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HomeMy WebLinkAboutAgreement A-22-509 MOU with DSH and CALMHSA.pdf Agreement No. 22-509 STATE OF CALIFORNIA — DEPARTMENT OF STATE HOSPITALS GAVIN NEWSOM, GOVERNOR ADMINISTRATIVE SERVICES DIVISION t 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, 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, 2022, through December 31, 2022 . The term of this MOU may be extended and/or amended one-time for sixty (60) calendar days, up to and including February 28, 2023, if the parties agree in writing to extend and/or amend this MOU before December 31 , 2022. The parties recognize that time is of the essence to work together in finalizing and executing the FY 2022-23 MOU. 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 2 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 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. 3 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. 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. 4 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 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. 5 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. 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 6 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. CaIMHSA/DSH shall make best efforts to develop a bed management protocol by December 31, 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 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 CaIMHSA, or counties not represented by CaIMHSA, 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 CaIMHSA, if represented by CaIMHSA, 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 CaIMHSA, or counties not represented by CaIMHSA, 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, CaIMHSA, 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 (I)(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 new ICF, APH and SNF bed rates have an effective date of July 1, 2022, as identified in Exhibit 3. 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 II, 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 8 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 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., username 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 9 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 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: 10 Department of State Hospitals a. Billing and general MOU provisions: Sharon Barrick, Associate Governmental Program Analyst trustoffice(a0sh.ca.gov (916) 654-2201 b. Patient Placement and Appeals coordination: Lydia Smith, Chief— Patient Management Unit Lydia.smith(aD-dsh.ca.gov (916) 562-2537 CalMHSA Laura Li, Chief Administrative Officer Laura.Li(acalmhsa.org (279) 234-0700 11 The County has designated the following as its MOU coordinator: Name: Joseph Rangel E-mail:dbhcontractedservicesdivis ion(c-)-fresnocountyca.gov Phone: 559-600-6055 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 12 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 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. Designee Date CalMHSA Paul Bernal, Chief Procurement and Contract Services Section Department of State Hospitals Date 13 EXHIBIT 1 Execution acknowledges the signatory possesses actual or apparent authority to declare Ithe applicable County is a participating County under this MOU. Y► r l -- � ? 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 14 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 15 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. 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. 16 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. EXHIBIT 3 COUNTY STATEMENT OF ANNUAL BED RATES AND COUNTY-ESTIMATED BED NEED July 1, 2022, through December 31, 2022 1. STATE HOSPITAL BED RATE FOR: Acute $753 Intermediate Care Facility (ICF) $728 Skilled Nursing Facility (SNF) $806 17 EXHIBIT 4 Purchase Agreement of State Hospital Beds July 1, 2022, through December 31, 2022 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 extends to the full term of this agreement, terminating December 31, 2022. 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. Fresno County Brian Pacheco Chairman of the Board of Supervisors of the County of Fresno Cou ty Di ctor or Director designee—print ATTEST: �� � BERNICE E.SEIDEL 7- Z Clerk of the Board of Supervisors County Director or Director designee—sign/date County of Fresno,State of California By T7 Deputy Paul Bernal, SSM ll, DSH Paul Bernal,Procurement and Contract Services Section—print Paul Bernal,Procurement and Contract Services Section —sign/date 18 Accounting String FUND/SUBCLASS: 0001/10000 ORG: 56309999 ACCOUNTS: 4383, 4402, 4404, 4408, 4412, 4428 19