HomeMy WebLinkAboutMINUTES - 10061992 - FC.2 r
FC. 2
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y, CALIFORNIA
Adopted this Order on October 6, 1992 by the following vote:
AYES: Supervisors Powers, Fanden, Schroder, Torlakson, McPeak
NOES: None
ABSENT: None
ABSTAIN: None
SUBJECT: Finance Committee Report on Efforts to Identify
Alternatives to Phase II Mental Health Reductions
Following comments of Mark Finucane, Health Services Director,
on the reduction of three Mental Health Clinical Specialist
positions and the Performance Contract with Phoenix, Inc. , the Board
considered the report of the Finance Committee, (attached hereto and
considered as a part of this document) .
The following persons spoke:
Violet Smith, Mental Health Coalition, 1103 Temple Drive,
Pacheco;
Mike Conwall, (no address given) ; and
Vicki Smith, Phoenix Program, P. O. Box 315, Concord.
IT IS BY THE BOARD ORDERED that the recommendations of the
Finance Committee are ADOPTED with the declaration that should the
Mental' Health Coalition with whom the County has an agreement for the
cost-of-living adjustment (COLA) decide on a redistribution of the
COLA in order to maintain services that the Board would allow that
redistribution.
I hereby certify that this Is a true and correct copy of
an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: 6 m f 'Z'---
PHIL BATCHELOR,Clerk of the Board
of SuperAsors and County Administrator
cc: Health Services Director By - ,Deputy
County Administrator
i
i
i
TO: BOARD OF SUPERVISORS
;- %` Contra
FROM: Supervisor Tom Torlakson 0i Costa
Supervisor Tom Powers _ o n,�
Finance Committee ;., ;��� County
osTq,d6'
DATE: October 6, 1992
SUBJECT: Efforts to Identify Alternatives to Phase II Mental Health Reductions
SPECIFIC REQUEST(S) OR RECOMMENDATION(S), BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS
1. ACKNOWLEDGE the diligent efforts made by the Health Services Department, Mental Health Coalition
and County Administrator's Office in exploring alternatives to the Phase II Mental Health budget
reductions.
2. CONSIDER the reports from the Health Services Director on Mental Health Clinical Specialist positions
and status of negotiations with Phoenix, Inc. on a contract for IMD patient care.
BACKGROUND/REASONS FOR RECOMMENDATIONS
During the Phase II budget reduction hearings, the Board of Supervisors requested the Health Services Director
to meet with the Mental Health Coalition and explore alternatives to the proposed Phase II reductions in Mental
Health and report back to the Finance Committee.
The Committee considered reports on these issues at its September 21, 1992 and September 28, 1992
meetings. The Health Services Director and staff from the Health Services Department and County
Administrator's Office met with the Mental Health Coalition on September 15, September 23 and September 25.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
_RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S): ow
1
CION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVIS
I HEREBY CE Y THAT THIS IS A
_ UNANIMOUS (ABSENT TRUE AND RRECT COPY OF AN
AYES: NOES: ACTIO AKEN AND ENTERED ON THE
ABSENT: ABSTAIN: MI ES OF THE BOARD OF
PERVISORS ON THE DATE SHOWN.
ATTESTED
PHIL BATCHELOR, CLERK OF
Contact: Sara Hoffman (646-1390) THE BOARD OF SUPERVISORS
ND COUNTY ADMINISTRATOR
cc: County Administrator
Health Services Direc
BY DEPUTY
Agreement was reached on a number of issues:
■ Removal of more patients from Napa State Hospital is a long-term project and is not an
alternative to avoiding the current budget reductions.
e The reductions to LaCheim and Crestwood Hospital should be implemented as planned.
■ Community placement of IMD patients were identified as a.possible alternative to reductions to
the Phoenix program.
■ Transfer of patients from IMDs to community placements will require resolution of many issues,
and both the Health Services Department and Mental Health Coalition have committed to
continuing discussions.
Transfer of Patients from IMDs
In exploring the possibility of placing more IMD patients in community facilities, the Mental Health Division
evaluated the patients currently in the IMDs to determine their suitability for.community placement. As a result
of this review, the Division identified 18 patients that might be successfully placed in community facilities if the
appropriate services were available to them.
Attached is a list of the services that a community facility must provide in order for a community placement to
succeed (Attachment 1). The Coalition requested more specific information about each patient, and it was
determined that a subcommittee of the Coalition should be formed which could meet with Conservator and case
management staff, who are more familiar with each individual patient. The meeting with the subcommittee was
held on September 25, and at the conclusion of the meeting, a number of issues still needed further discussion
before a conclusion could be reached regarding whether or not appropriate community services could be
developed for these patients. Some of the outstanding concerns are:
♦ Security for Staff and Neighbors
♦ Money Management (If placed in community, conservatorship ends)
♦ Medical Care (Insurance & Daily Needs)
♦ Substance Abuse (Some facilities are near sources of illegal substances)
♦ Need to Slowly Transition Patients to Ensure Success
♦ Preferences of the Patients ( such as geographical location)
♦ Need to Develop an MOU between Department & Providers
At the end of the meeting it was determined that the next steps would be:
1. The Department would obtain the specific information about each patient that the Coalition
requested and provide it to them the week of September 28th,
2. The Consumer Advocate and the Department would visit each patient and survey them to
determine their preferences and their individual needs.
It should be noted that community placement of IMD patients may not result in overall patient care cost
reductions. However, community care has the benefit of providing contract opportunities for community-based
organizations.
Staff Reductions in the Mental Health Clinics
During the meeting with the Coalition on September 15, the Health Services Director agreed to explore the
possibility that eli-,inating the three Mental Health Clinical Specialists would result in a loss of revenue. The
Department has investigated its record of actual claims made for the activities of the Clinical Specialists and
determined that less than 25%• of the cost of these positions is recovered through third-party billing. (See
Attachment 2.) .
Finance Committee Meetingof f September 28, 1992
Staff of the Health Services Department and members of the Mental Health Coalition met with the Finance
Committee on September 28, 1992. At this meeting, the Health Services Department presented further
information regarding the effect on revenue of increasing the billable hours of the Mental Health Clinical
Specialists. Vicky Smith, Executive Director of Phoenix, Inc., indicated that Phoenix would be very interested in
a performance contract for the provision of services to patients transferring from IMDs to community placement.
It was determined that further information was needed regarding both of these issues. The Finance Committee
directed the Health Services Department to report back to the Board of Supervisors on October 6, with the
following information:
1. Th;; net effect on revenue if all 6 of the Mental Health Clinical Specialists increased their billable
hours and the potential cost avoidance to I and J Ward placements provided by the positions.
2. The status of negotiations with Phoenix for a performance contract for IMD patient care.
ATTACHMENT I
Based upon ongoing clinical review and review of current (9/23/92) client status by Deputy
Conservators and IMD liaison staff, the following programmatic elements/structures/services are
determined to be minimum essential requirements that might lead to stable transition and
placement within the community.
INDIVIDUALIZED & COORDINATED TREATMENT PLANNING
The development, planning, and implementation of Treatment Plans needs to include the
assigned Case Manager, Deputy Conservator, and specific supportive day treatment program(s).
STAFF INVOLVEMENT AND AVMLABIL=
1. INTENSIVE CASE MANAGEMENT: Assigned individual with responsibility for
overall coordination of service needs, and who has access to various service components
required by client. This includes an "On-Duty" response capacity which can likewise
mobilize required resources 24 hours a day. The Mental Health Division has committed
to provide this service.
2. MEDICAL STAFF SUPPORT: Nursing care that is able to provide medical follow-
up, mental health care (IM medications and monitoring of medication compliance) to
clients within residential setting, and mobilize medical care as necessary.
3. RESIDENTIAL STAFF: All settings require 24 hour staff physical presence
including: at least 2 persons from 8 A.M. to 12 A.M., given transportation and or crises
needs of clients; AND I person through night.
RESIDENTIAL/ PLACEMENT CAPACITY
1. STABILITY: Residential setting/facility must assure tenure for client, and be able
to appropriately respond to and manage disruptive/problematic behaviors.
2. ACCESS TO INSTITUTIONAL LEVEL OF CARE: In the event that placement
cannot be maintained due to patient decompensation, immediate access to such level of
care is necessary.
STRUCTURED & SUPERVISED DAY ACTIVITY
Structured Day Treatment programming ranging from socialization and activity to Intensive Day
Treatment. Majority of these clients have historically not participated in, or tolerated, day
treatment structures, and require non-threatening social milieu environments with very low
outcome expectations.
i•
SPECIALIZED SERVICE COMPONENTS
1. DUAL DIAGNOSIS: Given significant role of ETOH/Substance abuse ir, many of
these clients, ongoing need for voluntary toxicology-screens/urine testings needs
to be examined and appropriately integrated.
2. MANAGEMENT OF BEHAVIORAL PROBLEMS: Given historical and
current behaviors exhibited by the majority of these clients, all programmatic components
must be able to appropriately respond to, manage, and tolerate problems that include:
a. intermittent incontinence, particularly at night;
b. fire setting, both intentional and as a result of carelessness;
C. history of assaultive behavior towards women, staff, or others;
d. history of substance abuse;
e. history of sexual disorders, including child molestation;
f. history of non-compliance with medications.
While these management issues be either historical and/or current, the program(s)
selected may not use them as a reason to exclude and/or summarily discharge clients from
service.
ATTACHMENT 2
THERAPIST REVENUE/REIMBURSEMENT STUDY
LEGEND FOR WORKSHEET
COLUMN NUMBER:
1. Description of revenue units.
2 . Number of units produced in a year by Therapist #1111.
Annualized 3 month data shown in Exhibit 1.
3 . Unit charge for service as approved by Board of
Supervisors in August, 1992 .
4 . Estimate of total cost to produce the service including
direct cost (salaries and benefits) and overhead costs
(building rents, utilities, insurance, accounting,
billing and collections, etc. ) . Actual cost will not
be known until the fiscal 1992-93 cost report is
completed at the end of the current fiscal year.
5 . Estimate of 1992-93 total reimbursable cost based upon
the fiscal 1990-91 Cost Report and the then effective
unit State Maximum Allowable (SMA) cost.
6 . Amount of column 5 that will be funded out of county
provided sources of cash as described on worksheet
by ** .
7 . Amount of cash expected to be received from sources
indicated on worksheet under * . "Hard" is a term
used to describe actual reimbursement as a direct
result of the provision of units of service.
8 . The cost of Salaries and Fringe Benefits for the
therapist #1111 and #1090 . Both receive the same
base compensation.
9 . Difference between "hard" revenue and direct salary
and benefit costs for the therapist.
9/23/92
i
I
-1-
n ... y
rt ti a to 1 y r ..1
CP "17 C r+• fD I 4 r
�c v < 1 a r9
. A n a -1 8 1 �- ►pI n
' 00 ' f�9 77 I n a0
►�.. � � 1 O "C O `C n 1 n � �
O (A C) 0 A
r• r• 1 r- r• O
�CD 7 A Q91
n n n l a a a
r e)
N A
n
C 1 A
I
'17 I
1 r+ 4 N
I f/1 f0
N I + A
C, h; CD I -< n
rrd l n th
I a
i1 CI C.
Irl {A 1 n l7 +
•*7 O M r z
••C fD C �D V �.: 1 H N W
A n O �•+ �i. 1 �- "1
00. x• 000 1 a fD N
1 R 0 0 0 I r• O
�p G7 fp 1 n
r`<
C•) n S
O C v
h9 1 a
In nt: R n a
n �l
n ti r•I O f� < N . r I n A
A R ft K R m { C n
fp -r
I. n 7 0 0 0 1 ft
R •• C O O O 1 r• R
M 1 n
•'17 II I t r• C) f1) K
O r• O
II I I F-• n IS fD
11 - 1 - I < •[ N fD
A) f0 C.
{I w l r t!+ N I 7 m G>
11 N I d C+' d 1 ft) m IS
11 1 I V ►-
G m
v
II 1 1 Cb •p LM
11 1 1 •"C K C
II 1 1 O Q
11 1 1 < N
11 w { r r l pn r• r• O•
u w l w d �• I
eat,•a<
H .o 1 W C>^ Ct I e+ C
11 1-+ I co ¢ d I l<
11 tr 1 w^ w w I
I 1 s
I'
fl 1 I x O '7
• II .•- 1 I < S fT C
11 w 1 ►•� y r I fD C N '✓• �+
11 1 - 1 7 •1 r• fD
11 w I Ca 100 1 C G Cr.
tl V 1 'D
rt
n 1 v: v4z >
11 I {b r• .�
II v+ I r•- K
11 IT I ft v d
n• - 1 + n �
It tr I n f9 r
11 CT I -rl A
11 d I Q
It I
II I In V.
It
It r I C •-••
11 r 1 r-• r
{I v 1 r