HomeMy WebLinkAboutAgreement A-22-202.pdf Agreement No. 22-202
STATE OF CALIFORNIA— DEPARTMENT OF STATE HOSPITALS GAVIN NEWSOM, GOVERNOR
ADMINISTRATIVE SERVICES DIVISION F1
1215 O Street, Suite 670 DSH
Sacramento, CA 95814
Purchase of State Hospital Beds
Memorandum of Understanding
California Department of State Hospitals
and
The California Mental Health Services Authority (CaIMHSA) and
Participating Counties
I. RECITALS
A. The parties to this Memorandum of Understanding ("MOU") are the California
Department of State Hospitals ("DSH"), the California Mental Health Services
Authority ("CaIMHSA") as administrative agent for participating Counties, and each
participating County which has executed this MOU ("County") as indicated in
Exhibit 1. "MOU" shall be deemed to include Exhibits 1-4, attached hereto.
B. The DSH has jurisdiction over all DSH facilities, as defined in Welfare and
Institutions Code, section 4100, including non-DSH treatment facilities contracted
with DSH pursuant to Welfare and Institutions Code, section 4361 (hereafter
collectively "Hospitals"), excluding community-based restoration of competency
services that are operated by the County. All DSH facilities that admit LPS patients
shall comply with the responsibilities noted for DSH in this MOU. A description of
services provided by the DSH shall be included in Exhibit 2.
C. Welfare and Institutions Code section 4330 requires counties to reimburse DSH
for the use of DSH Hospital beds and services, provided pursuant to the
Lanterman-Petris-Short Act ("LPS", Welfare and Institutions Code section 5000 et.
seq.) and in accordance with annual MOUs between DSH and each County acting
singly or in combination with other counties, pursuant to Welfare and Institutions
Code section 4331.
D. CaIMHSA is a joint powers authority pursuant to Government Code section 6500
(Joint Exercise of Powers Act) of counties and cities with mental health programs.
CaIMHSA was requested by its members to negotiate a joint agreement with DSH
and serve as liaison agency for matters of compliance with terms and conditions.
E. The parties are independent agents. Nothing herein contained shall be construed
as creating the relationship of employer and employee, or principal and agent,
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between the parties or any of their agents or employees. Notwithstanding the
independence of the parties, all Patient services should be integrated and
coordinated across levels of care for continuity of care.
II. TERMS AND CONDITIONS
A. The term of this MOU is July 1, 2021 through June 30, 2022 ("FY 2021-22").
B. County Referred Patient ("Patient")
1. The County Mental Health Director, the County Behavioral Health Director, or
their designee (collectively, "County Director") shall screen, determine the
appropriateness of, and authorize all referrals for admission of Patients to the
Hospital. The County Director shall, at the time of admission, provide admission
authorization and identify the preferred Hospital and bed type to which a Patient
is being referred, and identify the estimated length of stay for each Patient.
However, the Hospital's Medical Director or designee shall make the
determination of the appropriateness of a Patient for admission to the preferred
Hospital and assign the Patient to the appropriate level of care and treatment
unit.
2. If the Hospital Medical Director's, or their designee's, assessment determines
the Patient shall not be admitted to the preferred Hospital, the preferred
Hospital will notify the County Director and the DSH — Sacramento Patient
Management Unit (PMU) for review and consideration of placement within an
alternative appropriate DSH Hospital.
3. The County Director shall name a point-of-contact and provide assistance to
the Hospital treatment staff in the screening of Patients to initiate, develop and
finalize discharge planning and necessary follow-up services for the Patients.
The County and DSH mutually agree that the goal is to transition Patients into
their least restrictive setting, as clinically appropriate, and in alignment with
Welfare and Institutions Code 5358. Either party may initiate this process by
contacting the other party and engaging in collaborative discharge planning
with the other party to ensure the patient's treatment needs are met.
C. Description of Provided Hospital Services
1. The DSH defines bed types and uses in accordance with the following
California Department of Public Health hospital licensing definitions. These
definitions shall apply to the MOU:
2. Acute Psychiatric Hospital (APH) Acute psychiatric hospital means a
hospital having a duly constituted governing body with overall administrative
and professional responsibility and an organized medical staff which provides
24-hour inpatient care for mentally disordered, incompetent or other Patients
referred to in Division 5 (commencing with section 5000) or Division 6
(commencing with section 6000) of the Welfare and Institutions Code, including
the following basic services: medical, nursing, rehabilitative, pharmacy and
dietary services. An acute psychiatric hospital shall not include separate
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buildings which are used exclusively to house personnel or provide activities
not related to hospital patients.
3. Intermediate Care Facility (ICF) Intermediate care facility is a health facility, or
a distinct part of a hospital or skilled nursing facility which provides inpatient
care to patients who have need for skilled nursing supervision and need
supportive care, but do not require continuous nursing care.
4. Skilled Nursing Facility (SNF) Skilled nursing facility is a health facility or a
distinct part of a hospital which provides continuous skilled nursing care and
supportive care to patients whose primary need is for availability of skilled
nursing care on an extended basis. A skilled nursing facility provides 24-hour
inpatient care and, as a minimum, includes physician, skilled nursing, dietary,
pharmaceutical services and an activity program.
5. Provided the LPS Patient is admitted to a facility under the jurisdiction of DSH,
DSH shall provide inpatient psychiatric health care and treatment, including
outside medical health care and treatment, ancillary care and treatment, and/or
support services, to those persons admitted to DSH by the County for LPS
services, and Welfare and Institutions Code Section 5008, subdivision (h)(1)(B)
(Murphy Conservatorships). A summary of services provided to LPS Patients
and the definition of care is detailed in Exhibit 2.
6. The DSH and the County shall provide or cause to be provided, expert witness
testimony by appropriate mental health professionals in legal proceedings
required for the commitment, admission, or treatment of the Patients.
7. The County is responsible for transportation to and from the Hospitals in the
following circumstances: court appearances, County-initiated medical
appointments or services, and pre-placement visits and discharge to final
placements. The County is also responsible for transportation between
Hospitals when the County initiates the transfer. The DSH is responsible for all
DSH-initiated transportation between the Hospitals and transportation to and
from local medical appointments or services. The reimbursement rates in
Exhibit 3, entitled "Statement of Annual Bed Rates and County Estimated Bed
Need," include reimbursement for transportation that is the responsibility of
DSH.
8. Hospitals shall be culturally-competent (including sign-language) in staff and
resources to meet the needs of Patients treated pursuant to this MOU.
9. Multi-disciplinary treatment team composition will be provided as set forth in
Exhibit 2.
D. Admission and Discharge Procedures
1. Hospital admissions, intra-hospital transfers, inter-hospital transfers, referrals
to outside medical care, and discharges shall be in accordance with the
admission and discharge criteria established by court order, statute, or DSH. A
complete admission package must be submitted by the County with the referral,
including all assessments available, as referenced in Section F of the MOU.
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2. Denial of admission may be based on a Patient's failure to meet admission
criteria, insufficient pre-admission information supplied pursuant to Section F
of this MOU, the Hospital's lack of bed capacity, or based on Patient-specific
treatment needs such as if a patient's primary treatment needs are medical. All
denials of admission shall be in writing with an explanation for the denial. A
denial of admission may be appealed as provided in the next paragraph.
3. Appeal Process for Admissions. When agreement cannot be reached between
the County staff and the Hospital admitting staff regarding the admission of a
Patient, the following appeal process shall be followed; the case may be
referred to the Hospital Medical Director and the County Director within five (5)
business days. Such appeals may be made by telephone, and shall be followed
up in writing; email being an acceptable option. If the Hospital Medical Director
and the County Director are unable to achieve agreement, the case may be
referred to the Hospital Executive Director within five (5) business days. If the
Hospital Executive Director and the County Director are unable to achieve
agreement, the case may be referred to the DSH Deputy Directors of Clinical
Operations and Hospital Strategic Planning and Implementation within five (5)
business days. The DSH Deputy Directors of Clinical Operations and Strategic
Planning and Implementation shall discuss the case with the Hospital Medical
Director, or designee, and Executive Director and shall obtain additional
consultation from the County Director. The DSH shall render a final decision
within five (5) business days after receiving the documented basis on which the
appeal is based.
4. Discharge planning by the County Director, conservator and/or Public
Guardian, and Hospital shall begin at admission, as individuals should be
placed and receive services in the least restrictive setting appropriate for
treatment. However, the estimated length of stay shall not be used as a basis
for discharge, unless mutually agreed upon by both DSH and the County
Director, conservator and/or Public Guardian upon admission. The Hospital
shall discharge a Patient at the County's request, and only in accordance with
the approved discharge plan except: (1) if at the time the discharge is to occur,
the Hospital's Medical Director, or designee, determines that the Patient's
condition and the circumstances of the discharge would pose an imminent
danger to the safety of the Patient or others; or, (2) when a duly appointed
conservator refuses to approve the Patient's discharge or placement based on
a clinical assessment by a licensed medical doctor. A denial of discharge may
be appealed as provided the next paragraph.
5. The Parties agree to develop a process for elevating and discussing LPS
Patients for which DSH has provided notice to the County Director are clinically
eligible for discharge but have not discharged in a reasonable amount of time.
Process will be implemented for future fiscal years.
E. Bed Type Transfers
1. If, for any reason, a County Patient is in a bed that is inappropriate to that
Patient's needs, the attending clinician shall develop, in consultation with the
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Hospital's treatment team and the County (except when the urgency of the
Patient's situation precludes such consultation) a plan for transfer of the Patient
to an appropriate unit in accordance with the treatment plan. This plan shall be
developed and communicated to the County Director within forty-eight (48)
hours of any urgent transfer. The County may initiate a treatment team
discussion with the attending Hospital clinician at any time County feels that a
County Patient is in a bed that is inappropriate to the Patient's needs or does
not accurately reflect the level of care the Patient requires (APH, ICF, or SNF).
2. The Hospital shall provide the County Point-of-Contact notice of transfers
between bed types within two (2) business days of any such transfer.
3. Bed Types Appeals. When agreement cannot be reached between the County
staff and the Hospital staff regarding the type of bed the Patient needs, the
following appeal process shall be followed. When the County staff determines
that an impasse has been reached and further discussions would not be
productive, the bed type may be appealed, along with all available data and
analysis, to the Hospital Medical Director and the County Director, or designee,
within two (2) business days. If the County Director and Hospital Medical
Director are unable to achieve agreement, the case may be referred to the
Hospital Executive Director and the County Director within two (2) business
days. Such appeals may be made by telephone and shall be followed up in
writing. If the Hospital Executive Director and the County Director are unable
to achieve agreement, the case may be referred to the DSH Deputy Directors
of Clinical Operations and Strategic Planning and Implementation within two
(2) business days. The DSH Deputy Directors of Clinical Operations and
Strategic Planning and Implementation shall discuss the case with the Hospital
Medical Director and Executive Director and shall obtain additional consultation
from the County Director, or designee, The DSH shall render a final decision
within two (2) business days after receiving the documented basis on which the
appeal is based.
F. Pre-Admission Requirements
1. The County shall, prior to admission, provide the Hospital with the complete
medical records on file, the Short-Doyle Authorization Form, and all applicable
court commitment orders for each Patient. The County shall identify an initial
projected length of stay which the Hospital shall address in Patient's treatment
plan and discharge plan.
G. Coordination of Treatment/Case Management
1. It is the intent of the Parties to this MOU to be collaborative in all matters and
specifically in matters of Patient's care.
2. The County shall maintain a case management process and shall identify a
case manager or case management team for each Patient. The case manager
shall provide available assessment information on Patients admitted to the
Hospital.
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3. The Hospitals shall provide at least two weeks notification to the County
Director of treatment plan conferences or 90-day reviews. The Hospitals shall
identify a treatment team member to function as the primary contact for the
County case manager or the case management team.
4. The County Director may direct the Hospital to discharge the Patient to a facility
that the County determines to be more appropriate to the Patient's treatment
requirements. The Hospital shall provide to the County Director, within five (5)
business-days of request for copies of current medical records, copies of
current medical records needed to assist in this process. In such cases, the
Hospital shall discharge the Patient within two days of the date an alternative
placement option is identified and available except if the discharge is contrary
to the medical necessity of hospitalization or would pose an imminent danger
to the safety of the Patient or others, or as otherwise required by law.
5. When an agreement cannot be reached between the County and the DSH on
clinical assessment, treatment or the Patient's acuity, the DSH Hospital Medical
Director or designee and County Director or designee shall confer for a
resolution. If a resolution cannot be achieved, the issue will be elevated to the
DSH Deputy Directors of Clinical Operations and Hospital Strategic Planning
and Implementation. The DSH Deputy Directors of Clinical Operations and
Hospital Strategic Planning and Implementation will review the case and shall
make every effort to resolve the issue. If a resolution is not achieved, the
County may direct the Hospital to discharge the Patient. In such an event, the
DSH response will be handled in accordance with Section II, Admission and
Discharge Procedures (D).
H. Patient's Rights and Confidentiality
1. The parties to this MOU shall comply with The Health Insurance Portability and
Accountability Act (HIPAA) and all applicable state laws, regulations, and
policies relating to the Patient's rights and confidentiality.
I. Bed Usage and Availability
1. It is acknowledged by all parties to this MOU that prior MOUs, incorporated
herein by reference, including annual renewals, included an agreement to limit
referrals for civil commitment by all Counties, pursuant to the LPS Act, which
included Murphy Conservatorships, to a maximum total of 556 beds at any one
point in time. It is further acknowledged that exceeding this maximum total beds
limits DSH's ability to admit new LPS Patients to beds, and persons committed
to DSH pursuant to Penal Code sections 1026, 1370, and 2960 et. seq.
2. CalMHSA/DSH shall make best efforts to develop a bed management protocol
by July 1, 2022, for the purpose of aligning the number of beds allocated to
LPS patients to the current maximum threshold of 556. This management
protocol shall include, but not be limited to, DSH and Counties providing current
data on the patient population for each County, including data for those
counties which contract directly with DSH, and the number of Murphy
Conservatorship(s), CaIMHSA providing an allocation formula regarding how
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the 556 beds will be distributed among the various counties, DSH re-identifying
which LPS Patients are capable of discharge to a less restrictive levels of care,
and County and CaIMHSA's mutual identification of alternative placement
options for said qualifying LPS Patients, including a placement and/or final
discharge target date. This management and utilization protocol shall also
identify a plan to reduce the counties bed usage to 556 and describe how DSH
and the counties will ensure that counties do not exceed the 556 beds in the
future.
3. If DSH intends to change LPS bed rates, the following procedure shall apply:
a. No later than May 1, of each fiscal year, DSH shall provide CalMHSA,
or counties not represented by CalMHSA, with preliminary LPS bed rate
cost utilization notice applicable to types of LPS beds for the fiscal year
beginning fourteen (14) months from May 1 of that year.
b. After DSH's preliminary cost utilization notice, the County shall notify
DSH, through CalMHSA, if represented by CalMHSA, by July 1 of each
year, of its preliminary estimate of the number and type of LPS beds that
the County expects to use, during the fiscal year beginning twelve (12)
months from July 1 of that year, for bed planning purposes.
c. No later than November 1, of each fiscal year, DSH shall provide
CalMHSA, or counties not represented by CalMHSA, with a final LPS
bed rate cost utilization notice applicable to the number and types of
LPS beds sought for the fiscal year beginning eight (8) months from
November 1 of that year.
d. By January 1 , of each fiscal year, CalMHSA, or counties not represented
by CaIMHSA, shall provide DSH with final written notification of the
number and type(s) of LPS beds sought for the fiscal year beginning
July 1 of that year. For example, if CaIMHSA provides written notification
on the number and type(s) of LPS beds to DSH on December 1, 2021,
said notice will be for the fiscal year beginning July 1, 2022.
e. DSH shall provide a mechanism for memorializing a formal agreement
between CaIMHSA, or counties not represented by CaIMHSA, no later
than June 15, or fifteen (15) days before the start of the fiscal year, with
the new LPS bed rates and number of LPS beds contracted for, not to
exceed the County allocations and the total allocation of 556 beds.
f. Counties contracting directly with the DSH may submit the Statement of
Annual Bed Rates and County Bed Need directly to the DSH. However,
the County is only obligated to pay for beds it uses. The DSH will update
Exhibit 3 with the County's bed need estimate and submit it to the
County.
4. The County is required to execute Exhibit 1 of this MOU in order to obtain LPS
beds. A County shall complete Exhibit1 and provide a signed "Purchase
Agreement of State Hospital Beds" (Exhibit 4), within 120 days of submitting
any application for admission of a Patient from the County.
5. Patients under the care of the DSH, referred to outside medical facilities, will
remain the responsibility of the DSH unless the County initiates discharge.
Upon a County-initiated discharge, the Patient and all costs become the
responsibility of the County, during all offsite leave, Counties will continue to be
charged at the daily bed rate. For all offsite leave of greater than 30 days, the
DSH and the County may, at the request of either party, discuss appropriate
care options for Patients.
J. Bed Payment
1. The current bed rates, historical bed usage and current estimated bed usage
are reflected in Exhibit 3.
This MOU involves a minimum commitment of zero beds for any particular
County. The amount that the Controller is authorized to reimburse DSH from
the mental health account of the County's Health and Welfare Trust Fund,
pursuant to Welfare and Institutions Code section 17601, subdivision (b), is
based on the amounts provided to the Controller per the County Actual Use
statement reflecting actual bed usage by the County for the prior month.
2. Development of ICF, APH and SNF Rates for FY 2022-2023 — The parties to
this MOU acknowledge that on March 15, 2021, and as required by Welfare
and Institutions Code, section 4331, subdivision (b), and Section II (1)(3) of this
MOU, DSH disclosed its intent to begin negotiations with CaIMHSA and
Counties regarding a proposed increase to ICF, acute care APH and SNF bed
rates. The proposed new ICF, APH and SNF bed rates would have an effective
date of July 1, 2022. The parties are continuing to work collaboratively on the
corresponding methodology and data that would justify the proposed bed rate
increases. Prior to July 1, 2022, the current bed rates will remain in effect. DSH
represents that the current ICF and APH bed rate reflects a blended Acute and
ICF rate based on the prior year's established bed rates. DSH will review rates
on an annual basis, based on actual expenditures at Hospitals that serve LPS
patients.
3. The bed rates in this MOU represent the total amount due from the County for
services provided in Section 11, Terms and Conditions (C)(1-6, 8-9) by the DSH.
These rates may not represent the total claimable amount for services provided
to the Patient. Patient will be responsible for any costs exceeding the bed rates
described in this MOU.
K. Utilization Review — Hospital Operations
1. The Hospitals shall have ongoing utilization review activities which shall
address the appropriateness of Hospital admissions and discharges, clinical
treatment, length of stay and allocation of Hospital resources, to most
effectively and efficiently meet the Patient's care needs. Such utilization
reviews shall be at a minimum of one time per year and include the County's
participation. The DSH will provide written results of the utilization review, if
available.
2. The County shall take part in the utilization review activities.
L. Records
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1. Patient Records
a. Hospitals shall maintain adequate medical records on each Patient.
These medical records shall include legal status, diagnosis,
psychiatric evaluation, medical history, individual treatment plan,
records of Patient interviews, progress notes, recommended
continuing care plan, discharge summary, and records of services.
These records shall be provided by various professional and
paraprofessional personnel in sufficient detail to permit an evaluation
of services.
b. Subject to applicable federal and California privacy laws and
regulations, including DSH policies, the DSH will provide access to
Patient medical records to Counties and CalMHSA through the use of
a secure file sharing technology determined by the DSH. Access to
the information described in this section shall only be made available
to CalMHSA upon execution of a data sharing agreement. To facilitate
such access, the DSH will work with CaIMHSA and the Counties to
make sure that each County has an authorized person with sufficient
training and credentials (i.e., user name and password) that the
person will be able to access DSH Patient records on behalf of the
County.
c. Subject to applicable federal and California privacy laws and
regulations, including DSH policies, upon request by the County for
medical records of County's Patient, the DSH will ordinarily upload
and make available to the County through a secure file sharing
technology all current records of Patient within seven (7) business
days, provided, however, that if records of a Patient are unusually
voluminous the DSH may give notice that more than seven (7)
business days will be needed.
d. Subject to applicable federal and California privacy laws and
regulations, including DSH policies, upon request by the County for
physical access to medical records of County's Patient, the DSH will
make available all current records of Patient for inspection at the
facility where Patient resides, within a timeframe agreed upon by the
DSH Hospital representative and the County.
2. Financial Records
a. The DSH shall prepare and maintain accurate and complete financial
records of the Hospitals' operating expenses and revenue. Such
records shall reflect the actual cost of the type of service for which
payment is claimed, on an accrual basis. Additionally, such records
shall identify costs attributable to County LPS Patients, versus other
types of patients to whom the Hospitals provide services. Any
apportionment of, or distribution of costs, including indirect costs, to
or between programs or cost centers of the Hospitals shall be
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documented, and shall be made in accordance with generally
accepted accounting principles and applicable laws, regulations, and
state policies. The Patient eligibility determination, and any fee
charged to and collected from Patients, together with a record of all
billings rendered and revenues received from any source, on behalf
of Patients treated pursuant to this MOU, shall be reflected in the
Hospital's financial records.
3. Retention of Records
a. The Hospitals shall retain all financial and Patient records pursuant to
federal, State and DSH record retention requirements.
M. Inspections and Audits
1. Consistent with confidentiality provisions of Welfare and Institutions Code
section 5328, any authorized representative of the County shall have access
to the medical and financial records of the DSH for the purpose of conducting
any fiscal review or audit during the Hospital's record retention period. The
Hospital shall provide the County adequate space to conduct such review or
audit. The County may, at reasonable times, inspect or otherwise evaluate
services provided in the Hospitals; however, the County shall not disrupt the
regular operations of the Hospitals.
2. The County shall not duplicate reviews conducted by other agencies (e.g.,
State Department of Public Health, County Coroner's Office, and District
Attorney's Office), if the detailed review results, methods, and work papers of
any such review are made available to the County and the County determines
the review was sufficient for County purposes. Practitioner-specific peer review
information and information relating to staff discipline is confidential and shall
not be made available.
N. Notices
1. Except as otherwise provided herein, all communication concerning this MOU
shall be as follows:
Department of State Hospitals
a. Billing and general MOU provisions:
Christian Jones, Associate Governmental Program Analyst
trustoffice(c�dsh.ca.gov
(916) 651-8727
b. Patient Placement and Appeals coordination:
Lydia Smith, Chief— Patient Management Unit
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Lydia.smith(a-dsh.ca.gov
(916) 562-2537
CaIMHSA
Michael Helmick, Senior Program Manager
michael.helm ick(cDcalmhsa.org
(279) 234-0712
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The County has designated the following as its MOU coordinator:
Name: Susan Holt, Director
E-mail: sholt@fresnocountyca.gov
Phone: (559) 600-9058
1. The Hospitals shall notify the County by telephone (with subsequent written
confirmation), encrypted email or FAX, within twenty-four (24) hours of
becoming aware of any occurrence of a serious nature which involves a
Patient. Such occurrences shall include, but are not limited to, homicide,
suicide, accident, injury, battery, Patient abuse, rape, significant loss or
damage to Patient property, and absence without leave.
2. The Hospital shall notify the County of the conversion of a Patient on LPS
status to a PC commitment status that results in the DSH becoming financially
responsible for the placement of the Patient. The Hospital shall notify the
County, by telephone at the earliest possible time, but not later than five (5)
business days after such conversion. Such telephone notification shall be
followed by a written notification to the County, which shall be submitted no
later than ten (10) business days after the Patient's conversion.
III. SPECIAL PROVISIONS
A. This MOU is subject to and is superseded by, any restrictions, limitations, or
conditions enacted by the Legislature and contained in the Budget Act, or any
statute or regulations enacted by the Legislature which may affect the provisions,
terms, or funding of this MOU. The parties do not intend to amend or waive any
statutory provision applicable to the use of state hospital beds by counties pursuant
to Part 1 of Division 5 of the Welfare and Institutions Code, unless the subsection
to be amended or waived is specifically identified in this MOU with a statement
indicating the parties' intent to amend or waive the provision as thereinafter
described. If statutory, regulatory, bed rate, or billing process changes occur during
the term of this MOU, the parties may renegotiate the terms of this MOU affected
by the statutory, regulatory, bed rate or billing process changes.
B. Should the DSH's ability to meet its obligations under the terms of this MOU be
substantially impaired due to loss of a Hospital license, damage or malfunction of
the Hospital, labor union strikes, or other cause beyond the control of the DSH, the
parties may negotiate modifications to the terms of this MOU.
C. Mutual Indemnification
1. The County shall defend, indemnify, and hold the DSH and its agencies, their
respective officers, employees and agents, harmless from and against any and
all liability, loss, expense, attorneys' fees, or claims for injury or damages
arising out of the performance of this MOU but only in proportion to and to the
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DocuSign Envelope ID:C7D71985-2EE8-4EFD-86F4-5082F5F34DB8
extent such liability, loss, expense, attorneys' fees, or claims for injury or
damages are caused by or result from the negligent or intentional acts or
omissions of the County, its officers, agents, or employees.
2. The DSH shall defend, indemnify, and hold the County, its officers, employees,
and agents, harmless from and against any and all liability, loss, expense,
attorneys' fees, or claims for injury or damage arising out of the performance of
this MOU but only in proportion to and to the extent such liability, loss, expense,
attorneys' fees, or claims for injury or damages are caused by or result from
the negligent or intentional acts or omissions of the DSH and/or its agencies,
their officers, agents, or employees.
D. The signatories below represent that they have the authority to sign this MOU on
behalf of their respective agencies. Execution by a participating County of Exhibit
1 confirms the participating County agrees to the terms of this MOU and Exhibits
1-4. This MOU and its Exhibit 1 may be executed in counterparts.
E. This MOU, which includes Exhibits 1-4, comprises the entire agreement and
understanding of the parties and supersedes any prior agreement or
understanding.
F. This MOU which includes Exhibits 1-4 may be amended or modified only by a
written amendment signed by the parties.
DocuSigned by:
QwttL 11/26/2022
Amie Miller, ER98'60b'Director Date
CaIMHSA
FPDocuSigned by:
AA, bullnq.(, 11/29/2022
Paul Berna ,gCFiierBB44B5 Date
Procurement and Contract Services Section
Department of State Hospitals
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EXHIBIT 1
Execution acknowledges the signatory possesses actual or apparent authority to declare
the applicable County is a participating County under this MOU.
aoa a-
Signature Date
Name Brian Pacheco Title Chairman of the Board of Supervisors of the
County of Fresno
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State
of California
By_ �� `�~- Deputy
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EXHIBIT 2
LPS SERVICES SUMMARY
Licensure
The Hospitals comply with all applicable federal and state laws, licensing regulations and
provide services in accordance with generally accepted practices and standards
prevailing in the professional community at the time of treatment. The Hospitals, which
are accredited, shall make a good-faith effort to remain accredited by the Joint
Commission throughout the term of the MOU.
The DSH provides the services to its LPS patients as follows:
Core Treatment Team and Nursing Care
The Hospitals provide Treatment Team services that are the core to a Patient's
stabilization and recovery. The Treatment Team groups consist of the following
individuals: Psychiatrist, Psychologists, Social Workers, Rehabilitation Therapists, and
Nurses. These teams provide a highly-structured treatment for mental rehabilitation and
re-socialization in preparation for an open treatment setting or community placement.
Treatment Team Ratios
Treatment Team Member: ICF Staffing Ratio: Acute Care Staffing Ratio:
Psychiatrist 1:35 1:15
Psychologist 1:35 1:15
Social Worker 1:35 1:15
Rehabilitation Therapist 1:35 1:15
Registered Nurse 1:35 1:15
The Hospitals provide nursing care according to nursing licensing ratio requirements for
state hospitals as follows-
Licensing Compliance Nursing Staff Ratios Non-Treatment Team
Nursing Shift: ICF Staffing Ratio: Acute Care Staffing Ratio:
A.M. Shift 1:8 1:6
P.M. Shift 1:8 1:6
NOC Shift 1:16 1:12
The ratios provided above are the current staffing standards employed by the DSH. Each
facility may adjust unit ratios as necessary for the continued treatment and safety of
Patients and staff.
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Skilled Nursing Facility services provide continuous skilled nursing care and supportive
care to patients whose primary need is for availability of skilled nursing care on an
extended basis. A skilled nursing facility provides 24-hours inpatient care and, as a
minimum, includes physician, skilled nursing, dietary, pharmaceutical services and an
activity program.
Additional Treatment Services
Medical Services: Medical Clinics include Neurology, GYN, Ophthalmology, Optometry,
Endocrinology, Cardiology, Podiatry, Dental and X-Ray services as well as referral
services for Gastro-Intestinal care, Hematology, Nephrology, Surgery and related care for
diseases of the liver (e.g., Hepatitis C). Full Acute Medical Care services are provided via
contracts with community hospitals and/or a County Hospital.
Physical, Occupational and Speech Therapy (POST): Department provides physical
rehabilitation services to all the patients at Napa State Hospital with the goal of assisting
Patients to reach or maintain their highest level of functioning. The POST Team provides
assessment services, treatment services and training to staff and Patients on the use and
care of adaptive equipment that has been evaluated as appropriate for the Patient.
Individualized Active Recovery Services: Active Recovery Services focus on maximizing
the functioning of persons with psychiatric disabilities and are provided both within the
residential units and in the Treatment Mall. Treatment is geared to identify, support and
build upon each person's strengths to achieve their maximum potential in meeting the
person's hopes, dreams, treatment needs and life goals.
Active Recovery Services at the Hospitals:
• Are based on the specific needs of each Patient.
• Are developed and delivered based on a philosophy of recovery.
• Provide a wide range of courses and activities designed to help patients develop
the knowledge and skills that support recovery, and transition toward community
living.
• Are organized to fully utilize staff resources and expertise.
• Provide a range of services that lead to a more normalized environment outside of
the residential areas.
• Are facilitated by psychiatrists, psychologists, social workers, rehabilitation therapy
staff, and nursing staff.
Industrial Therapy: Opportunities include dining room cleaning services, grounds
maintenance, as well as other therapeutic services. Participants must demonstrate an
appropriate level of behavior to ensure safety and security.
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EXHIBIT 3
COUNTY
STATEMENT OF ANNUAL BED RATES
AND
COUNTY-ESTIMATED BED NEED
July 1, 2021 through June 30, 2022
1. STATE HOSPITAL BED RATE FOR FY 2021-22
Acute $626
Intermediate Care Facility (ICF) $626
Skilled Nursing Facility (SNF) $775
2. BED USAGE BY ACUITY (IN BED DAYS)
FY FY FY FY FY FY *FY Acuity
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 Totals
Acute 91,479 98,617 117,699 139,007 146,762 136,861 141,812 872,237
ICF 111,235 111,382 109,095 97,594 98,697 105,818 102,258 736,079
SNF 18,413 19,546 19,132 16,178 17,535 17,971 17,753 126,528
FY Totals 221,127 229,545 245,926 252,779 262,994 260,650 261,823 1,734,844
*Totals are an estimate based on the average of FY 2019-2020 and 2020-2021.
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DocuSign Envelope ID:C7D71985-2EE8-4EFD-86F4-5082F5F34DB8
EXHIBIT 4
Purchase Agreement of State Hospital Beds
Fiscal Year 2021-22
California Department of State Hospitals
By signing this Purchase Agreement, the County agrees to all recitals, terms and
conditions, and special provisions between the County below and the Department of
State Hospitals, (DSH) contained within the Fiscal Year (FY) 2021-22/Memorandum of
Understanding (MOU) for the purchase of state hospital beds from the DSH. The DSH
shall be reimbursed for use of state hospital beds by counties pursuant to Welfare and
Institutions Code section 4330 et seq. Any County signing this form will be entitled to the
same services contained in the FY 2021-22/MOU. The County will also abide by the
same remunerative and legal policies contained within the FY 2021-22/MOU. The
County agrees to sign Exhibit 1 of the MOU within the next 120 days. The DSH reserves
the right to not accept patients from any County without a signed Exhibit 1.
County of Fresno
County
Susan Holt, Director
County Director or Director designee—print
See page 14, Exhibit 1 for Board of Supervisor signature
County Director or Director designee—sign/date
Paul Bernal, SSM II, DSH
Paul Bernal,Procurement and Contract Services Section—print
FPDocuSigned by:
MAL bul/t , 11/29/2022
9D8CDB5A8BB44B5...
Paul Bernal,Procurement and Contract Services Section —sign/date
18