HomeMy WebLinkAbout000 Agreement A-22-204.pdf Agreement No. 22-204
Agreement No. 1109-PICR-2022-FC
Program Name:Psychiatric Inpatient Concurrent Review
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
PARTICIPATION AGREEMENT
COVER SHEET
1. Fresno County("Participant") desires to participate in the Program identified below.
Name of Program:Psychiatric Inpatient Concurrent Review
2. California Mental Health Services Authority ("CalMHSA") and Participant acknowledge that the
Program will be governed by CaIMHSA's Joint Powers Agreement and its Bylaws, and by this
Participation Agreement. The following exhibits are intended to clarify how the provisions of
those documents will be applied to this particular Program.
Q Exhibit A Program Description
Exhibit B General Terms and Conditions
0 Exhibit C County Specific Funding
3. The first installment of $76,518.40 is due by Participant within 30 days of execution of this
Agreement.
4. Funds payable under this agreement are subject to reversion:
Dyes:Reversion Date
®No.
5. The term of the Program is upon execution,through December 31,2024
6. Authorized Signatures:
CaIMHSA
Sign d: Name(Printed): Dr.Arnie Miller, Psy.D.,MFT
Title:Executive Director Date:
Participant: Fresno
��County
Signed: r' Name(Printed): Brian Pacheco
Title:Chairman of the Board of Supervisors of the County of Fresno Date: �--
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By Deputy
Fresno County—Exhibit A—General Tenns and Conditions
Page 1 of 7
Participation Agreement
EXHIBITA—PROGRAM DESCRIPTION
I. Name of Program: Psychiatric Inpatient Concurrent Review
II. Term of Program:This contract is effective upon execution through December 31, 2024,with
the option for early termination or extension as provided below.
III. Program Objective and Overview:
Objective:
The Program is the Psychiatric Inpatient Concurrent Review project being administered by
CaIMHSA on behalf of Participants with the primary purpose of conducting concurrent review
and authorization for all psychiatric inpatient hospital and psychiatric health facility services
on behalf of participating California County Mental Health Plans ("MHPs").
By utilizing a technology-assisted concurrent review process the contractor will ensure a
consistent and efficient review process across participating counties and will support MHP
compliance with California Department of Health Care Services (DHCS) Behavioral Health
Information Notice (BHIN) 19-026 (or any BHIN released by DHCS that supersedes BHIN 19-
026), and the Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity
Rule;Tittle 42 of the CFR, part 438.910).
Overview:
Per the DHCS Behavioral Health Information Notice (BHIN) 19-026, MHPs are required to
conduct concurrent review and authorization for all psychiatric inpatient hospital services and
psychiatric health facility services. This BHIN also outlines policy changes implemented to
ensure an MHP's compliance with the Parity in Mental Health and Substance Use Disorder
Services Final Rule (Parity Rule;Title 42 of the CFR, part 438.910).
Given these policy changes, CaIMHSA has entered into a services contract (hereinafter
referred to as the "Services Agreement") with Keystone Peer Review Organization, Inc.
("Contractor"), also known as Kepro, who shall conduct concurrent review and authorization
of inpatient psychiatric hospital services on behalf of multiple California County MHPs.
Contractor has agreed to provide a web-enabled utilization review platform and clinical
services to carry out psychiatric inpatient concurrent review and authorization services and
to provide other related services, as further described in the Services Agreement.
MHPs delegating concurrent review and authorization services to Contractorwill range in size
from small/rural to large counties and will be located throughout California. Although the
review and authorization requirements are uniform, the communication needs of the
participating counties or inpatient psychiatric hospitals where county beneficiaries are
hospitalized may vary.
Fresno County—Exhibit A— General Terms and Conditions
Page 2 of 7
Participation Agreement
EXHIBIT B—General Terms and Conditions
I. Definitions
The following words, as used throughout this Participation Agreement,shall be construed to have
the following meaning, unless otherwise apparent from the context in which they are used:
A. CaIMHSA — California Mental Health Services Authority, a Joint Powers Authority (JPA)
created by counties in 2009 at the instigation of the California Mental Health Directors
Association to jointly develop and fund mental health services and education programs.
B. Department of Health Care Services (DHCS)—A department within the California Health
and Human Services Agency that finances and administers a number of individual health
care service programs, including Medi-Cal.
C. Member — A County (or JPA of two or more Counties) that has joined CaIMHSA and
executed the CaIMHSA Joint Powers Agreement.
D. Mental Health Services Act (MHSA) — A law initially known as Proposition 63 in the
November 2004 election that added sections to the Welfare and Institutions Code
providing for, among other things, PEI Programs.
E. Mental Health Services Division (MHSD) —The Division of the California Department of
Health Care Services responsible for mental health functions.
F. Participant—Any County participating in the Program either as a Member of CaIMHSA or
under a Memorandum of Understanding with CaIMHSA.
G. Program—The program identified in the Cover Sheet.
II. Responsibilities
A. Responsibilities of CaIMHSA:
1. Act as the Fiscal and Administrative agent for the Program.
2. Invoice and collect funds from Participant for the Program.
3. Provide quarterly utilization reports to Participant.
4. Manage funds received through the Program, consistent with the requirements
of any applicable laws, regulations,guidelines and/or contractual obligations.
5. Work closely with the Contractor to coordinate on implementation and
onboarding of participating MHPs.
6. Monitor and administer the Services Agreement on behalf of Participants.
7. Provide regular fiscal reports to Participant and/or other public agencies with a
right to such reports.
8. Comply with CaIMHSA's Joint Powers Agreement and Bylaws.
B. Responsibilities of Participant:
Fresno County—Exhibit A— General Terms and Conditions
Page 3 of 7
1. Timely transfer of the funding amount for the Program as specified in section V
Fiscal Provisions, including administrative fee.
2. Provide CalMHSA and any other parties deemed necessary with requested
information and assistance in order to fulfill the purpose of the Program.
3. Provide feedback on Program performance, which shall include completing a
MHP Survey(6) months post implementation and Annual MHP Survey thereafter.
4. Acknowledge that funds contributed by Participant shall be pursuant to the
allocation formula adopted set forth in Exhibit C.
5. Comply with applicable laws, regulations, guidelines, contractual agreements,
JPAs, and bylaws.
III. Duration,Term, and Amendment
A. The term of the Program is effective upon execution through December 31, 2024.
B. This Participation Agreement may be supplemented, amended, or modified only by the
mutual agreement of CalMHSA and the Participant, expressed in writing and signed by
authorized representatives of both parties.
IV. Withdrawal, Cancellation, and Termination
A. Participant may withdraw from the Program and terminate the Participation Agreement
upon six (6) months'written notice in accordance with section VII.
B. The withdrawal of a Participant from the Program shall not automatically terminate its
responsibility for its share of the expense and liabilities of the Program. The
contributions of current and past Participants are chargeable for their respective share
of unavoidable expenses and liabilities arising during the period of their participation.
C. Upon cancellation,termination,or other conclusion of the Program,any funds remaining
undisbursed after CalM HSA satisfies all obligations arising from the administration of the
Program shall be returned to Participant. Unused funds paid for a joint effort will be
returned pro rata to Participant in proportion to payments made. Adjustments may be
made if disproportionate benefit was conveyed on particular Participant. Excess funds
at the conclusion of county-specific efforts will be returned to the particular County that
paid them.
V. Fiscal Provisions
A. Funding amount shall not exceed the amount stated in Exhibit C—Table B.
B. Payment Terms
a. Participant's Estimated Annual Cost in the amount of $306,073.60, shall be paid in
advance to CalMHSA in four(4) quarterly installments. Each installment shall be paid
within 30 days upon receiving CalMHSA's invoice. This amount is inclusive of a 12%
adminstrative fee equal to$32,793.60.
b. Each installment is subject to variance based on Participant's Actual Hospitalization
Cost invoiced and verified by Contractor to CalMHSA. The maximum amount due
from Participant shall not exceed the amount stated in Exhibit C-Table B.
Fresno County—Exhibit A— General Terms and Conditions
Page 4 of 7
c. The First Installment in the amount of$76,518.40 is due by Participant to CaIMHSA
within 30 days of execution of this Participation Agreement.
C. In a Multi-County Program, Participants will share the costs of planning, administration,
and evaluation in the same proportions as their overall contributions.
VI. Limitation of Liability and Indemnification
A. CaIMHSA is responsible for using all funds it receives, in accordance with this Participation
Agreement. CaIMHSA is not liable to Participant under this Participation Agreement for
damages beyond the total amount of Participant's funds received by CalMHSA during the
term of this agreement.
B. CaIMHSA is not undertaking responsibility for assessments, creation of case or treatment
plans, providing or arranging services, and/or selecting, contracting with, or supervising
providers (collectively, "mental health services"). Participant will defend and indemnify
CaIMHSA for any claim,demand,disallowance,suit,or damages arising from Participant's
acts or omissions in connection with the provision of mental health services.
VII. Notice
All notices underthis Participation Agreement shall be provided 1) by personal delivery, nationally
recognized courier service or mailed by U.S. registered or certified mail, return receipt requested,
postage prepaid; AND 2) by email. All notices shall be provided to the respective party at the
addresses and email addresses set forth below and shall be deemed received upon the relevant
party's receipt.
Either party may change its designee for notice by giving notice of the same and their relevant
address information.
If to CaIMHSA:
Name: Laura Li Position: Chief Administrative nfficer
Address: 1601 Arden Way, Suite 175,Sacramento, CA 95815
Email: laura.li@calmhsa.org Telephone: (279) 234-0700
CC Email to Name: Randall Keen, Manatt Email: RKeen(@manatt.com
If to Participant:
Name: Siican I Holt Position: Director
Address: 1925 E Dakota Ave. Fresno CA, 93726
Email: sholt(cDfresnocountyca.gov Telephone- W)-600-90SR
CC Email to Name: Email:
Fresno County—Exhibit A— General Terms and Conditions
Page 5 of 7
Participation Agreement
EXHIBIT C—County Specific Funding
I. Funding Allocation
Table A. County's Estimated Annual Hospitalization Cost
CaIMHSA
Installment Hospitalization Cost Administrative Fee Total Cost
12%
First Installment $68,320.00 $8,198.40 $ 76,518.40
Second Installment $68,320.00 $8,198.40 $ 76,518.40
Third Installment $68,320.00 $8,198.40 $ 76,518.40
Fourth Installment $68,320.00 $8,198.40 $ 76,518.40
Estimated Annual Cost $273,280.00 $32,793.60 $306,073.60
Note.The Total Cost above is subject to variance based on Actual Hospitalization Cost incurred by
Participant.
Table B. County's Annual Program Budget
Hospitalization Cost Breakdown Amount
Hospitalization Cost Per Unit $89.60
County's Average Hospitalization Per Year 3,416
*Estimated Annual Cost $306,073.60
**Overage Allowance (20% of estimated annual cost) $61,214.72
Maximum Funding Amount Due from Participant Per Year $367,288.32
*Annual Cost are an estimate based on the average hospitalization of year 2018-2019 and
2020-2021. Year 2019-2020 has been excluded due to the impact of Covid.
**These funds will be used in the event actual usage exceeds the average hospitalization per year currently
estimated at 3,416.
***Any unspent funds shall be rolled over to the next following fiscal year.
Fresno County—Exhibit A— General Terms and Conditions
Page 6 of 7
PARTICIPATION AGREEMENT BETWEEN THE COUNTY OF FRESNO
AND
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
Agreement No: 1109-PICR-2022-FC Term: Upon execution through December 31, 2024
FOR FRESNO COUNTY ACCOUNTING USE ONLY:
Fund/Subclass: 0001/10000
Organization: 5630/2666 ($918,223)
Account/Program 7295/0
Fresno County—Exhibit A— General Terms and Conditions
Page 7 of 7