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Home My WebLink AboutMINUTES - 06272000 - C80-C87 TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director , By: Ginger Marieiro, Contracts Administrator Contra Costa DATE: June 14, 2000 County SUBJECT: Approval of Contract #27-414-1 with Sharon Jones, M.D. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Milt Camhi) , to execute on behalf of the County, Contract #27-414.1 with Sharon Jones, M.D. , for the period from May 1, 2000 through April 30, 2001, for provision professional primary care services for Contra Costa Health Plan members, to be paid as follows : 1. For Medl-Cal Beneficiaries: a. County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 5%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment, County will thereafter increase the rates County pays to Contractor accordingly. b. County will pay a quarterly case management fee,as follows: Panel Size* Quarterly Fee 1 to 499 $3.00 per beneficiary per quarter 500 to 999 $3.25 per beneficiary per quarter 1000 or more $3.50 per beneficiary per quarter *Panel Size is the number of Medi-Cal beneficiaries receiving treatment by Contractor during each quarter as specified in the "CCHP's Community Provider Network Primary Care Providers Compensation Plan". 2. For Healthy Family Program Members. County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 10%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment,County will thereafter increase the rates County pays to Contractor accordingly. 3. For Plan B Commercial Members. County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 20%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment,County will thereafter increase the rates County pays to Contractor accordingly. FISCAL IMPACT: This Contract is funded by Contra Costa Health Plan member premiums . Costs depend upon utilization. As appropriate, patients and/or third party payors will be billed for services . BACKGROUND/REASON(S) FOR RECOMMENDATION(S) : On February 1, 1997 the Local Initiative for Medi-Cal managed care in Contra Costa County was implemented. Local Initiatives are required to include traditional Medi-Cal providers from the community in their provider networks. This Contract is necessary to meet State mandates to expand the number of community providers for the Local Initiative, along with a Department of Corporations audit finding that requires formal contracts with low volume providers . Under Contract #27-414--1, the Contractor will provide professional primary care services to Health Plan members through April 30, 2001 . 1 , / I Lcc e r�Ea� �'"RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE PPROVE OTHER ACTION OF BOARD O J�L i-t rd2 `7 c�dC 6 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT—Z---i AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED--�h f 52_24__--Z066 PHIL BATCHELOR,CLERK OF THE BOARD OF Contact Verson: Milt Camhi (3136004) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health Services(Contracts) Risk Management Auditor Controller BY '7. �'�7�-�- DEPUTY Contractor TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director , �+ Contra By: Ginger Marieiro, Contracts Administrator Costa DATE: June 14, 2000 County SUBJECT: Approval of Contract #27-467 with Yogesh Trehan, M.D. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve and authorize the Health Services Director, or his designee (Milt Camhi) , to execute on behalf of the County, Contract #27-467 with Yogesh Trehan, M.D. , for the period from ,June 1, 2000 through May 31, 2002, for provision professional primary care services for Contra Costa Health Plan members, to be paid as follows: 1. For Me&Cal Beneficiaries: a. County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 5%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment, County will thereafter increase the rates County pays to Contractor accordingly. b. County will pay a quarterly case management fee,as follows: Panel Size* Quarterly Fee I to 499 $3.00 per beneficiary per quarter 500 to 999 $3.25 per beneficiary per quarter 1000 or more $3.50 per beneficiary per quarter *Panel Size is the number of Medi-Cal beneficiaries receiving treatment by Contractor during each quarter as specified in the "CCHP's Community Provider Network Primary Care Providers Compensation Plan". 2. For Healthy Family Program Mernbers, County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 10%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment,County will thereafter increase the rates County pays to Contractor accordingly. 3. For Commercial Members.County will pay Physicians for covered services,those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998 plus 20%. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment,County will thereafter increase the rates County pays to Contractor accordingly. FISCAL IMPACT: This Contract is funded by Contra Costa Health Plan member premiums. Costs depend upon utilization. As appropriate, patients and/or third party payors will be billed for services. BACKGROUND/REASON(S) FOR RECOMMENDATION(S) : On February 1, 1997 the Local. Initiative for Medi.-Cal managed care in Contra Costa County was implemented. Local Initiatives are required to include traditional Medi-Cal providers from the community in their provider networks. This Contract is necessary to meet State mandates to expand the number of community providers for the Local Initiative, along with a Department of Corporations audit finding that requires formal contracts with low volume providers. Under Contract ##27-467, the Contractor will provide professional primary care services to Health Plan members through May 31, 2002 . CONTINUED ON AITACHMOT; SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE &'APPROVE OTHER Sir ACTION OF BOARD O 777c /I -� 000 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT r ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN, ATTESTED 1"°e- PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Milt Camhi (313--6004) CC: Health Services(Contracts) Risk Management Auditor Controller BY t l Gu- DEPUTY Contractor TO: BOARD OF SUPERVISORS William Walker, M.D. , Health Services Director i FROM: Ginger Marieiro, Contracts Administrator . Contra June 14, 2000 _.�,. Costa DATE: County SUBJECT: Approval of Contract ##27-262-3 with Arie Van Gemeren, M.D. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)3 BACKGROUND AND JUSTIFICATION RECQNDED ACTIQN: Approve and authorize the Health Services Director, or his designee (Milt Camhi) , to execute on behalf of the County, Contract #27-262-3 with Arie Van Gemeren, M.D. , for the period from February 1, 2000 through January 31, 2001, for the provision of professional cardiology services for the Contra Costa Health Plan, to be paid as follows : a. For Medi-Cal and Commercials Members: County shall pay Contractor those rates set forth in the Medi-Cal Schedule of Maximum Allowances in effect on August 1, 1998. In the event rate increases are subsequently approved by the State of California and are included in the County's Health Plan capitated payment, County will thereafter increase the rates County pays to Contractor accordingly. b. For Medicare m tubera: Services for members who are Medicare recipients will be reimbursed at the Medicare rate of payment. Physician will bill Medicare as primary payor and County will pay Medicare-required copayments and deductibles for Medicare approved services. FISCAL IMPACT: This Contract is funded by Contra Costa Health Plan (Health Plan) member premiums . Costs depend upon utilization. As appropriate, patients and/or third party payors will be billed for services . BACKGROUND/REASON(S) FOR RECOMMENDATION(S) : The Health Plan has an obligation to provide certain specialized professional health care services for its members under the terms of their Individual and Group Health Plan membership contracts with the County. On May 4, 1999, the Board of Supervisors approved Contract #27-262-2 with Arie Van Gemeren, M.D. , for the period from February 1, 1999 through January 31, 2000 . Approval of Contract #27-262-3 will allow the Contractor to continue to provide professional cardiology services to Contra Costa Health Plan members, through January 31, 2001 , O T A RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE. OTHER ACTION OF BOARD O C l `? 4900 APPROVED AS RECOMMENCED X OTHER VOTE OF SUPERVISORS i HEREBY CERTIFY THAT THIS IS A TRUE f` UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES. NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED TC-J-V)f c i 0?600 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Milt Camhi (313-6004) CC: Health Services(Contracts) Risk Management Y 1�,,�,f-,�.�.,.., , Auditor Controller By DEPUTY� Contractor TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director Y• Contra By. Ginger Marieiro, Contracts Administrator Costa DATE: June 14, 2000 County SUBJECT: Approval of Contract #74-058 with Seneca Residential & Day Treatment Center, Inc. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATXON(S) : Approve and authorize the Health Services Director or his designee (Donna Wigand) to execute on behalf of the County, Contract #74-058 With Seneca Residential & Day Treatment Center, Inc. , for the period from April 1, 2000 through June 30, 2000, in the amount of $200,000, for the provision of Mobile Crisis Response services. This contract includes a six-month automatic extension through December 31, 2000, in the, amount of $300,000. FISCAL IMPACT: This Contract is Federally funded. CHILDREN'S IMPACT STATEMENT: This Whole Circle System of Care program supports the Board of Supervisors "Children ready for and succeeding in school" ; "Families that are safe, stable, and nurturing" and "Communities that are safe and provide a high quality of life for children and families" community outcomes. Expected outcomes include all goals identified by Children's Statewide System of Care guidelines including an increase in positive social and emotional development as measured by the Child and Adolescent Functional Assessment Scale (CAFAS) and a decreased used of the acute care system. BACKgROUND I REASON(S) FOR RECOMMENDATION(S} This Contract meets the social needs of County's population in that it provides Intensive Crisis Stabilization Services to Seriously Emotionally Disturbed (SED) children and adolescents (and their families) in high-risk situations, to reduce the need for psychiatric hospitalization. Cinder Contract #74-058, Seneca Residential & Day Treatment Center, Inc. will provide Mobile Crisis Response services through June 30, 2000. RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME DATION OF BOARD COMMITTEE PPROVE OTHER SIGNKTUREM— ACTION OF BOARD _ C t h e ;2 .7, ;?_tWO APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS 13 A TRUE UNANIMOUS (ABSENT ,-,) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: _—_._- AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. i ATTESTED PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Donna Wigand, L.C.S.W. (313-6411) CC: Heath Services(Contract) Auditor-Controller Risk Management BY � �� -+ DEPUTY Contractor TO: BOARD OF SUPERVISORS � t l FROM: By: Walker, I.D. , Health Services Director ,� By: Ginger Marieiro, Contracts Administrator '�' Contra Costa DATE: ,lune 14, 2000 County SUBJECT: Approval of Intercounty Agreement #24-658-3 with Napa County SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECgMMENDATION(S) Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the County, Intercounty Agreement #24-658-3 with Napa County, for the period from July 1, 1999 through June 30, 2000, in the amount of $58, 128, for the provision of transitional residential treatment services for severely and persistently mentally ill County residents. FISCAL IMPACT: This Contract is funded by Mental Health Realignment. BACKGROUNDIREASON(S) FOR RECOMMENDATIONS) Napa County operates a facility known as "The Avenues" to provide transitional residential treatment services to prepare severely and persistently mentally ill individuals for their return to the community. This Contract is part of the Department's cost saving plan to reduce the number of high-cost State Hospital beds by developing alternative placements. On January 19, 1999, the Board of Supervisors approved Intercounty Agreement #24-658-2 with Napa County for the period from July 1, 1998 through June 30, 1999. Approval of Intercounty Agreement #24-658-3 will allow County to continue placing severely and persistently mentally ill County residents at its facility known as "The Avenues" through June 30, 2000. The Board Chair should sign seven copies of the agreement. Six signed copies of the agreement and six sealed/certified copies of this Board Order should be returned to the Contracts and Grants Unit. RECOMMENDATION OF COUNTY ADMINISTRATOR _ RECOMMENDATION OF BOARD COMMITTEE APPROVE _OTHER SIGNATURE * C & �" .Z- ACTION OF BOARD ct/, '7 1�1?e6 0 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT_ ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED -3-c-d-F !!- c 2 :2gQ 6 66 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Berson: Donna Wigand, L.C.S.W. (313-6411) CC: Health Services(Contract) Auditor-Controller Risk Management BY - �'��-_. , DEPUTY Contractor WILLIAM B. WALKER, M.D. CONTKA COSTA HEri.LTH SERWCEs DIRECTOR DONNA M. 'LIGAN©, LOW MENTAL HEALTH MENTAL HEALTH DIRECTOR ADMINISTRATION CONTRA COSTA 595 Center Avenue, Suite Martinez, California 94553HEAtTH SEfVlLS Ph {925)313-5411 Fax(925) 313-6449 DATE: May 15, 2000 TO: William Walker, M.D., Health Services Director ATTN: Clinger Marieiro, Contracts & Grants Administrator FROM: Donna M. Wigand, LCSW, Mental Health Director-7)/ SUBJECT: Request for Retroactive Approval for Contract with NAPA COUNTY Health and Human Services Agency (The Avenue Program) #24-658-3 Statement of Need for Retroactive Contract #24-658-3: The Mental Health division purchases two adult residential placements at The Avenue, which is operated by Buckelew Programs on the grounds of Napa State Hospital. Napa County is responsible for negotiating and processing the Intercounty Agreement with several counties that purchase placements at The Avenue. The Avenue is a transitional residential program for clients who are persistently and seriously mentally ill, following their discharge from Napa State Hospital. The clients experience a slow but gradual improvement in skills and functioning as they involve themselves at their own pace, with minimal use of crisis services or rehospitalization. Benefit to Contra Costa County: Due to the complexity of preparing an Intercounty Agreement between several counties, the document usually arrives late in the contract period. However, ongoing use of this program is necessary, as it is an important alternative to higher levels of care, such as a longer State Hospital stay or being discharged to an Institute for Mental Disease (IMD). Authorization of Services: These services were requested/authorized by the Adult Program Chief, who is granted this authority by the Mental Health Director, pursuant to the California Welfare and Institutions Code, and under the Bronzon-McCorquodale Act, W&I Section 5608. ' '+ • 1. Vu (, 2 ^."" 4 Cb d .^u 1:5 • ..t � S ^1.'ye C .2dICd�to 2 ' �0,'_ "?Ici7 • n_a',n "..ra C taiic Healt �� 1`� `� Costa F4'.h Ce~vers SOCIAL NEEDS STATEMENT FOR CONTRACT 24-658, Napa County Health & Human Services Agency(The Avenues Program) This contract meets the social needs of the County's population in that it provides an alternative to state hospitalization for Contra Costa County adults who are seriously and persistently mentally disabled who might otherwise be inappropriately placed in programs not designed to meet their special needs. Providing these mental health services and mental health rehabilitation services to these Medi-Cal beneficiaries and other clients referred by Contra Costa County keeps these County clients out of higher levels of care, including State Hospitals. 4 NAPA COUNTY NO. 4041 $ INTERCOUNTY AGREEMENT COMMUNITY MENTAL HEALTH SERVICES This contract is made and entered into on the dates recited herein, by and between two political subdivisions of the State of California: the COUNTY OF NAPA, hereinafter referred to as NAPA, and the COUNTY OF CONTRA COSTA, hereinafter referred to as CONTRA COSTA. WITNESSETH WHEREAS, CONTRA COSTA desires to extend to its residents certain mental health services established under the California Welfare and Institutions Code and other enabling legislation, and programs and projects administered by the State Department of Mental Health (hereinafter referred to as "Department")or by counties through the Mental Health System, and WHEREAS, NAPA has entered into a contract with a qualified provider of mental health services,under which contract services will be provided to clients of CONTRACOSTA's Mental Health service by virtue of this Agreement,in a program known as "The Avenue", located within NAPA, and WHEREAS, parts of the California Code of Regulations and the Welfare and Institutions Code provide a set of definitions,standards,procedures and regulations by and pursuant to which CONTRA COSTA and NAPA may lawfully contract for such services as are described in the Service Description incorporated in this Agreement as Exhibit "A NOW, THEREFORE,IT IS MUTUALLY AGREED between the parties as follows: 1. CONTRA COSTA agrees to: a) Designate the Adult Services Coordinator, or other appropriate staff of its Mental Health Services, to act as program liaison. Said program liaison shall be responsible for coordinating placements of CONTRA COSTA's clients at The Avenue, and in the development of policies and procedures made by NAPA, CONTRA COSTA, and the provider operating The Avenue. b) Identify appropriate placements for The Avenue program and cooperate with the provider in effecting placements and discharges. C) Place a maximum of two (2) CONTRA COSTA clients in The Avenue at any one time, subject to the provisions of Paragraphs 3(b) and 3(d): d) Retain responsibility for the collection of Supplemental Security Income (SSI)for its clients placed at The Avenue. -1- 2. NAPA agrees to: a) Designate the Adult Services Coordinator, or other appropriate.staff of its Mental Health Services, to act as program liaison. Said program liaison shall perform the same duties as are enumerated in paragraph 1(a). -2- IN`I'ERCOUNTY AGREEMENT #3574 COMMUNITY MENTAL HEALTH SERVICES b) Provide contract management and administration,including the receipt and payment of all claims by the contract provider operating The Avenue, and also including general contract liaison. C) Assume responsibility for collection and retention of all charges to Medi- Cal ediCal and Medicare for services provided by the contractor operating The Avenue. This shall include billing, record keeping, and quality assurance. d) Act as lessee under the terms of the lease of the premises on which The Avenue program will be conducted, including payment of lease costs and liaison with the contractor operating The Avenue on lease matters. e) Maintain all records required, including those provided by the contractor. 3. BOTH CONTRA COSTA AND NAPA agree: a) That both NAPA and CONTRA COSTA are included in a group of three California Counties which have agreed to place clients at The Avenue, that the remaining County is the County of Marin, and that Marin, and CONTRA COSTA are each engaged in intercounty agreements with NAPA which recite their respective duties regarding The Avenue. b) That, should circumstances require a change in CONTRA COSTA's maximum number of client placements hereunder, CONTRA COSTA may discuss the temporary increase or decrease with any other participating County, provided that no alteration in any obligation of CONTRA COSTA to NAPA be made, except as provided in Paragraph 3(d) herein, and further provided that no agreement shall be made with any other County or entity which is not recited in paragraph 3(a) regarding use of or placement in The Avenue, absent the prior approval of the three recited Counties. C) Each party shall defend, indemnify, and save harmless the other, from and against any and all claims and losses whatsoever for damage, injury, or death arising out of or connected with the performance of this agreement, or resulting from any act or omission of that party's employees, officers, or agents. Each party shall maintain liability insurance or self- insurance of the scope and nature required of the operations undertaken by virtue of this agreement, including, as applicable, vehicular liability,.professional liability, premises liability, and workers' compensation insurance for all persons as are required by state law to be,covered. _3- INTERCOUNTY AGREEMENT #3570 COMMUNITY MENTAL HEALTH SERVICES d) No modification or variation of the terms of this contract shall be valid unless made in writing and signed by the parties hereto,.and no oral understanding or agreement not incorporated herein shall be binding on any of the parties hereto. This writing is intended bath as the final expression of the Agreement between the parties hereto with respect to the included terms and as complete and exclusive statement of the terms of the Agreement, pursuant to C.C.P. Section 1856. The parties expressly recognize that their personnel are without authorization to either order extra or changed work or waive contract requirements. Failure of either to secure authorization of Board of Supervisors of both parties for such work shall constitute a waiver of any and all right to adjustment in the contract price or contract time due to such unauthorized work. e) . TERM: The term of this contract shall begin July 1, 1999, and shall terminated on June 30,.2004, unless terminated as hereinafter provided. This agreement may be terminated by either party by giving sixty (60) days written notice of intention to terminate. For the purposes of this Agreement, notice shall be deemed effective upon mailing by first class mail to the following addresses: For CONTRA COSTA Director,Mental health Division Contra Costa County Health Services Department 595 Center Avenue, Suite.200 Martinez,CA 94553 For NAPA Contracts Napa County Health and Human Services Agency, 2261 Elm Street Napa CA 94559-3721 This contract is made for a specific term. Nothing in this contract shall imply the renewal of this contract, or of any contract for similar or differing services between the parties hereto. Nothing herein shall imply or guarantee continuance of this contract of funding of any position or service by CONTRA COSTA to NAPA. -4- r INTERCOUNTY AGREEMENT #3574 COMMUNITY MENTAL HEALTH SERVICES 4 • 6 8 I m 3 IN WITNESS WHEREOF, the parties hereto have executed this contract the day and year hereinabove written. ATTEST: CLERK OF THE BOARD COUNTY OF NAFTA, a political subdivision of the State of California By: By: Date: Date: ATTEST: CLERK OF THE BOARD COUNTY OF CONTRA COSTA, a political s ivision o e tate of California Date: >L�.de v Date: 1..1a ya0'00 oAcoNT99-00Toco#4041 Cif (,4 -$_ "A" BUCKELEW PROGRAMS 43569 EXHIBIT FY1999-2000 Page 1 of DESCRIPTION OF SERVICES 1. Introduction COUNTY, through its Health and Human Services Agency (HHSA), operates a"Medi- Cal Managed Care Plan" (the Plan) under the auspices of a contract with the California Department of Health Services (CDHS). Pursuant to the Plan, COUNTY makes a range of mental health services available to Medi-Cal beneficiaries and other persons. CONTRACTOR has entered into this agreement with COUNTY to provide certain mental health rehabilitation services to Medi-Cal beneficiaries and other clients referred by COUNTY(or other counties designated by COUNTY pursuant to Section 4)who are appropriate for the receipt of those services. 2. Definitions a. CONTRACTOR refers to Buckelew Programs, a California non-profit corporation. b. Regulations refers to Title 9, Chapter 11, California Code of Regulations. Whenever terms in this Description of Services appear in quotation marks,they shall have the meaning set forth in the Regulations. 3. Provision of Services CONTRACTOR shall provide "Adult Residential Treatment Services" at a house located on the grounds of Napa State Hospital,Napa, California,which is leased by COUNTY from the State of California for the purposes of this agreement(the Contract Facility). The Contract Facility has the capacity to serve six(6)clients in residence at any one time. 4. Service Activities a. Referral. Clients to be served at the Contract Facility shall be referred by the mental health staff at HHSA and at other counties which are from time to time authorized by COUNTY to refer clients for residency and service at the Contract Facility. At the commencement of this agreement, candidates for placement may be referred by the following three counties, each of which has the right to two of the six beds:Napa,Contra Costa, and Marin. Referring counties shall provide CONTRACTOR with diagnostic information.on all persons.referred for admission to the Contract Facility. b. Provision of"Service Activities". Each client referred shall be assessed by CONTRACTOR.for admission to the Contract Facility. Each client who is accepted will receive an appropriate array of"service activities"each day that the client is in residency. These"service activities" shall include one or more of the following: "assessment,"."plan development,""therapy," "rehabilitation,"and"collateral." a BUCKELEW PROGRAMS#3569 EXHIBIT "A" FY1999-2000 Page 2 of 5 c. Scope of Practice. All "service activities" shall be provided by staff for wham the-provision of such services falls within their legal scope of practice. Without limiting this, diagnosis(which is one function within the larger"assessment" service activity) and "therapy" must be performed by staff Who hold appropriate mental health licenses. d. Additional Provisions. Additional provisions relating to the services to be provided to clients are set forth in the attachments to this description of services. 5. Facilitv Licensure and Certification a. Licensure, Throughout the effective term of this agreement,the Contract Facility shall be and remain licensed as a Social Rehabilitation Facility by the California Department of Social Services(CRSS). CONTRACTOR shall provide COUNTY with copies of the license and all written licensure, inspection,or complaint reports issued by DSS. b. Certification. Throughout the effective term of this agreement,the Contract Facility shall be and remain certified by DMH as an"Adult Residential Treatment Service." CONTRACTOR shall provide COUNTY with copies of each certification and all written certification, inspection, and related reports issued by DMH. c. Certification as an"Ori;anizational Provider". Throughout the effective term of this agreement, CONTRACTOR shall operate as and meet all standards required of an "organizational provider"delivering the services specified in Section 3 of this descriptiop of services, as well as the certification standards set forth in Attachment 3--Provider Certification by the Contractor or the Department, which is an attachment to the Plan and is attached to this description of services. At the commencementof this agreement, COUNTY shall make provisional certification of the CONTRACTOR in accordance with applicable.laws and regulations and the provisions hereof. COUNTY shall proceed to formal certification in accordance with the provisions of the Plan,and CONTRACTOR shall cooperate with COUNTY in this process. Without limiting the foregoing, COUNTY shall have the right to inspect and review CONTRACTOR's facility and program documentation at any time to determine compliance with applicable laws and regulations and the terms of this Agreement. 6. Staffin a. Staff{`qualifications. CONTRACTOR certifies that all staff at the Contract Facility providing services to clients under this agreement are qualified under the Regulations and other applicable laws and regulations to provide the services on which reimbursement is claimed,based upon education, experience, and licensure. CONTRACTOR shall maintain written documentation verifying degrees, licensure, training and experience for all staff`,which shall be made available to COUNTY upon request. BUCKELEW PROGRAMS#3569 EXHIBIT "A" FY1999-2000 Page 3 of 5 b. Staffin Levels.evels. CONTRACTOR shall maintain staffing levels at the Contract Facility in accordance with the requirements of the Regulations and other applicable laws and regulations, including Section 531 of Title 9, Division 1, Chapter 3, of the California Code of Regulations. CONTRACTOR shall maintain written staff schedules and time sheets or other documentation sufficient to evidence compliance to applicable staffing requirements., Upon request,these materials shall be made available to COUNTY for review. CONTRACTOR shall provide for adequate supervision of staff by qualified and trained managers and supervisors. c. "Head of Service . As required by Section 1810.435(c)(3)of the Regulations, the Contract Facility and the services provided therein shall be overseen by a"head of service"who is a"licensed mental health professional or other appropriate individual"as described in Sections 622 through 630 of Title 9, Division 1, Chapter 3, of the California Code of Regulations. In the event that the "head of service"is a"mental health rehabilitation specialist,"as defined in Section 630, COUNTY shall have the right to approve the individual who will serve as"head of service." 7. Client Documentation a. Documentation Standards. CONTRACTOR will document all services provided to clients under this agreement in accordance with(i)the requirements of this agreement; (ii)the requirements of Attachment 2—Documentation Standards for Client Records, which is an attachment to the Plan and is attached to this service description; (iii)the requirements of HHSA's Fiscal Office, which relate to the reporting of such information as is necessary to obtain allowable reimbursement for services provided to eligible clients; and (iv)the community standard of care. In the event of a conflict among these documentation standards, CONTRACTOR shall adhere to the most demanding requirement. COUNTY shall have the right to inspect and receive copies of such documentation to the extent necessary to obtain available reimbursement,perform its inspection and certification responsibilities, and as otherwise provided in this agreement or applicable laws or regulations. COUNTY shall observe all applicable laws regarding the confidentiality of client documentation. b. Document Maintenance. All client records shall be maintained on site at the program where services were provided for a minimum of seven(7)years. Such records shall be maintained in accordance with state and federal standards. c. Substantive Entries for"Service Activities". "Service activities"provided to clients shall be documented in a manner which evidences their compliance to the requirements of the Regulations. 8. Additional CONTRACTOR Responsibilities a. Cultural Competence. CONTRACTOR shall provide culturally, linguistically appropriate services to clients as defined in the Napa County Specialty Mental Health Plan. CONTRACTOR shall adhere to the provisions of the"Cultural Competence Plan" BUCKELEW PROGRAMS 93569 EXHIBIT "A" FY1999-2000 Page 4 of 5 adopted by COUNTY as a part of the Plan, including the provision of such training to its staff as required under the"Cultural Competence Plan." b. One Level of Service. All clients referred for service hereunder shall receive the same level of services appropriate for their needs,without discrimination based upon funding source. . c. Payment in Full. Sums provided in this agreement to be paid to CONTRACTOR for the"adult residential treatment services"to be provided hereunder shall be considered payment in full to the CONTRACTOR for such services. CONTRACTOR shall not seek to collect additional sums from the clients or third parties for such services. COUNTY shall be entitled to seek reimbursement for such services as may be allowed under applicable laws and regulations. CONTRACTOR shall be entitled to collect sums from clients served for the provision of services other than"adult residential treatment services."Additional sums charged for board and care shall not exceed state approved rate schedules. CONTRACTOR shall maintain books of account that accurately distinguish costs incurred in the provision of"adult residential treatment services"and other operating costs. These costs shall be reported to COUNTY in sufficient detail to enable COUNTY to determine which relate to services being funded under this agreement. d. Social Security Act Compliance. CONTRACTOR shall adhere to Title XIX of the Social Security Act and conform to all other applicable Federal and State statutes and regulations. e. Quality Assurance. CONTRACTOR shall institute and conduct a quality assurance process relating to services provided under this agreement. At a minimum, this process shall include the following activities: (1)CONTRACTOR shall designate a qualified management or supervisory level staff member who will participate in the"quality improvement program"operated by COUNTY in accordance with the Regulations. (2) CONTRACTOR shall cause a minimum of three randomly selected case records at the Contract Facility to be reviewed by a licensed clinician each quarter. This review will gauge compliance of the services provided to the needs of the client,the requirements of the Regulations with respect to the provision of specific"service activities,"as set forth in Section '7, and compliance to the documentation standards referred to in Section 6. CONTRACTOR shall provide the results of these reviews to COUNTY upon request. '(3) .Client Satisfaction/Program Evaluation surveys will be distributed by June 30 of each year to all clients being served under this agreement to obtain feedback for the.purpose of service enhancement and program development. CONTRACTOR will prepare the survey instrument, which will be approved by COUNTY prior to being administered. CONTRACTOR shall provide HHSA with the results of the survey on or BUCKELEW PROGRAMS#3569 EXHIBIT "A" FY1999-2000 Page 5 of 5 before September 30 of the calendar year in which it is administered. This obligation shall survive expiration of the contract term. (4) CONTRACTOR shall maintain statistics relating to the achievement of the following performance objectives. These statistics shall be reported to HHSA on or before September 30 of each calendar'year for activity occurring in the one year period ending on the preceding June 30. This obligation shall survive expiration of the contract term. (i) Upon discharge, a minimum of 60%of participants will return to their home communities to live in settings which constitute lower levels of care than that provided at the Contract Facility. (ii) Upon discharge, a minimum of 70%of participants will show new or improved community and/or daily living shills. 9. Additional COUNTY Responsibilities. COUNTY shall administer the lease from the State of California under which COUNTY occupies the houses comprising the Contract Facility. This agreement is conditioned upon the continuation of that lease. COUNTY shall be responsible for the maintenance of the houses to the extent responsibility is imposed on the tenant under COUNTY°s lease with the state. 10. Additional Incorporated Documents The following documents are attached to and incorporated in this Description of Services. In the event of any conflict between any provision in the attachments and this Description of Services, the Description of Services shall prevail. a. Attachment 1 -THE AVENUE—Description of Services. b. Attachment 2—Documentation Standards for Client Records c. Attachment 3 -Provider Certification by the Contractor or the Department g:\c6nt9-0\exa#3569 Buckelew Programs #3669 EXHIBIT "A" Attachment °I FY 1999-2000 maga i of 7 THE AVENUE Program Description 1. General Service Approach and Contractor Philosophy Buckelew Programs' vision is to provide quality services for our clients, enabling them to develop to fullest potential and to participate in the community. This philosophy is further enunciated by these three Key Goals: To provide high quality, cost effective programs that maximize the development of the individual. To offer programs responsive to and driven by clients' needs. • To increase social responsibility by educating the community toward greater acceptance, integration and support of the mentally ill and mentally disabled. 11. Outline of Services: A. The Avenue will provide the following services: 1. General Services: a. Lodging; b. Adequate daily food supplies for three nutritious meals and assistance with preparation as needed; c. Special diet as needed; d. Snacks; e. Laundry facilities and linen and assistance in use as needed; f. Cleaning materials and equipment and assistance in use as needed; g. Assistance in planning for and using transportation; h. Assistance in planning and accessing recreational activities. 2. Health Services: a. Daily observation of the resident's general health; b. Assistance with obtaining a doctor and dentist as needed and accessing medical and dental care; c. Assistance in obtaining bedside care for minor temporary illnesses. 3. Rehabilitation and Treatment Services: a. Day Program including education and practice in life skills, pre-vocational skills, exploration of community resources, and interpersonal relationships; b. Afternoon, Evening and Weekend Program including social and recreational activities; c. Individual and group supportive counseling; Buckelew Programs #3569 EXHIBIT "A" Attachment 1 FY 1999-2000 Page 2 of 7 d. Assistance with developing a community support system utilizing non- mental health resources; e. Family involvement where indicated in the resident's treatment plan; f. 24 hour crisis assistance and/or referral; g. 24 hour supervision. B. The Avenue will be a transitional program as defined by the Social Rehabilitation criteria. Special attention will be paid to transitions and to the stressors involved in order to provide additional supports at those times. It is well documented that persons with a mental illness are especially susceptible to stress. The contractor's experience shows that many persistently and seriously mentally ill residents prefer to be minimally involved in formal programs; nevertheless, they experience a slow but gradual improvement in skills and functioning as they involve themselves at their own pace, with minimal use of crisis services or rehospitalization. C. It is important to balance consistency and structure carefully with the needs of individuals and with the needs of the resident group as a whole. For some clients, a broader definition of structure will be necessary to avoid too high a stress level which might trigger a decompensation. The overall treatment approach will be supportive and psycho-educational in nature, enabling the residents to learn and develop the tools to manage their illness and increase the quality of their lives in concert with their own priorities and goals. Expectations for individuals residing in The Avenue will be within the context of membership in their household. D. As members who share the common goal of preparing for the eventual return to their own communities, each resident should expect to participate in the functioning of the household to the extent he or she is able. When residents are newly arrived, it is likely that staff will need to be highly involved in the daily tasks, to assure a sense of consistency and security as residents are becoming adjusted to the recent transition and need time to settle in to their new location. Part of the initial assessment and intake process will include a discussion of skills and interests of each individual. To ensure early success and an increase in self esteem, the resident will be invited to participate in those tasks which he or she is most interested and comfortable. Thus, the early schedule will be tailored to each person's strengths, and early involvement can be somewhat minimal with a great deal of staff assistance as needed. Once new members are settled in, a part of the life skills focus for residents and staff will be to involve each person in the division of tasks. The schedule includes increasing resident participation with staff help in teaching and/or participation to the degree needed to facilitate the smooth running of the house and program. E. Residents and staff alike will be expected to treat one another with dignity and Buckelew Programs #3569 EXHIBIT "A" Attachment 1 FY 1999-2000 Page 3 of 7 respect. This includes respect for individual differences, feelings, the need for privacy, safety, inclusion, and respect for one another's property. These issues and appropriate behaviors will be addressed throughout the program milieu. There will be times when staff needs to set firm limits on certain behaviors to assure that people are safe and rights are respected. This should always be done in a manner that conveys respect, and with a rationale that is grounded in a concern for safety and fairness. The way in which staff set limits is important role modeling for residents which they can learn and apply with one another. Whenever the situation allows, the rationale will be shared with the resident(s) involved. If it cannot be addressed in the moment, it will be discussed later. Since behavior that jeopardizes the safety or rights of others constitutes a barrier toward the achievement of the goal of community living, alternatives will be discussed and become a part of the,individual's service plan. At times, issues that are common to several residents may be the trigger for a focus group series or an invited speaker, e.g., conflict resolution, fire safety, alternatives to physical aggression, etc. 111. Anticipated Treatment Barriers and Approaches A. Alcohol and drug abuse either on or off site. The Avenue will provide educational information and support for a clean and sober lifestyle and culture with support and recommendations for active involvement in a Chemical Dependency Program for dually diagnosed people, and membership in AA or a 12 Step program, with a signed attendance form. B. Smoking The Avenue homes will be smoke-free environments. Clear statements of this rule and information regarding smoking areas will be conveyed to residents. Education regarding personal health and safety will be part of the ongoing program. Positive feedback will be given. C. Money Management, Borrowing, Begging, Stealing Staff will work directly with clients around the issues involved in these barriers. This will include encouragement for individuals in life skills groups to utilize alternative ways to interact with peers and in the community. Attention will be given not only to assist those clients who beg, borrow or steal in adopting more socially acceptable behavior patterns, but also to assist those clients whose skills in assertiveness and limit setting with others require encouragement and development. D. Real or Potential Assaultive Behavior, Threats, Verbal Intimidation Evidence of potential behavior of this nature will be addressed during the assessment and intake process, with clear expectations being conveyed regarding the unacceptability of such behavior at The Avenue. Program staff will Buckelew programs #3569 EXHIBIT "A" Attachment l FY 1998-2000 rage a of 7 ascertain known predictors of such behavior with the individual client, in order to plan for early intervention and treatment. E. Medication noncompliance Staff will actively negotiate medication compliance, as part of the client's individual Service Plan, and as a clearly understood support to the attainment of community placement. Medication Management and Symptom Management classes will be recommended to all residents, to enable them to be knowledgeable regarding their symptoms and the appropriate medications. Staff will advocate for alterations in medication regimen in cases in which the existing regimen is not facilitating client progress. F. Excessive Fear, Paranoia, including Unvoiced Fears Staff will make every effort to learn the history of each individual client, in order to anticipate the unvoiced concerns, their triggers, and predictor behaviors. Knowledgeable staff will thus be empowered to assist clients and initiate appropriate interventions at early indications of this behavior. The maintenance of a safe, caring, belonging site will enhance this. G. Excessive Dependency Staff will be attuned to the potential for transitional clients to maintain a dependent behavior. Individualized attention to clients, focusing on increasing the individual's self reliance at the individual client's pace and ability to take on this responsibility, will be a focus of staff interaction with the client. Joint work activities, with shifting degrees of responsibility, will be a method in which independent skills may be imparted. H. Behavior Actually Disturbing to Normal Program Activity Such behavior includes Sexual Acting Out, inability to live in Shared Room, Exaggerated or Loud Outbursts, Gross Inactivity or Refusal to Engage in Activity, and even Reversed Sleep Patterns. Each type of behavior must be assessed in terms of the individual and the effect which such activity may have on the program and progress of the client population. Behaviors such as Sexual Acting Out need to be addressed as part of the living skills which the client will require for community living. Groups and educational programs will address the aspects of human sexuality. Similar information and imparting of living skills will focus on other behavior patterns, such as Exaggerated Outbursts or Inability to Share Room. Staff will be aware of the history of specific clients which results in Gross Inactivity; encouragement and invitation to participate without pressure should be the rule. Finally, a Reversed Sleep Pattern must be assessed in terms of the underlying motivation to the client. Such a pattern is not in and of itself a barrier to treatment, provided the client is able to learn the skills which avoid disruption of others in the program. Buckelew Programs #3569 EXHIBIT "A" Attachment 1 FY 1999-2000 Page s of 7 IV. Detail of Residential Programming A. Life Skills Subject areas include basic independent living skills, interpersonal relationships and conflict resolution, medication management, and other subjects of crucial importance in developing skills necessary for community living. B. Other Programming This will include Afternoon Programs in community exploration, planning for activities, and individual meetings with the client's service coordinator; Evening Programs which will include art club, evening walks, 12-step meetings, and other recreational activities in modes which facilitate sleep; and Weekend Programs which will include recreational outings and time for family visits. C. Specialized Programming (Medication Management and Symptom Management courses will be given in eight- week segments. Staff will strongly recommend client participation in these courses. The Medication Management course will utilize the UCLA module; Symptom Management will use a syllabus developed and utilized by the contractor. Other programs, including establishment of appropriate 12-step groups, will be driven by client needs and aspirations as expressed in regular, ongoing meetings of the Resident Advisory Committee. V. Policies and Procedure A. Admission and Intake The Program director will establish ongoing linkages with Institutions for Mental Disease (IMDs) in which potential clients are placed. Pre-intake, informal IMD visits will be made to develop a level of comfort for potential residents. Once formal referral is proposed by the client's Case Manager, contractor staff will gather information leading to a formal assessment of the appropriateness of the referral. During this phase staff visits to the client will continue as needed to develop a positive relationship with the client. This will include one or a series of visits to The Avenue when feasible. . The formal assessment will be based on the criteria in the Medical Rehab Option and a Strength perspective. If the client decides to accept residency and all parties agree, the client's Case Manager and the IMD will coordinate the move, with appropriate assistance from staff of the contractor. The contractor will communicate any necessary requirements to the IMD or Case Manager, as appropriate. Should the referral be deemed inappropriate for The Avenue, this decision and the rationale will be communicated to the Case Manager and to the client. The contractor reserves the right to make this final decision. Buckelew Programs #3569 EXHIBIT "A" Attachment 1 FY 1999-2000 Page s of 7 B. Evaluation and Treatment Planning. Ongoing assessment will take place within the framework of an Individual Service Plan, developed by the client's assigned service coordinator in concert with the client, staff members assigned to the client's in house treatment team, the client's extra-program caregivers (e.g. psychiatrist, Case Manager), and the client's family or significant others, at the client's desire. The ISP will be reviewed on an informal, weekly basis, and formally to comport with MediCal/Medicare compliance. No major changes will be made in the ISP without the knowledge and involvement of the client. In addition, the client will be a participant in evaluation of the program and services, through the resident Advisory Committee. The assessment process will always strive to maximize personal, client wishes in treatment team selection and involvement of the client and family in the process. C. Emergency Services Staff of The Avenue will be trained in the skills and techniques of dealing with clients in crisis. An important factor will be staff immersion in the history and predictor behavior of resident clients, enabling quick, responsive, appropriate action. Emergencies which develop requiring physical restraint of the client will involve outside assistance, incorporating action protocols developed by contractor with the host County and ether referring counties. Crisis episodes will trigger contact and involvement with the client's Case Manager and other extra -program caregivers as appropriate. responses will always be governed by the health and safety of the person, other client residents and staff of The Avenue. Advance planning for emergency services, including physical medical services, will be made to ensure quick response in any emergency situation. D. residential Service Groups Client residents will be encouraged and recommended to attend groups which are deemed most helpful and appropriate to the individual client, as described in the Individualized Service Plan (ISP). While attendance will be encouraged and nurtured, each client will expand attendance at their own pace. Groups will fall into the following six types: 1. Support Groups, designed to give support and encouragement to the client in one-on-one meetings with staff and a weekly group, 2. Educational Classes, such as the Life Skills program, Symptom and Medication Management, and other classes in various living skills; 3. Task Groups, whose function is to facilitate actual operations of the residences (e.g. food preparation, activities, transportation); 4 A weekly House Meeting with once a month meeting of the entire Avenue staff and client group; 5. recreational/Social Activities as designed by staff and client members; and A Buckelew Programs #3569 EXHIBIT "A" Attachment 'I FY 1999-2000 Page 7 of 7 6. Various meetings, to include Individual, Family, and Resident Advisory Meetings which cover topics germane to the meeting membership. E. Medical Services and Referrals; Medication Management. 9. Appropriate Medical Services and Referrals for the resident will be factors of a pre-admission physical examination-performed prior to acceptance of the resident by the contractor, and on a detailed medical history, including current caregivers, to enable contractor staff to provide familiar, routine medical care to the extent possible. Emergency medical services will be established by agreement between the contractor and the closest medical facility, and in accordance with the guidelines established with the referring County. 2. Medication Assistance will be performed by contractor staff with the goal of enabling client residents to assume the greatest possible responsibility for their own medication. Medications will be prescribed by the resident's psychiatrist or by personal physician or other treating phys'ician/psychiatrist. They will be centrally stored and accounted for according to state law and licensing regulations. Staff role will be to assist clients in administering their own medication and in taking increased responsibility for the medication regimen as prescribed. P.R.N. medication will be similarly managed in accordance with prescription, and client reaction to medication will be observed and,noted by staff. The Avenue will maintain individual locked mailboxes, in which clients may secure their own medications (as well as money and other valuables) as their ability to self- manage medication increases. Medication Management and Symptom Management Classes will encourage and reinforce the importance of medication regimen and achievement of individual responsibility. F. Discharge Planning The client's individual service counselor has the lead responsibility in planning for discharge, in coordination with the client and with the treatment team, including the Case Manager. This planning will focus on the strengths and needs of the client. Contractor staff will assist with the transition from The Avenue to the new living situation. Aftercare and follow-up are the responsibility of the client's designated Case Manager, with consultation and appropriate assistance from staff of The Avenue. Unplanned discharges must be anticipated and planned for. To the extent possible, the Case Manager, caregivers, and supporting persons of a client at risk of an unplanned discharge will be alerted and involved in creating the best possible plan for the individual client's needs. As with planned discharges, primary responsibility for aftercare and follow-up will lie with the client's Case Manager, with consultation and appropriate assistance from staff of The Avenue. gAcont9-0\exa#3569att1 • SUCKELEW #3569 (The Avenue) EXHIBIT "A" 1'lly Addendum r 914 Mission Avenue Buckelew Programs Sen Rafael, California 9491 Telephone: (415)457.696L Fax: (415) 721-0281 The Avenue Performance Objectives P 19991.2004 1. Within 18 months of admission, 60% of the participants will return to their own community to live. 2. Annually, 70%of the participants will show new or improved community and/or daily living skills. 3. Client Satiisfactiow?rogram Evaluation Surveys will be distributed annually in the month of March to atttain feedbag to utilize in service enhancement and program, development.. EXHIBIT"B" AVENUES PROJECT BUDGET COUNTY APPORTIONMENT: CONTRA COSTA FY 1999-2000 PERIOD BEDS DAYS RATE COST 711199—6130100 2 730 79.627 $58,127.50 g:lcont8-91exb#4041 NAPA COUNTY NO. 4041 24 - 658 3 INTERCOUNTY AGREEMENT COMMUNITY MENTAL HEALTH SERVICES This contract is made and entered into on the dates recited herein, by and between two political subdivisions of the State of California: the COUNTY OF NAPA, hereinafter referred to as NAPA, and the COUNTY OF CONTRA COSTA, hereinafter referred to as CONTRA COSTA. WITNESSETI _ WHEREAS, CONTRA COSTA desires to extend to its residents certain mental health services established under the California Welfare and Institutions Code and other enabling legislation, and programs and projects administered by the State Department of Mental Health (hereinafter referred to as "Department")or by counties through the Mental Health System, and WHEREAS, NAPA has entered into a contract with a qualified provider of mental health services, under which contract services will be provided to clients of CONTRACOSTA's Mental Health service by virtue of this Agreement,in a program known as "The Avenue", located within NAPA, and WHEREAS, parts of the California Code of Regulations and the Welfare and Institutions Code provide a set of definitions,standards,procedures and regulations by and pursuant to which CONTRA COSTA and NAPA may lawfully contract for such services as are described in the Service Description incorporated in this Agreement as Exhibit "A NOW, THEREFORE,IT IS MUTUALLY AGREED between the parties as follows: 1. CONTRA COSTA agrees to: a) Designate the Adult Services Coordinator, or other appropriate staff of its Mental Health Services, to act as program liaison. Said program liaison shall be responsible for coordinating placements of CONTRA COSTA's clients at The Avenue, and in the development of policies and procedures made by NAPA, CONTRA COSTA, and the provider operating The Avenue. b) Identify appropriate placements for The Avenue program and cooperate with the provider in effecting placements and discharges. C) Place a maximum of two (2) CONTRA COSTA clients in The Avenue at any one time, subject to the provisions of Paragraphs 3(b) and 3(d): d) Retain responsibility for the collection of Supplemental Security Income (SSI)for its clients placed at The Avenue. -1- e) 1) Pay to NAPA the amount of Fifty-Eight Thousand, One Hundred Twenty-Seven Dollars and Fifty Cents ($58,127.50). This amount represents that proportion of the gross cost of provision of services, plus a five percent (5%) charge for program and fiscal administration by NAPA, less Medi-Cal reimbursement claimed by and paid to NAPA; apportioned in the same proportion which client placement slots, dedicated for use by CONTRA COSTA, bear to the total number of client placement slots (2/6). Components are displayed in Exhibit"B". 2) Pay to NAPA that portion of Medi-Cal reimbursement, as defined in Exhibit "B" attached, which may not be paid to NAPA due to the non-eligibility of the placed client for such reimbursement. For or the purposes of this agreement, a client shall be determined "eligible" for Medi-Cal reimbursement at placement in the Avenue program only if such eligibility has been determined,and a Medi-Cal card or other eligibility certification issues, upon which NAPA may base a claim for services provided under this Agreement. For the purposes of this section, clients placed with pending application or pending determination for Medi-Cal eligibility shall be defined as "non-eligible" unless and until such eligibility is determined. It shall be the responsibility of CONTRA COSTA to ensure eligibility of the client for such reimbursement. NAPA shall bill CONTRA COSTA monthly for these charges in accordance with the rate schedule described in Exhibit "B" attached. Upon determination that the placed client is eligible for Medi-Cal, and receipt by NAPA of said reimbursement, NAPA shall return to CONTRA COSTA all funds paid by CONTRA COSTA, which have subsequently been reimbursed by Medi-Cal. The maximum amount payable by CONTRA COSTA under subsection 2) above shall be Five Thousand,Eight Hundred Twelve Dollars ($5,812.00)for the term of this agreement, billed on a fee-for-service basis. CONTRA COSTA and NAPA acknowledge that this amount is an estimate of the annual amount which may be incurred by CONTRA COSTA during the term; should this amount be exhausted during the term of this agreement, the parties agree to process an amendment to this agreement which increases said maximum to conform with the revised estimate. f) Cooperate in provision of patient history and fiscal records including those necessary to enable NAPA to complete its duties. 2. NAPA agrees to: a) Designate the Adult Services Coordinator, or other appropriate staff of its Mental Health Services, to act as program liaison. Said program liaison shall perform the same duties as are enumerated in paragraph 1(a). b) Provide contract management and administration,including the receipt and payment of all claims by the contract provider operating The Avenue, and also including general -2- 4 . contract liaison. C) Assume responsibility for collection and retention of all charges to Medi- Cal and Medicare for services provided by the contractor operating The Avenue. This shall include billing, record keeping, and quality assurance. d) Act as lessee under the terms of the lease of the premises on which The Avenue program will be conducted, including payment of lease costs and liaison with the contractor operating The Avenue on lease matters. e) Maintain all records required, including those provided by the contractor. 3. BOTH CONTRA COSTA AND NAPA agree. a) That both NAPA and CONTRA COSTA are included in a group of three California Counties which have agreed to place clients at The Avenue, that the remaining County is the County of Marin, and that Marin, and CONTRA COSTA are each engaged in intercounty agreements with NAPA which recite their respective duties regarding The Avenue. b) That, should circumstances require a change in CONTRA COSTA"s maximum number of client placements hereunder, CONTRA COSTA may discuss the temporary increase or decrease with any other participating County, provided that no alteration in any obligation of CONTRA COSTA to NAPA be made, except as provided in Paragraph 3(d) herein, and further provided that no agreement shall be made with any other County or entity which is not recited in paragraph 3(a) regarding use of or placement in The Avenue, absent the prior approval of the three recited Counties. C) Each party shall defend, indemnify, and save harmless the other, from and against any and all claims and losses whatsoever for damage, injury, or death arising out of or connected with the performance of this agreement, or resulting from any act or omission of that party's employees, officers, or agents. Each party shall maintain liability insurance or self- insurance of the scope and nature required of the operations undertaken by virtue of this agreement, including, as applicable, vehicular liability, professional liability, premises liability, and workers" compensation insurance for all persons as are required by state law to be covered. d) No modification or variation of the terms of this contract shall be valid unless made in writing and signed by the parties hereto, and no oral understanding or agreement not incorporated herein shall be binding on any of the parties hereto. This writing is intended both as the final expression of the Agreement between the parties hereto with respect to the -3- included terms and as complete and exclusive statement of the terms of the Agreement, pursuant to C.C.P. Section 1856. The parties expressly recognize that their personnel are without authorization to either order extra or changed work or waive contract requirements. Failure of either to secure authorization of Board of Supervisors of both parties for such work shall constitute a waiver of any and all right to adjustment in the contract price or contract time due to such unauthorized work. e) TERM: The term of this contract shall begin July 1, 1999, and shall terminated on June 30, 2000, unless terminated as hereinafter provided. This agreement may be terminated by either party by giving sixty (60) days written notice of intention to terminate. For the purposes of this Agreement, notice shall be deemed effective upon mailing by first class mail to the following addresses: For CONTRA COSTA Director,Mental Health Division Contra Costa County Health Services Department 595 Center Avenue, Suite 200 Martinez,CA 94553 For NAPA Contracts Napa County Health and Human Services Agency 2261 Elm Street Napa CA 945593721 'This contract is made for a specific term. Nothing in this contract shall imply the renewal of this contract, or of any contract for similar or differing services between the parties hereto. Nothing herein shall imply or guarantee continuance of this contract of funding of any position or service by CONTRA COSTA to NAPA. -4- INTERCOUNTY AGREEMENT COMMUNITY MENTAL HEALTH SERVICES 24 "` 658 -' "` 3 IN WITNESS WHEREOF, the parties hereto have executed this contract the day and year hereinabove written. ATTEST: CLERK OF THE BOARD COUNTY OF APA, a political subdivision of the S to of California JBy: ZBy: / OZ rr -3 w ws!1 Date: ; 1 y/! Date: Y # ! P+• •.taw � 4 { ATTEST: CLERK OF THE BOARD COUNTY OF CONTRA COSTA, a political ivisio th State of California By: c .t, ,� - By: Date: ep'/Z-r /a-"0 Date: cAcoNr99-Mcoc0#4041 APPROVED an BOARD OF S 09iMSORS COUNTY OF NAPA MARY JEAN MCLAUGHUN r'IERK OF THE BO.:M i APS ROVED . S TO FORM By Deputy Office.ofCour�.y iunsel By: Date: - -5- f EXHIBIT "A" Page l of 5 DESCRIPTION OF SERVICES 1. Introduction COUNTY, through its Health and Human Services Agency (HHSA), operates a"Medi- Cal Managed Care Plan" (the Plan) under the auspices of a contract with the California Department of Health Services (CDHS). Pursuant to the Plan, COUNTY makes a range of mental health services available to Medi-Cal beneficiaries and other persons. CONTRACTOR.has entered into this agreement with COUNTY to provide certain mental health rehabilitation services to Medi-Cal beneficiaries and other clients referred by COUNTY(or other counties designated by COUNTY pursuant to Section 4)who are appropriate for the receipt of those services. 2. Definitions a. CONTRACTOR refers to Buckelew Programs, a California non-profit corporation. b. Regulations refers to Title 9, Chapter 11, California Code of Regulations. Whenever terms in this Description of Services appear in quotation marks, they shall have the meaning set forth in the Regulations. S. Provision of Services CONTRACTOR shall provide "Adult Residential Treatment Services" at a house located on the grounds of Napa State Hospital,Napa, California, which is leased by COUNTY from the State of California for the purposes of this agreement(the Contract Facility). The Contract Facility has the capacity to serve six (6)clients in residence at any one time. 4. Service Activities a. Referral. Clients to be served at the Contract Facility shall be referred by the mental health staff at HHSA and at other counties which are from time to time authorized by COUNTY to refer clients for residency and service at the Contract Facility. At the commencement of this agreement, candidates for placement may be referred by the following three counties, each of which has the right to two of the six.beds:Napa, Contra Costa, and Marin. Referring counties shall provide CONTRACTOR with diagnostic information on all persons referred for admission to the Contract Facility. b. Provision of"Service Activities". Each client referred shall be assessed by CONTRACTOR for admission to the Contract Facility. Each client who is accepted will receive an appropriate array of"service activities" each day that the client is in residency. These "service activities"shall include one or more of the following: "assessment,""plan development,""therapy," "rehabilitation,"and"collateral." y EXHIBIT "A" Page 2 of 5 c. Scone of Practice. All "service activities" shall be provided by staff for whom the provision of such services falls within their legal scope of practice. Without limiting this, diagnosis (which is one function within the larger"assessment" service activity) and "therapy" must be performed by staff who hold appropriate mental health licenses. d. Additional Provisions. Additional provisions relating to the services to be provided to clients are set forth in the attachments to this description of services. 5. Facility Licensure and Certification a. Licensure. Throughout the effective term of this agreement, the Contract Facility shall be and remain licensed as a Social Rehabilitation Facility by the California Department of Social Services(CDSS). CONTRACTOR shall provide COUNTY with copies of the license and all written licensure, inspection,or complaint reports issued by DSS. b. Certification, Throughout the effective term of this agreement,the Contract Facility shall be and remain certified by DMH as an"Adult Residential Treatment Service." CONTRACTOR shall provide COUNTY with copies of each certification and all written certification,inspection, and related reports issued by DMI . c. Certification as an "Organizational Provider". Throughout the effective term of this agreement, CONTRACTOR shall operate as and meet all standards required of an "organizational provider" delivering the services specified in Section 3 of this description of services, as well as the certification standards set forth in Attachment 3 —Provider Certification by the Contractor or the Department, which is an attachment to the Plan and is attached to this description of services. At the commencement of this agreement, COUNTY shall make provisional certification of the CONTRACTOR in accordance with applicable laws and regulations and the provisions hereof. COUNTY shall proceed to formal certification in accordance with the provisions of the Plan, and CONTRACTOR shall cooperate with COUNTY in this process. Without limiting the foregoing, COUNTY shall have the right to inspect and review CONTRACTOR's facility and program documentation at any time to determine compliance with applicable laws and regulations and the terms of this Agreement. 6. Staffin a. Staff Oualifications. CONTRACTOR certifies that all staff at the Contract Facility providing services to clients under this agreement are qualified under the Regulations and other applicable laws and regulations to provide the services on which reimbursement is claimed,based upon education, experience, and licensure. CONTRACTOR shall maintain written documentation verifying degrees,licensure, training and experience for all staff,which shall be made available to COUNTY upon request. EXHIBIT"A" Page 3 of 5 b. Staffing Levels. CONTRACTOR shall maintain staffing levels at the Contract Facility in accordance with the requirements of the Regulations and other applicable laws and regulations, including Section 531 of Title 9, Division 1, Chapter 3, of the California Code of Regulations. CONTRACTOR shall maintain written staff schedules and time sheets or other documentation sufficient to evidence compliance to applicable staffing requirements. Upon request,these materials shall be made available to COUNTY for review. CONTRACTOR shall provide for adequate supervision of staff by qualified and trained managers and supervisors. c. "Head of Service". As required by Section 1810.435(c)(3)of the Regulations, the Contract Facility and the services provided therein shall be overseen by a"head of service"who is a"licensed mental health professional or other appropriate individual" as described in Sections 622 through 630 of Title 9,Division 1,Chapter 3, of the California Code of Regulations. In the event that the "head of service" is a"mental health rehabilitation specialist,"as defined in Section 630, COUNTY shall have the right to approve the individual who will serve as"head of service." 7. Client Documentation a. Documentation Standards. CONTRACTOR will document all services provided to clients under this agreement in accordance with(i)the requirements of this agreement; (ii)the requirements of Attachment 2—Documentation Standards for Client Records, which is an attachment to the Plan and is attached to this service description; (iii)the requirements of HHSA's Fiscal Office, which relate to the reporting of such information as is necessary to obtain allowable reimbursement for services provided to eligible clients; and(iv)the community standard of care. In the event of a conflict among these documentation standards, CONTRACTOR shall adhere to the most demanding requirement. COUNTY shall have the right to inspect and receive copies of such documentation to the extent necessary to obtain available reimbursement,perform its inspection and certification responsibilities, and as otherwise provided in this agreement or applicable laws or regulations. COUNTY shall observe all applicable laws regarding the confidentiality of client documentation. b. Document Maintenance. All client records shall be maintained on site at the program where services were provided for a minimum of seven(7) years. Such records shall be maintained in accordance with state and federal standards. e. Substantive Entries for"Service Activities" "Service activities"provided to clients shall be documented in a manner which evidences their compliance to the requirements of the Regulations. 8. Additional CONTRACTOR Responsibilities a. Cultural Com etp ence. CONTRACTOR shall provide culturally, linguistically appropriate services to clients as defined in the Napa County Specialty Mental Health Plan. CONTRACTOR shall adhere to the provisions of the"Cultural Competence Plan" EXHIBIT "A" Page 4 of 5 adopted by COUNTY as a part of the Plan, including the provision of such training to its staff as required under the "Cultural Competence Plan." b. One Level of Service. All clients referred for service hereunder shall receive the same level of services appropriate for their needs, without discrimination based upon funding source. c. Payment in Full. Sums provided in this agreement to be paid to CONTRACTOR for the "adult residential treatment services" to be provided hereunder shall be considered payment in full to the CONTRACTOR for such services. CONTRACTOR shall not seek to collect additional sums from the clients or third parties for such services. COUNTY shall be entitled to seek reimbursement for such services as may be allowed under applicable laws and regulations. CONTRACTOR shall be entitled to collect sums from clients served for the provision of services other than"adult residential treatment services."Additional sums charged for board and care shall not exceed state approved rate schedules. CONTRACTOR shall maintain books of account that accurately distinguish costs incurred in the provision of"adult residential treatment services" and other operating costs. These costs shall be reported to COUNTY in sufficient detail to enable COUNTY to determine which relate to services being funded under this agreement. d. Social Security Act Compliance. CONTRACTOR shall adhere to Title XIX of the Social Security Act and conform to all other applicable Federal and State statutes and regulations. e. Quality Assurance. CONTRACTOR shall institute and conduct a quality assurance process relating to services provided under this agreement. At a minimum,this process shall include the following activities. (1) CONTRACTOR shall designate a qualified management or supervisory level staff member who will participate in the"quality improvement program"operated by COUNTY in accordance with the Regulations. (2) CONTRACTOR shall cause a minimum of three randomly selected case records at the Contract Facility to be reviewed by a licensed clinician each quarter. This review will gauge compliance of the services provided to the needs of the client,the requirements of the Regulations with respect to the provision of specific "service activities,"as set forth in Section 7, and compliance to the documentation standards referred to in Section 6. CONTRACTOR shall provide the results of these reviews to COUNTY upon request. (3) Client Satisfaction/Program Evaluation surveys will be distributed by June 30 of each year to all clients being served under this agreement to obtain feedback for the purpose of service enhancement and program development. CONTRACTOR will prepare the survey instrument, which will be approved by COUNTY prior to being administered. CONTRACTOR shall provide HHSA with the results of the survey on or EXHIBIT "A" Page 5 of 5 before September 30 of the calendar year in which it is administered. This obligation shall survive expiration of the contract term. (4) CONTRACTOR shall maintain statistics relating to the achievement of the following performance objectives. These statistics shall be reported to HHSA on or before September 30 of each calendar year for activity occurring in the one year period ending on the preceding June 30. This obligation shall survive expiration of the contract term. (i) Upon discharge, a minimum of 60%of participants will return to their home communities to live in settings which constitute lower levels of care than that provided at the Contract Facility. (ii) Upon discharge, a minimum of 70%of participants will show new or improved community and/or daily living skills. 9. Additional COUNTY Responsibilities. COUNTY shall administer the lease from the State of California under which COUNTY occupies the houses comprising the Contract Facility. This agreement is conditioned upon the continuation of that lease. COUNTY shall be responsible for the maintenance of the houses to the extent responsibility is imposed on the tenant under COUNTY's lease with the state. 10. Additional Incorporated Documents The following documents are attached to and incorporated in this Description of Services. In the event of any conflict between any provision in the attachments and this Description of Services,the Description of Services shall prevail. a. Attachment 1 - THE AVENUE—Description of Services. b. Attachment 2—Documentation Standards for Client Records c. Attachment 3 —Provider Certification by the Contractor or the Department g:\cont9-0\exa#3569 EXHIBIT "A" Attachment 1 Page 1 of 7 THE AVENUE Program Description 1. General Service Approach and Contractor Philosophy Buckelew Programs' vision is to provide quality services for our clients, enabling them to develop to fullest potential and to participate in the community. This philosophy is further enunciated by these three Key Goals: • To provide high quality, cost effective programs that maximize the development of the individual • To offer programs responsive to and driven by clients' needs. • To increase social responsibility by educating the community toward greater acceptance, integration and support of the mentally ill and mentally disabled. LI. Outline of Services: A. The Avenue will provide the following services: 1. General Services: a. Lodging; b. Adequate daily food supplies for three nutritious meals and assistance with preparation as needed; c. Special diet as needed; d. Snacks; e. Laundry facilities and linen and assistance in use as needed; f. Cleaning materials and equipment and assistance in use as needed; g. Assistance in planning for and using transportation; h. Assistance in planning and accessing recreational activities. 2. Health Services: a. Daily observation of the resident's general health; b. Assistance with obtaining a doctor and dentist as needed and accessing medical and dental care; c. Assistance in obtaining bedside care for minor temporary illnesses. 3. Rehabilitation and Treatment Services: a. Day Program including education and practice in life skills, pre-vocational skills, exploration of community resources, and interpersonal relationships; b. Afternoon, Evening and Weekend Program including social and recreational activities; c. Individual and group supportive counseling; EXHIBIT "A" Attachment '1 Page 2 of 7 d. Assistance with developing a community support system utilizing non- mental health resources; e. Family involvement where indicated in the resident's treatment plan; f. 24 hour crisis assistance and/or referral; g. 24 hour supervision. B. The Avenue will be a transitional program as defined by the Social Rehabilitation criteria. Special attention will be paid to transitions and to the stressors involved in order to provide additional supports at those times. It is well documented that persons with a mental illness are especially susceptible to stress. The contractor's experience shows that many persistently and seriously mentally ill residents prefer to be minimally involved in formal programs; nevertheless, they experience a slow but gradual improvement in skills and functioning as they involve themselves at their own pace, with minimal use of crisis services or rehospitalization. C. It is important to balance consistency and structure carefully with the needs of individuals and with the needs of the resident group as a whole. For some clients, a broader definition of structure will be necessary to avoid too high a stress level which might trigger a decompensation. The overall treatment approach will be supportive and psycho-educational in nature, enabling the residents to learn and develop the tools to manage their illness and increase the quality of their lives in concert with their own priorities and goals. Expectations for individuals residing in The Avenue will be within the context of membership in their household. D. As members who share the common goal of preparing for the eventual return to their own communities, each resident should expect to participate in the functioning of the household to the extent he or she is able. When residents are newly arrived, it is likely that staff will need to be highly involved in the daily tasks, to assure a sense of consistency and security as residents are becoming adjusted to the recent transition and need time to settle in to their new location. Part of the initial assessment and intake process will include a discussion of skills and interests of each individual. To ensure early success and an increase in self esteem, the resident will be invited to participate in those tasks which he or she is most interested and comfortable. Thus, the early schedule will be tailored to each person's strengths, and early involvement can be somewhat minimal with a great deal of staff assistance as needed. Once new members are settled in, a part of the life skills focus for residents and staff will be to involve each person in the division of tasks. The schedule includes increasing resident participation with staff help in teaching and/or participation to the degree needed to facilitate the smooth running of the house and program. E. Residents and staff alike will be expected to treat one another with dignity and EXHIBIT "A" Attachment 1 Page 3 of 7 respect. This includes respect for individual differences, feelings, the need for privacy, safety, inclusion, and respect for one another's property. These issues and appropriate behaviors will be addressed throughout the program milieu. There will be times when staff needs to set firm limits on certain behaviors to assure that people are safe and rights are respected. This should always be done in a manner that conveys respect, and with a rationale that is grounded in a concern for safety and fairness. The way in which staff set limits is important role modeling for residents which they can learn and apply with one another. Whenever the situation allows, the.rationale will be shared with the resident(s) involved. If it cannot be addressed in the moment, it will be discussed later. Since behavior that jeopardizes the safety or rights of others constitutes a barrier toward the achievement of the goal of community living, alternatives will be discussed and become a part of the individual's service plan. At times, issues that are common to several residents may be the trigger for a focus group series or an invited speaker, e.g., conflict resolution, fire safety, alternatives to physical aggression, etc. Ill. Anticipated Treatment Barriers and Approaches A. Alcohol and drug abuse either on or off site. The Avenue will provide educational information and support for a clean and sober lifestyle and culture with support and recommendations for active involvement in a Chemical Dependency Program for dually diagnosed people, and membership in AA or a 12 Step program, with a signed attendance form. B. Smoking The Avenue homes will be smoke-free environments. Clear statements of this rule and information regarding smoking areas will be conveyed to residents. Education regarding personal health and safety will be part of the ongoing program. Positive feedback will be given. C. Money Management, Borrowing, Begging, Stealing Staff will work directly with clients around the issues involved in these barriers. This will include encouragement for individuals in life skills groups to utilize alternative ways to interact with peers and in the community. Attention will be given not only to assist those clients who beg, borrow or steal in adopting more socially acceptable behavior patterns, but also to assist those clients whose skills in assertiveness and limit setting with others require encouragement and development. D. Real or Potential Assaultive Behavior, Threats, Verbal Intimidation Evidence of potential behavior of this nature will be addressed during the assessment and intake process, with clear expectations being conveyed regarding the unacceptability of such behavior at The Avenue. Program staff will EXHIBIT "A" Attachment 1 Page 4 of 7 ascertain known predictors of such behavior with the individual client, in order to plan for early intervention and treatment. E. Medication noncompliance Staff will actively negotiate medication compliance, as part of the client's individual Service Plan, and as a clearly understood support to the attainment of community placement. Medication Management and Symptom Management classes will be recommended to all residents, to enable them to be knowledgeable regarding their symptoms and the appropriate medications. Staff will advocate for alterations in medication regimen in cases in which the existing regimen is not facilitating client progress. F. Excessive Fear, Paranoia, including Unvoiced Fears Staff will make every effort to learn the history of each individual client, in order to anticipate the unvoiced concerns, their triggers, and predictor behaviors. Knowledgeable staff will thus be empowered to assist clients and initiate appropriate interventions at early indications of this behavior. The maintenance of a safe, caring, belonging site will enhance this. G. Excessive Dependency Staff will be attuned to the potential for transitional clients to maintain a dependent behavior. Individualized attention to clients, focusing on increasing the individual's self reliance at the individual client's pace and ability to take on this responsibility, will be a focus of staff interaction with the client. Joint work activities, with shifting degrees of responsibility, will be a method in which independent skills may be imparted. H. Behavior Actually Disturbing to Normal Program Activity Such behavior includes Sexual Acting Out, inability to live in Shared Room, Exaggerated or Loud Outbursts, Gross Inactivity or Refusal to Engage in Activity, and even Reversed Sleep Patterns. Each type of behavior must be assessed in terms of the individual and the effect which such activity may have on the program and progress of the client population. Behaviors such as Sexual Acting Out need to be addressed as part of the living skills which the client will require for community living. Groups and educational programs will address the aspects of human sexuality. Similar information and imparting of living skills will focus on other behavior patterns, such as Exaggerated Outbursts or Inability to Share Room. Staff will be aware of the history of specific clients which results in Gross Inactivity; encouragement and invitation to participate without pressure should be the rule. Finally, a Reversed Sleep Pattern must be assessed in terms of the underlying motivation to the client. Such a pattern is not in and of itself a barrier to treatment, provided the client is able to learn the skills which avoid disruption of others in the program. EXHIBIT "A" Attachment 1 Page 5 of 7 IV. Detail of Residential Programming A. Life Skills Subject areas include basic independent living skills, interpersonal relationships and conflict resolution, medication management, and other subjects of crucial importance in developing skills necessary for community living. S. Other Programming This will include Afternoon Programs in community exploration, planning for activities, and individual meetings with the client's service coordinator; Evening Programs which will include art club, evening walks, 12-step meetings, and other recreational activities in modes which facilitate sleep; and Weekend Programs which will include recreational outings and time for family visits. C. Specialized Programming Medication Management and Symptom Management courses will be given in eight-week segments. Staff will strongly recommend client participation in these courses. The Medication Management course will utilize the UCLA module; Symptom Management will use a syllabus developed and utilized by the contractor. Other programs, 'including establishment of appropriate 12-step groups, will be driven by client needs and aspirations as expressed in regular, ongoing meetings of the Resident Advisory Committee. V. Policies and Procedure A. Admission and Intake The Program director will establish ongoing linkages with Institutions for Mental Disease (IMDs) in which potential clients are placed. Pre-intake, informal IMD visits will be made to develop a level of comfort for potential residents. Once formal referral is proposed by the client's Case Manager, contractor staff will gather information leading to a formal assessment of the appropriateness of the referral. During this phase staff visits to the client will continue as needed to develop a positive relationship with the client. This will include one or a series of visits to The Avenue when feasible. The formal assessment will be based on the criteria in the MediCal Rehab Option and a Strength perspective. If the client decides to accept residency and all parties agree, the client's Case Manager and the IMD will coordinate the move, with appropriate assistance from staff of the contractor. The contractor will communicate any necessary requirements to the IMD or Case Manager, as appropriate. Should the referral be deemed inappropriate for The Avenue, this decision and the rationale will be communicated to the Case Manager and to the client. The contractor reserves the right to make this final decision. EXHIBIT "A" Attachment 1 Wage 6 of 7 B. Evaluation and Treatment Planning. Ongoing assessment will take place within the framework of an Individual Service Plan, developed by the client's assigned service coordinator in concert with the client, staff members assigned to the client's in house treatment team, the client's extra-program caregivers (e.g. psychiatrist, Case Manager), and the client's family or significant others, at the client's desire. The ISP will be reviewed on an informal, weekly basis, and formally to comport with MediCal/Medicare compliance. No major changes will be made in the ISP without the knowledge and involvement of the client. In addition, the client will be a participant in evaluation of the program and services, through the Resident Advisory Committee. The assessment process will always strive to maximize personal, client wishes in treatment team selection and involvement of the client and family in the process. C. Emergency Services Staff of The Avenue will be trained in the skills and techniques of dealing with clients in crisis. An important factor will be staff immersion in the history and predictor behavior of resident clients, enabling quick, responsive, appropriate action. Emergencies which develop requiring physical restraint of the client will involve outside assistance, incorporating action protocols developed by contractor with the host County and other referring counties. Crisis episodes will trigger contact and involvement with the client's Case Manager and other extra -program caregivers as appropriate. Responses will always be governed by the health and safety of the person, other client residents and staff of The Avenue. Advance planning for emergency services, including physical medical services, will be made to ensure quick response in any emergency situation. D. Residential Service Groups Client residents will be encouraged and recommended to attend groups which are deemed most helpful and appropriate to the individual client, as described in the Individualized Service Plan (ISP). While attendance will be encouraged and nurtured, each client will expand attendance at their own pace. Groups will fall into the following six types: 1. Support Groups, designed to give support and encouragement to the client in one-on-ane meetings with staff and a weekly group; 2. Educational Classes, such as the Life Skills program, Symptom and Medication Management, and other classes in various living skills; 3. Task Groups, whose function is to facilitate actual operations of the residences (e.g. food preparation, activities, transportation); 4 A weekly House Meeting with once a month meeting of the entire Avenue staff and client group; 5. Recreational/Social Activities as designed by staff and client members; and EXHIBIT "At9 Attachment 1 Page 7 of 7 6. Various meetings, to include Individual, Family, and Resident Advisory Meetings which cover topics germane to the meeting membership. E. Medical Services and Referrals; Medication Management. 1. Appropriate Medical Services and Referrals for the resident will be factors of a pre-admission physical examination performed prior to acceptance of the resident by the contractor, and on a detailed medical history, including current caregivers, to enable contractor staff to provide familiar, routine medical care to the extent possible. Emergency medical services will be established by agreement between the contractor and the closest medical facility, and in accordance with the guidelines established with the referring County. 2. Medication Assistance will be performed by contractor staff with the goal of enabling client residents to assume the greatest possible responsibility for their own medication. Medications will be prescribed by the resident's psychiatrist or by personal physician or other treating physician/psychiatrist. They will be centrally stored and accounted for according to state law and licensing regulations. Staff role will be to assist clients in administering their own medication and in taking increased responsibility for the medication regimen as prescribed. P.R.N. medication will be similarly managed in accordance with prescription, and client reaction to medication will be observed and noted by staff. The Avenue will maintain individual locked mailboxes, in which clients may secure their own medications (as well as money and other valuables) as their ability to self- manage medication increases. Medication Management and Symptom Management Classes will encourage and reinforce the importance of medication regimen and achievement of individual responsibility. F. Discharge Planning The client's individual service counselor has the lead responsibility in planning for discharge, in coordination with the client and with the treatment team, including the Case Manager. This planning will focus on the strengths and needs of the client. Contractor staff will assist with the transition from The Avenue to the new living situation. Aftercare and follow-up are the responsibility of the client's designated Case Manager, with consultation and appropriate assistance from staff of The Avenue. Unplanned discharges must be anticipated and planned for. To the extent possible, the Case Manager, caregivers, and supporting persons of a client at risk of an unplanned discharge will be alerted and involved in creating the best possible plan for the individual client's needs. As with planned discharges, primary responsibility for aftercare and follow-up will lie with the client's Case Manager, with consultation and appropriate assistance from.staff of The Avenue. gAcont9-01exa#3569aft1 BUMLEW #35E9 (The Avenue) EXHIBIT "A" �r Addendum +" 914 Mission Avenue Buckelew Programs' � San Rafael, Califomia 9490 Teiaphomet(415)4S7-696, Fax: (415) 721-0281 The Avenue Performance Objectives V 199.9-2000 1. Within I&months of admission, 600/6 of the participants will return to their own community to live. 2. Annually, 70%of the participants will show new or improved community and/or daily living skills. 3. Chem Satisfaction/Program Evaluation Surveys will be distributed annually in the month of March to attain feedback to utilize in service cn ancement and prem development.. EXHIBIT"B" AVENUES PROJECT BUDGET COUNTY APPORTIONMENT: CONTRA COSTA FY 1599-2000 PERIOD BEDS _ DAYS RATE COST 7/1/99—6/30/00 2 730 79.627 $58,127.50 g:tcont8-9texb#4041 TO: BOARD OF SUPERVISORS FROM: William Walker, M.D. , Health Services Director f By: Ginger Marieiro, Contracts Administrator `� y Contra DATE: Jlme 14, 2000 Costa County SUBJECT: Approval of Novation Contract #24-927-3 with Asian Pacific Psychological Services SPECIFIC REQUESTS)OR RECOMMENDATION($)&BACKGROUND AND JUSTIFICATION RECOMMENDATION(S) : Approve and authorize the Health Services Director or his designee (Donna Wigand) to execute on behalf . of the County, Novation Contract #24-927-3 with Asian Pacific Psychological Services, in the amount of $149,450, for the period from July 1, 2000 through June 30, 2001, to provide school and community based mental health services for Medi-Cal eligible Asian children and families enrolled in the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program. This Contract includes a six-month automatic extension through December 31, 2001, in the amount of $74,725. FISCAL IMPACT: This Contract is funded 51.5% by Federal FFP Medi-Cal Funds and 48.5% by State EPSDT Funds. No County funds are required. CHILDREN'S IMPACT STATEMENT: This Mental Health EPSDT Program supports the following Board of Supervisors' community outcomes: "Children Ready for and Succeeding in School" ; "Families that are Safe, Stable, and Nurturing"; and "Communities that are Safe and Provide a High Quality of Life for Children and Families" . Expected program outcomes include an increase in positive social and emotional development as measured by the Child and Adolescent Functional Assessment Scale (CAFAS) . BACKGROUND/REASON(S) FOR RECOMMENDATION(S) : This Contract meets the social needs of County's population in that it provides school and community based mental health services, including: assessments; individual, group and family therapy; medication support; case management; outreach; and crisis intervention services, to an underserved Asian population and will result in greater home, community, and school success. On September 21, 1999, the Board of Supervisors approved Novation Contract #24-927-2 with Asian Pacific Psychological Services for the period from July 1, 1999 through June 30, 2000 (which included a six-month automatic extension through December 31, 2000) to provide school and community based mental health services to Medi-Cal eligible Asian children and families enrolled in the EPSDT Program. Novation Contract #24-927-3 replaces the six-month automatic extension under the prior Contract and allows the Contractor to continue providing services through June 30, 2001. r ' CONTINUER ON RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE ,---APPROVE OTHER r ACTION OF BOARD iN 7U h e `T �CJG APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED_ UCZ lam ' 7 c520tl J PHIL BATCHELOR,CLERK OF THE BOARD OF Contact Parson: Donna Wigand, L.c.S.w. (313-6411) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health Services(Contract) Auditor-Controller Risk Management BY . / DEPUTY Contractor Contra TO: BOARD OF SUPERVISORS Costa FROM: John Cullen, Director., '� County Employment and Humani s Department DATE: June 7,2000 SUBJECT: APPROVE and AUTHORIZE the Employment and Human Services Director, or designee, to contract for services to the Independent Living Skills Program (ILSP) for the period July 1, 2000 through June 30, 2001 as listed below. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)S BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: APPROVE and AUTHORIZE the Employment and Human Services Director, or designee, to contract for services to the Independent Living Skills Program (ILSP) for the period July 1, 2000 through June 30, 2001 as follows: Contract Number Contractor Service Amount of Contract #21-470-3 Don Graves ILSP Coordinator $63,800 # 21-471-3 Alfred Arroyos ILSP Job Developer $50,000 #21-480-4 Gillian A. Clark ILSP Cross-cultural Outreach $48,000 Specialist #21-574-1 Mark G. Cruise ILSP After Care Outreach $46,000 Specialist #21-483-4 Linda Adams ILSP Education Specialist $44,000 #21-575-1 Michael D. Schlemer ILSP After Care Outreach $44,000 Specialist #21-573-1 Patricia Jeanne Ensley ILSP After Care Job Developer $44,000 #21-512-2 Ardella Arrington ILSP Administrative Assistant $42,000 FINANCIAL IMPACT: No County funds. These contracts are funded 100% with Federal Independent Living Skills Program funds. / (Continued) CONTINUED ON ATTACHMENT: LYES SIGNATURE: COMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE PPPPPROVE OTHER SIGNATURE(S): a6z:II2 ACTION OF BOA N : CQ_h dC9C7- APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT_ ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED TC-1--h f 2 C6 0 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact: 11�1A cc: EHSD(CONTRACTS UNIT) COUNTY ADMINISTRATOR BY aC4� ,DEPUTY AUDITOR-CONTROLLER CONTRACTOR CHILDREN'S IMPACT" STATEMENT The Independent Living Skills Program supports three of Contra Costa County's outcome goals: "Children Ready for and Succeeding MOSchool," "Children and Youth Healthy and Preparing for Productive Adulthood," arrd "Families that are Economically Self Sufficient." By preparing foster children for emancipation, foster children gain skills that lead to self sufficiency and improve opportunity for success in future endeavors. BACKGROUND: Through the use of contracted services, the Independent Living Skills Program provides service to foster children age 16 years and over, aiding them in transition to emancipation and adulthood. The Federal Grant requires that services are to include, but are not limited to: • development of the yearly program and coordination of contractors and service providers • employment assistance to difficult-to-employ ILSP youth • expansion of services and outreach to culturally specific groups • follow up and assistance to meet participants' educational and housing needs • follow up and assistance to youth emancipated from foster care. TO: BOARD OF SUPERVISORS � f FROM: William Walker, M.D. , Health Services Director f !�s" By: Ginger Marieiro, Contracts Administrator Contra COSUM DATE: June 7, 2000 County SUBJECT: Approval of Administrative Amendments to Provide Cost-of-Living Adjustments SPECIFIC REQUESTS)OR RECOMMENDATION(S)6 BACKGROUND AND JUSTIFICATION RECOMMENDATION(S) : 1. Approve and authorize the County Administrator, or his designee, to execute on behalf of the County, Administrative Amendments, as specified in the attached lists (Exhibits A, B, and C) , to increase the salary and administrative cost components by 5% for Fiscal Year 1999-2000, to make modifications in corresponding payment and budget provisions, and to incorporate State or County required changes in other provisions (if any) . 2 . Approve and authorize the Health Services Director to include Cost- of-Living Adjustments for those Contractors specified in the attached lists (Exhibits A, B, and C) for Fiscal Year 2000-2001 if the Contracts for those Contractors are renewed. Said Cost-of- Living Adjustment may be up to 3% of the salary and administrative costs of the Fiscal Year 1999-2000 Contract. FISCAL IMPACT: These Amendments provide a 5% cost-of-living increase to the salary and administrative cost components of the Contracts on the attached lists, and increase the FY 1999-2000 Contract Payment Limits based on the attached calculations. Furthermore, these increases are also reflected in the Payment Limits for the corresponding automatic six-month contract extensions in those contracts which contain this provision. This Board Order neither requires nor authorizes renewal of existing Contracts; however, if the Contracts for these Contractors are renewed, the Fiscal Year 2000-2001 Contracts may include a Cost-of-Living Adjustment. BACRGROUNDLREA80N(8) FOR RECOMMENDATIONtS) : These Administrative Amendments carry out the directives of the Board of Supervisors regarding cost-of-living increases for certain contract programs which are providing a vital and important part of the County's continuum of care and services for residents of Contra Costa County. The cost-of-living increase for each contract is based on the relative size of personnel and administrative costs of each contract payment limit (excluding any one-time- only amounts) . CONrINUEQONATTAQHMENT: VIYES SIQNATUR�Z-. RECCOMMENDATION OF COUNTY ADMINISTRATOR RECOM NDATION OF BOARD COMMITTEE __ Al!PROVE _ OTHER ACTION OF BOARD rn 660 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT, Z } AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED.Z Lt F1 e-- �2 r PHIL BATCHELOR,CLERK OF THE BOARD OF Contact Person: William Walker, M.D. (370-5010) SUPERVISORS AND COUNTY ADMINISTRATOR CC: Health Services(Contract) Auditor-Controller Risk Management BY ! 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