HomeMy WebLinkAboutMINUTES - 12181984 - 2.16A --6_.__•L Health Services Department
1
ot,
. 4
To:
,
. aAs
oosrq•couK't`;
To: Philip Batchelor Date: December 13, 1984
County Administrator
From: Mark Finucane, Director Subject: Proposed Subacute Skilled
Health Services Department ` Nursing Facility Treatment Patch
By: Stuart McCullough
Assistant Health Services Director
Alcohol/Drug Abuse/Mental Health Division
As per the Board of Supervisors request, the following is the rationale for patched
subacute treatment beds. A Request for Proposal has been completed for distribution
to prospective providers. This RFP details both programmatic and fiscal requirements
for this program;, If we are to have significant impact on the continuing overutiliza-
tion of State Hospital days, the selection of a provider, contract negotiations and
signing of a contract must occur prior to March 1 , 1985. In addition to patching
subacute beds for adults a patch to provide long term care for seriously disabled
geriatric patients is also to be funded through the Board of Supervisors recent allo-
cation to the Department.
1.' An appropriate and effective mental health delivery system must provide three
levels of intervention and treatment services:
• Primary Level - Acute Psychiatric Inpatient services provided in full charge
acute care hospital;
o Secondary Level - Subacute treatment capacity for those patients who no longer
require acute medical/psychiatric care but who remain too severely disabled to
benefit or be maintained in community treatment settings;
• Tertiary Level - A comprehensive continuum of community mental health
programs including: residential, day treatment, vocational, outpatient
therapy, and clinical case management services.
Contra Costa County has serious needs at both the subacute and community mental
health levels of care. Over the past several years mental health administration
has strongly advocated for the development of subacute treatment capability and
the augmentation of community based services.
Our current priority for the development of a 33 bed subacute treatment program is
based on the critical shortage and competition for subacute beds which is
occurring in the Bay Area and across the State. During the past several years
most Counties in the Greater Bay Area have entered into contracts with L-
facilities to secure access to augmented subacute treatment beds for their citi-
zens.
A-301 Contra Costa County v� b
Page 2, Batchelor, 12/13/84
2. Due to this escalating competition for patching L-facility beds, Contra Costa
County has not only been denied access to placing patients in L-facilities, but,
unless we move quickly, it appears likely that there will be insufficient numbers
of beds available for a treatment patch within the Bay Area to accommodate Contra
Costa County patients. This capacity problem has been underscored recently by
the results of a survey on acute and subacute needs conducted by the Greater. Bay
Area Conference of Local Mental Health Directors. (See Attachment A.) This sur-
vey indicates that 1) a 47% increase is needed in bed capacity for subacute care to
augment the Medi-Cal rate of reimbursement, and 2) a 27% increase is needed in non-
patched L-facility beds.
3. Over-Utilization of State Hospital Days - In spite of our intensive efforts
to reduce State Hospital utilization, Contra Costa County is projected to exceed
our fiscal year 1984-85 allocation by 9 to 10,000 patient days. This projection
is based on July through October utilization rates projected on a monthly basis
by the Department's Napa Liaison and confirmed by the State Department of Mental
Health. (See Attachment B.) The State Department of Mental Health has put Contra
Costa County on notice that unless an immediately viable plan is implemented to
reduce utilization, admissions to the State Hospital will be limited to one admit
for every two discharges. (Note: Beginning in fiscal year 1983-84, San Francisco
County was placed on the 2/1 limitation which resulted in that County patching
over 90 beds in order to decrease State Hospital census. San Francisco's
patching of these L-facility beds has seriously reduced our ability to find non-
patched placements for our patients.) It is our conclusion based.on the experience of
other Counties and from discussions with the State Department of Mental Health staff,
that this is the most readily attainable alternative to continued overutilization.
(See Attachment C.)
While we have strongly advocated for the need for a complete continuum of care
including a range of community based residential, outpatient treatment and case mana-
gement options, none of these alternatives can be implemented quickly enough to impact
on our use of the State Hospital system. (Note: Over the past year, Mental Health
Program Administration has initiated a planning process with extensive staff input to
identify and prioritize needed components in our local continuum of care. This
planning was a major factor in the plan for "Alternatives to State Hospitals",,which
was recently submitted to the State Department of Mental Health. (See Attachment D
for this proposal.) Additionally, a significant number of the patients who are
currently at Napa State Hospital cannot safely be placed directly into community set-
tings. Without a patched subacute treatment program, this County will have no alter-
natives other than discharging severely disturbed chronic mental patients to the
street and/or continuing to overcrowd our County Hospital Psychiatric Inpatient
Services.
4. It is the intent of the Health Services Department that the proposed patched L-
facility program include a strong clinical component with daily psychiatric review, a
psychosocial rehabilitation component and County control/approval over admissions and
discharges. The goal of the program will be to provide treatment and care which will
improve and- stabilize patients' mental, behavioral and social functioning sufficiently
to permit discharge to less restrictive community based care within ,3 to 6 months.
Appendix E provides a summary of major program components proposed to be incorporated
within the L-facility treatment program. The Department's Request for Proposal which
details both clinical and fiscal requirements of the proposed program is attached as
Appendix F. '
'Page •3, Batchelor, 12/13%84
5. During this fiscal year, 34 Contra Costa County patients have been discharged
from Napa State Hospital. Twenty percent of these patients were discharged to
inappropriate levels of community care. If a subacute treatment program were
• available to this County at least seven of the patients who have been recently _
discharged from Napa might have entirely avoided the State Hospital. With the
pressure on this County's mental health services to reduce Napa utilization, we-may
have no choice other than to effect discharges which cannot adequately take into
account the clinical needs of many of our patients.
Currently 24 patients at Napa (See Attachment G.) and 5 patients on the County
Hospital Psychiatric Inpatient Unit cannot be discharged to community care set-
tings without endangering their health and safety and potentially incurring liabi-
lity for the County. These patients could be placed in an intensive subacute
program. Approximately 8 other patients are being cycled between various L-
facilities and our psychiatric inpatient services in order to avoid utilizing the
State Hospital. This recycling of seriously disturbed patients in no way repre-
sents adequate or humane care for our citizens and as Counties patch more L-
facilities in the Bay Area, the problem will only be exacerbated.
6. A $10.00 per day patch is to be provided for four (4) beds for geriatric
patients (such as those with Alzheimers disease) who require skilled nursing care
but cannot be placed in L-facilities at the current Medi-Cal rate of reimbursement.
due to severe behavior management problems such as agitation and wandering.
Some of these patients require total nursing care. . (See Attachment A.) Several
of our geriatric patients at Napa State Hospital could be transferred to such a
patched L-facility program, if this option were available.
7. Finally, the A/DA/MH Division is obligated to do everything possible to create
effective treatment alternatives to Napa State Hospital. The attached article from
the Contra Costa Times (Attachment H) is only one of many publicized examples of
the serious problems regarding treatment deficiencies and security for patients and
staff. This fact has been recognized by the Mental Health Advisory Board which has
passed a resolution urging the Board of Supervisors to support a subacute treatment
patch program in a Skilled Nursing Facility as proximate to the County as possible.
(Attachment I)
Given these considerations as well as other documentation submitted to your
office and the Board of Supervisors over the past year, I believe the Board
should authorize the Health Services Department to let the RFP immediately.
ATTACHMENT A
NORTH COUNTY CENTER
ENTAL HEALTH ��11 1�.��\ 1408 PENNSYLVANIA AVENUE
71 v FAIRFIELD. CALIFORNIA 84533
SERVICES (101) 429-6366
DONALD S. FEINER. M.S.W.
DIR[GTOR !
November 21, 1984
Micnaal O'Connor, M.J. , Director
tate Department of Mental Health
100G Hinth Street
Sacramento, Ca 95814
Dear Dr. O'Connor:
We indicated in our response to Department of 'Mental Health Letter 84-26,
"Frc:posala for State hospital Alternatives", that we did not anticipate that new
pirn,rrams designed to provide alternatives to Napa State Hospital would have an
0=vdiate impact on utilization. Additionally, we identified the need for a
r•e ;ionalized or multi-county approach .to providing appropriate care and treat-
cant for populations which currently utilize state hospitals and long-tarm
car? cervices. z am writing to apprise you of some of our. major areas of
During this past month, the Greater Hay Area Conference of Locai Mental Health
DLrectors (GBACLMHD) conducted an informal survey regarding acute and subacute
level:, of care for adult and geriatric populations is the 10 Bay Area Counties.
in addition, we are asking the Northern California Children's Coordinators to
participate in regional planning regarding service requirements for the under-'.a .
k1GrJ13tit]n.
Th,-, a%Lr vey aszeissed availability, utilization and estimated level of need in the
Vo'-,lowing categories:
Napa State Hospital
Acute p3yehiatric - locked and unlocked including Psychiatric Health Facility
as well as At:ute T_naatient
:.,bacute - incLudes programs with income in exce33 of Medi-Cal plus STP paten
:tilled Nur3i>>g Facility - with or witnout STP
A::=,-:?yysent of acute. care utilizattcr. 1:-41 n3ei i lcludes both county and 'private
care provider-4 whloh accept coanty re erra/,3. "'deeds" are based on estimated
requirements for each ..level of care if an apzropriately balanced continuum ofservices weve avaiiZble_ The uur-:ey 1.�:=�. eio: :t•!tress nerds at it4 community":��
rr::identi:rl tredttuent (CRTs) :rvel Ot' .i ,0^'
-_ r �- `- ,.,s.�a .,� may.;.:..�::` •��s i��e� ,- -
v t
w
Y
_. '�':zs1.: thi:t �ut^eey waw. etut :;;,s�c►tiCicaZ1l
L Ji:'u.=L t.i'.i�, Z.r•.i l 1ildiZ J are L"Q•.Gsj''.j 4��►t
with tats neaanl3 i3anLLrieU in our re;giu:•al ;�L:unin;� us +:u::��- wriis:h �s-►�e
Systcy
occurred over the p3a:. year. The datajjjl tl sA ia�aes�-4untr•z Casts Haaltn +� '� icier
xiit ba complatin� a a
More survey by March of 19d5 WhiWi
Ciz ll Pro
comprmhdnsi"te data► ba-:jo for our continui4e3
regi'nna1 p 1�nn i na e[for".
da
Tables 1 . Assa4s, *at Or RaKl.OnAl tle*«
for Stats Hospital to SNIFFLevel of Care for lU bay Area Cnuatias
(6ase U ua FY 83..84 Da")
(Assuming Adequate Resources and Appropriate Contiautn of Care},
Bed/Days per year Avai3.�.bility Otil.uatiaa Ei44c'la E3ticsa.tcu
(al3ocatian)lnerxi (arraillus;zd} (incr or deer)
' �i
ADULTS Napa State Hospital il". 1Q5
(16-59)
Acut.a Perch (1nptli'hF)
Sub-Acu to 53:Q 9 y +�+7`l
yr +2T=
Svr 31 u ,,.
GE•RYdiP = Napa-* NA MA KA
(59 -04 -r
Acuta""Psych# N A !IA
Sub-Acura 73; 99�; +279
SNF tf�' riA +51't
*Th4 Figu-es from Table 1 do not raflett the needs of an individual Cauat9. For
exa=pla SolAmo County has riot acute inpatient facility.
*Mote: State Hospital and Acute Paycfti.atrtc [ap.atient bad/day avari].3biIIZ7 is cwt
brokers out between Adult and Gartatrtc popu"t.i.zaa is moat countias is a c�tusee'
which yialdAd appropriate data for this sur4my. f
in addition to stinting ava l.;.WiLity, tcttl.i_ation and needs for- each level O
aar4.. each County was asked to idantify program needs t'or specializes! target ;
Dnp+il.xtiarta'. Specialized programs to address the care and trea►t=mt require- ;z�r....
' vents oC MpmblemO popul.7►tion3 such as dial diagnosis (MI1D13, !4I/suhatatic+e -.,�' =�
.At-.aa) , the con tally iii with lunge}
term miiaal compLizatLOns, ,heattag :1�?aL ed,
n-,)n-EnAlizh spenXing, etC...is cl Arty s-I as botn aa CatictLJ 81td�'
regional planning priority. It. is ioportant to.note, th34" tndlviduil`
{priorities for levels.or care or �Fe+ci:3Li:.�e1 �ropsl:tclon� .raay,hOt;,�•
reftactead in the
conctwion�9jrnniijltj ct t Ore►_
• •' • ,..- ..� tt'E�`"+�i ��. .A�►71�.�+� '�w.v+M'1!.�'`'i.,,`^,.y,,, Y'Tr~R�,�•s'"Zr .
e.- i+-
1
Feiner/O'Connor
page 3
November 21 , 1983
1 . Adults: The results of this Survey clearly indicate ghat the greatest area
of need for adults is for increased bed capacity in sub-acute and long-term care
(SNF) facilities. It is estimated that we require a 47% increase in sub-acute
program capacity and a 271 increasa i.Z Psychiatric Skilled Nursing Facility
capacity in order to provide appropriate care for ;seriously mentally ill adults.
A significant problem noted by several counties is the need to develop programs
for per3oa3 who require supervised long term care and do not meet the State's
criteria for Special Treatment of Program (STP) funding. The amount of reimbur-
sement available through Medi-Cal is not sufficient to maintain these indivi-
duals in SNg's and counties are increasingly being asked to "patch" at the STP
rate. .
The augmentation of these levels of care may result in some decrease in utilization
of State Hospital and local acute-care facilities. However, the availability of
appropriate long-term and sub-acute care will not allow for dramatic reductions
in the need for State Hospital services. As you know, all counties are wit-
nessing a growth in the numbers of seriously mentally ill who require a secure
treatment environment. It remains our commitment to work closely with Napa State
Hospital to plan and implament. a reorganized treatment program which will better
serve the needs of our patients.
There is a need for programs at all levels of the care continuum which address
special popoulations including: mentally ill/developmentally disabled,
non-English speaking, the mentally ill with significant medical care needs,
pregnancy, mentally ill persons with a history of alcohol and substance abuse,
and mentally ill individuals who present serious behavior management and place-
ment problems Including history of fire setting, violence, suicide, and
r threatening or very bizarre behavior. The largest groupings of individuals are
in the categardeew-of behavioral/management problems, MI with substance abuse
history and those with concurrent medical complications.
2. Geriatric Population: Given the survey's short timeframe for completion and
the lac— k oP easily retrievable data, we are. not able to provide as complete an
analysis of geriatric population treatment requirements. Bed availability at
Napa State Hospital and in Acute Psychiatric Inpatient services is not differen-
tiated between geriatric and adults under the agd of 59. It is our general
conclusion that there is sufficient capacity to serve geriatric clients in
hospitalbased seg-vices. However•, thts does not mean that State Hospital and
acute services offer appropriate aga-specific programs to meet the particular
needs of older adults. ff
The Ba .Re asurvey
. y. gi n indicates that there a clear nerd to develop additional
capacity and programming for geriatric client3 at the Sub-acuta 'and skilled
nur�.Ing levels of care. It is estimated that'we require a 30% increase in sub-
4cute beds and a 501 increase in SNF beds for the mentally ill geriatric popula-
tion of this kvgfoa. A specific need cited by respondents is for. programs which = �=
2 •�tar •7`
_.�:•.. ,r r� .+,,``0~�c '' Kms='+_ �,•-T``r��
ff # 1
` - 4a - �•A -:� _ -y.r QYq..s ,+.s�xfi�,? N �.L ' -�i
. - "'!�:'�,'!.!t"i'.,:.._y e•�.`�"':�e•.s�Yfi ..e.^t Vii` -rY:�d...-9:'if¢r �:�*��•r�,,�. _ _ �_
Feiner/O'Connor
page 4
November 21 , 1984
ca- provise humane lona-term care for indiri.luais who present "management"
problems which cannot be handled at the current rate of Medi-Cal. reimbursement.
Thia "patch" requirement is in the range of $6 to $10 per day. In addition,
there is a growing awareness of the need to convert selected SNF's to spe-
cialized treatment programs for Alzhaimar3 Disease.
In sum= ry, the Greater Bay Area Conference of Local Mental Health Directors is
committed to a regional planning approach to the development of alternatives to the
use of Napa State Hospital. It is .our position that some reduction of State
Hosptial utilization can be accomplished through the development of sub-acute and
long-term care (SV) programs at both an individual county and regional level.
However, we believe that the need for additional capacity and programs is. far in
excess of What can be funded through any reduction in State Hospital days. 'It is
our hope that we can work effectively witz you in planning and developing stra-
tegies to fund these critically needed services.
We hope this assessment will assist you in presenting a strong 1985/86 budget .
request for community mental health programs. If you have any questions or com-
ments, please give me a call.
Sincerely,
Don Feiner, Chair
Greater Bay Area Conference
of Local Mental Health Directors
DF/GB/pr c
cc: Charles Moody, President, CCLMHD
Tim t•lullins, President Elect, CCUIND
Mental Health Directors, GBACLMHD
Bob Egnew, Administrative Services Committee, tCLKHD
b ,
LN
;.�: .... �v: .
... - - _�•-4.n ..� .`'^~.tH •-- •.,'CSR.' i
.n. Y,+r`�'x.:r'3+.a'..�.ii.�`.'+i :.�ciie'3' ''. `"/'C'�_i.'I.�se_...1 - 'n•.Ftr 4.7ri.3f-3t1_
ATTACFAIENT B I
As of 10/31/84 there were 228 Contra Costa County residents in Long
Term Care facilities (L-Facilities & Napa State Hospital). The breakdown is as
follows:
For the month of July Auq Set Oct Nov Dec Jan Feb Mar Apr May June
L-FACILITIES
Canyon Manor 35 34 33 33 28
Crestwood Manor
Eureka 2 2 2 2 2
Modesto 10 9 9 8 7
San Jose 3 5 6 8 6
Stockton 5 5 7 9
Vallejo. 2 2 2 2 2
El Dorado Guid. 10 12 14 15 13
Fresno Care &
Guidance 0 0 0 0 0
Harbor Hills 9 9 9 14 15
Merced Manor 1 1 1 1 1
San Jose Care &
Guidance 5 5 6 8 8
Westwood 10 9 10 8 8
TOTAL L-FACILITY 92 93 99 108 99
NAPA
Yac 1 3 3 3
PC 15 15 15 17
DO 23 23 23 23
LPS
Over 60 14 14 1 14 14
Under 18 21 21 19 20
Adults 78 72 80 78
Private Cons. 14 14 13 13
Public Cons. 99 92 89 87
Voluntary 1 2 2 1
Other Holds 9 9 7 21
*TOTAL NAPA LPS 123 117 1 113 112
ADMITS/DISCHARGE11/9 4/9 3/6 5/6
*STOCKTON STATE
HOSPITAL LPS 3 2 3 3
*PATTON LPS 4 0 4 4
*OTHER LPS 0 3 1 1
*TOTAL LPS * 130 122 121 118* 116
LPS SUMMARY
YEARLY ALLOCATION: — 35,22O
PER DAY: 9
YEAR TO DATE UTILIZATION FOR THE 1st QUARTER:
TOTAL LPS UTILIZATION PROJECTION FOR THE YEAR: 44,848
PROJECTED OVER/UNDER UTILIZATION: + 9,628
PLEASE CALL WITH ANY QUESTIONS OR CLARIFICATIONS
cc: Gale Bataille Pat Marlow Stuart McCullough `
s� Fred Behrens Julie Peck. Francyn Molina
Bonnie Granlund Carol Sebilia Jonna Stratton
*Please Note: There is an error of 2-4 /
over actual census that will be
1011D,'34 addressed with the State, v
:�tl
ATTACHMENT C
STATE'OF CALIFORNIA—HEALTH AND WELFARE AGENCY GEORGE DEUKMEJIAN,Governor
DEPARTMENT OF MENTAL HEALTH
1600-9th STREET
SACRAMENTO,CA 95814
(916) 323-8203
November 6, 1984
t^; rnLS
, i� ht
n
t',
Mark Finucane, Director - .�
Health Services Department
Contra Costa County „^� ��`n� 'N T"
2500 Alhambra Avenue �!3:';,C:._ :�_...•..'�;P.
Martinez, CA 94553
Dear Mr. Finucane:
It has come to our attention that there appears to be a slight
misunderstanding concerning our October 9 , 1984 letter to
Senator Nicholas C. Petris regarding Contra Costa County' s
proposed alternatives to its state hospital situation: :
We indicated in our letter that we were not committed to only
one alternative (.the Patch L Facility) in resolving the state
hospital overuse issue. However , this was one of many alternatives
we discussed at great length with Mr . McCullough and agreed that
based on past experience of other Bay Area counties , was the most
readily attainable alternative to immediately address and resolve
your state . hospital problem. Although we are receptive to other
alternative services such as crisis residential facilities, the
fact remains that Contra Costa County is currently over using
state hospitals by an ave-rage of 715 days a month, which means
that although other alternatives are available, they cannot
provide an immediate remedy. Moreover , as we have explained to
Mr . McCullough, unless your plan of action is initiated shortly
to alleviate the state hospital situation, we will have no other
recourse but to require two discharges for every admission to
control your overuse and to allow other counties access to the
state hospital programs . Mr . McCullough has been receptive to
our suggestions to work cooperatively with other Bay Area
counties in obtaining needed L Facility beds .
If we can be of further assistance in any way please do not
hesitate to call.
Sincerely,
Richard L. Gilberg, Chief
County Operations-North
cc: U tuart McCullough
Douglas G. Arnold
Charles Harper
..-fes;.'~:'P'..._..s'4_nYd''-rn..i...:F�.'��1..��•�e J!-•'.W �a4'� .
ATTACd II Nr D.
..0 Services Department
•:', ALCOHOL/DRUG ABUSE/MENTAL HEALTH
DIVISION
Please direct reply to:
n � y` Health Services Department
2500 Alhambra Avenue
Martinez, CA 94553
November 28, 1984
D. Michael O'Connor, M.D., Director
State Department of Mental Health
1600 9th Street
Sacramento, CA 95814
Dear Dr. O 'Connor:
This is in response to your DMH Letter No. 84-26 regarding proposals for state
hospital alternatives. Enclosed is a prioritized listof the services we believe
will significantly impact our overutilization of Napa State Hospital . I must
caution you that I have only had time for preliminary discussions regarding this
list with our Health Services Director and have not had time to obtain the
approval of our Board of Supervisors. It has also not been reviewed by our
Mental Health Advisory Board. Although this must be viewed as a preliminary
list, it is the result of our planning efforts over the past year.
Contra Costa County is committed to operating within our allocation of patient
days and to developing alternative treatment programs in our own County. We do
not anticipate the attached list of programs will significantly reduce our Napa
State Hospital utilization in 1985-86, but should begin to demonstrate a signi-
ficant reduction in 1986-87. This is because of the traditional delays in
receiving a final Short-Doyle allocation and the start-up time required to ini-
tiate and fully operate new programs.
As you have seen from the correspondence recently sent to you by the Bay Area
Mental Health Directors, we are also committed to regional planning to assist in
alleviating the severe capacity problem that all of the Bay Area counties face
in attempting to adequately and safely cope with the needs of the seriously
disturbed adult and geriatric populations.
If you have any questions or comments in this regard, please do not hesitate
to give me a call.
Sincerely,
Stuart McCullough
Assistant Health Services Director ' -
A/DA/MH Division
SMc:vn +2 'o-f
cc: Mark F inucane
Wi 11 i am Wal ker, M.D.
a
Richar d Gi 1 ber
g
yman Lum
*�6a1e Batai�le -
-
e:;Skarr lllii� 1! 111111
AITAQHMENT E
a Health Services Department
•:� - ALCOHOL/DRUG ABUSE/MENTAL HEALTH .
DIVISION
I
�Osra`C�
To: Stuart McCullough Date: November 16, 1984
Assistant Health Services Director '
Alcohol/Drug Abuse/Mental Health Division
From: Gale Bataille y Subject: "Patch" Program for
Division Deput /Director L-Facility
The following is a summary of the program elements and the fiscal reimbursement mech-
anism for a Contra Costa County program patch in a psychiatric Skilled Nursing Facility.
I. FISCAL REIMBURSEMENT
It is my recommendation that a "Request for Proposal" indicate that the rate of
reim-bursement for a treatment patch is not subject to negotiation and should be
considered a non-competitive element. Financial compensation shall be based on a
fixed per diem rate of $50.00 per day during the first three months of operation to
cover program start-up costs. Thereafter, compensation would be based on a rate of
$45.00 per day for the purchase of 33 beds for the exclusive use of Contra Costa
County. Per diem reimbursement will cover treatment program and staffing costs
over and above the Medi-Cal plus State of California Special Treatment Program reim-
bursement (approximately $46 per day).
The intent of holding reimbursement rate as a non-competitive element is to focus
the selection and contract negotiation process on the level of service quality to be
achieved within the limits of reimbursement rather than competition re: cost per bed
day. The reimbursement rate is based on the "going rate" in the Bay Area for patch
programs which approximate the level of care required for our target population.
This rate is approximately $45.00 per day.
II. TARGET POPULATION
Mentally ill Contra Costa County residents (ages 18-65) , who have a history of
multiple hospitalizations and require an intensive treatment, social learning and
behavioral management program in order to be placed and function in community based
programs. These clients have a diagnosis of major mental disorder, low personal and
social functioning skills, and a history of bizarre and threatening or assaultive
behavior. Approximately 1/3 of the clients identified as needing a patched program
have history of pLlcohol and/or substance abuse. Majority of clients will be in
20-40 age range. At least 20-25 of the patients requiring this intensive subacute
level of care are currently awaiting placement from Napa State Hospital.
Page 2, McCullough, 11/16/814
III. PROGRAM COMPONENTS
Specialized program and treatment includes but is not limited to:
A. Behaviorally-oriented social learning/re-socialization program organized to
"train"/teach to recognize and reward progress in areas such as: daily living-
skills, self care, interpersonal interaction, self-management of bizarre and
problematic behaviors, using community resources, prevocational skills, etc.
B. Program organized as a "tiered" or phased approach with major emphasis in
last phase of the program on community integration including visitation to poten-
tial community residential placements and day activity sites. Discharge planning
phase will include Facility Liaison/Conservator from County as well as County Case
Manager assigned to client whenever possible.
C. Psychiatric coverage: County patients should receive psychiatric care from '
one Psychiatrist (maximum of 2 individuals) to be reimbursed on the basis of
Medi-Cal fee for service plus a monthly stipend (contract) from Contra Costa
County. Stipend will provide payment for services including treatment coor-
dination, court appearances, linkage with County services, participation in admi-
nistrative and planning meetings not reimbursable through Medi-Cal. This
Psychiatrist shall be selected conjointly with County and subject to County appro-
val of hiring.
D. Medication Policy: The Psychiatrist shall perform medication assessment and
monitoring in order to adjust medication levels to the lowest possible dosage
required for remission of severe symptomotology. Medication levels should be
reduced to lowest possible level required for community maintenance prior to
discharge from facility. Program participants shall be offered information and
counseling regarding use of medications (e.g. , "Medication Informed Consent"
program shall be provided both on individual and group basis.)
E. Facility shall be capable of providing seclusion and restraint as required
in accordance with State -Regulations and Patients Rights provisions. Staffing
pattern shall reflect capacity to provide one-on-one interventions with clients In
order to intervene re: disruptive behavior and reduce need to utilize seclusion
and restraint.
F. Family Therapy and network intervention: Family therapy and counseling
shall be offered as a component of program. Facility shall include staff who are
skilled and experienced in family and network therapy interventions. Family
therapy and other fdamily educational programming shall be available during
evening and weekend hours as well as during weekdays.
G. Substance Abuse Program: Facility shall provide education and counseling
program regarding alcohol and other substance abuse to include provision of group
activities within program as well as utilization of self-help groups such as
Alcoholics Anonymous and Narcotics Anonymous. Facility staffing shall incorporate.
several individuals and trained in assessment and treatment of substance abuse
problems.
IV. STAFFING REQUIREMENTS
Facility shall provide staffing pattern including: ratio of staff to clients; pro-
fessional disciplines employed; average salaries of staff; staffing pattern and
disciplines per shift, etc.(see matrix). Staff trained to provide both program
r
Page 3, McCullough, 11/16/81
activities and clinical intervention shall be employed to provide coverage during
evening and weekend hours as, well as weekdays. Staff to provide Family Therapy and
counseling shall be available for evening and weekend sessions with clients' fami-
lies and significant others.
V. COORDINATION.WITH CONTRA COSTA MENTAL HEALTH
Facility shall work cooperatively with County facility liaison staff as well as
County Mental Health treatment staff to coordinate regarding referrals,
appropriate assessment, treatment and discharge planning.
VI. EVALUATION
County shall implement regularized program evaluation activites to assess
compliance with program goals and standards as well as qualitative assessment of
impact of program on clients served. The facility shall provide periodic data
to assist with evaluation and shall actively cooperate with evaluation program
initiated by County. Evaluation program elements shall be identified by County
during contract negotiations.
1
ATTACHMENT F
--------------
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
ANNOUNCES
SOLICITATION OF PROPOSALS FOR
TREATMENT PROGRAM CONTRACT IN
PSYCHIATRIC SKILLED NURSING FACILITY
THE ORIGINAL AND SEVEN (7) COPIES OF BIDDER'S PROPOSALS MUST BE
RECEIVED BY THE CONTRA COSTA COUNTY DEPARTMENT OF HEALTH SERVICES,
ALCOHOL/DRUG ABUSE/MENTAL HEALTH DIVISION NO LATER THAN:
5:00 P.M. , JANUARY 9, 1985
Send Responses to:
Gale Bataille, Deputy Director, A/DA/MH Division
Contra Costa County Health Services Department
Ward L-1 , 2500 Alhambra Avenue
Martinez, CA 94553
(415) 372-4380
December 11 , 1984
NOTICE TO BIDDERS
I. GENERAL BID SPECIFICATIONS/CONDITIONS
A. It is the intention of Contra Costa County to contract for treatment services in
a psychiatric Skilled Nursing Facility (SNF) for mentally ill residents who
require a level of psychiatric treatment and supervision over and above the
level of care reimbursed through Medi-Cal and the State of California's "Special
Treatment Patch" program. It is the intent of the County that a SNF Treatment
Program contract be negotiated with a start-up date of February 18, 1985.
Should the proposal rating and selection process take longer than anticipated,
the February start-up date may be revised.
B. Response to this solicitation of proposals shall in no way constitute an
agreement, obligation or contract on the part of Contra Costa County. THE
COUNTY BOARD OF SUPERVISORS RESERVES THE RIGHT TO REJECT ANY AND ALL BIDS, OR
ANY OR ALL ITEMS OF ANY BID. FURTHERMORE, THE BOARD RESERVES THE RIGHT TO WAIVE
ANY BID IRREGULARITY BUT THIS DOES NOT RELIEVE THE BIDDER FROM THE OBLIGATION OF
FULL COMPLIANCE WITH ALL BIDDING CONDITIONS IF AWARDED THIS CONTRACT.
C. Sections III and IV, Solicitation of Proposals - Program, and Solicitation of
Proposals - Fiscal, contain letter and numbered paragraphs that require either
narrative responses or ask for specific information such as job descriptions,
staffing patterns, resumes, etc.. Unless otherwise specified in these sections,
please respond to all questions or requests for information utilizing the same
topic oriented outline format indicated. Information requested in a chart for-
mat must be entered on forms provided.
D. This RFP holds the rate and method of reimbursement for services as a non-
competitive element of the bid process. Financial compensation shall be set at a
rate of $50.00 per day during a three month start-up period. Thereafter, compen-
sation shall be based on a $45.00' per diem reimbursement for 33 beds for the
exclusive use of Contra Costa County. The intent of holding reimbursement as a
non-competitive element is to focus the selection of a provider on the level of
service quality to be achieved within the limits of reimbursement.
Page- 2, CCC-RFP
E. A Sample Contract boilerplate is included (Appendix C) for review by prospec-
tive bidders. This Sample Contract includes both Special Conditions and
General Conditions which are requirements for organizations which enter into
contractural relationships with the -Health Services Department. Certain con-
ditions may be negotiable, but the bidder must specify in writing which con-_
ditions, if any, the bidder cannot or will not comply with.
F. Audit and insurance requirements detailed in the Sample Contract are items of cost
which must be considered in determining the level and type of services proposed
by bidders.
G. Location of proposed program site and time frame for start-up of services will
be considered as competitive items in the selection and review process.
Proposed program site must be within the Greater Bay Area in order to receive
consideration. Proximity to Contra Costa County and/or ability to transfer
program to a facility in close proximity to the County within a reasonable period
of time will receive positive weighting in the review process. Bidders must
attest to ability to begin to accept Contra Costa County clients into program by
March 1 , 1985, in order to receive consideration.
H. Proposals will be evaluated by a committee composed of Health Services Department
staff and members of the County's Mental Health Advisory Board. Evaluation cri-
teria will be based on the areas of inquiry in Sections III and IV. The
bidder(s) with the highest rating score(s) will be considered by the County for
the contract award. Rating criteria and potential weightings are noted in
Appendix The County reserves the right to change individual rating ori-
teria and weightings prior to initiation of the proposal review process.
I. Contra Costa County is in no way obligated for any costs to bidders associated with
response to this Request for Proposal. All proposals submitted become public
information.
J. Proposals shall include a transmittal memo on the organization's letterhead,
signed by a person with authority to represent the provider, and shall include:
provider's legal (corporate) name, mailing address, facility address, contact
person, telephone number and date of submission.
K. If more space is needed for answers to questions, use the back of the page on
which question appears.
Page 3, CCC - RFP
II. GENERAL BACKGROUND INFORMATION
I
The Contra Costa County Health Services Department intends to enter into a
contract for 33 beds with a psychiatric Skilled Nursing Facility to provide treat-
-. went and psychosocial rehabilitation for mentally ill adults between the ages of 18
and 60. It is expected that this treatment "patch" program will fill a major gap
in the County's continuum of mental health care and will function as an integral
component of the County's mental health services.
The specific function and intent of the program shall be to provide a geographi-
cally proximate and clinically appropriate alternative to prolonged hospitaliza-
tion in Napa State Hospital or County's acute psychiatric inpatient services.
This program shall provide a safe, structured treatment and psychosocial rehabi-
litation program designed to transition patients to the "least restrictive" pla-
cement possible within the community. The treatment patch program shall be
directed toward improving and stabilizing the client's mental, behavioral and
social functioning so that within an average of 3 to 6 months it is possible to
discharge to a lower level of care. The program shall enhance the client's
psychosocial skills and ability to utilize mental health and other supportive
services to be successfully maintained in a community setting.
For the past several years, Contra Costa County has exceeded its patient day
allocation for Napa State Hospital. Therefore, the County's first priority for
placements in a patched SNF program is for those patients who are currently at
Napa due to .the County's lack of a subacute treatment capacity. Another
priority population is individuals currently utilizing the County's psychiatric
inpatient services who no longer require an acute level of care but for whom
there is no alternative placement.
It is expected that the SNF provider who is awarded this contract will actively
participate and cooperate in planning and implementing activities to reduce
Contra Costa County's State Hospital census.
Page 4, CCC - RFP
A. Target Population - Contra Costa County residents ages 18 to 60 who have a
history of multiple hospitalizations for severe and chronic mental disorder as
well as poor community adjustment. The majority of patients will have a primary-
diagnosis of either schizophrenia or major affective disorder. Most clients
referred will have low personal and social functioning skills and a history of
serious behavior problems including bizarre, disruptive and threatening or
assaultive behavior. Clients who present a clear and current threat of serious
assaultive behavior, suicide or fire setting may be found inappropriate for a
subacute level of care based on a joint assessment and case review with the
County mental health liaison.
Based on a survey of patients at Napa State Hospital and patients utilizing
psychiatric inpatient services, it is estimated that approximately one third of
the clients in need of subacute care have some history of alcohol or other
substance abuse. Clients shall not be excluded because of past history of
substance abuse concurrent with a mental disorder when substance abuse is not
identified as the primary diagnosis.
Appendix provides brief case summaries of potential types of clients to be
referred to this treatment patch program.
Page 5, CCC - RFP
III. SOLICITATION OF PROPOSALS - PROGRAM
A. Facility Location
1. Indicate location of facility in which it is proposed to provide program for-
Contra. Costa County. Describe area in which facility is situated including:
characteristics of neighborhood, access to public transportation, shopping,
recreational or educational facilities.
2. If you anticipate that beds will become available for the Contra Costa County
program in a site within the County. or in closer proximity, indicate where and
anticipated time of availability.
B. Facility Capacity and Physical Plant
1. What is the client capacity of the facility?
2. What is the average utilization rate?
3. Briefly describe physical plant. (Refer to "STP" program description i-f it
includes physical plant description.) Include description of sleeping quarters,
size of wards, program areas, dining and kitchen areas utilized by patients,
outside recreational areas, facility security - e.g. , fences, etc. .
Page 6, CCC - RFP
4. Describe section of facility proposed to be utilized for Contra Costa County
program. To what extent is this area physically separated or integrated with
areas for the general population? Do any other counties have "patch" programs .
in this facility? If any, list.
C. Program Philosophy and Structure
Bidders must discuss proposed philosophy and theoretical framework of treatment
and rehabilitiation including the following areas:
1 . The SNF awarded this contract is expected to actively participate and cooperate
in planning and implementing activities to reduce Contra Costa County's State
Hospital census. Describe how bidder will participate with County in this process.
2. Summarize your theoretical framework and philosophy of treatment with
reference to mental health treatment and rehabilitation of the target popula-
tion for this program. .
3. Summarize major treatment/rehabilitation modalities proposed to be utilized
in your program.
Page 7, CCC - RFP
4. How will this program be organized and structured to accomplish the County's
stated goal of utilizing subacute level of care to transition severely
disturbed clients from institutionally based care to less restrictive com-
munity based care, e.g. , is program to be structured into distinct treatment
phases for groups of clients? Individualized program for each client?
5. Medication philosophy - What is your policy re: use of psychotropic
medications? (Note: It is the expectation of the County that medications be
reduced to the lowest possible level required for remission of symptomatology.)
Discuss how non-compliance, side effects and community management of medica-
tions are handled. Do you currently have, or propose to implement procedures
vis a vis the Jamison Ruling? What are your practices (or proposed practices
re: medication informed consent?) Include policy statements as attachment if
available.
Page 8, CCC - RFP
6. Coordination with County mental health re: program services and treatment of
individual clients - What is your policy regarding Contra Costa staff involve-
ment in program development and treatment of individual clients, e.g. , to what
extent are you committed to staff involvement in these areas? What problems do
you see with Contra Costa County staff involvement? Cite previous experience
relevant to this issue if applicable.
D. Program Services
This program is intended to enable the provider to treat and manage more
severely disturbed clients than are typically admitted to non-patched SNF's.
Funding is provided to augment and individualize treatment and psychosocial
rehabilitation services beyond those funded through Medi-Cal and the State of
California's "Special Treatment Program".
Attach 3 copies of your organization's most recent State Licensing approved
Special Treatment Program description for the SNF facility proposed for the
Contra Costa County program.
Responses to the questions which follow should specify which services or
levels of service are to. be provided over and above the STP program where
applicable.
1. Admissions Procedure - Describe admissions process from initial referral to
acceptance. What referral information is required? How is decision made to
accept referral? What client characteristics/history would preclude acceptance
of referral?
Page 9, CCC - RFP
a. Is your corporation willing to enter into an agreement with County to
accept patients on 14-Day Certification pending Temporary Conservator-
ship in order to expedite referrals?
2. Assessment and diagnosis - Describe diagnosis and assessment procedures
including time frame for completion. Describe capacity for and use of psycho-
logical
sycho-logical testing, neuropsychiatric and medical evaluation.
3. Individual treatment planning - Summarize treatment planning protocol.
What are the components of each treatment plan? Who participates in developing
treatment plan? Attach sample forms and indicate frequency of case review and
treatment plan updates.
4. Individual therapy program - What type and frequency of individual therapy
will be provided to each client?
a. What is minimum frequency and length of contact available to each
client for individual therapy and assessment by licensed or supervised. .
license eligible professionals?
b. What is the role of the psychiatrist regarding both individual treatment
as well as group therapy? What other activities will the psychaitrist
participate in?
Page 10, CCC - RFP
5. Family therapy and counseling - Family therapy and counseling are expected
to be integral components of the Contra Costa County program.
a. Describe proposed use of family therapy in program?
b. In addition to therapeutic interventions with an individual patient's
family and/or "significant others", are there other modes which you pro-
pose for working with families or groups of families?
c. What is the role of family therapy and/or family counseling with severely
mentally ill patients? What are the limitations of this approach with
this population?
6. Medical Care - How are medical needs of patients handled? Describe medical
care capabilities and limitations of this program.
What hospitals and outpatient medical facilities will� be utilized for Contra
Costa County clients? List names of medical facilities if possible.
7. Program description - Describe basic program services including both
psychotherapeutic and social rehabilitation components. Include a proposed
schedule of activities identifying evening, night and weekend schedule as well
as weekday program. Indicate approximate numbers of clients to be included in
various group activities. (Use separate attachments as necessary.)
Page ' 11 , CCC - RFP
a. Which program activities/components are specific to "patch" program,
e.g. , elements over and above STP program?
8. Substance Abuse program - Since a significant percentage of target population
has history of drug and alcohol abuse/use, it is the expectation of the County
that the provider develop education and counseling services specific .to this
problem.
a. Describe proposed substance abuse program including services to be
provided within the facility as well as use of community resources.
b. Does your current program staff include individuals experienced and
trained in assessment and treatment of substance abuse problems? If
yes, specify number of staff and professional discipline. If no, are
you committed to hiring additional staff with these skills?
9. Client involvement in program - How are clients motivated to become involved
in treatment and social rehabilitation program?
a. To what extent and how do clients participate in developing/selecting
program activities?
b. What incentives are offered/utilized to increase client participation?
Page 12, CCC - RFP
10. Management of behavioral problems -
a. Describe how substance abuse, theft, sexual acting out, and other
"anti-social" behaviors can best be addressed within the context of ,
this program? What is your facility's current policy?
b. Describe capacity in proposed program to handle clients who present
danger to self and/or others? Describe procedures for identifying,
treating and/or monitoring suicidal or threatening/assaultive beha-
vior.
11 . Restraints and seclusion - Does proposed facility have capacity to restrain
and seclude patients? Describe the use/role of restraints and seclusion in
the treatment program. Attach applicable written procedures.
12. "Pass" procedures - What is facility's policy and procedure regarding'
client pass privileges for home visits, visits to neighboring community?
13. Community involvement of clients - What is facility's policy and practice
regarding use of surrounding community - e.g. , use of outside day program acti-
vities, recreational resources, etc. . .? What involvement does the community
have with the facility and/or patients?
Page 13, CCC - RFP
14. Patients Rights - Describe patients' rights policy and procedures. How are
patients informed of their rights and resources? Does the facility have a
grievance procedure for patients? Describe current or proposed grievance proce-
dure.
15. Discharge planning - Describe program and individual activities included in
preparing client for planned discharge to less restrictive level of community
based care.
a. At what point and how are clients involved in planning and goal
setting re: discharge? Pre-discharge linkage with community resources?
b. Describe proposed role of Contra Costa County staff in discharge
planning.
IV. SOLICITATION OF PROPOSALS FISCAL/STAFFING/ADMINISTRATION
A. Fiscal
As stated in Section I.D. "General Bid Specifications", the rate and method
of reimbursement for this contract are specified as non-competitive elements of
this Request for Proposal. Financial compensation shall be based on a fixed per
diem of $50.00 per bed day during a three month program start-up phase.
Thereafter, compensation shall be based on a rate of $45.00 per bed day for a
33 bed patch program for the exclusive use of Contra Costa County patients.
��� .1a
Page 14 CCC - RFP
Program Start-Up
Contra Costa County is interested in contracting for up to 2,000 bed days from
March 1 through May 31 , 1985 at a rate of $50.00 per day. Maximum reimbursement _
for the three month start up period is estimated at $100,000. This reimbursement
rate is set at $5.00 per over the ongoing $45.00 per day rate in order to cover
expenses associated with program start-up.
Fixed Per Diem Reimbursement
Subsequent to the three month start-up phase, the County proposes to contract
for 33 beds per month reimbursable at the rate of $45.00 per patient day.
During final contract negotiations performance criteria will be established to
insure: 1) a 90-95% acceptance rate for County referrals and 2) a process for
resolving provider and/or County concerns re: appropriateness of referrals and
utilization rate.
It is the intent of this RFP that bidders respond by demonstrating the level of
service quality that can be achieved within the limits of reimbursement rather
than competitively bidding on the cost per day. The rate of reimbursement
offered is not subject to negotiation and should be considered a non competitive
element of the bidding process.
FISCAL YEAR 1984-85 REIMBURSEMENT SUMMARY
Fixed Bid Svc Period Max Reimb Conditions
$50.00/day 3/1/85 - 5/31/85 $1001000 Ability to accommodate increasing
census of up to 33 clients
$45.00/day 6/1/85 - 6/30/85 44,550 Minimum of 33 beds available for
County exclusive use.
$144,550
FISCAL YEAR 1985-86 REIMBURSEMENT SUMMARY (PROPOSED)
Max Reimb
Svc Period Available Conditions
7/1/85 - 6/30/86 $542,025 Minimum of 33 beds available for
exclusive use of Contra Costa
County
Page 15, CCC -RFP
In addition to the costs for which the County will reimburse facility (described
above) , the County intends to provide financial support for the following staff
positions to enhance quality of program services: 1) County proposes to pay a
salary stipend of $1200/month to reimburse costs of a psychiatrist over and above-
Medi-Cal "Fee for Service" and 2) County will directly pay for a .5 FTE County
Mental Health Program Liaison who will function as facility liaison, monitor, and
facilitate referrals and placement of County clients. Additional details regarding
the functions of these positions is available in Section IV.B. (Staffing) .
1 . Bidder is requested to indicate acceptance of financial reimbursement method
as well as to specify any concerns, comments or clarification required.
2. Cost Data - Bidders are encouraged to submit any information that may help
the County in its selection process. However, all bidders are required to pro-
vide the following cost data for period of April through September 1984:
a. Facility costs (building, utilities, taxes, insurance and debt service) as
a percentage of gross expenditures for same period.
b. Gross salaries as percentage of expenditures.
c. Employee benefits as percentage of expenditures.
d. Food costs per patient day (average for 4/1 - 10//1/84) .
e. Recreational and social program budget as percentage of total budget in
current fiscal year.
B. Facility Staffing Pattern
1 . County requirements re: specialized program staffing.
The following specialized staff are considered to be essential to provision of
Contra Costa County program. Indicate current availability and/or agreement to
employ staff with the following skills, professional discipline/licensing.
a. Psychiatrist - County requires that one psychiatrist be employed to provide
diagnostic, treatment, and. legal status related services (e.g. , court evalu-
ations/appearances) .for program patients. Psychiatrist shall commit
approximately 20 hours per week to program. Reimbursement shall be based
on Medi-Cal fee-for-service plus a $1 ,200 per month salary for reimbursement
���. 3o
Page, 16, CCC - RFP
of non-Medi-Cal reimbursable activities. Psychiatrist shall be available
for consultation and administrative/planning activities with County. If it
is not possible to hire one physician for 20 hours per week, County will
consider employment of maximum of two psychiatrists to fulfill these func--
tions. County shall participate in recruitment and final selection of
psychiatrist(s).
b. Family Therapy Specialist - At least one licensed professional shall have
training and experience in providing family therapy and be utilized for
family therapy sessions as well as other proposed family education and
counseling activities. Individual's work schedule shall include evening
and weekend availability.
c. Substance Abuse Specialist - At least one, and preferably several, staff
shall have experience in substance abuse assessment and intervention.
d. Licensed Psychiatric Technicians - Licensed Psych Techs shall be employed
on all shifts.
e. "Specialing" capability - Sufficient numbers of trained staff shall be
available within the program at all times in order to provide intensive
monitoring and one-to-one intervention as necessary for clients who become
agitated and/or suicide risks.
f. Community Activities Specialist - Staff shall be available to accompany
patients on community outings in order to identify and assess patient beha-
viors and develop behavioral goals and interventions to improve community
functioning.
2. Staffing summary - Complete the attached chart indicating staffing pattern by
FTEs and discipline. Summary shall identify staffing for STP program and addi-
tional staffing proposed for Contra Costa County program.
3. Staffing pattern
a. Attach a sample weekly staffing pattern for proposed contract program
(include both STP and county funded program) indicating number of FTEs on
duty by discipline. Include staffing pattern for weekdays, evenings.
nights and weekends.
% » � ƒ
%
t
@ - &
co
p
\ � t t
a w0 �
(0,4 v
�
\ �
�
% 0f
A
.� �
G
co
\ ®
A.:, � � �
® 0
. � _ 0-
� 05
to� $
� ®
■
® �to
CD
. 3w . �
,,A
)
@ .
v
6
Q rA
k
/
¥
PA ®
Page 17, CCC - RFP
b. Describe staff to patient ratio in proposed Contra Costa County Program
at full census of 33 clients for:
Weekdays -
Evening -
Nights -
Weekends -
4. Staff Development and Training - Describe staff development and training
program including: types of training offered and inservice training requirements
for various staff disciplines, hours of staff training per month, expertise and
professional discipline of trainers.
5. Corporate support staff - If applicable, describe central corporate staff
available to provide specialized services and consultation to augment and/or
assist facility located administrative and treatment staff in areas such as
treatment program planning, staff development and training.
C. Facility Administration
1 . Provide an organizational chart of facility administrative and program
management/supervisory staff. Indicate current STP program
management/supervisory staffing as well as proposed additional staffing for,,
Contra Costa County program. (Use separate attachment)
2. Submit job descriptions and resumes of key management/supervisory staff
currently employed in program. Submit summary job descriptions/functions of
additional management/supervisory staff proposed for augmented program.
D. Quality Assurance
1 . Describe facility's current Quality Assurance Plan and activities including:
a. Utilization Review procedures
b. Medical records procedures and process
c. Case dobumentation - include sample chart forms
d. Peer review procedures
e. Medication monitoring system and protocol
Page' 18, CCC - RFP
2. Describe any additional procedures/activities anticipated for insuring ade-
quate Quality Assurance Plan implementation for County program requirements.
E. Evaluation and Reporting
It is the intent of Contra Costa County to monitor program quality and outcomes
based on performance objectives to be negotiated with selected provider during
the contract development process. Contract performance plan will include plan
for program evaluation and will additionally specify requirements re: 1) Monthly
Statistical Reporting and 2) Quarterly Progress Reports, summarizing performance
to date and identifying problem areas regarding either contractor or County
expectations or obligations.
1. Describe corporation and proposed facility's experience in designing and
implementing program evaluation. Cite examples of evaluations (both qualitative
and quantitative) performed to date.
2. Describe corporation's/facility's current clinical management information
system. Do you anticipate the need to develop and implement additional clinical
management information system capability? If yes, what are the additional
requirements based on the program specifications cited in Contra Costa County's
RFP.
3. Indicate corporation's willingness to perform internal program evaluation
and cooperate with County evaluation activities. Cite current agency resources
for this activity.
Page 19, CCC -RFP
F. Background of Bidder
1. Bidders must show that the corporation and proposed facility for, Contra Costa
Program is legally constituted to operate in the State of California. Indicate
type of organization, i.e. , corporation, partnership, sole ownership, etc.
2. Tax status - Is the bidder a for-profit or non-profit agency? Bidders must
provide proof of tax status.
3. Corporate structure and staffing - Submit an organizational chart identifying
corporation's central management structure by position and relationship to
psychiatric skilled nursing facility proposed as site for Contra Costa County
program.
4. Potential Conflict of Interest - Bidder must identify whether any principal of
the corporation, or member of the Board of Directors is also an owner or part
owner or member of the Board of Directors of any other corporation, organization
or sole proprietorship that will pose an actual or potential financial conflict
of interest by virtue of entering into a contract with Contra Costa County.
G. Contract Development and Program Implementation
1. Review of Contra Costa County sample Health Services Department "Contract
Boilerplate" -, Review "Special Conditions" and "General Conditions" of sample
contract (see Appendix C ) and specify which, if any, conditions bidder
cannot/will not comply with.
2. Assuming contract can be negotiated and signed prior to March 1 , is your cor-
poration able and willing to begin program implementation by March 1 , 1985.
ATTACHMENT G
CLINICAL PROFILE FOR CURRENT
NAPA PATIENTS PROPOSED FOR
PATCHED PSYCHIATRIC FACILITY
POPULATION SIZE: 24
' AGE RANGE: 20-45
AVERAGE AGE: 32
LEGAL HOLD: Conservatorship
AVERAGE LENGTH OF STAY: 22 months
GENDER: 75% Male, 25% Female
PLACEMENT OBSTACLES:
HISTORY OF:
Firesetting 35%
Assault 70%
AWOL 25%
Self-Abuse 5%
Substance Abuse 35%
CURRENT WARD BEHAVIOR:
Patients have improved behaviorally and psychiatrically from admitting
condition and are ready to move to a facility which provides specialized
treatment rather than behavioral stabilization. Their continued treatment
needs include: close monitoring of medications; intensive environmental sup-
port and intervention for antisocial behavior (theft, drug abuse, inappropri-
ate sexual behavior, assaultive behavior) ; persistent and consistent support
for self-care (hygiene, dress, social interaction are all below levels
acceptable to the community); and the use of occasional restraints and/or
seclusion. for behavior management.
Average number of Napa admits: 6.15
Placement histories: All have extensive histories of placement 'failures'
- that is: being removed from facilities due to behavior or mental status
that was unacceptable or unmanageable in the placement facility. 20% show
a history of abusing peers in L-facilities (assault, rape of elderly
patients, etc.) .
Decompensation Indicators: Substance abuse, failure to take meds, family
conflict, unable to maintain self without the structure of a hospital
setting.
Family Involvement: Many patients present family conflict or involvement
as a major contribution to continued poor functioning and/or for failures
in community placement.
Criminal Justice Involvement: 25% show history of serious criminal activity
(burglaries, kidnap, rape, etc.)
ATTACHMERr H
Monday, December 3, 1984 Contra Costa Times—Page 7A
�1•
-Violence understaffin. .,::worr
state .wor ers dt "N.a a --Hos ital .
NAPA (AP) —State employees -' "It is often one or two of us in a
are worried about an increased lev _',State StatISt1CS STOW da room with 40 le said Ned
el of patient violence at Napa State y people,"
's " Moore, a psychiatric technician.
- Hospital. ; . -. p _y
„ that em to ees instate•: � ..-. :
"We have a great concern about -mental hoS Ita1S are
Said Carol Upton, another psy.
la ;°_ chiatric technician:."On m w
the amount of violence, said Dr. -: . - Y and
William Bewley, a staff psychia• mf ured more .freqUeIIt1k we have 66 patients and eight staff
trist and shop steward for the phy .- laIl pr1SOII guards members.Two of us are shift leads .
sicians' union. x.,, who supervise. the work of the
"This 'is no recent, sudden techs.That leaves six;Two of those .
change.I think o has been gradual-/. However; state statistics show`,.are-unlicensed hospital workers
that employees of. the Department : who ick u `soiled linens du
ly building up, because there has ..of Developmental Services, which '' and wash beds,.. F':;;.., stlock
--
-.tlbeen an erosion of staff. f
"Also,'we've been receiving' 'runs eight state hospitals,,are in -4 r y
We have:.a;seclusion corridor,::;
.,more and,more violent patients," jured more frequently than prison.. Viand if there:is.one.: ~son in-.seclu-1`
he added.:"The have been found. .'dards. -:�. ;:_=:. 3:-' #-
y 'Recently, the Joint Commission ``:sian,'one staffer has to be.there all
Jo be unmanageable in community on Accreditation of Hospitals noti- '.the time. So'that.leaves;:three'wi;
"'programs.,Unmanageabte fre- fled the hospital that its accredits-=:;the Hoar,or 22 patients per.11censed
:quently means violence toward oth- '-tion would not-be renewed...The _;-`$off member."` t '-. L'
er patients and staff." :ur. : `.: ",r .'`
commission cited significant staff :"Dr. D,:'Michael ( Connor; the
Last Sept 25,a ps chiatric tech- °losses"of 291 of Napa's 2,000 work=:;�_ Mate director,:of`men'tal;bealt>i ''
oiclan at Napa, 1 nzalez,,died ers,including 88 psychiatric technf� :.:says Napa fs-' adequately staffed. '.
after he suffered a head injury in . clans;. A._:';That doesn'i'mean I.ani._satisfied.•r
an attach by.& patient..;,,� , :.;, ... ,;;,- Workers at the hospital, which You can';hav 'staft runaing`out.of
Hospital executive director Fred :houses 1,250 to 1,300 mentally.itl pa-. '►our ears,�biut if yoti'area`t:qr�a=r
Yalenzuela said Gonzale:`s death tients;complain that they are over•:.' gazed prQ erly, tt:lvpn'E do t
'was an isolated incident. , sworked. n'4.
11 wi
_ 4
t,�
_ � �Y _ �r .�. � � eft '"x'.'��t•��4'!'A".
' CONTRA COSTA COUNTY ATTACHMENT I
MENTAL HEALTH ADVISORY BOARD
2500 ALHAMBRA AVENUE
MARTINEZ,CALIFORNIA 94553
Phone(415)3724395
December 4, 1984
Contra Costa County
Board of Supervisors
651 Pine Street
N,artinez, CA 94553
Dear Supervisors:
On November 29, 1984, the Mental Health Advisory Board of Contra
Costa County adopted the attached resolution. This resolution
endorses the Board of Supervisors allocation of $280,000 for
the initiation of a six-month contract to provide subacute treat-
ment in a Psychiatric Skilled Nursing Facility.
The urgency of expeditious action in securing this contract is
outlined in the resolution.
The Mental Health Advisory Board acknowledges your commitment to
providing this vital service and looks forward to your continued
support in this area.
Sincerely,
., Skarr
Chairperson
Pr
cc: Mark Finucane
Stuart McCullough
C. L. Van Marter
A-351
CONTRA COSTA COUNTY
MENTAL HEALTH ADVISORY BOARD
2500 ALHAMBRA AVENUE
MARTINEZ,CALIFORNIA 94553
Phone(415)372.4395
November 29, 1984 "
Mental Health Advisory Board
RESOLUTION to the Contra Costa County Board of Supervisors
The Mental Health Advisory Board of Contra Costa County strongly endorses your recent.
allocation of $280,000 for the initiation of a six month contract to provide sub-
acute treatment in a Psychiatric Skilled Nursing Facility (SNF) for mentally. ill
adults. It is our assumption that the Board of Supervisors' intent is to ensure that
sufficient funding is available during fiscal year 1985-86 to continue this program.
Historically, the lack of this level of care has resulted in the overutilization of
State Hospital days, crowding on our Pseyhiatric Inpatient wards and a denial of ade-
quate treatment to many of the most seriously mentally ill citizens of this County.
We urge you to support the efforts of our Health Services Department to proceed as
rapidly as possible to contract for this vital service for the following reasons:
1 . During the past several years, most other Bay Area Counties have contracted
for program patches with psychiatric SNF's. This has severely reduced the availabi-
lity of SNF beds for Contra Costa County patients. There are not enough beds in the
Bay Area to meet the current need. Contra Costa County has already lost out on the
possibility of contracting for SNF beds in facilities which are geographically the
most accessible. Any further delay may make it impossible to purchase this level of
care without placing patients at a great distance from this County.
2. Without the development of sub-acute treatment capacity, we will not be able
to sufficiently reduce utilization of Napa State Hospital to stay within our patient
day allocation for 1984-85. If Contra Costa County continues to overutilize the
State Hospital, the State Department of Mental Health may severely limit admissions
thus denying needed treatment for seriously disturbed individuals. (This limitation
was enacted for San Francisco County in FY 83-84.) Additionally the County may be
billed for excess utilization.
The Mental Health Advisory Board is aware that some opposition to initiating an L-
facility program contract has come to the attention of members of the Board of
Supervisors. We assure you that our Board's Program Review Committee has reviewed
treatment components of this proposed program patch and are in support of the stan-
dards and program criteria which will be utilized in selecting a service provider.
Proposed requirements include: capacity to serve a target population of serious
disordered clients, a structured and well staffed treatment and behaviorally oriented
social learning program, minimum standards for psychiatric coverage, willingness to
incorporate and cooperate with Contra Costa County mental health staff in treatment
and discharge planning activities, and commitment to participate in regular program
evaluation. Members of the Mental Health Advisory Board will continue to participate
in the development of this program in their advisory capacity to the Local Mental
Health Director.
Finally, the Mental Health Advisory Board-commends the Local Mental Health Director
and staff for their efforts to create a critically needed level of care for mentally
ill residents of Contra Costa County.
I
' A
1. Mental. Health Allocation Approved
2 . Subacute Psychiatric Facility L. Patch
3. Mental Health Funding Solutions Sought•
4 . Short-Doyle Allocation-.Formula; Revision Pipsl
5. Same as l
6. Bronzan Assemblyman Assistance Requested
I
I
I
i
I
i
i
j
I
I
I
i
i
i
i
I
i
i
i
I