HomeMy WebLinkAboutMINUTES - 03211995 - 2.2 si� z.
TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director
Contra
Costa
DATE: March 8, 1995 County
SUBJECT: Approval of Standard Agreement #29-469-3 with the State Department of
Mental Health (FY 1994-95 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 Standard Agreement #29-469-3 (State #94-74157) , including the Statement
of Compliance and Drug-Free Workplace Certification, with the State of California,
Department of Mental Health, representing the County's Mental Health Services
"Performance Contract" for Fiscal Year 1994-95, as required by the Bronzan-
McCorquodale Act (Mental Health Realignment Legislation) .
II. FINANCIAL IMPACT:
Like last year's Performance Contract, this Fiscal Year 1994-95 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 1994-95, 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 $4,017,902 for State Hospital use in FY
1994-95.
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:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S) ��,..��,��//��
ACTION OF BOARD ON �L�QA4 2 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Lorna Bastian (313-6411) �v✓1 A n c�
CC: Health Services (Contracts.) ATTESTED 9J
State Dept. of Mental Health Phil Batchelor, Clerk of the Board of
Supenlisors gad Gounty pdministraf�
M382/7-83 BY DEPUTY
ra
r
Board Order
Standard Agreement #29-469-3
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 1994-
95. 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 23, 1995, the County's Mental Health Advisory
Commission reviewed the FY 1994-95 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.
Five sealed copies of this Board Order should be returned to the Contracts and
Grants Unit.
n
S ATE OF rlj:IFORNIA
STANDARD AGREEMENT—" APPROVED BY THE CONTRACT NUMBER I AMNO.
ATTORNEY GENERAL
STD.2(FiEV'.s•91) i 94-74157
TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBE;
S
THIS AGREEMENT,made and entered into this 1St day of July 19_L4 94-6000509—W
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
TITLE OF OFFICER ACTING FOR STATE AGENCY
Del2uty. Director Mental Health hereafter called the State,and
CONTRACTOR'S NAME
Contra Costa County Mental Health • 2 9 — 469 hereafter called the Contractor.
WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed.
does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor,
time for performance or completion,and attach plans and specifications,if any.)
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 accordance 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 hospital 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 range of services
appropriate to the needs of each client, with the State Hospital(s) functioning as one of 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, THEREFORE, 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 b this reference do hereby constitute the Fiscal
Year mandated County Performance Contract including the County Use of State Hospitals
greel!n a mandated by Section 5650 of the Welfare and Institutions Code.
`gip This contract shall not be effective until it has been approved by the Department of Mental Health.
:ONTINUED ON SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
N WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above written.
STATE OF CALIFORNIA CONTRACTOR
GENCY CONTRACTOR(if other than an individual stale whePw a corporation.partnership.etc.)
Department of Mental Health Contra Costa CounYy Mental Health
Y(AUTHO IZED SIGNATURE) BY(AUTHORIZED SIGIN TUBE)
> Z —(IL—
RINTED NAM PERSON SIGNING PRINTED NAME AND TITLE OF PERSON SIG ING
LINDA A. POWELL, Deputy Director Mark Finucane, Health Services Director
rLE
ADDRESS
Administrative Services 651 Pine Street, Martinez CA 94553
MOUNT ENCUMBERED BY THIS PROGRAMICATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
OCUMENT Not Applicable Use Only
a (OPTIONAL USE)
1IOR AMOUNT ENCUMBERED FOR
4IS CONTRACT Exempt from compliance with
$ ITEM CHAPTER STATUTE FISCAL YEAR the Public Contract Code,
)TAL AMOUNT ENCUMBERED TO I --- --- 194125 the State Administrative
\TE OBJECT OF EXPENDITURE(CODE AND TITLE) manual, and from approval by
$ the Department of General
I hereby certify upon my own personal knowledge that budgeted funds T.B.A.No. B.R.No. Services per Sections 5706
are available for the period and purpose of the expenditure stated above. I and 4331 (a) of the Welfare
:INATUREOFACCOUNTINGOFFICER DATE and Institutions Code.
Not Applicable
MAY 8 1995
F1CONTRACTOR STATE AGENCY 0 DEPT.OF GEN.SER. 0 CONTROLLER
STATE OF CALIFORNIA S:
STANDARD AGREEMENT
STD.2 (REV. 5-91) (REVERSE)
r ,
1. The Contractor agrees to indemnify,defend and save harmless the State,its officers,agents and employees
from any and all claims and losses accruing or resulting; to any and all contractors, subcontractors,
materialmen,laborers and Any other person,firm or corporation furnishing;or supplying;work services,
materials or supplies in connection with the performance of this contract,and from any and all claims and
losses accruing or resulting;to any person, firm or corporation who may be injured or damaged by the
Contractor in the performance of this contract.
2. The Contractor,and the agents and employees of Contractor,in the performance of the agreement,shall
act in an independent capacity and not as officers or employees or agents of State of California.
3. The State may terminate this agreement and be relieved of the payment of any consideration to Contractor
should Contractor fail to perform the covenants herein contained at the time and in the manner herein
provided. In the event of such termination the State may proceed with the work in any manner deemed
proper by the State. The cost to the State shall be deducted from any sum due the Contractor under this
agreement,and the balance,if any,shall be paid the Contractor upon demand.
4. Without the written consent of the State,this agreement is not assignable by Contractor either in whole
or in part.
5. Time is of the essence in this agreement.
6. No alteration or variation of the terms of this contract shall be valid unless made in writing;and signed by
the parties hereto,and no oral understanding or agreement not incorporated herein,shall be binding on
any of the parties hereto.
7. The consideration to be paid Contractor, as provided herein, shall be in compensation for all of
Contractor's expenses incurred in the performance hereof, including travel and per diem, unless
otherwise expressly so provided.
91 61014
COUNTY PERFORMANCE CONTRACT
Fiscal. Year 1994/95
Pa e
I PERFORMANCE CONDITIONS
PART 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
Section 9 - Restriction of Inpatient Psychiatric
Treatment of Minors with Adults . . . . . . . . 5
PART B SPECIFIC PROVISIONS . . . . . . . . . . . . . . . 6 - 7
II STATE HOSPITAL BED USAGE
PART A TERMS AND CONDITIONS
Section . 1 - Facilities , Payments , and Services . . . . . . . 8
Section 2 - County Responsibilities . . . . . . . . . . . . 8
Section 3 - Description of Covered Hospital Services . . . 9
Section 4 - Standards of Care . . . . . . . . . . . . . . . 11
Section 5 - Planning. . . . . . . . . . . . . . . . . . . 12
Section 6 - Admission and Discharge Procedure . . . . . . . 12
Section 7 - Prior Authorization . . . . . . .
Section 8 - Coordination of Treatment/Case Management . . . 15
Section 9 - Bed Usage . . . . . . . . . . . . . . . . . . . 17
Section 10 - Utilization Review. . . . . . . . . . . . . . . 20
Section 11 - Quality Assurance . . . . . . . . . . . . . . . 21
Section 12 - Exchange of Information . . . . . . . . . . . . 21
Section 13 - Records . . . . . . . . . . . . . . . . . . . . 22
Section 14 - Revenue . . . . . . . . . . . . . . . . . . . . 23
Section 15 - Inspections and Audits . . . . . . . . . . . . . 24
Section 16 - Notices . . . . . . . . . . . . . . . . . . . 24
Section 17 - Notification of Death . . . . . . . . . . . . . 26
Section 18 - Reports . . . . . . . . . . . . . . . . . . . . 26
Section 19 = Small County Bed Pool . . . . . . . . . . . 26
Page
PART B SPECIFIC PROVISIONS 28 - 31
III GENERAL PROVISIONS
A. Term of Contract . . . . . . . . . . . . . . . . . . . . 32
B. Budget Contingencies . . . . . . . . . . . . . . . . . . 32
C . Confidentiality . . . . . . . . . . . . . . . . . . . . . 33
D. Nondiscrimination . . . . . . . . . . . . . . . . . . . . 33
E . Patients ' Rights . . . . . . . . . . . . . . . . . . . . 34
F. Recordkeeping . . . . . . . . . . . . . . . . . . . . . . 34
G. Relationship of the Parties . . . . . . . . . . . . . 35
H. Reports . . . . . . . . . . . . . . . . . . . . . . . . . 35
I . Severability . . . . . . . . . . . . . . . . . . . . . . 35
J. Subcontracting . . . . . . . . . . . . . . . . . . . . . 35
K. Waiver of Default . . . . . . . . . . . . . . . . . . . . 36
Attachment 1 - APPROVED NEGOTIATED RATES FOR SHORT-DOYLE MEDI-CAL
REIMBURSEMENT ( If Appropriate)
Attachment 2 - REQUEST FOR WAIVER PURSUANT TO SECTION 5751 . 7 OF THE
WELFAARE AND INSTITUTIONS CODE
Attachment 3 - SPECIFIC COUNTY COST COMPUTATION
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page I
I -- PERFORMANCE CONDITIONS
PART 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
rovidedto 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 .
Contract Number 94-74157 ,
Contractor Contra Costa Coiurltyr Mental Health
Page 2
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) (a) 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 1994-95 .
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 method, funds
allocated by the Department of Mental Health in accordance with
Section 3 of PART 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 legal entity
negotiated rates pursuant to Section 51516 (b) of Title 22 ,
California Code of Regulations .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 3
If this method is used, the County must adhere to Attachment 1,
"APPROVED NEGOTIATED RATE FOR SHORT-DOYLE/MEDI-CAL
REIMBURSEMENT" .
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 PART 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 REVIEW/OUALITY 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 and guidelines 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, 1994 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 1994-95 SG or SAMHSA allocations .
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 1994-
95 "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 1994=95 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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 4
SECTION 8 - PERFORMANCE OUTCOMES
a. Outcome Reporting
(1) Adults : County agrees to report outcome information for
adult clients 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) The County agrees to administer outcome surveys of adult
clients on a six-month interval schedule.
(b) The Department of Mental Health will randomly select adult
clients for the performance outcome surveys from the
Client Data System (CDS) .
(c) Client samples will be sufficient to yield statistically
reliable data (10 percent tolerable error at a 95 percent
confidence level) at the county level .
(d) The Department will provide the County with summaries and
analyses of county comparisons and statewide data for
relevant outcome measures .
(2) Children and Adolescents : County agrees to report outcome
information for children and adolescents as required by the
Director of the California Department of Mental Health
pursuant to Chapter 89 , Statutes of 1991 .
(a) County agrees to administer performance outcome surveys of
children and adolescent clients on a six month interval
schedule .
(b) The Department will randomly select children and
adolescent clients for the performance outcome survey from
the Client Data System (CDS) .
(c) Children and adolescent client samples will be sufficient
to yield statistically reliable data (10 percent tolerable
error at a 95 percent confidence level) at the county
level .
(d) The Department will provide the County with summaries and
analyses of County comparison and statewide data for
relevant outcome measures .
(3) Older Adults : The County agrees to report outcome
information for older adult clients as required by the
Director of the Department of Mental Health pursuant to
Chapter 89, Statutes of 1991 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 5
(a) The County agrees to administer performance outcomes of
older adult clients on a six month interval schedule .
(b) The Department will randomly select older adult clients
for the performance outcome survey from the Client Data
System (CDS) .
(c) Older adult client samples will be sufficient to yield
statistically reliable data (10 tolerable error at a 95
percent confidence level) at the county level .
(d) The Department will provide the County with summaries and
analyses of county comparisons and statewide data for
relevant outcome measures .
b. Target Population Reporting
(1) County agrees to report target population information as
required by the Director of the . California Department of
Mental Health pursuant to Chapter 89, Statutes of 1991 .
During Fiscal Year 1994-95, the target population information
will be gathered through questions included 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 .
SECTION 9 - RESTRICTION OF INPATIENT PSYCHIATRIC TREATMENT OF MINORS
WITH ADULTS
a. The County is aware that Section 5751 . 7 of the Welfare and
Institutions Code establishes an absolute prohibition against
minors being admitted for psychiatric treatment into the same
treatment ward as any adult receiving treatment who is in custody
of any jailor for a violent crime, or is a known registered sex
offender, or has a known history of, or exhibits inappropriate,
sexual or other violent behavior which would present a threat to
the physical safety of minors .
b. The County agrees to ensure that, whenever feasible, minors shall
not be admitted into psychiatric treatment with adults if the
health facility has no specific separate housing arrangements,
treatment staff, and treatment programs designed to serve
children or adolescents .
C . If the requirements of 9b. create an undue hardship for the
County, the County will be granted a waiver if requested.
d. If the County has not been granted a waiver, it must comply with
the provision of 9b.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 6
e. Section 5751. 7 delineates a procedure by which a county may
request a waiver from the Director of the Department of Mental
Health. All counties requesting a waiver pursuant to Section
5751 . 7 must complete Attachment 2 and submit it with the
Performance Contract .
f . Each admission of a minor to a facility that has an approved
waiver shall be reported to the Local Mental Director, or his or
her designee, in such a manner as prescribed by the Local Mental
Health Director.
PART 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 30OX 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 9596 of the funds allocated by the Department
of Mental Health in accordance with the budget for the
current fiscal year.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 7
Those Counties contracting with the Department of Mental
Health pursuant to welfare and Institutions Code,
Section 5708 shall be paid 1/12 of 1000 of the funds
allocated by the Department of Mental Health (SB 900
Counties) .
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 50o 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
"APPROVED NEGOTIATED RATES FOR SHORT-DOYLE/MEDI-CAL
REIMBURSEMENT" 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 .
S . Should a dispute arise relating to any issue within PART I of
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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 8
II -- STATE HOSPITAL BED USAGE
PART 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 PART A of II of this Contract . The State shall
operate the Hospital (s) continuously throughout the term, as
indicated in 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 PART
B of 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 .
(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) ' s 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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 9
e . The County shall provide case management services, as defined in
Section 8 of PART A in II of this contract .
SECTION 3 - DESCRIPTION OF COVERED HOSPITAL SERVICES
a. The State shall provide Lanterman-Petri s-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.
Former inmates of the California Department of Corrections (CDC)
who convert to Murphy Conservatees following concurrent
Incompetent to Stand Trial (IST) commitments will be the
responsibility of the county that sent the inmate to prison at
the expiration of their CDC commitment .
The County Mental Health Director, or designee, shall be involved
in the conversion 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 provide for the participation of counties in
long range planning through the counties' involvement with
the regional planning groups of the Future of State Hospital
Resources Task Force, and their participation in the
activities of the various committees of the California Mental
Health Directors Association (CMHDA) .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 10
(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 .
(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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 11
d. Electro-Convulsive Therapy
The Hospital (s) may cause to be provided Electra-Convulsive
Therapy, herein referred to 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
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.
rovidedhereunder.
(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 .
Contract Number . 94-74157
Contractor Contra Costa County Mental Health
Page 12
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 hospitalization shall
be handled and resolved by 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 .
. SECTIONS - PLANNING
The county may participate in regional committees of the CMHDA Long
Term Care Committee . Staff from the Department of Mental Health' s
Long Term Care Services Division and staff from the state hospitals
used by regional members may meet with the regional committee at the
Chairpersons request to discuss program, staffing, and capacity
changes . These types of issues may also be discussed between the
State and the counties as part of the agenda of the CMHDA Long Term
Care Committee and when appropriate with the CMHDA Executive Board.
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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 13
(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 .
(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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 14
(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) 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 will 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.
Contract Number 94-74157
Contractor Contra Costa touity Mental Health
Page 15
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 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 16
(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 Hospitals) 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.
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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 17
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
PART 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 - HED USAGE
a. General Provisions
(1) During the 1994/95 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 Conservatorships (Section 5008 (h) (1) (B)
of the Welfare and Institutions Code) . The number and type
of beds is specified in Attachment 3 . 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 II, PART "A" , Section 19 and in Attachment
3 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 18
(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 exceeded its dedicated
capacity on any given day on which more county patients are
assigned to a cost center than the county has dedicated
capacity in that cost center. The county shall only be
permitted to use beds in excess of its dedicated capacity
when use does not result in denial of access of other
counties to their dedicated capacity.
The State shall review the county' s use of state hospital
beds in accordance with this contract in January 1995, for
the period July 1 through December 31, 1994, and in July
1995 , for the period January 1 through June 30, 1995 to
determine if the county has used bed/days in excess of its
dedicated capacity during the respective half year periods of
the Performance Contract .
In calculating excess use in the Youth and Continuing Medical
Care (SNF) cost centers at Napa and Camarillo State
Hospitals, the use in excess of dedicated capacity shall be
calculated by subtracting under use from over use by
individual cost center and by hospital for the respective
half year period. The County shall be obligated to pay for
the net number of bed/days it used above the contracted
number of beds/days for the period, at the rate established
for the cost center in this contract .
Use in excess of dedicated capacity for Acute, ICF -
Psychiatric Subacute, ICF - Psychiatric Rehabilitation, and
Alternate Care cost centers during each half of the contract
year shall be calculated by reducing the number of excess
bed/days used during the period in any of these cost centers
by the number of bed/days underused in any of these cost
centers during the same period at each hospital respectively.
The county shall be obligated to pay the net dollar value of
its use in these cost centers if that value exceeds the
amount to be paid for the beds in these cost centers as
reflected in this contract .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 19
For example, if the county purchased 12 ICF - Psychiatric
Subacute beds and 12 Alternate Care beds, but used 14 ICF
Psychiatric Subacute and 10 Alternate Care beds, the net
number of bed/days used would be equal to the county' s
dedicated capacity, but the dollar value of this use pattern
would exceed the contracted amount by the marginal difference
in the rates between the two cost centers . Also, if the
county used 16 ICF - Psychiatric Subacute beds but only 6
Alternate Care beds the net number of bed/days used would be
less than the county' s dedicated capacity, but the cost of
this use pattern would exceed the contract amount and the
county would be required to pay the additional amount .
These methods of calculation notwithstanding, the County' s
obligation shall not be reduced below the contract amount set
forth in Attachment 3 . Overuse calculations for counties
which are members of the Small County Bed Pool shall be in
accordance with the provisions of II, PART 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 .
(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, purchase the services from the State as provided
in Item #3 above, or by 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) .
Contract Number . 94-74157
Contractor Contra Costa County Mental Health
Page 20
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) I 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 Hospitals)
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 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) ' 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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 21
SECTION 11 - QUALITY ASSURANCE
a. The Hospitals) 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 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 PART, 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 22
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 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 23
(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 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 1994 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, Medi-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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 24
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 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 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 paragraph a, above, 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 the following as its Project Coordinator and except as
otherwise provided herein, all communication concerning this
contract shall be with the County Project Coordinator:
Lorna Bastian
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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 25
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 after the treatment team
determines that a patient on a Penal Code commitment will likely
require continued treatment and supervision under a county LPS
commitment after the patient' s •Penal Code commitment expires .
Such telephone notification shall be followed by a written
notification to the County Mental Health Director, or designee,
which shall be submitted within ten (10) working days of the date
the treatment team' s determination that continued treatment and
supervision should be recommended to the county. The written
notice must include the basis for the Hospital' s recommendation
and the date on which the Penal Code commitment will expire .
(See "E. " below)
The above notices to the County Mental Health Director, or
designee, shall be given not less than thirty (30) days prior to
the expiration of the Penal Code commitment . If the hospital (s)
does not notify the county at least thirty (30) days prior to the
expiration of the Penal Code commitment, the county' s financially
responsible shall not commence until thirty (30) days after the
hospital (s) telephone notification.
The county shall be responsible for making the decision regarding
the establishment of an LPS commitment at the expiration of the
Penal Code commitment . The county shall notify the hospital, in
writing, at least fifteen (15) days prior to the expiration of a
patient' s Penal Code commitment of its decision regarding the
establishment of an LPS commitment and continued hospitalization.
e . The Hospital (s) shall notify the County Mental Health Director,
or designee, of the conversion of a patient on LPS 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 capacity as
defined in SECTION 9 above . The hospital shall notify the County
Mental Health Director, or designee, by telephone at the earliest
possible time, but not later than three (3) working days after
such conversion. Such telephone notification shall be followed
by a written notification to the County Mental Health Director,
or designee, which shall be submitted no later than ten (10)
working days after the patient' s conversion.
f . 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 26
SECTION 17 - NOTIFICATION OF DEATH
a. The Hospitals) 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 1994/95, 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 .
SECTION la- - SMALL COUNTY BED POOL (SCBP)
a. This Section applies only to the counties that have indicated
that they are members of the-'SCEP as reflected in Attachment 3 of
this agreement .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 27
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 Attachment 3 (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
SCEP 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 (SCEP) 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 Attachment 3 , 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 excess use provisions set forth in
Section 9, PART A, II of this contract apply to the SCBP as
though it were a single county user . The SCBP' s excess use, if
any, for the first six (6) months of this contract shall be added
to the excess use, if any, during the last six (6) months of the
contract year. The cost of the resulting annual use in excess of
the SCBP' s dedicated capacity, if any, shall be charged to member
counties in accordance with- instructions given to the state by
the Pool Coordinator at the end of the 1994/95 fiscal year.
d. The County shall pay the amount identified in Attachment 3 as the
County' s contribution to the SCBP and that portion, if any, of
the SCBP' s annual excess use amount identified by the Pool
Coordinator at the end of the contract year as being the
responsibility of the County.
After the SCBP members identified the number and mix of beds to
be purchased as the SCBP' s dedicated capacity for fiscal year
1994/95 , the State calculated the average cost per bed by
dividing the actual cost of the beds by the number of beds . As
indicated in Attachment 3 , the county is charged this average
rate for the bed (s) it purchases regardless of the cost center of
bed.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 28
Not withstanding the provisions of Section 9 (A) (3) of this
contract, use in excess of the SCBP' s dedicated capacity during
each half of the contract year shall be calculated, in January
for the period July 1 through December 31, 1994 and in July for
the period January 1 through June 30, 1995 , by reducing the
number of bed/days used in excess of the SCBP' s dedicated
capacity in all cost centers at a hospital during the period by
the number of bed/days underused in all cost centers at that
hospital during the same period.
The State shall determine the dollar value of the bed/days
actually used by the SCBP and compare that amount with the dollar
value of the SCBP' s dedicated capacity for the period. SCBP
members will .be charged the contract amount, or the value of the
SCBP' s actual use, whichever is greater.
This method of calculation notwithstanding, the SCBP members'
obligation shall not be reduced below the contract amount set
forth in Attachment 3 . The SCBP' s use in excess of its dedicated
capacity for the two half year periods shall be added together
and charged to the member counties at the end of the contract
year in accordance with instructions given to the State by the
Pool Coordinator.
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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 29
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 .
5 . The amount payable by the County to the State concerning all
aspects of PART II of this Contract shall be $4 , 017, 902 . 00 . The
contract amount reflected here was computed based on the
information contained in Attachment 3 . The amount represents the
application of the 111994/95 Gross Rate to Counties" , as published
in DMH Letter 94-16 which by this reference is made a part
hereof, to the county' s contracted beds, less $50 . 54 per day to
reflect the application of anticipated revenue .
6 . Any County use in excess of the contracted amount, as defined in
II, PART A, Section 9 (A) (2) , or Section 19 (D) for Small County
Bed Pool Members, during the 1994-95 fiscal year, shall be an
additional cost to the county and collected by adjusting the
State Controller' s Schedule "B" in February 1995 and August 1995 .
7 . To the degree that revenue projections are not realized, the
county shall be responsible for the cost of its State Hospital
use up to the 111994/95 Gross Rate to Counties" published in
ATTACHMENT "I" of the DMH LETTER: 94-16 referenced in #5 above .
Determination of available revenue shall be completed by the
State by September 30 , 1995 .
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
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 30
used. This amount shall not exceed the value of the unused
contracted amount .
11 . During Fiscal Year 1994/95 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 methodology to be used
in subsequent contracts to identify and categorize these services
and fairly reimburse the State for the associated costs .
12 . 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 .
13 . 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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 31
14. 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 .
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 32
III -- GENERAL PROVISIONS
A. TERM
The term of the Fiscal Year 1994/95 County Performance Contract
shall be July 1, 1994 through June 30, 1995 .
B. BUDGET CONTINGENCIES
1 . Federal Budget
a. All parties agree that relating to Short-Doyle/Medi-Cal,
the contract is based upon the following:
b. 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.
C. 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
amendment, however, shall require County approval .
d. 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.
e . 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 .
2 . State Budget
a. 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, both parties may shall regarding
the changes and may renegotiate the terms of this
Contract affected by the statutory or regulatory changes .
b. This contract may be amended upon mutual consent of the
parties . Such amendments shall be executed by a duly
authorized representative of each party.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 33
C . 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 .
C. CONFIDENTIALITY
1 . 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.
2 . 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 .
3 . County shall not disclose, except as otherwise specifically
permitted by this contract or authorized by the
client/patient, any such identifying information to anyone
other than the State without prior written authorization from
the State in accordance with State and Federal Laws .
4 . 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.
D. NONDISCRIMINATION
1 . 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 34
2 . 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 .
3 . 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, 1977 .
4 . _ County shall include the nondiscrimination and compliance
provisions of this contract in all - subcontracts to perform
work under this contract .
E. PATIENTS` RIGHTS
The parties to this 1994/95 County Performance Contract shall
comply with applicable laws, regulations and State policies
relating to patients' rights.
F. RECORDREEPING
1 . 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 .
2 . 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 35
G. 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 employment . 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 .
H. REPORTS
1 . 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) .
2 . 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 .
I. 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, 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.
J. 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) .
Contract Number : 94-74157
Contractor : Contra Costa County Mental Health
Page 36
K. WA76VER 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.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 37
ATTACHMENT 2
REQUEST FOR WAIVER PURSUANT TO SECTION 5751. 7 OF THE
WELFARE AND INSTITUTIONS CODE
hereby requests a waiver for the
following public or private health facilities pursuant to
Section 5751.7 of the Welfare and Institutions Code for the term
of this contract. These are facilities where minors may be
provided psychiatric treatment with nonspecific separate housing
arrangements, treatment staff, and treatment programs designed to
serve minors.
The request for a waiver must include, as an attachment, the
following:
1. A description of the hardship to the county due to inadequate
or unavailable alternative resources that would be caused by
compliance with the state policy regarding the provision of
psychiatric treatment to minors.
2 . The specific treatment protocols and administrative
procedures established by the county for identifying and
providing appropriate treatment to minors admitted with
adults.
Execution of this contract shall constitute approval of this
waiver. Any waiver granted in the prior fiscal year's contract
shall be deemed to continue until execution of this contract.
Contract Number 94-74157
Contractor Contra Costa County Mental Health
Page 38
O O O M N O M O --ct N N O u1 N
a1 (,H Q) O v (A (D O
. r r ti CO (n
a O R o (h Oo L r.
Q N C) LCO M r
fA 6n-.0 (A O
fj-:� 69-
U
N
7
C
C
N M OW) (D O LO O O d' N N O LO N
O (0 t0 O N 619. 0 O v v9 (D OO
O M CO w O to '14fl OCLN
C Q EH 00 O O fA r` �` G O M CO LO 00
000 N LO N M
Z Z EA 4N4 EA z 0 64 (A N Vf
V3, to
O
C N
0) C
U 4]
„ U
Z W
0 U U
Ch
0 0 0 0 0 0 0 CO 0 0 0 0 0 0 0
Q Cn «+ �, O O N O Oa �, <R 44 (f? (A A
Ef? ( tH
Cr a
-
O O bM4 60, � 6M CI4 N c0) a
g 0
Z 0 U c
W N
tQ N CUy
= O U p c w
Q M
H `0
F" O a oOf O CO c) N ao O O 01 O O O Os
Q V N r O O O O O O y C O EA Ef3 r FF? (A (A
W O (D N O N CD 0 y= (D
r F- 'C C C
W ZCn� CNI 04 N m `nU
f' O W q env G (D in R
LU U (�
N v a E CD
� � c
m Z
J O
_T
Q. a O1 O C w
Z
LL O CY LL C U) OU
U o O U LL
mU a LL U .. •2 O U C "
W `n Z y H CDCL
Z a °D a LL a) o
E' d Cc V Q 0 U H d UZj v a LL U
Wis 0 z aLi M F io (D (D a V .L N L Z R
O 0 c� •NU) HiQ LU w t •0 yNX R g �. a) y `� °�' •� cn 0 0 0
W U aTi a-i V 0 Z U a Z L U O Q' = U v nJ F-
U) M CUZ (D F' E}. d Z iio O V a y N y Z 'L U
C Z m L t c E In is is
L O L Cl U U C
m ° aQ �¢ >- v n Q ¢ >- U) C CL � a >• cYnLLa
Q
e� N P7
ent'a'1 Kealtn
84-14 a5 CoSta
� Co
u�tY M
Gt NUmbex ., �
Contrartos °
Conti 3g Ca fG
p age °; °; w V R
t
o-
y N v S -a is G 4- �►�.
N c4 w U N O G O� cQ
34
0 w0 G iG 0)
'N
N N G y
O rOi U
So
v %b U N ca o cy
T O L o0 OG p 7 0
SU ay G c6 L ^tS O tL
o
O O N .Q N c0 y cNa
o „ i 3
N d , J1 N
C:6 U N
N? .. 0.0 4 V t3 S3
L
1
Q 3 00 O Q v C5d N ° td N
0 O A V 4 —0 d: O OG -0 R t0t1 N
_ r 4O a- d coaM eN
�
r V G �i G O .► �% g G O c? Q O
t33 O r O t6 U y y N N C N N
d
T O Z
co
V d, � V
N O v L✓ GO �1- v : T 1 E N
�' G N V .-. O co 2 N '." D u� T,,,• 1'" p G m
N
—03
o U rd aul
W
N
d