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HomeMy WebLinkAboutMINUTES - 12191995 - C68 To: _ �; BOARD OF SUPERVISOR FROM: Mark Finucane, Health Services Director ontra Costa DATE: December 7, 1995 Approval of Contract #24-683-2 with Alameda ty or �ounty SUBJECT: Contra- Costa County's Participation in the Regional Neuro- Behavioral Care Program SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Health Services Director or his designee (Lorna Bastian) to execute on behalf of the County, Contract #24-683-2 with Alameda County, as host county, for Contra Costa County's participation in the Regional Neuro-Behavioral Care Program to provide skilled nursing facility (SNF) care and programs for County's organic brain syndrome (OBS) , traumatic brain injured, and medically debilitated patients, not to exceed a payment limit of $313, 090 for Fiscal Year 1995-96. II. FINANCIAL IMPACT: This Contract is included in the Department's Fiscal Year 1995-96 Budget and is funded by savings generated from the County's reduction of client placements at State Hospitals. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: On December 7, 1993 , the Board of Supervisors approved Contract #24-683 (as amended by Contract Amendment Agreement #24-683-1) for Fiscal Years 1993-94 and 1994-95, with Alameda County, as host County and the Guardian Foundation as the service provider, for Contra Costa County's participation in the Regional Neuro-Behavioral Care Program, as an alternative to State hospital placement, to provide skilled nursing facility (SNF) care and programs for this County' s organic brain syndrome (OBS) , traumatic brain injured, and medically debilitated patients. Approval of Contract #24-683-2 will continue Contra Costa County's participation in this collaborative effort among the counties to reduce usage of high-cost State Hospital beds, through June 30, 1996. CONTINUED ON ATTACHMENT: YES SIGNATURE: Az _i_� RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON f APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS ZUNANIMOUS (ABSENT ) I 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 OF SUPERVISORS ON THE DATE SHOWN. Contact: Lorna Bastian (313-6411) CC: Health Services (Contracts) ATTESTED ( 9 1 19J Risk Management Phil Batchelor,MA of the Board of Auditor-Controller Suvervisors and County Administrator Contractor M382/7-83 . BY J DEPUTY r .~ Contra Costa CoMtj�t# `y A'a Alameda County # INTERCOUNTY SERVICES CONTRACT (Skilled Nursing Services for OBS, Traumatic Brain Injured and Medically Debilitated Patients) 1. PARTIES. The following named Counties, for their respective Agencies and Departments specified below, mutually agree and promise as follows: d 11 P14\ County Providing Services: Alameda County (for its Health Care Services Agency/Mental Health Services) County Receiving Services: Contra Costa County (for its Health Services Department/ Mental Health Division) 2. TERM. The effective date of this Contract is July 1. 1995 and it terminates June 30, 1996, unless terminated sooner as provided herein. 3. OBLIGATIONS OF COUNTY PROVIDING SERVICES. Alameda County shall provide for Contra Costa County, during the term of this Contract, access to the mental health treatment services as set forth in the attached Program Description and Performance Requirements. (Exhibit A), which is incorporated herein by reference. 4. OBLIGATIONS OF COUNTY RECEIVING SERVICES AND PAYMENT LIMIT. Contra Costa County shall pay Alameda County $313,090, as an all inclusive amount for the guaranteed access and service availability as specified in the attached Exhibit B, which is incorporated herein by reference. 5. GENERAL PROVISIONS. This Contract is subject to the attached General Provisions which are incorporated herein by reference. 6. SIGNATURES. These signatures attest the parties' agreement hereto: CONTRA COSTA COUNTY ALAMEDA COUNTY By: By: sus Board of Supervisors R t/Designee President/Designee Approved: Designee Mental Health Director/Designee COUNTk ADMINISTRATOR ATTEST: A EST: C z the Board/Deputy Clerk o e Board/DeputyC lam^ ' APPROVED AS TO FORM: APPROVED AS TO FORM: Deputy County Counsel Deputy County Counsel Contra Costa Co�ntyr _C1Qj Alameda County # GENERAL PROVISIONS 1. Independent Contractor Status. This Contract is by and between two independent contractors and is not Intended to and shall not be construed to create the relationship of agent, servant, employee, partnership, joint venture, or association. 2. Amendments. This Contract may be modified or amended by a written document executed by each County's Board of Supervisors, or after Board approval, by their designees. 3. Indemnification. Each County and its respective employees, agents, and officers shall be indemnified and held harmless by the other County against any and all claims, demands, or causes of action arising out of any act or omission of any officer, agent, or employee of the other County while performing services under this Contract, or resulting from the condition of any property owned or controlled by the other County. Each County shall maintain a self- insurance program and/or other insurance, which maintains the following minimum coverage levels. A. Workers Compensation: Statutory requirements B. General and Automobile Liability: $3,000,000 per occurrence combined single limit bodily injury and property damage. Deductible of$5,000 or less per occurrence. C. Professional Liability: $3,000,000 per claim. Deductible of$5,000 or less per claim. Additionally, Alameda County shall require its subcontractor to name as additional insured the County Receiving Services and to maintain the above referenced coverage levels. 4. Termination. This Contract may be terminated by either party, at their sole discretion, upon sixty-day advance written notice thereof to the other, and may be canceled immediately by written mutual consent of each County's Mental Health Director. 5. Notices. All notices provided for by this Contract shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices shall be addressed as follows: Contra Costa County: Director, Contra Costa County Mental Health 595 Center Avenue, Suite 200, Martinez, CA 94553 Alameda County: Mental Health Contract Office 777 Davis Street, Suite 350, San Leandro, CA 94577 6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. Initials: Contra Costa Alameda 4 - 633 - 2 EXHIBIT A Description of Services/ Performance Requirements Page 1 PROGRAM DESCRIPTION AND PERFORMANCE REQUIREMENTS Contractor: Alameda County- Service Provider: Guardian Postacute Services, Inc. Contract Period: July 1, 1995 through June 30, 1996 1. Contracted Services: Skilled Nursing Facility, Care and Program for OBS, Traumatic Brain Injured and medically debilitated patients 2. Program Name: Neuro-Behavioral Care Program Highview Convalescent Hospital 1301 E. 31st Street Oakland, CA 94602 3. Program Objectives: A. To provide a regional program which enables residents previously placed in the state hospital or more expensive levels of care to be treated in the community. B. To provide a safe, secure and behaviorally focused environment which enhances the opportunity of the resident to reach their maximum level of functioning. C. To develop alternative therapeutic interventions which reduce recidivism to more restrictive levels of care and enable the resident to remain in community placement for significantly longer periods of time. D. To develop a current and comprehensive assessment and treatment program for all residents based on their individual needs. EXHIBIT A Description of Services/ Performance Requirements Page 2 4. Program Description and Requirements: A. Officers: Robert G. Peirce President&CEO James N. Eimers Vice President& Secretary Araceli D. Antonio Vice President& Chief Operating Officer Hugh J. Van Ness Chief Financial Officer Members of the Board of Directors: Martha Robinson Robert D. Reed Dana O'Brien B. Executive Director/Chief Executive Officer: Robert G. Peirce, President C. Medical Director: Floyd Huen and Jim Mettleberger D. Program Director: Lillian Fong E. Contract Fiscal Officer: Hugh J. Van Ness EXIMIT A Description of Services/ Performance Requirements Page 3 F. Program Description: Our basic philosophy of treatment in working with a permanently disabled population of OBS adults is to provide a pleasing and attractive living environment, a well supervised and safe nursing-led milieu, and a simple, yet comprehensive therapeutic program focusing on evaluation, medication, and a clearly defined program of behavioral expectations, rehabilitation and recreation opportunities, social skills training and discharge options, where appropriate. One of the major clinical and placement concerns in working with this population is their tendency to react unexpectedly, impulsively and perhaps aggressively. Additionally, they demonstrate clear limits in initiating interpersonal or individual behavior and tend to fatigue easily. It is essential for program staff to simultaneously present an expectation of appropriate program involvement and participation on behalf of the resident and at the same time accept their limits positively. Guardian Foundation and M.J. Gross & Associates are aware of the difficulty and challenge in providing and encouraging resident involvement and participation in the habilitative groups and structured activities. Many of the groups and activities intended for the Program are of low structure and demand, such as Coffee Break Group (offered daily), ADL's (daily), Board Games and Current Events. Other groups can be revised to allow an easier or more flexible level of participation, such as Outdoor Recreation, Socialization Group, Relaxation and Stretch, and Peer Support. We have found it most beneficial to our residents' overall progress to simultaneously: 1) acknowledge the difficulty this population has in participating in groups or structured activities; and 2) utilize a process of successive approximation, extensive resident praise and support, and interest stimulation to encourage initial and small group participation; and 3) encourage greater and more progressive degrees of program participation over time. Our program policy is to rely on encouragement, direction, persuasion, influence and reinforcement to support greater resident participation in group and program activity. Non-participation or program avoidance is a symptom of the illness and should be addressed as a treatment objective, not as an oppositional and contrary posture by the resident. Residents who are simply unable or unwilling to participate in program structure or groups shall be provided the other components of the overall treatment program, including medication, supervision, and case management to ensure the best possible therapeutic response for that particular resident at that particular time. EXHIBIT A Description of Services/ Performance Requirements Page 4 Our goal is to make resident participation a "Win-Win" process, where residents can begin to develop both interest and a sense of personal safety in socializing and participating in the program, and program staff can accept that the resident has a significant level of impairment which entails a slow, careful and guarded prognosis regarding full participation. Although we acknowledge the extensive impairment and disability our residents may have, we also acknowledge the tremendous potential for growth, recovery and adaptation our residents may possess. In many ways we perceive our residents as capable of great strides, but we are also aware of how slow and challenging any change may be. OBS patients all present with a wide variety of neuro-psychological impairment. In addition to standard medical and psychiatric work-ups, these patients can benefit from a neuro-psychological evaluation. These assessments can assist staff in developing individualized approaches for each resident and staff can be directed to approach some residents using verbal re-direction, others using tactile feedback, and still others using visual cues. Individual treatment plans will focus on achievable, pertinent goals, probably no more than two at a time, and may include reducing assaultiveness through provision of a verbal alternative (or tactile, or visual, etc) or may include increased self-care and ADL's. The primary objective of the program is to develop a current and comprehensive assessment, stabilization, safety, security and skills training, all within an atmosphere of positive regard and appropriate expectation. The staffing proposed allows for an intensity and quality that is necessary for these seriously debilitated residents. The program will treat older adults of any ethnic or ancestral group, race, sex, sexual orientation, religion, or national origin and will provide culturally oriented programming for that population. The program will provide translators for any non-english speaking adult for whom neither a family member or a staff member is able to act as translator. EXIMIT A Description of Services/ Performance Requirements Page 5 G. Program Goals: The goal of this program is to provide a caring, qualified staff, a pleasing environment and proven treatment programs. Since a single therapeutic approach does not work for everyone, program offerings are based on the needs of the individual, including group, individual and family therapy, behavior modification, a variety of activity therapy and one-to-one interactions with staff members and other residents through an approach that is solidly anchored in a well supervised therapeutic milieu. All activities and interactions are processed through this therapeutic milieu, so that everyday activities of daily living can be a source of therapeutic stabilization, impact and change. The treatment program reflects the belief that individuals, regardless of their level of impairment, can be rehabilitated and maintained at their maximum potential. The goal of treatment for the OBS population is to provide a comfortable and highly skilled nursing environment which provides health care services in a therapeutic, non-threatening milieu and allows the individual to progress or maintain at their own individual level of comfort. H. Performance Objectives A. To provide 24,888 patient days per year in a SNF certified by MediCal. B. To treat an average of 68 residents per year. C. To reduce recidivism (usage) to more restrictive levels of care by 80%. D. To decrease points an average of 2 points less restrictive levels of care annually. I. Discharge Criteria and Planning Discharge planning shall be an integral part of the residents treatment program. Beginning at the time of pre-admission screening and throughout the course of treatment, discharge planning is addressed by the social worker in conjunction with the multidisciplinary treatment team on the resident's initial treatment plan. Continued assessment of the resident's discharge planning status occurs through review by the Clinical Director, the multidisciplinary treatment team and the County monitor. EXIMIT A Description of Services/ Performance Requirements Page 6 All discharges will be planned in advance with every effort made to avoid precipitous discharges and/or readmissions. The objective is to provide long range planning to meet the needs of the residents and his/her family as well as to take preventative measures to avoid the necessity for repeated crisis intervention and to allow the resident and family to appropriately utilize community resources. Acute hospitalization may need to occur when dangerous, acutely unmanageable behavior presents serious threat to the safety of the resident or other, or if the resident becomes acutely medically unstable. Aftercare planning will be divided into five stages: 1. Assessing the resident and family needs 2. Exploring available resources 3. Making recommendations 4. Facilitating referral 5. Follow-up Anticipating the need for others to supplement and complement what this program provides, the staff will remain current in terms of available services and the quality of those services. The social service staff is responsible for being familiar with and knowledgeable about how other agencies, organizations and individuals are related, either directly or indirectly, in providing mental health and health services, in both the public and private sectors. J. Case Management: When the resident is discharged, an agreement will be made with the community resource or family receiving the resident that will enable the former to contact the program personnel if any problems arise relative to the continuing care of the resident. The uniqueness of this agreement, and the uniqueness of the consulting and training services being offered, cannot be overemphasized. The program will also make the commitment and have the capability to serve as a consulting resource to any placement institution or family member who needs assistance in the difficult task of caring for the discharged resident. We will expect a commitment from the family or agency to continue to work with the resident in the manner prescribed as being the most effective way of assisting the resident to adjust to the social environment to which he/she has been discharged. EXHIBIT A Description of Services/ Performance Requirements Page 7 The Social Service staff will be responsible for linking the resident with county case management services and providing information regarding aftercare recommendations to the placement agency. Meetings prior to discharge and involvement by the family, agency or case manager will be encouraged so that services flow appropriately, supporting the newly discharged adult in their new environment. This transition will be critical for the resident's success in the placement and a primary focus of the program's social workers. K. Limitations of Services: Residents who do not meet MediCal certification criteria for SNF level of care will not be able to be admitted and/or continued in the program. This includes residents who are considered medically and psychiatrically unstable and requiring acute levels of care. L. Patient Record Requirement: Resident records will be maintained in accordance with California Code of Regulations and MediCal certification requirements. Authorized county personnel will be permitted to review the charts and are encouraged to participate in the treatment planning and chart review process to determine clinical effectiveness, appropriateness and timeliness of services being delivered. M. Quality Assurance: Quality Assurance regulations, as promulgated by Alameda Co., the State of California and the facility itself include but are not limited to Peer Review, Medication Monitoring and Utilization Review. The facility will adhere to County reporting requirements as provided in the County's State approved Quality Assurance Plan. i. Medication Monitoring All psychotropic or psychoactive medications will be monitored on an on-going basis through Utilization Review, but also on a quarterly basis for the Quality Assurance Committee by the Medical Director. Medications will be monitored for appropriateness, interaction with other medications, effectiveness and drug sensitivity. Physicians will be provided with information and counseling regarding their use of medications as it relates to program and community standards. EX MIT A Description of Services/ Performance Requirements Page 8 ii. Peer Review All professional disciplines (physicians, psychologists, licensed nurses, social workers, rehabilitation therapists) will take part in the peer review process. Department heads will be responsible for reviewing the medical records of individual staff on a quarterly basis based on standards or criteria provided by the county or prepared by the facility. Feedback, counseling, and on-going education will be provided as necessary to maintain standards of care. iii. Utilization Review The medical record of each resident admitted to the Intensive Day Treatment Program will be reviewed against admission criteria within 15 days following admission and then every 30 days thereafter. The initial admission review will focus on the appropriateness of the treatment plan in relation to the diagnosis, while the continuing stay review will focus on continuing need for the level of service as defined by the treatment plan and the response of the resident to the treatment. All disciplines will be represented on the Utilization Review Committee. Deficiencies noted by the Committee will require corrective action by facility staff, and results and action of the Utilization Review Committee will be reported to the Quality Assurance Committee. 4N. Minimum Staffing Qualification: See Attached Position Descriptions. 40. Organizational Chart: See Attached. 5. Hours/Days of Operation: 24 hours/day, 7 days/week. 6. Reporting Requirements: Regular monitoring of each resident's progress, reassessments for continued stay, and coordination of aftercare services will be coordinated with the assigned county program liaison and individual case workers. To ensure that program objectives and county goals are satisfied, a close working relationship is expected between the County and the program staff. EXHIBIT A Description of Services/ Performance Requirements Page 9 7. Evaluation Requirements Family and placement resource satisfaction surveys will be conducted periodically to assess outside perception of the program and obtain valuable input for on-going evaluation and program adjustment. An Annual Report will be prepared for the Counties and the community detailing compliance with contract goals and objectives and describing internal and external achievement, as well as client performance objectives. 8. Certification/Licensure: 71 Skilled Nursing Facility Number: 020000047 Exp. Date: 5/23/96 Facility will also be MediCal certified 9. Target Population: A. Medically debilitated and compromised - Diagnoses will include but not be limited to clinical profile described in the RFQ. It is expected that total nursing care would be provided to each of these residents. In addition IV's, decubitus care, NG tubes, stomach tubes, suctioning & trach care and 02 will be provided. Exclusions will be ventilator patients -and patients meeting acute medical care standards for admission to med-surg hospitals. When the patient is discharged from the med-surg acute care hospital, the patient will be readmitted to this facility. B. Non ambulatory - Most residents are expected to be non ambulatory and will need assistance with ambulation (if at all appropriate). Those few residents who may be ambulatory may be isolated or confused, however, they will not present an elopement risk. C. Psychiatric behaviors - Assaultive, confused, isolative, aggressive behaviors will be managed through planned therapeutic interventions, appropriate psychopharmacology and treatment planning of medical and psychiatric MDs, RNs, LVNs, LCSWs, Rehab staff and certified nursing assistants. All staff will be trained in both appropriate medical and psychiatric interventions and behavioral management techniques. EXHIBIT A Description of Services/ Performance Requirements Page 10 10. Service Area: This program and facility'will be a regional program and service as a minimum 11 Bay Area Counties. Alameda County will serve as the host county with other counties contracting for services in this facility for their designated patients through this Alameda County contract. 11. Service Delivery Sites: Highview Convalescent Hospital 1301 E. 31st Street. Oakland, CA 94602 12. Service Criteria: To be eligible for admission, a resident must be: A. A referred resident of one of the participating counties. B. 21 years of age or older. C. Diagnosed as having either OBS, dementia or a serious medical disability needing SNF level of care. D. Temporarily or permanently conserved or agree to voluntarily admit themselves. E. Meet SNF/MediCal admission and continued stay requirements. (TAR eligibility for MediCal SNF). F. Have a MediCal card or number. Intake hours will be from 8:00 -4:30, Monday through Friday. Exhibit B Terms & Conditions 1 Contractor: Alameda County Service(s): Access to 24 Hour Skilled Nursing Care - Neuro-Behavioral provided by Guardian Foundation Period: July 1, 1995 through June 30, 1996 TERMS AND CONDITIONS OF PAYMENT In return for access to the aforementioned services as set forth in Exhibit A of this agreement, the County agrees to reimburse the Contractor on the following basis: 1. Total Remuneration Remuneration to the Contractor under this agreement shall be known as net reimbursable cost and shall, in no event, exceed the amount of$313,090. 2. Basis for Final Reimbursement Contractor shall be reimbursed on the basis of a negotiated net amount specified in Paragraph 3. County shall consider this amount as net final reimbursable cost. 3. Reimbursement Method, During Contract Period County acknowledges the necessity of providing a cash flow to Contractor to enable Contractor to pay program operating and other expenses of the Guardian Foundation herein after referred to as the program provider. Therefore, to establish the aforementioned cash flow, County shall pay Contractor for services in accordance with the following reimbursement method(s) and payment schedules: Net negotiated amount of$313.090 for access to 11 bed(s) at the Neuro-Behavioral Care program operated by the Guardian Foundation. Schedule of payments: Fiscal year 1995-96 net negotiated amount of$313090 to be paid on or before January 1, 1996. 4. Submittal Deadline for Claims Contractor shall submit claim(s) for payment to County 30 days prior to the payment date(s) as specified in Paragraph 3.