HomeMy WebLinkAboutInter-Dept DPH DBH Probation-Medical Behavioral Health Services_D-24-074.pdf D-24-074
1 INTER-DEPARTMENTAL AGREEMENT
2 THIS INTER-DEPARTMENTAL AGREEMENT is made and entered into this 5th day of
3 February 2024, by and between the COUNTY OF FRESNO DEPARTMENT OF PUBLIC
4 HEALTH (hereinafter referred to as DPH), and COUNTY OF FRESNO DEPARTMENT OF
5 BEHAVIORAL HEALTH (hereinafter referred to as DBH), and COUNTY OF FRESNO PROBATION
6 DEPARTMENT (hereinafter referred to as PROBATION), collectively "the parties."
7 WITNESSETH:
8 WHEREAS, PROBATION is required to provide necessary medical and behavioral health care
9 services to youth in need thereof, who are in the custody of PROBATION at the Fresno County
10 Juvenile Justice Campus, hereinafter referred to as the "JJC"; and
11 WHEREAS, DPH and DBH are willing and able to support PROBATION to provide the
12 necessary medical and behavioral health care services for youth in the custody of PROBATION, in a
13 manner consistent with all applicable standards of medical and behavioral health care, and in
14 compliance with all applicable laws including Title 15 of the California Code of Regulations (Title 15),
15 and all applicable State of California and Federal Court Orders; and
16 WHEREAS, the County of Fresno (COUNTY) entered into Agreement No. A-18-170 with
17 California Forensic Medical Group, Inc., now known as Wellpath (CONTRACTOR), effective April 3,
18 2018, with services commencing on July 1, 2018 to provide comprehensive medical and behavioral
19 health care services to youth in the custody of PROBATION.
20 WHEREAS, on June 20, 2023, County and CONTRACTOR entered into Amendment I to
21 Agreement No. A-18-170 to extend the term up to December 31, 2023, and increase the total
22 compensation accordingly, now collectively Agreement No. A-23-265, to allow for continuation of
23 services during the negotiation of a new agreement with CONTRACTOR.
24 WHEREAS, on December 12, 2023, County and CONTRACTOR entered into Amendment II to
25 Agreement No. A-23-265 to extend the term up to June 30, 2024, and increase the total
26 compensation accordingly, to further allow for continuation of services during the negotiation of a new
27 agreement with CONTRACTOR.
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I NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
2 hereto agree as follows:
3 1. PROBATION RESPONSIBILITIES
4 PROBATION will:
5 A. Supply CONTRACTOR with space to conduct all medical and behavioral health
6 care examinations, encounters and treatment, including sufficient office space for administrative
7 duties.
8 B. Supply DBH with sufficient space to conduct oversight of behavioral health care
9 service delivery, and to provide service and care coordination for youth who have or potentially have
10 a serious emotional disorder (SED) or serious mental illness (SMI) who are in Collaborative
11 Treatment Courts.
12 C. Support and facilitate, when appropriate, medical decisions made by
13 CONTRACTOR, including providing all therapeutic diets for youths ordered by CONTRACTOR.
14 D. Oversee medical and behavioral health programs at the direction of a Deputy
15 Chief PROBATION Administrative Officer or Deputy Chief PROBATION Officer and in close
16 coordination with an interdisciplinary team including DPH, and DBH, as applicable.
17 E. Deputy Chief PROBATION Administrative Officer or designee to coordinate and
18 process payment with CONTRACTOR, reviewing the monthly Staffing Report, Cost Report and
19 average daily population (ADP) as related to the monthly invoice.
20 F. In consultation with DPH and DBH Deputy Chief Probation Officer or designee
21 to confirm CONTRACTOR provides all staffing, medical and clerical equipment, services, supplies
22 and prescription medication necessary to provide adequate and timely medical and related clerical
23 services to the JJC youth.
24 G. Work with CONTRACTOR to establish standardized procedures for:
25 1) Medication administration: PROBATION will assist CONTRACTOR staff
26 when necessary to ensure the youth interacts appropriately with CONTRACTOR staff. This may
27 include verifying youth consume medication properly (i.e. swallows medication, does not pretend to
28 swallow or `cheek' the medication, etc.). For proper medication administration, youth cells and pods
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I must be well lit so CONTRACTOR staff can ensure the youth has taken the medication. Lights in
2 pods must be turned on when CONTRACTOR is present for optimal observation and safety. An
3 announcement will be made by PROBATION alerting the youth when medication pass will
4 commence.
5 2) Access to care (health service requests): Youth shall have access to
6 blank health service request forms. PROBATION will provide for privacy for youth during the health
7 service request submittal and collection process.
8 H. Provide sufficient assistance, as necessary, to CONTRACTOR including, but
9 not limited to, providing for the safety of CONTRACTOR medical and behavioral health care staff
10 working at the JJC whenever youth has access to said staff.
11 I. Provide oversight of other arresting agency staff that bring youth into JJC for
12 booking.
13 J. Provide all laundry services as normally provided for youth.
14 K. Provide for routine facility maintenance and repair of the medical/mental health
15 service areas including but not limited to electrical, plumbing, mechanical and structural.
16 L. Assist in compliance with medical and behavioral health care for Detention
17 Facility youth in accordance with Title 15 and all applicable State and Federal Court Orders, laws,
18 rules, and regulations.
19 M. Respond in a timely fashion to all inquiries by DPH, DBH and/or CONTRACTOR
20 regarding incidents related to youth care, or to any provision of this Inter-Departmental Agreement.
21 N. Provide CONTRACTOR access to PROBATION'S JJC Policy and Procedure
22 Manual, by this reference incorporated herein.
23 O. Comply with all Prison Rape Elimination Act (PREA) standards for juvenile
24 facilities and provide training to CONTRACTOR staff, as necessary.
25 P. Provide CONTRACTOR with INTRA ID and access to the PROBATION
26 Department's Computer Automated System.
27 Q. Provide all telephone equipment and related telephone service costs up to
28 $10,000 annually.
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I R. Provide telephone, fax and data support for CONTRACTOR through the
2 COUNTY's Information Technology Services Department and related charges for usage.
3 2. CONTRACTOR RESPONSIBILITIES
4 CONTRACTOR will:
5 A. Ensure compliance with all applicable laws and regulations, including the
6 applicable provisions of Title 15 and all applicable State and Federal Court Orders in effect at the
7 date this Inter-Departmental Agreement becomes effective.
8 B. Coordinate and facilitate the application for obtaining National Commission on
9 Correctional Health Care (NCCHC) accreditation. At such time NCCHC accreditation is obtained,
10 CONTRACTOR must maintain NCCHC accreditation throughout the term of the Agreement.
11 C. Maintain responsibility for providing, planning, coordinating, and evaluating
12 timely and adequate medical and behavioral health care services to youth, based on written and
13 approved policies and procedures.
14 D. Work with PROBATION to establish legally and medically acceptable
15 standardized procedures for medication administration and access to care through health services
16 requests.
17 E. Provide appropriate staffing for 15.5- daily clinic hours coverage and 24/7 on-
18 call support for medical and behavioral health care matters by the responsible physician and/or
19 psychiatrist assigned to the facility.
20 F. Provide a thorough medical and behavioral health intake screening by a
21 Registered Nurse (RN) at time of booking during clinic hours and complete health assessment within
22 ninety-six (96) hours for detained youth.
23 G. Provide training to PROBATION staff to conduct non-health care provider intake
24 screening during non-clinic hours.
25 H. Provide PROBATION continued access to medical and behavioral health care
26 information of youth in order to maintain a safe environment for youth, staff, and visitors. Direct
27 communication and/or written reports will address youth information including communicable
28 diseases, dietary restrictions, behavioral health, psychological disorders, physical restrictions, etc.
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1 I. Be available to answer questions during Title 15 medical and behavioral health,
2 nutritional and environmental health inspections of the JJC and comply with Title 15 requirements.
3 J. Maintain medical and behavioral health records on all youth seen by the
4 CONTRACTOR medical or behavioral health staff.
5 K. Provide all necessary staffing, supplies, and medical and/or behavioral health
6 and clerical equipment, and prescription medication necessary to provide timely and adequate
7 medical and/or behavioral health and related clerical (i.e., paperwork, documentation, scheduling,
8 billing, etc.) services to detained youth. All such charges for operating the JJC medical and
9 behavioral health programs are the responsibility of the COUNTY.
10 L. Provide necessary CONTRACTOR staffing at the JJC:
11 1) Medical program staff consisting of, but not limited to, physicians, mid-
12 level practitioners, registered nurses, licensed vocational nurses, psychiatric registered nurses, and
13 related clerical staff, as appropriate.
14 2) Behavioral health program staff consisting of, but not limited to,
15 psychiatrists, mid-level practitioners/licensed mental health professionals, licensed psychiatric
16 technicians, case managers, and related clerical staff, as appropriate.
17 3) To adequately maintain compliance with all applicable Title 15 and State
18 and Federal Court Order requirements related to medical, behavioral health, and dental care
19 including timely response to provide constitutionally required minimal care.
20 4) To adequately maintain compliance with PROBATION set standards to
21 respond to original youth grievances within 14 days of receipt by CONTRACTOR staff.
22 5) To adequately maintain compliance with PROBATION set standards to
23 youth grievance appeals.
24 6) Every effort shall be made to minimize the number of youth being
25 transported out of the JJC for specialty care treatment.
26 M. Provide the following behavioral health services:
27 1) Screen, identify, and assess the youth treatment needs.
28 2) Provide crisis intervention, as necessary.
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1 3) Assess suicide risk of youth or of persons being processed into custody.
2 4) Provide short-term counseling and reassessment of youth based on
3 acuity for recommendation of housing.
4 5) Evaluate youth's need for involuntary hospitalization per California
5 Welfare and Institutions Code (WIC), Section (§) 5150.
6 6) Complete discharge or release planning and referral of youth identified
7 as seriously emotionally disturbed (SED).
8 N. Provide routine janitorial services, and biohazard services for the clinic areas
9 and office space occupied by the CONTRACTOR in the JJC.
10 O. Provide immunizations to all youth detained in the JJC per the State of
11 California guidelines.
12 P. Comply with all applicable policies and procedures in PROBATION's JJC
13 Division Policy and Procedure Manual, by this reference incorporated herein.
14 Q. Respond in a timely manner to all inquiries by PROBATION, or the Courts,
15 regarding incidents related to youth medical or behavioral health care or to provisions of this Inter-
16 Departmental Agreement.
17 R. Submit monthly, all WIC, §5150 holds written to DBH Managed Care Division.
18 3. DPH RESPONSIBILITIES
19 DPH will:
20 A. Assign a Registered Nurse (RN) Auditor as needed to work at the direction of
21 JJC Administration to provide oversight and compliance auditing of CONTRACTOR. RN Auditor shall
22 do the following:
23 1) Conduct ongoing evaluation of CONTRACTOR performance.
24 2) Provide reports to JJC Administration of ongoing compliance.
25 3) Conduct oversight of medical, dental, and behavioral health grievance
26 process and conduct review of appeals.
27 B. Administer State Medi-Cal County Inmate Program (MCIP) in coordination with
28 CONTRACTOR.
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1 C. Coordinate with CONTRACTOR and PROBATION to address communicable
2 disease investigations (including TB and syphilis) needing to occur in the JJC.
3 D. Provide technical assistance, including consultation from the COUNTY Health
4 Officer, to PROBATION at the request of the JJC Administration.
5 E. Participate in administrative meetings.
6 F. Annually arrange and coordinate Title 15 inspections required of the COUNTY
7 Health Officer.
8 G. Work with PROBATION to conduct a comprehensive staffing audit prior to July
9 1st of each year, as applicable.
10 H. Work in coordination with PROBATION to provide for all telephone charges
11 above $10,000 annually.
12 I. All such charges for operating the JJC medical and behavioral health programs
13 are the responsibility of the COUNTY.
14 4. DBH RESPONSIBILITIES
15 DBH will:
16 A. Assign up to 0.20 full-time equivalent (FTE) Utilization Review Specialist (URS).
17 The URS qualifications include, but are not limited to, being a licensed mental health professional.
18 The URS will maintain responsibility to assist with oversight and compliance auditing of
19 CONTRACTOR at JJC in collaboration with PROBATION and DPH. The remaining 0.80 FTE will be
20 dedicated to assisting with oversight and compliance auditing of CONTRACTOR at Adult Jail working
21 in coordination with Jail Administration and DPH. The URS shall perform the following:
22 1) Conduct ongoing evaluation of CONTRACTOR's performance in
23 implementing and maintaining mental health and substance use disorder
24 programs and services.
25 2) Provide reports to PROBATION on COUNTY Agreement compliance
26 monitoring, including but not limited to:
27 a. Discharge planning and linkage;
28 b. Group/individual therapy;
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1 C. Release of information (ROI), verification of medication on intake,
2 prescription bridging, and psychiatric referrals (including
3 compliance to timeliness standards);
4 d. Suicide risk assessment, monitoring, and prevention; and
5 e. Substance use disorder services.
6 3) Liaison with other DBH-contracted providers of inpatient/direct mental
7 health and substance use disorder services (e.g., crisis stabilization
8 centers, acute inpatient psychiatric health facilities and Community
9 Regional Medical Center).
10 4) Attend appropriate administrative and coordination meetings with DPH,
11 DBH, PROBATION and/or CONTRACTOR, including but not limited to,
12 monthly administrative meetings, suicide prevention discussions,
13 monthly quality assurance meetings, and mortality reviews, as deemed
14 necessary.
15 5) Conduct audits of CONTRACTOR's mental health charts, at a minimum
16 annually, and review annual substance use disorder charts as conducted
17 by DBH Managed Care, to ensure compliance to COUNTY Agreements
18 as applicable and community standards.
19 If such URS position is unfilled at any time, another DBH URS will assist in this role as a consultant to
20 PROBATION.
21 B. Ensure CONTRACTOR maintains compliance with the standards of behavioral
22 health care for youth in accordance with the California Medical Association Guidelines, including the
23 applicable provisions of Title 15 of the California Code of Regulations and all applicable State of
24 California and Federal Court Orders.
25 C. Maintain full responsibility for ensuring CONTRACTOR is providing, planning,
26 coordinating, and evaluating timely and adequate behavioral health care services to appropriate
27 youth, based on written and approved policies and procedures.
28 D. Ensure that CONTRACTOR maintains all behavioral health care records on all
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1 youth seen by CONTRACTOR behavioral health care staff.
2 E. Confirm CONTRACTOR provides appropriate staffing, supplies and equipment
3 necessary for providing timely and adequate behavioral health, clerical, and related care/services, to
4 the youth within the JJC facility. These services and equipment shall include, but are not limited to,
5 personnel, telephones and copy/fax machine. In addition, CONTRACTOR psychiatric/medical staff
6 shall provide consultation, medication monitoring and written prescription for minors deemed
7 appropriate for psychotropic medication, in accordance with Medical Board Regulations, parental
8 consents/JV220/Court Orders, local, State and Federal laws, minors' knowledge and all applicable
9 laws. The administration of these medications shall be in collaboration among the medical and
10 behavioral health care staff of the CONTRACTOR and shall follow all applicable laws. All such costs
11 for operating the JJC's mental health program are to be incurred and budgeted for in the DBH
12 budget.
13 F. Ensure CONTRACTOR provides necessary staffing levels including:
14 psychiatrists, mid-level practitioners, licensed vocational nurses, licensed clinicians,
15 waivered/unlicensed clinicians, case managers, and clerical staff, as deemed appropriate. These
16 staff shall be available to provide adequate and timely mental health services to the youth housed in
17 the JJC facility. Work schedules for those CONTRACTOR employees assigned to the JJC will be
18 established by CONTRACTOR management.
19 G. Ensure CONTRACTOR shall provide the following behavioral health care
20 services:
21 1) Screen youth offenders appearing to require behavioral health care
22 services.
23 2) Assess treatment needs of those youth screened and/or identified.
24 3) Provide crisis intervention as necessary.
25 4) When requested, assess for suicide risk.
26 5) Provide short-term therapeutic services.
27 6) Participate in protocol to assess and determine youth's capability to
28 regain competency in order to stand trial per California Welfare and Institutions Code 709.
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1 7) Evaluate youth's need for involuntary hospitalization per California
2 Welfare and Institutions Code §5150.
3 8) As practical, provide pre-release planning and referral of youth who need
4 or request psychiatric treatment after release from custody.
5 9) When deemed medically necessary, shall provide appropriate behavioral
6 health care service(s) to youth in custody as well as those awaiting placement, which CONTRACTOR
7 staff will verify through adjudication status.
8 H. Ensure timely response by CONTRACTOR to all inquiries by PROBATION or
9 the Courts regarding incidents related to youth behavioral health care, or to provisions of this Inter-
10 Departmental Agreement.
11 I. Shall comply with all Prison Rape Elimination Act (PREA) standards for youth
12 facilities. Training will be provided by PROBATION to CONTRACTOR staff, as necessary.
13 J. Provide any behavioral health care service data as may be required by
14 PROBATION for its Performance-Based Standards measures.
15 5. DPH AND DBH RESPONSIBILITIES
16 DPH and DBH shall ensure CONTRACTOR has a plan in place for emergency
17 behavioral health and/or medical health care services for ALL youth housed within the JJC. Services
18 provided shall cover all behavioral health and/or medical health care services that are the result of a
19 crisis and/or emergency 24-hours a day, 7-days a week. When CONTRACTOR does not have the
20 appropriate equipment for accurate diagnosis or is not capable of providing emergency medical or
21 behavioral health care services within the JJC facility, CONTRACTOR may coordinate with area
22 hospitals to make such services available. When CONTRACTOR's intervention efforts are
23 unsuccessful and crisis stabilization services are deemed to be underserving the youth's needs while
24 experiencing a mental health crisis and therefore a determination is made that acute inpatient
25 psychiatric services are required, the CONTRACTOR shall coordinate with the DBH-contracted youth
26 psychiatric health facility or an out-of-county facility to facilitate admission and arrange for transport.
27 Where time is critical, PROBATION staff and/or CONTRACTOR staff may also call 911 for
28 emergencies, as deemed appropriate.
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1 6. TERM OF AGREEMENT
2 The term of this Inter-Departmental Agreement shall be effective January 01, 2024
3 through June 30, 2024. Negotiations between DPH, DBH and PROBATION, as applicable, should
4 begin after the execution of the new agreement with CONTRACTOR for continuity of services.
5 7. TERMINATION
6 A. Non-Allocation of Funds - The terms of this Inter-Departmental Agreement, and
7 the services to be provided thereunder, are contingent on the approval of funds by the appropriating
8 government agency. Should sufficient funds not be allocated, the services provided may be modified,
9 or this Inter-Departmental Agreement terminated at any time by DPH and/or DBH providing
10 PROBATION sixty (60) days advance written notice.
11 B. Without Cause - Under circumstances other than those set forth above, this
12 Inter-Departmental Agreement may be terminated by any party upon the giving of thirty (30) days
13 advance written notice of an intention to terminate. However, termination of this Inter-Departmental
14 Agreement shall not affect any pending activities which shall be handled to their conclusion by DPH
15 and DBH.
16 8. COMPENSATION
17 PROBATION, DBH and DPH provide funding for subcontracted program costs (staffing,
18 supplies, etc.) to operate the behavioral health and medical health care programs at the JJC as
19 identified in Paragraph 2X above.
20 PROBATION, DBH AND DPH shall provide funding to compensate for services
21 provided by the CONTRACTOR as identified in Exhibit A.
22
23 9. INVOICING
24 PROBATION shall process the monthly invoice for payment at such time the invoice
25 and backup documentation is received from the CONTRACTOR.
26 PROBATION shall provide DPH and DBH with a monthly invoice including, average
27 daily population (ADP) based on Section VII of Agreement No. A-18-170, monthly shift penalties as
28 applicable and the monthly Cost Report. PROBATION invoicing shall include the following:
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Fresno,CA
I A. Reference shall be made to the appropriate CONTRACTOR invoice of billing
2 cycle.
3 B. Copy of the CONTRACTOR's invoice, monthly ADP, shift penalty credit memo,
4 and the monthly Cost Report shall accompany PROBATION's invoice to DPH and DBH.
5 DPH and DBH shall process a journal voucher for reimbursement to PROBATION at
6 such time the invoice and backup documentation is received from PROBATION.
7 10. MODIFICATION
8 Any matters of this Inter-Departmental Agreement may be modified from time to time by
9 the written consent of all parties, without, in any way, affecting the remainder.
10 11. CONFIDENTIALITY
11 All services performed by PROBATION, DPH, DBH and CONTRACTOR under this
12 Inter-Departmental Agreement shall be in strict compliance with all applicable Federal, State of
13 California and/or local laws and regulations relating to Health Information Portability and
14 Accountability Act in accordance with confidentiality of Protected Health Information
15 12. NON-DISCRIMINATION
16 During the performance of this Inter-Departmental Agreement, PROBATION, DPH,
17 DBH, and CONTRACTOR shall not unlawfully discriminate against any employee or applicant for
18 employment, or recipient of services, because of race, religious creed, color, national origin, ancestry,
19 physical disability, mental disability, medical condition, genetic information, marital status, sex,
20 gender, gender identity, gender expression, age, sexual orientation, or military or veteran status
21 pursuant to all applicable State of California and Federal statutes and regulations.
22 13. UTILIZATION REVIEW
23 All non-emergency outpatient medical services/procedures shall have the prior
24 authorization of the DPH Medical Director.
25 14. DIFFERENCES ARISING FROM INTERPRETATION OF INTER-DEPARTMENTAL
26 AGREEMENT
27 Every effort shall be made by all parties concerned, to amicably resolve differences in
28 the interpretation and application of this Inter-Departmental Agreement. If differences cannot be
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1 resolved informally at a Division/Program Manager level, they may be referred to the DBH Director,
2 DPH Director, and/or Chief Probation Officer, or respective designees, for resolution.
3 15. RELATIONSHIP OF PARTIES
4 It is understood that this is an Inter-Departmental Agreement by and between three (3)
5 separate Departments of the County of Fresno and is not intended to and shall not be construed to
6 create a relationship of agent, servant, employee, partnership,joint venture, or association.
7 16. ENTIRE AGREEMENT
8 This Inter-Departmental Agreement constitutes the entire Inter-Departmental
9 Agreement between PROBATION, DPH, and DBH with respect to the subject matter hereof and
10 supersedes all previous agreement negotiations, proposals, commitments, writings, advertisements,
11 publications, and understandings of any nature whatsoever unless expressly included in this Inter-
12 Departmental Agreement.
13 IN WITNESS WHEREOF, the parties hereto have executed this Inter-Departmental
14 Agreement.
15
REVIEWED AND RECOMMENDED REVIEWED AND RECOMMENDED
16 FOR APPROVAL FOR APPROVAL:
17
18 PROBE N P MENT DEPARTMENT OF PUBLIC HEALTH
By By -
20 irk Ha nest SaGid Luchin
21 Chief Probe n Officer Director
22
Date: Date: 2 c
23
24
DEPARTMENT OF BEHAVIORAL HEALTH
25
26 By
—,Z W"C=
27 Susan Holt
Director
28
Date: C�a► �23 f Z f
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1 FOR ACCOUNTING PURPOSES ONLY:
2 DBH $527,714.50
Fund/subclass: 0135/13045
3 Organization: 5245
4 Account/Program: 7910
5 DPH $960,914.50
6 Fund/subclass: 0135/10000
Organization: 52430301
7 Account/Program: 7910
8
9 PROBATION $1,806,996.00
Fund/subclass: 0001
10 Organization: 3440
Account/Program: 5957
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EXHIBIT A
Inter-Dept.MOU Probation-DPH-DBH
Wellpath Extension Budget(January 1,2024
through June 30,2024)
1/1/2024—6/30/2024
Probation to Budget %of Total
Contract Professional&Specialized $ 1,806,996.00
TOTAL Appropriations $ 3,613,991.00
Health Realignment $ 960,914.50 53.177%
Mental Health Realignment $ 527,714.50 29.203%
Probation $ 318,367.00 17.619%
TOTAL Revenues $ 1,806,996.00 100.00000%