Resolution:

Authorizing the Department of Public Health, Division of Mental Health, To Assume Responsibility for Medi-Cal Authorization and Payment of the State/Local Match for All Medically Necessary Mental Health Services for San Francisco Medi-Cal Beneficiaries, April 22, 1997

WHEREAS, the State Department of Health Services is committed to expanding managed care within the Medi-Cal program as a means of improving beneficiary access to quality, cost effective, preventive and primary health care services, consistent with directions from the Legislature and the Governor, as embodied in Senate Bill 485 and Assembly Bill 757; and,

WHEREAS, the State's plan specifies that the most effective system of the delivery of Medi-Cal mental health services will be through mental health programs administered by County mental health departments, thus carving these services out of the models for physical health care, and consolidating the two existing Medi-Cal funding streams into a single County-run mental health plan; and,

WHEREAS, the State's plan has been implemented in phases, beginning level January 1, 1995 with the consolidation of the State funding for inpatient Medi-Cal mental health services at the County to be followed by the consolidation of the State funding for professional and nursing facility Medi-Cal mental health services on October 1, 1997; and,

WHEREAS, the San Francisco Health Commission adopted Resolution #2-93 on February 16, 1993; "Endorsing Principles for the Development of a Managed Care System in San Francisco;" Resolution # 15-94 on March 15, 1994; "Endorsing the Development of a Managed Mental Health Care System in San Francisco;" and Resolution #52-94 on November 15, 1994, "Endorsing the Transfer of Funds from the State for the Implementation of Inpatient Component of a Medi-Cal Managed Mental Health Care System in San Francisco;" and,

WHEREAS, the Board of Supervisors adopted Resolution #551-94 on July 7, 1994, "Endorsing the Development of a Managed Mental Health Care System in San Francisco;" and Resolution #148-94-7 on December 23, 1994, "Authorizing the Director of the Department of Public Health to Accept the Transfer of Funds from the State for the Implementation of the Inpatient Component of a Medi-Cal Managed Mental Health Care System in San Francisco;" and,

WHEREAS, the State has released a preliminary planning estimate for the amount of Counties' allocations for fiscal year 1997-98, and San Francisco will receive $3,699,056 State General Fund or the pro-rated amount for less than a year; and,

 WHEREAS, this allocation will be used to match an additional $3,699,056 in Federal Medi-Cal dollars for services provided to the Medi-Cal population for a maximum projected funding availability of $7,398,112 for inpatient and outpatient mental health services; and,

WHEREAS, the operation of a mental health plan imposes on the City and County of San Francisco the obligation to authorize payment of medically necessary mental health services to all eligible San Francisco Medi-Cal beneficiaries, even if the cost of providing services exceeds the amount allocated by the State; and,

WHEREAS, the City and County of San Francisco is committed to protecting public mental health services and safety net services for the indigent mentally ill in San Francisco County; and,

 WHEREAS, the City and County of San Francisco is at risk for the many high cost services used by individuals with mental illness if timely, effective and coordinated treatment is not provided; and,

 WHEREAS, the County Department of Public Health, Division of Mental Health Services, is committed to building partnerships with traditional, safety net, and private providers in order to establish a comprehensive system of care; and,

WHEREAS, the County would assume even greater risk if it did not elect to become the mental health plan for all Medi-Cal mental health services as it would lose the ability to manage the resources and services directly; and,

WHEREAS, the State has offered Counties the option to develop risk-sharing agreements with the State for the provision of Medi-Cal funded mental health services contingent on the Counties' willingness to commit not to reallocate funds, including realignment funds, from mental health services to other purposes as part of such agreements; and,

WHEREAS, the State of California requires the following assurances, now, therefore; be it

RESOLVED, that the Health Commission hereby:

  1. Authorizes the Department of Public Health, Division of Mental Health, to assume the administration of Medi-Cal mental health services for authorization and payment of the State Medi-Cal match for all medically necessary mental health services for eligible San Francisco Medi-Cal beneficiaries; and,
  2. Confirms San Francisco's willingness to develop a financial risk-sharing agreement with the State for the provision of these services, and willingness to agree not to reallocate funds, including realignment funds, from mental health services to other purposes as part of such an agreement; and,
  3. Assures that access for covered medically necessary mental health services will continue to be comparable to the current system; and,
  4. Confirms that San Francisco has a public planning process which involves consumers, family members, other stakeholders, and the local Mental Health Board; and,
  5. Agrees to submit an implementation plan that meets State Department of Mental Health requirements and has been reviewed by the local Mental Health Board.

and, be it

FURTHER RESOLVED, that the Health Commission recommends this to the Board of Supervisors.

I hereby certify that the foregoing resolution was adopted by the Health Commission at its meeting of Tuesday, April 22, 1997.

Sandy Ouye Mori Executive Secretary to the Health Commission