made for the pro- vision of services without proper County authorization. 4 . Ongoing Purchase of Service Contracts . The Department has now established a contract format for inpatient psychiatrist services in outside public and private hospitals and has processed a number of contracts with pri- vate psychiatrists for the physician services which are needed for minors placed in such facilities when no outside financial coverage is available . The Department is still in the process of establishing an approved contract format for the purchase of psychiatric hospital services for minors and is actively negotiating terms and conditions with the hospi- tals named above . The Department is requesting authorization to complete negotiations for purchase of service contracts with these hospitals in order to obtain acute psychiatric inpatient treatment for minors with no alternative financial coverage for the period from January 1 , 1989 , through June 30 , 1989 . As soon as these contracts are completed and approved by the Offices of the County Counsel and County Administrator , they will be presented to the Board for final approval and execution. BOARD ORDER Retroactive Payment and Policy and Procedures for Obtaining Psychiatric Treatment for Minors ATTACHMENT (List) MAXIMUM AMOUNTS HOSPITALS TO BE PAID Alta Bates-Herrick Hospital $ 5,600 CPC Walnut Creek Hospital 59,000 Gladman Memorial Hospital 12,596 Langley Porter Institute (UCSF) 12,000 McAuley Institute 91900 $ 99,096 PSYCHIATRISTS AND PSYCHOLOGISTS Jenan A1-Mufti, M.D. $ 350 Allan Barza, M.D. . 60 Howard Friedman, Ph.D. 2,100 David Golub, M.D. 9,160 Robert Hepps, M.D. 1,740 Robert Levit, Ph.D. (Oasis Center) 690 Lenore McKnight, M.D. 10,800 Jane Mertens, M.D. 100 Mary Olowin, M.D. 840 John Rostkowski, M.D. 2,100 Raymond Ruzicano, M.D. 240 Michael Schwab, M.D. 300 Stephen Sturges, M.D. 840 $ 29,320 TOTAL $ 128,416 Contra Costa County Health Services Department POLICY AND PROCEDURE STATEMENT FOR PROHIBITING THE INPATIENT` PSYCHIATRIC TREATMENT OF MINORS ON THE SAME TREATMENT 4MRDS AS ADULTS I. POLICY It is the policy of the Contra Costa County Health Services Department that, whenever possible, County Mental Health staff will place minors in outside public or private hospitals which provide separate acute psychiatric inpatient treatment facilities for minors and will avoid placing minors on inpatient wards which also treat adults-, except under special clinical or financial circumstances. Should the County's Mental Health Director, or his designee (Joseph Hartog, MD, Plcohol/ Drug Abuse/Mental Health Medical Director) determine that s-.-cial cli- nical or financial circumstances exist, they may invoke pro- vision of Welfare and Institutions Code Section 5751.7 and authorize County Mental Health staff to place a minor on the acute psychiatric inpatient wards at Merrithew Memorial Hospital. This policy carries out the provisions of Welfare and Institutions Code Sect _n_ 5751.7 which establishes a prohibition against minors being admitted for psychiatric treatment into the same treatment ward as certain adults which might present a threat to the physical safety of minors, except when a waiver is granted by the State Department of Mental Health. At the request of the County's Mental Health Director, Merrithew Memorial Hospital has been granted such a waiver. II. RESPONSIBILITY The County's Child/Adolescent Services Program Chief is designated as the person in charge of overseeing, managing, and otherwise admin- istering this policy and the following procedures. III. PROCEDURES A. Referral To Mental Health Crisis Service (Martinez) 1. All children and adolescents (minors) in possible need of acute psychiatric hospitalization will be evaluated by County's Mental Health Crisis Service at Merrithew Memorial Hospital in Martinez (except for referrals to the West County Crisis Service, set forth below) . 2. The referring clinician will call the Mental Health Crisis Service to discuss possible child or adolescent referrals. The clinician will be required to share all pertinent clinical impressions and recommendations, and, if possible, to accompany the minor to the Mental Health Crisis Service in Martinez. -2- 3. Mental Health Crisis Service staff will conduct an evaluation of the minor's psychiatric condition, provide all needed crisis intervention treatment services, and make a diagnostic assess- ment of the minor's need for acute psychiatric inpatient treat- ment. 4. Upon completion of the evaluation, Mental Health Crisis Service staff will provide feedback to the referring clinician regarding disposition. In the event that hospitalization is required, Mental Health Crisis Service staff will determine the minor's financial status and eligibility, including County responsibility for financial coverage when no other coverage is available. 5. In the event that there is a disagreement regarding disposition between the referring party and Mental Health Crisis Service staff, the issues will be referred to County's Child/Adolescent Services Program Chief or her designee to mediate and resolve and the decision of said Program Chief or designee will be final with regard to responsibility and actions to be taken by the County and its Mental Health staff. 6. When indicated by the diagnostic assessment, Mental Health Crisis Service staff will refer minors for hospitalization and make arrangements for admission to acute psychiatric inpatient treatment facilities in accordance with the above Policy. B. Referral To West County Crisis Service 1. From 8 A.M. to Midnight, Monday through Friday, including holi- days, the County's West County Mental Health Crisis Service (256 - 24th Street, Richmond) will carry out the above proce- dures for all minors residing in West County. 2. The West County Crisis Service staff will call the Mental Health Crisis Service in Martinez to obtain information regarding bed availability in acute psychiatric inpatient treatment facilities and will report the dispositions of all such cases to the Mental Health Crisis Service staff in Martinez so that they can maintain a Central Tracking Log. C. Referrals To Hospitals 1. The County's Child/Adolescent Services Program Chief will establish purchase of service contracts with appropriate public and private hospitals to obtain acute psychiatric inpatient treatment for minors who have no alternative financial coverage, in accordance with the above Policy. 2. County Mental Health Crisis Service staff will seek to get minors admitted to treatment facilities without County finan- cial responsibility (i.e., when the minors have outside finan- cial coverage, such as private insurance or Medi-Cal). -3- 3. When outside financial coverage is not available, County Mental Health Crisis Service staff will contact the County's Mental Health Director or his designee (Ruth Ormsby,. LCSW, Child/ Adolescent Services Program Chief) to request an authorization to place the minor in an appropriate public or private hospital at County expense under an established purchase of service contract. The Mental Health Director or designee will consider such requests and, as they deem appropriate, will authorize County Mental Health Crisis Service staff to place minors in appropriate public or private hospitals at County expense. 4. When there is no contract in place for a particular hospital and no alternative placement facilities are available for the emergency treatment of a minor, the Mental Health Director or designee will invoke County procedures for the emergency purchase of contract services until a standard contract can be negotiated and approved. Under these emergency circumstances, the Mental Health Director or Child/Adolescent Services Program Chief will obtain needed authorizations from the County's Health Services Director and/or Purchasing Agent, enter into an oral contract with the respective hospital, and follow through with the establishment of a corresponding written contract. D. Referrals To Private Physicians 1. The County's Child/Adolescent Services Program Chief will establish purchase of service contracts with private psychiatrists who are deemed appropriate and are cn the medical staffs of hospitals where minors may be placed by County Mental Health Crisis Service staff to obtain inpatient physician treatment services for minors with no alternative financial coverage. 2. County Mental Health Crisis Service staff will seek to get minors accepted by private psychiatrists without County finan- cial responsibility (i.e., when the minors have outside finan- cial coverage) . 3. when outside financial coverage is not available or is not accepted by a private psychiatrist and no alternative treating physician is available, County Mental Health Crisis Service staff will contact the County's Child/Adolescent Services Program Chief or her designee to request authorization to refer the minor to the private psychiatrist for inpatient physician treatment services at County expense under an established purchase of service contract. The Program Chief or designee will consider such requests and, as they deem appropriate, will authorize County Mental Health Crisis Service staff to refer minors to such private psychiatrists at County expense. 4. When there is no contract in place with a particular psychiatrist and no alternative treating physician is available, the Child/Adolescent Services Program Chief or •r . -4- designee will invoke County procedures for the emergency purchase of contract services until a standard contract can be negotiated and approved. Under these emergency circumstances, the Program Chief or designee will obtain needed authorization from the County's Health Services Director and/or Purchasing Agent, enter into an oral contract with the private psychiatrist, and follow through with the establishment of a corresponding written contract. E. Tracking System 1. The Mental Health Crisis Service staff in Martinez will main- tain a Central Tracking Log for all evaluations and placements (including those performed by West County Mental Health Crisis Service staff) , comprising dispositional information on each minor, diagnostic data, initial financial and eligibility information, and updated information received from the office of the Child/Adolescent Services Program Chief. 2. A case manager from County's Youth Interagency Assessment and Consultation Team (YIACT) will be assigned to visit each minor regularly in the facility where they have been hospitalized by County Mental Health Crisis Service staff at County expense or under potential County financial responsibility in order to monitor changes in each minor's psychiatric condition and financial eligibility status, to monitor hospitalization status and the availability of vacant beds, and to actively participate in discharge planning for each minor. 3. On a daily basis, the Children Program Senior Clerk in the Office of the Child/Adolescent Services Program Chief will call the designated YIACT Case Manager and Mental Health Crisis Service staff in Martinez to get information regarding new referrals, as well as the discharge status of hospitalized minors and to give information regarding changes in hospitali- zation status for each minor, so that the Mental Health Crisis Service staff can update its Central Tracking Log and monitor the availability- of vacant beds. 4. The Childrens Program Senior Clerk will maintain a Master Control Log for the Child/Adolescent Services Program Chief, including detailed admission, discharge, and financial infor- mation for the hospitalization of each minor. 5. The YIACT Case Manager will periodically provide updated infor- mation to the Mental Health Crisis Service staff and to the Childrens Program Senior Clerk regarding discharge planning and changes in each minor's hospitalization and financial eligi- bility status. 6. The Child/Adolescent Services Program Chief will review all bills from contractors (hospitals, private psychiatrists, or ancillary service providers) for approval and payment. IV. CHANGES IN PROCEDURES Subject to the approval of County's Mental Health Director, the Child/ Adolescent Services Program Chief may institute changes and modifica- tions in the above Procedures from time to time, as needed to improve the administration of this Policy and to obtain needed acute psychiatric inpatient treatment for minors within the programmatic and financial limitations established by the Health Services Department.