HomeMy WebLinkAboutSage View Services Funding020,
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of April 30, 2008
Please see directions for completing this document on the next page.
DATE: April 23, 2008
FROM: Scott Johnson Dept: Mental Health 322-7502
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Contract #2008-169 providing additional funds to Cascade
Healthcare Community to serve indigent clients at Sage View.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
Since January 2005, Cascade Healthcare Community (CHC) has operated Sage View as a secure
inpatient psychiatric facility, serving residents of Central Oregon and others in need of acute psychiatric
care. The facility has 15 beds to serve its clients. Since 2005, Deschutes County, on behalf of Crook
and Jefferson counties, has contracted with CHC to ensure indigent residents of our three counties have
access to these services and this facility. Funding for this contract has come from indigent Acute Care
dollars (Service Element 24) provided by the State of Oregon. Referred to as a risk-based contract.
Deschutes County has assured a payment level and, in turn, CHC has assured access to all Central
Oregonians who are eligible for services (provided beds are available).
The 2007 Legislature and the Department of Human Services Addictions & Mental Health Division
notified Deschutes County that we would receive additional 2007-2009 State dollars (Service Element
24) for our region's acute care system. By mutual agreement between the mental health agencies
working on behalf of our three counties, it was recognized that costs of indigent care exceeded the
payment level to CHC and that a portion of the funds were needed by CHC to cover the cost of Sage
View services for indigent Central Oregonians. While agreement was reached for an increased
payment level beginning October 1, 2007, the State of Oregon has failed to provide the necessary
Amendment to the Department of Human Services 2007-2009 Intergovernmental Agreement #119292
until now.
The attached document #2008-169 amends #2006-414 providing an additional $55,823 to CHC to help
offset the cost of care to indigent residents of Central Oregon from October 1, 2007 to June 30, 2008.
FISCAL IMPLICATIONS:
Amendment #119292- to the 2007-09 Intergovernmental Agreement for the Financing of Mental
Health, Developmental Disability, and Addiction Services provides additional State resources in Fund
276. Contract amendment #2008-169 will authorize disbursement of $55,823 from Fund 276
RECOMMENDATION & ACTION REQUESTED:
Signature of Contract #2008-169 authorizing an additional payment for Sage View services
ATTENDANCE: Scott Johnson
DISTRIBUTION OF DOCUMENTS:
Please return copies of the signed contract to Loretta Gertsch, Deschutes County Mental Health
Department, 2577 NE Courtney, Bend 97701 and Mike McGinnis, Interim CFO, Cascade Healthcare
Community, 2500 NE Neff Rd, Bend, OR 97701.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: April 23, 2008
Contact Person: Scott Johnson
Contractor/Supplier/Consultant Name:
Department:
Mental Health
Phone #:
322-7502
Cascade Healthcare Community
Goods and/or Services: Secure inpatient acute psychiatric care is provided to indigent
residents of Deschutes, Crook and Jefferson counties at Sage View, a facility and
program of Cascade Health Care Community.
Background & History: Since January 2005, Cascade Healthcare Community (CHC)
has operated Sage View as a secure inpatient psychiatric facility, serving residents of
Central Oregon and others in need of acute psychiatric care. The facility has 15 beds to
serve its clients. Since 2005, Deschutes County, on behalf of Crook and Jefferson
counties, has contracted with CHC to ensure indigent residents of our three counties
have access to these services and this facility. Funding for this contract has come from
indigent Acute Care dollars (Service Element 24) provided by the State of Oregon.
Referred to as a risk-based contract, Deschutes County has assured a payment level
and, in turn, CHC has assured access to all Central Oregonians who are eligible for
services (provided beds are available).
The 2007 Legislature and the Department of Human Services Addictions & Mental
Health Division notified Deschutes County that we would receive additional 2007-2009
State (Service Element 24) dollars for our region's acute care system. By mutual
agreement between the mental health agencies working on behalf of our three counties,
it was recognized that costs of indigent care exceeded the payment level to CHC and
that a portion of the funds were needed by CHC to cover the cost of Sage View services
for indigent Central Oregonians. While agreement was reached for an increased
payment level beginning October 1, 2007, the State of Oregon has failed to provide the
necessary Amendment to the Department of Human Services 2007-2009
Intergovernmental Agreement #119292 until now. Amendment #34 to #119292
providing the necessary funds is scheduled for County Commissioner action on May 30,
2008.
The attached document #2008-169 amends #2006-414 and provides an additional
$55,823 to CHC to help offset the cost of care to indigent residents of Central Oregon
from October 1, 2007 to June 30, 2008.
Agreement Starting Date:
2008
October 1, 2007
Annual Value or Total Payment:
Ending Date:
$349,441 July 2007 -June 2008
® Insurance Certificate Received (check box)
June 30,
4/23/200£'
Insurance Expiration Date:
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ® Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes ❑ No
Departmental Contact:
Title:
Director, DCMH
Scott Johnson
Department Director Approval:
Phone #:
322-7502
4}'.23 • S
Date
Distribution of Document: Include complete information if document is to be mailed.
Official Review:
County Signature Required (check one):,0 BOCC ❑ Department Director (if <$25K)
❑ Administrator (if
Legal Review
Document Number
25K butz$150K; if >$150K, BOCC Order No.
I
Date
o
4/23/200f
For Recordin• Stam• On
After Recording Return to:
• Loretta Gertsch, Deschutes County Mental Health Department, 2577 NE Courtney, Bend 97701.
• Jean Francis, Contracts Officer, Cascade Healthcare Community, 2500 NE Neff Rd, Bend, OR 97701.
DOCUMENT NO. 2008-169
AMENDING DESCHUTES COUNTY CONTRACT NO. 2006-414
THAT CERTAIN AGREEMENT, Deschutes County Contract No. 2006-414 dated July 1, 2006 as amended by
and between DESCHUTES COUNTY, a political subdivision of the State of Oregon ("County") and Cascade
Healthcare Community, Inc. (collectively "Contractor"), previously recorded in the Deschutes County Deed
Records is amended, effective upon signing of all parties, as set forth below. All other provisions of the contract
and assignment remain the same and in full force.
The above listed contract is amended as follows (see strikethrough and italicized (new) text:
Section 8:
Bed Day Rate. For the purpose of this Agreement and extensions or renewals of this Agreement, the Contractor
and the County have established a Bed Day Rate to assist in calculating future payments if both partes
discontinue the full risk capitation method of calculating compensation payable to Contractor and replace the
same with a fee-for-service payment method. Notwithstanding the 5% limit on annual increases, the parties to this
contract are agreeing to a change this one time due to the difficufty of determining cost of care when the project
began and recognition that current costs for indigent care exceed the original base rate funding. This calculaton
is based on an 2005 October 2007 — June 2008 bed day rate of $500 $675 with an annual rate increase not to
exceed 5% in any calendar year through December 31, 2024. This $675 payment rate is consistent with he
September 27, 2007 amendment to the 2007-2009 Deschutes County Biennial Plan. This Bed Day Rate will oily
affect payment and service levels if both parties agree to discontinue the full risk, capitation payment methoc in
and replace the same with a fee-for-service payment method. The parties agree that this will not occur sootier
than July 1, 2006.
Exhibit A is amended by adding the following:
Additional Considerations. In addition to the adjusted payment rate for the October 2007 through June 2008
period of the contract, the Contractor agrees to the following additional considerations:
a. To jointly sponsor training(s) and planning to strengthen the acute mental health care system in its use of
beneficial interventions for suicidal clients seeking hospital, crisis or outpatient services. This includes
incorporating Acceptance Commitment Therapy into the practices within theses settings, proript
involvement of each County's personnel in the admissions and assessment processes and use of
beneficial alternatives when appropriate. By agreeing to this action, the Contractor agrees to pursue more
financially viable and potentially more beneficial alternatives for some clients who might otherwise be
admitted or receive more extended care at Sage View;
b. To join with Jefferson, Crook and Deschutes counties in advocating for improvements in the State ac ite
mental health care system and for State reimbursement for the cost of care for indigent mental he'lth
clients on the State wait list for long term care. Based on recent experiences, such advocacy could re: ult
PAGE 1 OF 4 — DOCUMENT NO. 2008-169 AMENDING DESCHUTES COUNTY CONTRACT NO. 2006-414
in a comparable arrangement as exists with Portland area hospitals and could provide revenue that offsets
the costs of 50-100 days of care annually. Such action could help us retain the risk agreement as desired;
c. To advocate and offer support for the development of hold room services and hospital diversion options at
area contract hospitals; and
d. To include as part of the services provided under this agreement transport of patients between the
Psychiatric Emergency Services unit at St. Charles Medical Center and Sage View.
Exhibit A, paragraph 8 is amended to read as follows:
1. Semi -Annual Financial Report: Sage View will prepare and submit to Deschutes County written Serni-
Annual Financial Reports, including the elements described on Exhibit B. Upon County's request
Contractors shall provide current Financial Report information. Such information is proprietary, is not
required by law to be furnished and is being submitted in confidence, pursuant to ORS 192.502(4). The
parties agree that if such information were to be made public that it could undermine Sage View's abi'ity
to compete with other similar facilities and remain viable. The County obligates itself in good faith to
preserve the confidential nature of such information. Before disclosing such information in response to a
public records request, County shall furnish Contractor with an opportunity to formally dispute such
disclosure.
Exhibit B is amended by adding the following to the required financial reporting information:
The Financial Report will also include the bed day rate associated with the Medicare cost report.
Exhibit E is amended to read:
January 1, 2005 through July 1, 2006
Payment Due Date * Payment Amount
2005 Contract Year
Maximum Amount: $269,410
April 15, 2005 $65,852
April 15, 2005 $6,000 (a)
July 15, 2005 $65,853
October 15, 2005 $65,852
January 15, 2006 $65,853
2006 Contract Year (through June 30, 2006)
Maximum Amount: $131,705
April 15, 2006
July 15, 2006
$65,852
$65,853
Amendment / Extension for two full years July 1, 2006 - June 30, 2008
Full risk agreement is retained based on 1.4 indigent bed days per month
Total Amount = $572,473
October 15, 2006 $68,586 92 days x 1.42 beds/day @ $525/day
January 15, 2007 $68,586 92 days x 1.42 beds/day @ $525/day
April 15, 2007 $70,450 90 days x 1.42 beds/day @ $551.25/day
July 15, 2007 $71,233 91 days x 1.42 beds/day @ $551.25/day
October 15, 2007 $72,015 92 days x 1.42 beds/day @ $551.25/day
January 15, 2008 $72,015 92 days x 1.42 beds/day @ $551.25/day
April 15, 2008 $74,794 91 days x 1.42 bcds/day @ $578.81/day
July 15, 2008 $74,794 91 days x 1.42 bods/day @ $578.81/day
PAGE 2 OF 4 — DOCUMENT NO. 2008-169 AMENDING DESCHUTES COUNTY CONTRACT NO. 2006-414
* Upon receipt of written quarterly program reports.
(a) Approximate payment for December employment by Sage View of several Deschutes County employees.
The Contractor's Payment Rate and Schedule for Sage View services to indigent clients is increased for the
time period of October 1, 2007 — June 30, 2008 by $55,823. Modifications include the bed / day figure
(increased from 1.42 to 1.5 / day) and the bed day payment level (increased from $551.25 through December
31, 2007 and from $578.81 from January 1, 2008 through June 30, 2008 to $675 / day). Payments are amended
for the following:
Time period
Of Service
Payment date
10.1.7 - 12.31.7 January 15, 2008 payment
1.1.8 - 3.31.8 April 15, 2008 payment
4.1.8 — 6.30.8 July 15, 2008 payment
Amount
$ 93,150
$ 92,138
$ 92,138
Calculation
92 days x 1.5 beds/day @ $675 / day
91 days x 1.5 beds/day @ $675 / day
91 days x 1.5 beds/day @ $675 / day
Special note: This payment schedule is consistent with the initial agreement between the County and the
Contractor through which the County provides a quarterly payment and the Contractor agrees to serve all
indigent clients who reside in Crook, Deschutes or Jefferson counties and meet Sage View's eligibility criteria;
provided Sage View has beds available at the time of referral. The basis for payment and funding level was
reviewed in the spring of 2006. The County and Contractor, with the concurrence of the Mental Health Directors
for Crook and Jefferson Counties have agreed to retain the Contractor's full risk agreement through June 2008.
If and when the County and Contractor agree to shift the contract to a "fee for service" agreement, the equal
quarterly payment plan will no longer be in effect. At that time, the Contractor will bill and the County will pay
based on utilization up to the maximum amount of funds available in that program year. The Spring 2006 review
did include actual utilization of Sage View services for the benefit of indigent residents of Crook, Deschutes and
Jefferson counties (260 days 10/1/05-3/31/06), the financial health of Sage View and the region's ability and
Sage View's role in the planned reduction of admissions and bed day usage of Blue Mountain Recovery Center.
A change in the funding level but no change in the contracting approach is recommended to the Deschutes
County Board of Commissioners and CHC representatives as a result of this review. An estimated, average per
day use rate of 1.42 is based on actual indigent utilization between October 2005 and March 2006. The
calculation includes an annual increase of 5% (the maximum allowed) for the two year extension of the risk
agreement.
Reconciliation — Approval of this amendment was delayed due to a delay in the State of Oregon's execution of
the 119292-34 Amendment to the Department of Human Services 2007-2009 Intergovernmental Agreement for
the Financing of Mental Health, Developmental Disabilities and Addictions Services Agreement #119929. Upon
signature and as soon as State funds have been received by Deschutes County from the State, Deschutes
County shall pay the Contractorpursuant to this agreement an amount of $38,479. This amount will compensate
the Contractor for the newly agreed upon amount compared to the prior contract level for a January 15, 2008
payment (an additional $21,135) as well as for the April 15, 2008 payment (an additional $17,344).
The final payment amount will be disbursed in July as previously agreed but at the revised payment level.
Except as otherwise set forth herein, the provisions of Contract No. 2006-414 shall remain in full force
and effect.
PAGE 3 OF 4 — DOCUMENT NO. 2008-169 AMENDING DESCHUTES COUNTY CONTRACT NO. 2006-414
COUNTY: DESCHUTES
Dated this of , 2008 BOARD OF COUNTY COMMISSIONERS
ATTEST:
DENNIS R. LUKE, CHAIR
TAMMY BANEY MELTON, VICE CHAIR
Recording Secretary MICHAEL M. DALY, COMMISSIONER
CONTRACTOR: Cascade Healthcare Community, Inc.
Dated this
James A. Diegel, FACHE
President/CEO
of , 2008
PAGE 4 OF 4 — DOCUMENT NO. 2008-169 AMENDING DESCHUTES COUNTY CONTRACT NO. 2006-41�.