HomeMy WebLinkAboutAgreement A-21-162 with CalMHSA.pdf Agreement No. 21-162
Agreement No.543-2020-SHP-FC
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
PARTICIPATION AGREEMENT
COVER SHEET
1. Fresno County ("Participant")desires to participate in the Program identified below.
Name of Program: State Hospitals Program
2. California Mental Health Services Authority("CaIMHSA")and Participant acknowledge that the
Program will be governed by CalM HSA's Joint Powers Agreement and its Bylaws,this
Participation Agreement,and by the MOU through which non-Members participate.The
following exhibits are intended to clarify how the provisions of those documents will be applied
to this particular Program.
0 Exhibit A General Program Description
0 Exhibit B Scope of Services
0 Exhibit C Terms and Conditions
0 Exhibit D Budget Detail and Payment Provisions
❑ Exhibit E Special Terms and Conditions(optional)
3. The term of the Program is 7/1/2020 through 6/30/2021.
4. Authorized Signatures:
CaIMHSA
Signed: Name(Printed): Dr.Arnie Miller, Psy.D., LMFT
Title: Executive Director Date:
Participant: FRESNOJNTY
Signed: / Name (Printed): Steve Brandau
Title: Chairman of the Board of Sul2ervisors Date: I 2102.1
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
Coun of Fresno State of California
By
Deputy
State Hospital Bed Program-Participation Agreement—Cover Sheet
FUND/SUBCLASS: 0001/10000
ORG: 56302007
ACCT: 7295
PARTICIPATION AGREEMENT
Exhibit A—General Program Description
I. Recitals
Government Code section 6500 et seq. allows California public entities to form separate entities to
exercise powers held by its members. California Counties have under the authority of the Government
Code formed the California Mental Health Services Authority (CaIMHSA). CaIMHSA is authorized by its
Joint Exercise of Powers Act to jointly develop, and fund mental health services under, among other
things, Division 5 of the California Welfare and Institutions Code, including the provision of necessary
administrative services.
Sections 4330 through 4335 of the Welfare and Institutions Code provide for Counties, including Counties
acting jointly, to contract with the State Department of State Hospitals for use of State Hospital facilities
for their civil commitments under Division 5 of the California Welfare and Institutions Code. Certain
members of CaIMHSA desire to authorize CaIMHSA to jointly negotiate and contract with the State
Department of State Hospitals for use of such facilities on their behalf, and to explore and potentially
implement related, alternative, or replacement services
Based on the foregoing, the parties do hereby enter into this Participation Agreement for the CaIMHSA
State Hospitals Program to authorize CaIMHSA to contract for State Hospital beds on behalf of Program
Participants and to evaluate and implement collaborative opportunities in the development of programs
for special populations requiring secure 24-hour treatment services (i.e., IMD, court commitments, acute
treatment, incompetent to stand trial, etc.
II. Name of Program
The CaIMHSA State Hospitals Program (SHP).
III. Program Goals
A. CONTRACTING: In accordance with Welfare and Institutions Code section 4330 et seq.,
Participants will come together to act jointly through CaIMHSA in contracting with the California
Department of State Hospitals (DSH) for access and use of state hospital bed resources, and to
ensure compliance by DSH with all applicable requirements and provisions of CaIMHSA's contract
with DSH.
B. FISCAL:Work closely with DSH in the analysis of cost containment strategies that create efficiency
in the purchasing of state hospital beds and overall cost.
C. QUALITY OF CARE:Work collaboratively with the DSH in establishing"standardization of services"
and consistency in services provided to ensure the quality and levels of patient care needed by
counties.
State Hospital Bed Program-Exhibit A—General Program Description—Page 2 of 8
D. ALTERNATIVE OPTIONS FOR SERVICES: Work collectively across counties in the identification and
determination of the feasibility of utilizing alternatives to state hospital resources, and facilitate
implementation of such alternatives if so directed by Participants.
E. OTHER OPPORTUNITIES: Evaluate collaborative opportunities in the development of programs for
special populations requiring secure 24 hour treatment services (i.e., IMD, court commitments,
acute treatment, incompetent to stand trial, etc.).
F. OTHER:As defined by participants
IV. Program Outcomes
As directed by Participants, CaIMHSA will collectively work in achieving efficiencies as a single
administrative body engaging in a single negotiation of terms and rates for bed utilization,establish quality
assurance standards and procedures, review shared financial analysis, and explore and facilitate
opportunities and alternatives.
A. CONTRACTING:
1. Develop new contract terms that address all critical responsibilities, establish
performance standards, protect counties from improper inflation of rates, clearly denote
bed classification and processes, and require the state to indemnify counties for liability
due to the state's negligent acts.
2. Provide counties the ability to audit DSH costs,appeal DSH decisions,and pursue recourse
for unfair dealings by DSH.
3. Develop fair and accurate rates.
4. Enable counties to have more control over realignment funds owed to them. (WIC Section
Code 17601)
5. Maximize flexibility of bed utilization.
B. FISCAL:
1. Create a baseline to use as a projection of bed use by county and type of bed.
2. Create and maintain an actual cost reimbursement structure. (WIC Section Code 4330)
3. Ensure accuracy of costs charged based on actual use by county and for each bed type.
4. Create a fair and established process for assigning beds.
5. Stabilize and flat line individual county costs.
6. Facilitate an efficient and timely process for invoicing Participants.
7. Develop a process for county notification and reconciliation of federal reimbursement for
services (Medicare).
8. Begin establishment of a database in order to efficiently evaluate DSH and state hospital
services and contract compliance, as well as to evaluate alternatives.
9. Use database to enhance bed rate efficiency by bed type.
C. QUALITY OF CARE SERVICES:
1. Create a baseline for performance measurements and review for compliance.
State Hospital Bed Program-Exhibit A—General Program Description—Page 3 of 8
2. Provide for regular audits/reviews of performance activity of the counties and Hospitals
to ensure expectations are being met.
3. Enhance patient care.
4. Reduce bed use and/or length of stay, leading to less cost.
5. Allow CaIMHSA to research options for patient services not provided.
6. Ensure standardization across the board and creation of a system to measure against.
7. Track services not provided but needed by counties.
8. Allow counties to be more informed and better served, and for DSH to be more informed,
resulting in better service to counties. Enhance processes and outcomes.
D. ALTERNATIVES:
1. Determine what services are needed but not provided by DSH.
2. Evaluate alternative treatment providers.
3. Evaluate alternative treatment resources, allowing counties greater control.
4. Evaluate alternative sites
5. Facilitate alternatives as directed by Participants
E. OTHER OPPORTUNITIES:
1. Develop a list of challenges in the area of care where a collective solution (two or more
counties, regionally, or statewide) could benefit the members.
State Hospital Bed Program-Exhibit A—General Program Description—Page 4 of 8
PARTICIPATION AGREEMENT
Exhibit B—Scope of Services
I. RELATIONSHIP OF THE PARTIES
Sections 4330 through 4335 of the Welfare and Institutions Code (WIC) require counties to contract with
DSH to reimburse DSH for use of state hospital beds/services provided pursuant to Part 1 (commencing
with Section 5000) of Division 5 of the WIC. Sections 4330 through 4335 of WIC provide for counties to
contract in combination with other counties.
The purpose of this Participation Agreement is to grant CaIMHSA the authority to contract with DSH for
state hospital bed utilization on behalf of Participants, and to define roles and responsibilities between
CaIMHSA and Participants in the context of an MOU between CaIMHSA and DSH.
Demonstrate and provide proof of authorization to enter into this Agreement on behalf of Participant,
consisting of a resolution of Participant's Board authorizing such signature, proof of delegated authority
to execute contracts of a class that includes this Participation Agreement, or other comparable authority.
II. GOVERNANCE
A. Per CaIMHSA Bylaws,CaIMHSA members have the authority to create a Program such as the SHP,
while participants in the SHP govern its operation through adoption and execution of this
Participation Agreement and by voting on Program items.
B. Participants may determine the need for an oversight committee for this program.
III. GENERAL RESPONSIBILITIES OF PARTIES
A. Responsibilities of CaIMHSA
1. Comply with applicable laws,regulations,guidelines,CaIMHSA's Joint Powers Agreement,
Bylaws,this Participation Agreement, and the Program Bylaws.
2. Use best efforts to obtain an appropriate placement for Participants' patients in a state
hospital.
3. Facilitate coordination of treatment and case management by DSH and Participant as to
each of Participant's patients.
4. Provide dedicated administrative staff as necessary to perform under this Agreement.
5. Manage funds received through the Program, consistent with the requirements of any
applicable laws, regulations, guidelines and/or contractual obligations.
6. Provide regular fiscal and operational reports to Participants and any other public
agencies with a right to such reports.
7. Develop allocation model for allocation of beds,funds and expenses among Participants.
8. Facilitate operation of Participant focus groups, training, bed triage process, and dispute
resolution process.
State Hospital Bed Program-Exhibit B—Scope of Services—Page 5 of 8
B. Responsibilities of Participant
1. Compliance with applicable laws, regulations, guidelines, contractual agreements, joint
powers agreements and bylaws.
2. Designate CalMHSA as Participant's agent in contracting with DSH for purchase of beds at
State Hospitals on behalf of Participant pursuant to WIC 4330 through 4335.
3. Provide input and feedback as necessary to accomplish the purposes of the Program.
4. Timely and complete submission of information in response to requests.
5. Acknowledgement that certain funds contributed by the Participant will be aggregated
with the funds of other Participants in the Program, and jointly used to meet the
objectives of the Program,pursuant to the allocation formula adopted. Acknowledge that
Program expenses will include a proportionate share of CalMHSA's administrative
expenses and management costs.
6. Agree to pay for services provided by or through CalMHSA, including administrative and
management costs, upon adoption and approval by the Participants of a Program budget.
III. SERVICES TO BE CONTRACTED WITH DEPARTMENT OF STATE HOSPITALS AS DETAILED IN THE
MOU WITH DSH.
IV. BED USAGE
A. Contracting and Beds
Based on the contractual commitments made by Participants, through this agreement CalMHSA
will contract (MOU) with DSH to provide, within the state hospitals, specific numbers of beds
dedicated to the care of those patients referred by CalMHSA Participants, including those
admitted pursuant to Section 1370.01 of the Penal Code and Murphy Conservatorships (WIC §
5008(h)(1)(B)) (i.e., Participants' patients).
B. Participant's Financial Commitment
So that no Participant shall be obligated beyond its commitment, no one Participant's minimum
obligation shall be reduced below the contract amount set forth in Exhibit B of the DSH MOU.
A Participant that has not committed to any state hospital bed/years shall be financially
responsible for its use of state hospital resources resulting from, but not limited to,the conversion
of Penal Code commitments to Murphy Conservatorships (WIC§ 5008(h)(1)(8)).
State Hospital Bed Program-Exhibit B—Scope of Services—Page 6 of 8
PARTICIPATION AGREEMENT
Exhibit C-General Terms and Conditions
I. Duration and Term
A. The term of the Program is as shown on the Cover Sheet,with annual renewals thereafter,
with no change to the annual funding amounts, unless mutually agreed upon by both
parties via an Amendment to this Participation Agreement.
B. Any Participant may withdraw from the Program upon six months written notice. Notice
shall be deemed served on the date of mailing.
C. The majority of the Participants may vote to expel a Participant from the Program for
cause. Cause shall be defined as any breach of this Participation Agreement, any
misrepresentation, or fraud on the part of any Participant.
II. Withdrawal,Cancellation and Termination
A. The withdrawal of a Participant from the Program shall not automatically terminate its
responsibility for its share of the expenses and liabilities of the Program.The contributions
of current and past Participants are chargeable for their respective share of unavoidable
expenses and liabilities arising during the period of their participation.
B. Upon cancellation, termination or other conclusion of the Program, any funds remaining
undisbursed after CalMHSA satisfies all obligations arising from the operation of the
Program shall be distributed and apportioned among the Participants in proportion to
their contributions.
III. Fiscal Provisions
A. Funding required from the Participants will not exceed the amount stated in Exhibit D.
B. Participants will share in the costs of planning, administration and evaluation in the same
proportions as their overall contributions, which are included in the amount stated in
Exhibit D.
C. Participants who during any one year do not procure beds shall pay a minimum charge to
defray indirect costs to sustain the Program.
State Hospital Bed Program-Exhibit C—Terms and Conditions—Page 7 of 8
PARTICIPATION AGREEMENT
EXHIBIT D- BUDGET DETAIL AND PAYMENT PROVISIONS
STATE HOSPITAL BED PURCHASE AND USAGE
I. CONTRACT AMOUNT AND PAYMENT PROVISIONS
The amount payable by Participant to CaIMHSA concerning this Agreement shall be $1,402 per bed, per
fiscal year, unless the county does not procure any beds, commencing FY 2019-20. If Participant does not
currently procure state hospital beds, there is no amount due, until such time a bed is procured. The
annual rate will commence in the fiscal year that a bed is procured. The amount for operations does not
include the financial obligation of the Participant for actual bed use. The amount reflected here was
computed based on the information contained in the Exhibit B of the DSH MOU.The amount represents
the application of the State Hospital Rates for the Fiscal Year as published by DSH,which by this reference
is made a part hereof,to Participant's contracted beds. In addition,this amount includes an administrative
charge assessed on the number of contracted beds listed in Exhibit B of the DSH MOU, based the SHSP
administrative budget adopted for the fiscal year by the Participants.
Participants who currently do not regularly (each year) versus sporadically procure beds shall be
responsible for a minimum charge for indirect costs to sustain the Program. Amount to be determined
upon completion of an assessment of participant's state hospital bed procurement history.
II. BUDGET CONTINGENCIES
This Agreement is subject to any restrictions, limitations, or conditions enacted by the Legislature and
contained in the Budget Act or any statute enacted by the Legislature which may affect the provisions,
terms, or funding of this Agreement in any manner. If statutory or regulatory changes occur during the
term of this Agreement, both parties may renegotiate the terms of the Agreement affected by the
statutory or regulatory changes.
This Agreement may be amended only in writing upon mutual consent of the parties. A duly authorized
representative of each party shall execute such amendments.
State Hospital Bed Program-Exhibit D—Budget Detail and Payment Provisions—Page 8 of 8