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Agenda Item
ASR
Control 23-000670 |
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MEETING
DATE: |
05/21/24 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Annette
Mugrditchian (714) 834-5026 |
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Veronica
Kelley (714) 834-7024 |
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Subject: Contracts
for Adult Intensive Treatment Services
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ceo CONCUR |
County Counsel Review |
Clerk of the
Board |
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Concur |
Approved Agreement to Form |
Discussion |
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3 Votes Board Majority |
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Budgeted: N/A |
Current
Year Cost: N/A |
Annual
Cost: FY 2024-25 $35,947,219 |
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Staffing
Impact:
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No |
#
of Positions: |
Sole
Source: No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 9/27/2022 #31, 5/24/2022 #42,
5/11/2021 #14, 5/21/2019 #44 |
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RECOMMENDED
ACTION(S):
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1. |
Approve the Master Contract and
individual contracts with various providers for provision of Adult Long Term
Care Institutions for Mental Disease Services, for the term of July 1, 2024,
through June 30, 2026, for a total aggregate amount not to exceed $37,597,190,
renewable for three additional one-year terms. |
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2. |
Approve the Master Contract and
individual contracts with various providers for provision of Adult Mental
Health Skilled Nursing Facility with Special Treatment Program, for the term
of July 1, 2024, through June 30, 2026, for a total aggregate amount not to
exceed $23,083,330, renewable for three additional one-year terms. |
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3. |
Approve the Master Contract and
individual contracts with various providers for provision of Intensive
Skilled Nursing Facility Services with Psychiatric Services, for the term of
July 1, 2024, through June 30, 2026, for a total aggregate amount not to exceed
$2,672,895, renewable for three additional one-year terms. |
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4. |
Approve the selection of and Contract
with Life Generations Healthcare LLC for provision of Adult Mental Health
Intensive Residential Services, for the term of July 1, 2024, through June 30,
2026, for a total amount not to exceed $900,000, renewable for three
additional one-year terms. |
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5. |
Pursuant to Contract Policy Manual
Section 3.4-114, authorize the County Procurement Officer, or Deputized
designee, to exercise a contingency contract cost increase in an amount not
to exceed $1,844,308.50, 10 percent of the contract amount for the first year
of the Master Contract with various providers for provision of Adult Long
Term Care Institution for Mental Disease Services; $1,124,127, 10 percent of
the contract amount for the first year of the Master Contract with various
providers for provision of Adult Mental Health Skilled Nursing Facility with
Special Treatment Program; 10 percent
of the contract amount for the first year of the Master Contract with various
providers for provision of Intensive Skilled Nursing Facility Services with
Psychiatric Services; and 10 percent of the contract amount for the first
year of the Contract with Life Generations Healthcare LLC for Adult Mental
Health Intensive Residential Services; for the entire term of the Master
Contracts and Contract, including renewals, and within the scope of work set
forth in the contracts. The use of these contingency contract cost increases
are subject to approval requirements established by the County Procurement
Officer. |
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6. |
Approve Amendment No. 3 to extend the
Master Contract with various providers for the provision of Adult Mental
Health Psychiatric Skilled Nursing Facility Services, for the term of July 1,
2024, through December 31, 2024, for an aggregate amount not to exceed
$4,380,000, for a revised cumulative aggregate total amount not to exceed
$72,102,469. |
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7. |
Approve Amendment No. 3 to extend the
Contract with ASC Treatment Group DBA Anne Sippi Clinic Treatment Group for
the provision of Adult Mental Health Intensive Residential Services, for the
term of July 1, 2024, through September 30, 2024, for an amount not to exceed
$110,469, for a revised cumulative total amount not to exceed $2,131,704. |
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8. |
Authorize the County Procurement Officer
or Deputized designee to execute the Individual Contracts under the Master
Contracts with qualified providers for Adult Long Term Care Institutions for
Mental Disease Services, Adult Mental Health Skilled Nursing Facility with
Special Treatment Program, and Intensive Skilled Nursing Facility Services
with Psychiatric Services; to execute the Contract with Life Generations
Healthcare LLC for provision of Adult Mental Health Intensive Residential
Services; to execute Amendment No. 3 to the Master Contract with various
providers for the provision of Adult Mental Health Psychiatric Skilled
Nursing Facility Services; to execute Amendment No. 3 to the Contract with
ASC Treatment Group DBA Anne Sippi Clinic Treatment Group for Adult Mental
Health Intensive Residential Services; and to execute the Individual
Contracts with various providers as needed throughout the term of the Master
Contracts, as referenced in the Recommended Actions above. |
SUMMARY:
Approval of the
Master Contracts for provision of Adult Long Term Care Institutions for Mental
Disease Services, Adult Mental Health Skilled Nursing Facility with Special
Treatment Program, and Intensive Skilled Nursing Facility Services with
Psychiatric Services, the Contract for Adult Mental Health Intensive
Residential Services with Life Generations Healthcare LLC, and Amendment No. 3
to the Master Contract for provision of Adult Mental Health Psychiatric Skilled
Nursing Facility Services and Amendment No. 3 to Contract for Adult Mental
Health Intensive Residential Services with ASC Treatment Group DBA Anne Sippi
Clinic Treatment Group will provide adult intensive treatment services to adult
residents of Orange County living with a serious mental illness.
BACKGROUND
INFORMATION:
Your Honorable
Board of Supervisors (Board) previously approved the Contracts for Adult Mental
Health Psychiatric Skilled Nursing Facility Services, Adult Mental Health
Skilled Nursing Facility with Special Treatment Program, and Adult Mental
Health Intensive Residential Services. The current contracts for Adult Mental
Health Psychiatric Skilled Nursing Facility Services, Adult Mental Health
Skilled Nursing Facility with Special Treatment Program, and Adult Mental
Health Intensive Residential Services expire on June 30, 2024. The County of
Orange Preference Policy does not apply to these contracts. All related prior
actions are included in the table below:
|
Board Date |
Contract/Amendment |
Action |
Term |
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Adult
Mental Health Psychiatric Skilled Nursing Facility Services |
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May 21, 2019 |
Master Contract |
Board approved
master contract with various providers for Adult Mental Health Skilled
Nursing Facility Services |
July 1, 2019 -
June 30, 2022 |
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May 24, 2022 |
Amendment No. 1 |
Board approved
master contract amendment with various providers for two-year renewal |
July 1, 2022 -
June 30, 2024 |
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N/A |
Amendment No. 2 |
DPA Delegated
Authority contract amendment with various providers for administrative
revisions and contingency contract increase to increase rates and amount not
to exceed |
April 10, 2024 -
June 30, 2024 |
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Adult
Mental Health Skilled Nursing Facility with Special Treatment Program |
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May 11, 2021 |
Contract |
Board approved
contract with Extended Care |
July 1, 2021 -
June 30, 2024 |
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September 27,
2022 |
Contract |
Board approved
contract with Oceanside Harbor |
October 1, 2022
- June 30, 2024 |
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N/A |
Amendment No. 1 |
DPA Delegated
Authority contract amendment with Extended Care for budget and staffing
revisions due to ownership change |
October 1, 2022
- June 30, 2024 |
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Adult
Mental Health Intensive Residential Services |
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May 21, 2019 |
Contract |
Board approved
contract |
July 1, 2019 -
June 30, 2022 |
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May 24, 2022 |
Amendment No. 1 |
Board approved
contract amendment for a two-year renewal |
July 1, 2022 -
June 30, 2024 |
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N/A |
Amendment No. 2 |
DPA Delegated
Authority Contract Amendment for administrative modifications to the scope of
work |
July 1, 2022 -
June 30, 2024 |
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Request
for Proposal (RFP)
On November 21,
2023, the Health Care Agency (HCA) released a Request for Proposal (RFP) in the
Countys online bidding system to solicit proposals from qualified providers to
provide various levels of care of Adult Intensive Treatment Services. The RFP
included four levels of care: Adult Long-Term Care (LTC) Institutions for
Mental Disease (IMD) Services, Adult Mental Health Skilled Nursing Facility
with Special Treatment Program (SNF/STP) Services, Intensive Skilled Nursing
Facility (SNF) Services with Psychiatric Services, and Adult Mental Health
Intensive Residential Services. There were nine total responses received by the
due date of December 26, 2023; two responses for Adult LTC IMD, four responses
for SNF/STP Services, two for Intensive SNF with Psychiatric Services, and one
for Intensive Residential Services.
The following table shows the
responsive proposals HCA received for each service:
|
Service |
Proponent |
|
Adult LTC IMD
Services |
Telecare
Corporation Riverside
Sanitarium, LLC |
|
Adult Mental
Health SNF/STP Services |
Oceanside Harbor Holdings, LLC GHC of Newport LLC dba Newport Nursing
& Rehabilitation Center, LLC Extended Care Hospital of Westminster W D W Joint
Venture dba Downey Community Health Center |
|
Intensive SNF
with Psychiatric Services |
Vista Woods
Health Associates, LLC dba Vista Knoll Specialized Care (Vista Knoll) 2210 Santa Ana
OPCA, LLC dba Advanced Rehab Center of Tustin (Advanced Rehab) |
|
Adult Mental
Health Intensive Residential Services |
Life Generations
Healthcare, LLC |
Proposal
Evaluation Process
HCA received one
proposal for Adult Mental Health Intensive Residential Services from Life
Generations Healthcare, LLC in Upland, CA, which was reviewed by County staff
and deemed qualified. Although the RFP was shared with all County Online
bidding system registered users, few are able to meet the regulatory
requirements dictated by Title 9 and Title 22, to be able to provide the
solicited highly specialized services. A standard evaluation panel of three
members, two non-County and one County individual, were recruited to evaluate
proposals for services that received multiple proposals.
Evaluation panel
members independently rated the proposals using the following criteria and
possible maximum points:
|
Evaluation Criteria |
Maximum Points |
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Minimum
Submission Requirements Review |
Pass/Fail |
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Provider
Experience & Qualifications |
20 |
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Services |
20 |
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Performance
Objectives |
10 |
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Staffing |
10 |
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Facility |
20 |
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Budget |
10 |
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Interview |
10 |
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Total
Maximum Points |
100 points |
|
Service |
Proponent |
City/State |
Average
Score |
|
Adult LTC IMD Services |
Telecare Corporation |
Long Beach, CA |
80.72 |
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Adult LTC IMD Services |
Riverside
Sanitarium, LLC |
Riverside, CA |
75.88 |
|
SNF/STP Services |
Oceanside
Harbor Holdings, LLC |
Anaheim, CA |
70.57 |
|
SNF/STP Services |
GHC
of Newport, LLC, dba Newport Nursing & Rehabilitation Center |
Newport Beach, CA |
70.39 |
|
SNF/STP Services |
Extended
Care Hospital of Westminster |
Westminster, CA |
69.34 |
|
SNF/STP Services |
W
D W Joint Venture dba Downey Community Health Center |
Downey, CA |
69.14 |
|
Intensive SNF with Psychiatric Services |
Vista
Knoll |
Vista, CA |
63.69 |
|
Intensive SNF with Psychiatric Services |
Advanced
Rehab |
Santa Ana, CA |
55.86 |
*The
evaluation panel recommended award of contracts to those in bold.
Negotiations were unsuccessful with
Telecare Corporation due to their bed day rate submitted and the overall amount
of available funding. No protests were received from the other RFP respondents.
HCA staff have
conducted due diligence on the Contractors. Reference checks were satisfactory
and completed with the following by contract provider:
|
Services |
Proponent |
Reference
Checks |
|
Adult LTC IMD
Services |
Riverside
Sanitarium, LLC |
Healthcare
Services Group, VA Loma Linda Healthcare System, and Imperial County |
|
SNF/STP |
Oceanside Harbor
Holdings, LLC |
Amir
Aminimanizani, PharmD, MS, Yousef Ireifej, M.D., Pathway Medical Group, Joe
Cecil, LHNA, Links Healthcare |
|
SNF/STP |
GHC of Newport
LLC dba Newport Nursing & Rehabilitation Center |
Merced County,
Behavioral Health, County of Sacramento, and Tulare County |
|
SNF/STP |
Extended Care
Hospital of Westminster |
Chun Kee Ryu,
M.D., Anant Desai P.T., Ed, and Mariela Oblepias, RN |
|
SNF/STP |
W D W Joint
Venture dba Downey Community Health Center |
Elizabeth
Zarate-Rowell, M.D., Kregg Kjar, CTRS, Activity Consultant and Educator, and
Dr. David Melarkey, PsyD |
|
Intensive SNF
with Psychiatric Services |
Vista Knoll |
Imperial County
Behavioral Health Services, Riverside University Health System Behavioral
Health, and San Diego County |
|
Intensive SNF
with Psychiatric Services |
Advanced Rehab |
Foothill
Hospital; Cedars Family Medicine, Christopher Salem, D.O.; and MedCare
Transport |
|
Intensive
Residential Services |
Life Generations
Healthcare, LLC |
Riverside
University Health System Behavioral Health, Merced County Behavioral Health,
and Tulare County |
Each Contractors performance has been
confirmed as satisfactory. HCA has verified there are no concerns that must be
addressed regarding each Contractors ownership/name, litigation status, or
conflicts with County interests.
HCA is requesting a two-year initial term,
with three one-year renewal options for each of these contracts, as it
continues to assess the pending impact of available funding. These contracts
contain language that the contract may be terminated if funds are not
available, however the option to renew allows HCA to continue services without
issuing a new solicitation.
Scope
of Service
The LTC continuum of treatments known as
Adult Intensive Treatment Services is comprised of four tiered levels of care.
The tiered levels are as follows from highest to lowest: Adult Long-Term Care
(LTC) Institutions for Mental Disease (IMD) Services, Adult Mental Health
Skilled Nursing Facility with Special Treatment Program (SNF/STP), Intensive
Skilled Nursing Facility (SNF) Services with Psychiatric Services, and Adult
Mental Health Intensive Residential Services.
Adult
LTC IMD Services
IMDs are the highest level of care within
the LTC continuum of treatment. The target population for IMDs are adults
living with a serious mental illness, who may also experience co-occurring
medical and/or substance use conditions. The goal of IMDs is increase client
daily functioning skills and prepare clients for transition to less restrictive
levels of care and support. IMD are licensed as either SNF/STPs or Mental
Health Rehabilitation Centers (MHRC) and are to comply with California Code of
Regulations (CCR) Title 22 if licensed as a SNF/STP IMD and CCR Title 9 if
licensed as an MHRC IMD. Services are provided in locked facilities that
operate 24 hours per day, seven days per week, and provide recovery-based
mental health services including medication management and a minimum of 27
hours per week of structured therapeutic group activities.
Adult
Mental Health SNF/STP Services
SNF/STP are Medi-Cal certified programs
that provide mental health special rehabilitation services to behavioral health
clients who are transitioning from acute psychiatric inpatient facilities or
stepping down from an IMD. The primary goal of these services is to increase
client daily functioning skills and prepare clients for transition to
community-based services including independent living services. Services are to
comply with CCR Title 22 and are provided in locked facilities operating 24
hours a day, seven days a week.
Intensive
SNF Services with Psychiatric Services
Intensive SNFs with Psychiatric Services
programs provide skilled nursing and supportive care to behavioral health
clients whose primary need is for medical skilled nursing care, while also
accessing intensive psychiatric care to manage serious mental health symptoms.
The primary goal of these services is to treat the primary medical condition
and return the client to their primary behavioral health treatment placement,
such as an IMD or SNF/STP.
Intensive
Residential Services
Intensive Residential Services are
unlocked licensed Board and Care Facilities. The overall goal of this program
is to increase the functional levels of clients, enabling them to fully engage
in their recovery plan and transition to less restrictive levels of
interventions, including independent living. These enhanced Board and Care
programs provide step-down treatment for clients transitioning out of LTC
SNF/STPs, MHRCs, and/or IMDs. The treatment program provides a specialized
intensive residential program that operates 24 hours a day, seven days per week
with an emphasis on structured client-centered rehabilitative and treatment
services.
Amendment
No. 3 to the Master Contract for Adult Mental Health Psychiatric SNF Services
The RFP released on November 21, 2023, and
did not receive sufficient proposals to meet the 175 bed capacity needed for
the IMD level of care. As such, extension of contracts with existing providers
under the Master Contract for the provision of Adult Mental Health Psychiatric
SNF Services, for the term of July 1, 2024, through December 31, 2024, in an
amount not to exceed $4,380,000, is necessary to allow for the continuation of
services to existing clients, as well as time to release another RFP to solicit
proposals from qualified providers to provide this level of care. HCA is
seeking a six-month extension of contracts with Sylmar Health &
Rehabilitation Center, Inc. KF Community Care, LLC, and Landmark Medical
Services, Inc.
Amendment
No. 3 to the Master Contract for Intensive Residential Services
The proposed Amendment No. 3 to the
Contract with ASC Treatment Group DBA Anne Sippi Clinic Treatment Group for
Adult Mental Health Intensive Residential Services for the Boards
consideration will allow for a smooth transition of clients to Life Generations
Healthcare LLC. The Amendment will be for a three-month extension of services
for the term of July 1, 2024, through September 30, 2024, for an amount not to
exceed $110,469.
Performance
Outcomes
Current contracts
for the LTC continuum track and report the number of persons served and average
length of stay (LOS). In addition to continuing to track these activities, new
performance outcomes presented in the table below have been developed to better
evaluate the effectiveness of each LTC program. Outcomes are listed in Exhibit
A of each Contract.
|
Level
of Care |
New
Outcome Measures |
|
IMD |
90% of clients
discharge to a lower level of care 90% of clients
assessment & treatment plan completed within 30 days of admission 90% of clients
will participate in group/individual therapy & social activities 90% of clients
will increase well-being |
|
SNF/STP |
90% of clients
will discharge to a lower level of care 90% of clients
assessment & treatment plan completed within 30 days of admission 90% of clients
will participate in group/individual therapy and social activities 90% of clients
will increase well-being |
|
SNF with
Psychiatric Services |
80% of clients
will discharge to a lower level of care 90% of clients
assessment & treatment plan within 14 days of admission 100% discharged
to the community will have a behavioral health appointment within 3 days |
|
Intensive
Residential |
80% of clients
will not have a psych hospitalization 50% of clients
will discharge to a lower level of care Increase
independent level of functioning |
HCA requests that
the Board approve the Master Contracts for provision of Adult Long Term Care
Institutions for Mental Disease Services, Adult Mental Health Skilled Nursing
Facility with Special Treatment Program, and Intensive Skilled Nursing Facility
Services with Psychiatric Services, the Contract for Adult Mental Health
Intensive Residential Services, and Amendment No. 3 to the Master Contract for
provision of Adult Mental Health Skilled Nursing Facility Services and
Amendment No. 3 to Contract for Adult Mental Health Intensive Residential
Services with ASC Treatment Group DBA Anne Sippi Clinic Treatment Group, as
referenced in the Recommended Actions.
The individual
contracts, due to the nature of the services, could require the addition of
subcontractors. In order to add subcontractor(s) to the contract(s), the
provider/contractor must seek express consent from HCA. Should the addition of
a subcontractor affect the scope of work and/or contract amount, HCA will bring
the item back to the Board for approval. See Attachments Q regarding
subcontracts and Contract Summary Forms.
Pursuant to
Contract Policy Manual Section 3.4-114, authorize the Health Care Agency
Director or designee to exercise a contingency contract cost increase not to
exceed 10 percent of the contract amount for the first year of the Master
Contracts for Adult LTC IMD Services, Adult Mental Health SNF/STP, and
Intensive Skilled Nursing Facility with Psychiatric Service, and the Contract
for Adult Mental Health Intensive Residential Services for the entire term of
the contracts including renewals, and within the scope of work set forth in the
contract. The use of this contingency contract cost increase is subject to
approval requirements established by the County Procurement Officer. The contingency
provision would be exercised in the event there is an increase in the projected
services needed for the clients being served.
FINANCIAL IMPACT:
Appropriations for
these Contracts, and Master Contracts with various individual contracts will be
included HCA in Budget Control 042 FY 2024-25 Budget and will be included in
the budgeting process for future years.
The proposed Contracts include provisions
allowing HCA to terminate the Contracts, reduce the level of services, and/or
renegotiate the levels of services provided, as necessary. This includes a
notice that allows HCA adequate time to transition or terminate services to
clients, if necessary.
STAFFING IMPACT:
N/A
ATTACHMENT(S):
Attachment A Master Contract MA 042-24011029 for Provision
of Adult Long Term Care Institutions for Mental Disease Services
Attachment B Contract MA 042-24011029 for Provision of Adult Long Term Care
Institutions for Mental Disease Services with Riverside Sanitarium, LLC
Attachment C Master Contract MA 042-24011223 for Provision of Adult Mental
Health Skilled Nursing Facility with Special Treatment Program
Attachment D Contract MA 042-24011223 for Provision of Adult Mental Health
Skilled Nursing Facility with Special Treatment Program with W D W Joint
Venture dba Downey Community Health Center
Attachment E Contract MA 042-24011223 for Provision of Adult Mental Health
Skilled Nursing Facility with Special Treatment Program with GHC of Newport LLC
dba Newport Nursing & Rehabilitation Center
Attachment F Contract MA 042-24011223 for Provision of Adult Mental Health
Skilled Nursing Facility with Special Treatment Program with Extended Care
Hospital of Westminster
Attachment G Contract MA 042-24011223 for Provision of Adult Mental Health
Skilled Nursing Facility with Special Treatment Program with Oceanside Harbor
Holdings LLC
Attachment H Master Contract MA 042-24011218 for Provision of Intensive
Skilled Nursing Facility Services with Psychiatric Services
Attachment I Contract MA 042-24011218 for Provision of Intensive Skilled
Nursing Facility Services with Psychiatric Services with Vista Woods Health
Associates, LLC dba Vista Knoll Specialized Care
Attachment J Contract MA 042-24011218 for Provision of Intensive Skilled
Nursing Facility Services with Psychiatric Services with 2210 Santa Ana OPCA,
LLC dba Advanced Rehab Center of Tustin
Attachment K Contract MA 042-24011228
for Provision of Adult Mental Health Intensive Residential Services with Life
Generations Healthcare LLC
Attachment L Amendment No. 3 to Master Contract MA 042-20010215 for Provision
of Adult Mental Health Psychiatric Skilled Nursing Facility Services
Attachment M Amendment No. 3 to Contract MA 042-20010215 for Provision of
Adult Mental Health Psychiatric Skilled Nursing Facility Services with Sylmar
Health & Rehabilitation Centers, Inc.
Attachment N Amendment No. 3 to Contract MA 042-20010215 for Provision of
Adult Mental Health Psychiatric Skilled Nursing Facility Services with KF
Community Care, LLC
Attachment O Amendment No. 3 to Contract MA 042-20010215 for Provision of
Adult Mental Health Psychiatric Skilled Nursing Facility Services with Landmark
Medical Services, Inc.
Attachment P Amendment No. 3 to Contract MA 042-20010216 for Provision of
Adult Mental Health Intensive Residential Services with ASC Treatment Group DBA
Anne Sippi Clinic Treatment Group
Attachment Q Contract Summary Forms
Attachment R Individual Scoring Sheets
Attachment S Regulatory Reference California Code of Regulations Title 22
Attachment T Regulatory Reference California Code of Regulations Title 9
Attachment U Redline Version of Attachment L
Attachment V Redline Version of Attachment M
Attachment W Redline Version of Attachment N
Attachment X Redline Version of Attachment O
Attachment Y Redline Version of Attachment P