HomeMy WebLinkAboutAgreement A-16-068 with DSH Ca. Mental Health Serv. Auth..pdf Agreement No. 16-068
STATE OF CALIFORNIA— DEPARTMENT OF STATE HOSPITALS EDMUND G. BROWN JR., GOVERNOR
OFFICE OF ADMINISTRATION SPEETY rREgw
1600 Ninth Street, Room 150 f"m
Sacramento, CA 95814 N
STATE Ho
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 state hospitals ("Hospitals") which provide
services to persons with mental disorders, in accordance with Welfare and
Institutions Code Section 4100 et seq. All Hospitals 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 its use of Hospital beds and services provided pursuant to the Lanterman-
Petris-Short Act ("LPS", Welfare and Institutions Code section 5000 et seq.) 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
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independence of the parties, all patient services must 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, 2014 through June 30, 2016 ("FY 14-15/FY 15-
16").
B. County Referred Patient ("Patient")
1. County shall screen, determine the appropriateness of, and authorize all
referrals for admission of Patients to the Hospital. The County 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 Medical Director or designee's assessment determines the Patient shall not
be admitted to the preferred Hospital, the preferred Hospital will notify the
County and the DSH — Sacramento Patient Management Unit (PMU) for
review and consideration of placement within an alternative appropriate DSH
facility.
3. The County 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.
Either party may initiate this process by contacting the other party.
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 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
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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-hours
inpatient care and, as a minimum, includes physician, skilled nursing, dietary,
pharmaceutical services and an activity program.
5. As the Hospitals' bed capacity permits, the 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
Patients referred by the County for LPS services, including those admitted
pursuant to Penal Code Section 1370.01 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 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, and the
DSH. A complete admission package must be submitted with the referral,
including all assessments available.
2. Patients converting from a Penal Code (PC) commitment to a civil
commitment will become county-billable on the effective date of the civil
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commitment. If determined clinically appropriate, Patients occupying a bed
within the Hospital's secure treatment area will be placed in an LPS bed
outside of the secure treatment area upon conversion from a PC to civil
commitment. Or, if a bed outside of the security treatment area is not
immediately available, the Patient will remain in the secure treatment area
until transfer to an available LPS bed outside of the secure treatment occurs.
All intra-hospital, and inter-hospital transfers shall be communicated to the
County by the transferring Hospital Medical Director, and/or appropriate staff,
prior to transfer taking place.
3. All denials of admission shall be in writing with an explanation for the denial.
Any denial of admission shall be based on the lack of the Patient's admission
criteria, the Hospital's lack of bed capacity, or an inability to provide
appropriate treatment based on patient-specific treatment needs. A denial of
admission may be appealed as provided in the next paragraph.
4. Appeal Process for Admissions. When agreement cannot be reached
between the County staff and the Hospital admitting staff regarding whether a
Patient meets or does not meet the admission criteria for the bed(s) available,
the following appeal process shall be followed; the case may be referred to
the Hospital Medical Director and the County Medical Director, or designee,
within two (2) working 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 Medical Director, or designee, are
unable to achieve agreement, the case may be referred to the Hospital
Executive Director and the County Mental Health Director, or designee, within
two (2) working days. If the Hospital Executive Director and the County
Mental Health Director, or designee, 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) working 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 Mental Health Director, or designee. The DSH shall render a final
decision within two (2) working days after receiving the documented basis on
which the appeal is based. Appeal resolution for cases involving complex
factors may exceed the timelines referenced in section D4, above.
5. Discharge planning shall begin at admission. The Hospital shall discharge a
Patient at the County's request, or 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. A denial of discharge may be
appealed as provided the next paragraph.
6. Appeals of Discharges. When the Hospital Medical Director determines that a
discharge cannot occur in accordance with the approved plan or upon the
request of the County, he/she will contact the County Medical Director, or
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designee, immediately to review the case and shall make every effort to
resolve the issues preventing the discharge. If this process does not result in
agreement, the case may be referred to the Hospital Executive Director and
the County Mental Health Director, or designee, by either the Hospital
Medical Director, or designee, or the County Medical Director, or designee,
within two (2) working days of the Hospital's denial. Such appeals may be
made by telephone and shall be followed up in writing; email being an
acceptable option. If the Hospital Executive Director and the County Mental
Health Director, or designee, 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) working 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 Mental
Health Director, or designee. The DSH shall make the final decision within
two (2) working days of receiving the documentation of the basis of the
disagreement regarding the discharge, and communicate this decision to the
County Mental Health Director, or designee, and the Hospital Executive
Director. Appeal resolution for cases involving complex factors may exceed
the timelines referenced in section D6, above.
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 County 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) working 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
feels 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 Medical Director, or
designee, within two (2) working days. If the Hospital Medical Director and
the County Medical Director, or designee, are unable to achieve agreement,
the case may be referred to the Hospital Executive Director and the County
Mental Health Director, or designee, within two (2) working days. Such
appeals may be made by telephone and shall be followed up in writing; email
being an acceptable option. If the Hospital Executive Director and the County
Mental Health Director, or designee, are unable to achieve agreement, the
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case may be referred to the DSH Deputy Directors of Clinical Operations and
Strategic Planning and Implementation within two (2) working 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
Mental Health Director, or designee, The DSH shall render a final decision
within two (2) working days after receiving the documented basis on which
the appeal is based. Appeal resolution for cases involving complex factors
may exceed the timelines referenced in section E3, above.
F. Prior Authorization
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 develop an operational case management system for
Patients, 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 of treatment plan
conferences or 90-day reviews. The Hospitals shall identify a treatment team
member to function as the primary contact for the case manager or the case
management team.
4. The County 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 County, within five-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 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 and County Medical Director 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 Strategic Planning and Implementation to
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
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the Patient. In such an event, the DSH response will be handled in
accordance with Section II, Admission and Discharge Procedures (D)(5-6).
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. Based upon Hospital bed capacity, during the 2014-15 and 2015-16 FYs,
DSH shall provide mental health treatment to
a p p r o x i m a t e l y 5 5 6 Patients under this MOU, including those whose
PC commitments are expiring and will transfer to an LPS commitment,
admitted under the LPS Act, including Murphy Conservatorships, and under
PC Section 1370.01.
2. The County shall notify DSH, through CaIMHSA, by January 31 of each year
of this MOU, of its estimate of the number and type of beds that the County
expects to use during the subsequent fiscal year for bed planning purposes.
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.
3. This MOU constitutes specific approval of the Director of State Hospitals, as
described in Welfare and Institutions Code section 4333, for the elimination of
the County bed commitments, to facilitate the maximum flexibility
contemplated by Section 4333, subdivision (f) which constitutes an innovative
arrangement for delivery of Hospital services as stated in Welfare and
Institutions Code section 4335.
4. The County is required to execute Exhibit 1 of this MOU in order to obtain
beds. A County that has not previously executed a FY 2014-15/FY 15-16
Exhibit 1 shall, upon application for admission of a Patient from the County,
commit to executing Exhibit 1 by providing a signed "Purchase Agreement of
State Hospital Beds" (Exhibit 4) to demonstrate the County's intent to execute
Exhibit 1, within 120 days of submitting the bed Purchase Agreement of State
Hospital Beds.
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, at
which time 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.
2. This MOU involves a minimum commitment of zero beds. 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.
3. ICF and Acute Rates —The established bed rate reflects a blended Acute and
ICF rate based on the prior year's established bed rates. This rate shall be in
effect until the DSH can provide actual cost information in compliance with
Welfare and Institutions Code section 4330, subdivision (c). The DSH will
review rates on an annual basis, based on actual expenditures at Hospitals
that serve LPS patients.
4. SNF Rates — The rate established in the prior year will remain in effect
through June 30, 2016. This rate shall be in effect until such time the DSH
can provide actual cost information in compliance with WIC 4330, subd. (c).
The DSH will review rates on an annual basis, based on actual expenditures
at Hospitals that serve LPS patients.
5. 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 do 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 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,
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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. The DSH will provide access to Patient medical records to Counties
through the use of a secure file sharing technology determined by
the DSH. To facilitate such access, the DSH will work with 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. 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 working days, provided, however, that if records
of a Patient are unusually voluminous the DSH may give notice that
more than seven working days will be needed.
d. 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 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 the State and DSH record retention requirements.
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M. Revenue
1. The DSH shall collect revenues from the Patients and/or responsible third
parties (e.g., Medicare and/or insurance companies), in accordance with
Welfare and Institutions Code sections 7275 through 7279, and related laws,
regulations, and policies.
N. 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.
O. Notices
1. Except as otherwise provided herein, all communication concerning this MOU
shall be as follows:
a. Billing and general MOU provisions:
Christian Jones, Associate Governmental Program Analyst
CBBUa-dsh.ca.gov
(916) 651-8727
b. Patient Placement and Appeals coordination:
Candius Burgess, Chief— Patient Management Unit
Candius.Burgessa-dsh.ca.gov
(916) 654-0090
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The County has designated the following as its MOU coordinator:
Name: Dawan Utecht,Director
E-mail: dutecht@co.fresno.ca.us
Phone: 559-600-9180
2. 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.
3. The Hospitals shall notify the County by telephone at the earliest possible
time, but not later than five (5) working days, after the treatment team
determines that a Patient on a PC commitment will likely require continued
treatment and supervision under a County-LPS commitment after the PC
commitment expires. Within ten (10) working days of the date the treatment
team's determination that continued treatment and supervision should be
recommended to County, the Hospitals shall provide written notice to the
County. The written notice shall include the basis for the Hospital's
recommendation and the date on which the PC commitment will expire. The
above notices to the County shall be given not less than thirty (30) days prior
to the expiration of the PC commitment. If Hospital fails to notify the County at
least thirty (30) days prior to the expiration of the PC commitment, the
County's financial responsibility shall not commence until thirty (30) days after
the Hospital's telephone notification. However, if the DSH is given less than
thirty (30) days to change a Patient's commitment by court order, the DSH
shall notify the County of this change at the earliest possible time. In the
event a court order provides the DSH less than thirty (30) days to notify the
County, the County's financial responsibility shall commence on the day after
the expiration of the PC commitment.
4. The County shall be responsible for making the decision regarding the
establishment of any LPS commitment at the expiration of the PC
commitment. The County shall notify the Hospital, in writing, at least fifteen
(15) days prior to the expiration of Patient's PC commitment, of its decision
regarding the establishment of an LPS commitment and continued
hospitalization. If the County is given less than fifteen (15) days prior to the
expiration of a Patient's PC commitment to make its decision, the County
shall notify the DSH of its decision at the earliest possible time prior to the
expiration of the Patient's PC commitment.
5. Regardless of whether the County served proper notice on the DSH regarding
the expiration of a patient's commitment and any decision of the County
regarding an LPS conservatorship, both parties shall follow a court order for
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the transportation of the Patient to the County for the purpose of LPS
proceedings.
6. 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) working 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) working 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
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.
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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.
M( ('HL Cam_
Maureen Bauman, President Date
CaIMHSA
�Q 'U-LALCIk
Dawn DiBartolo, Chief
Acquisitions and Business Services Office
Department of State Hospitals Date
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EXHIBIT 1
Execution indicates'that County is a participating County under the MOU.
1
Signature Date
Nametrr)es_ P)LAAu Men itle Lkw rman\
Fresno County
ATTEST:
BERNICE E.SEIDEL,Clerk
Board of Supervisors
By S1�1 S� "1a`!J
Deput
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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.
15
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.
17
EXHIBIT 3
FRESNO COUNTY
STATEMENT OF ANNUAL BED RATES
AND
COUNTY-ESTIMATED BED NEED
July 1, 2014 through June 30, 2015
1. STATE HOSPITAL BED RATE FOR FY 2014-15
Acute $626
Intermediate Care Facility (ICF) $626
Skilled Nursing Facility (SNF) $775
2. BED USAGE BY ACUITY (IN BED DAYS)
FY 2012-13 FY 2013-14 FY 2014-15 *FY 2014-15
Actual Actual Estimated Annualized
Acute 258 274 0 0
ICF 365 456 2 730
SNF 0 0 0 0
Total 623 730 2 730
*FY 2014-15 Estimated number multiplied by 365 for total estimated bed need for entire FY.
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EXHIBIT 4
Purchase Agreement of State Hospital Beds
Fiscal Year 2014-15 through Fiscal Year 2015-16
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) 2014-15/FY 2015-16
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 2014-15/FY 2015-16 MOU. The
County will also abide by the same remunerative and legal policies contained within the
FY 2014-15/FY 2015-16 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
County Mental Health Director or Director designee—print
County Mental Health Director or Director designee—sign/date
Dawn DiBartolo, Chief, DSH
Dawn DiBartolo,Acqui and Business Services Office—print sition
Dawn DiBartolo,Acquisitions and Business Services Office —sign/date
19
1 APPROVED AS TO LEGAL FORM:
2 DANIEL C.CEDERBORG, COUNTY COUNSEL
3
4 By
5
6
APPROVED AS TO ACCOUNTING FORM:
7 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
8 TREASURER-TAX COLLECTOR
9
10 By
11
12
13 REVIEWED AND RECOMMENDED FOR
14 APPROVAL:
15
16 By �
Dawan Utecht, Director
17 Department of Behavioral Health
18
19 Fund/Subclass: 0001/10000
20 Organization: 56302175
Account/Pro gram: 729 5/0
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22
23
24
25
26
27
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COUNTY OF FRESNO
Fresno, CA