HomeMy WebLinkAboutAgreement A-14-118-2 with Corizon Health, Inc..pdf1
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AMENDMENT II TO AGREEMENT
THIS AMENDMENT,hereinafter referred to as “Amendment II”,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 CORIZON HEALTH,INC.,a
Delaware for-profit corporation,whose address is 103 Powell Court,Brentwood,Tennessee 37027,
hereinafter referred to as “CONTRACTOR”(collectively the “parties”).
WHEREAS the parties entered into that certain Agreement,identified as COUNTY Agreement
No.14-118,effective June 23,2014,and COUNTY Amendment No.14-118-1 effective July 14,
2015,hereinafter collectively referred to as the “Agreement,”whereby CONTRACTOR agreed to
provide medical and behavioral health care services to the adult inmates detained in COUNTY
Sheriffs Office (“SHERIFF”)Adult Detention Facilities (“JAIL”)and juvenile wards detained in
COUNTY Probation Department (“PROBATION”)Juvenile Justice Campus (“JJC”),hereinafter
collectively referred to as COUNTY’S Detention Facilities for the COUNTY’S Department of Public
Health (DPH)and the COUNTY’S Department of Behavioral Health (DBH);and
WHEREAS the parties now desire to amend the Agreement to reflect CONTRACTOR’S
continuing compliance with the Remedial Plan as a result of Hall,et.al.v.County of Fresno,Case
No.1:11-CV-02047-LJO-BAM (E.D.Cal.January 25,2012),and adjustments to compensation to
account for the Medi-Cal County Inmate Program (MCIP)regarding changes as stated below.
NOW,THEREFORE,in consideration of their mutual promises,covenants and conditions,
hereinafter set forth,the sufficiency of which is hereby acknowledged,the parties agree as follows:
1.The Agreement shall be extended for an additional one-year period from July 1 ,2017
through and including June 30,2018 (hereinafter the “Extension Period”)upon the same terms and
conditions as set forth in existing COUNTY Agreement No.14-118.Parties agree that the 3.3%
increase,as contemplated in Section 5.A.4.of the Agreement,shall apply to the Extension Period.
2.As used herein,“Medi-Cal Covered Inpatient Hospitalization Services”are defined as
inpatient hospital care off the jail grounds for an expected period of 24 hours or longer provided to a
patient who would be deemed Medi-Cal eligible as determined by the Department of Social Services
(DSS)as of the date of this Amendment except for his/her incarceration status that is or is anticipated
COUNTY OF FRESNO
Fresno,CA
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as determined by DSS as of the date of this Amendment to become reimbursable by the Department of
Health Care Services (DHCS)through the Medi-Cal County Inmate Program (MCIP)retrospective or
prospective payment systems.
3.That the following shall be added to existing COUNTY Agreement No.14-118,Exhibit
A2,Page Three (3)after the word “CONTRACTOR,”and shall be effective retroactively to January 1,
2015:
“17.Cost of Medi-Cal Covered Inpatient Hospitalization Services are not the financial
responsibility of the CONTRACTOR,provided the CONTRACTOR complies in full with the
provisions of Amendment II to existing COUNTY Agreement No.14-118,including,but not limited to
the CONTRACTOR’S obligation to pay to COUNTY an amount sufficient to pay all provider bills for
such services at a rate of 110%of cost pursuant to the terms contained in Paragraphs Five (5),Six (6),
and Seven (7)of Amendment II.”
4.That the existing COUNTY Agreement No.14-118,Section 5.E.beginning on Page
Twenty-Four (24),Line Twenty-Six (26)with the letter “E”and ending on Page Twenty-Five (25),
Line Twelve (12)with the word “laws”be deleted and the following inserted in its place,and shall be
effective retroactively to January 1,2015:
“E.Affordable Care Act
Parties acknowledge and agree that cost of Medi-Cal Covered Inpatient Hospitalization
Services are not the financial responsibility of the CONTRACTOR and is hereby specifically excluded
from the scope of work within the Agreement,provided the CONTRACTOR complies in full with the
provisions of Amendment II to existing COUNTY Agreement No.14-118,including,but not limited to
the CONTRACTOR’S obligation to pay COUNTY an amount sufficient to pay all provider bills for
such services at a rate of 110%of cost pursuant to the terms contained in Paragraphs Five (5),Six (6),
and Seven (7)of Amendment II.
Notwithstanding the foregoing,the CONTRACTOR shall manage the clinical process
and adjudicate claims on behalf of the COUNTY.The COUNTY retains sole responsibility for the
enrollment of inmates into Medi-Cal County Inmate Program (MCIP)and hereby agrees to timely and
properly enroll all inmates who receive Medi-Cal Covered Inpatient Hospitalization Services.It is
COUNTY OF FRESNO
Fresno,CA
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CONTRACTOR’S responsibility to promptly notify County of an inmate’s admission as an inpatient.
If the COUNTY is not notified timely,the CONTRACTOR may be responsible for the costs of
inpatient services.”
5.Effective retroactively to January 1 ,2015,Parties acknowledge and agree that
the total value of the Base Compensation,as defined in Section 5.A.of existing COUNTY Agreement
No.14-118;Additional Payments for Emergency,Inpatient Hospitalization,and Outpatient Specialty
Care Services,as defined in Section 5.B of existing COUNTY Agreement No.14-118;and Additional
Payments for Remedial Plan,as defined in Section 3.C.of existing COUNTY Agreement No.14-118
shall remain unchanged.CONTRACTOR acknowledges that it remains responsible for all Emergency,
Inpatient Hospitalization and Outpatient Specialty Care Services as defined in Section 5.B.of existing
COUNTY Agreement No.14-118;and Additional Payments for Remedial Plan,as defined in Section
3.C.of existing COUNTY Agreement No.14-118 for inmates that are not Medi-Cal Covered Inpatient
Hospitalization Services and agrees it will pay all such bills from providers incurred from the effective
date of this Amendment in a timely manner and in the amount agreed to by CONTRACTOR and the
providers.The provisions of this paragraph are expressly contingent upon the performance by
CONTRACTOR of the terms and conditions contained in this Amendment.
6.CONTRACTOR hereby agrees to give the COUNTY a refund equal to 110%of
actual cost of unpaid Medi-Cal Covered Inpatient Hospitalization Services including all medical
services provided during the inpatient hospitalization,that are eligible charges under the terms of any
applicable agreement between the CONTRACTOR and the providers with dates of service between
January 1,2015 and September 30,2016 (hereinafter “Refunded Services”).
Payment for Refunded Services will be made directly by the COUNTY to
provider.CONTRACTOR shall make the refund payment as follows:(i)A payment of Three Million,
Four Hundred Thousand ($3,400,000)dollars immediately from CONTRACTOR to COUNTY upon
execution of this Amendment II,but in any event,no later than December 30,2016;and (ii)
CONTRACTOR shall pay the remaining balance of Refunded Services to COUNTY at 110%of cost in
three (3)separate additional payments of one-third (1/3)the total remaining balance of Refunded
Services by the 5th day of each month of March,April and May of 2017.The COUNTY agrees that at
COUNTY OF FRESNO
Fresno,CA
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least Three Million ($3,000,000)dollars of the initial payment of Three Million,Four Hundred
Thousand ($3,400,000)dollars shall be paid directly to Community Regional Medical Center (CRMC).
7.CONTRACTOR hereby agrees to reimburse the COUNTY equal to 110%of
actual cost of Medi-Cal Covered Inpatient Hospitalization Services,including all medical services
provided during the inpatient hospitalization,that are eligible charges under the terms of any applicable
agreement between the CONTRACTOR and the providers with dates of service between October 1,
2016 and March 31,2017 according to the terms set forth below.CONTRACTOR will adjudicate
claims on behalf of the COUNTY and submit a monthly report of all Medi-Cal Covered Inpatient
Hospitalization Services (by the 15th of the subsequent month),including all necessary supporting
documentation necessary for COUNTY to remit payment (hereinafter the “Covered Inpatient
Hospitalization Report”)with the first Covered Inpatient Hospitalization Report coming due on January
15,2017 and the last Covered Inpatient Hospitalization Report coming due on September 15,2017.
COUNTY shall have thirty (30)business days to review and provide written approval of each Covered
Inpatient Hospitalization Report.Contingent upon COUNTY’S approval,CONTRACTOR’S base fees
will be offset by the total cost included on Covered Inpatient Hospitalization Report on
CONTRACTOR’S immediately subsequent invoice.COUNTY agrees to pay providers directly for
these services at 110%of cost.Parties acknowledge and agree that as set forth herein,as of January 1,
2015,COUNTY is solely financially responsible for the costs of Medi-Cal Covered Inpatient
Hospitalization Services.Furthermore,CONTRACTOR’S financial obligations to refund or offset
costs equal to 110%of actual cost of Medi-Cal Covered Inpatient Hospitalization Services as contained
in Paragraphs Five (5),Six (6),and Seven (7)of Amendment II to the Agreement terminate on March
31,2017.
8.COUNTY agrees to seek reimbursement of Medi-Cal Covered Inpatient
Hospitalization Services from DHCS with dates of services between January 1,2015 and March 31,
2017 upon implementation of the MCIP retrospective repayment program (hereinafter “Retrospective
Refunded Services”).COUNTY agrees to give CONTRACTOR a net amount of seventy-five percent
(75%)of all recovered monies for the Retrospective Refunded Services from DHCS.The COUNTY
does not guarantee that DHCS will reimburse the COUNTY for Retrospective Refunded Services and
COUNTY OF FRESNO
Fresno,CA
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COUNTY makes no warranty for DHCS’s repayment to COUNTY.However,if DHCS refunds
COUNTY for Retrospective Refunded Services,then payment to CONTRACTOR will be made no
later than sixty (60)days after COUNTY receives payment from DHCS for Retrospective Refunded
Services.If DHCS does not reimburse COUNTY for Retrospective Refunded Services,then COUNTY
has no obligation to pay CONTRACTOR for Retrospective Refunded Services.
9.This Amendment II to the Agreement does not make CRMC,its affiliates,
parents,subsidiaries,agents,contractors,or any other provider of hospitalization or medical services to
inmates of the Fresno County Jail third party beneficiaries to this Agreement.
10.That all references in the Agreement to “Exhibit B”and “Revised Exhibit B”
shall be changed to read “Revised Exhibit B2,”attached hereto and incorporated herein by this
reference.
11.CONTRACTOR agrees to address those specific items identified,and
corresponding timelines identified in Exhibit A of this Amendment II,attached hereto and
incorporated herein by this reference.CONTRACTOR acknowledges and agrees to diligently address
all issues outlined in the Remedial Plan,including providing adequate staffing to implement necessary
programs.Notwithstanding the foregoing,parties acknowledge that the agreed upon staffing plan is
attached hereto as Revised Exhibit B2.Should parties later determine additional staffing
modifications are warranted,parties shall enter into subsequent amendments defining such additional
staffing modifications and accounting for the associated costs by modifying the total Base
Compensation as contemplated in the Agreement,as amended.
12.Except as otherwise provided in this Amendment II,all other provisions of the
Agreement remain unchanged and in full force and effect.This Amendment II shall become effective
upon execution or upon full execution of the settlement agreement between CONTRACTOR and
CRMC,whichever is later.
13.COUNTY and CONTRACTOR agree that this Amendment II is sufficient to
amend the Agreement,and that upon execution of this Amendment II,the Agreement,Amendment I,
and Amendment II together shall be considered the Agreement.
Ill
COUNTY OF FRESNO
Fresno,CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II as of the day and year
2 first hereinabove written.
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CONTRACTOR:
CORIZON HEALTH, INC.
By ~t~~........l.-U-'------Jii{f----_
Karey L. Witty
Chief Executive Officer
Date:
Title:
arne:(}"". Sc..ot\ __ .:__i_N_Jt----
Stl.C..re..+o.r
----------~~----------Secretary (of Co ration), or
any Assistant Secretary, or
ChiefFinancia1 Officer, or
any Assistant Treasurer
Mailing Address:
1 03 Powell Court
Brentwood, TN 37027
Phone#: (615) 660-6754
Contact: Karey Witty
Chief Executive Officer
Email: Karey. Witty@corizonhealth.com
- 6 -
COUNTY OF FRESNO:
By£ ;t-~
Chairman, Board of Sup 1sors
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRESNO
Fresno, CA
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-7-
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Exhibit A:Key program implementation items
Requirement Timeline
1.The following Policies and Procedures shall be implemented,following review
by the Medical Evaluator,Sheriff,and the Department of Public Health.
J-E-02.00 Receiving screening
J-E-04.00 Initial and Periodic Health Assessment
J-G-01.00 Chronic Disease Services
J-E-09.00 Segregated Inmates
December 1,
2016
2.The following Policies and Procedures shall be implemented,following review
by the Medical Evaluator,Sheriff and the Department of Public Health.
J-G-03.00 Outpatient Housing Unit Care
J-G-07.00 Care of Pregnant Inmate
J-E-07.00 Non-emergency Health Care Requests and Services
J-E-12.00 Continuity of Care
J-H-01.00 Health Record Format and Contents
J-H-04.00 Management of Health Records
February 1,2017
3.Develop a system of documentation that records all steps taken to verify
community prescribed medications (for physical health and mental health)
within 24 hours of intake.The system must be easily audited to demonstrate
compliance.
February 1,2017
4.Enhance implementation of the Electronic Health Record to include the
following:
a .Offline administration of the Medication Administration Record
December 1,
2016
b.Drug Reorder Screen and related process enhancements December 1,
2016
c.Incorporate the prenatal and maternal health forms into the EMR December 1,
2016
d.Suicide Risk Assessment Form must be added as managed form to eOMIS.April 1,2017
5.Compliance Reports:The following compliance reports will be developed and
available prior to the monthly multi-agency coordinating meeting.
a.Receiving screening completed and not-completed within 24 Hours of
admission in the jail.This report shall be run monthly and compare
date/time of booking,date/time of release (if applicable),and date /time
the Receiving Screen was completed.Expected compliance is 100%of all
Prescreen competed within 24 hours.Variance below 95%will require
corrective action.
December 1,
2016
b.Outstanding History and Physical Report.This report shall be run monthly
and compare date/time of booking,date/time of release (if applicable),and
date/time the History and Physical was completed.Report summary must
include total number of H&P completed,total not-completed,and total not
completed due to release.
Compliance Standard:Expected compliance is 100%within 14 days.
Variance below 90%will require corrective action.
December 1,
2016
c.Verified medication administered within 24 hours of acceptance into the
jail.
Compliance Standard:All medications validated must be bridged within 24
hours or the patient must be seen by a provider.Expected compliance is
100%,corrective action required if below 90%.
February 1,2017
d.Non-Verified Medication seen by provider within 24 hours.
Compliance Standard:All inmates on medication that cannot be verified
must be seen by a provider within 24 hours.Expected compliance is 100%,
corrective action required if below 90%.
February 1,2017
e.Access to Care Report -Summary HSR's Triaged within 24 hours.This
report must demonstrate Health Service Requests are triaged and assigned
and acuity within 24 hours.The report will include total received in the
month,number triaged by acuity in 24 hours,number triaged by acuity
greater than 24 hours.
February 1,2017
f.Access to Care Detail -Grouped by Acuity.The report shall include
date/time HSR received,date/time triaged,date appointment scheduled,
and date seen.
February 1,2017
g.Inmates with chronic disease diagnosis seen every 90 days.This reportwilllistallchronicdiseasepatientsthathavenotbeenseenbyaprovider in
over 90 days.
February 1,2017
6.Provide for 24 hour coverage by a licensed health care professional to ensure
timely response to emergent mental health issues,crisis situations,and safety
cell placement,monitoring and removals;in the event the licensed health care
professional is not a mental health specialist,an on-call Psychiatrist will be
available for telephonic consultation,if deemed necessary.
January 1,2017
CarRIZON
HEALTH'
Revised Exhibit B2
North Annex /Main/South Jails
RIZON
HEALTH5'
POSITION Scheduled Hours
|Sun |Mon Tue [Wed |Thu Fri Sat TBS |Hrs/Wk |FTE
Day Shift
Program Administrator 8 8 8 8 8 40 1.00DirectorofNursing88888401.00AdministrativeAssistant/OA Supervisor 16 16 16 16 16 80 2.00NursingSupervisor(North/Main/South)16 16 16 16 16 80 2.00OfficeAssistant243232323232242085.20MedicalDirector88888401.00PhysicianServices(MD)8 8 8 8 8 40 1.00NP/PA 16 16 16 16 16 16 16 112 2.80RN(12 Hour Shifts)84 84 84 84 84 84 84 588 14.70LVN5664646464645643210.80MedicalAssistant323232323232322245.60Dentist84848320.80DentalAssistant88888401.00ClinicalSupervisor-Psych LMHC 8 8 8 8 8 40 1.00CommunityMentalHealthSpecialist88888401.00OfficeAssistant-Psych 8 8 8 8 8 40 1.00Psychiatrist8888888561.40PsychiatricRN1616161616802.00LicensedPsychiatricLVN/Psych Tech 8 8 8 8 8 8 8 56 1.40LicensedMentalHealthCounselor16404040404016362686.70Scheduler88888401.00GrievanceCoordinator88888401.00TOTALHOURS/FTE-Day 2,616 65.40
Evening Shift
NP/PA 8 8 8 8 8 8 8 56 1.40RN(12 Hour Shifts)48 48 48 48 48 48 48 336 8.40LVN565656565656563929.80MedicalAssistant243232323232242085.20OfficeAssistant243232323232242085.20LicensedPsychiatricLVN/Psych Tech 8 8 8 8 8 8 8 56 1.40LicensedMentalHealthCounselor8888888561.40TOTALHOURS/FTE-Evening 1,312 32.80
Night Shift
RN (12 Hour Shifts)48 48 48 48 48 48 48 336 8.40LVN484848484848483368.40MedicalAssistant242424242424241684.20LicensedMentalHealthCounselor
TOTAL HOURS /FTE-Night 'mzmMmamwmr/mMmmm.840 21.00
TOTAL HOURS/FTEs per week mmwMMMMmMMMm,4 ,768 119.20
Revised Exhibit B 2
Juvenile Justice Center
POSITION Scheduled Hours
Sun |Mon Tue |Wed |Thu Fri Sat |Hrs/Wk FTE
Day Shift
Director of Nursing (RN)-Juvi 8 8 8 8 8 40 1.00OfficeAssistant88888401.00MedicalDirector-Juvi 4 4 8 0.20MedicalAssistant88888401.00NP/PA 8 4 8 4 8 32 0.80RN8888888561.40LVN161616161616161122.80Psychiatrist88160.40LicensedMentalHealthCounselor161616161616161122.80Dentist4480.20DentalAssistant66120.30TOTALHOURS/FTE-Day 476 11.90
Evening Shift
RN 16 16 16 16 16 16 16 112 2.80LVN161616161616161122.80LicensedMentalHealthCounselor8888888561.40RN-Eval 8 8 8 24 0.60
TOTAL HOURS/FTE-Evening 304 7.60
Night Shift
0 0.000
0 0.000
TOTAL HOURS/FTE-Night 0 0.000TOTALHOURS/FTEs per week mMmamMmamMmr/mp/jm 780 19.50
TOTAL CONTRACT HOURS/WEEK 5,548TOTALCONTRACTFTEs/WEEK 138.70