Title
COMCARE CRISIS STABILIZATION UNIT EXPANSION.
Presented by: Marilyn Cook, LSCSW, Executive Director, COMCARE.
RECOMMENDED ACTION: Approve budget authority to reallocate existing positions within COMCARE's budget in order to staff the Crisis Stabilization Unit for a client capacity expansion.
Body
Background: COMCARE currently operates a Crisis Stabilization Unit (CSU) to address the needs of clients experiencing an acute psychiatric crisis. The CSU provides a safe, structured environment for the provision of crisis intervention and stabilization services 24 hours a day. The current four-bed facility is located at 1720 East Morris and includes a living area, dining area, kitchen, restroom, three bedrooms and laundry facilities. The program had 463 admissions in 2012.
In an effort to better meet the needs of citizens in Sedgwick County, COMCARE is requesting to expand the CSU from the current four-bed capacity to a twelve-bed capacity. Due to current economic and societal pressures, our community is experiencing a growth in the number of individuals suffering from mental health related crises. By expanding the program's capacity, we will be better able to divert clients from more expensive treatment options, such as inpatient care. This will help Sedgwick County to more adequately and efficiently meet the growing mental health needs of this community.
Although the primary benefit of expanded treatment capacity is to better meet individual client need, this expansion is projected to also have positive impacts for our law-enforcement partners. As a result of Crisis Intervention Team (CIT) training provided for local law enforcement agencies, COMCARE has noticed a 68% increase in client referrals to the Crisis and SCOAP programs from law enforcement providers. It is anticipated that the proposed additional capacity at the CSU will allow COMCARE to stabilize a greater number of individuals experiencing a psychiatric crisis in the community and avoid unnecessary hospitalization, or incarceration at the Sedgwick County Adult Detention Facility.
Currently clients without private medical insurance are often transported to state hospitals in Osawatomie and Larned, Kansas for treatment, at an average cost of approximately $375.00 per trip, or they may also be directed locally to Via Christi Behavioral Health to receive inpatient treatment. This results in additional transportation and treatment costs to COMCARE and the Sheriff's Office. It's expected that increasing the number of beds in the CSU will decrease the number of trips to state hospitals and referrals to Via Christi Behavioral Health. Through a projected reduction of at least two transports to the state hospital each week, this expansion is estimated to provide a savings to COMCARE in transportation costs of $13,000.00 for the first year and $39,000.00 each year thereafter. This should also result in a reduction in the number of EMS responses needed because fewer clients would need to be sent to the ER.
Due to changes in the structure of Medicaid funding, providers are being more adequately reimbursed for providing these inpatient services at a local level. COMCARE realizes revenue totaling approximately $342,000.00 each year for the current four CSU beds. Expanding to twelve beds would generate an additional $1,127,520.00 in projected annual revenue. (Revenue estimates were figured based on a Medicaid blended rate calculation.) This additional revenue generated would be more than sufficient to cover program expenses. Although expanding positions to cover the increased client capacity represents an increase to the personnel costs for this program, it should be noted that this does not represent an increase to COMCARE's overall budget, because the department is requesting to rearrange currently budgeted positions from within other COMCARE programs, and not to add additional positions to the overall staffing tables. (See attached spreadsheet with personnel funding details.)
This expansion also entails an estimated $72,823.00 in one-time construction costs for modifications to the current CSU facility. These costs are directly related to requirements to meet various fire/safety and licensing regulations in order to operate at an increased capacity. Details of the construction portion of this project are included in a Capital Improvement Program Amendment request on the Consent Agenda for the same 2/6/13 BOCC meeting.
Alternatives: The BoCC could choose to not approve budgeting authority to rearrange these existing positions within COMCARE's budget, in which case, the program would not be able to adequately staff an expansion and the program would be required to remain at the current four-bed capacity limit.
Financial Considerations:
Revenue: Additional gross revenue for the second half of CY 2013 resulting from this expansion is projected to be approximately $681,048.00. This expansion is projected to increase gross revenue by $1,127,520.00 on an annual basis for future years.
Cost: The main source of cost for an expansion of services is in personnel costs. Additional personnel costs to this program for the second half of CY 2013 are estimated to be $356,401.00. Additional annual personnel costs are estimated to be $712,802.00. These are additional to the program, but not to COMCARE's budget since they are already included within the current overall budget for COMCARE.
Funding Source: 310816-14 Crisis Stabilization Unit - positions and funding will be transferred from funding sources outlined on attachment. All existing fund sources have sufficient budget authority to transfer to 310816-14.
Legal Considerations: The authority for this action is K.S.A. 19-101 and a simple majority vote is required.
Policy Considerations: All Sedgwick County policies have been followed in the development of this program expansion request.
Outside Attendees: N/A
Multimedia Presentation: N/A