HomeMy WebLinkAboutMINUTES - 04231996 - C58 TO: BOARD OF SUPERVISORS �/• V
FROM: William Walker, M.D. , Health Services Director f
=-1 Contra
Costa
DATE: April 11, 1996 r '_ County
SUBJECT: Approval of Standard Agreement #29-469-4 with the State Department of Mental Health
(FY 1995-96 Performance Contract)
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Chair, Board of Supervisors (or his designee) to
execute on behalf of the County, Standard Agreement #29-469-4 (State #95-
75121) , 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 1995-96, as required by the Bronzan-McCorquodale Act (Mental Health
Realignment Legislation) .
II. FINANCIAL IMPACT:
Approval of this Performance Contract will guarantee the use of 31 State
Hospital beds, as specified in Attachment 3 of the Contract, at a cost of
$3,595,579 for Fiscal Year 1995-96. This amount will be paid from the Mental
Health Realignment Trust Fund.
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 1995-96. 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.
Nine signed copies of the Agreement and five sealed/certified copies of this
Board Order should be returned to the Contracts and Grants Unit for submission
to the State Department of Mental Health.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON April 23, 1996 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact
:Lorna Bastian (313-6411)
CC: Health Services (Contracts) ATTESTED Aril 23, 1996
State Dept. of Mental HealthP hil Batchelor, Clerk of the Board of
$upeivMrs midCounty Administrator
M382/7-e8 BY DEPUTY
NONDISCRIMINATION COMPLIANCE STATEMENT a3. 7
STA.19(FEV.2.0Z
2 ) - 469 - 4
COMPANY NAME
The company named above(hereinafter referred to as "prospective contractor")hereby certifies,unless
specifically exempted,compliance with Government Code Section 12990 (a-f) and California Code of
Regulations, 'Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the
development,implementation andmaintenance ofallondiscrinzi,nationProoram.Prospective contractor
agrees not to unlawfully discrit-ji te,harass or allow harassment against any employee or applicant for
employment because of sex, race, color, ancestry, religious creed, national origin, physical disability
(including HIV and AIDS), mental disability,medical condition(cancer), age(over 40),marital status,
and denial of family care leave,
CERTIFICATION
1, the official named below, hereby ,wear that 1 am duly authorized to legally bind the prospective
contractor to the above described certification.I am fully aware that this certification, executed on the
date and in the county below,is made under penalty of perjury under the laws of rhe Stare of Califvrniu.
CFF!C;AL3 NAME �.y�
OA76 MCUTED t EYEC.ITFq tN'LG CDLJFffY OF CNN 1 i Vl CMr1 CQWTY
l
PPMPSGTIVE CONTRACTOR'S SIGNATURE/
PROSAECTWE GONTRACTCR'S TME
PA00PE07IVE CONTIRAOTOq g L83AL BUBWESS NA7�E
TOTAL P.0=5
2g - 469 - 4
COMAAllYroMMaATON NAME
The contractor or grant recipient named above hereby certifies compliance with Government Code
Section 8355 in matters relating to providing a drug free workplace. The above named contractor or
grant recipient will:
1. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation,
possession,or use of a controlled substance is prohibited and specifying actions to be taken against
employees for violations, as required by Goveriunent Code Section 8355(x).
2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to
inform employees about all of the following:
(a) The dangers of drug abuse in the workplace,
(b) The person's or organization's policy of maintaining a drug-free workplace,
(c) Any available counseling,rehabilitation and employee assistance programs, and
(d) Penalties that may be imposed upon employees for drug abuse violations.
3. Provide as required by Government Code Section 835 3(c), that every employee who works on the
proposed contract or grant:
(a) Will receive a copy of the company's drug-free policy statement, and
(b) Will agree to abide by the terms of the company's statement as a condition of employment on
the contract or grant.
CERTIFICATION
i,the official named below,hereby swear that I am duly authorized legally to bind the contractor or
grant recipient to the above described certification.I am fully aware that this certification,executed on
the date and in the county below, is made under penalty of perjury under the laws of the State of
California.
oR:,-AAL'S NwF
DATE dXwUna ExEOuTEO 14 7KE OOUMY OF
, " TUREJr,
X
7ITL_
F-eUkRAL t_L7.MJMfBER
IAtYUHtiL! Hla!'iCtMtN 1 — A:Tr RNEYGENERAL y-a3
s`9 _�� 5� coNrRACTPfJM£EA I AM.NC.
STD.z(46v. t) 95-75121
TAXPAYERS i`EDM WIDYEh 10-X--?CAT1911
7TES AGRELNIME T.made and entered into this 1st day of July 119-95 94-6000509—W
in the State of Calif=!a,by sr:d between State of California,trro>;gt its duly epee:ed or appointed,qualified utd acting
TTT:c OF C;F!0V4 ACTING FCR s'ATe AGENCY -
Deputy Director Mental Health ,hereafter called the State,and
=NTAAC.ORS N"E A
Contra Costa County Mental Health 2C.) � 46 9 ,hereafter caller the Centrzcter.
`Vli'Iv'ESSETH: That the Cort actor for and in consideration of the covenants,conditions,a+reements,and stipulations of the State hexirtaftcr expressed.
does hereby agree to f=rtish to t:c State services Lnd rnateriala ae fn11nW9- (.SPt forth service to be re►tdertd 4 Contractor,anwwu to be paid Certs,c c tor,
rime for perform—ance or eompltdtion,and attach plants and Specifications,if any.)
WHEREAS, pursuant to Sections 5502 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, '6he Cuurnty drsireb to contrect with the State forthe provision of professional ane
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 integreted and coordinated ranur v( services
appropriate to the needs of each client, with the State Nospital;s) functioning as one of the provider;
in this range of services; and
WHFRFAS, tno G'a+p ie ASroPahlo tr, the rpnri?ring, of such services en the terms ano 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 .1995/96 mandated. County Performance Contract including the County Use of Stale Hospitals
Agreement) as mandated by Section ,5650 of the Welfare and Institutions Code. ,
CONMNUED ON SHIn-TS,LkCH 8£ARING NAME OF CONTRACTOR AND CONTRACT NUTADEP.
The pryvisions on the reverse side he-mof constir.:te a par.of this agreement.
2;RTiNESS w'HEREOP,this agreement has been executed by One parties hereto,Upon the date first above written.
STATE OF CALIFORNIA CONTRACTOR
AGENCY CON T FiACTOF{U ar w tha+er. •carporerhn,pernenh�, l
Department of Mental Health Conaunt
8`I'(AL1rMCR;=0 SIC,NAiLAE) 8 (All i K
PRIM cD NAME OF P:RSON S:GNNG PAIN i eO NAPERSON MING -
LINDA A. POW'ELL, Deputy Director Chai , ZaXd
of supervisors or his designee
T>rr Administrative Services 651Finestreet. Martinez, California 94553
AMOUNT ffNC:JM9r1r^D BY THIS PROGAAAt'CATLZOCRY(CODE AND TYLE) FJNO TITLE Department of Genera/services
DOCUMENT Not Applicable use only
MCA AMOJNT EhtC M6FRJD FCR ,
THIS CONTRACT Exempt from compliance with
ITEM CKAPieR STATUTE MAL YEAR the Public Contract Code.
TOTAL AMMNTeCUMIS 't:01170 I -- -- 195196 the State Administrative
oQc Caj;CTOFEEXPENDt7JRE(=ofANO
TfL Manual, and from approval by
$ the Department of General
I hereby der*uperr my own persona/kncwledge mar budgeted funds T.a.A.No. B.A No. Services per Sections 5706
are"Aabre for the penod end purpose of:he expenditure stated above. and 4331 (a) Of the Welfare
SGNATJitE CF ACCCL'N-e;o or.+caa PATE and institutions.Code,
Not Applicable j
F1 CONTRACTOR G STATE AGENCY U QVIT.Of.GEN.SM �{ COYrdCL'.£A
2. The Contractor agrees to indemnify,defend and save harmless the State,its oir�cers,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 carpor:ttion furni5hin_or cupplvinr work services,
watea ials ui suppli 5 w witnection with tl+e ptrfo1 :cud iivii1 any and ail cluinu and
tosses accruing or resulting to any person,firm or corporation who may be injured or damaged by the
Cortracttir in the performance of this contract.
2. The Contraactor,and the agents and etnplovees of Contracctor.in the perfor-mance of the a-reement,shat!
act in an independent capacity and not as officers or employees or agents oFState of California.
3.The State may terminate ibis a;reement and be relies eci of the pa}meat of ane consideration to Contractor
should Contractor fail to perforin the covenants herein contained at the time and m the manner herein
proviGed. In tt:e event of suc;3 tent:inaiion tt:e State may proceed wittl the work in am manner deemed
proper by the State. The cost to the State shall be deducted frurn any sura due the Contractor under this
a;gement,and the balance.if any,shall be pr id the Contractor upon demand.
4. Without the wrirmn consent of the State. this agree nett is not asSistnable bti Contractor either in whole
or in Fart. .
5. Time is of'he essence iz. this aereetrent.
6. No alter:tior.or variation of the ter.T.s oF:h:ds con rac:steal:Ix valid unless midi in writiflg and sf,ned bt
the parties hereto.and nir oral anderst:;ndint,or a-retment not incorporated herein,shall be binding. on
any of the parties hereto.
7. The cinsideration to be paid Contractor, as provided herein. sh.311 be in compensation for all of
Contractor's eYpensec incurred in the perfor 2nce heyof, inc?udin_ travel and per diem. un'r-ss
a:5er•�i,e expr2;ci_: sr., provided.
Contract No. : 95-75121
4 Contractor Contra Costa County Mental Health
COUNTY PERFORMANCE CONTRACT
Fiscal Year 1995/96
Paae ,
3 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 . . . . . . . . . 3
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 - 8
11 STATE HOSPITAL BED USAGE
PART A TERMS AND CONDITIONS
Section 1 - Facilities, Payments, and Services . . . . . . . . 9
Section 2 - County Responsibilities . . . . . . . . . . . . 9
Section 3 - Description of Covered Hospital Services . . . 10
Section 4 - Standards of Care . . . . . . . . . . . . . 12
Section 5 - Planning. . . . . . . . . . . . . . . . . . . . 13
Section 6 – Admission and Discharge Procedure . . . . . . . 13
Section 7 - Prior Authorization . . . . . . . . . . 16
Section 8 - Coordination of Treatment/Case Management 16
Section 9 - Bed Usage . . . . . . . . . . . . . . . . . . . 19
Section 10 —Utilization Review. . . . . . . . . . . . . . . 21
Section 11 - Quality Assurance . . . . . . . . . . . . 22
Section 12 - Exchange of Information . . . . . . . . . . 23
Section 13 - Records . . . . . . . . . . . . . . . . . . . . 23
Section 14 – Revenue . . . . . . . . . . . . . . . . . . . . . 25
Section 15 - Inspections and Audits . . . . . . . . . . . 25
Section 16 - Notices . . . . . . . . . . . . . . . . . . . 26
Section 17 - Notification of Death . . . . . . . . . . . . 27
Section 18 - Reports . . . . . . . . . . . . . . . . . . 28
Section 19 - Small County Bed Pool . . . . . . . . .. . . 28
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page
PART B SPECIFIC PROVISIONS . . . . . . . . . . . . . . 30 - 32
III GENERAL PROVISIONS
A. Term of Contract . . . . . . . . . . . . . . . . . . . . 33
B . Budget Contingencies . . . . . . . . . . . . . . . . . . 33
C. Confidentiality . . . . . . . . . . . . . . . . . . . . . 34
D. Nondiscrimination . . . . . . . . . . . . . . . . . . . . 34
E. Patients ' Rights . . . . . . . . . . . . . . . .. . . . 35
F. Recordkeeping . . . . . . . . . . . . . . . . . . . . . 35
G. Relationship of the Parties . . . . . . . . . . . . . . . 36
H. Reports . . . . . . . . . . . . . . . . . . . . . . 36
I . Severability . . . . . . . . . . . . . . . . . . . . . . 36
J. Subcontracting . . . . . . . . . . . . . . . . . . . . . 36
K. Waiver of Default . . . . . . . . . . . . 37
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 WELFARE AND INSTITUTIONS CODE
Attachment 3 —SPECIFIC COUNTY COST COMPUTATION
Contract No, 95-75121
Contractor Contra Costa County Mental Health C!
Page 1
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 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 .
Contract No. 95-75121
Contractor Contra Costa County Mental Health6. 7e
Page 2 b
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 .
i . To comply with Public Law 99-660 , the County agrees to provide
case management services to all seriously mentally ill adults and
seriously emotionally disturbed children who receive substantial
amounts of public mental health funds or services .
j . The County agrees to pursue a culturally competent system of care.
SECTION 3 - ROUTINE INFORMATION NEEDS
a. County shall continue to submit Client Data System (CDS) data and
CR/DC cost reports for the term of this agreement pursuant to
Welfare and Institutions Code, Sections 5610 (a) , 5651 (a) (8) and
(d) , 5664 (a) and (b) , and 5664 . 5 . Cost reports for counties with
a negotiated net amount contract are for information only and will
not be used to settle to actual cost .
b. The County shall submit CDS data within 60 days after the end of
the month to which the data applies . The Department shall process
the County data and return an edit listing or advise the County of
the results of the edit process within 25 days . The County shall
return the edit listing with corrections within 30 days of
receipt . Any exceptions to these conditions will be considered on
an individual County basis .
C . County and its subcontractors shall submit a fiscal year-end
Short-Doyle/Medi-Cal cost report, due November 30th, in accordance
with Welfare and Institutions Code, Sections 5651 (a) (4) , 5664 (a)
and (b) , and 5664 . 5 . The statewide maximum upper limits of
reimbursement for Short-Doyle/Medi-Cal services shall be those
-specified in Section 51516, Title 22, California Code of
Regulations, pursuant to Welfare and Institutions Code, Section
5720 .
SECTION 4 - PROGRAM PRINCIPLES
The Department of Mental Health and the County agree that, to the
extent funds are available, the program principles and the array of
treatment options are in accordance with Welfare and Institutions
Code, Sections 5600 . 2 through 5600 . 9 .
Contract No.,: 95-75121
Contractor Contra Costa County Mental Health
`
,Page 3
SECTION 5 - PROGRAM REIMBURSEMENT METHODS
Two methods of County reimbursement are applicable for PART I of this
agreement during Fiscal, Year 1995-96 .
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.
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/QUALITY 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:
contract NO. y)-/J12t
Contractor : Contra Costa County Mental Health
.Page 4 CF. 8�
a. Effective July 1, 1995 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 1995-9.6 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 1995-
96 "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 1995-96
attached hereto and by this reference incorporated herein. Each
federally funded SOC county shall also assure the Department of
Mental Health that it will comply with federal terms, conditions-
both fiscal and program-related to award of the SAMSHA federal
block grant .
SECTION 8 - PERFORMANCE OUTCOMES
a. Outcome Reporting
(1) Adults : County agrees to report outcome information 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 .
Contract No. : 95-75121
Contractor Contra Costa County Mental Health
Page 5
(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 .
(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 1995-96, the target population information
will be gathered through questions included in the performance
outcomes survey.
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 6
(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 jailer 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.
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.
,Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 7 C
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 300X 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 9501 of the funds allocated by the Department- of
Mental Health in accordance with the budget for the current
fiscal year.
Those Counties contracting with the Department of Mental
Health pursuant to Welfare and Institutions Code, Section 5708
shall be paid 1/12 of 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 50a Federal Funding and 500-. 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.
Contract No. 95-75121
Contractor Contra Costa County Mental Health .
Page 8 '
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 . If the County is
using negotiated rates, the "APPROVED NEGOTIATED RATES FOR
SHORT/DOYLE MEDICAL REIMBURSEMENT" . attachment may be made part of
this contract by processing an amendment at a later date when the
rates are established.
7 . Any funds allocated for conditions specified within PART I of this
contract, that by legislative requirement or department policy are
to be expended in . specified program categories, shall be spent
only in accordance with State statutes, policies, and regulations .
8 . Should a dispute arise relating to any issue within PART 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 No. 95-75121
Contractor Contra Costa County Mental Health
Page 9
II -- STATE HOSPITAL BED USAGE
PART A -- TERMS AND CONDITIONS
SECTION A I E E V E
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. and
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) I 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) Is Social Services staff to initiate, develop and
finalize discharge planning and necessary follow-up services .
d. The County shall provide such assistance as is necessary to assist
in the screening of County Patients for alternative placements,.
and shall facilitate such placements .
Contract No. 95-75121
Contractor Contra Costa County Mental Health
' Page 10,
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-Petris-Short (LPS) hospital
services only to those persons referred by the County specifically
for services under this Contract, including those admitted
pursuant to Sections 1370 . 01 of the Penal Code and Murphy
Conservatorship (Section 5008 (h) (1) (B) of the Welfare and
Institutions Code) . When patients committed pursuant to
provisions of the Penal Code are converted to LPS billing status
they shall become the financial responsibility of the county of
first admission and part of that County' s LPS dedicated bed
capacity as described in this contract .
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 specialty 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 No. 95-75121
Contractor Contra Costa County Mental Health
' Page 11
(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 No. 95-75121
Contractor Contra Costa County Mental Health
Page 12
d. Electro-Convulsive Therapy
The Hospitals) may cause to be provided Electro-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.
(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 Hospitals)
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 No. 95-75121
Contractor Contra Costa County Mental Health /� �•-p►
Page 13
C . Patient Rights
(1) The Hospitals) 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 .
SECTION 5 - 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 14 ,5 a
Health Director, or designee, shall be involved as
provided in this Contract and in accordance with the
provisions of Divisions 5 and 6 of the Welfare and
Institutions Code .
° (b) If the County is below dedicated capacity, it shall have
immediate access to a bed for any .County Patient who is
determined by the Hospital (s) Medical Director, or .
designee, to be clinically appropriate for the available
bed/service . Admission shall be accomplished in
accordance with the Hospital (s) admitting procedures and
admission hours . The hospital (s) shall make a good faith
effort to flexibly accommodate patients referred for
admission in a manner which maximizes access to
appropriate hospital beds and services .
(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
Ocounty 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 15
b. Dischagrge Procedures
(1) Discharge planning shall begin at admission.
(2) The development of a discharge plan and the setting of an
estimated discharge date shall be done jointly by the.
treatment team and the Case Manager. The treatment plan shall
identify the discharge plan.
(3) The Hospital (s) shall discharge a patient at the County' s
request or in accordance with the approved discharge plan
except : (1) if at the time the discharge is to occur, the
Hospital (s) Is 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) I 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 16. ,
with the County Mental Health Director and others will make
the final decision within two (2) working days of receiving
the documentation of the basis of the disagreement regarding
discharge, and communicate this decision to the County Mental
Health Director and the Hospital Medical Director by telephone
followed by written confirmation.
d. Penalties
(1) Should the State fail to process appeals from the County
relating to the denial of admissions or discharges within the
timelines specified in #1 and #2 above, the County 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
Contract No. 95-75121 County �' ✓�
Contractor Contra Costa Mental Health S
Page 17
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.
(4) Ensuring that appropriate alternative placement options are
developed as a part of the discharge planning process, and
working closely with the Hospital (s) treatment teams to assure
that discharges take place when and in a manner agreed upon by
the Hospital (s) Medical Director or designee, and the County
Mental Health Director or designee .
b. The Hospital (s) shall encourage and facilitate the involvement of
the case managers in the treatment team process, by providing,
among other services, notification of treatment plan conferences
or 90-day reviews no less than two weeks prior to the date of the
conference or review. The Hospitals) 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 . Hospitals) 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. ) .
Contract No. : 95-75121
Contractor Contra Costa County Mental Health
Page 18 C/
(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 .
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 .
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 19 e• p
SECTION 9 BED USAGE
• a. General Provisions
(1) During the 1995/96 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 Cons ervatorships (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 .
(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 1996, for the
period July 1 through December 31, 1995, and in July 1996, for
the period January 1 through June 30, 1996 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health /1
Page 20 C..
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 .
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 Cons ervatorships (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 Hospitals) and within a cost
center, unless this Contract is amended by mutual agreement .
Contract No. 95-75121
Contractor Contra Costa County Mental Health ,
Page 21
(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 specialty 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 specialty unit (s) .
b. County First Right of Refusal to Purchase LPS Beds
The State shall not unilaterally reduce the number of available
LPS beds during the term of the contract . If a county, or group
of counties, reduces its contracted level of LPS state hospital
beds the State shall offer these LPS beds to other counties prior
to making them available to any other purchaser. When LPS beds
become available the State shall notify the county mental health
directors and the directors shall have ten (10) working days from
the date of notification to submit requests to purchase the excess
beds .
SECTION 10 - UTILIZATION REVIEW (UR)
a. The Hospital (s) shall have an ongoing utilization . review program
which is designed to assure appropriate allocation of the
hospital (s) 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 Hospital (s)
Utilization Review Plan shall describe the utilization review
, program and identify the mechanisms for governing its operations .
The Plan is approved by the medical staff, the administration, and
the Director of the State Department of Mental Health, who is also
the chairperson of the Hospital (s) Governing Body. Policy and
operational direction regarding the Hospital (s) Utilization Review
Plan is provided in the Department of Mental Health' s Special
Order Number DSH-144 . Hospital (s) that provide services which are
certified for participation in the Federal Medicare or Medi-Cal
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 22
programs shall meet any additional . requirements imposed by those
certification regulations .
b. County representatives shall takepart in the utilization review
and quality assurance activities at the Hospital (s) I program and
unit level relating to County Patients . County Case Manager
participation in utilization review and discharge planning may
include attendance at treatment team and program meetings . The
Hospital (s) shall include the County' s monitoring of the quality
and appropriateness of the care provided to County Patients .
Hospital (s) shall conduct hospitalwide utilization review in a way
that maximizes the County' s access to the utilization review
process concerning County Patients . Hospital (s) shall provide the
County with information regarding the schedule of hospitalwide and
patient specific utilization review activities . The Hospitals)
shall also provide the County, upon request, summary aggregate
data regarding special incidents .
C. Utilization Review activities shall address the appropriateness of
hospital admissions and discharges, clinical treatment, length of
stay and allocation of hospital resources to most effectively and
efficiently meet patient care needs .
SECTION 11 QUALITY ASSURANCE
a. The 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Paye 23 ,
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 Hospitals) or County,
summary of treatment needs, and discharge summary.
b. The exchange of information will apply only to patients referred
by the County who are to be hospitalized, are currently
hospitalized, or have been discharged from the Hospital (s) .
Requests for information ' regarding any other patient, must be
accompanied by an authorization to release information signed by
the patient .
SECTION 13 - RECORDS
a. PATIENT RECORDS
The Hospital (s) shall maintain adequate medical records on each
individual patient . These medical records shall include legal
status, diagnosis, psychiatric evaluation, medical history, .
"individual treatment plan, records of patient interviews, progress
notes, recommended continuing care plan, discharge summary and
records of services provided by various professional and
paraprofessional personnel in sufficient detail to permit an
evaluation of services .
b. FINANCIAL RECORDS
The State shall prepare and maintain accurate and complete
financial records of the Hospital (s) I 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 24 C•
the County' s LPS patients, versus other types of patients to whom
the Hospital (s) provides services . Any apportionment of or
distribution of costs, including indirect costs, to or between
• programs or cost centers of the Hospital (s) shall be documented,
and shall be made in accordance with generally accepted accounting
principles, and applicable laws, regulations and State policies .
The patient eligibility determination and any fee charged to and
collected from patients, together with a record of all billings
rendered and revenues received from any source, on behalf of
patients treated pursuant to this Agreement, must be reflected in
the State ' s financial records .
C. RETENTION OF RECORDS
(1) All financial or patient records for patients who have not yet
been discharged shall be retained until the patient has been
discharged, at which time the record retention requirements in
2 . through 4 . below shall apply.
(2) Financial records shall be retained by the State in accordance
with the provisions of the State Administrative Manual,
Section 1671 . This Section requires that most financial
records, including CALSTARS Reports, be kept two (2) years,
after two (2) years they are to be kept until audited or four
(4) years which ever occurs first . County financial
records relating to this contract shall be retained in
accordance with applicable law, regulation, and County policy.
(3) Patient records for adults (age 18 and over) shall be retained
by the State for a minimum of seven (7) years from the date of
discharge .
(4) Patient records of persons under the age of eighteen (18)
years who have been discharged shall be retained for one (1)
year past the person' s eighteenth (18th) birthday, or for
seven (7) years, whichever is greater.
(5) Records which relate to litigation or settlement of claims
arising out of the performance of this Agreement, or costs and
expenses - of this Agreement as to which exception has been
taken by the parties to this agreement, shall be retained by
the parties until disposition of such appeals, litigation,
claims, or exceptions are completed.
(6) Except for records which relate to litigation or settlement of
claims, the parties may, in fulfillment of 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health C
Pale 25
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
1995 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 .
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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 26
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.
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
Contract No. 95-75121
Contractor Contra Costa County Mental Health C� dry
Page 27
responsibility 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.
SECTION 17 - NOTIFICATION OF DEATH
a. The Hospital (s) shall, notify the County by telephone immediately
Upon becoming aware of the death of any person served hereunder,
if the patient is an inpatient in the Hospital or is on leave from
the Hospital but is still considered an inpatient at the time of
death. However,- such notice need only be given during normal
business hours . In addition, the Hospital (s) shall use its best
efforts to, within twenty-four (24) hours after such death, send a
FAX written notification of death to the County.
b. The telephone report and written notification of death shall
contain the name of the deceased, the date and time of death, the
nature and circumstances of the death, and the name of the
Hospital representative to be contacted for additional information
regarding the patient ' s death.
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 28
SECTION 18 - REPORTS
During the fiscal year 1995/96, 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 19 - SMALL COUNTY BED POOL (SCBP)
a. This Section applies only to the counties that have indicated that
they are members of the SCBP as reflected in Attachment 3 of this
agreement .
b. As a member of the Small County Bed Pool, the County is
contracting for the number and types of State Hospital beds
described in 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 SCBP
beds . when a patient is referred for admission, the Hospital (s)
shall be provided written authorization from both the referring
County and the Pool Coordinator. The Pool Coordinator shall also
represent the County in its capacity of SCBP member on issues
relating to utilization review and quality assurance activities.
c . ' The purpose of the Small County Bed Pool (SCBP) is to facilitate
the efficient and economical utilization of state hospital beds by
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 29
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 1995/96 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
1995/96, 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.
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, 1995 and in July for the
period January ' l through June 30, 1996, 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health C
' Page 50
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.
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 .
S . The amount payable by the Contractor to the State concerning all
aspects of PART II of this Contract shall be $3 , 595, 579 . The
contract amount reflected here was computed based on the
information contained in Attachment 3 . The amount represents the
application of the 111995/96 Gross Rate to Counties" , as published
•Contract No. 95-75121 w,
Contractor Contra Costa County Mental Health C`
' Page 51
in a letter from DMH to Local Mental Health Directors dated June
2, 1995 entitled "STATE HOSPITAL RATES AND PLANNING ASSUMPTIONS
FOR FISCAL YEAR 1995/96" which by this reference is made a part
hereof, to the county' s contracted beds, less $83 . 32 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 1995-96 fiscal year, shall be an
additional cost to the county and collected by adjusting the State
Controller' s Schedule "B" in February 1996 and August 1996 .
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 111995/96 Gross Rate to Counties" published in ATTACHMENT
"A" of the DMH letter referenced in #5 above. Determination of
available revenue shall be completed by the State by September 30,
1996 .
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 dueafter
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 /fin
available to counties' that used fewer state hospital beds then
their contract number, proportional to the contracted amount not
used. This amount shall not exceed the value of the unused
contracted amount .
11 . During Fiscal Year 1995/96 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
Contract No. 95-75121
Contractor Contra Costa County Mental Health �•
Page 32
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 bN , 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 .
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 No. 95-75121
Contractor Contra Costa County Mental Health
Page 33 J
III -- GENERAL PROVISIONS
A. TERM
The term of the Fiscal Year 1995/96 County Performance Contract
shall be July 1, 1995 through June 30, 1996 .
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
Contract No. 95-75121
Contractor Contra Costa County Mental Health n
Page 34 lig
parties 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.
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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page 35
origin, age, sexual preference, or mental or physical
' handicap, in accordance with the requirements of applicable
Federal or State law.
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 1995/96 County . Performance Contract shall
comply with applicable laws, regulations and State policies
relating to patients' rights .
F. RECORDKEEPING
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 .
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Page;{
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.
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
Contract No. 95-75121
Contractor Contra Costa County Mental Health
Wage 37
of the Auditor General for a period of three years after final
payment under contract (Government Code, Section ..8546 .7) " . 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 8546 . 7) .
R. WAIVER OF DEFAULT
Waiver of any default shall not be deemed to be a waiver of any
subsequent default . Waiver of breach of any provision of this
Agreement shall not be deemed to be a waiver of any other or
subsequent breach, and shall not be construed to be a modification
of the terms of this Contract .
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.
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