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MINUTES - 09281993 - 1.29
TO: BOARD OF SUPERVISORS t FROM: Mark Finucane, Health Services Director �` � Contra By: Elizabeth A. Spooner, Contracts Administrator Costa DATE: September 15, 1993 County SUBJECT: Approval of Standard Agreement #29-441-12 with the State Department of Mental Health SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the County, Statement of Compliance, Drug Free Workplace Certificate and Standard Agreement #29-441-12 (State #93-73148) with the State Department of Mental Health, for the period from July 1, 1993 through June 30, 1994 , in the amount of $780, 280, for continuation of the Conditional Release Program (CONREP) . II. FINANCIAL IMPACT: Approval of this agreement will result in $780, 280 of State funding for the Conditional Release Program for the period from July 1, 1993 through June 30, 1994 . No County match is required. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: On September 8, 1992 , the Board approved Standard Agreement #29-441-10 (as amended by Standard Agreement [Amendment] #29-441-11) with the State Department of Mental Health for the Conditional Release Program. The agreement provides monies with which the County subcontracts with Many Hands, Phoenix Programs, Rubicon, and a number of board and care homes to provide additional (CONREP) services. Approval of Standard Agreement #29-411-12 will continue these services through June 30, 1994, for a caseload of 39 judicially committed patients. Ten signed copies of the agreement and five certified copies of the Board Order should be returned to the Contracts and Grants Unit for submission to the State Department of Mental Health. CONTINUED ON ATTACHMENT: YES SIGNATURE'- RECOMMENDATION IGNATURE:RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN ATI N OF BOARD 06MMITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON SEP 2 8 1993 APPROVED AS RECOMMENDED OTHER VOTE F SUPERVISORS UNANIMOUS (ABSENT � ) 1 HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD 1 OF SUPERVISORS ON THE DATE SHOWN. Contact: Lorna Bastian (313-6411) SEP 2 9 1993 CC: Health Services (Contracts) ATTESTED Auditor-Controller (Claims) Phil Batchelor, Clerk of the Board of State Dept. of Mental Health $upejviwr3BAdG%wt1AdMinistraW M382/7-83 BY DEPUTY STATE OF CALIFORNIA STANDARD AGREEMENT— APPROVED BY THE ATTORNEY GENERAL CONTRACTNUMBER AM,No. " STD.2,FIEV."',) 93-73148 3148 TAXPAYERS FEDERAL EMPLOYER IDENnFX:ATM NUMBER THIS AGREEMENT,made and entered into this 2nd day of July ,19 93 94-6000509w in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting TITLE OF OFFICER ACTING FOR STATE AGENT' Deputy Director Mental Health ,hereafter called the State,and r CONTRACTOR'S NAME Contra Costa Co. Health Services Department 9 - 44 1 — 12 ,hereafter called the Contractor. WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed, does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor, time for performance or completion,and attach plans and specifications,if any.) Contractor agrees to provide the services specified in: Exhibit "A", Program Narrative; Exhibit "B" , Specific Provisions; and Exhibit "C" , General Provisions; attached hereto and by this reference incorporated herein. This contract is exempt from compliance with the Public Contract Code, the State Administrative Manual, and from approval by• the Department of General Services per Section 4360(b) of the welfare and Institutions Code. This contract shall not be effective until it has been approved by the Department of Mental Health. CONTINUED ON SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER. The provisions on the reverse side hereof constitute a part of this agreement IN WPITIESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written. STATE OF CALIFORNIA CONTRACTOR AGENCY CONTRACTOR(d other than an individual state whetter a oorporaf m.7xhwrhQ,et_.) Department of Mental Health Contra Costa Co.Health Services Dept. BY(AUTHORI SIGNATURE) BY(AUTHOR�D-W-4A D 2 /; PRINTED NAME OF PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIGNING LINDA A. POWELL, Deputy Director (,FAIR, BOARD OF SUPERVISORS TITLE ADDRESS _._. Division of Administration 651 PINE STREET, MARTIN, CA 94553 AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services DOCUMENT 20 - State Hospitals General Use Only $ $780,280-00 (OPTIONAL USE) PRIOR AMOUNT ENCUMBERED FOR Conditional Release Program Exempt from compliance with THIS CONTRACT $ ITEM CHAPTER STATUTE I FISCAL YEAR the Public Contract Code, TOTAL AMOUNT ENCUMBERED TO 4440-016-001 55 1993 9394 the State -Adm)nistrative DATE OBJECT OF EXPENDITURE(CODE AND TITLE) Manual, and from approval by $ 1100-325-413 the Department of General I hereby certify upon my own personal knowledge that budgeted funds T.B.A NO. B.R.NO. Services per Section 4360(b) are available for the period and purpose of the expenditure stated above- of the Welfare and SIGN F ACCOUNTING OFFICER DATE Institutions Code. 1993 O O CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. 0 CONTROLLER -- Contract : 93-73148 Contractor: Contra Costa County Health Services Department EXHIBIT aAll PROGRAM NARRATIVE INTRODUCTION: Pursuant to Section 4360 (a) and (b) of the Welfare and Institutions Code (WIC) , the State operates the Forensic Conditional Release Program (CONREP) to provide a statewide system of community assessment, mental health treatment and supervision to the judicially committed population and to Mentally Disordered Offender (MDO) patients. The goal of the program is to ensure greater public protection in California communities via a system of mental health assessment, treatment, and supervision to persons placed on outpatient status. Section 1, DEFINITIONS: a. @$Patient" means a person who is eligible for services under the Forensic Conditional Release Program pursuant to WIC Section 4360. Patients in the Conditional Release Program are either judicially committed or are mentally disordered offenders. b. "Judicial Commitments1l include persons found Not Guilty by Reason of Insanity pursuant to Penal Code (PC) Section 1026 or WIC Section 702.3, Incompetent to Stand Trial pursuant to PC 1370 and Mentally Disordered Sex Offender pursuant to former WIC 6316. C. "Mentally Disordered Offenders" include parolees of the California Department of Corrections who have a special condition of parole established by the Board of Prison Terms (BPT) which requires mental health treatment pursuant to PC 2964 (a) or persons placed on a civil commitment under PC 2972 (d) . d. IlCore Services" are the minimal mental health services to be provided to CONREP patients. They are individual contacts, group contacts, home visits, collateral contacts, substance abuse screenings, and assessments. e. "Supplemental Services's are other specific treatment services which may be provided to patients as determined on an individual basis in addition to Core Treatment Services. Included are: 24-hour services, outpatient (crisis intervention and medication visits) , day care services, or other services as negotiated. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 2 of 9 Program Narrative f. '$Basic Services" are primarily liaison, evaluation and support services which relate to patient care and program administration. Included are: court ordered evaluation, state hospital liaison, attendance at Regional Coordinator's meetings and statewide meetings. g. $'Negotiated Net Amounts' is the amount of the total State payment negotiated between the State Department of Mental Health (DMH) and the Contractor for services specified in the contract. This amount is determined by subtracting the amount of projected revenues from the adjusted gross cost for those services. Negotiated Net Amount (NNA) funds are intended to provide the basic staff and support for program operation. The NNA is fixed and is not subject to subsequent adjustment to actual cost. h. ('Negotiated Net Amount Services's are basic, core, and supplemental services agreed upon by the State and the Contractor, as displayed in EXHIBIT "B-111, that are funded in aggregate by the NNA for the capacity to deliver the total number and type of services specified. i. $'Negotiated Rate" is the rate negotiated between the State and the Contractor as payment for services delivered on a unit of service basis listed in EXHIBIT Negotiated Rate Amount (NR) is the total derived by multiplying the NR by the units of service for all rate services. Each NR is determined by dividing the gross cost, less projected revenues, by the units to be provided. The rate is fixed for each service type and is not subject to subsequent adjustment to actual costs. If a Contractor incurs unforeseen costs during the course of the contract, DMH may consider a rate adjustment. A written request for approval by the Regional Forensic Coordinator is required. The State will pay the NR per unit even if a Contractor collects more revenues than projected. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 3 of 9 Program Narrative j . ('Negotiated Rate Services, means basic, core, or supplemental services agreed upon by the State and the Contractor as displayed in EXHIBIT "B-111, that are funded by NR. k. "Revenue" means service related income from government (i.e. , Medicare, Champus) , as well as nongovernmental patient related funds (i.e. , patient fees, patient insurance) . 1. @'Dedicated Capacity's is the staffing and support services necessary to provide the services specified in the contract. Contractors are to maintain this NNA funded level of staff and support, regardless of any fluctuation in actual . caseload. M. ('Negotiated Cost" is the amount agreed upon for the costs of providing services negotiated between the State and the Contractor. n. "Unexpended Funds" are NNA funds contracted in a specific fiscal year which are not spent during the course of the contract period. Unexpended NNA funds are exclusively for the provision of CONREP services to the eligible patient population and are primarily for short-term expenditures. o. ('Special Fund Accounts' consists of all accumulated unexpended funds, including the amount of NNA expenditures deemed inappropriate by audit, and the accumulated interest accrued on the principal. Interest shall be treated as part of the total and must be spent on CONREP services. Section 2. PROGRAM OBJECTIVES: a. Dedicated Capacity During the term of this contract, the Contractor shall maintain the NNA resources detailed in EXHIBIT 11B-1" to exclusively provide at least the service capacity detailed in form MH-7001 in EXHIBIT 11B-111. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 4 of 9 Program Narrative The Contractor assumes the risk that more service units may be required than that level agreed upon by Contractor and State. The Contractor is responsible to ensure that necessary services are provided during the entire term of the contract. The State assumes the risk that fewer service units will need to be provided than are allowed in the NNA Dedicated Capacity. The Department may consider an amendment to an NNA contract during the contract period if the six month average caseload (excluding AWOLs and patients on Not Available status for four months or more) has significantly exceeded the contract caseload. It is intended that the costs of the Contractor in maintaining this dedicated capacity shall be met by the total funding available for these services. This total funding shall be derived from a combination of fixed funds (CONREP funds) and variable funds from patient fees, patient insurance, Medicare, grants and other miscellaneous sources. The Contractor assumes the risk and responsibility for the collection of variable funds. The State will pay the NNA for the dedicated capacity. The Contractor agrees that all funds paid out by the State pursuant to this agreement shall be used for mental health services to CONREP patients. Should the Contractor realize unexpended funds in the contract, such funds shall be used to enhance services to the eligible patient population served under this contract. The Contractor shall submit a plan for approval by the Regional Forensic Coordinator on the use of these funds with the cost report, which is due 5 months after the close of the fiscal year. b. Negotiated Rate Services During the term of this contract, the Contractor shall be responsible for providing necessary NR services in accordance with the schedule of services in EXHIBIT "B- 1", as negotiated by the State and the Contractor. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 5 of 9 Program Narrative Claims for reimbursement for NR services, listed in EXHIBIT "B-111, shall be billed to the State monthly in arrears as services are provided. The Contractor's total funding for these services shall be based on the rates and units of service negotiated. The State shall pay the NR per unit even if the Contractor collects more revenues than projected. Contractors shall be paid for NR services based on the rate negotiated for each service, up to the contracted amount for CONREP Rate Services specified in EXHIBIT 11B-111 . Changes to the service rate or the addition of service types within the total amount for the NR services may be made with the approval of the State using form MH 1715, Contract Data Sheet. The Contractor may request modification of the NR services until the cost report submission date. Should the Contractor project excess utilization of CONREP NR services beyond the contract maximum amount, the Contractor shall contact the State within five days of discovery. If the State determines that the utilization of rate services is appropriate and no viable alternatives are found, amendments to the contract may be negotiated to the extent funds are available. Section 3. MINIMUM CORE SERVICE PERFORMANCE STANDARDS: Contractor agrees to comply with such minimum core performance standards for all patients as shall be provided . for by DMH policy. Any deviation below the core service level shall require a prior written approved waiver from the State. In the event of consistent and documented failure to meet core services performance standards, the State reserves the right to enact the fiscal sanction provisions outlined in EXHIBIT "A-1t0. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 6 of 9 Program Narrative Section 4, DO UMENTATION OF SERVICES RENDERED: All services rendered to patients shall be adequately documented in the patient's case .record. The patient's case record or medical record shall include, but not be limited to: assessment; quarterly reports to court; annual renewals; placement evaluations; psychological testing results or other evaluations; treatment plans with measurable objectives linked to offense; progress notes to problem-based plans; and forensic data base (CONREP referral face sheets, arrest reports, probation and panelist reports as applicable, hospital records and CI&I rap sheets) . Any NR services claimed which are not documented may result in a claim adjustment, directly related to the undocumented units of service. Section 5, COST REPORTING: The Contractor shall submit to the State an annual cost report detailing units of service delivered during the contract period, costs of delivered services, and revenue collected based on the formats used for budgeting. The cost report is due five (5) months after the close of the fiscal year. Section 6. CLAIMING AND DATA REPORTING: The Contractor shall comply with CONREP claiming and data requirements, as detailed in State policy, to include transmission of data, utilization of the appropriate forms and automated billing process within the stipulated deadlines. Section 7, EXPENDITURE PLAN for Unexpended Negotiated Net Amount (NNA) Funds: For each year NNA unexpended funds are realized, the Contractor must submit form MH 1769, Plan for Expenditure of Prior Years Unexpended NNA Funds, to the Regional Forensic Coordinator for approval. Contractor shall maintain an expenditure log accounting for the use of unexpended NNA funds and the log shall be available for inspection by the Regional Forensic Coordinator. Upon the termination of the contract, Contractor will liquidate the final unexpended NNA Fund Balance at the direction of the Department of Mental Health. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 7 of 9 Program Narrative Section 8, ACCESS: The Contractor agrees that the State shall have access to facilities, programs, documents, records, staff, patients, or other material or persons the State deems necessary to perform monitoring and auditing of services rendered. Section 9. STATUTES AND POLICY: The Contractor agrees to comply with all statutes, regulations, and State DMH policies concerning operation of CONREP. Section 10, COMPLIANCE/AUDIT REQUIREMENTS: The State will monitor and audit services rendered and may take fiscal sanctions against the Contractor in accordance with the attached EXHIBIT "A-111 . Section 11, STAFF OUALIFICATIONS: All employees of the Contractor or Subcontractors shall possess clinical licensure and educational qualifications appropriate to the scope of their practice and to meet the .mental health treatment needs of CONREP program patients. Section 12, SERVICE AVAILABILITY: The Contractor shall have the capacity for appropriate response capability 24 hours a day, seven days per week. Contractor shall submit this plan to the State annually on July first, of the contract period. Section 13, EQUIPMENT: The Contractor agrees to purchase or supply equipment as identified in EXHIBIT "B-1" unless prior approval for modification is received from the State. Within 30 days of equipment purchase, the Contractor shall submit to the State a list identifying all equipment (having an asset cost of $300 or more) purchased with funds under this contract along with inventory number(s) or serial number(s) . The Contractor shall tag all equipment listed on the inventory with numbered decals provided by the State. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 8 of 9 Program Narrative Equipment funds identified in the contract for specific items cannot be transferred, redirected or used for any other purpose without the written approval of the Regional Forensic Coordinator. At the conclusion of the contractual relationship between the State and the Contractor, the Contractor shall provide a final inventory to the State and shall, at that time, query the State as to the State's requirements, including the manner and method in returning said equipment to the State. Final disposition of such equipment shall be at State expense in accordance with instructions from the State to be issued immediately after receipt of the final inventory. Section 14 , PATIENT RECORDS: The State retains title to all patient case records, patient related reports, and any documentation which pertains to patient services. The maintenance and keeping of all CONREP patient records and reports must be accomplished in a manner consistent with the policy and procedures established by the Department of Mental Health Office of Forensic Services. Section 15, SUBCONTRACTORS: The Contractor is responsible for all requirements under the contract. The Contractor's liability for compliance with provisions of DMH contract is not assignable. The policy and procedures are the same for Subcontractors as they are for Contractors. All subcontracts shall include a provision(s) requiring compliance with the terms and conditions of the CONREP contract. Subcontracts shall include pertinent information, such as the billing procedures, funding limits, reimbursement method, type of services to be rendered, term of the contract, termination provisions, rights and obligations of Contractor and Subcontractors, claim submission deadline, year-end cost reports, and such other information deemed necessary by the Contractor and DMH. Subcontracts shall further include EXHIBITS that show financial detail that support the Net Negotiated Rate(s) requested. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A Page 9 of 9 Program Narrative The Contractor shall submit a copy of all subcontracts,to the Department pursuant to Item I, EXHIBIT "C", of this contract. For reasons of timely data input, the Department may enter the prior year Negotiated Rates into the Automated Claims of Submission (ASC) before fully executed Subcontracts are finalized. Should this be done, the Contractor may claim and be reimbursed based on prior year's Negotiated Rates. Once the current fiscal year Subcontracts are fully executed, the Contractor shall retroactively adjust prior claims using the ASC system. Subcontracts shall be fully executed before the end of the fiscal year. Contract : 93-73148 Contractor: Contra Costa County Health Services Department EXHIBIT "A-191 COMPLIANCE/AUDIT REQUIREMENTS 1. Core Service Compliance The State is funding Core Services in the Conditional Release Program primarily through Negotiated Net Amount (NNA) . Each program will be required to ensure that staff positions funded pursuant to NNA are reserved solely for this function regardless of caseload size. Contractor is required to provide the minimum mandated services to each patient unless a waiver of this mandate for a specific patient has been previously obtained in writing from the State. Therefore, if a patient is AWOL, incarcerated, or otherwise not available for treatment, the Contractor shall notify the State of this circumstance pursuant to policy. The State will exclude these patients for the purpose of monitoring program performance of the minimum required Core Services. The State will monitor compliance with each Core Service through various means to ensure that services are provided to each patient. 2. Dedicated Capacity Compliance The State will monitor Negotiated Net Service Contractors to ensure compliance with the dedicated capacity as stipulated in this contract. The Contractor is expected to show documentation of dedicated capacity compliance for any given time period. Documentation of compliance may be in the .form of time sheets for employees, scheduled appointments for each employee, patient case records, or any other method to validate percentages of time dedicated to the Conditional Release Program. This information will be compared to the contracted dedicated capacity. 3. Negotiated Rate Services Compliance The State funds some services through Negotiated Rates (typically Supplemental Services) . There is no payment for services rendered unless the provider is operating under this contract. Payment will be made based upon the contracted negotiated rate times the number of service units rendered. Each unit of service billed to the State must have supporting documentation in a patient case record. Claim adjustment will be made for services not documented. Although day treatment services allow for a weekly summary of services rendered, dates of a patient's attendance must be documented. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department Exhibit A-1 Page 2 of 2 Compliance/Audit Requirements 4. Fiscal Sanctions The State reserves the right to withhold NNA payments in full or in part in the event of documented failure on the part of the Contractor to .meet any of the contract requirements. Prior to any such withhold, the State shall send to the Contractor a letter of intent to withhold with a justification. The Contractor may request a meeting with the State within ten working days of the date of the State's letter of intent. If the issue cannot be resolved during the meeting, the Contractor may file a letter with the Chief, Forensic Services Branch, within 10 days of the meeting, appealing the intended action of the State. If the Chief, Forensic Services Branch, denies the appeal, notice will be sent to the Contractor of that fact prior to any withhold. Withholding of payments would continue until the Contractor achieves compliance with the requirements or until such time that the Chief, Forensic Services Branch, deems it appropriate to resume NNA payments. Contract #: 93-73148 Contractor: Contra Costa County Health Services Department EXHIBIT "B" Specific Provisions I. The term of this contract shall be from 07/01/93 through 06/30/94. 2. The State has designated Grant Ute, LCSW, to be its Project Coordinator. Except as otherwise provided herein all communication concerning this contract shall be with the Project Coordinator. 3. The total amount payable by the State to the Contractor under this contract shall not exceed $780,280. Of this amount, total payments for Negotiated Net Amount (NNA) Services shall not exceed $541,699. The total payments for Negotiated Rate (NR) Services - Conditional Release Program shall not exceed $238,581. The Contractor may, with the written approval of the Project Coordinator, shift funds between the contract categories of CONREP NNA and CONREP NR. 4. In consideration of the services, as specified in EXHIBIT "A" herein, performed in a manner acceptable to the State, the State agrees to make payment to the Contractor as follows: Upon the effective date of this agreement and upon the submission of Summary Claim for Reimbursement (MH 1701) , in triplicate, as specified herein and in accordance with the Budget, EXHIBIT "B-1" attached hereto and by this reference incorporated herein, the State will make advance payment for one month of NNA Services as specified in the Budget. Monthly, thereafter, Contractor may submit Summary Claim for Reimbursement (MH 1701) , in triplicate, for advance payment for each month of NNA Services, provided however that such additional advance payment may not exceed $496,557. Reimbursement for NR Services will be made using Summary Claim for Reimbursement (MH 1701) , in triplicate, submitted monthly in arrears, for actual expenditures in accordance with provisions of EXHIBIT "A-111, Paragraph 3 and the Budget, EXHIBIT 11B-111. Contract : 93-73148 Contractor: Contra Costa County Health Services Department Exhibit B Page 2 of 2 Summary Claim for Reimbursement (MH 1701) shall be submitted as follows: The original and copy of the Summary Claim for Reimbursement (MH 1701) shall be submitted to: Accounting Section Division of Administration Department of Mental Health 1600 Ninth Street, Rm. 140 Sacramento, CA 95814 One copy of the Summary Claim for Reimbursement shall be submitted to the Project Coordinator at: Grant Ute, LCSW Regional Forensic Coordinator Department of Mental Health Office of Forensic Services World Trade Center, Suite 231 San Francisco, CA 94111 5. This agreement shall become effective on 07/01/93, but shall not become effective unless and until approved by the Department of Mental Health. Department of Mental Health Forensic Services Branch Division of State Hospitals Conditional Release Program CONREP PROGRAM - EXHIBIT B-1 NEGOTIATED NET AMOUNT AND RATE SERVICES SUMMARY MH 7001 (12/92) Page 1 Contractor Name: Contra Costa County Type of Report Dates: Contract No. 93-73148 _�Contract Budget Submission: Fiscal Year Ending: June 30, 1994 _Year End Cost Report Amendment: Item 1 — Units of Service Based on Caseload and Year in Program Year One Two Three Four Five Total A. Caseload 13 7 5 2 12 39 B. Mode and Service Function Forensic Weekly Weekly Weekly 3 Times Once Individual 4/Month 4/Month 4/Month /Month Monthly Contact 15-80 624 336 240 72 144 1,416 Group Weekly Weekly Weekly Twice Once Contact 4/Month 4/Month 4/Month Monthly Monthly 15-50 624 336 240 48 144 1,392 Home Once Once Once Every Once Visits Monthly Monthly Monthly 6 Weeks Quarterly 50-40 156 84 60 18 48 366 Collateral 6 Per Year 6 Per Year 6 Per Year 6 Per Year 6 Per Year 15- 10 78 42 30 12 72 234 Lab Once Twice Twice Once Once Screenings Weekly Monthly Monthly Monthly Quarterly 15-21 676 168 120 24 48 1 1,036 Assessments 1 Per Year 1 Per Year 1 Per Year 1 Per Year 1 Per Year 115-30 13 7 5 2 12 39 Total Units 2,171 973 695 176 468 4,483 Total Amount Item 2. Total Negotiated Net Amount Services(NNA): $541,699 Item 3. Total Negotiated Rate Services Amount(NR): $238,581 Item 4. Total Contract Amount: $780,280 ' CAOOO 00:... CD z :Z n CDD INA ::.14 C O Z C, Cl) 1e� � + U � N ..J 0 — CO f9 � � C07 M c Q rIM 9 u � to + .. m a 0 Z_ � H a m � ¢ 4969 U m _O m h O p E c LL m U CO Q 69 49 49 69 fie 49 69 49 4) >N t0.. g Clo to Co $ o CO a NN r fN CA O ::,: O U CL 0::;: LO m CC � v Z F- c m U o in Q LO Lr) in N O N N r N N CD U C 1A r N r r r N N d Q s Wd r r c r W o " CC 49 Q m (oj } r U U co CND N r r tN N Z _ co M a r 0 0 C r U LO Q Q 0000 O 0 zzZZ zz C .: .:;+� �. 0 d {� 0 + + + d p :•.. r r c7 Ie:. ZZ ZZ ' r + + + + tz- W NZZ ::: J Z:.Z +.+`.: W r Q m Q a+ c ME O O' m o c 00 o m _ Cc m W O co a y m w ` _ %a U c v Z Z E O Z .. 1q� O + < m2 Z N U0 c Z a .0 Ha cJCDD � " V Z ie O 0 m m m C O ZQ � m oa E � � L)Lb �z y LLI com o G' _m N oz e`v m cRE � IL CL o o :::. - is E c W } ` >E i mQ Qe`oe`o _ (DCL o min Z m O W Q 2 Z Q UZ O y = � m UU W �CVCM � tD 1 :31 CMN„ Department of Mental Health Forensic Services Branch Division of State Hospitals Conditional Release Program CONREP PROGRAM -EXHIBIT B-1 CONDITIONAL RELEASE PROGRAM UNIT COST MH 7003(12/92) Page 3 Contractor Name: Contra Costa County Type of Report Dates: Contract No. 93-73148 _ Contract Budget Submission: Fiscal Year Ending: June 30, 1994 _Year End Cost Report Amendment: LINE ITEMS Subtotal Total 1. Personnel Costs $410,188 2. Operating Expenses $111,610 a. Office Services&Supplies $6,500 b.Communications 9,000 c.Travel(Including Training) 8,000 d. Facility 50,445 e. Medical procedures,Supplies,Pharmacy 1,000 f. Consulting Fees g. Emergency Life Support h. Other: Life Support-Residential-(05/90 600 units @$24.33) 14,598 i. Other:05/85 700 units @$25.00 17,500 J. Other: Money Management(via MOU with HSD Conservatorship Unit) 2,500 k. Other: Equipment Maintenance 2,067 I. Other: m. Other: 3. Equipment Over$300 Per Unit $0 4.Administrative Services&Overhead $61,528 5.Total Cost of the CONREP Unit $583,326 6. Revenues (Sum of.items a through g) .:::.::.:::;;.: ::: $5;250. a. Patient Fees $250 b.Patient Insurance 0 c. Life-Support Reimbursement(05/85 and 05/90) 5,000 d.Medicare 0 e.Medical 0 f. Prior Years' Unexpended Funds 0 g.Other(Specify) 0 7. Net Cost $578,076 0 0co t § 0 C @2 to m � e k � @ g % } R = u § ( k ZZ� e @ ( @zz 2 2 ° CD( B § § CD .2 tk $ \ - kcc 4 \ k o � O5CD I , Q U. . $ 2 } \ k ■ $ k § := t 8 \ a \ 0 coo0Lnto000 co a � Imco M 8 k co ° ° r- 2BSR $ � g k �o \ / ® Cl) } A w - oo0Lnoo e R g e � ® w R \ 2 $ - - 000 - \ 3 LL Lu S \ a � fCD o \ kZZm 3 ) OD o o W o � o 0zz 4) omww - wow o c ( a) Rcr) CD (D R R R LU 2 06 (D- n m o m - m om � 0 � � Q � � � � o _ � \ 0 }� d . « :: \ o - eIt m % ' e o n 0 _ _ � w � aRRR - - R « EgODLnLnI- LnV - 2 � �\ \ � LL c CO (n _ NWm0N ¢ CD / ko & � $ $ 8 � . \ ECO214Lnt \ � � 2 � \ . � K \ � « � w � . « ƒ � 7 \ \ � � i 8 O 2 0 $U m a b kco _a . k a \ M2 Taa� aa � § O 21 § C0 3U2 C E ° E k - o � I R cc� Q ■ .. $ 2 & a && cm m E ' 2 a � « e - - c 2 § cr z� & W k - ZccEaokox � / Z k ■ QeJO f \ i0 cr 20 2 $ f � o £O £Ok7 � 8 g $ 3 E� 2 £ -f � � < EWf � � q O6 U a � 3u � O § § § § § b0a � 01 wo cc 404 Is % ilk s itoga 0 8 2 2 2 2 k 8 co R k @ cu @ 0 m � d d \ $\ 2 S S 2 2§ } E o CO § e @ co o m 2a: co / \ k0 0 0 0 © 00 « o # e # . _ # . : e LL0 U .. .. 2 S 2 8 49 2 ¢ 2 S S S 82 Q � = Q 0 2 \ � Q 00 0 ooh\ o a 2 2 k- 69e m = e # < # co = @w o « 2 0 § %cc ' ( CL Cl 00 » 00 »« o b # e e e # m? _ « w w cc d` / a d \ to e e e e \. � e c 2 O ¢ ca e \ CO ?« U k © �) 7 § m m _ . . 2 \ y m � � C 2 U@ 3. m _ x « a 2 , Q _ n Q « q c « > 2 IZ (n 2 CO - N r © � .. a ? c CD 0 E _ $ © m w a tf/ 2 0 a o « 2 • e m - S e . co .B ¢ w « « ■ E - Q@ k K k k a t 2 a � z z \ CD 2 £ 0 ¢ � o @ - acr £\ D � m S z z � D o � _ • � � Q o » � ■ � cr w k E k b o b Q E - w \ k E � 2 \ z ¢ - � z d � § O § 2 � Q 3 # §... WO a « z _ CD 0 c - Q m w w o o E c w R o § e 2 2 � o - a ¢ o Q o ».§ ■ u v >- 0 0 0 m - z z _ _ .�< a %2 O @@ Q Q ■ m o a § o 0 o & J 0 m £ A S k k k k 2CD a w R Q o Q A 2 \� O o Q Z Q Q LL CO R ® w a d _ _ f 'CONTRACT N0. : 93-73148 CONTRACTOR : Contra Costa Co. Health Services Dept. EXHIBIT "C" General Provisions 1. Contractor shall submit any subcontracts to the Section 7285.0 et seq.). The applicable regulations State designated Project Manager for approval prior of the Fair Employment and Housing Commission to implementation. Upon termination of any implementing Government Code, Section 12990(a-f), subcontract, the State shall be notified set forth in Chapter 5 of Division 4 of Title 2 of immediately. the California Code of Regulations are incorporated into this contract by reference and made a part 2. By signing this contract, Contractor swears under hereof as set forth in full. Contractors and its penalty of perjury that no more than one final subcontractors shall give written notice of their unappealable finding of contempt of court by a obligations under this clause to labor organizations Federal court has been issued against this with which they have a collective bargaining or Contractor within the immediately preceding two-year other agreement. period because of the Contractor's failure to comply with an order of a Federal court which orders the This Contractor shall include the nondiscrimination Contractor to comply with an order of the National and compliance provisions of this clause in all Labor Relations Board. (Public Contract Code Section subcontracts to perform work under the contract. 10296) (SAM 1225) 3. This contract may be canceled at any time by 7. The State reserves the right to use and reproduce either party, by giving 30 days written notice to all reports and data produced and delivered pursuant the other party, and may be amended upon mutual to this agreement, and reserves the right to consent. authorize others to use or reproduce such materials. 4. Contractor understands that no Federal or State 8, Should a dispute arise under this contract, income tax will be withheld from the payments under Contractor may, in addition to any other remedies this contract. However, the State is required to which may be available, provide written notice of report all payments to the Internal Revenue Service the particulars of such dispute to the Deputy for tax purposes. No distinction of fee, travel or Director, Division of Administration, Department of per diem will be made. No wage and tax statement (W- Mental Health, 1600 Ninth Street, Sacramento, CA. 2) will be issued for the services performed under 95814. Such written notice must contain the this agreement. Contract Number. Within ten days of receipt of such 5. Contractor is advised and understands that its notice, the . Deputy Director, Division of performance under this contract will be evaluated in Administration shall advise Contractor of his accordance with the provisions of Public Contract findings and a recommended means of resolving the Code Section 10367. dispute. (Public Contract Code, Section 10381) 6. During the performance of this contract, 9. Contractor is hereby notified that Public Contractor and its subcontractors shall not Contract Code Section 10381 provides that unlawfully discriminate, harass or allow harassment, Contractors have certain specific rights, duties, against any employee or applicant for employment and obligations when entering into consultant because of sex, race, color, ancestry, religious services contracts with the state. creed, national origin, physical disability (including HIV and AIDS), mental disability, medical 10. Travel and per diem if, authorized under this condition (cancer), age (over 40), marital status, agreement shall be paid in accordance with the State and denial of family care leave. Contractors and Administrative Manual Section 1243 and the subcontractors shall insure that the evaluation and Department of Personnel Administration Rules and treatment of their employees and applicants for Regulations and as amended from time to time. No employment are free from such discrimination and travel outside the State of California shall be harassment. Contractors and subcontractors shall reimbursed unless expressly authorized herein or comply with the provisions of the Fair Employment unless prior written authorization is obtained from and Housing Act (Government Code, Section 12900 et the State. (SAM 1242) seq.) and the applicable regulations promulgated thereunder (California Code of Regulations, Title 2, 11. Contractor agrees to maintain books, records, 'CONTRACT NO. : 93-73148 CONTRACTOR : Contra Costa Co. Health Services Dept. EXHIBIT "C" General Provisions documents, and other evidence necessary to support prior written authorization from the State. contractor's claims for reimbursement under this contract. (SAM 1272) 17. For purposes of this paragraph, identity shall include but not be limited to name, identifying 12. Contractor agrees that the State reserves title number, symbol, or other identifying particular to any property purchased or financed from the assigned to the individual, such as finger or voice proceeds of this contract if such property is not print, or a photograph. fully consumed in the performance of this contract. This provision shall be operational even though such 18. In accordance with the provisions of Section property may have been purchased in whole or in 1618 of the Penal Code, "The administrators and the part by Federal funds and absent a Federal supervision and treatment staff of the conditional requirement for transfer of title. (SAM 1269 & 8602) release program shall not be held criminally or civilly liable for any criminal acts committed by 13. Contractor agrees to place in each of its the persons on parole or judicial commitment status subcontracts, which are in excess of $10,000 and who receive supervision or treatment. This waiver utilize State funds, a provision that: The of liability shall apply to employees of the State contracting parties shall be subject to the Department of Mental Health and the agencies or examination and audit of the Auditor General for a persons under contract to this department to provide period of three years after final payment under supervision or treatment to mentally ill parolees or contract (GOVERNMENT CODE SECTION 10532)". The persons under judicial commitment." Contractor shall also be subject to the examination 19. It is mutually understood between the parties and audit of the Auditor General for a period of that this contract may have been written and three years after final payment under contract (GOVERNMENT CODE SECTION 10532)". executed prior to July 1, for the mutual benefit of both parties, in order to avoid program and fiscal 14. Contractor shall protect from unauthorized delays which could occur if the contract were disclosure, names and other identifying information executed after July 1, of the State fiscal year. concerning persons receiving services pursuant to 20. This contract is valid and enforceable, only if this contract, except for statistical information sufficient funds are made available by the Budget not identifying any client. Client is defined as Act for this fiscal year for the purposes of this "those persons receiving services pursuant to a program. In addition, this contract is subject to Department of Mental Health .funded program". any additional restrictions, limitations, or Contractor shall not use such identifying conditions enacted by the Legislature which may information for any purpose other than carrying out affect the provision, terms, or funding of this the Contractor's obligations under this contract. contract in any manner. 15. Contractor shall promptly transmit to the State 21. It is mutually agreed that if the Budget Act all requests for disclosure of such identifying does not appropriate sufficient funds for the information not emanating from the client. program, this contract shall be invalid and of no further force and effect. In this event, the State 16. Contractor shall not disclose, except as shall have no further liability to pay any funds otherwise specifically permitted by this contract or whatsoever to the Contractor or to furnish any other authorized by the client, any such identifying considerations under this contract, and the information to anyone other than the State without Contractor shall not be obligated to perform any provisions of this contract. STATE OS CALIFORNIA / y� NONDISCRIMINATION COMPLIANCE STATEMENT STD.19(REV.2-93) COMPANY NAME The company named above(hereinafter referred to as "prospective contractor")hereby certifies,unless specifically exempted,compliance with Government Code Section 12990(a-f)and California Code of Regulations, Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the development,implementation and maintenance of a Nondiscrimination Program.Prospective contractor agrees not to unlawfully discriminate,harass or allow harassment against any employee or applicant for employment because of sex, race, color, ancestry, religious creed, national origin, physical disability (including HIV and AIDS), mental disability,medical condition(cancer), age(over 40),marital status, and denial of family care leave. CERTIFICATION I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to the above described certification.I am fully aware that this certification, executed on the date and in the county below,is made under penalty of perjury under the laws of the State of California. OFFICIAL'S NAME DATE EXECUTED SEP 2 8 1993 EXECUTED IN THE COUNTY OF CONIT2A .COSTA PROSPECTIVE CONTRACTOR' E /DYy�jr lzko4 PROSPECTIVE CONTRACTORI TITLE affm, BOARD OF SU ERVISORS PROSPECTIVE CONTRACTOR'S LEGAL BUSINESS NAME STATE OF CALIFORNIA' r DRUG-FREE WORKPLACE CERTIFICATION STD.21(NEW 11-90) COMPANY/ORGANIZATION NAME The contractor or grant recipient named above hereby certifies compliance with Government Code Section 8355 in matters relating to providing a drug-free workplace. The above named contractor or grant recipient will: 1. Publish a- statement notifying employees that unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations, as required by Government Code Section 8355(a). 2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to inform employees about all of the following: (a) The dangers of drug abuse in the workplace, (b) The person's or organization's policy of maintaining a drug-free workplace, (c) Any available counseling, rehabilitation and employee assistance programs, and (d) Penalties that may be imposed upon employees for drug abuse violations. 3. Provide as required by Government Code Section 8355(c), that every employee who works on the proposed contract or grant: (a) Will receive a copy of the company's drug-free policy statement, and (b) Will agree to abide by the terms of the company's statement as a condition of employment on the contract or grant. CERTIFICATION I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the above described certification. I am fully aware that this certification,_ executed.on the date and in the county below, is made under penalty of perjury under the laws of the State of California. OFFICIAL'S NAME DATE EXECUTED SEP 2 8 1993 EXECUTED IN THEM HE CMOU�TY OF NCOM CONTRACTOR or G�d�i�E6IPIEWF3TGIQA'I IE/ TITLE CKAM, BOARD OF SUPERVISORS FEDERAL I.D.NUMBER STATE OFCAi)FORNUI '• /�� VENDOR DATA RECORD ATTACHMENT III (Required In lieu of IRS W-9 when doing business with the State of California) STD.20/(NEW 392) DEPARTMENT/OFFICE PURPOSE: Information contained inthis form SE STREET ADDRESS ETURN Contract ,laof MentftIn4�e;✓�IIt section will be used by State agencies to prepare Infor- R � � mation Returns(Form 1099)and forwithholding ETU TO: on payments to nonresident vendors. CITY,STATE.ZIP CODE 1600 — (See Privacy Statement on reverse.) Sacram-anto, VENDORS BUSINESS NAME OWNERS FULL NAME anK Fkat ALL) STREET ADDRESS ARE YOU SUBJECT TO FEDERAL BACKUP WRHHOLDND? 9be iffuotions for Fam W-9) CITY,STATE..AND ZIP CODE ❑ YES ❑ NO INSTRUCTIONS: (1). Check box indicating type of business entity and provide taxpayer Identification number. (2). Check box indicating resident or nonresident. (See reverse for additional inibanadon). (3). Check one or more VENDOR ACTIVITY boxes speclfying vendor activity w <:. .:. N Y STA . :::::':::> z::: <:::: R J E C ..YENDO TYPE .REBID ... ::::::r.::.:::..•n:>::.:�:>::::•::::::: ..:::'i.isY::`:::::>::iii:;i::5::;+::::::::rc >'::i:::6i:5i::.. .......... ❑ CORPORATION MEDICAL SERVICES(Ir"m'rpdeniis9y (Enter Federal Employer Identification Number) ❑ Podoby,peyd-than w qMm seb'y, ❑ SERVICES(NON MEDICAL) d�icp+ 4 aft) I — I I I I I I 1:1EOUtPMENT/SUPPLIES (Exmpr loom staff atlfhold:ip) Resident-Qualified to do business in CA/❑ ❑ RENT Permanent place of business in CA OTHER Non Resident (See Reverse) ❑ (saah� ❑ INDIVIDUAUSOLE PROPRIETOR ElNON EMPLOYEE COMPENSATION tkwkA rip ❑ EQUIPMENT/SUPPLIES (Enter Social Security Account Number only,NOT FEIN) AMPOm and montenawo'Oona •0110 (Exe"pt for"Stab fig) i MEDICAL SERVICES(hdudro den6sdy, L I I — I — I I ❑ Podiatiy,pamf or-spy.optometry. dwoprae0e,era) ❑ Resident ❑ Non Resident (See Reverse) ❑ INTEREST X""W from Sayer eNgwOV) ❑ PARTNERSHIP ❑ RENT (Enter Federal Employer Identification Number) I i I I I I I i I I ❑ ROYALTIES ❑ Resident ❑ Non Resident (See Reverse) ❑ PRIZES AND AWARDS ❑ ESTATE OR TRUST ❑ (Enter Federal Employer/dentification Number) OTHER(cacti) ❑ Resident (Estate)-Decedent was a CA resident at the time of death ❑ Resident (Trust)-At least one trustee is a CA resident ❑ Non Resident (See Reverse) I hereby certNy under penalty of perjury that the Information provided on this document Is true and corroct. N my residency status should change, I will promptly Inform you. aUTHORIZED VENDOR REPRESENTATIVES NAME(Type or Print) TITLE SIGNATURE DATE TELEPHONE NUMBER CONTRACT/LEASE NUMBER ❑ NONEMPLOYEEMEDICAL Ispo°" NONRESIDENT WITHHOLDING COMPENSATION ❑ SERVICES ❑ RENT ❑ OTHER ❑ STANDARD RATE REPORTABLE INCOME CODE PER STATE ADMINISTRATIVE MANUAL SECTION 9122.19(CMdr One) INITIALS DATE NIT ALED ❑ WAIVED 7 1 7 2 7 3 ❑ 4 ❑ 5 0 6 ❑ 7 ❑ REDUCED RATE % ir � � W fuj O 8 g �� as Ca mm� �0.� � g �� O lo to a 9 (k CO.0- -.0 0 o 00 45- o 2;