ALAMEDA COUNTY HEALTH CARE SERVICES

AGENCY DAVID J. KEARS, Director

AGENCY ADMIN. & FINANCE 1000 San Leandro Boulevard, Suite 300

San Leandro, CA 94577 Tel: (510) 618-3452 Fax: (510) 351-1367

December 1, 2008 Agenda December 16, 2008

The Honorable Board of Supervisors County Administration Building 1221 Oak Street Oakland, CA 94612

Dear Board Members:

Subject: Approval of Master Contract Exhibits with Children's Hospital and Research Center of Oakland for the Provision of Medical Services at the Alameda County Juvenile Justice Center

RECOMMENDATION:

1. Approve the attached Exhibits A and B to Master Contract 900159 with Children's Hospital and Research Center at Oakland (Principle: Douglas T. Myers, Chief Operating Officer and financial Officer; Location: Oakland) in the amount of $3,325,230 for the period beginning July 1, 2008 and ending June 30, 2009 for the provision of medical services at the Alameda County Juvenile Justice Center. This amount represents an increase of $340,000 from the amount that was approved with the passage of the FY 08/09 budget in order to honor the extraordinary expense clause in the amount of $200,000 that was contained in the FY 07/08 contract and to provide an additional augmentation of $140,000 for psychotropic medications.

2. Approve the attached financial recommendations

SUMMARYLDUSCUSSIONLFINDINGS:

With the passage of Alameda County's FY 08/09 budget your board approved funding for a contract with Children's Hospital and Research Center (CHRCO) in the amount of $2,985,230 for the provision of medical services at the Alameda County Juvenile Justice IVledical Center which began operations on April 11th

, 2007.

Implementing a treatment model that utilizes the best practices from juvenile justice, adolescent health, mental health, and youth development has represented both a challenge and an opportunity for anyone invested in better outcomes for youth and their families. CHRCO is a nationally recognized leader in adolescent health service design and delivery. After some initial hurdles related to hiring, equipment challenges, transition issues, inpatient treatment, etc. the model system of care for juvenile justice involved youth as designed by the Juvenile Justice Health Services Collaborative has become a reality. All county departments involved with the provision of services to these youth are extremely pleased with the outcomes achieved to date, for example:

• Reduced the number of medical transports by more than 50% due to the expanded scope of practice in the medical services unit

• Brought new and expanded on-site specialty care services including digital radiology, dental operatory, orthopedics and optometry

• Established health education program on every living unit

• Placed clinicians on every living unit to provide daily mental health services

It is necessary to increase the approved funding level on this contract by $340,000 for the following reasons: To honor the extraordinary expense clause in the amount of $200,000 that was contained in the FY 07/08 contract and to provide an additional augmentation of $140,000 for psychotropic medications. This additional funding will come from two sources; unspent Measure A revenue that was allocated in FY 07/08 to non-county Hospitals and for medical costs for JJC totaling $261,881 and $78,119 in TMSF revenue.

CHRCO has submitted a budget for FY 08/09 which projects actual costs to be $3,167,953 for direct services and $475,193 in indirect expense which is capped at 15%. This is partially offset with fee fro service billing in the amount of $240,000 which leaves a projected shortfall of $77,916. HCSA continues to work with CHRCO on billing mechanisms to enhance revenue and strategies to reduce dental and pharmacy costs

FINANCING:

Approval of the above recommendations will have no impact on County general fund revenue.

Sincerely,

~C~ David J. Kears, Director Health Care Services Agency

Cc: County Administrator Auditor-Controller County Counsel CHRCO CEO CHRCO CFO

2

FINANCIAL RECOMMENDATION AGENDA nATE: 12/16/2008

Subject of Board Letter: Approval ofMC exhibits with CHRCO for Medical Services @JJC

BV: 2009 10000

'rhe use of Designations, as follows:

NAME Of DESIGNATION

'I'he increase (decrease) in anticipated revenue. as follovvs: II1/ri/'/IW[IO//,J!

ORG ACCT PROG PRO;J/GR :,

350100 470720 00000 $78,119

ORGTOTAL $78,119

1,11;)1'111<1[101101

PROJ/GR

ORGTOTAL $0

(;RANI) TOTAL ANTICIPAT[~DREVENUE $78,119 =========

Il1jiwJ1Iul/IJ//ul

, PROJ/GR 350100 610000 00000 $78,119

ORG TOTAL $78.119

!1I1;Jrlllalirmu!

PROJ/GR

ORC TOTAL $0

GRANO TOTAL APPROPRIATION $78,119 ==========

Fonn 110-8 Rev 01/08 COMMUNITY BASED ORGANIZATION

Master Contract Exhibit A and B Coversheet Dept Name: HCSA CMSP#465 Vendor ID #: 0000026459 Board PO #:

Bus Unit: HCSVC Master Contract #: 900]59 Procurement Contract #: Budget Year: 2009

Acct# Fund # Dept # Program #

Subclass #

Project IGrant # Amount to be Encumbered

Total Contract Amount

640]]] ]0000 350]2] 40]50 $3,063,349.00 $3,063,349.00 640]]] ]]000 350]6] 40]50 26],881.00 26],881.00

Contract MaxImum: $3,325,230.00-------- ­Procurement Contract Begin July], 2008

----'------------- ­Expire Date: June 30, 2009

Period of Funding: From: July], 2008 To: June 30, 2009 Department Contact: Vana Chavez Telephone 667-7996 QIC 4250]

Contract Name: Children's Hospital & Research Center at Oakland

Contractor Address: 4 Oakland; CA 94609 94-0382330

Remittance Address: 5400 Telegraph Ave.

Oakland, CA 94609

Contractor Telephone: Contractor Contact Person:

5] 0-428-3483 Terry Oertel

E-mail: Fax #:

TOertel@mail.cho.org 5]0-60]-3922

Contract Service Category:

Estimated Units of Service:

Juvenile Justice Center Medical Services

Maximum Single Payment & Exceptions: $831,307.50 per quarter ,----::-:----:-----:----,,---,..---:--...,..------:------:--------- ­

Method of Reimbursement (Invoicing Procedures): Submission ofquarterly invoices and quarterly reports

History of Funding: Original Amendment #I Amendment #2 Amendment #3 Amendment #4

Funding Level $3,325,230.00

Exhibit #

Amount of Encumbrance $3,325,230.00

File Date .~ r'nn

File / Item #

ReasonI

Funding Source Allocation: Federal / CFDA # ( ) State County

$3,325,230.00

The signatures below signifY that the attached Exhibits A and B have been reviewed, negotiated and finalized. The Contractor also signifies agreement with all provisions of the Master Contract.

DEPARTMENT

By

Signature

Print or Type Name

Title: President, Board of Supervisors, Alameda County Title: Chief Operating and Financial Officer, CHRCO

Date:

Approved as to Form RICHARD E. ~lNNIE, CouQty Counsel

BY~~~_

Exhibit A-Scope of Services

Community Based Organizations

Alameda County Juvenile Justice Center Medical Services

Program Description and Performance Requirements

Children's Hospital & Contractor: Research Center at Oakland Contracting Dept: Health Care Services Agency

Contract Period: July 1, 2008 - June 30, 2009 Master Contract Number: 900159""-=-:::...:...:"-"------­

Exhibit Number: ---------- ­ Encumbrance Number: --------- ­

1.0 Contracted Services

1.1 General CONTRACTOR shall provide licensed medical practitioners, dentists, dental assistants, nurses and other personnel who will perform medical services to detained minors in accordance with The Juvenile Justice Center Model Program Design. CONTRACTOR is expected to provide capable, qualified and dependable employees and to provide adequate staff to cover each shift daily.

1.1.1 CONTRACTOR is responsible for total staff supervision including: staff conduct; staff professionalism in providing services; the following of established policies and procedures; infection control; isolation and sanitation; and the accuracy and completeness of entries into minors' medical records, charts and files.

1.1.2 CONTRACTOR shall be responsible for identifying the need, scheduling and paying for all non-emergency medical and health care services rendered inside and outside the facility. This shall include hospital charges, physician charges and all other charges.

1.1.3 If extraordinary expenses are required, (defined as expenses that exceed 110% of any budgeted line item) CONTRACTOR shall obtain prior authorization from COUNTY and maintain documentation sufficient to justify the extraordinary expenses. Approved expenses shall be paid through separate invoice listing the type of service required and the names of minors. COUNTY agrees to pay up to $200,000 of such expenses prior to seeking board approval for an augmentation of the contract. If extraordinary expenses exceed $200,000, the parties agree to negotiate in good faith to reach an agreement to reimburse CONTRACTOR for those extraordinary expenses.

1.104 CONTRACTOR shall identify the need, schedule, coordinate, and pay for all emergency medical and health care services rendered inside and outside the facility. This shall include all institutional charges, physician charges and any additional charges. It shall include all services rendered in a hospital emergency room and/or physician's office, i.e. all charges rendered for the emergency medical care.

1.1.5 CONTRACTOR shall prepare Management Information Reports on a regular basis as required concerning its activities as they affect the contract duties. CONTRACTOR shall submit all

reports, fonns and other correspondence at the time, frequency and in the number of copies requested by the Health Care Services Agency or the Probation Department.

1.1.6 Minors will periodically require the services of a medical specialist. CONTRACTOR shall be responsible for the arrangement and payment of all specialty care.

1.2 Medical Services

1.2.1 A nurse, physician, or mid level practitioner shall be available, twenty-four (24) hours per day, to perfonn intake medical evaluations on new minors, on an as needed basis, as referred by the Officer of the Day.

1.2.2 An initial screening exam (assessment) shall be perfonned within a reasonable time, but not to exceed four (4) hours, on all juveniles upon their arrival. The exam must be perfonned by qualified health care personnel. The current County Initial Screening fonn will be used or incorporated in a new form. At a minimum, the initial screening exam shall include the following:

- Inquiry into current illness and health problems including mental, dental and communicable diseases (immunization history). - Body defonnities and ease of movement. - Condition of skin, including trauma markings, bruises, lesions, jaundice, rashes, infestations and needle marks or other indications of drug abuse. - Selected tests, i.e. urinalysis (dip stick). - VDRLlRPR, pregnancy test (if indicated).

1.2.3 A health appraisal examination must be completed by a qualified health care professional for each juvenile within 96 hours after admission. The health appraisal shall include the following:

- Review of the initial screening examination. - Complete history and physical examination of undressed minor. - Psycho-Social Evaluation. - Dental screening. - Vision and hearing screening. - Laboratory tests and/or diagnostic testing to detect communicable diseases including venereal disease and tuberculosis. - Other tests, examinations, and immunizations as required and indicated. - Referral for initiation of therapy when appropriate.

The health assessment of females shall also include:

- Inquiry about menstrual cycle and unusual bleeding, current use of contraceptive medications, the presence of an IUD, breast masses and nipple discharge and possible pregnancy; and - A pelvic and breast examination and pap smear conducted by health care licensed professional provider.

1.2.4 Sick Call

Sick call shall be offered daily simultaneously with medication delivery. Sick call shall be staffed with licensed providers. If a juvenile's custody status precludes attendance at a sick call session, arrangements must be made to provide sick call services at the place of minor's confinement.

1.2.4.1 Daily Triaging of Complaints Health complaints from minors must be processed at least daily as follows:

- Appropriate personnel shall solicit and act upon all medically appropriate follow up to any complaint received from a patient at sick call;

Responsible physician shall detennine the appropriate triage mechanism and/or protocols to be utilized for specific categories of complaints. 1.2.5. Specialty Services Provided Off Site

CONTRACTOR shall provide or arrange for the provision of the following services:

1.2.5.1 Emergency room services: Minors with emergency medical conditions which are beyond the scope of on site staff to treat will be transported via ambulance to the appropriate Emergency Department for assessment and treatment as follows: minors over the age of 14 will be transported to CONTRACTOR'S Emergency Department; minors over the age of 14 will be transported to Alameda County Medical Center.

1.2.5.2 Forensic examinations: Forensic examinations will be performed by staff other than those providing ongoing health care to the minor. In accordance with preexisting policies and procedures, minors under the age of 14 who require forensic examinations will be transported to CONTRACTOR'S Emergency Department for such examinations; minors 14 years of age and older who require forensic examinations will be transported to Alameda County Medical Center for such examinations.

1.2.5.3 Specialty services: Specialty services for cardiology, endocrinology, and pulmonology will be done by consultation. Should a physician specialist require a face-to-face examination, special arrangement will be made for on-site or off-site services. Hospitalization: Minors 14 years of age and younger who require hospitalization will be hospitalized at Children's Hospital & Research Center at Oakland (CHRCO). Minors over the age of 14 will be hospitalized at Alameda County Medical Center.

1.2.5.4 Dental Services CONTRACTOR shall provide dental treatment to minors as necessary to respond to acute conditions and to avert adverse effects on the minor's health. Such treatment shall not be limited to extractions.

1.2.6 Patient Records CONTRACTOR shall maintain complete up-to-date patient records compatible with existing system records, on each patient, which shall include but not be limited to, progress notes and record of services provided in sufficient detail to pennit the evaluation of services rendered. The patient record shall accompany the minors at all health encounters and be forwarded to the appropriate facility in the event of a transfer.

1.2.7 Phannaceuticals CONTRACTOR shall be responsible for the ordering, payment and proper distribution and security control of all pharmaceuticals.

1.2.8 Vision Examinations CONTRACTOR shall be responsible for vision examinations of minors. Whenever possible CONTRACTOR will arrange for providing eyeglasses, as medically warranted, at no additional costs to the County as medically required.

1.2.9 Support Services CONTRACTOR shall be responsible for all laboratory, x-ray, and other ancillary services as required.

1.2.10 Orientation and Continuing Education CONTRACTOR shall be responsible for adequate orientation of all new contract employees and for assisting them in meeting continuing education requirements. "Orientation to the Justice Center" will also be required of all new employees. This orientation will be provided by the Probation Department.

1.2.11 Emergency Services CONTRACTOR shall make provisions for twenty-four (24) hour emergency medical and dental care including but not limited to twenty-four (24) hour medical on-call services.

1.2.12 Camp Clearance CONTRACTOR shall conduct a camp clearance (review of medical records) within twenty-four (24) hours after minor is ordered to Camp Wilmont Sweeney.

1.2.13 Health Education and Youth Development CONTRACTOR will design and deliver health education and youth development services by arrangement at a minimum of 2-3 workshops per week. As funding permits, CONTRACTOR will seek to expand this service to all living units.

1.2.14 Laws and Limitations CONTRACTOR shall be required to comply with all applicable local, State and Federal laws and regulations including CAL OSHA standards for HIV, Hepatitis B, etc. The CONTRACTOR understands that any findings and/or recommendations must conform to the codes, laws, rules and regulations governing the agencies and departments involved.

1.3 CONTRACTOR's Security Requirements

1.3.1 Employee security identification badges, including photograph and physical description of subject employee, shall be provided by the CONTRACTOR at his expense. Such badge shall be subject to COUNTY approval and displayed on CONTRACTOR's employee's person at all times while he/she is within the confines of any Probation Department facility.

1.3.2 CONTRACTOR 's employees are subject to reasonable dress codes as defined by the facility; may not bring visitors into the facility without prior approval from the Justice Center Superintendent, Camp Sweeney Director, or their designees,; may not bring in any form of weapons or contraband; are subject to search; must conduct themselves in a reasonable manner at all times; must not cause any disturbance in the facility; must not have social contact with minors in the institutions or after a minor's release from the institutions; and are otherwise subject to all rules and regulations of the facility.

1.3.3 CONTRACTOR shall immediately report to Probation Staff any accidents or loss of any medical equipment and supplies. CONTRACTOR shall make counts of all medical equipment and supplies when directed by the Superintendent and/or Director for security and inventory purposes. A record of these counts will be maintained by CONTRACTOR subject to COUNTY inspection.

1.3.4 CONTRACTOR shall maintain and provide to the Superintendent (s) an ongoing current list of employees.

1.3.5 CONTRACTOR'S employees shall enter through only designated locations in each facility and are not permitted on the facility grounds for reasons other than providing medical services.

1.3.6 Keys and J.D. tokens issued by COUNTY to CONTRACTOR's employees must be picked up and left in a designated area by the Justice Center Superintendent. CONTRACTOR's employees shall immediately report (verbally) to the Superintendent any loss of keys and/or J.D. tokens, and follow up with a written report by the end of their shift. Facility keys must be attached to the employee's person at all times.

1.3.7 In the case of an emergency or unusual event, all employees of CONTRACTOR located in a Probation facility shall be subject to the direction of the Superintendent/Director or his designee. CONTRACTOR will provide services contracted for during any work action or strike through existing or alternative staff.

1.4 Minimum Age of CONTRACTOR Employees CONTRACTOR shall employ no person younger than the age of 21 for services provided under this contract.

1.5 Reimbursement for Costs Incident to Loss of Keys

CONTRACTOR shall reimburse COUNTY for any and all costs, as defined by COUNTY, incurred incident to loss of keys by CONTRACTOR IS employees, including, but not limited to, costs of re­keying locks at the facility.

1.6 Work Outside of Scope of Contract

1.6.1 CONTRACTOR agrees that any work performed outside this exhibit, without the prior written approval of the COUNTY shall be deemed to be a gratuitous effort on the part of the CONTRACTOR (s), and the CONTRACTOR shall have no claim therefore against the COUNTY.

1.6.2 Start Up Costs will be limited to furniture, fixtures, and equipment not to exceed $250,000.

1.7 Uniforms for Employees All uniforms for medical services employees will be provided by CONTRACTOR or employee at itslhis expense.

1.8 Security of Supplies and Equipment

CONTRACTOR is responsible for the security of all supplies and equipment used in the course of the Contract in the Medical Service exam rooms on each of the living units.

1.9 Security of Juvenile Records

CONTRACTOR shall provide a security system which will protect against the unauthorized release of any information contained in any juvenile records. CONTRACTOR shall ensure that all employees of CONTRACTOR have been thoroughly briefed regarding the confidentiality requirements of Sections 827 and 828 of the Welfare and Institutions Code and 1203.05 and 1203.10 of the Penal Code of California. CONTRACTOR shall ensure all employees read, understand and sign the Confidentiality of CORI information form.

2.0 PROGRAM NAME:

Juvenile Justice Center Medical Services

3.0 PROGRAM OBJECTIVES:

With the opening of the Juvenile Justice Center, Alameda County has an opportunity to set national standards for services to our community'S most vulnerable and troubled youth. The objective of the Juvenile Justice Center Medical Program is the design and delivery of innovative, high quality adolescent health services to juveniles pre-detention, in detention, and after release.

Beginning with effective community-based preventative programming, and continuing with effective linkages to placement, treatment and community based providers, The Juvenile Justice Center will play a critical role in the comprehensive system of care for Alameda County's most at-risk youth and young adults.

The Juvenile Justice System is increasingly being used as an alternative of last resort for Alameda County Youth. Local and national research points to an increasing acuity in the medical, mental health, and youth development needs of youth in custody. Insufficient medical care of this vulnerable population represents a serious public health concern. Utilization data from a review of our current services and national data are universal in their call for more intensive, effective, and immersive treatment models that connect youth to preventative and supportive services in and out of detention.

Alameda County shares the challenges and opportunities of a system that disproportionately serves young people of color, young people from families in crisis, and young people with striking health care disparities. Current data shows a troubling trajectory for youth through the Juvenile Justice system in Alameda County and beyond. The following program design draws heavily from a number of methodologies, but first and foremost, the Juvenile Justice Center Program will be based on an adolescent health paradigm that promotes treatment, education, and the principles of youth development.

4.0 PROGRAM DESCRIPTION AND REQUIREMENTS:

The Adolescent Medicine Division will provide comprehensive primary care (including health screenings and physicals, preventive care, reproductive health care, management of chronic conditions, assessment and treatment of minor infections and injuries, health education, medication management and distribution, availability to address acute conditions as they present, and referral for subspecialty services), triage referral, health education (promoting healthy youth development, and youth

leadership). Services to be provided by agreement with CHRCO and other specialty departments associated with Bay Children's Physicians Group include radiology, orthopedics, cardiology, pulmonology (asthma), emergency room services, and in-patient hospitalizations. Dental services will be provided onsite by contract with outside providers. Health services to be provided at the Juvenile Justice Center will be consistent with Title IS requirements for medical services in juvenile detention centers

The plan for continued treatment/management in the transition from detention into the community will be followed by referral to: I. CONTRACTOR'S out-patient health centers at Teen Clinic (5400 Telegraph Ave, Oakland) or Youth Uprising/Castlemont (8711A MacArthur Blvd., Oakland); or 2. to other community providers as appropriate. In particular, vision correction, follow-up dental, obstetrical, and other specialty services will be directly referred through CONTRACTOR'S existing contact network of physicians (i.e. East Bay Perinatology, CHOP dental registry, etc.).

5.0 HOURS AND DAYS OF OPERATION 24 Hours a day, 365 days a year.

6.0 REPORTING REQUIREMENTS Quarterly statistics, as well as year to date data will be made available and submitted to the Chief Probation Officer and Health Care Director or his/her designee to include but not be limited to the following:

Number of: - First time registrations

First time reg. - previously known to CHO minors seen at sick call minors seen as a result if injury minors seen as a result of illness minors seen by the clinicians minors seen by the dentist infirmary admissions, patient days average length of stay, (infirmarylhospital) hospital admissions, patient days (non-psych) hospital admissions, patient days (psych) transfers to an offsite hospital emergency room medical specialty referrals intake medical evaluations initial screening 96 hour physical (assessment) diagnostic studies communicable disease reports filed suicide data (attempts-successes-follow-up training) number of immunizations total number of minors on medication total number of minors on psychotropic medication

In a quarterly narrative (template to be provided by HCSA), CONTRACTOR will also provide updates on the following programmatic areas:

Revenue Generation: Total number of billable visits, development of new funding streams, and progress towards licensure.

Service Delivery: Progress towards achieving the goals and objectives of the model program design, specifically Expanded Services and Treatment, Interagency Collaboration, Continuity of Care, Focus on Youth Development.

Challenges and Opportunities: Issues of concern or opportunity.

Report on Actual Costs Incurred: Line item detail on costs incurred quarterly.

7.0 EVALUATION REQUIREMENTS CONTRACTOR will be asked to participate in a formal evaluation - evaluation process and schedule to be determined.

The medical services areas used by CONTRACTOR shall be subject to inspection by any COUNTY authorized designated persons and staff of other appropriate public entities responsible for inspection of COUNTY juvenile facilities.

CONTRACTOR shall establish and maintain a Quality Control Plan to assure the requirements of the contract are met. An updated copy must be provided to the Contract Manager within 3 months of the contract start date and as changes occur. The original plan and any future amendments are subject to COUNTY review and approval and shall include, but not be limited to, the following:

7.1 An inspection system covering all the services listed in "1.0 Contracted Services" above. It must specify the activities to be inspected on either a scheduled or unscheduled basis, how often inspections will be accomplished, or the title of the individual(s) who will perform the inspection.

7.2 The methods for identifying and preventing deficiencies in the quality of service performed before the level of performance becomes unacceptable.

7.3 A file of all inspections conducted by the CONTRACTOR and, if necessary, the corrective action taken. This documentation shall be made available as requested by COUNTY during the term of the contract.

7.4 The methods for ensuring uninterrupted service in the event ofa strike of the COUNTY'S or the CONTRACTOR'S employees or any other unusual occurrence.

7.5 The methods for assuring that confidentiality ofjuvenile records is maintained.

8.0 CERTIFICATION AND LICENSURE CONTRACTOR will explore the necessity of obtaining licensing and the possibility of applying for Federally Qualified Health Center (FQHC) status for these services at the Juvenile Justice Center.

9.0 TARGET POPULATION Minors brought to the Juvenile Justice Center, Minors detained at the Juvenile Justice Center and Camp Wilmont Sweeney, and minors recently discharged from the Juvenile Justice Center or Camp Sweeney.

10.0 SERVICE AREA Alameda County Juvenile Justice Center and Camp Wilmont Sweeney. Continuity of care to be provided in existing community based settings.

11.0 SERVICE DELIVERY SITES Juvenile Justice Center and Camp Wilmont Sweeney located at 2500 Fairmont Ave., San Leandro, CA.

12.0 SERVICE CRITERIA Medical services provided to minors at the Juvenile Justice Center, minors booked into the Justice Center or Camp Wilmont Sweeney, minors awaiting placement, and minors recently discharged from either Camp Sweeney or the Justice Center without regard to insurance or ability to pay for services rendered.

13.0 TERMINATION

Paragraph 12 of the Community-Based Organization Master Contract ("Master Contract") is amended to delete the following language: "Termination Without Cause -- County shall have the right to terminate this Agreement without cause at any time upon giving at least 30 days written notice prior to the effective date of such termination." In its place, the following language is substituted: "Termination Without Cause --Either party shall have the right to terminate this Agreement without cause at any time upon giving at least 90 days written notice prior to the effective date of such termination. "

EXHIBIT B COMMUNITY BASED ORGANIZATIONS

Alameda County Juvenile Justice Center Medical Services Program Description and Performance Requirements

Contractor: Children's Hospital & Research Center at Oakland Contracting Department: County Medical Services Program (CMSP) Contract Period: July 1, 2008 to June 30.2009 Master Agreement Number:900159 Exhibit Number: Encumbrance Number: _

I. Budget Related(See Attached Budget)

II. Terms and Conditions of Payment: A. Reimbursement:

1. The total amount of reimbursement under the terms of this Agreement shall not exceed 13,325,230. Funds shall be used solely in support of the Juvenile Justice Center Medical Services operational budget. Funds may not be used for any purpose other than those specified in Exhibit A of this Agreement without prior written approval from the Assistant Director, HCSA.

2. Contractor shall invoice i831 ,307.50 quarterly for actual expenses incurred. The fourth quarter invoice shall reflect actual expenses incurred, but not exceeding the remaining balance of the contract. After review, the HCSA Finance Director must sign off on invoice for payment.

3. County shall process invoice submitted for reimbursement by contractor within ten (10) working days from receipt of invoice, submission of acceptable quarterly status reports as delined in Exhibit A, Section 6, of this Agreement and any other back up documentation as requested.

4. Contractor shall claim no more than 15% of direct costs for administrative overhead costs.

B. Invoicing Procedures:

Contractor shall invoice County quarterly. Invoice, with an original signature, must be accompanied by required quarterly report. Invoice should be sent to:

Alameda County Health Care Service Agency 1000 San Leandro Blvd" Suite 300 San Leandro, CA 94577 AnN: Alex Briscoe, Assistant Director, HCSA

Juvenile Justice Center Budget 08-09

2,248,745

BUdget ACCOUNT Budget Description FTE Budget $'5 Revenue County Contract 3,325,230 Fee for Service billing 200,000 CLASP 40,000

Subtotal 3,565,230

Salaries Job Code 0000 - Management NURSE MANAGER 1.00 124,800 0100 - Technician/Specialist HEALTH EDUCATOR 1.00 41,600 0100 - Technician/Specialist MEDICAL ASST. 2.60 145,385 0200 - RNs RN 5.00 629,705 0300 - LVNs LVN 5.20 322,755 0500 - Clerical/Administrative ADMIN COORDINATOR 0.00 o 0500 • Clerical/Administrative MEDICAL CLERK 0.20 13,312 0500 - Clerical/Administrative WARD CLERK 0.80 48,256 0700 • Physicians PHYSICIAN DIRECTOR 1.00 66,175 0800 - Non- MD PNP 2.60 276,839

Subtotal 19.40 1,668,827 Benefits

Benetits % ot all personnel AII- 34.75% subtotal, 16.6383

Total Labor Expense

Non-Labor Expense 3800 - Pharmaceuticals pharmacy 305,000 4100 - Other Medical Supplies medical supplies 20,100 4600 - Office Supplies office supplies 5,700 4800 - Minor Medical Equipment small medical equipment 2,000 4900 - Other Minor Equipment small non-medical equipment 1,000 5000 - Other Non-Medical Supplies health ed supplies 2,000 5000 - Other Non-Medical Supplies non-medical supplies 5,595 6100 - Medical Purchased Services Dental 74,000 6100 - Medical Purchased Services Hospitalizations o

384,073 6100 - Medical Purchased Services ORTHOPEDICS 6100 - Medical Purchased Services lab costs

25,000 6100 - Medical Purchased Services OTHER SUBSPECIALTY 25,000 6100 - Medical Purchased Services radiology 22,609 6200 - Repairs & Maintenance maintenance and repair 1,000 6900 - Other Purchased Services courier service 17,378 7600 - Rental - Equipment COPY/PRINT/FAX/RENT 692 8000 - Utilities - Other hazardous waste pickup 2,041 8500 - Telephone phone/fax 20,877 8700 - Outside Training training 2,000 8800 - Travel local travel 3,143

Total Non-Labor Expense 919,208

Total pirect Expense 3,167,953

Indirect Expense 15% of Direct Expense 475,193

Total Budgeted Expense 3,643,146

Net Gain/Loss (Revenue less Bydgeted Expense)

12/2/2008

EXHIBITD

COUNTY OF ALAMEDA DEBARMENT AND SUSPENSION CERTIFICATION

(Applicable to all agreements funded in part or whole with federal funds and contracts over $25,000).

The contractor, under penalty of perjury, certifies that, except as noted below, contractor, its principals, and any named and unnamed subcontractor:

• Is not currently under suspension, debarment, voluntary exclusion, or

determination of ineligibility by any federal agency;

• Has not been suspended, debarred, voluntarily excluded or determined

ineligible by any federal agency within the past three years;

• Does not have a proposed debarment pending; and

• Has not been indicted, convicted, or had a civil judgment rendered against it by

a court of competent jurisdiction in any matter involving fraud or official

misconduct within the past three years.

If there are any exceptions to this certification, insert the exceptions in the following space.

Exceptions will not necessary result in denial of award, but will be considered in determining contractor responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action.

Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Standard Services Agreement. Signing this Standard Services Agreement on the signature portion thereof shall also constitute signature of this Certification.

CONTRACTOR: Children's Hospital & Research Center at Oakland

PRINCIPAL: Douglas T. Myers TITLE: Chief Operating and Financial Officer

Exhibit E

Business Associate Provisions relating to HIPAA Effective 4/24/2003

Definitions

Capitalized terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms are defined in 45 Code of Federal Regulations Parts 160 and 164 (the "HIPAA Privacy RUle"). In the event of an inconsistency between the provisions of this Agreement and the mandatory provisions of the HIPAA Privacy Rule, as amended, the Privacy Rule shall control. Where provisions of this Agreement are different than those mandated in the HIPAA Privacy Rule, but are nonetheless permitted by the Privacy RUle, the provisions of this Agreement shall control. All regulatory references in this Agreement are to HIPAA Privacy Rule unless otherwise specified.

(a) Business Associate. "Business Associate" shall mean the Contractor, Children's Hospital & Research Center At Oakland

(b) Covered Entity. "Covered Entity" shall mean that any part of the County of Alameda Health Care Services Agency, a County of Alameda "hybrid entity", is subject to the Standards for Privacy of Individually Identifiable Health Information set forth in 45 Code of Federal Regulations Part 160 and Part 164, Subparts A and E ("County").

(c) Individual. "Individual" shall have the same meaning as the term "individual" in Section 164.501 and shall include a person who qualifies as a personal representative in accordance with Section 164.502(g).

(d) Privacy Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 Code of Federal Regulations Part 160 and Part 164, Subparts A and E.

(e) Protected Health Information. "Protected Health Information" (PHI) shall have the same meaning as the term "protected health information" in Section 164.501 and is limited to the information created or received by Business Associate from or on behalf of Covered Entity.

(f) Required By Law. "Required by law" shall have the same meaning as the term "required by law" in section 164.501.

(g) Secretary. "Secretary" shall mean the Secretary of the United States Department of Health and Human Services or his or her designee.

Obligations and Activities of Business Associate

(a) Business Associate acknowledges and agrees that all PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording and electronic display by Covered Entity or its operating units to Business Associate or is created or received by Business Associate on Covered Entity's behalf shall be subject to this Agreement.

(b) Business Associate agrees to not use or further disclose Protected Health Information other than as permitted or required by the Agreement or as Required by Law.

(c) Business Associate agrees to use appropriate administrative, physical and technical safeguards to prevent the use or disclosure of the Protected Health Information other than as provided for by this Agreement.

(d) Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement. Mitigation includes, but is not limited to, the taking of

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Exhibit E

Business Associate Provisions relating to HIPAA Effective 4/24/2003

reasonable steps to ensure that the actions or omissions of employees of Business Associate do not cause Business Associate to breach the terms of this Agreement.

(e) Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information, of which it becomes aware, that is not directly related to Business Associate's performance of the Scope of Work set forth in Exhibit A of this Agreement. This includes the reporting of any security incident, of which it becomes aware, affecting the electronic protected health information.

(f) Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. Business Associate shall not subcontract with respect to this agreement without the advanced consent of Covered Entity.

(g) Business Associate agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity available to the Covered Entity, or at the request of the Covered Entity to the Secretary, in a time and manner designated by the Covered Entity or the Secretary, for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule.

(h) To the extent Business Associate is required to make PHI available to an Individual pursuant to Sections 164.524 and/or 164.526, Business Associate shall do so solely by way of coordination with Covered Entity.

(i) Business Associate agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with Section 164.528.

U) Business Associate agrees to provide to Covered Entity or an Individual, in the time and manner designated by Covered Entity, information collected in accordance with Section (h) of this Agreement, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with Section 164.528.

Permitted Uses and Disclosures by Business Associate

(k) Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in Exhibit A of this Agreement, provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity.

(I) Business Associate may use and disclose PHI as permitted in Section 164.504.

Business Associate Obligations upon Termination or Expiration of Agreement

(m) Covered Entity has the right to terminate this Agreement as set forth in Exhibit D (Additional provisions) and as otherwise permitted by applicable state and federal law. In the event of termination for any reason, or upon the expiration of this Agreement, Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information.

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Exhibit E

Business Associate Provisions relating to HIPAA Effective 4/24/2003

(n) In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Parties that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information.

Miscellaneous

(0) Regulatory References. A reference in this Agreement to a section in the Privacy Rule means the section as in effect or as amended, and for which compliance is required.

(p) Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act, Public Law 104-191.

(q) Survival. In addition to the provisions with respect to survival as set forth in Exhibit D (Additional provisions), the following shall apply. The respective rights and obligations of Business Associate with respect to PHI in the event of termination, cancellation or expiration of this Agreement shall survive said termination, cancellation or expiration of this Agreement, and shall continue to bind Business Associate, its agents, employees, contractors and successors as set forth herein.

(r) Third Parties. Except as expressly provided herein or expressly stated in the Privacy Rule, the parties to this Agreement do not intend to create any rights in any third parties.

(s) Preemption. The provisions of this Agreement are intended to establish the minimum requirements regarding Business Associate's use and disclosure of PHI under the HIPAA Privacy Rule. The use and disclosure of individually identified health information is also covered by applicable California law. To the extent that California law is more stringent with respect to the protection of such information, applicable California law shall govern Business Associate's use and disclosure of confidential information related to the performance of this Agreement.

(t) Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rule.

CONTRACTOR: Children's Hospital & Research Center at Oakland

By:

Douglas T. Myers iet Operating and Financial Officer

Title Address: 747 52nd Street

Oakland. CA 94609

Tax Payer 1.0.# 94-0382330

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