HomeMy WebLinkAboutMINUTES - 07181995 - C44 _ c 7BOARD OF SUPERVISORS r
t Contra
FROM: Mark Finucane, Health Services Director
Costa
DATE: July 6, 1995 County
SUBJECT: Approval of Drug/Medi-Cal Contract with the State Department of Alcohol and
Drug Programs for FY 94-95
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the
County, Standard Agreement (Amendment) #29-489-1 (State DMC07-94, A-1) with the
State Department of Alcohol and Drug Programs, effective July 1, 1994, to decrease
the payment limit by $146 ,148, from $1,972,388 to a new total of $1,826,240, for
provision of Drug/Medi-Cal Substance Abuse Treatment Services to Medi-Cal
beneficiaries.
II. FINANCIAL IMPACT:
The amendment decreases State General Funds by $73,074 and Federal Drug Medi-Cal by
a similar amount, for a total decrease of $146,148. The reduction in funding is due
to lower projected utilization in Drug Medi-Cal services. The decrease in State
General Funds of $73,074 will be added to the NNA Contract (#29-488-2) with the
State.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On February 28, 1995, the Board of Supervisors approved Standard Agreement #29-489
with the State Department of Alcohol and Drug Programs for the period from July 1,
1994 through June 30, 1995 . The contract amount was based on a higher projected
utilization in Drug Medi-Cal services. This amendment is based on eight months of
actual utilization and projections for four months. Approval of this amendment is
required by the State in the provision of Drug Medi-Cal services, and would
guarantee payment for these services.
The Board Chair should sign ten copies of the Agreement. Nine copies of the
Agreement and three certified/sealed copies of this Board Order should be returned
to the Contracts and Grants Unit.
CONTINUED ON ATTACHMENT: YES SIGNATURE: .^-
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON g 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: Chuck Deutschman (313-6350)
cc: health Services (Contracts) ATTESTED
State Dept. of Alcohol & Drug Programs
Phil B chef , Clerk of the Board of
SUpenliwrs 4W Gouaty Administrator
1
M382/7-83 BY DEPUTY
STATE OF CALIFORNIA
T4ND,4RD AGREEMENT— APPROVED BY THE �7-IS -5S c, µ CONTRACT NUMBER AM.NO.
STD:2(REv.s-syj ATTORNEY GENERAL DMC07-94 A-1
' TAXPAYERS FEDERAL EMPLOYER IDENTIFICATION NUMBER
THIS AGREEMENT,made and entered into this 1St day of Jul y , 19-A, 0
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
DEPUTY DIRECTOR. DIV. OF ADMIN.1 ALCOHOL D DRUG PROGRAMS ,hereafter called the State,and
CONTRACTOR'S NAME
COUNTY OF CONTRA COSTA 29 0 ,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.)
1. Agreement No. DMC07-94, entered into by and between the Department of
Alcohol and Drug Programs, the Department of Health Services, and County
of Contra Costa is amended as hereafter specified:
Paragraph 3 of the contract face sheet is amended to decrease the
contract amount by $146,148 for Fiscal Year 1994/95 for a new
total not to exceed $1,826,240. Exhibit A, Revised Budget of
Expenditures and Revenues, Fiscal Year 1994/95, is attached hereto
and incorporated by this reference.
2. The effective date of the amendment is July 1, 1994.
3. Except as hereinstated, all other terms and provisions shall remain in
full force and effect.
APPROVED
4-Lf 9�
CONTINUED ON 11 SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBE ` DePal
t :w .„-----
The provisions on the reverse side hereof constitute a part of this agreement udg-e tv .Ti vision
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date first above wn en.
STATE OF CALIFORNIA CONTRACTOR
AGENCY DEPARTMENT OF DEPARTMENT OF CONTRACTOR(it other than an individual state whether a corporation,partnership,etc.)
ALCOHOL & DRUG PROGRAMS HEALTH SFRVICES COUNTY OF CONTRA COSTA
BY(AUTHORIZED SIGNATURE) Y( UTH IZED SIGNATURE)
D
PRINTED NAME OF PERSON SIGNING TED NA&X AND TITLE OF PERSON SIGNKG
DESIREE WILSON ” 8 JOHN RODRIGUEZ Chair, Board of Supervisors
TITLE Deputy Director IJ Deputy Director AD651 DRESS
Administration Medical Care rvi Pine Street, Martinez, California 94553
AMOUNT ENCUMBERED BY THIS PROGRAM/CATEGORY(CODE AND TITLE) FUND TITLE Department of General Services
DOCUMENT Use Only
� Local Assistance Gen/Reimb.
(OPTIONAL USE)
PRIOR AMOUN NdUMB RtD OR
THIS CONTRACT Drug/Medi -Cal This contract exempt
$ . 1,972,388.00 ITEM CHAPTER STATUTE FISCALYEAR from Dept. of General
TOTAL AMOUNT ENCUMBERED TO 4200-101/102-001 139 1994 94/95 Services per Welfare
DATE OBJECT OF EXPENDITURE(CODE AND TIRE) and Institutions Code
$ attached fundinq information Section 14087.4
l hereby certify upon my own personal knowledge that budgeted funds T.B.A.NO. B.R.NO.
are available for the period d purpose of the expenditr stated above.
SIGNATURE OF ACCOUNTING IC R p
D
CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. F CONTROLLER
I
DRUG MEDI-CAL AMENDMENT FY 1994-95
Object of Expenditure (Code and Title)
County: CONTRA COSTA Contract No. DMC 07-94 Al
$ 754 , 173 7000-59410-705 (SGF Allocation)
$ 0 7000-59412-705 (SGF Reserve Accessed)
$ 754 , 173 7000-59494-705 (FFP Reimbursement)
$ 158 , 947 7000-59411-705 (Perinatal SGF Allocation)
$ 0 7000-59413-705 (Perinatal Reserve Accessed)
$ 158 , 947 7000-59495-705 (FFP - PTEP Reimbursement)
$ 1, 826 , 240 TOTAL AMOUNT
G;\CM\CONTRACT\DMC94-95\OBJ.FRM (05-05-95)
EXHIBIT A
(REVISED)
Page'1
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
COUNTY-WIDE SUMMARY
COUNTY CONTRA COSTA
CONTRACT PERIOD 7/1/94-6/30/95
DATE PREPARED 4/17/95
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
S „.
GROSS COSTS S .
.. ..............................................
A. PROGRAM(TREATMENT) 706,391 6,418 432,240 267,733 699,973
B. COUNTY ADMINISTRATION 0 0 0 0 0
C. TOTAL GROSS COSTS 706,391 6,418 432,240 267 733 699.973
REVENUES
D. PARTICIPANT FEES 37,936 5,312 0 32,624 32,624
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0 0 0 0
F. CONTRAC S GRANTS(SPECIFY)
CONTRACTS&
F1. COUNTY-FEDERAL ALCOHOL&DRUG ERR 0 0 ERR ERR
F2. COUNTY-STATE ALCOHOL&DRUG 45,033 0 0 45,033 45,033
F3. COUNTY-COUNTY ALCOHOL&DRUG 116,613 0 0 116,613 116,613
F4. COUNTY-FEDERAL PERINATAL 0 0 0 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0 0 0 0
F6. COUNTY-COUNTY PERINATAL 0 0 0 0 0
F7. COUNTY/STATE -FEDERAL MEDI-CAL ALCOHOL&DRUG 57,173 0 57,173 0 57,173
F8. COUNTY/STATE -STATE MEDI-CAL ALCOHOL&DRUG 57,173 0 57,173 0 57,173
F9. COUNTY/STATE -FEDERAL MEDI-CAL PERINATAL 158,947 0 158,947 0 158,947
F10.COUNTY/STATE -STATE MEDI-CAL PERINATAL 158,947 0 158,947 0 158,947
F11.FEDERAL/STATE-DIRECT CONTRACT 0 0 0 0 0
F12. 0 0 0 0 0
F13. 0 0 0 0 0
F14. 0 0 0 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE) 0 0 0 0 0
G1. 0 0 0 0 0
G2. 0 0 0 0 0
G3. 0 0 0 0 0
TOTAL REVENUES ERR 5,312 432,240 ERR ERR
NET COSTS GROSS COSTS LESS LINES D E G 668.455 1,106 432,240 235 109 667.349
C
H. UNITS OF SERVI E
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 11,220 114 5,839 5,267 11,106
H2. FACE TO FACE VISITS DOSES 0 0 0 0 0
H3. DAY CARE HABILITATIVE DAY 0 0 0 0 0
H4. RESIDENTIAL DAY 0 0 0 0 0
H5. OTHER(SPECIFY) 0 0 0 0 0
H6. 0 0 0 0 0
H7. 0 0 0 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH H7 11,220 114 5,839 5,267 11;106
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 18,327 217 10,387 7,723 18,110
J. METHADONE SLOTS(OMM only) 0 0 0 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE H8 62.96 56.30 74.03 50.83 63.03
L. COST PER STAFF HOUR GROSS COSTSILINE q 38.54 29.58 41.61 34.67 38.65
M. COST PER SLOT GROSS COSTS LINE 0.001 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 102,206 01 57,173 45,0331 102,206
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 158,947 ol 158,947 ol 158,947
ADP FORM 78958 (8/94)
EXHIBIT A
(REVISED)
Page 2
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER
CONTRACTOR AIRS EAST
CONTRACT PERIOD 07/01/94-06/30/95 MEDI-CAL PROV. NO. 07AA
DATE PREPARED 04/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
: ...... ::i::i:::i::i::::i::i::::::i:::iiiiiiii:isi:%:.:i::>::>::>::>::>:>:;
GROSS COSTS
.'•;::iiiiiiiiii::::ii5;:i;:Sis
A. PROGRAM(TREATMENT) 109,908 5,312 36,480 68,116 104,596
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 109,908 5,312 36.480 68 116 104,596
REVENUES UES
D, PARTICIPANT FEES 5,312 5,312 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
S C
F. CONTRACTS&GRANTS PE IF
Ft. COUNTY-FEDERAL ALCOHOL&DRUG 28,355 28,355 28,355
F2. COUNTY-STATE ALCOHOL&DRUG 17,382 17,382 17,382
F3. COUNTY-COUNTY ALCOHOL&DRUG 22,379 22,379 22,379
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE -FEDERAL MEDI-CAL ALCOHOL&DRUG 18,240 18,240 18,240
F8. COUNTY/STATE -STATE MEDI-CAL ALCOHOL&DRUG 18,240 18,240 18,240
F9. COUNTY/STATE -FEDERAL MEDI-CAL PERINATAL 0 0
F10.COUNTY/STATE -STATE MEDI-CAL PERINATAL 0 0
F11.FEDERALISTATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE) 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 109,908 5,312 36,480 68,116 104,596
NET COSTS GROSS COSTS LESS LINES D E G 104,596 0 36,480 68.116 104.596
H. UNITS OF SERVICE
Hi. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 1,797 87 597 1,113 1,710
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAY CARE HABILITATNE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECT 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH H7 1,797 87 597 1,113 1,710
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 3,838 185 1,275 2,378 3,653
J. METHADONE SLOTS(OMM oni 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE H8 61.16 61.06 61.11 61.20 61.17
L. COST PER STAFF HOUR GROSS COSTS/LINE 4 28.64 28.71 28.61 28.64 28.63
M. COST PER SLOT GROSS COSTS/LINE JQ 0.00 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 -35,6221 0 18,240 17,382 35,622
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 ol 01 ol 01 0
ADP FORM 7895B (8/94)
(R=Sm)
Page 3 _
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER
CONTRACTOR BORN FREE - CENTRAL
CONTRACT PERIOD 7/1/94-6/30/95 MEDI-CAL PROV. NO. 0770
DATE PREPARED 04/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDT-CAL FUNDED NNA/PUBLIC
_. O
GR SS COSTS
A. PROGRAM(TREATMENT) 157,923 123,534 34,389 157,923
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 157,923 0 123,534 34.389 157,923
REVENUES
D. PARTICIPANT FEES 0 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
F. CONTRACTS&
GRANTS
(SPECIFY)
F1. COUNTY-FEDERAL ALCOHOL&DRUG 0 0
F2. COUNTY-STATE ALCOHOL&DRUG 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 34,389 34,389 34,389
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE-FEDERAL MEDI-CAL ALCOHOL&DRUG 0 0
F8. COUNTY/STATE -STATE MEDT-CAL ALCOHOL&DRUG 0 0
F9. COUNTY/STATE -FEDERAL MEDT-CAL PERINATAL 61,767 61,767 61,767
F10.COUNTY/STATE -STATE MEDI-CAL PERINATAL 61,767 61,767 61,767
F11.FEDERAL/STATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER(SPECIFY)TCM/MAC(AB2377)(FEDERAL SHARE) 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 157,923 ol 123,534 34,389 157,923
NET COSTS GROSS COSTS LESS LINES D E G 157,923 ol 123,534 34 389 157,923
SE OF
RV
H. UNITS ICE
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 1,619 1,295 324 1,619
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAY CARE HASILITATIVE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECIE 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH 1-17 1,619 0 1,295 324 1,619
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC.).. 3,055 2,444 611 3,055
J. METHADONE SLOTS(OMM onl 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE Ha)_ 97.54 0.00 95.39 106.14 97.54
L. COST PER STAFF HOUR GROSS COSTS/LINE Q 51.69 0.00 50.55 56.28 51.69
M. COST PER SLOT GROSS COSTS/LINE 0.00 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 0 ol 0 0 0
TOTAL PI=RINATAL GENERAL FUND ADD LINES F5 F10 61,7671 0 1 61,767 1 ol 61,767
ADP FORM 78956 (8/94)
EXHIBIT A
(REVISED)
Page'4
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER
CONTRACTOR BORN FREE - WEST
CONTRACT PERIOD 07/01/94-06/30/95 MEDI-CAL PROV. NO. 0773
DATE PREPARED 04/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
GROSS COSTS
A. PROGRAM(TREATMENT) 140,270 129,866 10,404 140,270
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 140,270 0 129,866 10,404 140.270
REVENUES
D. PARTICIPANT FEES 0 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
F CONTRACTS&GRANTS(SPECIFY)
F1. COUNTY-FEDERAL ALCOHOL&DRUG 0 0
F2. COUNTY-STATE ALCOHOL&DRUG 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 10,404 10,404 10,404
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE -FEDERAL MEDI-CAL ALCOHOL&DRUG 0 0
F8. COUNTY/STATE-STATE MEDI-CAL ALCOHOL&DRUG 0 0
F9. COUNTY/STATE -FEDERAL MEDT-CAL PERINATAL 64,933 64,933 64,933
F10.COUNTY/STATE -STATE MEDI-CAL PERINATAL 64,933 64,933 64,933
F11.FEDERAL/STATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 140,270 0 129,866 10,404 140,270
NET COSTS GROSS COSTS LESS LINES D E G 140,270 0 129,866 10,404 140,270
F SERVICE
O
H. UNITS E
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 1,482 1,347 135 1,482
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAY CARE HABILITATIVE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECIE 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH 1-17 1,482 0 1,347 135 1,482
1. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 2,798 2,544 2541 2,798
J. METHADONE SLOTS(OMM only) 0 1 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE 1-18 94.65 0.00 96.41 77.07 94.65
L. COST PER STAFF HOUR GROSS COSTS/LINE 0 50.13 0.00 51.05 40.96 50.13
M. COST PER SLOT GROSS COSTS/LINE 0.00 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 0 -77 0 0 01 0
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 64,933 01 64 933 01 64 933
ADP FORM 7895B (8/94)
EXHIBIT A
(REVISED)
Page'5
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY. CONTRA COSTA CONTRACT NUMBER
CONTRACTOR BORN FREE - EAST
CONTRACT PERIOD 07/01/94-06/30/95 MEDI-CAL PROV. NO. 0774
DATE PREPARED 04/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
GROSS COSTS
A. PROGRAM(TREATMENT) 75,714 64,494 11,220 75,714
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 75,714 ol 64,494 11,220 75 714
REVENUES
D. PARTICIPANT FEES 0 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
C
F. CONTRACTS&GRANTS(SPECIFY)
Ft. COUNTY-FEDERAL ALCOHOL&DRUG 0 0
F2. COUNTY-STATE ALCOHOL&DRUG 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 11,220 11,220 11,220
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE-FEDERAL MEDT-CAL ALCOHOL&DRUG 0 0
F8. COUNTY/STATE -STATE MEDI-CAL ALCOHOL&DRUG 0 0
F9. COUNTY/STATE -FEDERAL MEDI-CAL PERINATAL 32,247 32,247 32,247
F10.COUNTY/STATE -STATE MEDT-CAL PERINATAL 32,247 32,247 32,247
F11.FEDERAL/STATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE) 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 75,714 0 64,494 11,220 75,714
NET COSTS GROSS COSTS LESS LINES D E G 75,714 0 64,494 11,220 75 714
H. UNITS OF SERVICE
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 763 665 98 763
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAY CARE HABILITATNE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER(SPECIFY) 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH 1-17 763 0 665 98 763
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 2,106 1,836 270 2,106
J. METHADONE SLOTS(OMM onl 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE 1-18 99.23 0.00 96.98 114.49 99.23
L. COST PER STAFF HOUR GROSS COSTS/LINE D 35.95 0.00 35.13 41.56 35.95
M. COST PER SLOT GROSS COSTS/LINE 0.00 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 ol 0 ol ol 0
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 32,2471 0 32,2471 ol 32,247
ADP FORM 7895B (8/94)
EXHIBIT A
(REVISED)
Page 6
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER
CONTRACTOR SOJOURNE
CONTRACT PERIOD 07/01/94-06/30/95 MEDI-CAL PROV. NO. 0761
DATE PREPARED 04/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
GROSS COSTS
A. PROGRAM EATMEN 157,472 1',106 61,490 94,876 156,366
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 157,472 1.106 61,490 94876 156.366
REVENUES
D. PARTICIPANT FEES 0 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
NTS
ONTRACTS&GRA I
F. C SPEC
F1. COUNTY-FEDERAL ALCOHOL&DRUG 45,108 45,108 45,108
F2. COUNTY-STATE ALCOHOL&DRUG 27,651 27,651 27,651
F3. COUNTY-COUNTY ALCOHOL&DRUG 22,117 22,117 22,117
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE PTEP PERINATAL 0 0`
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE -FEDERAL MEDI-CAL ALCOHOL&DRUG 30,745 30,745 30,745
F8. COUNTY/STATE -STATE MEDI-CAL ALCOHOL&DRUG 30,745 30,745 30,745
F9. COUNTY/STATE -FEDERAL MEDI-CAL PERINATAL 0 0
F10.COUNTY/STATE -STATE MEDI-CAL PERINATAL 0 0
F11.FEDERAL/STATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0,
F14. 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTALREVENUES 156,366 0 61,490 94,876 156,366
NET COSTS GROSS COSTS LESS LINES D E G 157,472 1,106 61,490 94,876 156,366
RVIC
H.
UNITS OF SEE
H1, FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 3,861 27 1,508 2,326 3,834
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAYCARE HABILITATNE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECT 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH 1-17 3,861 27 1,508 2,326 3,834
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 4,558 32 1,792 2,734 4,526
J. METHADONE SLOTS(OMM onl 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE 1-18 40.79 40.96 40.78 40.79 40.78
L. COST PER STAFF HOUR GROSS COSTSILINE Q 34.55 34.56 34.31 34.70 34.55
M. COST PER SLOT GROSS COSTS/LINE 0.00 0.00 0.00 0.00 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 58,396 0 30,745 27,651 58,396
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 0 0 0 0 0
ADP FORM 7895B (8/94)
EXHIBIT A
(REVISED)
Page7,..
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (ODF1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY Contra Costa CONTRACT NUMBER
CONTRACTOR 7/1/94- 6/30/95
CONTRACT PERIOD San Pablo Discovery MEDI-CAL PROV. NO. New
DATE PREPARED 4/25/95 CADDS PROVIDER NO. 070732
TYPE OF PROGRAM ODF (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
GROSS COSTS
A. PROGRAM EATMEN 65,104 16,376 48,728 65,104
B. COUNTY ADMINISTRATION 0 0
C. TOTAL GROSS COSTS 65,104 0 16,376 48,728 65,104
N
REVE UES
D. PARTICIPANT FEES 32,624 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
F. CONTRACTS
&GRANTS SPECT
F1. COUNTY-FEDERAL ALCOHOL&DRUG 32,624 32,624 32,624
F2. COUNTY-STATE ALCOHOL&DRUG 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 16,104 16,104 16,104
F4. COUNTY-FEDERAL PERINATAL 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE-FEDERAL MEDT-CAL ALCOHOL&DRUG 8,188 8,188 8,188
F8. COUNTY/STATE-STATE MEDT-CAL ALCOHOL&DRUG 8,188 8,188 8,188
F9. COUNTY/STATE -FEDERAL MEDT-CAL PERINATAL 0 0
F10.COUNTY/STATE -STATE MEDT-CAL PERINATAL 0 0
F11.FEDERAUSTATE-DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER SPECT TCM/MAC(AB2377)(FEDERAL SHARE) 0 0-
G1. 0 0
G2. 0 0
G3. 0 2-
TOTAL REVENUES 97,728 0 16,376 48,728 65,104
NET COSTS GROSS COSTS LESS LINES D E G 32,480 0 16,376 16,104 65 104
H UNITS OF SERVICE
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 1,698 427 1,271 1,698
H2. FACE TO FACE VISITS DOSES 0 0
H3. DAYCARE HABILITATIVE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECT 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH H7 1,698 0 427 1,271 1,698
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 1,972 496 1,476 1,972
J. METHADONE SLOTS(OMM only) 0 0
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE H8 38.34 0.00 38.35 38.34 38.34
L. COST PER STAFF HOUR GROSS COSTS/LINE Q 33.01 0.00 33.02 33.01 33.01.
M. COST PER SLOT GROSS COSTS/LINE 0.001 0.00 0.001 0.001 0.00
TOTAL STATE GENERAL FUND ADD LINES F2,F8 8,1881 0 8,1881 01 8,188
TOTAL PERINATAL GENERAL FUND ADD LINES F5 F10 01 0 01 01 0
ADP FORM 7895B (8/94)
EXHIBIT A
(REVISED)
1
Page'1
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (OMM1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
COUNTY-WIDE SUMMARY
COUNTY CONTRA COSTA
CONTRACT PERIOD 7/1/94-6/30/95
DATE PREPARED 4/17/95
TYPE OF PROGRAM OMM (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDI-CAL FUNDED NNA/PUBLIC
GROSS COSTS S
A. PROGRAM(TREATMENT) 1,690,000 376,000 1,314,000 0 1,314,000
B. COUNTY ADMINISTRATION 80,000 0 80,000 0 80,000
C. TOTAL GROSS COSTS 1 770 000 "376,0001 1,394,000 0 1 394,000
REVENUES
E ES
D. PARTICIPANT FEES 376,000 376,000 0 0 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0 0 0 0
T & A CI
F. CONTRACTS S GRANTS SPE
F1. COUNTY- FEDERAL(ALCOHOL&DRUG) 0 0 0 0 0
F2. COUNTY- STATE ALCOHOL&DRUG 0 0 0 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 0 0 0 0 0
F4. COUNTY- FEDERAL PERINATAL 0 0 0 0 0
F5. COUNTY-STATE(PTEP) (PERINATAL 0 0 0 0 0
F6. COUNTY-COUNTY PERINATAL 0 0 0 0 0
F7. COUNTY/STATE - FEDERAL MEDI-CAL ALCOHOL&DRUG 697,000 0 697,000 0 697,000
F8. COUNTY/STATE - STATE MEDI-CAL(ALCOHOL&DRUG) 697,000 0 697,000 0 697,000
F9. COUNTY/STATE - FEDERAL MEDI-CAL PERINATAL 0 0 0 0 0
F10.COUNTY/STATE - STATE MEDT-CAL PERINATAL 0 0 0 0 0
F11.FEDERALISTATE- DIRECT CONTRACT 0 0 0 0 0
F12. 0 0 0 0 0
F13. 0 0 0 0 0
F14. 0 0 0 0 0
G. OTHER(SPECIFY)TCM/MAC(AB2377)(FEDERAL SHARE) 0 0 0 0 0
G1. 0 0 0 0 0
G2. 0 0 0 0 0
G3. 0 0 0 0 0
TOTAL REVENUES 1,770,000 376,000 1,394,000 0 1,394,000
NET COSTS GROSS COSTS LESS LINES DEG 1,394,000 0 1,394,000 0 1,394,000
SERVICE
H. UNITS OF ;:«.:<.;:.:::.:::•;:;. :::�::::::::::::::::r� :l;;:.: ::::ii5i:i :•:: :;:8::: :
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 0 0 0 0 0
H2. FACE TO FACE VISITS DOSES 193,142 41,156 151,986 0 151,986
H3. DAY CARE HABILITATIVE DAY 0 0 0 0 0
H4. RESIDENTIAL DAY 0 0 0 0 0
H5. OTHER SPECIE 0 0 0 0 0
H6. 0 0 0 0 0
H7. 0 0 0 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH H7 193,142 41,156 151,986 0 151,986
I. STAFF HOURS DIRECT SVCS-COUNSELING,MEDICAL,ETC. 62,400 1 13,307 49,093 1 ol 49,093
J. METHADONE SLOTS OMM onl 7601 2001 5601 ol 560
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE H8 9.16 9.14 9.17 0.00 9.17
L. COST PER STAFF HOUR GROSS COSTS/LINE Q 28.37 28.26 28.40 0.00 28.40
M. COST PER SLOT GROSS COSTS/LINE 2328.95 1880.00 2489.29 0.00 2489.29
TOTAL STATE GENERAL FUND(ADD LINES F2,F8) 697,000 ol 697,000 0 697,000
TOTAL PERINATAL GENERAL FUND ADD LINES F5.1`10 ol ol ol 0 0
ADP FORM 78958 (8/94)
EXHIBIT A
(REVISED)
Page'2
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (OMM1)
DRUG MEDI-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER .24-469
CONTRACTOR BAART - RICHMOND
CONTRACT PERIOD 7/1/94-6/30/95 MEDI-CAL PROV. NO. 0708
DATE PREPARED 4/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM OMM (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDT-CAL FUNDED NNA/PUBLIC
GROSS S COSTS
A. PROGRAM(TREATMENT) 1,052,000 192.000 860,000 860,000
B. COUNTY ADMINISTRATION 51,440 51,440 51,440
C. TOTAL GROSS COSTS 1.103.440 192.000 911.440 0 911.440
REVENUES
D. PARTICIPANT FEES 192,000 192.000 0
E. INSURANCE,MEDICARE.&OTHER THIRD PARTY 0 0
TRACT RANTS(SPECIFY)
F. CON
CONTRACTS
F1. COUNTY- FEDERAL(ALCOHOL&DRUG) 0 0
F2. COUNTY- STATE ALCOHOL&DRUG 0 0
F3. COUNTY- COUNTY ALCOHOL&DRUG 0 0
F4. COUNTY- FEDERAL PERINATAL 0 0
F5. COUNTY- STATE(PTEP) (PERINATAL 0 0
F6. COUNTY- COUNTY PERINATAL 0 0
F7. COUNTY/STATE - FEDERAL MEDI-CAL ALCOHOL&DRUG 455,720 455,720 455,720
F8. COUNTY/STATE - STATE MEDI-CAL(ALCOHOL&DRUG) 455,720 455,720 455,720
F9. COUNTY/STATE - FEDERAL MEDT-CAL PERINATAL 0 0
1`10.COUNTY/STATE - STATE MEDI-CAL PERINATAL 0 0
F11.FEDERAUSTATE- DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER(SPECIFY)TCM/MAC(AB2377)(FEDERAL SHARE) 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 1,103,440 192,000 911,440 0 911,440
NET COSTS GROSS COSTS LESS LINES D E G 911,440 0 911,440 0 911,440
H. UNITS OF SERVICE
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 0 0
H2. FACE TO FACE VISITS DOSES 119,162 20,734 98,428 98.428
H3. DAY CARE HABILITATIVE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECIE 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH 1-17 119,162 20,734 98,428 0 98,428
I. STAFF HOURS DIRECT SVCS-COUNSELING.MEDICAL, ETC. 38,400 6,681 31,719 31,719
J. METHADONE SLOTS(OMM only) 4601 100 1 360 360
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE HB 9.26J 9.26 9.26 0.00 9.26
L. COST PER STAFF HOUR GROSS COSTS/LINE Q 28.74 1 28.74 28.73 0.00 28.73
M. COST PER SLOT GROSS COSTS/LINE 2-1913781 lQ90001 2531.78 0.00 2531.78
TOTAL STATE GENERAL FUND(ADD LINES F2,F8) 455,720 0 455,720 0 455.720
TOTAL PERINATAL GENERAL FUND(ADD LINES F5,F10) ol ol ol ol 0
ADP FORM 7895B (8/94)
EXHIBIT A .
(REVISED)
Page 3
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS (OMM1)
DRUG MEDT-CAL FISCAL DETAIL
BUDGET OF EXPENDITURES AND REVENUES
CURRENT PROVIDERS
SUMMARY
COUNTY CONTRA COSTA CONTRACT NUMBER 24-469
CONTRACTOR BAART - PITTSBURG
CONTRACT PERIOD 07/01/94-06/30/95 MEDI-CAL PROV. NO. 0709
DATE PREPARED 4/17/95 CADDS PROVIDER NO.
TYPE OF PROGRAM OMM (Specify as OMM, ODF, DCH, NAL, RES)
A B C D E
TOTAL PRIVATE NNA/PUBLIC TOTAL MC/
CATEGORIES PROGRAM PAY MEDT-CAL FUNDED NNA/PUBLIC
GROSSSTS
CO
A. PROGRAM(TREATMENT) 638,000 184,000 454,000 454,000
S. COUNTY ADMINISTRATION 28,560 28,560 28,560
C. TOTAL GROSS COSTS 666 560 184,000 482,560 0 482 560
REVENUES
D. PARTICIPANT FEES 184,000 184,000 0
E. INSURANCE,MEDICARE,&OTHER THIRD PARTY 0 0
CT
F
. CONTRA S&GRANTS(SPECIFY)
F1. COUNTY- FEDERAL(ALCOHOL&DRUG) 0 0
F2. COUNTY- STATE ALCOHOL&DRUG 0 0
F3. COUNTY-COUNTY ALCOHOL&DRUG 0 0
F4. COUNTY- FEDERAL PERINATAL 0 0
F5. COUNTY- STATE(PTEP) (PERINATAL 0 0
F6. COUNTY-COUNTY PERINATAL 0 0
F7. COUNTY/STATE- FEDERAL MEDI-CAL ALCOHOL&DRUG 241,280 241,280 241,280
F8. COUNTY/STATE - STATE MEDI-CAL(ALCOHOL& DRUG) 241,280 241,280 241,280
F9. COUNTY/STATE - FEDERAL MEDT-CAL PERINATAL 0 0
F10.COUNTY/STATE - STATE MEDI-CAL PERINATAL 0 0
F11.FEDERAL/STATE- DIRECT CONTRACT 0 0
F12. 0 0
F13. 0 0
F14. 0 0
G. OTHER(SPECIFY)TCM/MAC (AB2377)(FEDERAL SHARE) 0 0
G1. 0 0
G2. 0 0
G3. 0 0
TOTAL REVENUES 666,560 184,000 482,560 0 482,560
NET COSTS GROSS COSTS LESS LINES D E G 482 560 0 482.560 0 482.560
H. UNIT FSERVICE
SO
H1. FACE TO FACE VISITS INDIVIDUAL,GROUP,ETC. 0 0
H2. FACE TO FACE VISITS DOSES 73,980 20,422 53,558 53,558
H3. DAY CARE HABILITATIVE DAY 0 0
H4. RESIDENTIAL DAY 0 0
H5. OTHER SPECIE 0 0
H6. 0 0
H7. 0 0
H8.TOTAL UNITS OF SERVICE ADD LINES H1 THROUGH H7 73,980 20,4221 53,558 0 53,558
I. STAFF HOURS DIRECT SVCS -COUNSELING, MEDICAL, ETC.) 24,000 6,626 1 17,374 17,374
J. METHADONE SLOTS(OMM only) 300 1001 200 200
K. COST PER UNIT OF SERVICE UNITS GROSS COSTS/LINE H8 9.01 9.01 9.01 0.00 9.01
L. COST PER STAFF HOUR GROSS COSTS/LINE I 27.77 27.77 27.77 0.00 27.77
M, COST PER SLOT GROSS COSTS/LINE 2221.87 1840.001 2412.80 0.00 2412.80
TOTAL STATE GENERAL FUND(ADD LINES F2,F8) 241,280 01 241,2801 0 241,280
TOTAL PERINATAL GENERAL FUND ADD LINES F5.F10 0 01 01 0 0
ADP FORM 78958 (8/94)