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HomeMy WebLinkAbout70-082RESOLUTION APPROVING AGREEN~NT FOR MFI~ITAL HEALTH SERVICES WHEREAS, this Board has reviewed the attached Agreement for Mental Health Services, wh.ich ag~eement is attached hereto as Exhibi~. "A" and incorporated herein as if set forth in fuli. NOW, T~iEREFORE, BE IT RESOLVED by the Board of Super- visors: l. That this Board approves t~e agreement attached hereto as Exhibi.t "A" and incorporated herein as if set for~h in full, and authorize the Chairman of the Board to sign same on behaLf of the County. PASSED AND ADOPTED by the Board of Supervisors of the County of Butte this 9th day of June , 1970, by the following vote: AYES: S~apervisors Howsden~ McKillop~ Reynolds; Chairman Dunaway NOES: ~one "~~~~~T~ ~u~ rvisor Maxon ~ ATTEST: CL;ARK A. NELSON, County Clerk and ex-officio Clerk o£ the Soard of Supervisors °~~~.~e ~!~~ ~ ~ ~ ~ ~ . E. A , C airman o t e Butte County Board of S pe~visors ~'D- 8'~ ~1~~ f1 ~ AGREF~~N'I' FOR MENTAL HEALTH SERV~CES THIS AGREEMENT, made and entezed inta this day of , 19 , by and between C4UNTY, acting by and through their Baard of Supervzsars, hexeinafter referred to as "County" and the STATE OF CALIFORN~A, DEPARTMENT OF MENTAL HYGIENE, acting by and through the Directa~ o~ Men~al Hygie~e with the approva~ of the Direct~r of Genera~ Services, h~rein- after referred ta as "State" ; ~ W I T N E 5 S E T H~ WHEREAS, the County d~sires to ob~.aa.n ~ram the S~a~e patien~ care. ~reatment, facili~.ies and rel.ated services und~r the provisions of Division 5 of ~he Welfare and znstitutions Code, S~at~ of California, in accordance with Sect~.~on 4417. 5401 and 5602 of said code; and WHEREAS. ~he State Hospital(s) has{have the necessary staf~, ~acilities, and services to adequatel.y provide such specialized care and t~eat- ment; NOW. THEREF4RE, it is mu~ually agreed betwe~n the parties as follaws: I In considerata~on of the payments here~nafter provided, State agrees to provide inpati~n~ services as described in Sectian 5~1, Title 9. Cal.ifor~rxa.a Administrative Code, at I~Witt , and Mendocino State Hospita].s ta adult patients 16 years of age and over, and ta ~hi.ldrEn patients under the age of lfi at {Camari~.l.o or Napa} S~ate Hosp~tal, re~erred by the Director of Local Men~a~. Hea~.th Services of ~utte County. Admission of children patients to {Camarillo ar Napaj State Hosp~.~a1 is contingent upon the submission af an eva].uation af th~ pa~ien~ by County to S~.ate, a d~termina~ion by State that the pata,ent is suitab~.e ~a~ tr~atrnent, tha~. there is availab].e bed sp~c~ in the Children's Unit, and upan ~he furnishing by County of necessary a~tercare services on discharge of the patien~ fram the hospitai, II Tn accordance wi~h Sec~ion 541, Tit~.e 9 Califar strative Code, iripa~ient services are de£in~d as men z. h~alth services wi~hin a hospital providin,g~,diaqnosis~ eva~ua~ tion,_care and ~reat~ient of persons suffer~nq from menta~, emotional ox behavinral disorders, mental~~r~tardat~on or mental disorders resul~ing from alcoholism. zxx The admission, treatment,,,,,,and discharqe o~ ,~ta.ents sha].]. be in accardance wi-~h qenerallv accepted standards of ~he medical professione State wiii obtain a histo~rv~and perfo~n a physica]. examination an ~~each~~~pata.ent~~~~as soon as, - - - - _ ,... , , . _,~ ^-^ possibl~: a~tear admission and not later~ than~ 24 hours after admi~ssion, excludin w~ekends and holida s. Stat~ rna ~acce t County's histor~r, physical examination and 1.aboratorv findinqs to avoid a dup~.icatiQn of servzce~s~.'~ .~.~~.~~~.~.~~..~~_~.~ ,-~.~~^ Genera~ medieal~ neuxologica~.__and stxrqical services shall be ava~~.ab1.e to each a~.~.er~t. Also en~ral laborator~, radioloqica~ and electraencephaloctra,ph .se~~rices shall be avail- able. Provisions for ~rans~er~of „~pa~i.ents to an approtariate ^ facili~y for^m~dical orT surqic,a~l ~tzeatment~„may be made. ~' Shau].d ex'~~aordinar services be re ~ired b a atient, S~ate a rees ~a consu~.t wi~h the Local Menta~. H~a1th Director rior ta erformin the service or makin an a ro riat~ re- ~erral. Prior consu3.tation sha3.1 not be re uired b Stat~ in renderin~ emerg,ency Fnedical care. TV Upon dischar_qe or transf~r af a pati~nt State w.~ii ~ communica~~ with the individual. ar a enc to which the a~ien~. is beina refea~red, and farward an request pertinen~ inpa~ient hosp~.ta1. ~ecords where the patient's_ best inter~sts wil~. be ,_~ ~ ~ sex~ved. PatiEnts' records wi~.l_be comp~e~ed w~.thin 72 hours followinq d~.~charqe, excludinct weekends ~and ~ho~.idays. Summar~.es wiJ.~. be pravided in a11 ca~es to the agency~to which ~.he ,pa~.ient is beinc~ re£err~d. ' ~ V State agrees ~o ha~e admission policies which shall be in writing az~d availab}.e to the p~b~.ic. Such policies shall inc~ude a provision that pa~.ien~s W~.ii be accep~ed for care without discrimination on the basis of race, color, reliqion, national ari.gin, or ancestry. VZ ~ State ~urther agrees no~ to employ discri.minato~y practic~s ~.n the admissian of patients, assignment o~ accoinmo- datians, employment of personn~l, or in any other respect on the basis o~ ra~e. calor, religion, national origin ar ancestry. 2. v~~ Sta~e w~ll maintain adequa~e medical records on each individna~ pa~ien~. The records shall include diagnostic studies and a record af services provided by the various professional • personnel in sufficient detail to make poss~ble an evaluation of services. The records sha11 contain aZ~ of the data necessary in reporting to the llepart~ent af Men~a1 Hygiene, including records af patient intervi~ws. A qualifi~d medical reco~d libra~ain shall be respansible for completion of inedical records and the transmission af r~ports. V~~I Sta~e agre~s that prof~ssional and technica~ pe~son- nel sha~~ mee~ the standards s~t forth in Artic~~ 8, Sub~h~pter 3, Tit~e 9, California Administrat~ve Code, un~ess the Departinent o~ Mental Hygxene permits exceptians to ~hese reqtiiremen~s. TX Fees for services provided shall be cha~ged by State in accordance with the ability o~ the patient or his r~sponsible rela~ives to pay but no~ in excess of actual cost to the Depart- ment of ~ental Hygiene. Charges shaLl be in accordan~e with the attached prevailing schedule of charges which has been adopted by the Director of Mental Hygiene for patients receiving State Hospital ~ervic~s and in accordance with any cha~ges in the schedu~e o~ charges, no~ to exceed actual cos~s, adapted by the Director of Mental Hygiene du~ing thE term of this agreement. X zn consideration o£ the afo~esaid s~rv~ees rendered by State ta patien~s ~ef~rred by the Local Menta~ Health Director, County agrees ta pay State ~4~ of a~~ ne~ costs of reimbursable services, ~ess pa~ient fees collected. State to re~a~n 9Qq6 af ~he cost of these ser~ices from County's alloca~ion pursuant to W~~fare and xnsti~utions Code Sec~ion 5714. A11 non-reimbursable services, less patient £ees callected, shal~ be paid by County in full. S~rvices fox which County is ~.iable for paymen~ shall inc~.ude a].J. extraordinary servi,ces and emergency care, less patient fees collected. The total amoun~ pa abl.e by Count to State under this . agreemen~ shal3 nat exceed F~ve Thousand Eigh~ Hundred and Fo~y-One do3.lax~s (~ ~ ' } un~.ess the partaes shauld increase this amoun~ ~hrough app~op~iate amendment. Tn ordex to arrxve at ne~ costs set £orth in Secta.on 5705 of ~.he Welfare and Tnstituti.ons Code '~he amount shown in this paragraph {$ ) may be adjustecl npwards if actual expenditux~es 3. ~or locally-operated and S~ate Hospital services, when added tagether, do not exce~d the ceiling'far County expenditur~s as def~ned in Sections 5709 and 570905 0~ the Welfare and Tns~itutxons Code. XT Payment by County for which State reimbursem~nt shal be made pursuant ta S~ctian ~705 0~ th~ Welfare and Institutio ~. .. .~ ~ ~ ~~., _ _ ...~ Code shall be Ii~i.ted, to paYment fo_r_ inpati.ent serviees as set ~orth in Artac~e TT ~f this aareement, incl.udina the nrescrib- in or furnishan o~ neces5ax dru s to e~her w~,~h such eneral. m~dica~. and sur ica3. racedures as are necessary in the treatment of a Asvchzatr~.c conditian. ~ ^ ' ~ ~ ~^~' xxz Ad~quate £i.nancaal records shall be kept by State so that they c~.early refl~ct the cost of each type of service fo~ which pay~nent is claim~d. Any appor~.ionmen~ o~ cos~s shall be rnade ~.n accordance with accepted accounting principl.es a,n order ta refl~ct the true cost o~ ~.he services render~d. Statistical data sha].1 be kep~ and regor~s made as required by the Depart- ment o£ Mental Hygiene on forms provided by the Department of Men~a3 Hygiene. All su~h reca~ds sha11 be available for inspec- ti.on by th~ audito~s o~ Coun~.y a~. reasonable ti~es during normal busin~ss hour~. XI~~ S~.ate sha11 bi11 County ba.--monthly in a~~ears ~or services xendered to eligible patxents in an amoun~ no~ tp exceed actual. costs to State in accordance with Article ]C Of this agreement, said bzll to clearly reflect the cost of services rendered in the care of each pa~.ient. Du~ing 1974-71 bills shall be submitted for two«~nonth periods commencing with the July-August p~xiod for that year. Coun~y payment sha11 b~ inade within a reasanable ti.me by warrant or by deductions frvm the next claim for reiml~urs~ment submitted by Caunty. X~V The Arovis Patien~~ who are res S'~ate Hospi~als and ,.... -- -- -- - Department of Men'~a~ ~ram t1 of such an Mental Health Direct or prepetition scxee reQuests the trans~e pr~,mary r~sponsibili such a trans~er if s Countv. 5 s aareement sha~.3. alauiv to at~. ura~s y ror cou ace a.s av ^ and to consult w to performing diag. th~ Local Mental : ~ient to the Stat~ ~o other t~.on of ~he tify County h the Local stic screeni alth Directo pa~ients, State_ aqxees e and~ at tha expense ~o 4. X~I State ~e expense,_ an~ pati.e ~he j urisdiction o it appears, in_the '~hat the space ava and the patient wo aqrees 'to consul~c~ ~to s~.ch trans~er. ~er to a S~ate Hos district. ves th~ ri ht to ~rans~er at its own o~ Caun~y to another State Hospital under .~~ ....._.~,..~ - he De artm~nt of Mental H~i,ene whenever inion o~ the Da~rectar of Mental Hygiene, b7.e is inade uate for treatment ur ses be benefitted bv ~uch a trans€er. State h~he Local Menta~. Hea~th Dir~ctor prior eference sha~.3 be qiv~n in any such.,trans- al in an adioi.~ina rather than a remote XVI The ~~ovisa.ons of ~his aqreement~ shal3. apply to any resident of Coun~.v confined to a publi.c insti.tution of ano~her state having a reci~roca~ workina aqreement with the Depar~ment of Menta]. Fivqiene fo~r ~che mutual e~cchanqe or rsturn _o~ such ~ _ . --- _ -- persons. Stat~ aqrees to consult wi.~h the Loea1 Mental Health, ~_^ - - , Diree~or ri.or tv ~he r~turn o~ such ~erson,, and u~on his rectuest to move such^ erson to the S~ate Hos~ital ha.vin pri- marv res nsibi~.itV for Coun~y` s_ pati~nts. County sha~.1 not he ~esponsibl.e for trans~e~ costs but wi,ll be responsible far all costs for services rendered followinq the_adma.ssi.onrof such a~a.ent to a hospital af State as provided in this agree- menfi.. ~ State aqr~e~ to admit non-resident ~ersons referrEd by the Loca~. I+~ental Hea~th Director wY~o ar~ residents of~ a state havin a rec~. rocal workin a reemen~ with the De art-- ment of Mental Hvqiene for the mutual exchanqe or r~turn of such persons. Caunty ~haii not b~ responsible for the_services r~ndered to s~xch persons by, State or fox the costs af traris- portation o~ such pexson~ tv their state of residence, XVII This agreemen~ sha].1 be ef~~ctive only ~ar such period of ~.ime as ~he Controller of ~he County ce~tif i~s that ~unds have been appropriated, are availabl.e, and have been set aside for the purposes hereof, and th~ County's obliga~ion hereunder ~ha11 not exceed ~he amount certified by the Con~roller of the County unless an addi~.a.onal c~r~i~'ication is secured. XVTII A}1 re~erences in this agreem~nt ~o sections of Title 9, Cali~ornia Adnninistra~ive Code, shal.~. ba applied as now exi.sting or hereinaf~.er amended. 5. XIX This agreemen~ rnay be terminated by-"either party by giving thirty (30) days writt~n notice of intention ~o terminate. Tn the event that County fails to cer~ify as to the availab~l~ty of funds State reserves the right ~o tg~~na~e this agreement immediately by giving wr~tten notice to County. Unless so terminated, ~his agreement shal~ remain in fu11 ~orce and e~~e~t commencing July 1, 1970, and ending June 30, 1971. TN WTTNESS WHEREOF, the pa~ties hereby have caused ~heir duZy a~thorized representa~~ves ta execut~ ~his ag~eernent the day and year first above written. C4UNTY OF ~ By aa.rman, oard o Supervi rs STATE 4F CALIFORNIA DEPARTMENT OF MENTAL HYGTENE By Chief Deputy Directar O~'fice of Administrative Managemen~ Approved: STATE OF CALIFORNIA DEPARTMENT OF G~NERAL SERVIC~S By D~rector of Gen~ral Services APPROVED AS TO FOI~M Butte Courrly Cauns~l ~17a,niel~ Y• Sfaclc toclc ~y ._,..~........ ~-.L..~ ..M......,.w. 6. ~UTPAT~ENT CONTRACT PRQVZS~ONS I {Same as ingatien~ Except for "outpatient" and "542" which are suhs~~.tuted where underlined.) II In aecordanee with S~ction 542, Title 9, California Administrati.ve Code, outpatient services ar~ defined as m~ntal health serE~ices p~ovided on an outpatient (non~inpatiant) basis and providi.ng a direct service o~ xe~erral, evaluati.on, diagnosis, care or txea~ment ~o persons ~uff~ring from mental, emotiona~. or behavioral d~.sorders, men~al ret~rdation or mental da.sorders ~~sultir~g fram alcaho~ism. IIT State agree~ t'ha~ the outpa~ient services shall be ~~asonably available and accesszble ~o Caun~y's patients and ~and~~ the general direction of a gsychiatra.st who is present o~ availab~.e on a r~gularly scheduled hasis. A physician shall m~sume medical responsibili~i~s for a11 patients. In mental. retardation and alcoholic prvgrams a phys~.- ~~~n ~ther than a p~ychiatrist may be substitut~d by State when t~is ~ou1d be more appropriate ~o the ~reatment needs of the ~~~ient. Iv The m~.nimum professional staff for the nutpa~i.ent ~~rvices provided by State sha7.1 a.nclude a gsychiatrist and c~t`~ie~ personn~l necessary to achieve pxogram objectives, such as physa.cians, psycholog~.~ts and social workers. Participation by di~~erent aisciplines may vary according to program design and objectives. A physic~.an must be present at Ieast half time during which ~he services are provided, exc~pt tha~ under ~pecial circumstances the Department of Menta}. Hygiene may gea~mit moda.fication o~' th3,s requirement. V In condueting the outpatient servicea 5tate agrees ta provide #or corttinuity of care and flex3ba.lity oE staffing to meet the needs of the individ~al patien~. The staff may ~,nclude qua~.ifxed ~eg~s~ered nurses and other profes~ianal disciplines. The servi.ce~ provided by ~he various professional disciplines ~hail be integrated throug'h regular sta~f ineetings and other c~onferences for join~ planning and evaluation of treatmen~. ~ 1. XI Payinent by County for which State reimburaemer~t shall be made pursuant to Section 5745 of the Welfare and Ynstitu- tions Code eha11 be 3.imited to gayment for outpatient services rendered as ~e~ farth i.n ~rtia].e ~T of this agreement, includ- ing the prescribing o= furnishing of necessary drugs but excluda.ng other medical care or treatment not necessary to evaluation of psychi,atric diso=der~. 2. PARTYAL H05P~TAL~ZAT~~N SERVTCES C~~TTRACT PROVY5Y~NS r (Same as inp~t.ien~ agreement except for "partial hospitalizat~on" and "543" which are substi.tuted where underlined.y II xn a~cordance w~,th Se~~ion 543, Titl.e 9, California Administrative Code, pagti,a~. hospita~.ization services are d~fined as menta]. hEalth servaces far patients ~rith mental, emotiona~ or behavioral aisorders, mental retardation or mental disorders resulting ~~om a~.cohol.ism, who may spend an~y part af any 24-hour period in the program. The pra~maxy purpose of this service is to proviae a planned prograzn of mil~,eu therapy and other treat~- ment modalities, anc~ may include diags~ostic sezvices. This aervice m~y provid~ day care and ~rea~ment for patients able to r~tuxn Ybome evenings and weekends. Th~.s servi.ce may in addition incl.ude ~vening car~, night care, and weekend care. ~I~ ~he minimum proEessiona~ ~taff prova.ded by State shal.l includ~ a psychiat~ist ar~d other pe~sonnel r~ecessary to achieve program objecti.v~s, 9~ach as physicians, cl~,nical psycho~ogis~s, p~ychiatric soc~.a~ work~rs, nurs~s, educators, occupational therapa.s~s. rehabi~.i.~ation therapists, recreationa~ therapists, and psycY~~.at~c~.c aa,ds. Participation by dif~erent disci.p~.ines may vary accoxd~.ng ~.o program d~sign and objectives. TV Stat~ agrees that tY~e partial hospitalization services shall be under ~he gener~l direction of a psychiatrist who is present or availabl.e. A physieian must he present at least ha3f time during which the services are provided, except tha~ under spec~al c~rcums~ance~ the Department af Mental Hygiene rnay permit modi,fication of this requirement. XT Pay~t3ent by County for which State reimbursement shall be made pursuaa~t to Section 5705 of the Wel£are and Insti~utions Code sha~~. be l.imi~ed to paymen~ £or partial hospitalization services sendered as set forth in Artic~.e II of this agreeraent, including ~he prescribin~ or furnishing o~ neceesary drugs but excluding other medical care or t~ceatment noti nec~s~ary ~o evaluation of psych~.atric disorder~, EMERGENCY...SERV~CES CONTRACT PROV~524NS N.B. Permi~sive additional services ta cantracts under Cali- fornia Administ~ative Code Sections 541, 542 and 5~3. Emergency serv~ces may not be separately contracted, but must be ~nclude~ in a contract for either inpatient services, outpati~nt services, or partzal hoepital- ixation services. (Cal. Admin. Code 544.) XX {Same as inpatient agreement excep~ Eor "emergency" artd "544" which are added aFter the underlined service and section.j XXI In accozdance with Section 544, T~tle 9, California Administrative Code, emexgen~y services are defined as ~hose mental. health services which provide immediate pxofessional attention to persons suffering from mental, emational or behaviaral disorders, menta], retardation or mental da.sorders resulting from alcoholism. X.X~ I State agrees that the emergency services provided shall be ~eada.}.y avai~.able and accessib].e to Caunty' s patients 24 hours a day, seven days a w~ek, X~CI I I Payment by County ~or which S~ate reimbursement shall be made pursuant to Section 5705 0~ the Welfare and Insti~utians Code sha1.1 be ~~.mi.ted ~o payment for emergency servxces set ~orth in Article XXI of this agre~m~nt, including ~he prescribing or furnishing of necessary drug~, but excludi.ng other medical care or treatment not n~cessary to eva~.uation of psychiatric disorders. DIAGNOSTIC SERVZCES CONTRACT PROVI5~ON5 T (Same as inpatient agre~ment except for "diagnostic" and "546" which are ~ubstituted wher~ unde~lined.) II ~n accoxdance with Section 546, T~t~e 9~ Caiifornza Administrative Code, diagnostic services are defined as those. services,provid~d in the evaluation or analysis o~ the causE or nature af inenta~, emotional ox behavioral disorders, mental retardation or men~a~ disorders resulting from a~coholism. This service may include referra~ and recommenda~iona for appropriate care. IiI It is agreed that this service may include d~agnosis, evaluation, ref~rral, prepetition sc~eening and conse~vato~ship recommendations. xr Payment by County for which S~ate reimbursement sha~~ be made pursuant to Section 5705 of the We~~are and ~nstitutxons Code shall be ~imit~d to p~yment far diagnas~ic servic~s rendered as set forth in ~rticl~ ~I o~ this agreement, includ~ ing the prescr~bing or furnishing of necessary drugs but ex~ c~uding other medical care or treatment not necessary to evaluation o~ psychiatric disorders. REt~A~TLTTATIVE SERVICES COLVTRACT PRQVISI~NS ~ (Sam~ as inpatient agreement excep~ ~or "zehabi~~tative" and "547" which are substi~uted where underlined.) II ~n accordance with Section 547, Title 9, Califarnia Administrative Code, xehab,ilita~ive services are def~.ned as those services pxovided under psychiatric direction or by eont~a~t upon psychiatric referraJ., review, and aonsultation, to persons with a diagnosed mental, ernotiona~. or behav~.oral disorder, ~~ntal retardation or mental disorders resulting ~rom alcoholism, to r~store, establish, and maintain optim~ leve~s of social, vocational, and physical funeta.oning and to minimixe residua~ disability. III State agrees that the rehabilitative services pro-- vided sha11 include psycha.atric raferrai, review, and cons~l~a~ tion to a.naure cantatnuous medical responsibility. Professional co].~.aboration around tZae rehabilitative service sha11 include . staff conferene~~, caee conferences, and eva~.uat~.on of progress. ~V State agrees to provide ~ psychiatri.c diagnosi.s on a~.]. of County's patients served in rehabilitative ser~ices. At its inception part of the treatment plan of each patient sha}.1 include an assmssment of hi.s potential for rehaba.litation and the place o~ rehabilitative services in his total program, the plan to be reviewed and modified accorda.ng to the gatient's grogress. V The rehabiZitative servi.ces sha11 be sta~£ed by State with ~uitable professi,onal and technical personnel with specia~.ized training and exp~rience appropri~ate ta the objectives defined in the program description. XI Paymen~ by County for which State rei.mburaement ~hall be made gursu~nt to Section 5705 of the Welfar~ and Institutione Code-sha11 be limited to paym~nt for rehabilitative se~vice~s render~d a~a set forth in Articl~ TI of this agreement, includ- ing the prescribing ar furnishing of n~cessary drugs bu~. ex- cluding other meda.cal care or treatment not neeessary to eva~.ua- ~~.on of ~sychiatric disoxders. PRECA,,,RE AND AFTERCARE CONTRACT_PROVIS~ONS ~ , . - „~_~ ..,,..__... I (5ame as i.npat~ent agreement except tor "precare and a~tercare" and "548" which are sitbstitut~d where underlined.) ~~ Yn accordance w~.'~h Sectio~ 548, Ttitle 9, Cali~o=nia Administrative Code, precare and aftercare services are defined as follows: (a) Precare services shal]. mean those d~rect services intended to de~ine the nature of the illness or the presenting probJ.em, and to determine and in~t~.ate ~he kind of trea~ment required, a.nc~.uding a consideration of hospi,tal~.zation and alternata.ves to hospita~ization. {b) Aftercare services shall mean those dir~ct servic~s to and far patients ~eaving a hospita~, and intend~d to enable the patient to achieve a maximum leve~~ of functioning or to avoid rehospitalizati.on, or bath. III State agrees to advise County's patients of appropriate precare and aftercare sexv~,ces as defin~d above ~o provide conta,nuity of care. XI Payment by County fror whieh State reimhu~sement sha}.l be made pursuant to S~ctian 5705 of the We1~'ar~ and znstitu- tions Code sha1L be lima.ted to pay~nent for precare and after- care services rend~red ~s set forth in Article II ~af tha.s agreemen~, includzng the prescribing ar ~urna.shing of necessary drugs but excluding othe~ medical care or tr~atment not neces- sary to evaluatian of psych~,atric disorders.