HomeMy WebLinkAboutAgreement A-16-294 with IMD_SNF_MHRC Placement Providers.pdf
COUNTY OF FRESNO
Fresno, CA
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MASTER AGREEMENT
THIS AGREEMENT is made and entered into this _______ day of _______________, 2016, by
and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and each contractor listed in Exhibit A, attached hereto and by
this reference incorporated herein, and collectively hereinafter referred to as "CONTRACTOR", and
such additional CONTRACTOR(S) as may, from time to time during the term of this Agreement, be
added by COUNTY. References in this Agreement to “party” or “parties” shall be understood to
refer to COUNTY and each CONTRACTOR, unless otherwise specified.
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), pursuant to
various provisions of the California Welfare and Institutions Code and the California Code of
Regulations, must provide geropsychiatric skilled nursing care, locked skilled nursing care with
special mental health treatment programs, mental health rehabilitation center services, and other
enhanced treatment services and facilities to house and treat adults with severe and serious mental
health impairments; and
WHEREAS, each CONTRACTOR has the secured facilities, staff and expertise, and is licensed
by the State of California, to provide residential mental health services to severely and persistently
mentally disabled persons in appropriate skilled nursing or mental health rehabilitation center
facilities.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. SERVICES
A. CONTRACTOR(S) shall perform all services and fulfill all responsibilities
identified in COUNTY’s RFSQ No. 952-5447, dated February 25, 2016 and CONTRACTOR(S)
responses to said RFSQ No. 952-5447, all incorporated by reference and herein made part of this
Agreement. In the event of any inconsistency among these documents the inconsistency shall be
resolved by giving precedence to the following order: 1) to this Agreement including all Exhibits,
and all amendments thereto; to CONTRACTOR(S) Responses to the RFSQ No. 952-5447. A copy of
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COUNTY’s RFSQ No. 952-5447, and CONTRACTOR(S) Responses shall be retained and made
available during the term of this Agreement by COUNTY’s Purchasing Department.
B. It is understood that each CONTRACTOR shall be providing residential mental
health treatment services at one (1) or more of the type of facilities as described in the Scope of Work
as identified in Exhibit B, attached hereto and by this reference incorporated herein. The types of
facilities include: Skilled Nursing Facilities (SNFs), Geropsychiatric Nursing Care Facilities
(GNCFs), Institutions of Mental Disease (IMDs), and Mental Health Rehabilitation Centers
(MHRCs). Each CONTRACTOR shall be fulfilling all responsibilities applicable to the provision of
the necessary residential mental health treatment services as identified for that respective facility as
described in each sub-part of Exhibit C “Description of Services & Rates”, attached hereto and by
this reference incorporated herein. Additional facilities may be identified and added to Exhibits A
and C pursuant to Paragraph 14 herein, based on the need by COUNTY to provide appropriate
residential mental health treatment services to Fresno County clients. All references to Exhibit C
shall be to CONTRACTOR(S)’ corresponding sub-part, Exhibit C-1, Exhibit C-2, Exhibit C-3,
Exhibit C-4, Exhibit C-5, Exhibit C-6, Exhibit C-7(a-g), Exhibit C-8(a-b), Exhibit C-9, and Exhibit
C-10, as indicated on Exhibit A.
C. Upon termination of this Agreement for any reason, each CONTRACTOR
agrees to assist COUNTY in the placement of COUNTY’s clients who can no longer remain at
CONTRACTOR(S)’ facilities.
D. COUNTY shall provide transportation services for its clients to and from each
CONTRACTOR’s residential mental health service facility, as needed.
E. Each CONTRACTOR warrants that it possesses all licenses and certificates
required by local, State of California and/or Federal laws and regulations for the conduct of its
business and shall operate its business in accordance with all applicable laws and regulations. Each
CONTRACTOR further warrants that all of its personnel performing services under this Agreement
shall be licensed and certified where required, to lawfully perform their duties and shall maintain such
licensure and certifications throughout the term of this Agreement.
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CONTRACTORS shall maintain copies of all licenses and certifications noted
above and shall allow COUNTY to review these documents upon request.
F. Each CONTRACTOR performing services under this Agreement shall execute a
“Description of Services & Rates” which will become part of this Agreement, as a sub-part of Exhibit
C. Each “Description of Services & Rates” shall specify the services to be provided by the individual
CONTRACTOR and the specific duties, rates, and responsibilities COUNTY requires of each
CONTRACTOR. Once the CONTRACTOR has signed, dated and returned the “Description of
Services & Rates” to COUNTY, COUNTY’s DBH Director, or designee, shall review the
“Description of Services & Rates” and indicate approval by signing and dating the “Description of
Services & Rates”. Upon the execution of the “Description of Services & Rates” by COUNTY’s
DBH Director, or designee, as described herein, the CONTRACTOR shall be added to this
Agreement. After a CONTRACTOR is added to this Agreement, they will be processed through the
COUNTY’s DBH Managed Care credentialing process. Once cleared and credentialed, the
CONTRACTOR(S) shall be eligible to provide residential mental health treatment services pursuant
to the terms and conditions set forth in this Agreement, Scope of Work (Exhibit B), and in that
CONTRACTOR’s “Description of Services & Rates” (Exhibit C).
2. TERM
This Agreement shall become effective on the 1st day of July 1, 2016 and shall terminate
on the 30th day of June 30, 2019. CONTRACTOR(S) added to this Agreement after July 1, 2016,
shall become part of the Agreement effective upon the date the executed “Description of Services &
Rates” is received and approved by the COUNTY’s DBH Director, or designee, as set forth in
Paragraph 1.F. of this Agreement.
Effective July 1, 2019, this Agreement, subject to satisfactory performance, shall be
extended for two (2) additional twelve (12) month periods upon the same terms and conditions herein
set forth, unless written notice of non-renewal is given no later than thirty (30) days prior to the close
of the current Agreement term by COUNTY’s DBH Director, or designee, or one (1) or more
CONTRACTOR(S). A CONTRACTOR’s written notice of non-renewal shall be understood to
effect renewal only to the extent of that CONTRACTOR’s involvement in this Agreement.
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The June 30 termination date specified herein shall be the termination date for all
CONTRACTORS, regardless of when CONTRACTOR is added to this Agreement. Any 12-month
renewal period of this Agreement for any CONTRACTOR already providing services under this
Agreement shall commence on July 1 of 2019 and 2020, as appropriate.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated at any time by giving one (1) or all CONTRACTORS thirty (30) days advance
written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, as to one (1) or all CONTRACTORS, where in the determination of
COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of any
CONTRACTOR. Neither shall such payment impair or prejudice any remedy available to COUNTY
with respect to the breach or default. COUNTY shall have the right to demand of each
CONTRACTOR the repayment to COUNTY of any funds disbursed to that CONTRACTOR under
this Agreement, which in the judgment of COUNTY were not expended in accordance with the terms
of this Agreement. Each CONTRACTOR shall promptly refund any such funds upon demand or, at
the COUNTY’s option such repayment shall be deducted from future payments owing to that
CONTRACTOR under this Agreement. COUNTY shall provide notice to the CONTRACTOR of
such a breach or default prior to taking any action to suspend payments or terminate the Agreement.
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In addition, each CONTRACTOR shall have the right to terminate this Agreement upon
giving a written thirty (30) day notice to COUNTY, in the event COUNTY fails to comply with the
term of this Agreement or fails to perform its services as stated herein.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY’s DBH Director, or designee, or one (1) or more
CONTRACTOR(S) upon the giving of thirty (30) days advance written notice of an intention to
terminate.
4. COMPENSATION
All parties acknowledge that COUNTY shall not pay for services for any client who has
not, pursuant to Paragraph 13 of this Agreement, been authorized in advance by COUNTY’s DBH
Director, or designee, to receive residential mental health treatment services from
CONTRACTOR(S). All clients who have been authorized by the COUNTY’s DBH Director will
hereinafter be referred to as “authorized COUNTY client”. All parties further acknowledge that any
Enhanced Services provided to authorized COUNTY clients must have separate authorization as
described further in the Scope of Work (Exhibit B), if such separate authorization is required in the
CONTRACTOR(S)’ “Description of Services & Rates” (Exhibit C) described in Paragraph 1.F.
above.
COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive
compensation for each day for each authorized COUNTY client placed within the
CONTRACTOR(S)’ facility, in accordance with the maximum daily rates identified by each
CONTRACTOR(S) within their respective “Description of Services & Rates”, as set forth herein as
Exhibit C. For authorized COUNTY clients that do not qualify for Medi-Cal or are receiving non-
Medi-Cal billable services, COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S)
agree to receive compensation for additional physician services required. Physician services rates
shall be included in the “Description of Services & Rates” (Exhibit C) identified by each individual
CONTRACTOR and shall be included in an all-inclusive basic daily rate or included as an additional
line item to be billed on the invoice.
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The maximum amount of compensation to be paid to all CONTRACTORS collectively
for daily rate charges for the first 12-month period of the initial contract term, (July 1, 2016 through
June 30, 2017) shall not exceed the amount of Ten Million, One Hundred Fifty Thousand, and
No/100 Dollars ($10,150,000.00).
The maximum amount of compensation to be paid to all CONTRACTORS collectively
for daily rate charges for the second 12-month period of the initial contract term, (July 1, 2017
through June 30, 2018) shall not exceed the amount of Ten Million, Six Hundred Fifty-Seven
Thousand, Five Hundred and No/100 Dollars ($10,657,500.00).
The maximum amount of compensation to be paid to all CONTRACTORS collectively
for daily rate charges for the third 12-month period of the initial contract term, (July 1, 2018 through
June 30, 2019) shall not exceed the amount of Eleven Million, One Hundred Ninety Thousand, Three
Hundred Seventy-Five, and No/100 Dollars ($11,190,375.00).
The maximum amount of compensation to be paid to all CONTRACTORS collectively
for daily rate charges for the first 12-month period of the renewal contract term, (July 1, 2019 through
June 30, 2020) shall not exceed the amount of Eleven Million, Seven Hundred Forty-Nine Thousand,
Eight Hundred Ninety-Four, and No/100 Dollars ($11,749,894.00).
The maximum amount of compensation to be paid to all CONTRACTORS collectively
for daily rate charges for the second 12-month period of the renewal contract term, (July 1, 2020
through June 30, 2021) shall not exceed the amount of Twelve Million, Three Hundred Thirty-Seven
Thousand, Three Hundred Eighty-Eight, and No/100 Dollars ($12,337,388.00).
In no event shall the total maximum amount for the services provided by
CONTRACTOR(S) collectively under the terms and conditions of this Agreement for the entire five
(5) year term exceed Fifty-Six Million, Eighty-Five Thousand, One Hundred Fifty-Seven, and
No/100 Dollars ($56,085,157.00).
It is acknowledged by all parties hereto that the rate(s) specified in each
CONTRACTOR’S “Description of Services & Rates” may change during the term of this Agreement
and such rate changes must be approved by COUNTY’s DBH Director, or designee, upon receipt of a
written application for such a rate increase. Any such approved rate change shall become a part of
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this Agreement. It is also acknowledged that as additional CONTRACTORS are added to this
Agreement, Exhibit C shall be updated to include the specific “Description of Services & Rates”
which includes services, requirements and rates for each added CONTRACTOR, and shall be
effective upon approval and execution by COUNTY’s DBH Director, or designee.
Commencing April 1st of each term of this Agreement, each CONTRACTOR shall
provide a new “Description of Services & Rates” with the updated rates of services for the following
12-month term of the Agreement (beginning with the new fiscal year). Said updated “Description of
Services & Rates” shall be reviewed for approval by COUNTY’s DBH Director, or designee, as set
forth in Paragraph 1.F. of this Agreement.
Adjustments for Basic, Special Treatment Program services, Enhanced Rate services for
SNFs, GNCFs, IMDs and MHRCs: COUNTY and CONTRACTORS acknowledge that the rates
recited in the “Description of Services & Rates” for each individual CONTRACTOR may be subject
to adjustment based upon rates set by the California State Department of Health Care Services for
such services, hereinafter referred to as the “Medi-Cal Rate”. COUNTY agrees to pay the adjusted
Medi-Cal Rate for each and every unit of service provided after the effective date of such adjustment
as published by the California State Department of Health Care Services, and CONTRACTOR agrees
to accept such adjusted Medi-Cal Rate as of the effective date of such adjustment, whether or not the
cost of providing such services shall have exceeded the amount of the payments hereunder.
COUNTY and CONTRACTORS further acknowledge that tiered Enhanced Services rates per day, if
provided for in the respective CONTRACTOR(S)’ “Description of Services & Rates”, may apply
based on client need and may be adjusted during the term of this Agreement. Said tiered Enhanced
Services rates per day, if provided by CONTRACTOR(S), shall be indicated within the
CONTRACTOR(S)’ respective Exhibit C. Adjustments to said Enhanced Services rates may be
requested by CONTRACTOR only when accompanied by a comprehensive written justification of
the need for the rate increase. Such a rate change for the Enhanced Services may be approved by the
COUNTY’s DBH Director, or designee, and the respective CONTRACTOR and shall become a part
of this Agreement. CONTRACTOR shall be responsible for billing Medi-Cal, Medi-Care and other
third party payers for the ancillary and secondary costs above COUNTY compensation for said
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services.
The daily rate(s), times the number of days utilized by authorized COUNTY clients in
CONTRACTOR(S)’ residential mental health treatment facility, less adjustments, if any, will
determine the actual reimbursement to CONTRACTOR(S). It is understood and agreed by the parties
that the foregoing is the total sum to be paid to all CONTRACTORS for the services to be provided
hereunder for each twelve (12) month period of this Agreement, irrespective of whether the cost of
providing such services shall have exceeded the amount of the payments.
5. THIRD PARTY PAYMENTS
In the event any authorized COUNTY client is a recipient of income from any source,
including Supplemental Security Income/State Supplemental Program (SSI/SSP), Veterans
Administration benefits, retirement benefits, or annuities, and the authorized COUNTY client’s
representative payee or the conservator of the client’s estate is the Fresno County Public Guardian
(PG), COUNTY remains responsible to pay CONTRACTOR(S) the full amount for services rendered
under this Agreement. When PG is the representative payee or conservator of the estate, the
authorized COUNTY client’s income shall be collected by PG and utilized to reimburse COUNTY
for the costs of services provided hereunder.
If a CONTRACTOR is informed that the authorized COUNTY client’s representative
payee or conservator of the estate is a person or entity other than COUNTY’s PG, said
CONTRACTOR shall attempt to obtain payment for the services (rendered by said CONTRACTOR)
directly from the client’s representative payee or conservator of the estate. The amount
CONTRACTOR shall attempt to collect is the amount of the client’s monthly income, less the
client’s “personal needs” fund contribution of Forty-Five and No/100 Dollars ($45.00) per month for
clients placed within an IMD or Thirty and No/100 Dollars ($30.00) per month for clients placed
within a SNF. If CONTRACTOR is successful in collecting any amount from the client’s
representative payee or conservator of the estate, CONTRACTOR shall deduct that amount from the
amount invoiced to COUNTY for the services provided to that client. All amounts actually collected
by CONTRACTOR shall be deducted from the amount otherwise payable to CONTRACTOR
pursuant to this Agreement. When any amount is collected by CONTRACTOR, that amount shall be
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deducted from CONTRACTOR’s next invoice to COUNTY regardless of the date the services for
which money was received were delivered. In the event that CONTRACTOR is paid for an
authorized COUNTY client from a third party source, CONTRACTOR shall not seek reimbursement
from COUNTY for any service provided, in whole or in part, and COUNTY shall not be liable to
CONTRACTOR therefore.
CONTRACTORS shall maintain and forward to COUNTY on a monthly basis a list of
all clients who have third-party payees or conservators of the estate, other than COUNTY’s PG.
In the event CONTRACTOR(S) fails to comply with any provisions of this Agreement,
COUNTY shall withhold payment until such time as the non-compliance has been corrected.
6. INVOICING AND PAYMENTS
A. Invoicing
CONTRACTORS shall invoice COUNTY by the fifteenth (15th) day of each
month following the month in which the services were provided via email addressed to
DBHInvoices@co.fresno.ca.us with a carbon copy (cc) to DBHLPSConservatorship@co.fresno.ca.us
and the assigned DBH Mental Health Contracts Staff Analyst. Invoices shall be summarized in a
statement format. All invoices submitted should include the following required information: name of
facility, facility address, invoice date range, client name, admit date, discharge date, number of days,
social security #, date of birth, case manager, daily rate and total. In no event shall CONTRACTORS
submit claims to COUNTY for clients that are not duly authorized by COUNTY to receive services.
B. Contract Payment Schedule
Payments by COUNTY shall be in arrears, within forty-five (45) days after
receipt and verification of CONTRACTOR(S)’ invoices by COUNTY's DBH in an amount
equivalent to the daily rate times the total monthly utilization of beds under this Agreement, including
any rate adjustment provided for in Paragraph 4 herein. However, if invoice(s) is not received in
proper form or substance as stated in Paragraph 6.A. above, COUNTY may withhold subsequent
payment(s) until such invoice(s) is received.
C. Reconciliation of Payments to Invoices
COUNTY shall complete a reconciliation of payments made to costs invoiced. If
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an adjustment to the payment is necessary, COUNTY shall notify CONTRACTOR(S) in writing
within five (5) working days after the completion of the reconciliation. Within forty-five (45) days
thereafter, COUNTY shall make payment to CONTRACTOR or CONTRACTOR shall reimburse
COUNTY as appropriate. In the event that CONTRACTOR(S) bills the COUNTY for supplemental
charges for a previous month’s services, those charges shall be sent to the COUNTY for review via a
separate invoice and summarized statement and are not to be included within the next regular month’s
invoice.
7. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any
and all of CONTRACTOR(S)’ officers, agents, and employees will at all times be acting and
performing as independent contractors, and shall act in an independent capacity and not as an officer,
agent, servant, employee, joint venturer, partner, or associate of the COUNTY. Furthermore,
COUNTY shall have no right to control or supervise or direct the manner or method by which
CONTRACTOR(S) shall perform its work and function. However, COUNTY shall retain the right to
administer this Agreement so as to verify that CONTRACTOR(S) is performing their obligations in
accordance with the terms and conditions thereof. CONTRACTOR(S) and COUNTY shall comply
with all applicable provisions of law and the rules and regulations, if any, of governmental authorities
having jurisdiction over matters which are directly or indirectly the subject of this Agreement.
Because of their status as independent contractors, CONTRACTOR(S) shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR(S) shall be solely liable and responsible for providing to, or on behalf of, its
employees all legally-required employee benefits. In addition, CONTRACTOR(S) shall be solely
responsible and save COUNTY harmless from all matters relating to payment of CONTRACTOR(S)’
employees, including compliance with Social Security, withholding, and all other regulations
governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR(S) may be providing services to others unrelated to the COUNTY or to this
Agreement.
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8. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to the List of Contracted Providers (Exhibit A),
including changes to CONTRACTOR(S)’ addresses, as well as changes to the “Description of
Services & Rates” (Exhibit C) for rate adjustments due to state-required facility rate increases for
each of CONTRACTOR(S)’ facilities may be made with the written approval of the COUNTY’s
DBH Director, or designee, and the individual CONTRACTOR.
In addition, non-material changes to the Scope of Work (Exhibit B) as needed to
accommodate revisions in the law relating to mental health treatment services may be made with the
signed written approval of COUNTY’s DBH Director, or designee, and respective
CONTRACTOR(S) through an amendment approved by COUNTY’s County Counsel and Auditor-
Controller/Treasurer-Tax Collector. Said changes shall not result in any change to the maximum
compensation amount payable by COUNTY to CONTRACTOR(S), as stated herein.
9. NON-ASSIGNMENT
COUNTY and CONTRACTOR(S) shall not assign, transfer or subcontract this
Agreement nor their rights or duties under this Agreement, without the prior written consent of
COUNTY and the individual CONTRACTOR seeking to make such assignment.
10. HOLD-HARMLESS
CONTRACTOR(S) agrees to indemnify, save, hold harmless, and at COUNTY's
request, defend COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting
to COUNTY in connection with the performance, or failure to perform, by CONTRACTOR(S), its
officers, agents or employees under this Agreement, and from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting
to any person, firm or corporation who may be injured or damaged by the performance, or failure to
perform, of CONTRACTOR(S), their officers, agents or employees under this Agreement.
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CONTRACTOR(S) agrees to indemnify COUNTY for Federal and/or State of
California audit exceptions resulting from noncompliance herein on the part of CONTRACTOR(S).
11. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from
CONTRACTOR(S) or any third parties, each CONTRACTOR, at its sole expense, shall maintain in
full force and effect the following insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of Five Hundred Thousand Dollars ($500,000). Coverage
should include owned and non-owned vehicles used in connection with this
Agreement.
C. Professional Liability
If CONTRACTOR(S) employs licensed professional staff (e.g. PH.D., R. N.,
L.C.S.W., M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR(S) agree that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
D. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
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E. Child Abuse/Molestation and Social Services Coverage
CONTRACTOR shall have either separate policies or umbrella policy with
endorsements covering Child Abuse/Molestation and Social Services Liability
coverage or have a specific endorsement on their General Commercial liability
policy covering Child Abuse/Molestation and Social Services Liability. The
policy limits for these policies shall be $1,000,000 per occurrence with
$2,000,000 annual aggregate. The policies are to be on a per occurrence basis.
CONTRACTOR(S) shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under the CONTRACTOR(S)' policies
herein. This insurance shall not be cancelled or changed without a minimum of thirty (30) days
advance written notice given to COUNTY.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
3133 N. Millbrook Avenue, Fresno, California 93703, Attn: Mental Health Contracted Services
Division, stating that such insurance coverages have been obtained and are in full force; that the
County of Fresno, its officers, agents and employees will not be responsible for any premiums on the
policies; that such Commercial General Liability insurance names the County of Fresno, its officers,
agents and employees, individually and collectively, as additional insured, but only insofar as the
operations under this Agreement are concerned; that such coverage for additional insured shall apply
as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
officers, agents and employees, shall be excess only and not contributing with insurance provided
under CONTRACTOR(S)’ policies herein; and that this insurance shall not be cancelled or changed
without a minimum of thirty (30) days advance, written notice given to COUNTY.
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In the event CONTRACTOR(S) fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC
VII or better.
12. CONFLICT OF INTEREST
No officer, agent, or employee of the COUNTY who exercises any function or
responsibility for planning and carrying out the services provided under this Agreement shall have
any direct or indirect personal financial interest in this Agreement. CONTRACTORS shall comply
with all Federal, State of California, and local conflict of interest laws, statutes, and regulations,
which shall be applicable to all parties and beneficiaries under this Agreement and any officer, agent,
or employee of the COUNTY.
13. ADMISSION OF AUTHORIZED COUNTY CLIENTS
In order for proper reimbursement:
A. All referrals to CONTRACTORS must be authorized by the COUNTY’s DBH
Director, or designee. Authorized COUNTY clients will be referred to CONTRACTORS from
COUNTY’s DBH with the supporting documents identifying the level of care needed and treatment
that is desired by COUNTY. Upon acceptance of the referral by CONTRACTORS, COUNTY shall
authorize in writing the placement of the authorized COUNTY client at CONTRACTORS’ facility.
Any Enhanced Rate services needed by the authorized COUNTY client will be mutually agreed upon
by both parties and approved by COUNTY’s DBH Director, or designee.
B. CONTRACTORS and COUNTY shall work together to ensure the most
appropriate placement within the facility.
C. If admission is denied by CONTRACTOR(S), the COUNTY’s DBH Director, or
designee, will be immediately notified in writing concerning the reasons for the denial.
D. Policies and procedures for admission shall be written by CONTRACTORS in
compliance with this Agreement. Policies shall include a provision that authorized COUNTY clients
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are accepted for care without discrimination on the basis of race, color, religion, gender, national
origin, or disability or mental status.
14. ADDITIONS/DELETIONS OF CONTRACTORS
COUNTY’s DBH Director, or designee, reserves the right at any time during the term of
this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A. It is understood any such
additions will not affect compensation paid to any other CONTRACTOR, and therefore such
additions may be made by COUNTY without notice to or approval of the other CONTRACTOR(S)
under this Agreement. These same provisions shall apply to the deletion of any CONTRACTOR(S)
contained in Exhibit A, except that deletions shall be by written mutual agreement between the
COUNTY and the particular CONTRACTOR to be deleted, or shall be in accordance with the
provisions of Paragraph 3 of this Agreement.
15. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR(S) and CONTRACTOR(S)’
staff shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
necessary for the provision of the services hereunder and required by the laws and regulations of the
United States of America, State of California, the County of Fresno, and any other applicable
governmental agencies. CONTRACTOR(S) shall notify COUNTY immediately in writing of its
inability to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTOR(S) and
CONTRACTOR(S)’ staff shall comply with all applicable laws, rules or regulations, as may now
exist or be hereafter changed.
16. RECORDS
A. Medical Records: Clinical records of each client shall be the property of each
individual CONTRACTOR and shall be maintained for seven (7) years or until audit findings are
resolved. All such records shall be considered confidential client records in accordance with
California Welfare and Institutions Code, Section 5328. Clinical records shall include evaluative
studies and sufficient detail to make possible an evaluation by COUNTY’s DBH Director, or
designee.
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B. Financial Records: Each CONTRACTOR shall maintain financial records in the
manner provided by the State Health and Welfare Agency and make such records available to
COUNTY’s DBH Director, or designee, and the California Health and Human Services Agency.
If COUNTY or CONTRACTOR(S) are requested to disclose any books,
documents or records relevant to this Agreement, for the purpose of an audit or investigation by an
entity authorized by law to conduct such an audit or investigation, COUNTY or CONTRACTOR(S)
shall notify the other party of the nature and scope of such request and shall make available to the
other party all such books, contracts, documents or records. By agreeing to the aforementioned,
COUNTY and CONTRACTORS do not waive any legal rights that they have with regard to
disclosure of documents or information.
CONTRACTORS shall maintain accurate accounting records of its costs and
operating expenses. Such records of costs and expenditures shall be maintained for at least four (4)
years, or until audit findings are resolved, and shall be open to inspection by COUNTY’s DBH
Director, COUNTY’s Auditor-Controller/Treasurer-Tax Collector, the Grand Jury, the State
Controller, the State Director of the Department of Health Care Services, or any of their deputies.
C. Other: CONTRACTOR(S) shall maintain and provide to COUNTY, with prior
notice, client information for purposes of trend studies conducted by COUNTY's Quality Assurance
Coordinator and other staff as appropriate, as authorized by COUNTY’s DBH Director, or designee.
17. REPORTING
Each CONTRACTOR agrees to provide COUNTY with any reports which may be
required by State and/or Federal agencies for compliance with this Agreement. In addition,
COUNTY requires the submission of monthly and quarterly reports detailing the work accomplished
during the reporting period, work to be accomplished during the subsequent reporting period, and
problems, existing or anticipated, which should be brought to COUNTY's attention. At the expiration
of each twelve (12) month period of this Agreement, each CONTRACTOR shall submit a written
evaluation of its performance relative to this Agreement.
At the end of each quarter of this Agreement, each CONTRACTOR shall submit a
financial report listing the name of clients served, with dates when they were in the various programs
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and the total expenditure based on actual usage by COUNTY for that quarter.
All such reports shall be sent attention to the Division Manager, Adult Services
Division, County of Fresno, Department of Behavioral Health, 4441 E. Kings Canyon Road, Fresno,
California 93702.
18. MONITORING
Each CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director,
and the State Department of Health Care Services, or their respective designees, the right to review
and monitor records, programs or procedures, at any time, in regard to clients, as well as the overall
operation of CONTRACTOR(S)’ programs in order to ensure compliance with the terms and
conditions of this Agreement.
19. COMPLIANCE WITH STATE REQUIREMENTS
Each CONTRACTOR shall recognize that COUNTY operates its mental health
programs under an agreement with the State of California Department of Health Care Services, and
that under said agreement the State imposes certain requirements on COUNTY and its
subcontractors. CONTRACTORS shall adhere to the State requirements identified in this
Agreement.
20. CONFIDENTIALITY
All services performed by CONTRACTOR(S) under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
21. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR(S) each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
Law 104-191(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required
by law.
COUNTY and CONTRACTOR(S) acknowledge that the exchange of PHI between them
is only for treatment, payment, and health care operations.
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COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
security of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR(S) to enter into a contract containing specific requirements prior to the disclosure of
PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
Code of Federal Regulations (CFR).
22. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse
of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
enter into a contractual relationship with the COUNTY for the purpose of providing services under
this Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR(S) by the COUNTY, including but not limited to the following:
A. CONTRACTOR(S)-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR(S) may not connect to COUNTY networks via personally-
owned mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR(S) has received authorization by
COUNTY for telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR(S)-Owned Computers or Computer Peripherals
CONTRACTOR(S) may not bring CONTRACTOR(S)-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY’s
Chief Information Officer, and/or designee(s), including but not limited to mobile storage devices. If
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data is approved to be transferred, data must be stored on a secure server approved by the COUNTY
and transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR(S), including its subcontractor(s) and employees, may not use
COUNTY computers or computer peripherals on non-COUNTY premises without prior authorization
from the COUNTY’s Chief Information Officer, and/or designee(s).
D. CONTRACTOR(S) may not store COUNTY’s private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR(S) shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR(S) is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information,
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR(S)’ response to all
incidents arising from a possible breach of security related to COUNTY’s confidential client
information provided to CONTRACTOR(S). CONTRACTOR(S) will be responsible to issue any
notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole
discretion. CONTRACTOR(S) will be responsible for all costs incurred as a result of providing the
required notification.
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23. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR(S) shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
sexual orientation, or military or veteran status pursuant to all applicable State of California and
Federal statutes and regulations.
24. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)
(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, sub. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTOR(S) shall make available,
upon written request of the Secretary of the United States Department of Health and Human Services,
or upon request of the Comptroller General of the United States General Accounting Office, or any of
their duly authorized representatives, a copy of this Agreement and such books, documents, and
records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR(S) under this Agreement. CONTRACTOR(S) further agrees that in the event
CONTRACTOR(S) carries out any of its duties under this Agreement through a subcontract, with a
value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month
period, with a related organization, such Agreement shall contain a clause to the effect that until the
expiration of four (4) years after the furnishing of such services pursuant to such subcontract, the
related organizations shall make available, upon written request of the Secretary of the United States
Department of Health and Human Services, or upon request of the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify
the nature and extent of such costs.
25. PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR(S)’ advertising, fundraising, or publicity (i.e.,
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purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
26. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR(S) shall comply
with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R.
Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
from discriminating against persons based on race, color, national origin, sex, disability or religion.
This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal
access and participation in federally funded programs through the provision of comprehensive and
quality bilingual services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, training of staff on the policies and
procedures, and monitoring its language assistance program. CONTRACTOR(S)’ procedures must
include ensuring compliance of any subcontracted providers with these requirements.
C. CONTRACTOR(S) shall not use minors as interpreters.
D. CONTRACTOR(S) shall provide and pay for interpreting and translation
services to persons participating in CONTRACTOR(S)’ services who have limited or no English
language proficiency, including services to persons who are deaf or blind. Interpreter and translation
services shall be provided as necessary to allow such participants meaningful access to the programs,
services and benefits provided by CONTRACTOR(S). Interpreter and translation services, including
translation of CONTRACTOR(S)’ “vital documents” (those documents that contain information that
is critical for accessing CONTRACTOR(S)’ services or are required by law) shall be provided to
participants at no cost to the participant. CONTRACTOR(S) shall ensure that any employees, agents,
subcontractor(s), or partners who interpret or translate for a program participant, or who directly
communicate with a program participant in a language other than English, demonstrate proficiency in
the participant's language and can effectively communicate any specialized terms and concepts
peculiar to CONTRACTOR(S)’ services.
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E. In compliance with the State-mandated Culturally and Linguistically
Appropriate Services standards as published by the Office of Minority Health, CONTRACTOR(S)
must submit to COUNTY for approval, within sixty (60) days from date of contract execution,
CONTRACTOR(S)’ plan to address all fifteen (15) national cultural competency standards as set
forth in the “National Standards on Culturally and Linguistically Appropriate Services (CLAS)”
http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf. COUNTY’s annual on-site review
of CONTRACTOR(S) shall include collection of documentation to ensure all national standards are
implemented. As the national competency standards are updated, CONTRACTOR(S)’ plan must be
updated accordingly.
27. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR(S) is a disclosing entity, fiscal
agent, or managed care entity as defined in Code of Federal Regulations (C.F.R.). Title 42, Section
455.101, 455.104, and 455.106(a)(1),(2).
In accordance with C.F.R. Title 42 Sections 445.101, 455.104, 455.105, and
455.106(a)(1)(2), the following information must be disclosed by CONTRACTOR(S) by completing
Exhibit D, “Disclosure of Ownership and Control Interest Statement”, attached hereto and by this
reference incorporated herein. CONTRACTOR(S) shall submit this form to the COUNTY’s DBH
within thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR(S)
shall report any changes to this information within thirty-five (35) days of occurrence by completing
Exhibit D, “Disclosure of Ownership and Control Interest Statement. Submissions shall be scanned
PDF copies and are to be sent via email to DBHAdministration@co.fresno.ca.us, attention: Mental
Health Contracted Services.
28. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR(S) is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR(S)”):
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A. Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract under a public
transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three (3) year period preceding their Agreement award, they have had
a public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate
CONTRACTOR(S) from further business consideration. The information will be considered as
part of the determination of whether to continue and/or renew the Contract and any additional
information or explanation that a CONTRACTOR(S) elects to submit with the disclosed
information will be considered. If it is later determined that the CONTRACTOR(S) failed to
disclose required information, any contract awarded to such CONTRACTOR(S) may be
immediately voided and terminated for material failure to comply with the terms and conditions of
the award.
CONTRACTOR(S) must sign a “Certification Regarding Debarment, Suspension, and
Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit E,
attached hereto and by this reference incorporated herein. Additionally, CONTRACTOR(S) must
immediately advise the COUNTY in writing if, during the term of this Agreement: (1)
CONTRACTOR(S) becomes suspended, debarred, excluded or ineligible for participation in federal
or state funded programs or from receiving federal funds as listed in the excluded parties’ list system
(http://www.sam.gov); or (2) any of the above listed conditions become applicable to
CONTRACTOR(S). CONTRACTOR(S) shall indemnify, defend and hold the COUNTY harmless
for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter
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listed in the signed Certification Regarding Debarment, Suspension, and Other Responsibility
Matters.
29. COMPLAINTS
Each CONTRACTOR shall log complaints and the disposition of all complaints from a client or
a client’s family. CONTRACTORS shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the fifteenth (15th) day
of the following month, in a format that is mutually agreed upon. In addition, CONTRACTORS shall
provide details and attach documentation of each complaint with the log. CONTRACTORS shall
post signs informing client of their right to file a complaint or grievance. CONTRACTORS shall
notify COUNTY of all incidents reportable to State licensing bodies that affect COUNTY clients
within twenty-four (24) hours of receipt of a complaint.
Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTORS shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or
corrective action taken to resolve the complaint.
30. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR(S) is operating as a corporation
(a for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR(S)
changes its status to operate as a corporation.
Members of the CONTRACTOR(S)’ Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR(S) is providing goods or performing
services under this agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR(S) is a party and in which one or more of its directors has a material financial
interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are
a party to by completing and signing a Self-Dealing Transaction Disclosure Form, as identified in
Exhibit F, attached hereto and by this reference incorporated herein, and submitting it to the
COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
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31. SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by
a court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions
shall remain in full force and effect, and shall in no way be affected, impaired or invalidated.
32. SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among the individual CONTRACTORS. By execution of the Agreement,
CONTRACTORS understand that a separate Agreement is formed between each individual
CONTRACTOR and COUNTY.
33. AUDITS AND INSPECTIONS
CONTRACTOR(S) shall at any time during business hours, and as often as COUNTY
may deem necessary, make available to COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. CONTRACTOR(S) shall, upon request by
COUNTY, permit COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR(S)’ compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor for a period of
three (3) years after final payment under contract (Government Code section 8546.7).
34. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR(S)
Director, Fresno County SEE EXHIBIT A
Department of Behavioral Health
4441 E. Kings Canyon Road
Fresno, CA 93702 Any and all notices between the COUNTY and the CONTRACTOR(S) provided for or
permitted under this Agreement, or by law, shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
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United States Mail, postage prepaid, addressed to such party.
35. GOVERNING LAW
The parties agree that for the purposes of venue performance under this Agreement is to
be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
36. ENTIRE AGREEMENT
This Agreement, including all Exhibits, RFSQ #952-5447 and Responses to RFSQ
#952-5447 constitutes the entire agreement between the CONTRACTOR(S) and COUNTY with
respect to the subject matter hereof and supersedes all previous agreement negotiations, proposals,
commitments, writings, advertisements, publications, and understandings of any nature whatsoever
unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF , the parties hereto have executed this Agreement as ofthe day and
2 year first hereinabove written.
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CONTRACTORS:
PLEASE SEE ADDITIONAL
SIGNATURE PAGES ATTACHED
COUNTY OF FRESNO
By ££--~~
Chairman, Board of pervtsors
BERNICE E . SEIDEL, Clerk
Board of Supervisors
Date: :Ju.Y"\JL 7 . a.J)\ Lo
j
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Fr esno , CA
Exhibit A
LIST OF CONTRACTORS
CONTRACTOR NAME EXHIBIT REFERENCE
1. Mental Health Management I, Inc., d.b.a. Canyon Manor C-1
2. CF Merced Behavioral, LLC., d.b.a. Merced Behavioral Center C-2
3. Crestwood Behavioral Health Inc. C-3
4. Golden State Health Centers, Inc., d.b.a.
Sylmar Health and Rehabilitation Center
C-4
5. Helios Healthcare, LLC., d.b.a. Idylwood Care Center C-5
6. KF Community Care, LLC., d.b.a. Community Care Center C-6
7. Telecare Corporation C-7 (a-g)
8. Vista Pacifica Enterprises, Inc., d.b.a. Vista Pacifica Center
and d.b.a. Vista Pacifica Convalescent
C-8 (a-b)
9. Medical Hill Rehab Center, LLC., d.b.a.
Kindred Nursing and Rehabilitation – Medical Hill
C-9
10. 7th Avenue Center C-10
Exhibit B
Page 1 of 15
SCOPE OF WORK
I. GEROPSYCHIATRIC NURSING CARE SERVICES
Fresno County Department of Behavioral Health (DBH) is responsible for the provision of appropriate Skilled
Nursing Facility (SNF) and Geropsychiatric Nursing Care Facility (GNCF) services to Fresno County residents
who are age 65 years or older, have serious and persistent psychiatric impairment and problems with their
physical health.
SNFs operate under Title 22, California Code of Regulations, sections 51335, 71443-724 75 and the California
Department of Health Care Services’ (DHCS) Policies and Directives. Title 22 of the California Code of
Regulations describes and defines programs that serve clients who have a chronic psychiatric impairment
and whose adaptive functioning is moderately impaired.
A. GOALS AND OBJECTIVES
1. Provide a safe and healthful living environment;
2. Control and modify the person's destructive behavior patterns;
3. Prevent or reduce acute psychiatric hospitalizations or long-term hospitalization;
4. Provide care as close to the client's home community (Fresno County) as possible; and
5. Provide high quality care and supervision at the lowest appropriate cost.
B. LOCATION
The location of the facility should be in relatively close proximity to Fresno County. This will help
expedite the integration of these clients back into community living, decrease the travel expense
required by court hearings and staff travel, and facilitate involvement by family and friends for client
support.
C. TYPES OF SERVICES
The Department of Behavioral Health contracts for a number of SNF beds for both Basic and Enhanced
levels of care. The rates for the Basic Services per bed per day are dictated by the State. Enhanced
Services are described in Subsection 6.B below. The following are the types of SNF beds needed,
depending on a client's mental/physical health condition:
1. Basic Services: includes reasonable access to required medical treatment, up-to-date
psychopharmacology and transportation to needed off-site services, and bilingual/bicultural
programming, as appropriate.
2. Secured SNF: includes the services listed under "Basic Services" in a secured environment, but
not in a locked facility.
3. Locked SNF with or without enhanced services: includes the services listed under "Basic
Services" in a locked building.
4. Sub-Acute SNF: includes services that are non-acute 24-hour voluntary or involuntary care that
is required for the provision of mental health services to clients with serious mental conditions
who are not in need of acute mental health care, but who require general mental health
evaluation, diagnostic assessment, treatment, nursing and/or related services, on a 24-hour per
day basis in order to achieve stabilization and/or an optimal level of functioning. Such clients are
those who, if in the community, would require the services of a licensed health facility providing
24-hour sub-acute mental health care. Such facilities include, but are not limited to, skilled
nursing facilities with special treatment programs. Sub-acute has the same meaning as non-
acute as defined in this section.
Exhibit B
Page 2 of 15
5. Special Treatment Program: therapeutic services provided to clients with serious mental
conditions having special needs in one (1) or more of the following areas: self-help skills,
behavioral adjustment, and interpersonal relationships. They also include pre-vocational
preparation and pre-release planning. Contractor will provide a copy of the Policy or Procedure
Guide (PPG) on agency's Special Treatment Program to the Department of Behavioral Health
within ten (10) working days from the day the Agreement becomes effective. The PPG is to be
sent to Department of Behavioral Health, Attn: Contracted Services Division – Mental Health,
3133 N. Millbrook Avenue, Fresno, California 93703.
6. SERVICES:
A. Basic Services:
i. Treatment Setting
1. A facility that provides reasonable security, supervision, and substantial
compliance. Substantial compliance means conformity to regulations to
be a licensee to such an extent that client safety, welfare, and quality of
care is assured.
2. Development of an individual, written client care plan which indicates
the care to be given, the objectives to be accomplished, and the
professional discipline responsible for each element of care. Objectives
shall be measurable and time limited. For specifics on supervision, refer
to Title 22.
3. Safeguards for clients' monies and valuables. For specifics, refer to Title
22.
4. Activity Programs (Title 22, California Code of Regulations, and State
DHCS' Policies and Directives):
a. An activity program means a program that is staffed and
equipped to encourage the participation of each client, meets
the needs and interests of each client, and encourages self-care
and resumption of normal activities.
b. Clients shall be encouraged to participate in activities planned
to meet their individual needs. An activity program shall have a
written, planned schedule of social and other purposeful
activities.
c. The program shall be designed to make life more meaningful, to
stimulate and support physical and mental capabilities to the
fullest extent, to enable the client to maintain the highest
attainable social, physical, and emotional functioning, but not
necessarily to correct or remedy a disability.
d. The activity program shall consist of individual, small and large
group activities designed to meet the needs and interests of
each client.
5. The provision for basic living needs includes, but is not limited to food,
laundry, and care of resident's personal clothing, and security of
personal items.
Exhibit B
Page 3 of 15
a. The dietetic service shall provide food of the quality and
quantity to meet each client's needs in accordance with the
physician's orders and meets "the recommended daily dietary
allowance" as specified in the most current edition adopted by
the Food and Nutrition Board of the National Research Council
of the National Academy of Sciences. For specifics, refer to Title
22.
b. Laundry and care of residents' personal clothing - for specific
information, refer to Title 22, for specifics.
c. Security of personal items and safeguards for clients' monies
and valuables - for specific information, refer to Title 22 for
specifics.
d. Resident Security - It is expected that these residents may be
segregated from other residents of the facility to insure
security.
ii. Clinical
1. Pre-admission screening process.
2. Admission policy describing the extent of the facility's right of refusal.
3. Review process, if requested, for persons not accepted for admission or
discharged as inappropriate for the facility.
4. Program designed to modify combative behavior, protect the client,
prevent the breakage of property, and promote personal responsibility
for behavior.
5. Use of restraints and postural supports. For specifics, refer to Title 22.
6. Provision of medical care with availability of physician services for
treatment of any physical ailments of the clients housed at the facility.
7. Consultation and/or case staffing to be held with appropriate County
assigned mental health professionals, as needed, but no less frequently
than on a quarterly basis.
iii. Administration
1. Administrator will meet with the County’s DBH Adult Services Division
Manager, or designee, as required to monitor the Agreement.
2. Facility will immediately report all incidents involving Fresno County
clients to the contract liaison. Notification will be made to Fresno
County in cases of illegality, death, self-injury, absence without leave,
property destruction and violence towards others.
3. Daily census records will be maintained and sent to the County’s DBH
Adult Services Division Manager.
4. Prepare reports as may be required to fulfill the terms of the
agreement.
5. Occurrences such as epidemic outbreaks, poisoning, fires, major
accidents, death from unnatural causes or other catastrophes and
Exhibit B
Page 4 of 15
unusual occurrences which threaten the welfare, safety, or health of
clients, personnel, or visitors shall be reported by the facility within
twenty-four (24) hours, either by telephone at (559) 600-9180, and
confirmed in writing, or by fax at (559) 600-7674 to the Director,
Department of Behavioral Health. An incident report shall be prepared
by Contractor, on each occurrence.
6. Every incident report shall be retained on file by the facility for one (1)
year. The facility shall furnish such other pertinent information related
to such occurrences to the Director, Department of Behavioral Health
3133 N. Millbrook Avenue, Fresno, California 93703, upon request.
7. Every fire or explosion that occurs in or on the premises shall be
reported within twenty-four (24) hours to the local fire authority or, in
areas not having an organized fire service, to the State Fire Marshal.
Contractor shall meet all fire safety requirements set by the local Fire
Marshal and other requirements cited in the California Health and
Safety Code.
8. All facilities shall have a placement contact person readily available to
respond to requests for placements from the County. This is to prevent
placement delays in placing a client at the appropriate level of care.
9. No notice is required to move a person to a different level of care or
when there is a need to discharge the client because this is dependent
on clinical prognosis.
10. The daily rate for the client will be commensurate with the level of care
being provided at that facility.
11. All services, other than the Basic Services, must be pre-approved prior
to placement utilizing Special Services Authorization Form (Exhibit G),
attached hereto to this Agreement and by this reference incorporated
herein.
12. For the purposes of this Agreement, the term "bed day" includes beds
held vacant for patients who are temporarily (not more than seven (7)
days) absent from a facility. Contractor will notify County in the event
that a client has to be moved to an acute treatment facility and a bed
hold needs to be made. County will approve any bed-hold days that may
be required on a case-by-case basis.
B. Enhanced Services:
Enhanced Services augment the services of Basic and Special Treatment Programs.
Enhanced Services are designed to serve clients who have sub-acute psychiatric
impairment and/or whose adaptive functioning is severely impaired.
The target population is adults with serious and persistent mental health conditions
whose behavior requires more intensive programming than is available from Basic
Services. It is anticipated that the intensive treatment and staffing provided by
enhanced services will prevent State Hospital admissions. The target population may
include persons who are often at risk of elopement and occasionally assaultive or self-
destructive. They may have complicating medical problems. Additionally, they may
require specialized services to insure successful transition to community living.
Exhibit B
Page 5 of 15
Clients needing these services are male or female; have a major psychiatric diagnosis,
organic brain syndrome or major mental disorder; are a LPS conservatee of Fresno
County; may be physically impaired, perhaps non-ambulatory; and present a special or
unusual behavior management issue.
The major objectives for these services are: to control and modify the client's
destructive behavior; and, to prevent or reduce acute psychiatric hospitalization or long-
term State hospitalization.
D. REPORTING/OUTCOMES
Contractor shall be required to submit monthly census reports detailing the number of County clients
living in the facility on a daily basis.
Contractor shall provide, at County’s request, any required reports to County, which may include
performance outcome measurement reports as communicated by the County to Contractor. Outcome
measures may include, but are not limited to:
• Successful program completion and transition to lower level of care placement
• Reduced or no inpatient hospitalizations
• Reduced or no incidents of self-injury, injury to others or property damage
• Reduced or no incidents of medical emergency or hospitalization
E. OBJECTIVES/EVALUATION
A strong evaluation component will be required for these services. Contractor will be required to have
an evaluation program that includes observable, measurable, time-limited outcome and process
objectives. The evaluation program will be submitted in writing to the assigned DBH Mental Health
Contracts Analyst for review and approval by the County within sixty (60) days after the Agreement is
executed. Process objectives are defined as those describing or delineating the amount, frequency, and
kinds of services to be provided. Outcome objectives are those indicators that describe the effect of
program activities on client behavior or status.
F. CORPORATIONS
For incorporated businesses, the Contractor shall notify the Department of all facilities that the
Department of Behavioral Health might use.
G. INSURANCE
Contractor will provide County with new certificates of insurance if there is any change in coverage.
H. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
County and Contractor each consider and represent themselves as covered entities as defined by the
U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA) and agree
to use and disclose protected health information as required by law.
I. County reserves the right to revise and/or update the Scope the Work as needed, within the regulations
of applicable CCR, CFR, and/or WIC codes.
Exhibit B
Page 6 of 15
SCOPE OF WORK (Continued)
II. LOCKED SKILLED NURSING FACILITY CARE / INSTITUTIONS OF MEDICAL DISEASE SERVICES
Fresno County Department of Behavioral Health is responsible for the provision of appropriate locked Skilled
Nursing Facility/Institutions for Mental Disease (SNF/IMD) services to Fresno County residents eighteen (18)
to sixty-four (64) years of age, having serious and persistent psychiatric impairment, and are in need of
Skilled Nursing Facility/Institutions for Mental Disease services (SNF/IMD) with Special Treatment Programs
(STPs) and Enhanced Services.
Skilled Nursing Facility/Special Treatment Program/Institutions for Mental Disease (SNF/STP/IMD) operate
under Title 22, California Code of Regulations, Sections 51335, 71443-72475 and the California Department
of Health Care Service’s (DHCS) Policies and Directives. Title 22 of the California Code of Regulations
describes and defines programs that serve clients who have a chronic psychiatric impairment and whose
adaptive functioning is moderately impaired. Contractor will provide "Basic Services", which include
reasonable access to required medical treatment, up-to-date psychopharmacology and transportation to
needed off-site services, and bilingual/bicultural programming as appropriate.
A. GOALS AND OBJECTIVES
1. Provide a safe and healthful living environment;
2. Control and modify the person's destructive behavior patterns;
3. Prevent or reduce acute psychiatric hospitalizations or long-term hospitalization;
4. Provide care as close to the client's home community (Fresno County) as possible; and
5. Provide high quality care and supervision at the lowest appropriate cost.
B. LOCATION
The location of the facility should be in relatively close proximity to Fresno County. This will help
expedite the integration of these clients back into community living, decrease the travel expense
required for court hearings and staff travel, and facilitate involvement by family and friends for client
support.
C. TYPES OF SERVICES
The Department of Behavioral Health contracts for a number of SNF/STP/IMD beds for both Basic and
Enhanced levels of care. The distribution, types, and total number of beds depend on the facilities
selected. The rates for the Basic services per bed per day are dictated by the State. Enhanced services
are described in Subsection 3 below.
1. Basic Services:
A. Treatment Setting
i. A facility that provides reasonable security, supervision, and substantial
compliance. Substantial compliance means conformity to regulations to be a
licensee to such an extent that client safety, welfare, and quality of care is
assured.
ii. Development of an individual, written client care plan which indicates the care
to be given, the objectives to be accomplished, and the professional discipline
responsible for each element of care. Objectives shall be measurable and time
limited. For further specifics on supervision, refer to Title 22.
iii. Safeguards for clients' monies and valuables. For specifics, refer to Title 22.
iv. Activity Programs (Title 22, California Code of Regulations, and State DHCS'
Policies and Directives):
Exhibit B
Page 7 of 15
a. An activity program means a program that is staffed and equipped to
encourage the participation of each client, meets the needs and
interests of each client, and encourages self-care and resumption of
normal activities.
b. Clients shall be encouraged to participate in activities planned to meet
their individual needs. An activity program shall have a written, planned
schedule of social and other purposeful activities.
c. The program shall be designed to make life more meaningful, to
stimulate and support physical and mental capabilities to the fullest
extent, to enable the client to maintain the highest attainable social,
physical, and emotional functioning, but not necessarily to correct or
remedy a disability.
d. The activity program shall consist of individual, small and large group
v. The provision for basic living needs includes, but is not limited to food, laundry,
and care of resident's personal clothing, and security of personal items.
a. The dietetic service shall provide food of the quality and quantity to
meet each client's needs in accordance with the physician's orders and
meets "the recommended daily dietary allowance" as specified in the
most current edition adopted by the Food and Nutrition Board of the
National Research Council of the National Academy of Sciences. For
specifics, refer to Title 22.
b. Laundry and care of residents' personal clothing - refer to Title 22 for
specific information.
c. Security of personal items and safeguards for clients' monies and
valuables - refer to Title 22 for specific information.
vi. Resident Security - It is expected that these residents may be segregated from
other residents of the facility to insure security.
B. Clinical
i. Pre-admission screening process.
ii. Admission policy describing the extent of the facility's right of refusal.
iii. Review process, if requested, for persons not accepted for admission or
discharged as inappropriate for the facility.
iv. Program designed to modify combative behavior, protect the client, prevent the
breakage of property, and to promote personal responsibility for behavior.
v. Use of restraints and postural supports. For specifics, refer to Title 22 related to
these issues.
vi. Consultation and/or case staffing to be held with appropriate County assigned
mental health professionals, as needed, but no less frequently than on a
quarterly basis.
C. Administration
i. Administrator will meet with the assigned DBH Mental Health Contracts Analyst,
or designee, as required to monitor the contract.
Exhibit B
Page 8 of 15
ii. Facility will immediately report all incidents involving Fresno County clients to
the contract liaison. Notification will be made to Fresno County in cases of
illegality, death, self-injury, absence without leave, property destruction and
violence towards others.
iii. Daily census records will be maintained and sent to the County’s DBH Adult
Services Division Manager.
iv. Prepare reports as may be required to fulfill the terms of the agreement.
v. Occurrences such as epidemic outbreaks, poisoning, fires, major accidents,
death from unnatural causes or other catastrophes and unusual occurrences
which threaten the welfare, safety, or health of clients, personnel, or visitors
shall be reported by the facility within twenty-four (24) hours, either by
telephone at (559) 600-9180, and confirmed in writing, or by fax at (559) 600-
7674 to the Director, Department of Behavioral Health. An incident report shall
be prepared by the Contractor on each occurrence.
vi. Every incident report shall be retained on file by the facility for one (1) year. The
facility shall furnish such other pertinent information related to such
occurrences to the Director, Department of Behavioral Health 3133 N. Millbrook
Avenue, Fresno, California 93703, upon request.
vii. Every fire or explosion that occurs in or on the premises shall be reported within
twenty-four (24) hours to the local fire authority or, in areas not having an
organized fire service, to the State Fire Marshal. Contractor shall meet all fire
safety requirements set by the local Fire Marshal and other requirements cited
in the California Health and Safety Code.
viii. All facilities shall have a placement contact person readily available to respond
to requests for placements from the County. This is to prevent placement delays
in placing a client at the appropriate level of care.
ix. No notice is required to move a person to a different level of care or when there
is a need to discharge the client because this is dependent on clinical prognosis.
x. The daily rate for the client will be commensurate with the level of care being
provided at that facility.
xi. All services, other than the Basic Services, must be pre-approved prior to
placement utilizing Special Services Authorization Form (Exhibit G).
xii. For the purposes of this Agreement, the term "bed day" includes beds held
vacant for patients who are temporarily (not more than seven (7) days) absent
from a facility. Contractor will notify County in the event that a client has to be
moved to an acute treatment facility and a bed hold needs to be made. County
will approve any bed-hold days that may be required on a case-by-case basis.
Exhibit B
Page 9 of 15
2. Special Treatment Program
Special Treatment Program (STP) services are those therapeutic services provided to clients with
serious mental health conditions having special needs in one (1) or more of the following areas:
self-help skills, behavioral adjustment, and interpersonal relationships. They also include pre-
vocational preparation and pre-release planning.
Contractor shall provide a copy of the Policy and Procedure Guide (PPG) on agency's Special
Treatment Program/Approach to the Department of Behavioral Health within ten (10) working
days from the day the Agreement becomes effective. The PPG is to be sent to the Department
of Behavioral Health, Attn: Mental Health Contracted Services Division, 3133 N. Millbrook
Avenue, Fresno, California 93703.
3. Enhanced Services
Enhanced Services augment the services of Basic and Special Treatment Programs. Enhanced
Services are designed to serve clients who have sub-acute psychiatric impairment and/or whose
adaptive functioning is severely impaired.
The target population is adults with serious and persistent mental health conditions whose
behavior requires more intensive programming than is available from Basic Services. It is
anticipated that the intensive treatment and staffing provided by Enhanced Services will prevent
State Hospital admissions. The target population may include persons who are often at risk of
elopement and occasionally assaultive or self-destructive. They may have complicating medical
problems. Additionally, they may require specialized services to insure successful transition to
community living.
Clients needing these services may be male or female; have a major psychiatric diagnosis,
organic brain syndrome or major mental disorder; are a LPS conservatee Fresno County; are
physically impaired, perhaps non-ambulatory; and present a special or unusual behavior
management issue.
The major objectives for these services are: to control and modify the client's destructive
behavior; provide a safe, secure, and healthful environment; provide adequate supervision; and,
prevent or reduce acute psychiatric hospitalization or long-term State hospitalization.
D. REPORTING/OUTCOMES
Contractor shall be required to submit monthly census reports detailing the number of County clients
living in the facility on a daily basis.
Contractor shall provide, at County’s request, any required reports to County, which may include
performance outcome measurement reports as communicated by the County to Contractor. Outcome
measures may include, but are not limited to:
• Successful program completion and transition to lower level of care placement
• Reduced or no inpatient hospitalizations
• Reduced or no incidents of self-injury, injury to others or property damage
• Reduced or no incidents of medical emergency or hospitalization
E. OBJECTIVES/EVALUATION
A strong evaluation component will be required for these services. Contractor will be required to have
an evaluation program that will include observable, measurable, time-limited outcome and process
objectives. The evaluation program will be submitted in writing to the assigned DBH Mental Health
Contracts Analyst for review and approval by the County within sixty (60) days after the Agreement is
executed. Process objectives are defined as those describing or delineating the amount, frequency, and
Exhibit B
Page 10 of 15
kinds of services to be provided. Outcome objectives are those indicators that describe the effect of
program activities on client behavior or status.
F. CORPORATIONS
For incorporated businesses, the Contractor shall notify the Department of all facilities that the
Department of Behavioral Health might use.
G. INSURANCE
Contractor will provide County with new certificates of insurance if there is any change in coverage.
H. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
County and Contractor each consider and represent themselves as covered entities as defined by the
U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA) and agree
to use and disclose protected health information as required by law.
I. County reserves the right to revise and/or update the Scope the Work as needed, within the regulations
of applicable CCR, CFR, and/or WIC codes.
Exhibit B
Page 11 of 15
SCOPE OF WORK (Continued)
III. MENTAL HEALTH REHABILITATION CENTERS
Mental Health Rehabilitation Centers (MHRCs) provide intensive support and rehabilitation to clients as an
alternative to state hospital or other 24-hour care facilities. MHRCs help clients develop the skills to become
self-sufficient and increase their levels of independent functioning.
MHRCs operate under Title 9, California Code of Regulations, Division 1, and the California Department of
Health Care Services’ Policies and Directives. Participation in MHRCs is limited to facilities that meet the
licensing and certification requirements of the California Department of Health Care Services Licensing and
Certification Division.
MHRCs are needed for clients upon discharge from an acute inpatient psychiatric facility or outpatient crisis
stabilization program like the twenty-four (24) hour program providing intensive services to persons
eighteen (18) years of age or older. These clients would otherwise be placed in a State hospital or another
mental health facility to develop skills to become self-sufficient and increase their levels of independent
functioning.
The contracted MHRC(s) focus on mental health rehabilitation, rather than skilled nursing, and will include
short-term, rehabilitative, individualized, goal-oriented programs. The length of stay for clients with serious
mental health conditions will vary. A newly conserved client may reside in the facility for ninety (90) days,
whereas, another client may reside in the facility from eight (8) to eleven (11) months. The target population
may include clients who have an active temporary conservatorship; and, recently conserved Fresno County
clients (no longer than three (3) years), or clients who are unsuccessful in transitioning from an IMD to a
lower level of care.
Specific "Basic Services" are outlined in Title 22, California Code of Regulations, which describes and defines
programs that serve clients who have a chronic psychiatric impairment and whose adaptive functioning is
moderately impaired.
It is expected that the Contractor will provide "Basic Services", which include reasonable access to required
medical treatment, up-to-date psychopharmacology and transportation to needed off-site services, and
bilingual/bicultural programming as appropriate
A. GOALS AND OBJECTIVES
1. Offer early restorative interventions;
2. Avoid admissions of clients to acute level facilities who do not meet medical necessity criteria;
3. Decrease the average length of stay and administrative stay days in acute psychiatric facilities by
providing a more appropriate treatment program;
4. Avoid extended hospital stays of clients waiting for placement at other sub-acute, long-term or
out-of-County facilities;
5. Interrupt the cycle of increased dependence on the utilization of skilled nursing facilities as a
placement option;
6. Decrease recidivism; and
7. Provide a safe and healthful living environment.
B. LOCATION
The location of the facility should be in relatively close proximity to Fresno County. This will help
expedite the integration of these clients back into community living, decrease the travel expense
required by court hearing and staff travel, and facilitate involvement by family and friends for client
support.
Exhibit B
Page 12 of 15
C. TYPES OF SERVICES
The Department of Behavioral Health contracts for a number of MHRC beds. The distribution, types, and
total number of beds depend on the facilities available.
1. Basic Services:
A. Treatment Setting
i. A facility that provides reasonable security, supervision, and substantial
compliance. Substantial compliance means conformity to regulations to be a
licensee to such an extent that client safety, welfare, and quality of care is
assured.
ii. Development of an individual, written client care plan which indicates the care
to be given, the objectives to be accomplished, and the professional discipline
responsible for each element of care. Objectives shall be measurable and time
limited. For further specifics on supervision, refer to Title 22.
iii. Safeguards for clients' monies and valuables. For specifics, refer to Title 22. 4.
iv. Activity Programs (Title 9, Title 22, California Code of Regulations, and State
DHCS' Policies and Directives):
a. An activity program means a program that is staffed and equipped to
encourage the participation of each client, to meet the needs and
interests of each client, and encourage self-care and resumption of
normal activities.
b. Clients shall be encouraged to participate in activities planned to meet
their individual needs. An activity program shall have a written, planned
schedule of social and other purposeful activities. The program shall be
designed to make life more meaningful and to stimulate and support
physical and mental capabilities to the fullest extent, and enable the
client to maintain the highest attainable social, physical, and emotional
functioning but not necessarily to correct or remedy a disability.
c. The activity program shall consist of individual, small and large group
activities that are designed to meet the needs and interests of each
client.
v. The provision for basic living needs includes, but is not limited to food, laundry,
and care of resident's personal clothing, and security of personal items.
a. The dietetic service shall provide food of the quality and quantity to
meet each client's needs in accordance with the physician's orders and
meets "the recommended daily dietary allowance" as specified in the
most current edition adopted by the Food and Nutrition Board of the
National Research Council of the National Academy of Sciences. For
specifics, refer to Title 22.
b. Laundry and care of residents' personal clothing. Refer to Title 22 for
specific information.
c. Security of personal items and safeguards for clients' monies and
valuables. Refer to Title 22 for specific information.
Exhibit B
Page 13 of 15
vi. Resident Security - It is expected that these residents may be segregated from
other residents of the facility to insure security.
B. Clinical
i. Pre-admission screening process.
ii. Admission policy describing the extent of the facility's right of refusal.
iii. Review process, if requested, for persons not accepted for admission or
discharged as inappropriate for the facility.
iv. Program designed to modify combative behavior; protect the client; prevent the
breakage of property; and, promote personal responsibility for behavior.
v. Use of restraints and postural supports. For specifics, refer to Title 22.
vi. Consultation and/or case staffing to be held with appropriate County-assigned
mental health professionals, as needed, on a quarterly basis.
C. Administration
i. Administrator will meet with the County’s DBH Adult Services Division Manager,
or designee, as required to monitor the contract.
ii. Facility will immediately report all incidents involving Fresno County clients to
the contract liaison. Notification will be made to Fresno County in cases of
illegality, death, self-injury, absence without leave, property destruction and
violence towards others.
iii. Daily census records will be maintained and sent to the County’s DBH Adult
Services Division Manager.
iv. Prepare reports as may be required to fulfill the terms of the agreement.
v. Occurrences such as epidemic outbreaks, poisoning, fires, major accidents,
death from unnatural causes or other catastrophes and unusual occurrences
which threaten the welfare, safety, or health of clients, personnel, or visitors
shall be reported by the facility within twenty-four (24) hours, either by
telephone at (559) 600-9180, and confirmed in writing, or by fax at (559) 600-
7674 to the Director, Department of Behavioral Health. An incident report shall
be prepared by the Contractor on each occurrence.
vi. Every incident report shall be retained on file by the facility for one (1) year. The
facility shall furnish such other pertinent information related to such
occurrences to the Director, Department of Behavioral Health, 3133 N.
Millbrook Avenue, Fresno, California 93703.
vii. Every fire or explosion that occurs in or on the premises shall be reported within
twenty-four (24) hours to the local fire authority or, in areas not having an
organized fire service, to the State Fire Marshal. Contractor shall meet all fire
safety requirements set by the local Fire Marshal and other requirements cited
in the California Health and Safety Code.
viii. All facilities shall have a placement contact person readily available to respond
to requests for placements from the County. This is to prevent placement delays
in placing a client at the appropriate level of care.
Exhibit B
Page 14 of 15
ix. No notice is required to move a person to a different level of care or when there
is a need to discharge the client because this is dependent on clinical prognosis.
x. The daily rate for the client will be commensurate with the level of care
provided at that facility.
xi. All services, other than the Basic Services, must be pre-approved prior to
placement utilizing Special Services Authorization Form (Exhibit G)
xii. For the purposes of this Agreement, the term "bed day" includes beds held
vacant for patients who are temporarily (not more than seven (7) days) absent
from a facility. Contractor will notify County in the event that a client has to be
moved to an acute treatment facility and a bed hold needs to be made. County
will approve any bed-hold days that may be required on a case-by-case basis.
2. Special Treatment Program:
The MHRC(s) will focus on mental health rehabilitation, rather than skilled nursing, and will
include short-term, rehabilitative, individualized, goal-oriented special treatment programs. The
length of stay for clients with serious mental health conditions will vary.
3. Enhanced Services:
Enhanced Services augment the services of Basic and Special Treatment Programs. Enhanced
Services are designed to serve clients who have sub-acute psychiatric impairment and/or whose
adaptive functioning is severely impaired.
The target population is adults with serious and persistent mental health conditions whose
behavior requires more intensive programming than is available from Basic Services. It is
anticipated that the intensive treatment and staffing provided by enhanced services will prevent
State Hospital admissions. The target population may include persons who are often at risk of
elopement and occasionally assaultive or self-destructive. They may have complicating medical
problems. Additionally, they may require specialized services to insure successful transition to
community living.
Clients needing these services may be male or female; have a major psychiatric diagnosis,
organic brain syndrome, or major mental disorder; are a LPS conservatee of Fresno County; may
be physically impaired; and present a special or unusual behavior management issue.
The major objectives for these services are: to control and modify the client's destructive
behavior; provide a safe, secure, and healthful environment; provide adequate supervision; and,
prevent or reduce acute psychiatric hospitalization or long-term State hospitalization.
D. TARGET POPULATION:
1. Clients who no longer are in need of acute hospital care.
2. Clients who have an active temporary conservatorship.
3. Recently conserved Fresno County clients (no longer than three (3) years).
Exhibit B
Page 15 of 15
E. REPORTING/OUTCOMES
Contractor shall be required to submit monthly census reports detailing the number of County clients
living in the facility on a daily basis.
Contractor shall provide, at County’s request, any required reports to County, which may include
performance outcome measurement reports as communicated by the County to Contractor. Outcome
measures may include, but are not limited to:
• Successful program completion and transition to lower level of care placement
• Reduced or no inpatient hospitalizations
• Reduced or no incidents of self-injury, injury to others or property damage
• Reduced or no incidents of medical emergency or hospitalization
F. OBJECTIVES/EVALUATION
A strong evaluation component will be required for these services. Contractor will be required to have
an evaluation program that will include observable, measurable, time-limited outcome and process
objectives. The evaluation program will be submitted in writing to the assigned DBH Mental Health
Contracts Analyst for review and approval by the County within sixty (60) days after the Agreement is
executed. Process objectives are defined as those describing or delineating the amount, frequency, and
kinds of services to be provided. Outcome objectives are those indicators that describe the effect of
program activities on client behavior or status.
G. CORPORATIONS
For incorporated businesses, the Contractor shall notify the Department of all facilities that the
Department of Behavioral Health might use.
H. INSURANCE
Contractor will provide County with new certificates of insurance if there is any change in coverage.
I. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
County and Contractor each consider and represent themselves as covered entities as defined by the
U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA) and agree
to use and disclose protected health information as required by law.
J. County reserves the right to revise and/or update the Scope the Work as needed, within the regulations
of applicable CCR, CFR, and/or WIC codes.
EXHIBIT C-1
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
MENTAL HEALTH MANAGEMENT I, INC., d.b.a. CANYON MANOR
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the State Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, transportation to needed off-site services and
bilingual/bicultural programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
this Agreement. The County does not guarantee any minimum number of beds.
IV. RATES
Program Services Rate
Basic Daily Rate* $305.14
* The Basic Daily Rate shall be inclusive of all psychiatric services such as weekly visits, initial
psychiatric assessment and two affidavits for LPS conservatorship renewal per year.
EXHIBIT C-1
Page 2 of 3
**Any rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate higher
than the Basic Rate Services, both the rationale and the extra services must be specified and
time-limited and approval must be sought using the Special Services Authorization Form
(Exhibit G).
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-2
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
CF MERCED BEHAVIORAL, LLC, d.b.a. MERCED BEHAVIORAL CENTER
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the State Department of Health Care Services’ Policies and Directives; and other
applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES:
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions, plus those services that are included in Special Treatment programs
as contained in Title 22 of the California Code of Regulations, sections 72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services and bilingual/bicultural
programming.
SPECIAL TREATMENT PROGRAMS:
Special Treatment Programs (STP) serve clients who have a chronic psychiatric impairment and
whose adaptive functioning is moderately impaired. These clients require continuous
supervision and may be expected to benefit from an active rehabilitation program designed to
improve their adaptive functioning or prevent any further deterioration of their adaptive
functioning. Services are provided to individuals having special needs or deficits in one (1) or
more of the following areas: self-help skills; behavioral adjustment; interpersonal relationships;
pre-vocation preparation, alternative placement planning, and/or pre-release planning.
II. ENHANCED SERVICES:
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated for an individual
client on an as-needed basis between the County’s Department of Behavioral Health (DBH)
Director, or designee, and Contractor for Enhanced and STP services by using the Special
Services Authorization Form (Exhibit G). The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place.
EXHIBIT C-2
Page 2 of 3
III. REQUIREMENTS:
Contractor shall provide up to thirty-five (35) beds per day for authorized County clients during
each term of the Agreement. In addition, Contractor shall provide additional beds as needed by
the County, subject to availability of said beds by the Contractor. The County does not
guarantee any minimum number of beds for all services provided by the Contractor and
payment will be based on usage.
IV. RATES:
Program Services Rate
Basic Daily Rate $191.69
Bed Hold Rate $184.61
Enhanced Services Rate* Negotiable with Pre-Authorization
*All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
Rates are inclusive of psychiatric services.
Rate is set at the State Medi-Cal rate and will be adjusted if the Medi-Cal rate changes. In the
event a client is placed who does not have Medi-Cal and is under age 65, County will pay both
the “with Medi-Cal” rate and the “without Medi-Cal” rate above to cover room and board
charges.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-3
Page 1 of 9
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
CRESTWOOD BEHAVORIAL HEALTH, INC.
Contractor has many facilities throughout the State of California providing all services listed in Exhibit B
and agrees to provide County with the agreed upon services for adults with mental health conditions,
pursuant to Welfare and Institutions Code, Section 5900 et seq., Title 22 of the California Code of
Regulations, the California Department of Health Care Services’ Policies and Directives, and other
applicable statues and regulations at the following types of facilities: Skilled Nursing Facility (SNF),
Institutions of Mental Disease (IMD), Geropsychiatric Nursing Care Facilities (GNCF), and Mental
Health Rehabilitation Center (MHRC).
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES:
Basic Daily Rate services are listed by facility listed in Exhibit C-3 pages 4 through 9. Services
provided are itemized within the “”Scope of Work” (Exhibit B).
SPECIAL TREATMENT PROGRAMS
Special Treatment Programs (STP) serve clients who have a chronic psychiatric impairment and
whose adaptive functioning is moderately impaired. These clients require continuous
supervision and may be expected to benefit from an active rehabilitation program designed to
improve their adaptive functioning or prevent any further deterioration of their adaptive
functioning. Services are provided to individuals having special needs or deficits in one (1) or
more of the following areas: self-help skills; behavioral adjustment; interpersonal relationships;
pre-vocation preparation, alternative placement planning, and pre-release planning.
II. ENHANCED SERVICES:
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated for an individual
client on an as-needed basis between the County’s Department of Behavioral Health (DBH)
Director, or designee, and Contractor for Enhanced and STP services by using the Special
Services Authorization Form (Exhibit G). The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place.
EXHIBIT C-3
Page 2 of 9
III. REQUIREMENTS:
Contractor shall provide available beds needed for authorized County clients during each term
of this Agreement. The County does not guarantee any minimum number of beds for all
services provided by the Contractor and payment will be based on usage.
IV. RATES:
Contractor’s rates are identified in pages 4-9 of this Exhibit C-3.
All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-3 Page 4 of 9
EXHIBIT C-3 Page 5 of 9
EXHIBIT C-3 Page 6 of 9
EXHIBIT C-3 Page 7 of 9
EXHIBIT C-3 Page 8 of 9
EXHIBIT C-3 Page 9 of 9
EXHIBIT C-4
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
GOLDEN STATE HEALTH CENTERS, INC.,
d.b.a. SYLMAR HEALTH AND REHABILITATION CENTER
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the California Department of Health Care Services’ Policies and Directives; and
other applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions. Basic Daily Rate services include reasonable access to required
medical treatment, up-to-date psychopharmacology, transportation to needed off-site services
and bilingual/bicultural programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
Other charges in addition to the Enhanced Services bed rate may be negotiated for an
individual client on an as-needed basis between County’s Department of Behavioral Health
(DBH) Director, or designee, and Contractor. The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place. Approval for such services may be sought using the Special Services Authorization Form
(Exhibit G).
III. SUB-ACUTE TREATMENT SERVICES
Sub-acute SNF includes services that are non-acute 24-hour voluntary or involuntary care that
is required for the provision of mental health services to adults with a mental health condition
who are not in need of acute mental health care, but who require general mental health
evaluation, diagnostic assessment, treatment, nursing and/or related services, on a 24-hour per
day basis in order to achieve stabilization and/or an optimal level of functioning. Such clients
are those who, if in the community, would require the services of a licensed health facility
providing 24-hour sub-acute mental health care. Such facilities include, but are not limited to,
Skilled Nursing Facilities with special treatment programs. Sub-acute has the same meaning as
non-acute as defined in this section.
EXHIBIT C-4
Page 2 of 3
IV. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
V. RATES *
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal)** $178.24 per client per day
Bed Hold Rate $171.16 per client per day
Enhanced Services Rate (with Medi-Cal)** $204.09 per client per day
Subacute $253.79 per client per day
Other Services Rate Range
Physician/Psychiatric Services ^ $75.00 - $190.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
The Basic Daily Rate will either be inclusive of all physician/psychiatric services provided to
clients such as weekly visits, which may consist of an initial, brief or routine psychiatric
assessments/visits, and annual evaluation and declarations for LPS conservatorship
renewal, or a separate rate (or rate range) shall be established for psychiatric services as
stated below.
** Rate is set at State Medi-Cal rate and will be adjusted if the Medi-Cal rate changes. In the
event a client is placed who does not have Medi-Cal and is under age 65, County will pay
both the “with Medi-Cal” rate and the “without Medi-Cal” rate above to cover room and board
charges.
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
EXHIBIT C-5
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
HELIOS HEALTHCARE, LLC, d.b.a IDYLWOOD CARE CENTER
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the California Department of Health Care Services’ Policies and Directives; and
other applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. ENHANCED SERVICES:
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
by using the Special Services Authorization Form (Exhibit G).
II. REQUIREMENTS:
Contractor shall provide available beds needed for authorized County clients during each term
of the Agreement. The County does not guarantee any minimum number of beds for all
services provided by the Contractor and payment will be based on usage.
III. RATES:
The following are the rates per client per day:
Program Services Rate
Enhanced Services Rate-Tier 1* $ 105.00 per day
Enhanced Services Rate-Tier 2* $ 124.00 per day
Enhanced Services Rate-Tier 3* $ 150.00 per day
Conversion (requires private room)* $ 270.20 per day
*All rates other than Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
Basic Services, both the rationale and the extra services must be specified and time-limited and
approval must be sought using the Special Services Authorization Form (Exhibit G).
EXHIBIT C-5
Page 2 of 3
The identified rates include room and board, nursing care, special treatment program services,
activity program, over-the-counter medications, diet, etc. Physician services, pharmacy and
other ancillary medical services are not included in the per diem rate and are separately billable
in accordance with Title 22, CCR, section 51511 C.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-6
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
KF COMMUNITY CARE, LLC., d.b.a. COMMUNITY CARE CENTER
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the State Department of Health Care Services’ Policies and Directives; and other
applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions, plus those services that are included in Special Treatment Programs
(STP) as contained in Title 22 of the California Code of Regulations, sections 72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off -site services and bilingual/bicultural
programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit H).
III. SUB-ACUTE TREATMENT SERVICES
Sub-acute SNF includes services that are non-acute 24-hour voluntary or involuntary care that
is required for the provision of mental health services to adults with mental health conditions
who are not in need of acute mental health care, but who require general mental health
evaluation, diagnostic assessment, treatment, nursing and/or related services, on a 24-hour per
day basis in order to achieve stabilization and/or an optimal level of functioning. Such clients
are those who, if in the community, would require the services of a licensed health facility
providing 24-hour sub-acute mental health care. Such facilities include, but are not limited to,
Skilled Nursing Facilities with special treatment programs. Sub-acute has the same meaning as
non-acute as defined in this section.
EXHIBIT C-6
Page 2 of 3
IV. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
V. RATES*
Program Services Rate
Basic Daily Rate (Bungalow) $317.32 per client per day
1:1 Supervision (Bungalow) $12.50 per hour per client
Basic Daily Rate (IMD) $216.30 per client per day
Enhanced Services (IMD) $325.00 per client per day
Other Services Rate (Range) / Unit
Physician/Psychiatric Services ** $60.00-$155.00 per visit
*All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
**Physician/Psychiatric services (provided to clients placed by County at Contractor’s facilities
who are not covered by Medi-Cal, private insurance or personal/other funds) shall be billed
through the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will be
rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-7a
Page 1 of 4
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
MORTON BAKAR CENTER, A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the State Department of Health Care Services’ Policies and Directives; and other
applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES:
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions, plus those services that are included in Special Treatment Programs
as contained in Title 22 of the California Code of Regulations, sections 72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated for an individual
client on an as-needed basis between the County’s Department of Behavioral Health (DBH)
Director, or designee, and Contractor for Enhanced and STP services by using the Special
Services Authorization Form (Exhibit G). The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place.
III. REQUIREMENTS
Contractor shall provide available beds for authorized County clients during each term of the
Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7a
Page 2 of 4
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) ** $222.39 per client
Basic Daily Rate (IMD/STP without Medi-Cal) $222.39 per client
Enhanced Services (with Medi-Cal) ** $127.18 per client
Enhanced Services (without Medi-Cal) $127.18 per client
Bed Hold Rate $349.57 per client
1:1 Supervision $26.72 per hour
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
** Rate is set at State Medi-Cal rate and will be adjusted if the Medi-Cal rate changes. In the
event a client is placed that does not have Medi-Cal and is under age 65, County will pay
both the “with Medi-Cal” rate and the “without Medi-Cal” rate above to cover room and board
charges.
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
EXHIBIT C-7a
Page 3 of 4
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7b
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
CORDILLERAS MENTAL HEALTH CENTER (MHRC),
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the State Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, transportation to needed off-site services and
bilingual/bicultural programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7b
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) $263.10 per client
Bed Hold Rate $263.10 per client
1:1 Supervision $27.34 per hour
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7c
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
GLADMAN MENTAL HEALTH REHABILITATION CENTER,
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the State Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, transportation to needed off-site services and
bilingual/bicultural programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7c
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) $419.82 per client
Bed Hold Rate $419.82 per client
1:1 Supervision $23.50 per hour
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7d
Page 1 of 4
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
LA PAZ GEROPSYCHIATRIC CENTER,
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Geropsychiatric Nursing Care Facility (GNCF) services for
adults age 65 years and older with mental health conditions, pursuant to California’s Welfare and
Institutions Code, section 5900 et seq., Title 22 of the California Code of Regulations, sections 51335,
71443-72475, and the California Department of Health Care Services’ Policies and Directives, and
other applicable statutes and regulations.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults, ages 65
and older, with mental health conditions, plus those services that are included in Special
Treatment Programs as contained in Title 22 of the California Code of Regulations, sections
72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services and bilingual/bicultural
programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated for an individual
client on an as-needed basis between the County’s Department of Behavioral Health (DBH)
Director, or designee, and Contractor for Enhanced and STP services by using the Special
Services Authorization Form (Exhibit G). The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place.
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7d
Page 2 of 4
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) ** $172.41 per client
Basic Daily Rate (IMD/STP without Medi-Cal) $172.41 per client
Enhanced Services (with Medi-Cal) ** $135.20 per client
Enhanced Services (without Medi-Cal) $135.20 per client
1:1 Supervision $20.51 per hour
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
** Rate is set at State Medi-Cal rate and will be adjusted if the Medi-Cal rate changes. In the
event a client is placed that does not have Medi-Cal and is under age 65, County will pay
both the “with Medi-Cal” rate and the “without Medi-Cal” rate above to cover room and board
charges.
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
EXHIBIT C-7d
Page 3 of 4
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7e
Page 1 of 4
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
GARFIELD NEUROBEHAVIORAL CENTER,
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults between the ages of 18 to 64 years with mental health conditions,
pursuant to California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California
Code of Regulations, the State Department of Health Care Services’ Policies and Directives; and other
applicable statutes and regulations that apply to the SNF/IMD facilities and programs.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES:
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions, plus those services that are included in Special Treatment Programs
as contained in Title 22 of the California Code of Regulations, sections 72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services and bilingual/bicultural
programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated for an individual
client on an as-needed basis between the County’s Department of Behavioral Health (DBH)
Director, or designee, and Contractor for Enhanced and STP services by using the Special
Services Authorization Form (Exhibit G). The County’s DBH Director, or designee, must
approve these rates before the client is placed or initiation of any enhanced services takes
place.
III. REQUIREMENTS
Contractor shall provide available beds for authorized County clients during each term of the
Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7e
Page 2 of 4
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) ** $283.52 per client
Basic Daily Rate (IMD/STP without Medi-Cal) $283.52 per client
Enhanced Services (with Medi-Cal) ** $241.11 per client
Enhanced Services (without Medi-Cal) $241.11 per client
Bed Hold Rate $524.63 per client
1:1 Supervision $26.32 per hour
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
** Rate is set at State Medi-Cal rate and will be adjusted if the Medi-Cal rate changes. In the
event a client is placed that does not have Medi-Cal and is under age 65, County will pay
both the “with Medi-Cal” rate and the “without Medi-Cal” rate above to cover room and board
charges.
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
EXHIBIT C-7e
Page 3 of 4
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7f
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
VILLA FAIRMONT MENTAL HEALTH REHABILITATION CENTER,
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the State Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Care Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, bilingual/bicultural programming, and will assist in
arranging transportation to needed off-site services.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7f
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) $375.00 per client
Enhanced Services (with Medi-Cal) $375.00 per client
Bed Hold Rate $375.00 per client
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-7g
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
VILLA FAIRMONT MHRC – FLEX UNIT,
A DIVISION OF TELECARE CORPORATION
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the State Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Care Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, bilingual/bicultural programming, and will assist in
arranging transportation to needed off-site services.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-7g
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal) $440.00 per client
Enhanced Services (with Medi-Cal) $440.00 per client
Bed Hold Rate $440.00 per client
Other Services Rate / Rate Range
Physician/Psychiatric Services ^ $175.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
^ Physician/psychiatric services (provided to clients placed by County at Contractor’s facilities)
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
V. HOLD HARMLESS
Contractor will adhere to the following Hold Harmless clause, in place of the contract language
stated on Page 11, Paragraph 10, Lines 20 through 27 of this Agreement:
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request defend
the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR, its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and
losses occurring to or resulting from any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents or
employees under this Agreement, excluding, however, such liability, claims, losses, damages,
or expenses arising from COUNTY's sole negligence or willful acts.
EXHIBIT C-8a
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
VISTA PACIFICA ENTERPRISES, INC.,
d.b.a. VISTA PACIFICA CENTER
Contractor agrees to provide County with Skilled Nursing Facility (SNF)/Institutions for Mental Disease
(IMD) services for mentally disabled adult persons ages 18 or older, pursuant to California’s Welfare
and Institutions Code, Division 5, commencing with section 5000, Title 22 of the California Code of
Regulations, sections 72001, et seq.; the California Department of Health Care Services’ Policies and
Directives, and other applicable statutes and regulations.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily [not more than seven (7) days] absent from a facility. An emergency IMD bed-hold for
psychiatric reasons beyond one (1) day must be approved by the County’s Department of Behavioral
Health (DBH) Director, or designee. The County will pay for the first bed-hold day and approval may be
provided by the County for an additional two (2) bed-hold days after consulting with the Contractor.
The County will have the final say on a case–by-case basis if an extended bed-hold of beyond three (3)
days is necessary. The Contractor will notify the County immediately if client has a relapse and
Contractor has knowledge that the client will require long-term treatment at an acute facility lasting
seven (7) days or more. A bed-hold day cannot be in place when the client is in a psychiatric health
facility (PHF) or any acute hospital for psychiatric reasons. A bed hold can only be placed for non-
psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary SNF/IMD services to adults with
mental health conditions, plus those services that are included in Special Treatment Programs
as contained in Title 22 of the California Code of Regulations, sections 72443-72475.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services and bilingual/bicultural
programming.
SPECIAL TREATMENT PROGRAMS
Special Treatment Programs (STP) serve clients who have a chronic psychiatric impairment and
whose adaptive functioning is moderately impaired. These clients require continuous
supervision and may be expected to benefit from an active rehabilitation program designed to
improve their adaptive functioning or prevent any further deterioration of their adaptive
functioning. Services are provided to individuals having special needs or deficits in one (1) or
more of the following areas: self-help skills; behavioral adjustment; interpersonal relationships;
pre-vocation preparation, alternative placement planning, and/or pre-release planning.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
EXHIBIT C-8a
Page 2 of 3
A charge in addition to the Enhanced Services bed rate may be negotiated on an individual
client need basis between County’s DBH Director, or designee, and Contractor for Enhanced
and STP services by using the Special Services Authorization Form (Exhibit G). The County’s
DBH Director, or designee, must approve these rates before the client is placed or initiation of
any enhanced services takes place.
III. REQUIREMENTS
Contractor shall provide up to thirty-five (35) beds per day for authorized County clients during
each term of the Agreement. In addition, Contractor shall provide additional beds as needed by
the County, subject to availability of said beds by the Contractor. The County does not
guarantee any minimum number of beds for all services provided by the Contractor and
payment will be based on usage.
IV. RATES*
Program Services Rate
Basic Daily Bed + STP $198.20 per client per day
Bed Hold Rate $191.07 per client per day
Enhanced Services (Negotiable & with Pre-Authorization) Rate
Patch Level A (augmented behavioral problems)+ daily rate $60.00 per client per day
Patch Level B (augmented behavioral problems)+ daily rate $130.00 per client per day
Patch Level C (augmented behavioral problems)+ daily rate $170.00 per client per day
Patch Level D (Competency to Stand Trial)+ daily rate $250.00 per client per day
Other Services Rate Range
Physician Services^ $60.00-$100.00 per visit
*All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
^Psychiatric services (provided to clients placed by County at Contractor’s facilities who are not
covered by Medi-Cal, private insurance or personal/other funds) shall be billed through the
Contractor via the monthly service invoice. Psychiatric services billed by the service provider
on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will be
rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but are not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal
ineligible clients in advance of services being provided, where possible. Ancillary charges for
non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately from the
monthly service invoice and submitted with supporting documentation to County.
EXHIBIT C-8b
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
VISTA PACIFICA ENTERPRISES, INC., d.b.a. VISTA PACIFICA CONVALESCENT
Contractor agrees to provide County with Skilled Nursing Facility (SNF) pursuant to California’s Welfare
and Institutions Code, Division 5, commencing with section 5000, Title 22 of the California Code of
Regulations, sections 72001, et seq.; the California Department of Health Care Services’ Policies and
Directives, and other applicable statutes and regulations.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily [not more than seven (7) days] absent from a facility. An emergency bed-hold for
psychiatric reasons beyond one (1) day must be approved by the County’s Department of Behavioral
Health (DBH) Director, or designee. The County will pay for the first bed-hold day and approval may be
provided by the County for an additional two (2) bed-hold days after consulting with the Contractor.
The County will have the final say on a case–by-case basis if an extended bed-hold of beyond three (3)
days is necessary. The Contractor will notify the County immediately if client has a relapse and
Contractor has knowledge that the client will require long-term treatment at an acute facility lasting
seven (7) days or more. A bed-hold day cannot be in place when the client is in a psychiatric health
facility (PHF) or any acute hospital for psychiatric reasons. A bed hold can only be placed for non-
psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES:
Basic Daily Rate services consist of usual and customary SNF services to adults with medical
and mental health conditions.
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services and bilingual/bicultural
programming.
II. ENHANCED SERVICES:
Enhanced Services consist of specialized program services, which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
A charge in addition to the Enhanced Services bed rate may be negotiated on an individual
client need basis between the County’s Department of Behavioral Health (DBH) Director, or
designee, and Contractor for Enhanced and Behavioral Services by using the Special Services
Authorization Form (Exhibit G).
III. REQUIREMENTS:
Contractor may provide up to forty-nine (49) beds per day for authorized County clients during
each term of the Agreement, as needed by the County, subject to availability of said beds by the
Contractor. The County does not guarantee any minimum number of beds for all services
provided by the Contractor and payment will be based on usage.
EXHIBIT C-8b
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Bed $182.14 per client per day
Enhanced Services (Negotiable & with Pre-Authorization) Rate
Patch Level A (augmented behavioral problems) + daily rate $60.00 per client per day
Patch Level B (augmented behavioral problems) + daily rate $130.00 per client per day
Patch Level C (augmented behavioral problems) + daily rate $170.00 per client per day
Bed Hold Rate $175.06 per client per day
Other Services Rate Range
Physician/Psychiatric Services^ $60.00 - $100.00 per visit
*All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
^Psychiatric services (provided to clients placed by County at Contractor’s facilities who are not
covered by Medi-Cal, private insurance or personal/other funds) shall be billed through the
Contractor via the monthly service invoice. Psychiatric services billed by the service provider
on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will be
rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but are not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal
ineligible clients in advance of services being provided, where possible. Ancillary charges for
non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately from the
monthly service invoice and submitted with supporting documentation to County.
EXHIBIT C-9
Page 1 of 4
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
MEDICAL HILL REHAB CENTER, LLC., d.b.a.
KINDRED NURSING AND REHABILITATION - MEDICAL HILL
Contractor agrees to provide County with Skilled Nursing Facility/Institutions for Mental Disease
(SNF/IMD) services to adults ages 18 to 64 years with mental health conditions, pursuant to Welfare
and Institutions Code, section 5900, et seq., Title 22 of the California Code of Regulations, the
California Department of Health Care Services’ Policies and Directives, and other applicable statutes
and regulations. In addition, Contractor agrees to provide County with Geropsychiatric Nursing Care
Facility (GNCF) services for adults age 65 years and older with mental health conditions, pursuant to
California’s Welfare and Institutions Code, section 5900 et seq., Title 22 of the California Code of
Regulations, sections 51335, 71443-72475, and the California Department of Health Care Services’
Policies and Directives, and other applicable statutes and regulations.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily [not more than seven (7) days] absent from a facility. An emergency IMD bed-hold for
psychiatric reasons beyond one (1) day must be approved by the County’s Department of Behavioral
Health (DBH) Director, or designee. The County will pay for the first bed-hold day and approval may be
provided by the County for an additional two (2) bed-hold days after consulting with the Contractor.
The County will have the final say on a case–by-case basis if an extended bed-hold of beyond three (3)
days is necessary. The Contractor will notify the County immediately if client has a relapse and
Contractor has knowledge that the client will require long-term treatment at an acute facility lasting
seven (7) days or more. A bed-hold day cannot be in place when the client is in a psychiatric health
facility (PHF) or any acute hospital for psychiatric reasons. A bed hold can only be placed for non-
psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary GNCF services to adults ages 65 and
older with mental health conditions as an alternative to State hospitalization or other higher
levels of care. In addition, contractor will provide SNF/IMD services to adults ages 18 to 64
years of age with mental health conditions.
Services shall be provided in a secure, skilled nursing facility located at 475 Twenty-Ninth
Street, Oakland, CA 94609, which offers twenty-four (24) hour care and staffing. Contractor
shall, in conjunction with County, develop and implement a treatment plan, using resources
available to both Contractor and County.
Contractor shall provide appropriate activities for County clients and ongoing consultation with
the County DBH’s Older Adult Team.
Contractor shall use its best efforts to facilitate each patient’s transfer to a lower level of care,
through collaboration with County.
Contractor shall ensure that the County Public Guardian receives two (2) physician’s
declarations required to renew LPS Conservatorships at least forty-five (45) days prior to the
expiration of the conservatorship term.
EXHIBIT C-9
Page 2 of 4
Basic Daily Rate services include reasonable access to required medical treatment, up-to-date
psychopharmacology, transportation to needed off-site services, and bilingual/bicultural
programming as appropriate.
II. SPECIAL TREATMENT PROGRAMS
Special Treatment Programs (STP) serve clients who have a chronic psychiatric impairment and
whose adaptive functioning is moderately impaired. These clients require continuous
supervision and may be expected to benefit from an active rehabilitation program designed to
improve their adaptive functioning or prevent any further deterioration of their adaptive
functioning. Services are provided to individuals having special needs or deficits in one (1) or
more of the following areas: self-help skills; behavioral adjustment; interpersonal relationships;
pre-vocation preparation, alternative placement planning, and pre-release planning.
III. ENHANCED SERVICES
Enhanced Services augment the services of Basic and Special Treatment Programs. Enhanced
Services are designed to serve clients who have sub-acute psychiatric impairment and/or
whose adaptive functioning is severely impaired.
The target population includes adults with serious and persistent mental health conditions
whose behavior requires more intensive programming than is available from Basic Services. It
is anticipated that the intensive treatment and staffing provided by enhanced services will
prevent State Hospital admissions. The target population may include persons who are often at
risk of elopement and occasionally assaultive or self-destructive. They may have complicating
medical problems. Additionally, they may require specialized services to insure successful
transition to community living.
The major objectives for these services are: to control and modify the client’s destructive
behavior; and, to prevent or reduce acute psychiatric hospitalization or long-term State
hospitalization.
IV. REQUIREMENTS
All patients designated to receive enhanced services shall be approved in writing by the
County’s Department of Behavioral Health (DBH) Director, or designee, prior to the
implementation of said enhanced services at the time of placement. If the services of a client
housed in the facility has a need to increase the level of care from Basic to Enhanced services
then a prior approval must be obtained from the County’s DBH Director, or designee, utilizing
the Special Services Authorization Form (Exhibit G). Any emergency provision of enhanced
services will need a written authorization within five (5) working days of any oral authorization.
The above bed requirements are based on average use and County does not guarantee any
minimum bed days. Payment will only be made for beds utilized.
Upon mutual oral consent of the Contractor and County’s DBH Director, or designee, Contractor
shall accept and place into Contractor’s facility all clients referred by County. County shall
coordinate the placement of consumers with Contractor’s admission staff.
EXHIBIT C-9
Page 3 of 4
V. RATES*
Program Services Rate
Basic Daily Rate (IMD/STP with Medi-Cal)
SNF Geropsychiatric Bed
$400.55 per client per day
Basic Daily Rate (IMD/STP without Medi-Cal)
SNF Geropsychiatric Bed
$160.00 per client per day
Enhanced Services (with Medi-Cal)
SNF Geropsychiatric Bed (STP)
Negotiated by DBH Director on a case-by-case basis
Enhanced Services (without Medi-Cal)
SNF Geropsychiatric Bed (Enhanced)
Negotiated by DBH Director on a case-by-case basis
Bed Hold Rate Negotiated by DBH Director on a case-by-case basis
Other Services Rate (Range)
Physician Services** $165.00 per visit
*All rates other than the Basic Daily Rate services must be pre-approved by the County’s DBH
Director, or designee, prior to placement or initiation of such services. For any rate higher than
the Basic Rate Services, both the rationale and the extra services must be specified and time-
limited and approval must be sought using the Special Services Authorization Form (Exhibit G).
**Physician/Psychiatric services (provided to clients placed by County at Contractor’s facilities
who are not covered by Medi-Cal, private insurance or personal/other funds) shall be billed
through the Contractor via the monthly service invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will be
rerouted to Contractor for inclusion in monthly invoice. Contractor shall attach supporting
documentation verifying services provided on all psychiatric invoices submitted. Supporting
documentation should include, but is not limited to, date and location of service, service
provided, service duration, name of provider.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite to a
client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to Title 22 of
the CCR. County shall be informed and/or approve of any such service(s) to Medi-Cal ineligible
clients in advance of services being provided, where possible. Ancillary charges for non-Medi-
Cal clients or non-Medi-Cal billable services may be billed separately from the monthly service
invoice and submitted with supporting documentation to County.
EXHIBIT C-10
Page 1 of 3
DESCRIPTION OF SERVICES & RATES (FY 2016-17)
7th AVENUE CENTER, LLC
Contractor agrees to provide County with Mental Health Rehabilitation Center (MHRC) services for
adults with mental health conditions 18 to 64, pursuant to California’s Welfare and Institutions Code,
section 5900 et seq., Title 22 of the California Code of Regulations, the California Department of Health
Care Services’ Policies and Directives, Title 9, California Code of Regulations, Division 1, Sub-Chapter
3.5, and other applicable statutes and regulations. Participation in MHRCs is limited to facilities that
meet the licensing and certification requirements of the California Department of Health Services
Licensing and Certification Division.
For the purposes of this Agreement, the term "bed day" includes beds held vacant for clients who are
temporarily (not more than seven (7) days) absent from a facility. A bed-hold day cannot be in place
when the client is in a psychiatric health facility (PHF) or any acute hospital for psychiatric reasons. A
bed hold can only be placed for non-psychiatric reasons, e.g., medical hospitalization.
In addition to the services listed in “Scope of Work” (Exhibit B), Contractor shall provide the following:
I. BASIC DAILY RATE SERVICES
Basic Daily Rate services consist of usual and customary MHRC services to adults with mental
health conditions. Basic Daily Rate services include reasonable access to required medical
treatment, up-to-date psychopharmacology, transportation to needed off-site services and
bilingual/bicultural programming.
II. ENHANCED SERVICES
Enhanced Services consist of specialized program services which augment basic services.
Enhanced Services are designed to serve clients who have sub-acute psychiatric impairment
and/or whose adaptive functioning is severely impaired.
The Enhanced Services bed rate or any other charges in addition to the Enhanced Services bed
rate may be negotiated for an individual client on an as-needed basis between the County’s
Department of Behavioral Health (DBH) Director, or designee, and Contractor. The County’s
DBH Director, or designee, must approve these rates before the client is provided any services
more intensive than the Basic Services. Approval for such services may be sought using the
Special Services Authorization Form (Exhibit G).
The need for continuing Enhanced Services will be re-assessed on a weekly to monthly basis
throughout the individual’s stay.
III. REQUIREMENTS
Contractor shall provide available beds needed for authorized County clients during the term of
the Agreement. The County does not guarantee any minimum number of beds.
EXHIBIT C-10
Page 2 of 3
IV. RATES*
Program Services Rate
Basic Daily Rate $220.58 per client per day
Bed Hold Rate $213.73 per bed per day
Enhanced Services Rate $35.00 to $250.00 per bed per day
1:1 Supervision $200.00 per day
Other Services Rate
Physician/Psychiatric Services^ $100.00 per visit
* All rates other than the Basic Daily Rate services must be pre-approved by the County’s
DBH Director, or designee, prior to placement or initiation of such services. For any rate
higher than the Basic Rate Services, both the rationale and the extra services must be
specified and time-limited and approval must be sought using the Special Services
Authorization Form (Exhibit G).
^ Psychiatric services (provided to clients placed by County at Contractor’s facilities who are
not covered by Medi-Cal, private insurance or personal/other funds shall be billed through
the Contractor via the monthly services invoice. Psychiatric services billed by the service
provider on Health Insurance Claim Forms (HICF 1500) or other forms directly to County will
be rerouted to Contractor for inclusion in the monthly invoice. Contractor shall attach
supporting documentation verifying services provided on all psychiatric invoices submitted.
Supporting documentation should include, but are not limited to, date and location of
service, service provided, service duration, name of provider.
Should a client require 1:1 Supervision longer than 24 hours while awaiting return to his/her
home county, there will be an additional charge of $200.00 per day for a period not to
exceed five (5) days.
Ancillary outpatient services (laboratory, x-rays, or other medical services performed offsite
to a client residing in an IMD/SNF/MHRC) must be billed directly to Medi-Cal, pursuant to
Title 22 of the CCR. County shall be informed and/or approve of any such service(s) to
Medi-Cal ineligible clients in advance of services being provided, where possible. Ancillary
charges for non-Medi-Cal clients or non-Medi-Cal billable services may be billed separately
from the monthly service invoice and submitted with supporting documentation to County.
Exhibit D
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit D
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit E
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit E
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit F
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit F
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature: Date:
Department of Behavioral Health
Dawan Utecht, Mental Health Director/Public Guardian
Providing Quality Mental Health and Substance Abuse Services for the People of Fresno County
4441 E. Kings Canyon Road / Fresno, California 93702-3604
(559) 600-9180 FAX (559) 600-7674
Equal Employment Opportunity Affirmative Action Disabled Employer
www.co.fresno.ca.us www.fresno.networkofcare.org
SPECIAL SERVICES AUTHORIZATION FORM (Exhibit G)
Date:
Whereas the Fresno County Client:
Name:
Has exhibited the following behaviors:
Fresno County hereby authorizes: Facility:
Address:
City: Zip Code:
Phone: Fax:
To provide the following special services on behalf of this client:
Service:
Daily Duration:
For the period of time (please fill by month):
Beginning Date:
Ending Date:
The treatment strategy upon completion of these services will be:
In consideration of these services, Fresno County agrees to pay this Facility the additional amount of:
$ Per:
This agreement is authorized by:
Division Manager (Print Name): Signature Date
Supervisor (Print Name): Signature Date
This Facility agrees to provide these special services and to abide by the terms of this agreement.
Authorized Person (Print Name): Signature Date