HomeMy WebLinkAboutRetroactive MOU with California Deparment of Stat Hospitals and CalMHSA and Participation Agreement with CalMHSA.pdf co
Board Agenda Item 36
O 1556 O
FRE`7
DATE: May 17, 2022
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Retroactive Memorandum of Understanding with California Department of State
Hospitals and CaIMHSA and Participation Agreement with CaIMHSA
RECOMMENDED ACTION(S):
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, 2021 through June 30, 2022 ($850,000);
2. Approve and authorize the Chairman to execute a retroactive Participation Agreement(No.
1162-2021-SHP-FC)with the California Mental Health Services Authority for purchase of
state psychiatric hospital beds on behalf of the County, effective July 1, 2021 through June
30, 2022 ($1,402/per bed); and,
3. Approve and authorize the Director of the Department of Behavioral Health, or designee, to
act as the authorized representative for the County and receive notices related to the
Memorandum of Understanding with the California Department of State Hospitals and the
California Mental Health Services Authority.
Approval of the recommended actions will allow for a one-year Memorandum of Understanding (MOU)with
the California Department of State Hospitals (DSH) and the California Mental Health Services Authority
(CaIMHSA)for state hospital beds. 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 gravely disabled mentally ill clients, as ordered by the Fresno County Superior Court
(Court). The agreement will be funded with Mental Health Realignment funds. Approval of the recommended
actions will also allow for a one-year Participation Agreement with the CaIMHSA to contract for state hospital
beds on the County's behalf, along with all other counties under the agreement. Approval of the
recommended actions will also allow the Department of Behavioral Health's Director to act as a
representative of the County to receive notices regarding the MOU or agreement and to provide input and/or
feedback as necessary. 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 CaIMHSA MOU and the
Participation Agreement for adults with severe mental illness deemed by the Court to require a higher level
of care in a locked facility.
County of Fresno Page 1 File Number.22-0030
File Number:22-0030
RETROACTIVE AGREEMENT:
The recommended MOU and Participation Agreement are retroactive to July 1, 2021 as the Department
received the final approved MOU from CaIMHSA on February 10, 2022 and the agreement on March 22,
2022. CaIMHSA has historically provided documents to the Department late in the fiscal year.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum
compensation allocated for the MOU in FY 2021-22 is$850,000, 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 $1,402 per bed
per fiscal year also offset by Mental Health Realignment funds. The actual cost for the FY 2020-21
agreement was$525,840. Sufficient appropriations and estimated revenues are included in the
Department's Org 5630 FY 2021-22 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 CaIMHSA, authorizing the
Department to join the CaIMHSA 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 CaIMHSA is an
administrative agent for the County.
With your Board's approval of the retroactive 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 FY 2021-22. 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, 2021 through June 30, 2022, are as follows:
• Acute $626/bed/day
• Intermediate Care Facility$626/bed/day
• Skilled Nursing Facility$775/bed/day.
The CaIMHSA State Hospitals Program authorizes CaIMHSA to contract with DSH for state hospital bed
utilization on behalf of the County. The recommended Participation Agreement includes an annual payment
of$1,402/per bed to CaIMHSA to cover administrative charges associated with their procurement of state
hospital beds.
County of Fresno page 2 File Number.22-0030
File Number:22-0030
The recommended actions allow the Department Director, or designee, to serve as the authorized
representative on behalf of the County to receive notices regarding the MOU or agreement and to provide
input and/or feedback as necessary to accomplish the purposes of the MOU or agreement.
As this is state-drafted agreement language, the County's traditional insurance language and hold harmless
language is not present in the recommended MOU and agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of these recommended action items during the April 20, 2022
meeting.
REFERENCE MATERIAL:
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- MOU
On file with Clerk- Participation Agreement
CAO ANALYST:
Sonia M. De La Rosa
County of Fresno Page 3 File Number.22-0030