COUNTY OF LOS ANGELES
COUNTY OF LOS ANGELES
MARVIN J. SOUTHARD, D.S.W.
Director
DEPARTMENT OF MENTAL HEALTH
RODERICK SHANER, M.D.
FAX No.: (213) 386-1297
January 19, 1999
The Honorable Board of Supervisors
County of Los Angeles
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 90012
Dear Supervisors:
APPROVAL OF THE IMPLEMENTATION PLAN
FOR THE DEPARTMENT OF MENTAL HEALTH'S PROGRAM EXPANSION
AND
APPROVAL OF THE DEPARTMENT OF MENTAL HEALTH'S
REQUEST FOR APPROPRIATION ADJUSTMENTS
FOR FISCAL YEAR 1998-1999
(ALL SUPERVISORIAL DISTRICTS)
(4 VOTES)
IT IS RECOMMENDED THAT YOUR BOARD:
2. Approve the Request for an Appropriation Adjustment for $10,780,000 for FY 1998-1999 to augment critically needed programs in the following areas: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, Adult Targeted Case Management Services (ATCMS), and Dual Diagnosis Services (Attachment I).
3. Approve the Request for an Appropriation Adjustment for $1,329,000 which is already in the FY 1998-1999 Adopted Budget. This amount will be shifted from the Services and Supplies Account to the Salaries and Employee Benefits Account. This shift will enable DMH to fund additional staff positions for the remainder of this fiscal year to augment critically needed programs in the following areas: Healthy Families Program (HFP), CalWORKs, and Phase II Fee-For-Service (FFS) Medi-Cal Consolidation (Attachment II).
4. Approve the accompanying ordinance which implements these recommendations (Attachment III).
PURPOSE OF RECOMMENDED ACTIONS:
Board action is requested in order to implement the following program initiatives:
1. Expansion of the Early and Periodic Screening, Diagnosis and Treatment Program to meet the requirements of the Medicaid Program to provide comprehensive mental health care. A total of 34.0 FTEs will be hired to provide these services. Contracted programs will be augmented by $6 million in FY 1998-1999.
2. Augmentation of the Adult Targeted Case Management Services Program to provide services to an additional 50 Metropolitan State Hospital clients who are high utilizers of services and hard-to-place. A total of 3.0 FTEs will be hired to provide these services. Contracted programs will be augmented by $300,000 FY 1998-1999.
3. Enhancement of Dual Diagnosis Services to enable each service area to address the needs of substance abusing mentally ill children and adults. A total of 27.0 FTEs will be hired to provide these services. Contracted programs will be augmented by $2.5 million in FY 1998-1999.
4. Expansion and implementation of the Healthy Families Program as approved by your Board on June 30, 1998, instructing the Director of Mental Health to enter into a Memorandum of Understanding (MOU) with HFP providers. A total of 5.0 FTEs will be hired to provide these services.
6. Increase in service capability of Linkage Agencies to meet the needs resulting from Phase II Fee-For-Service Medi-Cal Consolidation. A total of 19.0 FTEs will be hired to provide these services. Contracted programs will be augmented by $500,000 in FY 1998-1999.
JUSTIFICATION:
Program augmentation in the aforementioned children's and adults' services areas will comply with legislative mandates and the Board of Supervisors' motion of June 30, 1998. This action will enable DMH to enhance current service delivery efforts and achieve a more comprehensive, integrated and effective system of care. For the remaining five months of this fiscal year, and on an ongoing basis, the program expansion, with increased staffing resources, will facilitate service integration and continuity of care.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program: This program provides medically necessary services to full scope Medi-Cal eligible beneficiaries under 21 years of age to correct or ameliorate a physical or mental disability or a condition, even if the service is not included in the State's Medicaid Plan. EPSDT funds consist of 51% Title XIX Federal Financial Participation (FFP) funds and 49% State funds, which are specifically designated for the EPSDT program.
Program expansion through EPSDT funding will greatly increase and enhance the ability to address specifically needed services in the following priority areas:
Dual Diagnosis Services: The enhancement of dual diagnosis services assures each service area the opportunity to address the needs of dually diagnosed child and adult clients. It affords service areas additional resources to integrate treatment modalities into the mainstream of the local system of care. The clients identified for the Dual Diagnosis Program have a history of co-occurring mental illness and substance abuse problems and are historically difficult to engage in treatment and rehabilitation. These client services require staff, comprised of experienced and dedicated workers, to be trained in both the mental health and substance abuse areas.
This program includes an interagency system in each mental health service area -- comprised of mental health, drug and alcohol, social services, schools, law enforcement, and medical services; new dual diagnosis programs supported by mental health and substance abuse professionals; training for mental health and drug and alcohol providers focusing on co-occurring conditions; enhanced community resources allowing easy access to services and flexibility in programming; and a system of care for individuals with dual diagnosis which allows easy cross-referral to meet emerging service needs.
Healthy Families Program (HFP): The Balanced Budget Act of 1997 amended the Social Security Act to add a new section to create the State Children's Health Insurance Program in order to provide funds to states to expand the provision of child health assistance to uninsured, low income children. Children who are ages birth to 19 in families with income of less that 200 percent of the federal poverty level and who are not eligible for no cost Medi-Cal are eligible for the program. In California, the State's Children's Health Insurance Program is called Healthy Families.
The implementation of the HFP requires staff to coordinate a number of activities delineated in the MOUs between DMH and nine Healthy Families Plans to provide basic behavioral health benefits. The details of these agreements are outlined in the MOU format that was developed by the California Managed Risk Medical Insurance Board (MRMIB), the administrator for the HFP for the State Department of Health Services, and that was previously approved by your Board.
The child health assistance provided by this insurance program consists of basic benefits for medical, vision and dental services. Included in the medical component are mental health services and services for alcohol and drug issues. California has included an additional mental health benefit for children who are severely emotionally disturbed (SED). SED services will be provided by DMH through the existing network of Short-Doyle/Medi-Cal County operated and contracted providers.
CalWORKs: The Department of Public Social Services requires CalWORKs participants who have a mental health-related barrier to employment to be seen for their first appointment within ten days of the referral for services. The mental health system has had difficulty meeting this requirement due to staffing shortages and high caseloads. Due to time limits on the receipt of cash benefits and a strict work requirement, it is critical that participants receive these services in a timely manner. Augmentation of DMH staff and agreements with the existing network of contract providers will enable DMH to ameliorate the waiting period service barrier. These actions will also enable the system to increase the range of clinical experiences among mental health professionals to better address the needs of CalWORKs participants.
Given that CalWORKs mental health services require different interventions and treatment strategies than more traditional services provided by public mental health systems, DMH will participate in a research project conducted by the California Institute of Mental Health (CIMH). This project will seek to develop successful models of employment for CalWORKs participants with mental health, family violence, and alcohol and other drug problems. The project will also provide ongoing technical assistance to other counties. DMH's contribution to the CIMH study will be $125,000 per year.
Phase II Fee-For-Service Medi-Cal Consolidation: Mental health clinicians will facilitate prompt service connection and care monitoring for clients by completing client assessments, evaluating service needs, referring clients/beneficiaries to qualified mental health service providers in the community, providing quality case management and therapeutic rehabilitation services, and evaluating other community points of service. Additional clinical staff, augmented by a limited number of support personnel in directly-operated and contracted DMH programs, will assist clients in securing services, further maximizing utilization of existing community social service and health programs. Part of the responsibility of linkage staff is to bring other community support agencies into the local mental health network of service organizations assisting in the rehabilitation of the seriously mentally ill or those experiencing short-term crises or emotional disabilities. Staff will also aid clients in securing appropriate benefits to support service costs within the system.
FISCAL IMPACT:
There is no net County cost impact.
FINANCING:
Enhancement of the following programs will be funded for the remaining five months of FY 1998-1999 through a shift of $1,329,000 in the FY 1998-1999 Adopted Budget from the Services and Supplies Sub-Account (S&S) to the Salaries and Employee Benefits Sub-Account (S&EB):
Amount No. of Positions
TOTAL $ 1,329,000 56.0
Expansion of the following programs will be funded by:
Additional Federal and State revenues
$ 3,679,000 30.0
Medi-Cal Trust Funds from successful resolution of various audit and cost
report settlements
TOTAL $ 10,780,000 64.0
FACTS AND PROVISIONS:
To comply with legislative mandates and the Board of Supervisors' motion of June 30, 1998, program planning with community representatives, contractors and DMH management is underway to enhance mental health services in these critically needed areas. Programs being expanded focus on special populations, i.e., children and their families, dually diagnosed, CalWORKs participants with mental health barriers to employment, and the chronically mentally ill high utilizers of mental health services. These proposed programs make mental health services more readily available and accessible to special, unique target populations.
DMH will use the existing infrastructure to implement these expanded programs for the initial five months. DMH will request these new budgeted positions through the FY 1999-2000 County Budget Process. Subsequent to your Board's approval of this Board matter, DMH will recruit to fill the 120.0 FTE ordinance positions, using established personnel recruiting and hiring procedures.
This Board matter has been reviewed by the Chief Administrative Office, County Counsel, Department of Human Resources, DMH management, and the Chief of the CalWORKs Program Division of the Department of Public Social Services.
CONTRACTING PROCESS:
Expanded services will be provided by a combination of DMH directly-operated programs and existing contract providers to ensure continuity of the network of care throughout the County. Funds will be allocated by program areas. DMH will negotiate and execute contract amendments with contractors to ensure that the distribution of funds for program enhancement remains equitable as for directly-operated programs.
IMPACT ON CURRENT SERVICES:
With Board approval, DMH will implement an integrated and comprehensive system of care and augment current levels of mental health services in critically needed areas.
NEGATIVE DECLARATION/ENVIRONMENTAL IMPACT REPORTS:
This subject does not apply.
CONCLUSION:
Approval of this letter will provide enhanced mental health services countywide.
The Department of Mental Health will need four (4) copies of your Board's approved action. Please forward one (1) executed copy of the document to County Counsel. It is requested that the Executive Officer, Board of Supervisors notify the Contracts Development and Administration Division of the Department of Mental Health at (213) 738-4684, when these documents are available.
Respectfully submitted,
MARVIN J. SOUTHARD, D.S.W.
Director of Mental Health
MJS:JD:MAR:KT
Attachments (3
)
c: Chief Administrative Officer
County Counsel
Executive Officer, Board of Supervisors
Chairperson, Mental Health Commission
DPSS (Lisa Nuñez)
KT10:BOARDLETTER
