HomeMy WebLinkAboutMINUTES - 03081994 - 1.43 P,e/ i S 7- S/&
1 y 3
TO: BOARD OF SUPERVISORS /,,'' — Contra
FROM, Mark Finucane, Health Services Director t
ra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: February 17, 1994 County
SUBJECT: Approval of Standard Agreement #29-469-2 with the State Department of
Mental Health (FY 1993-94 Performance Contract)
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director to execute on behalf of the
County:
A. Standard Agreement #29-469-2 (State #93-73277) with the State of California,
Department of Mental Health, representing the County's Mental Health
Services "Performance Contract" for Fiscal Year 1993-94, as required by the
Bronzan-McCorquodale Act (Mental Health Realignment Legislation) ; and
B. The Statement of Compliance (nondiscrimination) and the Drug-Free Workplace
Certification.
II. FINANCIAL IMPACT:
Like last year's Performance Contract, this Fiscal Year 1993-94 Contract refers
to a separate allocation process under which the State will make funding
allocations to the County (as was routinely done prior to Realignment Legislation)
for certain mental health services in Fiscal Year 1993-94, particularly for
Community Services (Vocational Rehabilitation) ; Special Education Pupil (S.E.P.)
Assessment, Treatment and Case Management (under AB 3632) ; and Federal PATH
(Homeless) and SAMHSA (formerly ADAMHA) Block Grant Funds. This Contract also
contains provisions for: (1) State reimbursement to the County for the County's
delivery of Medi-Cal services and (2) County Use of State Hospitals. The Contract
obligates the County to pay the State $4,736,852 for State Hospital use in FY
1993-94.
The Contract for FY 1993-94 reduces by nearly one half the number of State
Hospital beds contracted for in FY 1992-93 (from 71 to 39) ; and represents savings
of $2.8 million. The Performance Contract for FY 1992-93 totalled $7,511,850 for
State Hospital use.
In keeping with the goal to provide the lowest level of appropriate care, the
Health Services Department, Mental Health Division has worked to develop
alternatives to usage of high-cost State Hospital beds at a cost of $712,088
through contracts with Telecare Corporation facilities at Garfield, Gladman and
Villa Fairmont Hospitals ($178,795) ; participation in a Regional Neuro-Behavioral
Care Program to provide skilled nursing facility care and programs for organic
brain syndrome (OBS) , traumatic brain injured and medically debilitated patients
($306,238) ; and subcontracting with Alameda County for use of several of their
unused contract Telecare beds ($227,055) .
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
lien A-0-
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMM D ION OF BOARD C MMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON March R ., 1994 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT IV ) 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 March 8 , 1994
Auditor-Controller (Claims)
State Department of Mental Health .Phil Batchelor, Clerk of the Board of
Sup i�ars�d �AQmini�ttator
M382/7-83 BY - DEPUTY
Board Order
Standard Agreement #29-469-2
Page 2
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Board approval of this Mental Health Services Performance Contract is required for
the County to retain the above allocations of State and Federal Funds for FY 1993-
94. The Contract also covers other County Realignment requirements, including
maintenance of effort, access to and use 'of State Hospital, data collection and
reporting, and cost reporting on County mental health programs.
At its meeting on February 22, 1994, the County's Mental Health Advisory
Commission reviewed the FY 1993-94 Mental Health Services Performance Contract.
Furthermore, the Mental Health Advisory Commission has reviewed and approved
procedures for ensuring citizen and professional involvement in the.mental health
services planning process.
sE L CONTRA COSTA COUNTY
MENTAL HEALTH COMMISSION
595 CENTER AVENUE,SUITE 200
-- MARTINEZ,CALIFORNIA 94553-4639
0 =y;ei+?',+. Phone(510)313-6414
�F 4
_covtzRECEIVED
srA `�
MAR 41994
CLERK BOARD OF SUPERVISORS
February 23, 1994 CONTRA COSTA CO.
Tom Powers, Chair
Contra Costa County Board of Supervisors
651 Pine Street
Martinez, CA 94553
Dear Supervisor Powers and Members of the Board:
On February 22, 1994, in accordance with Welfare & Institutions Code,
Section 5651.5, the Mental Health Advisory Board reviewed the proposed
Mental Health Services Performance Contract #93-73277 between the County
and the State of California (Department of Mental Health) for the
provision of certain mental health program services in FY 1993-94.
Furthermore, the Mental Health Advisory Commission has reviewed and
approved procedures for ensuring citizen and professional involvement in
the planning process for mental health services.
We recommend approval of the proposed Performance Contract #93-73277.
Sincerely,
Violet Smith, Chair
pr
cc: Supervisor Bishop
Supervisor McPeak
Supervisor Torlakson
Supervisor Smith
Phil Batchelor
Mark Finucane
Lorna Bastian
A351 (6193)
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93-73277
TAXPAYERS FEDERAL EMPLOYER IDeffIFICATION NUMBERTBIS AGREEMENT.made` and entered into thisIst day of July . 19 93 .
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
CONTRACTORS NAME 469 - �
NOY
Deputy Director Mental Hesj�A
TITLE OF OFFICER ACTING FOR STA17E
hereafter called the State,and
______ _____ County Mental Health .hereafter Called the Contractor.
VIITNES3ETH: That the Contractor for and inconsideration of the covenants,conditions,agreements,and stipulations of the State hereirtafter expressed
d ^b�dyu�e�b��b�the Su� �m� � � materials �� ��
uuo�s; for�v��euo6en�� � ����
^ ayC� m�w�*v/e pp�Com� �
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�tLmeforp*rfo,maqcxnrcompletion,and attach plans and gpuoificatiomu.ifuny.) r'
WHEREAS, pursuant to Sections 5602 and 4330 of the California Welfare and Institutions Code. the
County is responsible for establishing a community mental health service to cover the entire area of
the County, and for reimbursing the Department for its use of state hospital beds; and
WHEREAS, the State has jurisdiction over Atascadero. Camarillo, Metropolitan, Napa and Patton
State Hospitals, which provide services to persons with mental disorders, in accnrde�cn with the
California Welfare and Institutions Code Section 4100 et seq.; and —
WHEREAS, the County desires to contract with the State for the provision of professional and
inpatient hnspital services to persons who are acutely mentally ill, including mentally ill persons who
require health care services; and
WHEREAS. the County is committed to providing an integrated and coordinated ranye of services
appropriate to the needs of each client, with the State Hospital(s) functioning as one uf the providers
in this range of services; and
WHEREAS, the State is agreeable to the rendering of such services on the terms and conditions
hereinafter set forth'
.
NOW, T8ERERORE, in consideration of the mutual promises and covenants stated in this Contract' the
County and the State agree as follows:
The documents attached hereto and incorporated herein bv this reference do hereby constitute the Fiscal
Year 94 mandated County Performance Contract Ancluding the County Use of State Hospitals
Agreement) as mandated by Section 5660 of the Welfare and Institutions Code.
This contract shall not be effective until it has been approved by the Department of Mental Health.
CONTINUED ON — SHEETS,EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
IN NVITNESS WHEREOF,this agreement has been executed by the parties hereto,upori the date first above written.
STATE OF CALIFORNIA CONTRACTOR
AGENCY CONTRACTOR(11 #W an 1ndivi&Aa4 st%�
Department of Mental Health 06�os C( y I
Contra
BY(AUTHORIZED!�QNATURE)
;K(AUTHOPIZED SIG7
;RIN17GO NAME OF PERSON SIGNING PRINTE6�AMIE Z&-Tp OF PERSON SIGNING
LINDA A. POWELL, Deputy Director Mark FiMjcMe, Beill-th. T)i rp(-t-
TITLE ADDRESS
Administrative Services
L651 Pine Strept- =t-inp7- CA- -94553
WOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TI Depenment of General
DOCUMENT Not Applicable Use only Services
PRIOR AMOUNT ENCUMBERED FOR
THIS CONTRACT Exempt from compliance with
$ ITEM CHAPTER tSTATUTE FISCAL YEAR the Public Contract Code,
TOTAL AMOUNT ENCUMBERED TO I --- - .1111,—— 93/94 the State Administrative
DATE OBJECT OF EXPENDITURE(CODE AND TITLE) Manual, and from approval by
the Department of General
I hereby cerfify upon my own personal knowledge that budgeted funds T.B.A.NO. S.R.NO. Services per Sections 5706
are available for the period and purpose of the expenditure stated above. and 4331 (a) of the Welfare
SrGNATURE OF ACCOUNTING OFFICER 04ATE and Institutions Code.
> Not Applicable
F-1 CONTRACTOR r-1 oTATEAGENCY DEPT.OF GEmSIEn. 0 CONTROLLER APR 1 3 1994
Co+itract ,No. 93-73277
Contractor Contra Costa County Mental Health
COUNTY PERFORMANCE CONTRACT
Fiscal Year 1993/94
Page
PART I PERFORMANCE CONDITIONS
EXHIBIT "A" GENERAL ASSURANCES AND PROGRAM PRINCIPLES
Section 1 - Maintenance of Effort . . . . . . . . . . . . . 1
Section 2 - Administrative Assurances . . . . . . . . . . . 1
Section 3 - Routine Information Needs . . . . . . . . . . . 2
Section 4 - Program Principles . . . . . . . . . . . . . . 2
Section 5 - Program Reimbursement Methods . . . . . . . . . 2
Section 6 - Utilization Review/Quality Assurance. . . . . . 3
Section 7 - Children' s Projects . . . . . . . . . . . . . . . 3
Section 8 - Performance Outcomes . . . . . . . . . . . . . . 4
EXHIBIT "B" SPECIFIC PROVISIONS . . . . . . . . . 6 - 7
Attachment 1 Approval of County/Provider Negotiated Rates 8
Attachment 2 Negotiated Short-Doyle/Medi-Cal Rates 9
PART II STATE HOSPITAL BED USAGE
EXHIBIT "A" TERMS AND CONDITIONS
Section 1 - Facilities, Payments, and Services . . . . . . . 10
Section 2 - County Responsibilities . . . . . . . . . . . 10
Section 3 - Description of Covered Hospital Services . . . 11
Section 4 - Standards of Care . . . . . . . . . . . . 13
Section 5 - Planning. . . . . . . . . . . . . . . . . 14
Section 6 - Admission and Discharge Procedure . . . . . . . 14
Section 7 - Prior Authorization . . . . . . . . . . . 17
Section 8 - Coordination of Treatment/caseManagement . . . 17
Section 9 - Bed Usage . . . . . . . . • • • • • • • 19
Section 10 - Utilization Review. . . . . . . . . . . . . . 21
Section 11 - Quality Assurance . . . . . . . . . . . . . . 22
Section 12 - Exchange of Information . . . . . . . . . . . . 23
Section 13 - Records . . . . . . . . . . . 23
Section 14 - Revenue . . . . . . . . . . 25
Section 15 - Inspections and Audits . . . . . . . . . . . . . 25
Section 16 - Notices . . . . . . . . . . . . . . . . . . 26
Section 17 - Notification of Death . . . . . . . . . . . 27
Section 18 - Reports . . . . . . . . . . . . . . . . . . 27
Section 19 - Small County Bed Pool . . . . . . . . . . . . . 28
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Contraci No. 93-73277
Contractor Contra Costa County Mental Health
Page
EXHIBIT "B" SPECIFIC PROVISIONS . . . . . . . . . . . 30 - 33
B-1 Specific County Cost Computation . . . . . . . 34
PART III GENERAL PROVISIONS
1 . Term of Contract . . . . . . . . . . . . . . . . . . . . 36
2 . Budget Contingencies . . . . . . . . . . . . . . . . . . 36
3. Confidentiality . . . . . . . . . . . . . . . . . . 37
4 . Nondiscrimination . . . . . . . . . . . . . . . . . . . 38
5 . Patients ' Rights . . . . . . . . . . . . . . . . . . . . 38
6 . Recordkeeping . . . . . . . . . . . . . . . . . . . . . 39
7 . Relationship of the Parties . . . . . . . . . . . . . . 39
8 . Reports . . . . . . . . . . . . . . . . . . . . . . . . 39
9 . Severability . . . . . . . . . . . . . . . . . . . . . . 39
10 . Subcontracting . . . . . . . . . . . . . . . . . . . . . 40
11 . Waiver of Default . . . . . . . . . . . . . . . . . . . 40
Contrzct No. 93-73277
Contractor Contra Costa County Mental Health
PART I -- PERFORMANCE CONDITIONS
EXHIBIT "A" - GENERAL ASSURANCES AND PROGRAM PRINCIPLES
SECTION 1 - MAINTENANCE OF EFFORT
The County is in compliance with the expenditure requirements of
Welfare and Institutions Code (WIC) , Section 17608 .05 .
SECTION 2 - ADMINISTRATIVE ASSURANCES
Part I of this agreement includes the following County
assurances :
A. The County will comply with all requirements necessary for
Short-Doyle/Medi-Cal reimbursement for mental health services
provided to Medi-Cal eligible individuals, including, but not
limited to, the provisions set forth in Welfare and
Institutions Code, Section 5718 through 5724 .
B. The County attests that , the Local Mental Health Board has
reviewed and approved procedures ensuring citizen and
professional involvement in the planning process.
C. The County will provide other information required, pursuant
to State or Federal statutes .
D. The County is in compliance with the expenditure requirements
of Welfare and Institutions Code, Sections 5704 .5 and 5704 .6 .
E. The County and its subcontractors shall provide services in
accordance with all applicable Federal and State statutes and
regulations .
F. The County has a certification review hearing procedure in
force which shall comply with applicable State statutes .
G. The County assures that all recipients of services are
provided information in accordance with provisions of Welfare
and Institutions Code, Sections 5325 through 5331 pertaining
to their rights as patients, and that the County has
established a system whereby recipients of service may file a"
complaint for alleged violations of their rights . The County
further assures compliance with Title VI of the Civil Rights
Act of 1964 and Federal regulations at 45 CFR, Parts 80 and
84 .
H. All (professional level) persons employed by the County
mental health program (directly or through contract)
providing Short-Doyle/Medi-Cal services have met applicable
professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
1
Contrzct No. 93-73277
Contractor Contra Costa County Mental Health
I . To comply with Public Law 99-660, the County agrees to
provide case management services to all seriously mentally
ill adults and seriously emotionally disturbed children who
receive substantial amounts of public mental health funds or
services .
J. The County agrees to pursue a culturally competent system of
care.
SECTION 3 - ROUTINE INFORMATION NEEDS
A. County shall continue to submit Client Data System (CDS) data
and CR/DC cost reports for the term of this agreement
pursuant to Welfare and Institutions Code, Sections 5610(a) ,
5651(a) ( 8) and (d) , 5664 (a) and (b) , and 5664 .5 . Cost
.reports for counties with a negotiated net amount contract
are for information only and will not be used to settle to
actual cost.
B. The County shall submit CDS data within 60 days after. the end
of the month to which the data applies . The Department shall
process the County data and return an edit listing or advise
the County of the results of the edit process within 25 days .
The County shall return the edit listing with corrections
within 30 days of receipt. Any exceptions to these
conditions will be considered on an individual County basis.
C. County and its subcontractors shall submit a fiscal year-end
Short-Doyle/Medi-Cal cost report, due November 30th, in
accordance with Welfare and Institutions Code, Sections
5651(a) (4 ) , 5664(a) and (b) , and 5664 .5 . The statewide
maximum upper limits of reimbursement for Short-Doyle/Medi-
Cal services shall be those specified in Section 51516,
Title 22, California Code of Regulations, pursuant to Welfare
and Institutions Code, Section 5720 .
SECTION 4 - PROGRAM PRINCIPLES
The Department of Mental Health and the County agree that, to the
extent funds are available, the program principles and the array
of treatment options are in accordance with Welfare and
Institutions Code, Sections 5600 .2 through 5600 .9 .
SECTION 5 - PROGRAM REIMBURSEMENT METHODS
Two methods of County reimbursement are applicable for PART I of
this agreement during Fiscal Year 1993-94 .
A. The first method of reimbursement applies only to former
"SB 900" counties now operating under the provisions of
Welfare and Institutions Code, Section 5708. Under this
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l Contract No. 93-73277
Contractor Contra Costa County Mental Health
method, funds allocated by the Department of Mental Health in
accordance with Section 3 of Exhibit "B" shall be obligated
pursuant to Welfare and Institutions Code, Section 5705(b) ( 1) .
Reimbursement for Federal Grants shall be based on actual cost
subject to Federal cost containment requirements and
availability of funds . Reimbursement for Short-Doyle/Medi-Cal
services shall be based on countywide negotiated rates
pursuant to Section 51516 (b) of Title 22, California Code of
Regulations .
If this method is used, the County must complete the
attachment labeled "NEGOTIATED SHORT-DOYLE/MEDI-CAL RATES" .
B. The second method of reimbursement applies to all "non-
SB 900" counties . Under this method, funds allocated by the
Department of Mental Health in accordance with Section 3 of
Exhibit "B" shall be obligated pursuant to Welfare and
Institutions Code, Section 5705(b) ( 1) . Reimbursement for
Short-Doyle/Medi-Cal and Federal Grants. shall be settled to
actual cost, subject to existing State and Federal cost
containment requirements and principles .
SECTION 6 - UTILIZATION REVIEWIOUALITY ASSURANCE
A. The County and its subcontractors shall establish and use
systems to review the quality and appropriateness of services
in accordance with applicable Federal and State statutes and
regulations operative. during the term of this contract.
B. The Department of Mental Health shall review the existence
and effectiveness of the County' s and subcontractor' s
utilization review systems in accordance with applicable
Federal and State laws and regulations .
. SECTION 7 - CHILDREN'S PROJECTS
HUMBOLDT, LOS ANGELES, MERCED, MONTEREY, PLACER, RIVERSIDE, SAN
LUIS OBISPO, SAN MATEO, SANTA CRUZ, STANISLAUS, AND VENTURA
COUNTIES ONLY
The Department of .Mental Health will assure the AB 377/AB 3015
counties (hereafter referred to as "System of Care" - SOC -
counties) the following:
A. Effective July 1, 1993 and until the end of the fiscal year,
the Department of Mental Health shall make monthly payments
from either the State General (SG) fund or federal block
grant Substance Abuse and Mental Health Services
Administration (SAMHSA) funds to each of the AB 377 (SG) and
the AB 3015 (SAMHSA) funded SOC counties in amounts equal to
1/12 of the respective fiscal year 1993-94 SG or SAMHSA
allocations.
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TCon trac t No. . 93-73277
Contractor . Contra Costa County Mental Health
B. Provision of technical assistance, training, and
consultation, as resources allow, to assist the respective
SOC county to achieve the goals/objectives specified in its
submitted Fiscal Year 1993-94 "Scope of Work Plan" which is
required as a condition to assure that the goals/objectives
of the enabling legislation (Chapter 1229, Statutes of 1992,
AB 3015) -are met.
Each SOC county shall assure the Department of Mental Health
that it will comply with all the state goals and measurable
objectives, terms and conditions and all other requirements
contained in the Department approved "Scope of Work Plan" for
Fiscal Year 1993-94 attached hereto and by this reference
incorporated herein. Each federally funded SOC county shall
also assure the Department of Mental Health that it will
comply with federal terms, conditions-both fiscal and
program-related to award of the SAMSHA federal block grant.
SECTION 8 - PERFORMANCE OUTCOMES
A. Outcome Reporting
1. Adults: County agrees to report outcome information as
required by the Director of the California Department of
Mental Health in consultation with the Performance Outcome
Committee established pursuant to Chapter 89, Statutes of
1991 .
a. Performance outcome surveys will be `Uconducted no more
than twice a year in six-month intervals .
b. The Department of Mental Health will randomly select
clients for each of the county/city program surveys
from the Client Data System (CDS) .
c . The samples will be no larger than that needed to yield
statistically reliable data ( 10 percent tolerable error
at a 95 percent confidence level) at the county level.
2 . Children and Adolescents: County agrees to report outcome
information as required by the Director of the California
Department of Mental Health in consultation with the
Performance Outcome Committee established pursuant to
Chapter 891 Statutes of 1991.
a. A pilot for this reporting will be conducted during the
period of this contract.
b. The purpose of the pilot will be to refine in
consultation with the Services, Outcomes and Standards
Committee the questions, the questionnaire, the process
and training.
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
c. The Department will ask counties to volunteer to
participate in this, pilot.
3 . Results of the, reporting of outcome information will be
used to refine reporting process requirements, further
revise or decrease remaining CDS data requirements, and
establish a basis for evaluating and reporting client
outcomes . Results will not be used to negatively impact
the amount of funds otherwise allocated or provided by the
Department for local services . '
B. Target Population Reporting
1. County agrees to report target population information as
required by the Director of the California Department of
Mental Health in consultation with the Performance Outcome
Committee established pursuant to Chapter 89, Statutes of
1991. During Fiscal Year 1993-94, the target population
information will be gathered through a series of questions
contained in the performance outcomes survey.
2 . Results of the reporting of target population information
will be used to refine reporting process requirements and
further revise or ' decrease remaining CDS data
requirements . Target population information will be used
to identify the clients served that belong to this
population .and does not represent, nor should be used as,
a State eligibility requirement for receiving services.
5
r T
(Contract No. 93-73277
Contractor Contra Costa County Mental Health
PART I -- PERFORMANCE CONDITIONS
EXHIBIT "B" - SPECIFIC PROVISIONS
1. The State has designated the Deputy Director, Administration,
for all issues relating to PART I of this contract, to be its
Project Coordinator. Except as otherwise provided herein,
all communication concerning PART I of this contract shall be
with the Project Coordinator.
2 . The Department of Mental Health shall make allocations to the
County, in relation to conditions in PART I, from budget
sources as follows:
a. 4440-101-001(a) COMMUNITY SERVICES - OTHER
b. 4440-101-001(c) CHILDREN' S MENTAL HEALTH SERVICES
c . 4440-131-001 S.E .P. ASSESSMENT, TREATMENT, AND CASE
MANAGEMENT
These allocations shall be consistent with the statutory
provisions governing their allocation and the County' s
expenditure of these funds shall be consistent with the
statutory provisions governing their expenditure.
3. The County agrees that if it accepts Federal PATH and/or
SAMHSA (formally ADAMHA) Block Grant funds, the County will
abide by the specific conditions of Section 3OOX et seq. of
Title 42 of the United States Code as well as those
conditions established by other Federal and State laws,
regulations, policies, and guidelines .
4 . In a manner acceptable to the State in consideration of the
services as specified within PART I of this contract, the
Department of Mental Health agrees to make payment to the
County as follows:
a. Upon the effective date of the agreement, the Department
of Mental Health shall pay the County, at the beginning
of each month, 1/12 of 95% of the funds allocated by the
Department of Mental Health in accordance with the budget
for the current fiscal year.
Those Counties contracting with the Department of Mental
Health pursuant to Welfare and Institutions Code,
Section 5708 shall be paid 1/12 of 100% of the funds
allocated by the Department of Mental Health (SB 900
Counties) .
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Contract No. : 93-73277
`Contractor Contra Costa County Mental Health
b. The County agrees that all funds paid out by the
Department of Mental Health pursuant to this agreement
and any interest accrued locally shall be used
exclusively for providing mental health services,
including defraying ' operating and capital costs and
allowable County overhead.
5 . The County shall be reimbursed by Department of Mental Health
with Federal Title XIX funds (Short-Doyle/Medi-Cal
reimbursement will be made on the . basis of 50% Federal
Funding and 50% County match unless otherwise notified by the
Department of Health Services) for the cost of federally
eligible Short-Doyle/Medi-Cal services rendered to federally
eligible Medi-Cal beneficiaries . Reimbursement of
expenditures will be made to the County upon receipt of these
funds from the Department of Health Services in accordance
with current procedures and provided the County has submitted
the required claims in the prescribed format and within time
lines .
6 . If the County chooses to reimburse Short-Doyle/Medi-Cal
subproviders using negotiated rates, the negotiated rates
shall be specified in the attachment, incorporated herein,
labeled "APPROVAL OF COUNTY/PROVIDER NEGOTIATED RATE
CONTRACTS" and shall be approved by the Department of Mental
Health pursuant to Welfare and Institutions Code, Section
5716
7 . Any funds allocated for conditions specified within PART I of
this contract, that by legislative requirement or department
policy are to be expended in specified program categories,
shall be spent only in accordance with State statutes,
policies, and regulations.
8 . Should a dispute arise relating to any issue within PART Iof
this contract, the County shall, prior to exercising any
other remedies which may be available, provide written -notice
within a thirty-day period of the particulars of such dispute
to:
Director
Department of Mental Health
1600 9th Street
Sacramento, CA 95814
Such written notice shall contain the contract number. The
Director, or his designee, shall meet with the County,
review the factors in the dispute, and recommend a means of
resolving the dispute before a written response is given to
the County. The Director, or his designee, shall provide a
written response within thirty days .
7
1
t Con h-oc t No. 93-73277
Con trac for Contra Costa County Mental Health
PART I -- PERFORMANCE CONDITIONS
ATTACHMENT 1
APPROVAL OF COUNTY/PROVIDER
NEGOTIATED RATE CONTRACTS
Provider Provider Mode of Service Negotiated
Number Name Service Function Rate
J
Instruction: This form to be 'completed by those non-SB 900
counties negotiating rate contracts with providers
for Short-Doyle/Medi-Cal services.
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IConti-act No. 93-73277
Contractor Contra Costa County Mental Health
PART I -- PERFORMANCE CONDITIONS
ATTACHMENT 2
NEGOTIATED SHORT-DOYLE/MEDI-CAL RATES
(FOR FORMER "SB 900" COUNTIES)
Consistent with the provisions of Welfare and Institutions Code,
Section 5705 and Title 22, California Code of Regulations, Section
51516, the negotiated rates for reimbursement under the Short-
Doyle/Medi-Cal program shall be -as follows for Fiscal Year 1993-94:
APPROVED RATE PER UNIT OF SERVICE
Hospital inpatient services, per day'
Adult crisis residential services, per day
Adult residential services, per day
Day treatment intensive, half day
Day treatment intensive, full day
Day rehabilitative services, half day
Day rehabilitative services, full day
Mental health services, per minute
Medication support services, per minute
Crisis intervention servicesy per minute
Crisis stabilization services, per 4 hours
Case management, brokerage, per minute
Instructions: This form is only to be completed by those Counties
reimbursed pursuant to Welfare and Institutions Code,
Section 5708.
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Contract No. 93-73277
Contractor Contra Costa County ,Mental Health
PART II -- STATE HOSPITAL BED USAGE
EXHIBIT "A" -- TERMS AND CONDITIONS
SECTION 1 — FACILITIES, PAYMENTS, AND SERVICES
The County shall compensate the State and the State agrees to
provide the services including, staffing, facilities, equipment,
and supplies in accordance with EXHIBIT A of PART II of this
Contract. The State shall operate the Hospital(s) continuously
throughout the term, as indicated in PART III of this Contract,
with at least the minimum number and type of staff which meet
applicable State and Federal regulations, and which are necessary
for the provision of the services hereunder. Payment(s) shall be
made in accordance with EXHIBIT B of PART II of this Contract.
SECTION 2 - COUNTY RESPONSIBILITIES
A. The County shall review the quantity and quality of services
provided pursuant to this Agreement, including the following.
1 . Medical and other records of County Patients . A copy of
the review report, if any, shall be provided to the
State.
2 . The Hospital(s) ' procedures for Utilization Review and
Quality . Assurance, and related committee minutes and
records, except for privileged communications and
documents . 1
3 . Periodic meetings regarding the quantity and quality of
services are encouraged with the Hospital' s Medical
Director, or designee.
B. The County shall screen, determine the appropriateness of,
and authorize all referrals for admission of County patients
to the Hospital(s) . The County shall, at the time of
admission, provide admission authorization, identify the
program to which the patient is being referred, and identify
the estimated length of stay for each County Patient. The
Hospital(s) Medical Director or designee shall make the
determination of the appropriateness of a County referred
patient for admission to the • hospital(s) and assign the
patient to the appropriate level of care and treatment unit.
C. The County shall provide such assistance as is necessary to
assist the Hospital(s) Is Social Services staff to initiate,
develop and finalize discharge planning and necessary follow-
up services .
D. The County shall provide; such assistance as is necessary to
assist in the screening of County Patients for alternative
placements, and shall facilitate such placements .
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Cont *qct No. 93-73277
Con trac tor Contra Costa County Mental Health
E. The County shall provide case management services, as defined
in Section 8 of EXHIBIT A in PART II of this contract.
SECTION 3 - DESCRIPTION OF COVERED HOSPITAL SERVICES
A. The State shall provide Lanterman-Petris-Short (LPS) hospital
services only to those. persons referred by the County
specifically for services under this Contract, including
those admitted pursuant to Sections 1370.01 of the Penal Code
and Murphy Conservatorship (Section 5008(h) ( 1) (B) of the
Welfare and Institutions Code) . When patients committed
pursuant to provisions of the Penal Code are converted to LPS
billing status they shall become the financial responsibility
of the county of first admission and part of that County's
LPS dedicated bed capacity as described in this contract.
The County Mental Health Director or designee shall be
involved in the process and the conversion shall be made in
accordance with the provisions of Section 16 D. of this
contract and the provisions of Divisions 5 and 6 of the
Welfare and Institutions Code. The following services are
provided:
1. Catalog of Services
The State shall prepare and make available ' a list of
available State Hospital services, to be updated
annually. This list shall indicate whether or not the
program is to be certified for participation in the
Federal MediCare or Medi-Cal program. Each county shall
be notified by the Department of any additional
speciality programs which are developed during the
contract year.
2 . Long Range Planning
The State shall develop a process by which the County
participates in long range planning and program
development within the Hospital(s) to ensure provision of
appropriate services to County patients .
3. Psychiatric and Ancillary Services
a. The State shall provide inpatient psychiatric health
care and support services, including appropriate care
and treatment to County Patients in the Hospital(s)
who suffer from mental, emotional or, behavioral
disorders and who have been referred to the
Hospital(s) by the County. The State shall not
refuse to admit patient referrals from the County
when the County has a bed available within its
dedicated capacity and the patient, in the judgment
of the Hospital(s) Medical Director or designee,
meets the established criteria for admission, and any
other provisions contained in this Contract.
Con trac t No. 93-73277
Contractor Contra Costa County Mental Health
b. The Hospital(s) shall provide psychiatric treatment
and other services in accordance with all applicable
laws and regulations, including, but not limited to,
Title 22 and Title 9 of the California Code of
Regulations .
C . The Hospital(s) shall provide all ancillary services
necessary for the evaluation and treatment of
psychiatric conditions . To the extent possible,'
medical procedures performed prior to a patient ' s
admission to the hospital shall not be duplicated.
B. Expert Testimony
The State and the Counties shall provide or cause to be
provided expert witness testimony by appropriate mental
health professionals in legal proceedings required for the
institutionalization, admission, or treatment of County
Patients . These proceedings may include, but not be limited
to, writs of habeas corpus, capacity hearings (Reise) as
provided in Section 5332 et seq. of the W&I Code,
conservatorship, probable cause hearings, court-ordered
evaluation, and appeal and post-certification proceedings .
C. Health Care Services
The State shall provide or cause to be provided any health
care services, including physician or other professional
services, required by County Patients served pursuant to this
Agreement. In cases where non-emergent ' or elective
medical/surgical care is recommended by hospital medical
staff and where the cost for such care is likely to exceed
$2, 000, the Hospital(s) Medical Director shall confer with
the County's Medical Director, or designee, regarding the
provision of service, including the option that, at the
County' s discretion, the County may make arrangements for the
provision of such service.
D. Electro-Convulsive Therapy
The Hospital(s) may cause to be provided Electro-Convulsive
Therapy, herein referred do as "ECT, " in accordance with
applicable laws, regulations, and established State policy.
E. Transportation
Transportation to and from the Hospital(s) , including court
appearances, County-based medical appointments or services,
and pre-placement visits and final placements, shall be the
responsibility of the County. The County shall also be
responsible for transportation between hospitals when the
transfer is initiated by the County. Other transportation
I
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
between state hospitals and transportation to. and from local
medical appointments or services shall be the responsibility
of the Hospital(s) .
SECTION 4 - STANDARDS OF CARE
A. Staffing
1- The State shall staff each Hospital unit which provides
services under this Agreement in accordance with
acceptable standards of clinical practice, applicable
State staffing standards and any applicable court orders
or consent decrees . The State shall provide
administrative and clerical staff to support the staffing
specified and the services provided hereunder.
2 . The County shall be provided access to Hospital staffing
information upon request (i.e. name, title, professional
degree, work experience, etc . ) for program evaluation
purposes .
3 . The State shall make a good faith effort to provide
sufficient bilingual staff with experience in a
multicultural community 'sufficient to meet the needs of
patients treated pursuant to this Contract.
B. Licensure
The Hospital(s) shall comply with all applicable Federal and
State laws, licensing regulations and shall provide services
in accordance with generally accepted practices and
standards prevailing in the professional community at the
time of treatment. The Hospital(s) which are accredited
shall make a good faith effort to remain accredited by the,
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) throughout the term of this Contract.
C. Patient Rights
1. The Hospital(s) shall in all respects comply with
Federal and State requirements regarding patient rights
in accordance with 'Sections 5325 and 5325. 1 of the
Welfare and Institutions Code and Sections 862 through
868 of Title 9 of the California Code of Regulations .
The Hospital(s) shall include ECT reporting, as required
by law,, in its quarterly "Electro-Convulsive Therapy"
report submitted to the State.
2 . The State Hospital(s) shall follow established
procedures for resolving patient complaints. Patient
complaints relating to violations of their rights during
their hospital i zation . shall be handled and resolved by
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'Contract No. 93-73277
Contractor Contra Costa County Mental Health
the Department ' s Contract Advocate, Protection and
Advocacy Incorporated (PAI) or the Hospital ' s Patients '
Rights Advocate in the case of Camarillo State Hospital .
Patient ' s rights issues pertaining to matters outside
the jurisdiction of the hospital, shall be the
responsibility of the County' s patients ' rights
advocate. Issues relating to the denial of patients '
rights pursuant to . Section 5325 of the Welfare and
Institutions Code, shall be reported quarterly to the
state, as required by law, on the Department of Mental
Health' s "Denial of Rights" form.
D. Informed Consent
The Hospital(s) shall comply with applicable law relating to
informed consent.
SECTION 5 - PLANNING
The State shall make provisions for the inclusion of the County
in all planning and decisions regarding program changes, bed
capacity, and treatment and staffing standards .
SECTION 6 - ADMISSION AND DISCHARGE PROCEDURES
A. Admission and Discharges Procedures
1. Admission Procedures
a. The County shall ,be directly involved in referring
County Patients for admission to the Hospital(s) ,
discharge planning, and the actual discharge
process . When an individual committed pursuant to
provisions of the Penal Code is converted to an LPS
commitment the County Mental Health Director, or
designee, shall be involved as provided in this
Contract and in accordance with the provisions of
Divisions 5 and 6 of the Welfare and Institutions
Code.
b. If the County is below dedicated capacity, it
shall have immediate access to a bed for any County
Patient who is determined by . the Hospital(s)
Medical Director, or designee, to be clinically
appropriate for the available bed/service.
Admission shall be accomplished in accordance with
the Hospital(s) admitting procedures and admission
hours . The hospital(s) shall make a good faith
effort to flexibly accommodate patients referred
for admission in a manner which maximizes access to
appropriate hospital beds and services .
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Con trQc t No. 93-73277
Contractor Contra Costa County Mental Health
C. The hospital(s) shall maintain statistics
regarding: ( 1) the total number of referrals for
admission from each county for the month; ( 2 ) the
number and percentage of instances, by county, when
patients were denied admission; ( 3) the reason for
each denial; and, (4) the final resolution each
case where referral for admission was denied. This
data shall be made available to the county upon
request.
d. If the County is at' or above its dedicated
capacity, the County may arrange a bed exchange,
with another County which is below its dedicated
capacity. At the time of admission the hospital
shall be provided written authorization from both
the referring County and the County whose bed will
be used.
e. If, - for any reason, a County Patient is in a bed
which is inappropriate to that patient ' s needs, the
attending physician shall develop, in consultation
with the treatment team and the County, except when
the urgency of the patient ' s situation precludes
such consultation, a plan for transfer of the
patient to an appropriate unit in accordance with
the treatment plan.
f . All denials of admission shall be in writing with
an explanation for the denial : Denials shall not
occur if the patient meets the admission criteria
and the County has dedicated capacity available, or
has obtained authorization from another County to
use its available dedicated capacity. A denial of
admission may be appealed as provided in paragraph
C. 1. within this Section.
B. Discharge Procedures
1 . Discharge planning shall begin at admission.
2 . The development of a discharge plan and the setting of an
estimated discharge date shall be done jointly by the
treatment team and the Case Manager. The treatment plan
shall identify the discharge plan.
3 . The Hospital(s) shall discharge a patient at the
County' s request or in accordance with the approved
discharge plan except: ( 1) if at the time the discharge
is to occur, the Hospital(s) ' s Medical Director, or
designee, determines that the patient ' s condition and the
circumstances of the discharge would pose an imminent
danger to the safety of the patient or others; or, (2)
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
when a duly appointed conservator refuses to approve the
patient ' s discharge or placement. A denial of discharge
may be appealed as provided in paragraph C.2 . within this
Section.
C. Appeal Procedures
1 . ADMISSIONS - When agreement cannot be reached between the
County' s staff and the Hospital(s) ' admitting staff
regarding whether a patient meets or does not meet the
admission criteria for the bed(s) available the following
appeal process shall be followed. When the County' s
staff feel that impasse has been reached and further
discussions would not be productive, the denial of
admission may be appealed, along with all available data
and analysis to the Hospital ' s Medical Director and the
County Mental Health Director. Such appeals may be made
immediately by telephone. If the Hospital(s) Medical
Director and the County Mental Health Director are unable
to achieve agreement, the case may be referred to the
Deputy Director, Long Term Care Services within two ( 2 )
working days . The Deputy Director shall discuss the case
with the County Mental Health Director and may obtain
additional consultation. The Deputy Director shall
render a final decision within two (2) working days after
receiving the documented basis on which the appeal is
based.
2 . DISCHARGES - When the Hospital(s) ' Medical Director, or
designee, determines that discharge cannot occur in
accordance with the approved plan or upon the request of
the County, he/she 1will contact the County' s Mental
Health Director or designee immediately to review the
case and make every effort to resolve the issues
preventing the discharge. If this process does not
result in agreement, the case may be referred to the
Deputy Director, Long Term Care Services, by the County
Mental Health Director within one ( 1) working day of the
Hospital ' s denial. The Deputy Director after
consultation with the County Mental Health Director and
others will make the final decision within two (2)
working days of receiving the documentation of the basis
of the disagreement regarding discharge, and communicate
this decision to the County Mental Health Director and
the Hospital Medical Director by telephone followed by
written confirmation.
D. Penalties
1 . Should the State fail to process appeals from the County
relating to the denial of admissions or discharges within
the timelines specified in #1 and #2 above, the County
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-Contract No.- 93-73277
Contractor Contra Costa County Mental Health
shall be allowed to use additional bed days equal to the
number of days lost due to the State ' s failure to respond
within the established time lines . The penalty days thus
provided shall be in the cost center to which the patient
in question was . referred.
2 . If the decision on appeal shall be against the
hospital(s) , the County shall be allowed to use
additional bed days equal to the number of days lost due
to the Hospital(s) failure to admit or discharge the
patient in accordance with the County' s request.
SECTION 7 - PRIOR AUTHORIZATION
The County shall, prior to admission, provide the Hospital(s)
with a completed Short-Doyle Authorization Form (MH 1570) and all
applicable Court commitment orders . An initial projected length
of stay shall be identified by the County and addressed in the
patient ' s treatment plan and discharge plan.
SECTION 8 - COORDINATION OF TREATMENT/CASE MANAGEMENT
The parties agree that client services must be integrated and
coordinated across levels of care, and that an active case
management system is a critical factor in this continuity of
care. Accordingly, the parties agree to the following case
management system:
A. The County shall develop an operational case management
system for County Patients, and shall identify a 'case manager
or case management team for each County Patient. The duties
of the case manager include, but are not limited to:
1 . Providing available assessment information on patients
admitted to the Hospital(s) .
2 . Participating in person or by telephone in an initial
meeting with the patient and the hospital treatment team
within a reasonable time frame after admission, for
purposes of participating in the development of a
treatment plan and a discharge plan, and to determine the
level of the case manager' s involvement during the
patient ' s hospitalization. The treatment plan shall form
the basis for the treatment and services provided to the
County Patient.
3 . Meeting, in person, with the County Patient and with the
Hospital treatment team on a regular basis, not to exceed
180 days between meetings, to provide direct input into
the development and implementation of the patient ' s
treatment plan.
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•Cont"ract No. 93-73277
Con trac for Contra Costa County Mental Health
4 . Ensuring that appropriate alternative placement options
are developed as a part of the discharge planning process,
and working closely with the Hospital(s) treatment teams
to assure that discharges take place when and in a manner
agreed upon by the Hospital(s) Medical Director or
designee, and the County Mental Health Director or
designee.
B. The Hospital(s) shall encourage and facilitate the
involvement of the case managers in the treatment team
process, by providing, among other services, notification of
treatment plan conferences or 90-day reviews no less than two
weeks prior to the date of the conference or review. The
Hospital(s) shall identify an appropriate treatment team
member to function as the primary contact for the case
manager or the case management team.
C. A treatment plan shall be used for planning services for each
County Patient, and it shall identify each goal, and
objective for the patient with projected time lines for their
completion. Development of the treatment plan shall be the
responsibility of the Hospital(s) with County consultation as
requested. The County case manager is to review the
treatment plan and indicate in writing his/her agreement or
disagreement. The treatment plan shall be developed in
accordance with the following requirements:
1. The plan shall address reasons for admission.
2 . Patient treatment and stabilization directed toward
expediting discharge shall be considered the desired
outcome for all County Patients, and all interventions
shall relate to achieving discharge.
3 . Any special treatment needs shall be addressed in the
treatment plan.
4 . The Hospital(s) shall provide programs which assist
patients in achieving the objective of returning to a
level of community living, (i.e. , a facility offering a
protective environment, a residential facility, a board
and care facility, independent living, etc) .
5 . The treatment plan shall identify responsibility
for each item included in the plan.
6 . The treatment plan shall not be changed solely based upon
staffing changes within the Hospital(s) .
7 . The County case manager/case management team shall be
consulted whenever substantial changes to a patient 's
treatment plan are under consideration.
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Contract No. 93-73277
'Contractor Contra Costa County Mental Health
D. The case manager shall be encouraged to participate in
treatment team meetings, clinical reviews or utilization
review meetings and in clinical rounds which relate to County
Patients.
E. Primary criteria for continued treatment in the Hospital(s)
shall include, but not be limited to, the medical necessity
of hospitalization within the state hospital setting,
including LPS criteria, as reflected within the medical
record. The County' s Director of Mental Health or designee
may conclude that a County Patient no longer meets these
primary criteria and may direct that the Hospital(s)
discharge the patient to a facility the County determines to
be more appropriate to the patient ' s treatment requirements .
In such cases, discharge must occur within two ( 2) days of
the date an alternative placement option is identified and
available except as provided in B(2 ) (c) of this Exhibit or
otherwise required by law.
F. When agreement cannot be reached between case manager and the
treatment team regarding treatment, transfer, and/or
discharge planning, the issues shall be referred to the
Hospital ' s Medical Director and the County Mental Health
Director within three days. On specific treatment issues the
Medical Director' s decision shall be 'final. Any contract or
program policy issues arising from discussions which are not
resolved between the Medical Director and the County Mental
Health Director may be referred to the Assistant Deputy
Director, Long Term Care Services within five (5) working
days . The Assistant Deputy Director will review the case
with the County Mental Health Director. A response on the
referred issue will be communicated to the County' s Mental
Health Director within two (2 ) working days after the
Assistant Deputy Director receives the documented basis for
the appeal .
SECTION 9 - BED USAGE
A. General Provisions
1 . During the 1993/94 Fiscal Year, the State shall provide,
within the Hospital(s) , specific numbers of beds
dedicated to the care of only those patients referred by
. the County, including those admitted pursuant to Section
1370 . 01 of the Penal Code and Murphy Conservators hips
(Section 5008(h) ( 1) (B) of the Welfare and Institutions
Code) . The number and type of beds is specified in PART
II, Exhibit 11B-111 . For Counties who are members of the
Small County Bed Pool the number and types of beds in the
Pool and the special Performance Contract provision
relating to the Small County Bed Pool participation are
contained in PART II, Exhibit "A" , Section 19 and in PART
II, Exhibit 11B-211 .
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
2 . For the purposes within PART II of this Contract the term
"dedicated beds" shall mean that the hospital(s) shall
ensure that the number of beds contracted for by a County
in a particular cost center category shall be available
to the County at all times for patients who are
appropriate for the services and facilities included in
that cost center at the hospital to which the patient is
being referred. The County expressly agrees that the
Hospital(s) admissions, intra-hospital transfers,
referrals to outside medical care, and discharges are
made in accordance with the admission criteria
established by the State and the . Counties, and the
judgment of the Hospital(s) Medical Director or designee.
3 . The county shall be considered to have overused its
dedicated capacity on any given day on which more county
patients are assigned to a cost center than the county
has dedicated bed capacity in that cost center. Over use
shall only be permitted when it does not result in denial
of access to other counties to their contracted beds .
The County shall be obligated to pay for the net number
of patient/days it uses above the contracted number of
beds in a given cost center during each half of the
contract year. Net overuse of a cost center during each
half of the contract year shall be calculated by reducing
the number of bed/days overused during the period in that
cost center by the number of bed/days underused in that
cost center during the same period. This method of
calculation notwithstanding, the County' s obligation
shall not be reduced below the contract amount set forth
in Part II, Exhibit "B-1" . Overuse calculations for
counties which are members of the Small County Bed Pool
shall be in accordance with the provisions of Part II,
Exhibit B, Section 19 of this contract.
4 . If the county does not contract for any state hospital
beds, it may purchase access to the dedicated bed
capacity of the Small County Bed Pool or from other
counties. Notwithstanding the fact that the county does
not purchase any state hospital dedicated bed capacity,
the county shall be financially responsible for its use
of state hospital resources resulting from, but not
limited to, the conversion of Penal Code commitments to
Murphy Conservatorships (Section 5008(h) ( 1) (B) of the
Welfare and Institutions Code) .
5 . There shall be no increase or decrease in the number of
beds provided by the State within the Hospital(s) and
within a cost center, unless this Contract is amended by
mutual agreement.
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Conti-act No. . 93-73277
Contractor . Contra Costa County Mental Health
6 . When the County has a patient at Patton or Atascadero
State Hospital, it shall use one of its vacant dedicated
beds, in an equivalent cost center at its primary use LPS
hospital, to cover the costs of that patient ' s care at
Patton or Atascadero. If the County has no available
dedicated capacity, it must obtain the required capacity
by purchasing it from a county that has available
capacity in the proper cost center, or amending this
Contract as provided herein.
7 . The State, in consultation with the agencies who refer
patients to the hospital(s) , may provide special programs
for patients with unique needs, e.g. , hearing impairment,
Neurobehavioral problems, etc . . . The County may have
access to these beds on a first come first served basis .
If the County' s dedicated capacity for the cost center in
which the speciality unit(s) reside is all in use or if
the County does not have any dedicated capacity in the
cost center, the County may use any other of its
available dedicated capacity to support the admission to
the speciality unit(s) .
B. County First Right of Refusal to Purchase LPS Beds
The State shall not unilaterally reduce the number of
available LPS beds during the term of the contract. If a
county, or group of counties, reduces its contracted level of
LPS state hospital beds the State shall offer these LPS beds
to other counties prior to making them available to any other
purchaser. When LPS beds become available the State shall
notify the county mental health directors and the directors
shall have ten ( 10) working days from the date of
notification to submit requests to purchase the excess beds .
SECTION 10 - UTILIZATION REVIEW (UR)
A. The Hospital(s) shall have an ongoing utilization review
program which is designed to assure appropriate allocation of
the hospital(s) ' resources by striving to provide quality
patient care in the most cost-effective manner. The
utilization review program is to address over-utilization,
under-utilization, and the scheduling or distribution of
resources . The Hospital(s) Utilization Review Plan shall
describe the utilization review program and identify the
mechanisms for governing its operations . The Plan is
approved by the medical staff, the administration, and the
Director of the State Department of Mental Health, who is
also the chairperson of the Hospital(s) Governing Body.
Policy and operational direction regarding the Hospital(s)
Utilization Review Plan is provided in the Department of
Mental Health' s Special Order Number DSH-144 . Hospital(s)
that provide services which are certified for participation
21
Con trac t No. 93-73277
Contractor Contra Costa County Mental Health
in the Federal MediCare or Medi-Cal programs shall meet any
additional requirements imposed by those certification
regulations.
B. County representatives shall take part in the utilization
review and quality assurance activities at the Hospital(s) I
program and unit level relating to County Patients . County
Case Manager participation in utilization review and
discharge planning may include attendance at treatment team
and program meetings . The Hospital(s) shall include the
County' s monitoring of the quality and appropriateness of the
care provided to County Patients . Hospital(s) shall conduct
hospitalwide utilization review in a way that maximizes the
County' s access to the utilization review process concerning
County Patients . Hospital(s) shall provide the County with
information regarding the schedule of hospitalwide and
patient specific utilization . review activities . The
Hospital(s) shall also provide the County, upon request,
summary aggregate data regarding special incidents .
C. Utilization Review activities shall address the
appropriateness of hospital admissions and discharges,
clinical treatment, length of stay and allocation of hospital
resources to most effectively and. efficiently meet patient
care needs .
SECTION 11 - QUALITY ASSURANCE
A. The Hospital(s) shall have an ongoing quality assurance (QA)
program designed to objectively and systematically evaluate
the quality and appropriateness of patient care, pursue
opportunities to improve patient care, and resolve identified
problems . The written plan for the Hospital(s) quality
assurance program shall describe the program' s objectives,
organization, scope, and mechanisms for overseeing the
effectiveness of monitoring, evaluation, and problem-solving
activities . The Plan shall be updated at least annually and
approved by the Director of the Department of Mental Health,
who is also the Chairperson of the Hospital(s) Governing
Body.
B. The Hospital(s) I Quality Assurance Plan shall address all of
the elements of Quality Assurance which are required by
applicable sections of the California Code of Regulations
(Title 22 ) , Federal Medicare certification regulations, and
the standards of the Joint Commission on the Accreditation of
Healthcare Organizations . It shall also describe the
operational linkages between the risk management functions
related to the clinical aspects of patient care and safety
and quality assurance functions . The Hospital(s) shall
provide to the County summary data relating to aggregate
review of incident reports, reports of untoward events, and
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
related trend analysis . Hospital(s) shall provide the County
with information regarding the schedule of hospitalwide and
patient specific quality assurance activities .
C. Quality assurance activities shall address the quality of
records, including but not limited to, quality review studies
and analysis, peer review and medication monitoring
procedures, drug use studies, medical care evaluation and
standards studies, profile analysis and clinical care
standards addressing patient care.
D. In accordance with the provisions outlined in paragraph B of
Section 10 within this exhibit, County representatives shall
take part in QA activities at the Hospital(s) program and
unit levels and in monitoring the quality and appropriateness
of care provided to County Patients .
SECTION 12 - EXCHANGE OF INFORMATION
A. The parties agree to make a good faith effort to exchange as
much information as is possible, to the extent authorized by
law. Such information may include, but not be limited to,
medication history, physical health status and history,
financial status, summary of course of treatment in the
Hospital(s) or County, summary of treatment needs, and
discharge summary.
B. The exchange of information will apply only to patients
referred by the County who are to be hospitalized, are
currently hospitalized, or have been discharged from the
Hospital(s) . Requests for information regarding any other
patient must be accompanied by an authorization to release
information signed by the patient.
SECTION 13 — RECORDS
A. PATIENT RECORDS
The Hospital(s) shall maintain adequate medical records on
each individual patient. These medical records shall include
legal status, diagnosis, psychiatric evaluation, medical
history, individual treatment plan, records of patient
interviews, progress notes, recommended continuing care plan,
discharge summary and records of services provided by various
professional and paraprofessional personnel in sufficient
detail to permit an evaluation of services .
B. FINANCIAL RECORDS
The State shall prepare and maintain accurate and complete
financial . records of the Hospital(s) ' operating expenses and
revenue. Such records shall reflect the actual cost of the
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
type of service for which payment is claimed, on an accrual
basis. Additionally, such records shall identify costs
attributable to the County' s LPS patients, versus other types
of patients to whom the Hospital(s) provides services . Any
apportionment of or distribution of costs, including indirect
costs, to or between programs or cost centers of the
Hospital(s) shall be documented, and shall be made in
accordance with generally accepted accounting principles, and
applicable laws, regulations and State policies . The patient
eligibility determination and any fee charged to and
collected from patients, together with a record of all
billings rendered and revenues received from any source, on
behalf of patients treated pursuant to this Agreement, must
be reflected in the State ' s financial records .
C. RETENTION OF RECORDS
1 . All financial or patient records for patients who have
not yet been discharged shall be retained until the
patient has been discharged, at which time the record
retention requirements in 2 . through 4 . below shall
apply.
2 . Financial records shall be retained by the State in
accordance with the provisions of the State
Administrative Manual, Section 1671 . This Section
requires that most financial records, including CALSTARS
Reports, be kept two (2) years, after two (2) years they
are to be kept until audited or four (4) years which ever
occurs first. County financial records relating to this
contract shall be retained in accordance with applicable
law, regulation, and County policy.
3. Patient records for adults (age 18 and over) shall be
retained by the State for a minimum of seven (7) years
from the date of discharge.
4 . Patient records of persons under the age of eighteen ( 18)
years who have been discharged shall be retained for one
( 1) year past the person' s eighteenth ( 18th) birthday, or
for seven (7 ) years, whichever is greater.
5. Records which relate to litigation or settlement of
claims arising out of the 'performance of this Agreement,
or costs and expenses of this Agreement as to which
exception has been taken by the parties to this
agreement, shall be retained by the parties until
disposition of such appeals, litigation, claims, or
exceptions are completed.
6 . Except for records which relate to litigation or
settlement of claims, the parties may, in fulfillment of
24
Contract No. 93-73277
Contractor Contra Costa County Mental Health
their obligations to retain the financial and patient
records as required by this Agreement, substitute
photographs, micro-photographs, or other authentic
reproductions of such records which are mutually
acceptable to the parties; after the expiration and two
(2) years following termination of this Agreement, unless
a shorter period is authorized, in writing, by the
parties.
SECTION 14 REVENUE
The County and the State agree to comply with . all of the
applicable provisions of Sections 7275 through 7278 of the
California Welfare and Institutions Code and the applicable
provisions of the Budget Act of 1993 regarding the collection and
deposit of revenues for state hospital services.
The State shall collect revenues from patients and/or responsible
third parties, e.g. , MediCare, M6di-Cal, and insurance companies,
in accordance with the provisions of the above cited sections of
the Welfare and Institutions Code and related state laws,
regulations and policies . When the county acts as the
conservator of the patient and has control of the patient' s
estate it shall, on behalf of the patient ' s estate, pay the State
for state hospital care in the same way that it pays other
financial obligations of. the patient ' s estate.
SECTION 15 - INSPECTIONS AND AUDITS
A. Consistent with confidentiality provisions of Section 5328 of
the Welfare and Institutions Code, any authorized
representative of the County shall have
ve reasonable access to
the books, documents and records, including medical and
financial records and audit reports of the State for the
purpose of conducting any budget or fiscal review, audit,
evaluation, or examination during the periods of retention
set forth in the Records- paragraph of this Agreement. The
County representative may at all reasonable times inspect or
otherwise evaluate the services provided pursuant to this
Agreement, and the premises in which they are provided. The
County's mental health department shall not duplicate
investigations conducted by other responsible agencies or
jurisdictions, e.g. , State Department of Health Services
(Hospital Licensing) , County Coroner' s Office, District
Attorney' s Office, and other review or regulatory agencies .
Practitioner specific peer review information and information
relating to staff discipline is confidential and shall not be
made available for review.
B. The Hospital(s) shall actively cooperate with any person
specified in subparagraph A. above, in any evaluation or
monitoring of the services provided pursuant to this
25
Contract No. 93-73277
Coa trac for Contra Costa County Mental Health
Agreement, and shall provide the above-mentioned persons
adequate space to conduct such evaluation or monitoring. As
each of the Hospital(s) have contracts with several Counties,
the County agrees that the Executive Director of the
Hospital(s) shall coordinate the access described in Part VI
in such a manner as to not disrupt the regular operations of
the Hospital(s) .
SECTION 16 - NOTICES
A. Except as otherwise provided in this contract, all notices,
claims, correspondence, reports, and/or statements authorized
or required by PART II of contract shall be effective when
deposited in the United States mail, first class postage
prepaid and addressed as specified in PART II of this
Contract.
B. State has designated the Assistant Deputy Director, Long Term
Care Services to be its Project Coordinator for all issues
relating to PART II of this Contract. Except as otherwise
provided herein, all communications concerning this contract
shall be with the State ' s Project Coordinator. The County
has designated
Lorna Bastian
as its Project Coordinator and except as otherwise provided
herein, all communication concerning this contract shall be
with the County Project Coordinator.
C. The Hospital(s) shall notify the County immediately by
telephone or FAX, and in writing, within twenty-four (24)
hours of becoming aware of any occurrence of a serious nature
which involves one of the County' s patients. Such
occurrences may include, - but are not limited to, homicide,
suicide, accident, injury, battery, patient abuse, rape,
significant loss or damage to patient property, and AWOL.
D. The Hospital(s) shall 'notify the County Mental Health
Director or designee by telephone at the earliest possible
time, but not later than three ( 3) working days of becoming
aware of the impending conversion of a Hospital patient on
Penal Code status to Lanterman-Petris-Short (LPS) status and
County financial responsibility. Such telephone notification
shall be followed by a written notification to the County
Mental Health Director, which shall be submitted within ten
( 10) working days of the date the Hospitals) learned of the
impending conversion. Following these same timeframes, the
Hospital(s) will also notify the County Mental Health
Director, or designee, of the conversion of a patient on LPS
26
Contract No. 93-73277
Contractor Contra Costa County Mental Health
status to a Penal Code commitment status that results in the
state becoming financially responsible for the placement of
the patient and removes the patient from the county' s
dedicated contract bed.
E. For purposes of this Agreement, any notice to be provided by
the County to the State shall be given by
Lorna Bastian
or by other authorized representatives designated in writing
by the County.
SECTION 17 - NOTIFICATION OF DEATH
A. The Hospital(s) shall notify the County by telephone
immediately upon becoming aware of the death of any person
served hereunder, if the patient is an inpatient in the
Hospital or is on leave from the Hospital but is still
considered an inpatient at the time of death. However, such
notice need only be given during normal business hours . In
addition, the Hospital(s) shall use its best efforts to,
within twenty-four ( 24) hours after such death, send a FAX
written notification of death to the County.
B. The telephone report and written notification of death shall
contain the name of the deceased, the date and time of death,
the nature and circumstances of the death, and the name of
the Hospital representative to be contacted for additional
information regarding the patient' s death.
SECTION 18 - REPORTS
During the fiscal year 1993/94, the parties shall continue to
work on improving the information system. The state will
continue to work with the CMHDA and county representatives to
define more detailed data needs and develop the specification of
staff, financial, physical and technological resources needed to
pursue an arrangement whereby data can be delivered directly to
the counties .
The state will create a data file on a weekly basis containing
state hospital midnight census and year-to-date totals by level-
of-care for all counties . The file will be available for
downloading to the California Mental health Directors Association
(CMHDA) via a computer at CMHDA and at each county, at the
county' s request.
The state will provide the counties with quarterly reports
showing the status of revenue collections from third parties, for
services to county LPS patients . This report will identify the
anticipated sources of revenue, the amounts projected to be
received and the amount received year to date.
27
Co'n,tract No. 93-73277
Con trac for Contra Costa County Mental Health
SECTION 19 - SMALL COUNTY BED POOL (SCBP)
A. This Section applies only to the counties that have indicated
that they are members of the SCBP as reflected in PART II,
Exhibit 11B-2" of this agreement.
B. As a member of the Small County Bed Pool, the County is
contracting for the number and types of State Hospital beds
described in PART II, Exhibit "B-2" (Cost Computation) of
this contract. These beds are to be considered as part of
the Small County Bed Pool and may be used by any member of
the pool . The County' s access to the SCBP ' s beds shall be
coordinated on behalf of the member counties by the
California Mental Health Directors Association, hereinafter
referred to as the "Pool Coordinator" . The County shall
refer patients and provide authorization for admission as
described in this contract. In addition, the County agrees
to be bound by the decisions of the SCBP ' s Utilization Review
Committee and the Pool Coordinator regarding access to SCBP
beds . When a patient is referred for admission, the
Hospital(s) shall be provided written authorization from both.
the referring County and the Pool Coordinator. The Pool
Coordinator shall also represent the County in its capacity
of SCBP member on issues relating to utilization review and
quality assurance activities .
C. The purpose of the Small County Bed Pool (SCBP) is to
facilitate the efficient and economical utilization of state
hospital beds by small counties who could only purchase a few
beds with their own resources . Member counties purchase a
Portion of the SCBP ' s total dedicated capacity, but have
access to the number and mix of beds in the total pool. As
indicated in Part I I, Exhibit B-2, an average cost per SCBP
bed has been calculated by determining the actual cost of the
number and mix of beds to be purchased by the SCBP and then
dividing that amount by the total number of beds purchased.
The dedicated capacity and over use provisions set forth in
Section 9, Exhibit "A" , PART II of this contract apply to the
SCBP as though it were a single county user. The SCBP net
overuse for the first six ( 6) months of this contract shall
be added to the net overuse during the last six (6) months of
the contract year. The .cost of the resulting annual overuse
shall be charged to member counties in accordance with
instructions given to the state by the Pool Coordinator at
the end of the 1993/94 fiscal year.
D. The County shall pay the amount identified in Part II,
Exhibit 11B-2" as the County' s contribution to the SCBP and
that portion, if any, of the SCBP' s annual net overuse amount
identified by the Pool Coordinator at the end of the contract
year as being the responsibility of the County. Net overuse
during each half of the contract year shall be calculated by
28
Con uric t No. 93-73277
Contractor Contra Costa County Mental Health
reducing the number of bed/days overused in a cost center
during the period by the number of bed/days underused in a
cost center during the same period. This method of
calculation notwithstanding, the SMBP members , obligation
shall not be reduced below the contract amount set forth in
Part II, Exhibit "B-2" . The sum of the net overuse for the
two half year periods shall be charged to the member counties
at the end of the contract year in accordance with
instructions given to the State by the Pool Coordinator.
29
Contract No. 93-73277
Contractor Contra Costa County Mental Health
PART II -- STATE HOSPITAL BED USAGE
EXHIBIT "B" — SPECIFIC PROVISIONS
1 . The State has designated the Assistant Deputy Director, Long
Term Care Services for all issues relating to PART II of this
contract, to be its Project Coordinator. Except as otherwise
provided herein, all communications concerning PART II of
this contract shall be with the Project Coordinator.
2 . No amendment or modification to the terms and conditions of
PART II of this contract, whether written or verbal, shall be
valid unless made in writing and formally executed by both
parties and approved by the State Department of Mental
Health.
Any amendments to PART II of this Contract may include
increases or decreases in the number of beds purchased within
a cost center for the remainder of the current Contract term.
In the case of a decrease in the number of beds purchased
within a cost center, the County will remain responsible for
the fixed costs of the beds which are eliminated pursuant to
such Contract amendment, unless the State contracts these
bed(s) to another entity, in which case the County shall be
absolved of all charges for such bed(s) . In the case of an
increase in the number of beds purchased within a cost
center, the purchase cost shall be the rate established for
those beds for the current fiscal year.
3 . The parties understand and agree that PART II of this
Contract shall not be terminated during its term. The
provisions for altering PART II of this Contract during its
life are articulated in paragraph 2 above.
Section 4331 of the Welfare and Institutions Code defines the
process to be followed in renewing the County' s contract for
state hospital services . It is understood by the parties
that this annual renewal process is for the purpose of
ensuring an orderly adjustment in the use of state hospitals
by the counties .
4 . Should the State ' s ability to meet its obligations under the
terms of this Contract be substantially impaired due to loss
of license to operate, damage or malfunction of the physical
facilities, labor unions, or other cause, the State and the
County shall negotiate modifications to the terms of this
Contract which ensure the safety and health of County
patients .
30
Contract No. 93-73277
Contractor Contra Costa County Mental Health
5. The total amount payable by the County to the State
concerning all aspects of PART II of this Contract shall be
$4, 736, 852 . The contract amount reflected here was computed
based on the information contained in PART II, Exhibit "B-1"
or Exhibit "B-21' ( for Small County Bed Pool members only) .
The amount represents the cost of contracted beds plus any
over use as defined in Sections 9 and 19 ( for Small County
Bed Pool members) , Exhibit "A" , PART II, less $47 per day to
reflect the application of anticipated revenue.
6 . Any County overuse as defined in PART I-I, Exhibit "A" ,
Section 9 .A(2) , or Section 19 .0 for Small County Bed Pool
Members, during the months of January through June 1994,
shall be an additional cost to the county and collected by
adjusting the Controller' s Schedule "B" in August 1994 .
7 . To the degree that revenue projections are not realized, the
county shall be responsible for the cost of its utilization
up to the "All Inclusive Daily Rate" published in ATTACHMENT
"C" of DMH LETTER: 93-10 which by this reference is made a
part hereof. Determination of available revenue shall be
completed by the State by, September 30, 1994 .
8. If the pro rata share payments do not equal the total
contract amount, the county shall pay the difference to the
State for deposit to the State Hospital Account of the Mental
Health Facilities Fund. The final County payment is due
after adjustments are made according to WIC 4330(d)
"Distribution of unencumbered funds . " See paragraph 10
below.
9 . If the State borrows money because a county elects a pro rata
share, there may be an interest charge levied against the
County. Interest charged by the State Controller for the
loan of money is in addition to and separate from the County
Performance Contract which encompasses State , Hospital
Services.
10. The County. understands that it is purchasing a dedicated bed
capacity for a fixed price plus the cost of any overuse as
defined in PART II, Section 9 . After final determination of
state hospital costs for all county patients, funds that
remain unencumbered at the close of the fiscal year shall be
made available to counties that used fewer state hospital
beds then their contract number, proportional to the
contracted amount not used. This amount shall not exceed the
value of the unused contracted amount.
12 . During Fiscal Year 1993/94 the State and the Counties shall
review the current method of identifying, organizing,
reporting and charging for state hospital ancillary services.
The product of these efforts shall clearly define the
31
-Contract No. 93-73277
Contractor Contra Costa County Mental Health
methodology to be used in subsequent contracts to identify
and categorize these services and fairly reimburse the State
for the associated costs .
13 . Should a dispute arise relating to any issue within PART II
of this contract, the County shall, prior to exercising any
other remedies which may be available, except those described
in Section 6 .C. of PART, II, provide written notice within a
thirty-day period of the particulars of such dispute to:
Director
Department of Mental Health
1600 9th Street
Sacramento, CA 95814
Such written notice shall contain the contract number. The
Director, or his designee, shall meet with the County, review
the factors in the dispute before a written response is given
to the County. The Director, or his designee, shall provide
a written response within thirty days .
14 . INDEMNIFICATION AND INSURANCE
a. Except as provided in the following paragraph B. , and to
the extent authorized by law, and as provided for in
Section 895 of the California Government Code the State
shall indemnify and hold harmless the County, its
officers, agents and employees from all claims, losses
and demands or actions for injury or death of persons or
property damage arising out of acts or omissions of the
State, its officers, agents or employees in performance
related to PART II of this Contract.
b. County warrants that it is self-insured or maintains
policies of insurance placed with reputable insurance
companies licensed to do business in the State of
California which insure the perils of bodily injury,
medical, professional liability and property damage. The
County shall indemnify and hold harmless and defend the
State, its officers, agents and employees from all
claims, losses and demands or actions for injury or death
of persons or damages to property arising out of acts or
omissions of the County, its officers, agents or
employees in performance related to PART II of this
Contract.
32
• ' Contract No. 93-73277
Contractor Contra Costa County Mental Health
15. LICENSES AND LAW
The State, its officers, agents, employees and
subcontractors shall, throughout the term of this Agreement,
maintain all licenses, permits, approvals, certificates,
waivers and exemptions necessary for the provision of the
services hereunder and required by applicable laws and
regulations . The State shall immediately notify the County
in writing of its inability to obtain or maintain,
irrespective of the pendency of an appeal, such permits,
licenses, approvals, certificates, waivers and exemptions .
33
Contract No. : 93-73277
Contractor . .Contra Costa County Mental Health
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34
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Contractor : Contra Costa County Mental Health
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35
Contract No. 93-73277
Contractor Contra Costa County Mental Health
Fiscal Year 1993/94 COUNTY PERFORMANCE CONTRACT
PART III -- GENERAL PROVISIONS
1. TERM
The term of the Fiscal Year 1993/94 County Performance
Contract shall be July 1, 1993 through June 30, 1994 .
2. BUDGET CONTINGENCIES
a. Federal Budget
1) All parties agree that relating to Short-Doyle/Medi-
Cal, the contract is based upon the following:
2 ) It is mutually understood between the parties that
this contract may have been written before
ascertaining the availability of congressional
appropriation of funds . This was done to avoid
program and fiscal delays which would occur if it
were written after that determination was made.
3) It is mutually agreed that, if the Congress does not
appropriate sufficient funds for the program, the
State has the option to void the contract or to amend
the contract to reflect any reduction of funds . Such
I
mendment, however, shall require County approval.
4 . The contract is subject to any . additional
restrictions, limitations, or conditions enacted by
the Congress or any statute enacted by the Congress
which may affect the provisions, terms, or funding of
this contract in any manner.
5) The State and the County agree that if Congress
enacts such changes during the term of this contract,
both parties shall meet and confer to renegotiate the
terms of this Contract affected by the restrictions,
limitations, conditions, or statute enacted by
Congress .
b. State Budget
1) This contract is subject to any restrictions,
limitations, or conditions enacted by the Legislature
and contained in the Budget Act or any statute
.enacted by the Legislature which may affect the
provisions, terms, or funding of this contract in any
manner. The State and the County mutually agree that
if statutory or regulatory changes occur during the
term of this contract which affect this contract,
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Cotitract No. 93-73277
Cbntractor Contra Costa County Mental Health
both parties shall renegotiate the terms of this
Contract affected by the statutory or regulatory
changes.
2) This contract may be amended upon mutual consent of
the parties . Such amendments shall be executed by a
duly authorized representative of each party.
3) It is mutually agreed that if the Budget Act does not
appropriate sufficient funds for the program, this
Contract shall be void and of no further force and
effect. In such an event, the State shall have no
further liability to pay any funds whatsoever to the
County or to furnish any other considerations under
this Contract, and the County shall not be obligated
to perform any provisions of this contract or to
provide services intended to be funded pursuant to
this contract.
3. CONFIDENTIALITY
a. The parties to this agreement shall comply with
applicable laws and regulations, including but not
limited to Section 5328 et seq. of the Welfare and
Institutions Code regarding the confidentiality of
patient information.
b. County shall protect, from unauthorized disclosure, names
and other identifying information concerning persons
receiving services pursuant to this contract' except for
statistical information. This pertains to any and all
persons receiving services pursuant to a Department of
Mental Health funded program. County shall not use such
identifying information for any purpose other than
carrying out the County' s obligations under this,
contract.
C. County shall not disclose, except as otherwise
specificall permitted by this contract or authorized by
the client7patient, any such identifying information to
anyone other , than the State without prior written
authorization from the State in accordance with State and
Federal Laws.
d. For purposes of the above paragraphs, identifying
information shall include, but not be limited to, name,
identifying number,, , symbol, or other identifying
particular assigned, to the individual, such as finger or
voice print, or a ,photograph.
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
4. NONDISCRIMINATION
a. The State and the County shall not employ any unlawful
discriminatory practices in the admission of patients,
assignment of accommodations, treatment, evaluation,
employment of personnel, . or in any other respect on the
basis of race, color, gender, religion, marital status,
national origin, age, sexual preference, or mental or
physical handicap, in accordance with the requirements of
applicable Federal or State law.
b. During the performance of this contract, County and its
subcontractors shall not unlawfully discriminate against
any employee or applicant for employment because of race,
religion, color, national origin, ancestry, mental or
physical handicap, medical condition, marital status,
age, or sex. County and subcontractors shall comply with
the provisions of the Americans with Disabilities Act of
1990, the Fair Employment and Housing Act (Government
Code, Section 12900 et seq. ) , and the applicable
regulations promulgated thereunder (California
Administrative Code, Title 2, Section 7285 et seq. ) .
County shall ensure that the evaluation and treatment of
their employees and applicants for employment are free of
such discrimination. The applicable regulations of the
Fair Employment and Housing Commission implementing
Government Code, Section 12990, set forth in Chapter 5,
Division 4 of Title 2 of the California Administrative
Code are incorporated into this contract by reference and
made a part hereof as if set forth in full . County and
its subcontractors shall give written notice of their
obligations under this clause to labor organizations with
which they have a collective bargaining or other
agreement.
C . County shall employ with the provisions of Section 504 of
the Rehabilitation Act of 1973, as amended, pertaining to
the prohibition of discrimination against qualified
handicapped persons in all federally assisted programs or
activities, as detailed in regulations signed by the
Secretary of Health and Welfare Agency, effective June 2,
1977, and found in the Federal Register, Volume 42, No.
86, dated May 4, 1.977 .
d. County shall include the nondiscrimination and compliance
provisions of this contract in all subcontracts to
perform work under this contract..
5. PATIENTS' RIGHTS
The parties to this 1993/94 County Performance Contract shall
comply with applicable laws, regulations and State policies
relating to patients' rights .
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t Contract No. 93-73277
Contractor Contra Costa County Mental Health
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6. RECORDREEPING
a. County agrees to maintain books, records, documents, and
other evidence necessary to facilitate contract
monitoring and audits pursuant to Section 640, Title 9,
of the California Code of Regulations and Department of
Mental Health Policy letter #87-05 .
b. County agrees that the State shall have access to
facilities, programs, documents, records, staff,
clients/patients, or other material or persons the State
deems necessary to monitor and audit services rendered.
7 . RELATIONSHIP OF THE_ PARTIES
The State and the County are, and shall at all times be
deemed to be, independent agencies . Each party to this
Agreement shall be wholly responsible for the manner in which
it performs the services required of it by the terms of this
Agreement. Nothing herein contained shall be construed as
creating the relationship of employer and employee, or
principal and agent, between the parties or any of their
agents or employees . Each party assumes exclusively the
responsibility for the acts of its employees or agents as
they relate to the services to be provided during the course
and scope of their emplgyment. The State, its agents and
employees, shall not be entitled to any rights or privileges
of County employees and shall not be considered in any manner
to be County employees . The County, its agents and
employees, shall not be entitled to any rights or privileges
of State employees and shall not be considered in any manner
to be State employees .
8. REPORTS
a. Any products or reports which are produced pursuant to
this contract, shall name the Department of Mental
Health, the contract number, and the dollar amount of the
contract (Government Code, Section 7550) .
b. The State reserves the right to use and reproduce all
reports and data produced and delivered pursuant to this
Contract, and reserves the right to authorize others to
use or reproduce such materials, unless of a confidential
nature.
9. SEVERABILITY
If any provision of this' Contract or application thereof to
any person or circumstance shall be declared invalid by a
court of competent jurisdiction, or is found by a court to be
in contravention of any Federal or State law or regulation,
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Contract No. 93-73277
Contractor Contra Costa County Mental Health
the remaining provisions of this Contract or the application
thereof shall not be invalidated thereby and shall remain in
full force and effect, and to that extent the provisions of
this Contract are declared severable.
10. SUBCONTRACTING
County agrees to place in each of its subcontracts, which
are in excess of $10,000 and utilize State funds, a
provision that: "The contracting parties shall be subject to
the examination and audit of the Auditor General for a
period of three years after final payment under contract
(Government Code, Section 10532) " . The County shall also be
subject to the examination and audit of the Auditor General
for a period of three years after final payment under
contract (Government Code, Section 10532 ) .
11. WAIVER OF-DEFAULT
Waiver of any default shall not be deemed to be a waiver of
any subsequent default. Waiver of breach of any provision of
this Agreement shall not be deemed to be a waiver of any
other or subsequent breach, and shall not be construed to be
a modification of the terms of this Contract.
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