HomeMy WebLinkAboutMINUTES - 04021996 - C32 STj1TE OF CALJFORNIA
APPROVED BY THE -a
CONTAAS„TAIU—1µ91E� q(
STANDARD AGREEMENT- ATTORNEY GENERAL / 005 AMAO�1
STD.^c(REV.5 91),
19th December 95 TAXPAYER gb 1J �y1J 0Eg bEdPd)g6 yWIFICATION NUMBER
THIS AGREEMENT,made and entered into this day of ' 19—,
in the State of California,by and between State of California,through its duly elected or appointed,qualified and acting
TITLE OF OFFICER ACTING FOR STATE AGENCY
Deputy Director Mental Health
CONTRACTOR'S NAMEhereafter called the State,and
Contra Costa County , . 9 - 4141 0 16
,hereafter called the Contractor.
WITNESSETH: That the Contractor for and in consideration of the covenants,conditions,agreements,and stipulations of the State hereinafter expressed,
does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor,amount to be paid Contractor,
time for performance or completion,and attach plans and specifications,if any.)
In that certain agreement by and between the Department of
Mental Health and Contra Costa County Health Services
Department; the parties thereto desire to amend said agreement
accordingly:
1. EXHIBIT "B" is amended, relabeled EXHIBIT "B" A-1, attached
hereto and by this reference incorporated herein.
2 . EXHIBIT "B-1" is amended, relabeled EXHIBIT "B-1" A-1,
attached hereto and by this reference incorporated herein.
All other terms and conditions of said agreement shall remain
in full force and effect.
This contract is exempt from compliance with the Public
Contract Code, the State Administrative Manual, and from
approval by the Department of General Services per Section
4360(b) of the Welfare and Institutions Code.
CONTINUED ON SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER.
The provisions on the reverse side hereof constitute a part of this agreement.
IN WITNESS WHEREOF,this agreement has been executed by the parties hereto,upon the date fust above written.
STATE OF CALIFORNIA CO TRACTOR
AGENCY CONTRACTOR(If other than an individu ,st to wheth r a cnrporad partnership,eta)
Department of Mental Health Contra s unt _
BY(AUTHORIZED SIG RE) BY(AUTHORIZED S NA R
PRINTED NAME OF PERSON SIGNING 1PRINTED NAME AND TI SIGNING
LINDA A. POWELL, Deputy Director Chair, d Supervisors or his designee
TITLE SS
Administrative Services ADDR 6511 Pine Street, Martinez, California 94553
AMOUNT ENCUMBERED BY THIS PROGRAMICATEGORY(CODE AND TITLE) FUND TITLE Department Of General Services
DOCUMENT Long Term Care Services General use only
$ 22 ,799 .00 (OPTIONAL USE)
PRIOR AMOUNT THIS
DFORHIS CONTRACTConditional Release Program Exempt from compliance with
745,841.00 ITEM CHAPTER STATUTE I FISCAL YEAR the Public Contract Code,
TOTAL AMOUNT ENCUMBERED TO 4440-016-001 303 1995 95-9 the State Administrative
DATE OBJECT OF EXPENDITURE(CODE AND TITLE) Manual, and from approval by
$ 768 640 .00 1100-325-413 the Department of General
I hereby certify upon my own personal knowledge that budgeted funds T.B.A.NO. B.R.NO. Services per Section
are available for the period and purpose of the expenditure stated above. 4360(b)of the Welfare and
SIG ACCOUNTING OFFICER DATE Institutions Code.
10,
CONTRACTOR STATE AGENCY DEPT.OF GEN.SER. r CONTROLLER a
STANDARD AGREEMENT
STD.2(REV.5-91) (REVERSE) n y
1. The Contractor agrees to indemnify,defend and save harmless the State,its officers,agents and employees
from anv and all claims and losses accruing or resulting to any and all contractors, subcontractors,
materialmen,laborers and any other person,firm or corporation furnishing or supplying work services,
materials or supplies in connection with the performance of this contract,and from any and all claims and
losses accruing or resulting to any person,firm or corporation who may be injured or damaged by the
Contractor in the performance of this contract.
2. The Contractor,and the agents and employees of Contractor,in the performance of the agreement,shall
act in an independent capacity and not as officers or employees or agents of State of California.
3.The State may terminate this agreement and be relieved of the payment of any consideration to Contractor
should Contractor fail to perform the covenants herein contained at the time and in the manner herein
provided. In the event of such termination the State may proceed with the work in any manner deemed
proper by the State. The cost to the State shall be deducted from any sum due the Contractor under this
agreement,and the balance,if any,shall be paid the Contractor upon demand.
4. Without the written consent of the State,this agreement is not assignable by Contractor either in whole
or in part.
3. Time is of the essence in this agreement.
5. No alteration or variation of the terms of this contract shall be valid unless made in writing and signed by
the parties liereto,and no oral understanding or agreement not incorporated herein,shall be binding on
any of the parties hereto.
7. The consideration to be paid Contractor, as provided herein, shall be in compensation for all of
Contractor's expenses incurred in the performance hereof, including travel and per diem, unless
otherwise expressly so provided.
91 61014
Contract #: 95-75005 A-1
Contractor: Contra Costa County
Health Services Department
EXHIBIT "B"
Specific Provisions
1. The term of this contract shall be from 07/01/95 through
06/30/96.
2 : The State has designated Grant Ute, LCSW, to be its Manager,
CONREP Operations. Except as otherwise provided herein all
communication concerning this contract shall be with the
Manager, CONREP Operations.
3 . The total amount payable by the State to the Contractor
under this contract shall not exceed $768,640 . Of this
amount, total payments for Negotiated Net Amount (NNA)
Services shall not exceed $641,890 . The total. payments for
Negotiated Rate (NR) Services - Conditional Release Program
shall not exceed $126,750. The Contractor may, with the
written approval of the Manager, CONREP Operations, shift
funds between the contract categories of CONREP NNA and
CONREP NR.
4 . In consideration of the 'services, as specified in EXHIBIT
"A« herein, performed in a manner acceptable to the State,
the State, agrees .to make payment to the Contractor as
follows:
Upon the effective date of this agreement and upon the
submission of Summary Claim for Reimbursement (MH 1701) , in
triplicate, as specified herein and in accordance with the
Budget, EXHIBIT "B-1" attached hereto and by this reference
incorporated herein, - the State will make advance payment for
one month of NNA Services as specified .in the Budget.
Monthly, thereafter, Contractor may submit Summary Claim for
Reimbursement (MH 1701) , in triplicate, for advance payment -
for each month of NNA Services, provided however that such,,-
additional
uchadditional advance payment may not exceed $588,399.
Reimbursement for NR Services will be made using Summary
Claim for Reimbursement (MH 1701) , in triplicate, submitted
monthly -in arrears, for actual expenditures in accordance
with provisions of EXHIBIT "A-111 , Paragraph. 3 and the
Budget, EXHIBIT "B-111 .
�• Contract #: . 95-75005 A-1 '
Contractor: Contra Costa County
Health Services Department
Exhibit B
Page 2 of 2
Summary Claim for Reimbursement . (MH 1701) shall be submitted
as follows•
The original and copy of the Summary Claim for Reimbursement
(MH 1701) shall be submitted to:
Accounting Section
Division of Administration
Department of Mental Health
1600 Ninth Street, Rm. 140
Sacramento, CA 95814
One copy of the Summary Claim for Reimbursement shall be
submitted to the Manager, CONREP Operations at:
Grant Ute, LCSW
Manager, CONREP Operations
Department of Mental Health
Forensic Services
World Trade Center, Suite 231
San Francisco, CA 94111
5 . This agreement shall become effective on 07/01/95, but shall
not become effective unless and until approved by the
Department of Mental Health.
Department of Mental Health Forensic Services Conditional Release Program
CONREP PROGRAM - EXHIBIT B-1, A-1
NEGOTIATED NET AMOUNT AND RATE SERVICES SUMMARY .
MH 7001 (05/94) Page 1
Contractor Name: Contra Costa County Type of Report . Dates:
Contract No. 95 - 75005 X_Contract Budget Submission:
Fiscal Year Ending: June 30, 1996 —Year End Cost Report Amendment#1 12/18/95
Item 1 — Units of Service Based on Caseload and Year in Program
Year One Two Three Four Five Total
A. Caseload 9 8 4 5 15 41
B. Mode and Service Function
Forensic Weekly Weekly Weekly 3 Times Once
Individual 4/Month 4/Month 4/Month /Month Monthly
Contact
15 -80 432 384 192 180 180 1,368
Group Weekly Weekly Weekly Twice Once
Contact 4/Month 4/Month 4/Month Monthly Monthly
15 - 50 432 384 192 120 180 1,308
Home Once Once Once Every Once
Visits Monthly Monthly Monthly 6 Weeks Quarterly
50-40 108 96 48 45 60 357
Comm.Care Fac. Aug (Annual Projection 6 Beds X 365 Days'X 90%)
10-50 1,971
Collateral 6 Per Year 6 Per Year 6 Per Year 6 Per Year 6 Per Year
l
15 - 10 54 48 24 30 90 246
Lab Once Twice Twice Once Once
Screenings Weekly Monthly Monthly Monthly Quarterly
.15 - 21 468 192 96 60 60 876: -
Assessments 1 Per Year 1.Per Year 1 Per Year 1 Per Year 1 Per Year-
15 -30 9 8 4 5 15 41
Total Units 1,503 1,112 556 440 585 6,167
Total Amount
Item 2. Total Negotiated Net Amount Services (NNA): $641,890
Item 3. Total Negotiated Rate Services Amount(NR): 126,750
Item 4. Total Contract Amount: $768,640
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Department of Mental Health Forensic Services Conditional Release Program
CONREP PROGRAM — EXHIBIT B-1, A-1
CONDITIONAL RELEASE PROGRAM UNIT COST
MH 7003 (05/94) Page 3
Contractor Name: Contra Costa County Type of Report Dates:
Contract No. 95 -75005 X_Contract Budget Submission:
Fiscal Year Ending: June 30, 1996 _Year End Cost Report Amendment#1 12/18/95
LINE ITEMS Subtotal Total
1. Personnel Costs $475,320
2. Operating Expenses $140,543
a.Office Services&Supplies $6,000
b. Communications 10,000
c.Travel(Including Training) 11,000
d. Facility 60,152
e. Medical procedures,Supplies,Pharmacy 1,000
f.Consulting Fees 1,000
g. Emergency Life Support 1,000
h. Life Support-Residential Care(05/90 500 units @$24.60) 12,300
i. Life Support-independent Living(05/85 700 units @$22.04) 15,428
j. Other: Money Management(via MOU with HSD Conservatorship Unit) 3,000
k. Other:50/50(2500 units @$6.00) 15,000
I. Other:Assessment Quality Control - FHC, Inc.) 1,843
m. Other: STEP Program(Office supplies$720; Recreation$1,000;Mileage&Maint.$600; 2,820
Insurance$500)
3. Equipment Over$300 Per Unit $0
4.Administrative Services&Overhead (15%of Personnel Cost-less On-Call) $69,498
5.Total Cost of the CONREP Unit $685,361
6. Equipment Offset 0
7. Subtotal $685,361
8. Revenues (Sum of ms a through: g)
ite $5;000,
a. Patient Fees $0
b. Patient Insurance 0
c. Life-Support Reimbursement(05/85 and 05/90) 5,000
d.Medicare 0
e.Medical 0
f. Prior Years' Unexpended Funds 0
g. Other(Specify) 0
9. Net Cost $680,361
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