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HomeMy WebLinkAboutMINUTES - 04081986 - 1.36 'BOARD OF SUPERVISORS Mark Finucane, Health Services Director FROM: By: Stuart McCulough, Assistant Health Services Director Contra DATE: March 19, 1986 Cc la rt Cly �JL,11 Ily SUBJEC-Kpplication to the State Department of Mental Health for Funding to Implement a Supplemental Rate System for Residential Care Facilities ' SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AMS JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Health Services Director or his designee to submit to the State Department of Mental Health the attached application for SB 155 funding to implement a Supplemental Rate System for Residential Care Facilities. II. FINANCIAL IMPACT: This application, if approved .by the State Department of Mental Health, will provide an annualized increase in Short-Doyle funds of $325,654 for the provision of Supplemental Services in Residential Care Facilities for mentally disabled adults. The county's Short-Doyle allocation shall be augmented by $162,827 for fiscal year 1985-86 and by $325,654, annualized for each subsequent fiscal year for the provision of these specific ser- vices (State Department of Mental Health Allocation Worksheet attached"for reference) . This new funding will not require a ten percent match. until fiscal year 1987-88. III. REASON FOR RECOMMENDATION/BACKGROUND: Contra Costa County's application for Supplemental Services for Residential Care Facilities is in response to DMH letter No. DMH 85-40. The State of California Budget Act of 1983 and Chapter 1352 of the Statues of 1985 (SB 155, Petris) specified $11 .3 million to be used for a statewide Supplemen- tal Rate. System for Residential Care Facilities. Contra Costa County's share of this appropriation, subject to State Department of Mental Health approval of the program application is $162,827 ($325,654 annualized). The Health Services Department proposes to implement a Supplemental Rate System for Residential Care Facilities in compliance with State Department of Mental Health regulations. Supplemental Services is defined as services designed to augment basic care provided to mentally disabled adults living in licensed community care . facilities. These Supplemental Services include, but are not limited to, supportive, supervisory and rehabilitative services. It is the intention of the Health Service Department to contract with qualifed licensed com- munity care facilities to provide these services. These f cilities will CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER - SIGNATURE(SI: ACTION OF BOARD ON APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X 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: County Administrator ATTESTED April 8 , 1986 Auditor-Controller PHIL BATCHELOR, CLERK OF THE BOARD OF Health Services SUPERVISORS AND COUNTY ADMINISTRATOR State Health Department All) BY M382/7-83 ,DEPUTY Board Order (Page 2) Application to the State Department of Mental Health for Funding to Implement a Supplemental Rate System for Residential care Facilities receive the Supplemental Services Rate as determined by the State. The amount allowed for administration is 9.79% of the allocation. Administration funds ($31 ,882 annualized amount) will be used to fund a county staff position to assess clients, certify facilities and implement a training program for Residential Care Facility administrators who par- ticipate in the Supplemental Services Program. IV. CONSEQUENCES OF 'NEGATIVE ACTION: Failure to endorse this proposal will result in the county's continued ina- bility to provide critically needed services to residents of Residential Care Facilities who require extra services to remain in community place- ments. It is estimated that 240 individuals currently require these supplemental services. An additional 200 individuals are projected to require these services within the next year. MF/SMc/WR/bv Attachments DEPARTMENT OF MENTAL HEALTH COMMUNITY MENTAL HEALTH SERVICES 1985-86 F.Y. ALLOCATION WORKSHEET CONTRA COSTA REVISION NUMBER 2 PROGRAM CURRENT ADJUSTMENT REVISED ALLOCATION ALLOCATION COMMUNITY SERVICES (INC. C.R.T.S. ) $8,338,989 $0 $8,338,989 ----------------------------------------- -------------- -------------- -------------- 4% COST-OF-LIVING ADJUSTMENT -___$333,559 ----------$0- -----$333,559 ----------------------------------------- - -- - -- MDO(AB1229) INC. COLA (6 MONTHS FUNDING) $62,468 . $0 $62,468 I -OMHSS-OPT_OUT--------------------------- -------------- -----------$-- -----------5--� EQUITY ADJUSTMENT ----$760,993 -_-_-----_$0- -----$760_993 1 ---------------------------------- -------------- - ---- OTHER ADJUSTMENT ----$0_ _--$0- _ ---$0-1 ----------------------------------------- ------- -------- ------- T LESS) 547 SUPPLEMENTAL RESIDENTIAL CARE SERVICES $0 $162,827 $162,827 TOTAL COMMUNITY SERVICES $10,003,556 $162,827 $10,166,383 PROGRAM DATA BY FUND SOURCES 4440-101-001(A) CRTS -_51,004_760 $0 --$1,004,760_ _---------------_----____________________ _ _ ______________ _ 4440-101-001(B) COMMUNITY SERVICES $8,998,796 $162,827 $9,161,623 TOTAL FUND SOURCES $10,003,556 $162,827 $10,166,383 I MEMO DATA STATE HOSPITALS GROSS $5,595,401 $0 $5,595,401 --- - ---- ---- -- - --- -- -- REVENUE $-1,116,122 $0 $-1,116,122 - ----------------------------------------- -------------- -------------- ------------- NET TOTAL $4,479,279 $0 I $4,479,279 ----------------------------------------- --------------I-------------- -------------- DAYS 35,220 0 35,220 OFFICE OF MENTAL HEALTH SERVICES DIRECT SO $0 $0 ----------------------------------------- -------------- -------------- -------------- PLACEMENT $0 $0 I $0 ----------------------------------------- ------ ----------- TOTAL $0 $0 SO I CERTIFY THAT FUNDS ARE AVAILABLE IN ITEMS 4440-001-001, 4440-101-001 AND 4440-121-001 OF THE BUDGET ACT OF 1985 AND THAT THIS ACTION WILL NOT CREATE A DEFICIENCY. PURPOSE: RESIDENTIAL CARE RATE ALLOCATION DATE ��-�� ' LYDE L. MURK Y, D UTY DI OR ==ATIO DATE G���0-S 'DEPARTMENT OF FINANCE Health Services Department •I; '1 ALCOHOL/DRUG ABUSE/MENTAL HEALTH _ DIVISION o '• __ 2500 Alhambra Avenue, L-1 C, s` _cotiK Martinez, CA 94553 q (415) 372-4380 February 5, 1986 Lyman Lum, Staff Analyst State Department of Mental Health 1600 Ninth Street Sacramento , CA 95814 Dear Lyman: Enclosed is Contra Costa County Alcohol/Drug Abuse/Mental Health Division's Application for SB 155 funding. We plan to use these much needed funds to improve our Residential Care- System.- We areSystem.We will establish a training program for Residental Care Administrators and improve the linkage between Residential Care Facilities and County services. Unfortunately, these funds are insufficient to meet all residential care needs of the severely and chronically mentally disturbed adults in Contra Costa County. Also the cost for implementing and administering these funds is far greater than the 9.79% allocated. . Therefore, in order to use these dollars as effectively as possible we intend to use Supplemental Services monies in our CRTS programs when and if indicated. We welcome your comments on this application as well as any questions re our request to include CRTS programs in our Supplemental Services Program. i Sincerely, Stuart McCullough, Assistant Director Health Services Department . Alcohol/Drug Abuse/Mental Health Division cc: Mark Finucane Gale Bataille i Contra Costa Countv SB 155 Application SUPPLEMENTAL SERVICES PROGRAM Upon receipt of SB 155 monies the following Supplemental Services Program will be implemented in Contra Costa County. I. The Supplemental 'Services Program will consist of three major components. ._e A training program for Residential Care Administrators and staff. e Certification of qualified Residential Care Facilities for the provision of the Supplemental Services Program. Certified Residential Care Facilities will be reviewed annually. e Assessment of current and potential residential care clients. Clients placed in Supplemental Services Program beds will be reassessed quarterly. These components will be coordinated by a Supplemental Services Coordinator who will work closely with the Regional Case Management Team Leaders and the Continuing Care Coordinator to plan, implement and monitor provision of services within the SB 155 Program. A. TRAINING PROGRAM A Training Program for Residential Care Facility Administrators and staff will be developed, willT include 50 hours of courses and practicum. 1 . A basic curriculum of 30 hours including, but not limited to the following: Cardio Pul4monary Resuscitation Basic First Aid Fire Safety Patients' Rights/Consumer Rights Psychotropic Medications Behavior Management Sex Education Nu tr it ion Record Keeping 2. Continuing! education courses of at least 20 hours to include: Cardio Pulmonary Resuscitation Basic First Aid { Fire Safety other courses as determined by the needs of the Residential Care and county staff It is our intention to model our program after the highly acclaimed Board and Care Certification' Program in San Joaquin County. Page 2, Supplemental Services Program, SB 155 B. CERTIFICATION PROGRAM As with our training program, we will be modeling the certification procedures for the Supplemental Services Program after the certification procedures in San Joaquin County. With their permission, their certification materials will be adapted and used ',for our local program. The Certification of Licensed Residential Care Facilities for the Supplemental Services Program ;will be the responsibility of the Supplemental Services Coordinator in coordination with the Regional Case Management Team Leaders. Criteria for Residential Care Facility participation in the Supplemental Services Program Will include: County Standards - 1 . Recommendation by Regional Case Management Team Leader. 2. Mandatoryt attendance at regularly scheduled regional meetings (75% atten- dance) by' facility administrators and/or staff. 3. Satisfactory completion of all required training and continuing education. 4. Participation/cooperation with complaint/peer review procedures as developed. 5. ' Be in full compliance and in good standing with licensing. 6. Consultation with Regional Case Management staff when hiring facility staff. 7. Compliance with Patients' Rights guidelines for residential care facilities. State Standards - i 1 . Cooperate with county staff in developing a facility program plan. 2. Participate in county's training activities including 20 hours minimum training for supervisory staff. 3. Maintain all required client records. 4. Allow reasonable access to the facility. 5. Maintain capability to provide agreed upon Suppplemental Services . k 6. Participate in the county's Mental Health 'Information System. i i • i Page 3, SupplementalServices Program, SB 155 Each Certified Facility will be required to sign a contract with Contra Costa County. The contract will include:. ® The above county and state criteria. o Payment procedures including the provisions for county payment for supple- mental Services in a timely manner. © Reference to the facility's Supplemental Services Program Plan which indi- cates the manner in which the facility will provide Supplemental Services (e.g. , extra staff, supplies, etc.) , and what level of client(s) will be served. (Level II, IIA or IIB) C. CLIENT ASSESSMENT PROGRAM Current and potential residents of licensed residential care facilities may be referred for acceptance into the Supplemental Services Program by a primary treatment provider or family member. The referral will be made to the Regional Case Management Team Leader or to the Supplemental Services Coordinator if more than one region is involved The Client Assessment Form will be completed by the primary treatment provider and rated by the 'Supplemental Services Coordinator. If accepted into the program, placement of the client will be coordinated by the Case Management Team Leader. All clients on County Case Management caseloads and on conservatorship with the County Lanterman-Petris-Short UPS) Conservatorship office will be assessed for the 'Supplemental Services Program. Upon acceptance of a .client into the program, the Case Management Team Leader in consultation with all relevant individuals (client, conservator, family member, therapist, etc.) will assign follow-up case management responsibility (including regular reassessment) to a County Case Manager, outpatient clini- cian or LPS Conservator. i An individual (family member, conservator, therapist) other than a County Case Manager who is: i e aware of the` responsibilities connected with providing follow-up and assessment services, m agrees to meeting some or all of those responsibilities, and i ® assessed tobe capable of meeting those responsibilities by the Regional Case Management Team Leader may provide follow-up and assessment services to the resident accepted into the program. If not, a Regional Case Manager and/or other helper will be assigned. Page 4, Supplemental Services Program, SB 155 Responsibilities of Count Case Managers in the Supplemental Services Program are: 1. Completing the Client Assessment Form, 2. Completing the Client Assessment form every 90 days as required in placement, 3. Completing the "Appraisal/Needs and Services Plan" (form required by licensing) with the Operator/Administrator of the certified Residential Care facility and the client, and 4. Carrying out the responsibilities agreed to in that Plan (e.g., refer to day program, meet with the resident weekly, etc.) . Responsibilities of other individuals who provide follow-up and supportive service may be: 1 . Completing the "Appraisal/Needs and Services Plan" (form required by licensing):'i: with the Operator/Administrator of the certified Residential Care Facility and the client, and 2. Carrying out the responsibilities agreed to in that Plan (e.g., refer to day program, meet with the resident weekly, etc.) . All "Appraisal/Needs and Service Plan Forms" must be approved by the Regional Case Management Team Leader before a client is accepted into the Supplemental Services Program. D. SUPPLEMENTAL SERVICES COORDINATOR The Supplemental Services Coordinator is responsible for.- 1 . or:1 . Assisting ,Regional Case Management Team Leaders in identifying and re- cruiting licensed facilities for the Supplemental Services Program. 2. Assisting Regional Case Management Team Leaders in recruiting and encouraging the development of new Residential Care facilities. i i 3. Developing; a training program for Residential Care Facility staff and administrators in collaboration with case management staff. Existing resource, (community colleges, adult education services, Mental Health providers, etc.) , will be coordinated to provide the training. 4. Certifying' Residential Care Facilities for acceptance of Supplemental Services monies according to criteria set by the Case Management staff, with consumers and Residential Care Facility Administrators input. 5. Assisting facility administrators in developing their program plans. Page 5 , Supplemental', Services Program, SB 155 6. Reviewing, and recertifying the facilities annually. 7. Rating Client Assessment Forms. 8. Monitoring the Client Assessment Forms and service plans at each 90 day review to assure provision of supplemental services and to determine the appropriateness of continued use of the Supplemental Services Program. .' i 9. Investigating complaints and problems with the Supplemental Services System. 10. Establishing and updating list of certified facilities for distribution to placement staff. The Supplemental Services Coordinator will report to the Division Deputy _ I Director for Operations. II. Conflict Resolution It is anticipated that disputes may arise regarding assessment, service require- ments , etc. Therefore, the following procedures have been developed to more effi- ciently and fairly resolve conflicts. A. For disagreements arising between Residential Care Facility Administrators and the Regional Case Management Team Leaders and/or the Supplemental Services Coordinator: 1 . The majority of disputes can be resolved among the involved parties. and as needed may involve the assistance of peers and/or supervisors. 2. In those situations where an agreement cannot be reached and all par- ties agree, the dispute will be presented to the Residential System Advisory Committee. 3. The Residential Advisory Committee will then study the issues and arbitrate ia solution or make recommendations regarding steps to be taken to resolve the problem. 4. If appropriate , the committee will refer the dispute to the Alcohol/ � Drug Abuse`/Mental Health Administration for final resolution. i B. For disagreements arising between Consumers and Residential Facility Administrators or between Consumers and County Staff: 1 . The majority of disputes can be resolved among the involved parties and as needed may involve assistance of a Patients' Rights Advocate if requested by the consumer, peers, and/or the Supervisors of the county staff involved. I 2. In those situations where an agreement cannot be reached and all par- ties agreel, the dispute will be presented to the Residential System Advisory Committee. i' Page 6, Supplemental Services Program, SB 155 3. The Residential Advisory Committee will then study the issues and arbitrate a solution or make recommendations regarding steps to be taken to ',resolve the problem. 4. If reconciliation cannot be reached, the committee will refer the dispute to the Alcohol/Drug Abuse/Mental Health Administrator for final resolution. C. Disagreements' arising between -county staff will be settled in compliance with Alcohol/Drug; Abuse/Mental Health Division's Conflict Resolution Policy. The Residential System Advisory Committee shall consist of: Independent Living Home and Licensed Residential Care Facility Representative Residential Treatment Facility Representative Consumer AMI Representative Patients' Rights Advocate County Case Management Staff Conservatorship Representative Continuing Care Coordinator l' This committee, approved by the Mental Health Advisory Board, serves in an advisory capacity, to the Residential System and serves as a forum for iden- tifying problems and the resolution of complaints and conflicts. In this capacity thiscommittee will monitor the performance of the Supplemental Services Program. III. Implementation' Priority for Supplemental Services Program funds will be given to: A. County case managed clients already in placement and receiving or in need of Supplemental Services. B. Clients ready ',for discharge from Napa, L-facilities or acute hospitals who are assessed to be in need of supplemental services upon placement. I C. Other clients in residential facilities assessed to be in need of Supplemen- tal Services. Priority for certification of licensed Residential Care Homes. A. Those facilities run by administrators and/or staff who have demonstrated a willingness 'to work with Regional Case Management staff and participate in current Residential Care activities. B. Other licensed!, facilities who participate with this program upon implemen- tation. mplemen- tation. i We have approximately:' 25 individuals placed out-of-county in Licensed Residential Care Facilities. It is our intention to cooperate fully with the Host Counties in negotiating the use of Supplemental Services Program funding for our clients. T _... •Page 7, SupplementalService Program, SB 155 I k IV. Fiscal information The funding allocation for this program is not sufficient to provide Supplemental Services to all clients who require this level of care. In addi- tion, the 9.7% allocated for administration of the program will not cover the . county's cost for managing this program. Of the 288 licensed beds we have identified in our county, we estimate 85% (or 244) of the individuals in those beds are currently receiving extra services gratis or are in need of Supplemental Services. Our allocation affords us approximately 41 Level II A&B beds and 97 Level I beds at any point in time. The use of these beds and management of this limited resource will be the responsibility of the Case Management Teams within each Region and the Supplemental Services Coordinator. We anticipate that to administer this program we will minimally require: $ 40,000 Coordinator $ 721000 2 Case Managers $ 13 ,000 1/2 Clerical Support $ 5,000 Supplies $ 20 ,000 Accounting/Bookkeeping $150,000 The county's annualized allowable funding level for program administration is $31 ,882 or 21% of the assessed need. WR:bv 1-30-86 i