HomeMy WebLinkAboutAmendment II with WestCare California Inc.pdf Agreement No. 24-293
1 AMENDMENT 11 TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as "Amendment II", is made and entered into this
3 18th day of June , 2024, by and between the COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereinafter referred to as "COUNTY", and WESTCARE
5 CALIFORNIA, INC., a California Non-profit corporation, hereinafter referred to as "CONTRACTOR"
6 (collectively the "parties").
7 WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. 18-686, effective January 1, 2019, and COUNTY Amendment 23-302 ("Amendment I"), effective
9 July 1, 2023, hereinafter referred to together as "Agreement", whereby CONTRACTOR agreed to
10 provide supervised after hours/overnight stay services, linkage, targeted case management,
11 assessments and other specialty mental health services for adults referred from local hospital
12 emergency departments and California Welfare and Institutions Code 5150 facilities; and
13 WHEREAS, the parties have agreed to change the billing structure from Medi-Cal billing and a
14 line item budget to Medi-Cal billing and a daily bed rate to better utilize the program's funding and
15 allow CONTRACTOR the option to pay their staff more competitive wages.
16 WHEREAS, Amendment I incorrectly stated that the maximum compensation was Seven
17 Million Seven Hundred Thirty-Five Thousand Three Hundred Sixty-Nine and No/100 ($7,735,369)
18 when it should have been Seven Million Seven Hundred Fifteen Thousand Three Hundred Sixty-Nine
19 and No/100 ($7,715,369). This Amendment II further updates the maximum compensation as stated
20 below.
21 WHEREAS the parties now desire to amend the Agreement regarding changes as stated
22 below and restate the Agreement in its entirety.
23 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
24 hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows:
25 1. That all references to "Exhibit A" shall be deemed references to "Exhibit A1," attached
26 and incorporated by this reference.
27 2. That all references to "Exhibit B" shall be deemed references to "Exhibit B1,"
28 attached and incorporated by this reference.
1 - COUNTY OF FRESNO
Fresno, CA
1 3. That the existing COUNTY Agreement No. 18-686, section seven (7), page twelve (12),
2 Line twenty-five (25) beginning with the word "Any", and ending on page thirteen (13), line twelve (12)
3 with the word "Agreement" be deleted and the following inserted in its place:
4 "Except as provided in Section 3, "Termination", this Agreement may not be modified
5 and no waiver is effective, except by written agreement signed by both parties. The CONTRACTOR
6 acknowledges that COUNTY employees have no authority to modify this Agreement except as
7 expressly provided in this Agreement.
8 (A) Notwithstanding the above, changes to services, staffing, and responsibilities of
9 the CONTRACTOR, as needed to accommodate changes in the laws relating to service requirements
10 and specialty mental health treatment may be made with the signed written approval of COUNTY's
11 DBH Director, or designee, and CONTRACTOR through an amendment approved by COUNTY's
12 County Counsel and the COUNTY's Auditor/Controller/Treasurer-Tax Collector's Office.
13 (B) In addition, changes to service rates on Exhibit B1 that do not exceed 3% of the
14 approved rate, or that are needed to accommodate state-mandated rate increases, may be made with
15 the written approval of the DBH Director or designee. These rate changes may not add or alter any
16 other terms or conditions of the Agreement. Said modifications shall not result in any change to the
17 maximum compensation amount payable to Contractor(s), as stated herein."
18 4. That the existing COUNTY Agreement No. 18-686, section four (4), "COMPENSATION"
19 shall be revised by adding the following at Page five (5), Line twelve (12), after the word "Agreement.":
20 "COUNTY agrees to pay and CONTRACTOR agrees to receive compensation for the
21 ten (10) beds guaranteed to COUNTY each day in the Overnight Stay Facility, whether or not the
22 person served receives Supplemental Social Security Insurance (SSI)/State Supplementary Payment
23 (SSP) funds, has Medi-Cal, private insurance or has no other coverage, at the reimbursement rates
24 set forth within Exhibit BV'
25 5. That the existing COUNTY Agreement No. 18-686, section four(4), "COMPENSATION"
26 shall be revised by adding the following at Page six (6), Line fourteen (14), after the word
27 "($1,436,162).":
28 "If the Agreement is extended for an additional one-year period, the maximum amount
- 2 - COUNTY OF FRESNO
Fresno, CA
1 payable to the CONTRACTOR for the period July 1, 2024 through June 30, 2025 for Specialty Mental
2 Health Services is Three Hundred Forty Thousand Two Hundred Sixty-Six and No/100 ($340,266.00),
3 which is not a guaranteed sum but shall be paid only for services rendered and received.
4 The maximum compensation payable to CONTRACTOR under this Agreement for the
5 period of July 1, 2024 through June 30, 2025 for Non-Medi-Cal Supports is Six Hundred Eighty-Nine
6 Thousand Three Hundred Seventy-Three and No/100 ($689,373.00).
7 In no event shall the maximum contract amount for the full contract term from January
8 1, 2019 through June 30, 2025, for all services provided by CONTRACTOR to County under the terms
9 and conditions of this agreement be in excess of Seven Million Six Hundred Three Thousand Five
10 Hundred Sixty-Eight and No/100 ($7,603,568.00)."
11 6. The existing COUNTY agreement No. 18-686, Page seven (7), Line four(4) beginning
12 with the word "Payments" and ending on Page seven (7), Line seven (7) with the word "expenditures."
13 be deleted and the following inserted in its place:
14 "Payments shall be made after receipt and verification of CONTRACTOR'S invoice by
15 COUNTY DBH in an amount equivalent to the rate set in Exhibit 131. However, if invoice is not
16 received in proper form or substance as stated herein, COUNTY may withhold subsequent payment
17 until such invoice is received."
18 7. That the existing COUNTY Agreement No. 18-686, Section 5, subsection E, on Page
19 nine (9), lines twenty-three (23) through twenty-six (26) be deleted in its entirety.
20 8. When both parties have signed this Amendment 11, the Agreement, Amendment I, and
21 this Amendment II together constitute the Agreement.
22 9. Except as otherwise provided in this Amendment, all other provisions of the Agreement
23 remain unchanged and in full force and effect. This Amendment shall become effective on July 1,
24 2024.
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- 3 - COUNTY OF FRESNO
Fresno, CA
I IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to Agreement
2 as of the day and year first hereinabove written.
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5 WESTCARE CALIFORNIA, INC. COUNTY OF FRESNO
6 r=PW
_ .
Shawn Jenkins, CO Nathan Magsig, Chairman of the Board of
8 Resolution WCCA 2 4-01 Supervisors of the County of Fresno
1900 N Gateway Blvd Suite 101
9 Fresno, CA 93727 Attest:
Bernice E. Seidel
10 Clerk of the Board of Supervisors
County of Fresno, State of California
11
12 By.
Ap�ty
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For accounting use only:
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Org No.: 56304782
15 Account No.: 7295
Fund No.: 0001
16 Subclass No.: 10000
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COUNTY OF FRESNO
Fresno, CA
Exhibit Al
Page 1 of 5
Overnight Stay
Facility
Scope of Work
ORGANIZATION: WestCare California, Inc.
SITE ADDRESS: 2772 S. Martin Luther King Blvd, Fresno, CA 93706 (Overnight Stay
Facility)
3636 N. First Street Suite#123, Fresno, CA 93726 (Outpatient
Facility)
SERVICES: Overnight stay services,clinical response services,peer support
services, crisis intervention and assessments, discharge
services,transportation and linkage to appropriate mental health
programs.
SCHEDULE OF SERVICES:
CONTRACTOR'S staff shall be available to provide Overnight Stay Facility services to
individuals seven days a week,24 hours a day.
Contractor shall provide services on eleven (11)County observed holidays in each calendar
yearas follows:
New Year's Day
Martin Luther King, Jr. Holiday
President's Day
Cesar Chavez Day
Memorial Day
Independence Day
Labor Day
Veterans Day
Thanksgiving Day
Day after Thanksgiving Day
Christmas Day
TARGET POPULATION:
Adults and older adults receiving services from emergency departments/5150 facilities who are in
crisis but do not require a 5150 hold. The program will provide services client referred from local
emergency departments and 5150 facilities including but not limited to: Fresno Community
Regional Medical Center(CRMC), St. Agnes, Clovis Community Regional Medical Center and
Exodus Crisis Stabilization Center.
Exhibit Al
Page 2 of 5
PROJECT DESCRIPTION:
The overnight stay program will provide individuals who present at the ED in crisis, but do not
require a 5150 hold the opportunity to be voluntarily discharged to the care of SOS where they
may spend the night, receive a meal, a shower, a place to sleep, and be assessed and linked
the following day to an appropriate mental health or co-occurring treatment service. The
program will also provide mental health assessment, crisis intervention, targeted case
management, bridge medication support and other short-term, specialty mental health
services delivered by qualified staff with the goal to increase engagement, address symptoms
and bridge the gap while the consumer awaits admission to other services in the community.
This will reduce ED recidivism and lengths of stay in the emergency department or crisis
stabilization unit. Individuals may stay at the SOS facility for up to four nights consecutively
when necessary to enhance the probability that a successful linkage will occur. Because at
least 80% of individuals of the population to be served are homeless, this opportunity for a
longer stay may enable housing to be secured as well as mental health service linkage. When
individuals are housed first,the likelihood of initiating and staying with treatment services is
enhanced, they are less likely to be lost to follow-up and the opportunity to build a helpful
therapeutic alliance is strengthened. The SOS program is an established bridge and
permanent supportive housing provider in Fresno County and has long-term and ongoing
partnerships with housing providers including Fresno Housing Authority and Turning Point.
CONTRACTOR'S RESPONSIBILITIES:
CONTRACTOR shall:
1. Provide services to individuals discharged from local hospital Emergency Department's
(ED)/designated 5150 facilities as requested by the County. The CONTRACTOR may
expand to provide services to other agencies in the County of Fresno as needed or if
requested to do so by COUNTY, Department of Behavioral Health(DB-1).
2. Transport individuals referred by local ED/5150 facilities to the overnight stay facility.
Response time to the ED is expected to be less than 30 minutes from referral call from ED.
Individuals are transported as necessary 24 hours per day, 7 days per week, including
holidays. Individuals will additionally be transported by staff to the Outpatient Center every
morning for assessment and other services. SOS case managers are expected to facilitate
linkage services of all kinds by accompanying the consumer in a program vehicle to various
necessary appointments, including navigation of the mental health system in order to
support engagement and followthrough.
3. Maintain a census of current beds filled and track all referrals including a denial reason for
all denied referrals to the program.
4. Provide overnight stay and linkage to appropriate levels of care the following business
day. Services can be anywhere from 24 hours up to four nights if a client arrives at the
facility on a Friday of a holiday weekend and linkage cannot be provided until regular
business hours are resumed. The overnight stay shall be between the hours of 8pm-
8am; however, the hours of 8arn to 8pm will be used for linkage, targeted case
management, assessments and other mental health services as needed.
Exhibit Al
Page 3 of 5
5. Engage individuals at the EDs where they have been admitted.
6. Be notified by ED staff or County's CPRS staff assigned at the ED of the pending discharge of a
consumer.
7. Encourage individual to accept the offer to stay overnight and be provided
transportation and assistance to outpatient services the following day, or the following
business day when applicable.
8. Provide supervision of individuals who are being discharged from the emergency
department/designated 5150 facility. Provide for the basic care of individuals i.e.:food,
bedding, shower/bath,medication supervision,etc.
9. Maintain staffing including, but not be limited to: program supervisor, clinician, case
manager, peer support specialist, personal service coordinator, data/program assistant
and medical director.
10. Ensure that the safety of the community, consumer and staff are a priority.
11. Have a process in place for each individual who utilizes the overnight-stay facility to
ensure the individual is actively participating in services. CONTRACTOR will make
telephone contacts with each participant's service provider once a week for up to 45
days. Individuals who are not keeping appointments or following through on referrals
will be contacted directly, twice weekly at a minimum. Individuals who drop out will be
located and motivational interviewing techniques will be used to encourage their return
to their treatment program. CONTRACTOR will contact participants at least once a
month until the individual has consistently participated in an outpatient program for 3
months and is functioning at a lower level of care
12. Ensure service delivery is culturally sensitive and appropriate for individuals and their
families
13. Provide family support services through Peer Support Specialists and Linkage
Specialists to aid in the recovery of the individual as well as to educate and engage the
whole family.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Provide program and budget oversight through the County Department of Behavioral Health
(DBH), Contracted Services Division to the CONTRACTOR'S Overnight Stay Facility. In
addition to contract monitoring of the program, oversight includes, but not limited to,
coordination with the State Department of Mental Health, Mental Health Services Act in
regard to program administration and outcomes.
2. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and be available to the CONTRACTOR for
Exhibit Al
Page 4 of 5
ongoing consultation.
3. Receive and analyze statistical data outcome information from vendor throughout the term
of contract on a monthly basis. DBH will notify the vendor when additional participation is
required. The performance outcome measurement process will not be limited to survey
instruments but may also include, as appropriate, consumer and staff interviews, chart
reviews, and other methods of obtaining required information.
4. Recognize that cultural competency is a goal toward which professionals, agencies, and
systems should strive. Becoming culturally competent is a developmental process and
incorporates at all levels the importance of culture, the assessment of cross-cultural
relations, vigilance towards the dynamics that result from cultural differences, the
expansion of cultural knowledge, and the adaptation of services to meet culturally-unique
needs. Offering those services in a manner that fails to achieve its intended result due to
cultural and linguistic barriers is not cost effective. To assist the vendor efforts towards
cultural and linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR):
A. Technical assistance and mandatory cultural competency training including sexual
orientation and sensitivity training for vendor personnel, at minimum once per year.
County will provide mandatory training regarding the special needs of this diverse
population. Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training.
Literature suggests that the mental health needs of lesbian, gay, bisexual, transgender
(LGBT) individuals may be at increased risk for mental disorders and mental health
problems due to exposure to societal stressors such as stigmatization,prejudice, and
anti-gay violence. Social support may be critical for this population. Access to care
may be limited due to concerns about providers' sensitivity to differences in sexual
orientation.
B. Technical assistance for vendor in translating behavioral health and substance abuse
services information into DBH's threshold languages (Spanish, Laotian, Cambodian and
Hmong). Translation services and costs associated will be the responsibility of the
vendor.
PROGRAM OUTCOMES
At minimum, one performance indicator will be identified for each of the four CARF domains
listed below.
a. Access to care: The ability of clients to receive the right service at the right time. Examples
include:
1. Timeliness of bridging prescriptions
2. Timeliness of identifying clients with a seriousmental illness
3. Timeliness between client referral for assessment and completion of assessment;
assessment to first treatment service; and, first treatment service to next follow-up
4. Timeliness of subsequent follow-up visits
Exhibit Al
Page 5 of 5
5. Timeliness of response to sick call/health service requests
b. Effectiveness: Objective results achieved through health care services. Examples include:
1. Effectiveness of crisis interventions
2. Effectiveness of treatment interventions(medical and behavioral health indicators)
3. Effectiveness of discharge planning (such as percentage of clients successfully linked to
County programs, community providers, and/or other community resources after
release)
4. Timely continuity of verified community prescriptions for medication(s), upon client's
release
5. Effectiveness of transportation coordination, upon release
c. Efficiency: The demonstration of the relationship between results and the resources used to
achieve them.
Examples include:
1. Cost per client
2. Number of units of services per FTE bydiscipline
3. Number of clients served per general population
4. Comparison of numbers served against industry standards
d. Satisfaction and Compliance: The degree to which clients, County, and other stakeholders
are satisfied with theservices.
Examples include:
1. Audits and other performance and utilization reviews of health care services and
compliance with agreement terms and conditions
2. Surveys of persons served, family members, other health care providers, and other
stakeholders
Exhibit 131
Page 1 of 2
' d
widely 1rtearal felt
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Contract Provider '
County Approved
Daily Rate
WestCare California, Inc. $188.87
Exhibit 131
Page 2 of 2
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
FSP and AOT
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1,140.98
Physicians Assistant $511.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LVN $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
ILPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
Other Qualified Providers-Other Designated MIA staff that bill
medical $223.41