HomeMy WebLinkAboutAgreement A-22-450 Amendment IV to Master Agreement No. 18-250.pdf Agreement No. 22-450
1 AMENDMENT IV TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as Amendment IV, is made and entered into
3 this 11t" day of October , 2022 by and between the COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereinafter referred to as "COUNTY", and each CONTRACTOR
5 listed in Exhibit A "List of Contractors" attached hereto and incorporated herein by reference, and
6 collectively hereinafter referred to as "CONTRACTOR(S)", and such additional CONTRACTOR(S) as
7 may, from time to time during the term of this Agreement, be added or deleted by COUNTY. Reference
8 in this Agreement to party or"parties" shall be understood to refer to COUNTY and each individual
9 CONTRACTOR(S), unless otherwise specified.
10 WITNESSETH
11 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY
12 Agreement No. A-18-250, effective May 8, 2018, COUNTY Amendment No. A-18-250-1, effective
13 September 1, 2018, County Amendment No. A-18-250-2, effective September 1, 2018, and County
14 Amendment No. A-18-250-3, effective February 1, 2021 hereinafter collectively referred to as County
15 Agreement No. A-18-250, whereby, CONTRACTORS agreed to provide inpatient psychiatric hospital
16 services to Fresno County Persons Served eligible for such services under the Medi-Cal program,
17 pursuant to Sections 14700 et seq. and 14712 et seq. of the California Welfare and Institutions Code
18 and COUNTY may also determine the need to refer persons not eligible for Medi-Cal; and
19 WHEREAS, the parties desire to amend the Agreement regarding changes as stated below and
20 restate the Agreement in its entirety.
21 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which is
22 hereby acknowledged, the parties agree as follows:
23 1. That Section Fourteen (14) "Payment Provisions", Subsection I of the existing COUNTY
24 Agreement No. A-18-250, beginning on Page Fourteen (14), Line Fourteen (14) with the word
25 "Psychiatrist" and ending on Page Fourteen (14), Line Sixteen (16) with the word "Rate." be replaced in
26 its entirety as follows:
27 "Psychiatrist Services: Psychiatrist/professional services (Professional Services), as negotiated
28 by COUNTY and CONTRACTOR(S) shall be identified in CONTRACTOR(S)'S respective Exhibit D, et
-1 - COUNTY OF FRESNO
Fresno,CA
1 seq. shall not be included in the Inpatient Day Rate. All Psychiatrist Service claims shall include the
2 total number of minutes used to provide each service. All Psychiatrist Services provided must be billed
3 using minutes as units (e.g. 1 minute = 1 unit, 2 minutes = 2 units, etc.). All Psychiatrist Service claims
4 shall be billed and paid per-minute. The duration of service must be included on the claim form, as well
5 as documented within each corresponding progress note. Psychiatrist Service claims without a
6 corresponding progress note, or without the duration of service documented within the corresponding
7 progress note, will not be processed for payment.
8 1) Condition for Payment— COUNTY will reimburse CONTRACTOR(S) for Psychiatrist
9 Services rendered to clients only when all of the following conditions are met:
10 (a) The client is eligible for Medi-Cal Program or UMDAP benefits at the time the
11 Psychiatrist Service is rendered by CONTRACTOR(S);
12 (b) The service is billable under the Medi-Cal Billing Manual;
13 (c) Progress notes meet Medi-Cal documentation standards;
14 (d) Claims for payment are submitted within sixty (60) days after the month in which
15 services were rendered; and
16 (e) CONTRACTOR(S) staff has submitted a credentialing application and supporting
17 documentation for review and has been approved by the COUNTY's Mental Health Plan prior to the
18 delivery of the Psychiatrist Service.
19 2) Claims— CONTRACTOR(S) shall obtain and complete claim forms as adopted by the
20 COUNTY, as may be amended from time to time for use in the Mental Health Plan, for Psychiatrist
21 Services rendered to clients, and shall submit completed claims to COUNTY within sixty (60) days after
22 the month in which services were rendered.
23 Payment by COUNTY for CONTRACTOR(S) services shall be in arrears within forty-five
24 (45) days after receipt and verification of CONTRACTOR(S) claims by the COUNTY.CONTRACTOR(S)
25 certifies that with each claim submitted that the Psychiatrist Services were provided solely by a licensed
26 physician with hospital admitting privileges credentialed by the Mental Health Plan. CONTRACTOR(S)
27 further certifies with each claim submitted, that no active employee of COUNTY has provided any
28 service to any clients on said claim, (Government Code § 1090 and Fresno County Charter § 41).
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Fresno,CA
1 Should CONTRACTOR(S) fail to comply with any provision of this Agreement, COUNTY shall be
2 relieved of any obligation to compensate for services provided. It is understood by all parties that all
3 expenses incidental to CONTRACTOR(S) performance of services under this Agreement shall be
4 borne by CONTRACTOR(S).
5 It is understood that each claim is subject to audit for compliance with Federal and State
6 regulations, and that COUNTY may be making payments on billings in advance of said review. In the
7 event that a claim is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off
8 from other payments due in the amount of said disapproved billings. This remedy is not exclusive and
9 COUNTY may seek requital from any other means, including but not limited to, a separate contract or
10 agreement with CONTRACTOR(S).
11 3) Claim Submission — CONTRACTOR(S) shall submit claims for Psychiatrist Services at
12 least monthly to: County of Fresno, Department of Behavioral Health, Managed Care, P.O. Box 45003,
13 Fresno, CA 93718-9886, Attention: Provider Relations Specialist. Claims for Psychiatrist Services shall
14 be submitted on the CMS 1500 insurance form on a calendar month basis for all Psychiatrist Services
15 provided to clients, within sixty (60) days after the month in which services were rendered. Each claim
16 shall be for one client only and shall include the name of individual client, type of service, time and date
17 of service, COUNTY billing code, and duration of service in minutes. COUNTY shall have the right to
18 deny payment for invoices not submitted within sixty (60) days after the month in which services were
19 rendered, with the exception of claims submitted by CONTRACTOR(S) which received a prior
20 authorization from COUNTY. Any other claiming mechanism must be approved by COUNTY's
21 Department of Behavioral Health (DBH). COUNTY shall not make payment for services rendered to
22 clients which are, in the opinion of COUNTY, determined to be not medically necessary or which have
23 not been authorized for reimbursement by COUNTY.
24 CONTRACTOR(S) shall submit paper claims to COUNTY as identified in this Section
25 14, unless otherwise approved by COUNTY's DBH. CONTRACTOR(S) must provide all necessary data
26 to allow the COUNTY to bill Medi-Cal and any other third-party source, for services and meet State and
27 Federal reporting requirements. The data for billing must be reconciled by CONTRACTOR(S) to the
28 monthly claims submitted for payment.
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Fresno,CA
1 CONTRACTOR is not obligated to claim for Psychiatrist Services as described above
2 unless CONTRACTOR seeks reimbursement for Psychiatrist Services through this agreement.
3 2. ELECTRONIC SIGNATURE: The parties agree that this Agreement may be executed by
4 electronic signature as provided in this section. An "electronic signature" means any symbol or process
5 intended by an individual signing this Agreement to represent their signature, including but not limited to
6 (1) a digital signature; (2) a faxed version of an original handwritten signature; or (3) an electronically
7 scanned and transmitted (for example by PDF document) of a handwritten signature. Each electronic
8 signature affixed or attached to this Agreement (1) is deemed equivalent to a valid original handwritten
9 signature of the person signing this Agreement for all purposes, including but not limited to evidentiary
10 proof in any administrative or judicial proceeding, and (2) has the same force and effect as the valid
11 original handwritten signature of that person. The provisions of this section satisfy the requirements of
12 Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code,
13 Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital signature
14 represents that it has undertaken and satisfied the requirements of Government Code section 16.5,
15 subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely upon that
16 representation. This Agreement is not conditioned upon the parties conducting the transactions under it
17 by electronic means and either party may sign this Agreement with an original handwritten signature.
18 3. That in existing COUNTY agreement No. 18-250 all references to Exhibit A shall be
19 replaced with Revised Exhibit A, which is attached hereto and incorporated herein by this reference.
20 4. The parties agree that this Amendment IV is sufficient to amend the Agreement; and that
21 upon execution of this Amendment IV, the Agreement, Amendment I, Amendment II, Amendment III
22 and Amendment IV together shall be considered the Agreement.
23 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
24 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
25 in full force and in effect. This Amendment IV shall be effective July 1, 2022.
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-4- COUNTY OF FRESNO
Fresno,CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment IV to Agreement No.
2 A-18-250 as of the day and year first hereinabove written.
3
4 CONTRACTOR(S): COUNTY OF FRESNO
5 PLEASE SEE SIGNATURE
PAGES ATTACHED LOL
6
7 Brian Pacheco, Chairman of the Board of
Supervisors of the County of Fresno
8
9
ATTEST:
10 Bernice E. Seidel
11 Clerk of the Board of Supervisors
County of Fresno, State of California
12
13 By:
Deputy
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18 FOR ACCOUNTING USE ONLY:
19 Fund/Subclass: 0001/10000
20 Organization: 56302666
Account/Program: 7223/0
21
22 $47,000,000 Term Maximum
23 $ 500,000 FY 2017-18 (Prorated)
$5,000,000 FY 2018-19
24 $5,500,000 FY 2019-20
$12,000,000 FY 2020-21
25 $12,000,000 FY 2021-22
$12,000,000 FY 2022-23
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5 COUNTY OF FRESNO
Fresno,CA
1 CONTRACTOR: AURORA VISTA DEL MAR, LLC
2
By
3
4 Print Name: �S�a✓�`�p6i
5
g Title:
Chairman of the Board, President, or Vice President
7
8 �
Date: �y
9
10 a�
11 By
12 /1
Print Name: /'rk5�i.�/ /��l.l►�-eta
13
14 Title: C ��
15 Secretary(of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
16 J
17 Date: 7
18
19 MAILING ADDRESS:
20 801 Seneca St.
21 Ventura, Ca 93001
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6 COUNTY OF FRESNO
Fresno,CA
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-7- COUNTY OFFRESNO
Fresno,CA
DocuSign Envelope ID:A10BBBEO-OC2A-42DD-BE80-B352E7FEB2C8
1 CONTRACTOR: SAN JOSE BEHAVIORAL HEALTH HOSPITAL
rDocuSigned by:
2 IA.U.t, C1 t,bl,lil,U'1dlLl,
By
3
DocuSigned by:
4 Print Name: �lAant, aUnandwAJA,
SM40bA4'214 _.
5
6 Title: Group President
Chairman of the Board, President, or Vice President
7
8 Date: 8/23/2022
9
10
11 By -
12
Print Name: RAMek C U X
13
14 Title: L1 In'i e-L r wW.-I eAAt Qy7'cter
15 Secretary (of Corporation), A istant Secretary,
Chief Financial Officer, or Assistant Treasurer
16 G
17 Date: d /17
18
19 MAILING ADDRESS:
20
455 Silicon Valley Blvd.
21 San Jose, CA 95138
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-8- COUNTY OFFRESNO
Fresno,CA
MASTER AGREEMENT Revised Exhibit A
INPATIENT PSYCHIATRIC MENTAL HEALTH SERVICES
LIST OF CONTRACTORS
SERVES SERVES MEDI- CA MILES
PROVIDER ADULTS YOUTH AEDP* CAL REGION (1-WAY) CITY ZIP INTAKE PHONE INTAKE FAX NOTES
Aurora Vista Del Mar
Yes Yes No Yes Soutern 213.5 Ventura 93001 (805)519-1824 (805) 653-0612
San Jose Behavioral
Health Yes Yes No Yes Bay Area 139.3 San Jose 95138 (669) 234-5950 (669) 234-5936
AEDP* =Adolescent Eating Disorders Program Effective July 1, 2022