HomeMy WebLinkAboutINTER-DEPT DSS DPH In Home Supportive Services and Adult Protective Services_M-24-656.pdf M-24-565
1 INTER-DEPARTMENTAL AGREEMENT
2 THIS INTER-DEPARTMENTAL AGREEMENT is made and entered into this 30th day of
3 October 2024, by and between the COUNTY OF FRESNO, DEPARTMENT OF SOCIAL SERVICES,
4 hereinafter referred to as "DSS", and the COUNTY OF FRESNO, DEPARTMENT OF PUBLIC
5 HEALTH, hereinafter referred to as "DPH".
6 WITNESSETH:
7 WHEREAS, DSS's In-Home Supportive Services (IHSS) Program was developed to meet the
8 needs of the aged, blind, or disabled who are unable to perform the activities of daily living to
9 stay safely and independently in their own homes; and
10 WHEREAS, DSS's Adult Protective Services (APS) Program was developed to meet the needs
11 of the elderly and dependent adults who are unable to meet their own needs and/or are victims of
12 abuse, neglect, or exploitation; and
13 WHEREAS, DSS's IHSS and APS Programs need Public Health Nurse (PHN) services; and
14 WHEREAS, through this Interdepartmental Agreement, DPH can be reimbursed for the
15 services provided by PHNs assigned to IHSS and APS Programs; and
16 WHEREAS, DPH is both willing and qualified to provide services consistent with the intent and
17 purpose of the IHSS and APS Programs as authorized by the State of California Department of Social
18 Services (CDSS) and the State of California Department of Health Care Services (DHCS).
19 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
20 hereto agree as follows:
21 1. SERVICES
22 A. DPH shall make available two (2) Full-Time Equivalent (FTE) PHN 1/II to provide
23 appropriate nursing services within DSS' IHSS and APS Programs.
24 B. DPH shall ensure each PHN maintains current licensure with the State of
25 California.
26 C. DPH agrees to provide all services as specified in this Interdepartmental
27 Agreement and as set forth in Exhibit A, "Summary of Services", attached hereto and by this reference
28 incorporated herein and made part of this Interdepartmental Agreement.
1 _ COUNTY OF FRESNO
Fresno, CA
1 D. For the delivery of services as described in the Interdepartmental Agreement,
2 DSS and DPH agree that DPH's two (2) FTE PHNs shall be co-located with DSS staff currently
3 located at DSS Building 3, 250 West Pontiac Way, Clovis, CA 93612. Should DSS APS and IHSS
4 program staff be relocated, DPH PHNs will follow, Through this provision, DPH PHNs shall be
5 provided by DSS with all necessary program office supplies to deliver the services as outlined in this
6 Interdepartmental Agreement.
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E. DSS may request additional services from DPH, which are not otherwise
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provided for in this Interdepartmental Agreement, which DPH, at its sole discretion, may choose to
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provide. If DPH is unable to provide said additional services to DSS when requested, DPH shall
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immediately notify DSS. Compensation for any such additional services shall be mutually agreed
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upon and provided within the scope of this Interdepartmental Agreement as determined by the DPH
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Director, or designee and DSS Director or designee, unless DPH and DSS agree otherwise in
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writing.
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F. All costs to DSS are for services provided and are auditable based on State and
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Federal regulations.
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17 2. TERM
18 A. This Inter-Departmental Agreement shall be effective as of the 1st day of July
19 2024 and shall terminate on the 301h day of June 2027.
20 3. TERMINATION
21 A. Non-Allocation of Funds - The terms of this Interdepartmental Agreement, and
22 the services to be provided there under, are contingent on the approval of funds by the appropriating
23 government agency. Should sufficient funds not be allocated, the services provided may be modified
24 or this Interdepartmental Agreement terminated at any time by DSS providing DPH sixty (60) days
25 advance written notice.
26 B. Without Cause - Under circumstances other than those set forth above, this
27 Interdepartmental Agreement may be terminated by either party upon the giving of sixty (60) days
28 advance written notice of an intention to terminate. However, termination of this Interdepartmental
2 _ COUNTY OF FRESNO
Fresno, CA
1 Agreement shall not affect any services to active cases pursuant to this Interdepartmental Agreement,
2 which shall be handled to their conclusion by DPH.
3 4. COMPENSATION
4 A. DSS agrees to pay DPH and DPH agrees to receive compensation for services
5 provided pursuant to Paragraph One (1) of this Interdepartmental Agreement and as identified in
6 Exhibit A, "Summary of Services" and in accordance with the budget identified in Exhibit B, "Budget
7 Summary", attached hereto and incorporated herein, and made part of this Interdepartmental
8 Agreement. In no event shall actual services performed under this Interdepartmental Agreement be
9 in excess of One Million Three Hundred Eighty-Three Thousand Seven Hundred Sixty-Seven and
10 No/100, Dollars ($1,383,767.00),It is understood that all expenses incidental to DPH's performance of
11 services under this Interdepartmental Agreement shall be borne by DPH, including but not limited to
12 any and all personnel, equipment (computers, portable devices, cell phones and any ancillary items)
13 and supplies required in the performance of these services.
14 B. Payments by DSS shall be in arrears for services provided during the
15 preceding quarter, within forty-five (45) days after receipt and verification of DPH's quarterly invoices
16 by DSS. In the event the State of California is unable to meet its financial obligations and funding to
17 DSS is reduced or delayed, DSS may reduce, delay, or defer payment to DPH until such time as
18 State budget issues are resolved. In these circumstances, DPH must accept reduced, delayed, or
19 deferred payment for services.
20 5. INVOICE AND SUPPORTING DOCUMENTATION
21 A. DPH shall submit quarterly invoices to DSS that detail DPH's requested
22 expenditure reimbursement for services provided pursuant to the terms and conditions of this
23 Interdepartmental Agreement. Supporting documentation shall include payroll and accurate
24 documentation of time spent on APS or IHSS activities. Invoices shall be submitted by the 20th of the
25 month for the prior quarter's expenses to DSS.
26 B. No reimbursement for services rendered under this Interdepartmental
27 Agreement shall be made until said invoices and supporting documentation, as identified herein
28 above, are received, and reviewed by DSS. If said invoices are incorrect, incomplete, or otherwise not
3 _ COUNTY OF FRESNO
Fresno, CA
I in proper form, DSS shall have the right to withhold payment as to only that portion of the invoice that
2 is incorrect or improper.
3 C. Once invoices have been approved for payment by DSS, an Inter-Department
4 Journal Voucher shall be prepared to reimburse DPH for expenditures. The Inter-Departmental
5 Journal Vouchers shall be subject to County, State and Federal audits.
6 D. All invoices shall be supported by properly executed payrolls, time records,
7 invoices, vouchers, orders, or other accounting documents pertaining in whole or in part to this
8 Interdepartmental Agreement, and they shall be clearly identified and readily accessible. The
9 supporting documentation must indicate the line-item budget account to which the cost is charged, if
10 applicable.
11 E. Invoices and all supporting documentation shall be sent to DSS, via email, at
12 DSSlnvoices@fresnocountyca.gov.
13 6. MODIFICATION
14 A. Any matters of this Inter-Departmental Agreement may be modified from time to
15 time by the written consent of DSS and DPH without, in any way, affecting the remainder.
16 B. DPH hereby agrees to any amendments in funding to reflect a reduction from
17 State and Federal sources. In addition, this Inter-Departmental Agreement is subject to any
18 restrictions, limitation, or enactments of all legislative bodies which affect the provisions, term, or
19 funding of this Inter-Departmental Agreement in any manner.
20 7. AUDITS AND INSPECTIONS
21 DPH shall at any time during business hours, and as often as DSS may deem
22 necessary, make available to DSS for examination all its records and data with respect to the matters
23 covered by this Inter-Departmental Agreement. DPH shall, upon request by DSS, permit DSS to audit
24 and inspect all such records and data necessary to ensure DPH compliance with the terms of this
25 Inter-Departmental Agreement.
26 8. NON-ASSIGNMENT
27 Neither party shall assign, transfer, or subcontract this Interdepartmental Agreement
28 nor their rights or duties under this Interdepartmental Agreement without the prior written consent of
4 _ COUNTY OF FRESNO
Fresno, CA
I the other party.
2 9. CONFIDENTIALITY
3 All services performed by DPH under this Agreement shall be in strict conformance with
4 all applicable Federal, State of California, and/or local laws and regulations relating to confidentiality.
5 10. RECORDS
6 DPH shall assume responsibility for maintaining detailed records to support its invoices
7 to DSS for services provided under this Interdepartmental Agreement. DPH shall provide DSS with
8 access to said records for audit purposes. Furthermore, DPH shall retain said records for a minimum
9 of five (5) years following the expiration of this Interdepartmental Agreement. In the event of any
10 outstanding State of California or Federal audits or exceptions, DPH agrees to retain its records until
11 such audits and exceptions are finalized.
12 No party shall assign, transfer, or subcontract this Inter-Departmental Agreement nor
13 their rights or duties under this Inter-Departmental Agreement without the prior written consent of the
14 other party.
15 11. RELATIONSHIP OF PARTIES
16 It is understood that this is an Inter-Departmental Agreement by and between two (2)
17 separate departments of the County of Fresno and is not intended to and shall not be construed to
18 create a relationship of agent, servant, employee, partnership, joint venture, or association.
19 12. DATA SECURITY
20 For the purpose of preventing the potential loss, misappropriation, or inadvertent
21 disclosure of DSS's or DPH's data including sensitive or personal client information; abuse of County
22 resources; and/or disruption to County operations, DSS and DPH must employ adequate data security
23 measures to protect the confidential information exchanged between DSS and DPH, for the purpose of
24 providing services under this Inter-Departmental Agreement as required by the County Administrative
25 Office Management Directives, Chapter 1300, Information Services.
26 13. CONFIDENTIALITY AND MEDI-CAL PRIVACY
27 All services performed by DPH under this Inter-Departmental Agreement shall be in
28 strict conformance with all applicable Federal, State, and local laws and regulations relating to
5 - COUNTY OF FRESNO
Fresno, CA
1 confidentiality including, but not limited to: California Welfare and Institutions Code Sections 10850
2 and 14100.2; the California Department of Social Services (CDSS) Manual of Policies and
3 Procedures, Division 19-0000; and the California Department of Health Care Services (DHCS) Medi-
4 Cal Eligibility Procedures Manual, Section 2H. In addition, all services performed by DPH under this
5 Inter-Departmental Agreement shall be in conformance with the Medi-Cal Data Privacy and Security
6 Agreement between DHCS and the County of Fresno (hereinafter referred to as "Medi-Cal Data
7 Agreement") that is then in effect, which is by this reference incorporated herein. The current Medi-
8 Cal Data Agreement is available upon request or can be viewed at:
9 www.fresnocountyca.gov/Medi-CalPrivacy. The purpose of this section is to assure all applications
10 and records concerning program recipients shall be kept confidential and shall not be opened to
11 examination, publicized, disclosed, or used for any purpose not directly connected with the
12 administration of this program. DPH shall inform all it's employees, agents, officers, and
13 subcontractors of this provision, and that any person knowingly and intentionally violating this
14 provision is guilty of a misdemeanor.
15 14. GOVERNING LAW
16 The rights and obligations of the parties and all interpretation and performances of this
17 Inter-Departmental Agreement shall be governed in all respects by all Federal, State, and local
18 statutes and regulations.
19 15. ENTIRE AGREEMENT
20 This Inter-Departmental Agreement, including all Exhibits, constitutes the entire Inter-
21 Departmental Agreement between DSS and DPH with respect to the subject matter hereof, and
22 supersedes all previous agreements, negotiations, proposals, commitments, writings, advertisements,
23 publications, and understandings of any nature whatsoever unless expressly included in this Inter-
2 4 Departmental Agreement.
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6 _ COUNTY OF FRESNO
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_ COUNTY OF FRESNO
Fresno, CA
1 IN WITNESS WHEREOF, the parties hereto have caused this Inter-Departmental Agreement to
2 be executed by their signatures below.
3
4 ATTEST:
5 COUNTY OF FRESNO COUNTY OF FRESNO
DEPARTMENT OF SOCIAL SERVICES DEPARTMENT OF PUBLIC HEALTH
7
8 By. By.
Sanja B ay, Direct r David Luchini, Director
f /yo9 Date: to �' Date: U
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Department of Social Services
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Fund/Subclass: 0001/10000
13 Organization: 56107001 rn
14 Account/Program: 7295/0 0
rn
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Department of Public Health
16 Fund/Subclass: 0001/10000
Organization: 56201618
17 Account/Program: 599010
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- 8 - COUNTY OF FRESNO
Fresno, CA
EXHIBIT A
Page 1 of 4
SUMMARY OF SERVICES
ORGANIZATIONS: Department of Public Health
SERVICE: Public Health Nurses for IHSS and APS
CONTRACT PERIOD: July 1, 2024 —June 30, 2027
CONTRACT AMOUNT: July 1, 2024 —June 30, 2025: $433,004
July 1, 2025 — June 30, 2026: $462,832
July 1, 2026 —June 30, 2027: $487,931
Three (3) Year Total: $1,383,767
PROJECT DESCRIPTION:
Two (2) Full-Time Equivalent (FTE) PHN 1/II employed by DPH shall provide services within the
IHSS and APS Programs administered by the Department of Social Services (DSS). These
nursing services are necessary to meet the needs of the more severely impaired population
receiving services through IHSS, and the elderly and dependent adults in APS who are unable
to meet their own needs and/or are victims of abuse, neglect, or exploitation.
DPH/PHN RESPONSIBILITIES
1. Requests for joint homes visits and referral to Public Health Nurses (PHN) will be submitted
by email per PPG to identify medical needs of eligible seniors and disabled clients,
including but not limited to, recommending appropriate levels of supportive care and
alternative resources and expediting health services. PHNs will respond to IHSS/APS referrals
in a timely manner based on the number of referrals received and urgency of follow-up, based
on the IHSS and APS regulations. Paramedical assessments will be completed as received
unless they are emergent. Consult on form SOC 321, PHNs will contact health care providers
for clarification when necessary. For IHSS expedited cases and appeal cases ordered by judge
for PHN assessment, PHNs will respond immediate or 10 day-in-person response for recipient
who are at risk of health or safety. PHN's will complete protective service assessments and
referrals from APS as immediate or within a 10 day in person response. If PHN follow-up is
immediate, the SW will indicate at the time of the referral.
2. Act as contact between DSS staff, clients and the medical community including providing in-
service to providers on paramedical services.
3. Review documentation from medical professionals, care plans and other pertinent
information to ensure services as determined by DSS staff are consistent with
clients' medical needs, including but not limited to:
EXHIBIT A
Page 2 of 4
a) Bed bound and/or cognitively impaired clients with inability to respond to harmful
situation and/or living alone.
b) Developmentally disabled client with multiple medical problems/paramedical issues.
c) Clients with tracheostomy and/or ventilator dependent, central lines /IV fluids/ IV
meds in home, active, and/or frequently recurring pressure ulcers (decubitus ulcers).
d) Clients with multiple and/or complex paramedical services such as ostomy, G-tube,
home dialysis, bowel program, suprapubic or intermittent catheter.
e) Client with recent and/or frequent hospitalization with reassessment request.
f) Initial Protective Supervision case or cases that request PS where the client is
unable to move with significant human assistance or is immobile.
4. Conduct consultation and home visits with DSS staff, as requested, to evaluate
clients' health issues and make recommendations for supportive services and
appropriate level of care, including but not limited to:
a) Previous or recent paramedical forms that are excessive or the social worker
dispute a medical doctor's recommendations.
b) Follow-up visits for medical-related concerns (outside of
intake/revert/reassessment requests) if not already covered by APS visit.
c) Respond to APS request for home visit for the following reasons:
■ Presence of pressure ulcers (bedsores) with no or lack of medical
attention and/or intervention.
■ Presence of dehydration and/or malnourishment, outside of end-
stage terminal illness/hospice clients.
• Observe or complaints of unexplained and/or repeated
injuries/falls. Report of wounds/falls/worsening of condition/new
symptoms and medical attention has not been sought. Or no
follow-up with medical personnel after a hospitalization.
■ Empty medical bottles, unfilled prescriptions, and expired
prescriptions without explanation.
■ Visible dirt/soiling on skin, excessive oral, and/or body odors
(personal hygiene), urine/stool odors, infestations (lice, fleas,
roaches, bedbugs, etc.).
■ Reports of confused/wandering states, environmental hazards, or
hazardous behaviors with no safety plan. Inability to contact
EXHIBIT A
Page 3 of 4
emergency services when alone. Cognitive impairment with no
advocate for instrument ADL's
5. Provide consultation, guidance, and training to DSS staff in the areas of
documentation, medical terminology, medications, diagnoses, and universal
precautions.
6. PHNs will partner with Public Authority to provide training to the IHSS providers, including but
not limited to:
• communicable diseases
• universal precautions
7. Upon request, assist DSS staff in the interpretation of medical reports and related
documents as part of program service review.
8. Document all nursing activities and interventions, as appropriate, within IHSS and APS
regulations.
9. Provide skilled nursing consultation for clients who are or at risk of being victims of
abuse or neglect.
10. Provide expert testimony during legal proceedings related to program services
and/or paramedical issues.
11. Participate in the development of health-related policies and procedures for IHSS
and APS.
12. Upon request, review case files to ensure supportive services are appropriate to
clients' medical needs.
13.Attend meetings and trainings to maintain and enhance knowledge and expertise in the
areas of senior health care, assessments, and case planning for senior and disabled clients.
14. Complete timesheets with accurate work codes to document program activities, and all
timesheets will be retained by DPH for audit purposes.
15. Submit monthly activity reports by the 10th of the following month. Reports will
document the activity, number of clients worked with, and time spent on each case.
Format of the report will be determined by, and can be reformatted based on need,
by both Departments.
16.Attend contract monitoring meetings with DSS staff. If meetings are not required cancel
upon mutual agreement.
DEPARTMENT OF PUBLIC HEALTH
EXHIBIT A
Page 4 of 4
17. Department of Public Health will provide assigned PHNs with computers, portable devices,
cell phones, ancillary items required in the performance of services under this Interdepartmental
Agreement.
18. Health supplies such as masks, gloves, hand sanitizers, and Purell wipes.
PUBLIC HEALTH NURSING STUDENTS
19. PHN students may be assigned to shadow the Public Health Nurses assigned to the DSS
offices as part of the Public Health Rotation at no cost to DSS. Students come from approved
accredited schools through Public Health.
20. Designated workspaces are not.required for the students.
DSS RESPONSIBILITIES
1. Provide workspace, desk phone, chair, computer monitors, necessary program office
supplies for DPH PHNs co-located in DSS facilities for purposes of this Interdepartmental
Agreement.
2. Communicate and coordinate referrals and consultations with PHNs as often as
needed to ensure client services are provided in the most effective, efficient and
timely manner.
Results
1. The ability to review monthly assistance totals with IHSS and APS cases.
2. The ability to review how many clients received paramedical services on IHSS and APS
cases.
Exhibit B
Page 1 of 3
BUDGET SUMMARY
(Annual)
ORGANIZATION: Department of Public Health
SERVICES: Public Health Nurse Services for In-Home Supportive Services and
Adult Protective Services
CONTRACT PERIOD: FY 24—25
Annual Amount: $433,004
Account No. Account Name Amount
6000 Salaries and Employee Benefits
6100 Regular Salaries $250,718
6200 Extra Help $0.00
6300 Overtime $5,000
6350 Unemployment Insurance $186
6400 Retirement Contribution $132,130
6500 OASDI Contribution $19,180
6550 Workers' Comp Contribution $0.00
6600 Health Insurance Contribution $23,216
6650 Life and Disability Insurance $0.00
6670 Benefits Administration $574
Total Salaries and Employee Benefits $431,004
7000 Services and Supplies
741S Training $ 2,000
Total Services and Supplies 2,000
TOTAL APPROPRIATIONS $433,004
Exhibit B
Page 2 of 3
BUDGET SUMMARY
(Annual)
ORGANIZATION: Department of Public Health
SERVICES: Public Health Nurse Services for In-Home Supportive Services and
Adult Protective Services
CONTRACT PERIOD: FY 25—26
Annual Amount: $462,832
Account No. Account Name Amount
6000 Salaries and Employee Benefits
6100 Regular Salaries $267,604
6200 Extra Help $0.00
6300 Overtime $5,000
6350 Unemployment Insurance $202
6400 Retirement Contribution $143,289
6500 OASDI Contribution $20,472
6550 Workers' Comp Contribution $0.00
6600 Health Insurance Contribution $23,680
6650 Life and Disability Insurance $0.00
6670 Benefits Administration $585
Total Salaries and Employee Benefits $460,832
7000 Services and Supplies
7415 Training $ 2,000
Total Services and Supplies 2,000
TOTAL APPROPRIATIONS $462,832
Exhibit B
Page 3 of 3
BUDGET SUMMARY
(Annual)
ORGANIZATION: Department of Public Health
SERVICES: Public Health Nurse Services for In-Home Supportive Services and
Adult Protective Services
CONTRACT PERIOD: FY 26—27
Annual Amount: $487,931
Account No. Account Name Amount
6000 Salaries and Employee Benefits
6100 Regular Salaries $280,968
6200 Extra Help $0.00
6300 Overtime $5,000
6350 Unemployment Insurance $216
6400 Retirement Contribution $153,501
6S00 OASDI Contribution $21,494
6550 Workers' Comp Contribution $0.00
6600 Health Insurance Contribution $24,1S4
6650 Life and Disability Insurance $0.00
6670 Benefits Administration $598
Total Salaries and Employee Benefits $485,931
7000 Services and Supplies
7415 Training $ 2,000
Total Services and Supplies S 2,000
TOTAL APPROPRIATIONS $487,931