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COUNTY OF FRESNO
Fresno, CA
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FIFTH AMENDED AND RESTATED AGREEMENT
THIS FIFTH AMENDED AND RESTATED AGREEMENT, hereinafter referred to as “Fifth
Amended and Restated Agreement,” is made and entered into this __________ day of
______________ 2016, by and between the COUNTY OF FRESNO, a Political Subdivision of the
State of California, hereinafter referred to as "COUNTY", and TURNING POINT OF CENTRAL
CALIFORNIA, INC., a California Private Non-Profit Corporation, whose service address is 3636 N.
First Street, Suites 162 and 135, Fresno, CA 93726, and remit to, address is P.O. Box 7447, Visalia,
CA 93290, hereinafter referred to as "CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH) has determined
there is a need for certain Fresno County residents to receive Mental Health Full Service Partnership
(FSP) services, Mental Health Outpatient Services, and Substance Use Disorders treatment services as
required by AB109 Public Safety Realignment and the Postrelease Community Supervision Act of
2011; and
WHEREAS, COUNTY is authorized to contract with privately operated agencies for the
provision of alcohol and drug abuse treatment services, pursuant to parts of Title 9, Division 4 of the
California Code of Regulations and Division 10.5 (commencing with section 11750) of the California
Health and Safety Code; and
WHEREAS, COUNTY and CONTRACTOR entered into Agreement number 12-184 dated
April 24, 2012, pursuant to which CONTRACTOR agreed to provide Mental Health Full Services
Partnership (FSP) services, Mental Health Outpatient Services, and Substance Use Disorders treatment
services as required by AB 109 Public Safety Realignment and Postrelease Community Supervision
Act of 2011; and
WHEREAS, COUNTY and CONTRACTOR entered into a First Amendment to Agreement 12-
184 effective September 11, 2012, (hereinafter “Amendment I”) to allow CONTRACTOR to purchase
of additional daily residential substance use disorder treatment beds; and
WHEREAS, COUNTY and CONTRACTOR entered into a Second Amendment to Agreement
12-184 effective April 22, 2014, (hereinafter “Amendment II”) to support a 15-slot expansion of Full
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Fresno, CA
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Service Partnership (FSP) services; and
WHEREAS, COUNTY and CONTRACTOR entered into a Third Amendment to Agreement
12-184 effective July 1, 2015, (hereinafter “Amendment III”) to support a 60-slot expansion of Full
Service Partnership services; and
WHEREAS, COUNTY and CONTRACTOR entered into a Fourth Amendment to Agreement
12-184 effective February 1, 2016, (hereinafter “Amendment IV”) to allow CONTRACTOR greater
access to the Department’s integrated mental health information system, known as Avatar, removal of
contract language that is not applicable to Turning Point, and allow the DBH director, or designee, to
approve modifications of services to accommodate changes in the law as well as budget line items
greater than ten percent (10%) of the contract maximum, which do not exceed the contract maximum,
through an amended version of the original contract that is approved by County Counsel and the
County Auditor-Controller/Treasurer Tax Collector.
WHEREAS, the parties desire to amend the Agreement, and that upon execution of this Fifth
Amended and Restated Agreement, the Agreement shall be restated in its entirety, superseding
Agreement 12-184, including Amendment I, Amendment II, Amendment III, and Amendment IV.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities for the
provision of mental health FSP services, mental health outpatient services, and substance use disorders
treatment services for the specific criminal justice population under supervision by the Probation
Department awaiting trial, and adult population transfers set forth in AB 109, as identified in
COUNTY’s Request for Proposal (RFP) No. 962-5011, dated November 16, 2011, and Addendum
No. One (1) to COUNTY’s RFP No. 962-5011 dated December 12, 2011, hereinafter collectively
referred to as COUNTY’s Revised RFP No.962-5011 and CONTRACTOR’s response to said Revised
RFP No. 962-5011, dated December 27, 2011, all incorporated herein by reference and made part of
this Agreement. CONTRACTOR shall also perform all services and fulfill all responsibilities in a
manner consistent with the objectives and client outcomes identified in Exhibit A, “Scope of Work,”
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and Exhibit B, “Full Service Partnership Service Delivery Model,” attached hereto and by this
reference incorporated herein.
In the event of any inconsistency among these documents, the inconsistency shall
be resolved by giving precedence in the following order of priority: 1) to this Agreement, including all
Exhibits, 2) to the Revised RFP No. 962-5011, 3) to the Response to the Revised RFP No. 962-5011.
A copy of COUNTY’s Revised RFP No. 962-5011 and CONTRACTOR’s response shall be retained
and made available during the term of this Agreement by COUNTY’s DBH Contracts Division.
B. CONTRACTOR shall maintain, at CONTRACTOR’s cost, a computer system
compatible with COUNTY’s Substance Abuse Information System (SAIS) for the provision of
submitting information required under the terms and conditions of this Agreement. CONTRACTOR
shall complete required SAIS data entry as follows: Registrations and admissions must be complete
within Five (5) business days of entry into the program and discharges within five (5) business days of
program completion or dismissal.
C. It is acknowledged by all parties hereto that COUNTY’s DBH Contracts
Division shall monitor said substance use disorder treatment services and mental health outpatient
services operated by CONTRACTOR, in accordance with Section Fourteen (14), MONITORING, of
this Agreement; and COUNTY’s DBH Contracts Division shall monitor said FSP services operated by
CONTRACTOR, in accordance with Section Fourteen (14), MONITORING, of this Agreement.
D. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH Contracts Division to discuss AB109 program
requirements, data reporting, training, policies and procedures, overall program operations, program
outcomes, and any problems or foreseeable problems that may arise.
E. CONTRACTOR shall maintain requirements as an organizational provider
throughout the term of this Agreement, as described in Section Seventeen (17), COMPLIANCE WITH
STATE MEDI-CAL REQUIREMENTS, of this Agreement. If for any reason, this status is not
maintained, COUNTY may terminate this Agreement pursuant to Section Three (3), TERMINATION,
of this Agreement.
2. TERM
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This Agreement shall become effective on the 1st day of July 2016 and shall terminate
on the 30th day of June 2017.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand, or at COUNTY’s option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY’s DBH Director or
designee upon the giving of sixty (60) days advance written notice of an intention to terminate.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the budget attached hereto and referenced herein as Exhibit C,
“Budget.”
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A. Maximum Contract Amount – The maximum amount under this Agreement for
the period July 1, 2016 through June 30, 2017 shall not exceed Four Million Two Hundred Eighty
Thousand Eight Hundred Eighty-Four and No/100 Dollars ($4,280,884.00).
1) Substance Use Disorders and Outpatient Mental Health – The maximum
compensation under this Agreement for Substance Use Disorders Services and Outpatient Mental
Health Services shall not exceed Two Million Seven Hundred Twenty-Four Thousand Nine Hundred
Eighty-One and No/100 Dollars ($2,724,981.00), including a maximum compensation of Two
Hundred Thousand and No/100 Dollars ($200,000.00) for Intensive Substance Use Disorder Services
and a maximum compensation of Eight Hundred Forty-Eight Thousand Six Hundred Twenty-Five and
No/100 Dollars ($848,625.00) for Residential Substance Use Disorder Services. CONTRACTOR shall
execute a Memorandum of Understanding with each contracted provider as specified in Section
Twenty-Nine (29), SUBCONTRACTS, of this Agreement.
2) Full Service Partnership - The maximum compensation under this
Agreement for FSP Services shall not exceed One Million Five Hundred Fifty-Five Thousand Nine
Hundred Three and No/100 Dollars ($1,555,903.00).
B. If CONTRACTOR fails to generate the Medi-Cal revenue amounts set forth in
Exhibit C, “Budget,” the County shall not be obligated to pay the difference between the estimated
revenue and the actual revenue generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal
revenue above the amounts stated herein will be used to directly offset the COUNTY’s contribution of
funds as identified in Exhibit C, “Budget.” The offset of funds will also be clearly identified in
monthly invoices received from CONTRACTOR as further described in Section Five (5),
INVOICING, of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage reimbursement
shall be at CONTRACTOR’s adopted rate per mile, not to exceed the IRS published rate.
Payment shall be made upon certification or other proof satisfactory to COUNTY’s
DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
C. For services rendered herein, CONTRACTOR shall assure that an ongoing quality
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assurance component is in place and is occurring. CONTRACTOR shall assure that clinical records for
each participant are of such detail and length that a review of said record will verify that appropriate
services were provided. If the record is unclear, incomplete, and/or indicates that appropriate services
were not provided, COUTNY reserves the right to withhold payment for the applicable unit(s) of
services. It is understood that all expenses incidental to CONTRACTOR’s performance of services
under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with any
provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
D. Payments by COUNTY to CONTRACTOR shall be in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval
by COUNTY of the monthly invoicing as described in Section Five (5), INVOICING, herein. Payments
shall be made after receipt and verification of actual expenditures incurred by CONTRACTOR for
monthly program costs, as identified in Exhibit C, in the performance of this Agreement and shall be
documented to COUNTY on a monthly basis by the twentieth (20th) of the month following the month
of said expenditures.
CONTRACTOR shall submit to COUNTY by the twentieth (20th) of each month a
detailed general ledger (GL) itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5), INVOICING, herein.
E. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
All final invoices, including actual cost per unit, and/or any final budget
modification requests shall be submitted by CONTRACTOR within sixty (60) days following the final
month of service for which payment is claimed. No action shall be taken by COUNTY on invoices
submitted beyond the sixty (60) day closeout period. Any compensation which is not expended by
CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY.
F. The services provided by CONTRACTOR under this Agreement are funded in
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whole or in part by the State of California. In the event that the funding for these services is delayed
by the State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the
deferred payment shall not exceed the amount of funding delayed by the State Controller to the
COUNTY. The period of time of the deferral by COUNTY shall not exceed the period of time of the
State Controller’s delay of payment to COUNTY plus forty-five (45) days.
G. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State
audit process or COUNTY utilization review during the course of this Agreement. At COUNTY’s
election, the disallowed amount will be remitted within forty-five (45) days to COUNTY upon
notification or shall be withheld from subsequent payments to CONTRACTOR. CONTRACTOR
shall not receive reimbursement for any units of services rendered that are disallowed or denied by the
Fresno County Mental Health Plan (Mental Health Plan) utilization review process or through the
DHCS cost report audit settlement process for Medi-Cal eligible clients.
H. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve individuals with SMI (Serious Mental Illness), many of whom have
co-occurring substance use disorders. It is further understood by CONTRACTOR and COUNTY that
funds shall be used to support appropriately integrated services for co-occurring substance use
disorders in the target population, and that integrated services can be documented in crisis
assessments, interventions, and progress notes documenting linkages.
J. Funding Sources – It shall be the obligation of CONTRACTOR to determine and
claim all revenue possible from private pay sources and third party payers. CONTRACTOR shall not
use any funds under this Agreement for services covered by Drug Medi-Cal or other health insurance
for eligible beneficiaries.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY in arrears by the twentieth (20th) day of
each month for the prior month’s actual services rendered to DBHInvoices@co.fresno.ca.us. After
CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for
payment, certify the expenditure, and submit electronic claiming billing directly into COUNTY’s
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billing system for the DHCS reimbursements for all clients, including those eligible for Medi-Cal as
well as those that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per
unit. COUNTY must pay CONTRACTOR before submitting a claim to DHCS for Federal
reimbursement for Medi-Cal eligible clients. For Outpatient Mental Health and Outpatient Substance
Use Disorder services, submit invoices to: sas@co.fresno.ca.us
B. COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th day
of each month for the prior month’s hosting fee for access to the COUNTY’s electronic information
system in accordance with the fee schedule as set forth in Exhibit F, “Electronic Health Records
Software Charges” attached hereto and incorporated herein by reference. COUNTY shall invoice
CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY’s
electronic information system in accordance with the fee schedule as set forth in Exhibit F.
COUNTY shall invoice CONTRACTOR annually for the Reaching Recovery fee for access to the
COUNTY’s electronic information system in accordance with the fee schedule as set forth in Exhibit
F. CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno County
Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712,
Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR of
the invoicing provided by COUNTY.
C. At the discretion of COUNTY’s DBH Director, or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or designee,
shall have the right to withhold payment as to only that portion of the invoice that is incorrect or
improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to
provide services for a period of ninety (90) days after notification of an incorrect or improper invoice.
If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH’s
satisfaction, COUNTY’s DBH Director, or designee, may elect to terminate this Agreement, pursuant
to the termination provisions stated in Section Three (3), TERMINATION, of this Agreement. In
addition, for invoices received ninety (90) days after the expiration of each term of this Agreement or
termination of this Agreement, at the discretion of COUNTY’s DBH Director, or designee,
COUNTY’s DBH shall have the right to deny payment of any additional invoices received.
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D. Monthly invoices shall include a client roster, identifying volume reported by
payer group clients served (including third party payer of services) by month and year-to-date.
E. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
the line item charges for monthly program costs (per applicable budget, as identified in Exhibit C,
“Budget”), including the cost per unit calculation based on clients served within that month, and
excluding unallowable costs. Unallowable costs such as lobbying or political donations must be
deducted from the monthly invoice reimbursements. The invoices and general ledgers will serve as
tracking tools to determine if CONTRACTOR’s program costs are in accordance with its budgeted
cost, and cost per unit negotiated by service modes compared to actual cost per unit, as set forth in
Exhibit C, “Budget.” The actual cost per unit will be based upon total costs and total units of service.
It will also serve for the COUNTY to certify the public funds expended for purposes of claiming
Federal and State reimbursement for the cost of Medi-Cal services and activities. CONTRACTOR
shall remit to COUNTY on a quarterly basis, a summary report of total operational costs and volume
of service unit to report the actual costs per unit compared to the negotiated rate, as identified in
Exhibit C, ”Budget,” to report interim cost per unit. The quarterly reports will be used by COUNTY
to ensure compliance with Federal and State reimbursements certified public expenditures.
F. CONTRACTOR will remit annually within ninety (90) days from June 30, a
schedule to provide the required information on published charges for all authorized direct specialty
mental health services. The published charge listing will serve as a source document to determine the
CONTRACTOR’s usual and customary charges prevalent in the public mental health sector that are
used to bill the general public, insurers or other non-Medi-Cal third party payers during the course of
business operations.
G. CONTRACTOR shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as
a tracking tool to determine if CONTRACTOR’s program is staffed according to the services
provided under this Agreement.
H. CONTRACTOR must maintain such financial records for a period of seven (7)
years or until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be
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responsible for any disallowances related to inadequate documentation.
I. CONTRACTOR is responsible for collection and managing data in a manner to
be determined by DHCS and the Mental Health Plan in accordance with applicable rules and
regulations. COUNTY’s electronic information system is a critical source of information for
purposes of monitoring service volume and obtaining Federal and State reimbursement.
CONTRACTOR must attend COUNTY DBH’s Business Office training on equipment reporting for
assets, intangible and sensitive minor assets; COUNTY’s electronic information system; and related
cost reporting.
J. CONTRACTOR shall submit service data into COUNTY’s electronic
information system within ten (10) calendar days from the date services were rendered. Federal and
State reimbursement for Medi-Cal specialty mental health services is based on public expenditures
certified by the CONTRACTOR. CONTRACTOR must submit a signed certified public expenditure
report, with each respective monthly invoice. DHCS expects the claims for Federal and State
reimbursement to equal the amount the COUNTY paid the CONTRACTOR for the service rendered
less any funding sources not eligible for Federal and State reimbursement.
K. CONTRACTOR must provide all necessary data to allow the COUNTY to bill
Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
requirements. The necessary data can be provided by a variety of means, including but not limited to:
1) direct data entry into COUNTY’s information system; 2) providing an electronic file compatible
with COUNTY’s information system; or 3) integration between COUNTY’s electronic information
system and CONTRACTOR’s information system(s).
L. If a Medi-Cal client has other health coverage (OHC), such as private
insurance, or Federal Medicare, the CONTRACTOR will be responsible for billing the carrier and
obtaining a payment/denial, or have validation of claiming with no response ninety (90) days after
the claim was mailed, before the service can be entered into the COUNTY’s electronic information
system. A copy of explanation of benefits or CMS 1500 is required as documentation.
CONTRACTOR must report all revenue collected from OHC, third party, client-pay or private-pay
in each monthly invoice and in the cost report that is required to be submitted. CONTRACTOR
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shall submit monthly invoices for reimbursement that equal the amount due CONTRACTOR less
any funding sources not eligible for Federal and State reimbursement. CONTRACTOR must
comply with all laws and regulations governing the Federal Medicare program, including, but not
limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2) the
regulations and rules promulgated by the Federal Centers for Medicare and Medicaid Services as
they relate to participation, coverage and claiming reimbursement. CONTRACTOR will be
responsible for compliance as of the effective date of each Federal, State or local law or regulation
specified.
M. Data entry shall be the responsibility of the CONTRACTOR. The direct
specialty mental health services data must be reconciled by the CONTRACTOR to the monthly
invoices submitted for payment. COUNTY shall monitor the volume of services and cost of services
entered into COUNTY’s electronic information system. Any and all audit exceptions resulting from
the provision and reporting of Medi-Cal services by CONTRACTOR shall be the sole responsibility
of the CONTRACTOR. CONTRACTOR will comply with all applicable policies, procedures,
directives and guidelines regarding the use of COUNTY’s electronic information system.
N. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR will establish and maintain Medi-Cal certification or become
certified within ninety (90) days of the effective date of this Agreement through COUNTY to provide
reimbursable services to Medi-Cal eligible adult clients. In addition, CONTRACTOR shall work
with the COUNTY’s DBH to execute the process if not currently certified by COUNTY for
credentialing of staff. During this process, the CONTRACTOR will obtain a legal entity number
established by the DHCS, as this is a requirement for maintaining Mental Health Plan organizational
provider status throughout the term of this Agreement. CONTRACTOR will be required to become
Medi-Cal certified prior to providing services to Medi-Cal eligible clients and seeking reimbursement
from the COUNTY. CONTRACTOR will not be reimbursed by COUNTY for any services rendered
prior to certification.
CONTRACTOR shall provide specialty mental health services in accordance
with the COUNTY’s Mental Health Plan. CONTRACTOR must comply with the “Fresno County
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Mental Health Plan Compliance Program and Code of Conduct” set forth in Exhibit D, attached
hereto and incorporated herein by reference and made part of this Agreement.
CONTRACTOR may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
supervised by licensed staff, works within his/her scope and only delivers allowable direct specialty
mental health services. It is understood that each service is subject to audit for compliance with
Federal and State regulations, and that COUNTY may be making payments in advance of said
review. In the event that a service is disapproved, COUNTY may, at its sole discretion, withhold
compensation or set off from other payments due the amount of said disapproved services.
CONTRACTOR shall be responsible for audit exceptions to ineligible dates of services or incorrect
application of utilization review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no
right to control or supervise or direct the manner or method by which CONTRACTOR shall perform
its work and function. However, COUNTY shall retain the right to administer this Agreement so as to
verify that CONTRACTOR is performing its obligations in accordance with the terms and conditions
thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters which are
directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees
all legally-required employee benefits. In addition, CONTRACTOR shall be solely responsible and
save COUNTY harmless from all matters relating to payment of CONTRACTOR’s employees,
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including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be
providing services to others unrelated to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services as needed to accommodate changes in
the law relating to mental health and substance use disorder treatment, as set forth in Exhibit A,
“Scope of Work,” may be made with the signed written approval of COUNTY’s DBH Director or
designee and CONTRACTOR through an amendment approved by County Counsel and Auditor.
Changes to line items in the budget, as set forth in Exhibit C, “Budget,” that do not
exceed 10% of the maximum compensation payable to the CONTRACTOR, may be made with the
written approval of COUNTY’s Department of Behavioral Health Director, or her designee. Changes
to the line items in the budget that exceed 10% of the maximum compensation payable to the
CONTRACTOR, may be made with the signed written approval of COUNTY’s Department of
Behavioral Health Director, or her designee through an amendment approved by County Counsel and
Auditor. Said budget line item changes shall not result in any change to the annual maximum
compensation amount payable to CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties
under this Agreement without the prior written consent of COUNTY.
9. HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
agents or employees under this Agreement, and from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to any
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person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, its officers, agents or employees under this Agreement. CONTRACTOR agrees
to indemnify COUNTY for Federal, State of California and/or local audit exceptions resulting from
noncompliance herein on the part of CONTRACTOR.
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
following insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of One Million Dollars ($1,000,000). Coverage should
include owned and non-owned vehicles used in connection with this Agreement.
C. Real and Personal Property
CONTRACTOR shall maintain a policy of insurance for all risk personal
property coverage which shall be endorsed naming the County of Fresno as an
additional loss payee. The personal property coverage shall be in an amount that
will cover the total of the County purchased and owned property, at a minimum,
as discussed in Section Twenty-One (21), PROPERTY OF COUNTY, of this
Agreement.
D. All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of
the County’s Personal Property in the possession of CONTRACTOR and/or used
in the execution of this Agreement. COUNTY will be identified on an
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appropriate certificate of insurance as the certificate holder and will be named as
an Additional Loss Payee on the Property Insurance Policy.
E. Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
F. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under the CONTRACTOR's policies herein.
This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
N. Millbrook Avenue, Fresno, California, 93703, Attention: Contracts Division, stating that such
insurance coverages have been obtained and are in full force; that the County of Fresno, its officers,
agents and employees will not be responsible for any premiums on the policies; that such Commercial
General Liability insurance names the County of Fresno, its officers, agents and employees,
individually and collectively, as additional insured, but only insofar as the operations under this
Agreement are concerned; that such coverage for additional insured shall apply as primary insurance
and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and
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employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR’s policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VIII or better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff
shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
for the provision of the services hereunder and required by the laws and regulations of the United States
of America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain
such licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of
any appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply
with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
12. RECORDS
A. CONTRACTOR shall maintain records in accordance with Exhibit E,
“Documentation Standards for Client Records”, attached hereto and by this reference incorporated
herein and made part of this Agreement. During site visits, COUNTY shall be allowed to review
records of services provided, including the goals and objectives of the treatment plan, and how the
therapy provided is achieving the goals and objectives.
B. CONTRACTOR may maintain its records in COUNTY’s Electronic Health
Record (EHR) system in accordance with Exhibit E, “Documentation Standards for Client Records”.
The client record shall begin with registration and intake and include client authorizations,
assessments, plans of care, and progress notes, as well as other documents as approved by the
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COUNTY’s DBH. COUNTY shall be allowed to review records of services provided, including the
goals and objectives of the treatment plan and how the therapy provided is achieving the goals and
objectives. If CONTRACTOR determines to maintain its records in the COUNTY’s EHR system, it
shall provide COUNTY’s DBH Director, or designee, with a thirty (30) day notice. If at any time
CONTRACTOR chooses not to maintain its records in the COUNTY’s EHR system, it shall provide
COUNTY’s DBH Director, or designee, with a thirty (30) day notice and CONTRACTOR will be
responsible for obtaining its own system, at its own cost, for Electronic Health Records management.
C. Disclaimer – COUNTY makes no warranty or representation that information
entered into the COUNTY’s EHR system by CONTRACTOR will be accurate, adequate or
satisfactory for CONTRACTOR’s own purposes or that any information in CONTRACTOR’s
possession or control, or transmitted or received by CONTRACTOR, is or will be secure from
unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR is solely responsible for
client information entered by CONTRACTOR into the COUNTY’s EHR system. CONTRACTOR
agrees that all Private Health Information (PHI) maintained by CONTRACTOR in COUNTY’s EHR
system will be maintained in conformance with all HIPAA laws, as stated in Section Nineteen (19),
“HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.”
D. Documentation – CONTRACTOR shall maintain adequate records in sufficient
detail to make possible an evaluation of services, and contain all the data necessary in reporting to the
State of California and/or Federal agency. All client records shall be maintained pursuant to
applicable State of California and Federal requirements concerning confidentiality.
E. Suspension of Compensation – In the event that CONTRACTOR fails to provide
reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
payments until CONTRACTOR is in compliance with reporting requirements.
///
13. REPORTS
Mental Health Services
A. Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as
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requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to change at
COUNTY’s DBH discretion.
B. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records,
reports, data, and other information as COUNTY’s DBH may request pertaining to matters covered by
this Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
until there is compliance. In addition, CONTRACTOR shall provide written notification and
explanation to COUNTY within five (5) days of any funds received from another source to conduct
the same services covered by this Agreement.
C. Quarterly Progress Reports
For the FSP services provided under this Agreement, CONTRACTOR shall
complete Quarterly Progress Reports according to State DHCS regulations. Quarterly reports shall be
submitted to COUNTY’s DBH Contracts Division for review within thirty (30) days of the end of
each quarter.
D. FSP Data Collection and Reporting to DHCS
For the FSP services provided under this Agreement, CONTRACTOR shall
report client/partner information and outcomes of the FSP program directly into the FSP Data
Collection and Reporting (DCR) system according to State DHCS regulations.
E. Client Rents
CONTRACTOR shall also provide records of rents collected from each
consumer and include the consumer’s name, date of birth and social security number. All data
transmitted must be in strict conformance with Section Nineteen (19), HEALTH INSURANCE
PORTABILITY AND ACCOUNTABILITY ACT, and Section Twenty (20), DATA SECURITY, of
this Agreement.
F. Cost Report – CONTRACTOR agrees to submit a complete and accurate
detailed cost report on an annual basis for each fiscal year ending June 30th in the format prescribed
by the State DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for
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programs. The cost report will be the source document for several phases of settlement with the
DHCS for the purposes of Short Doyle Medi-Cal reimbursement. CONTRACTOR shall report costs
under their approved legal entity number established during the Medi-Cal certification process. The
information provided applies to CONTRACTOR for program related costs for services rendered to
Medi-Cal and non Medi-Cal clients. The CONTRACTOR will remit a schedule to provide the
required information on published charges for all authorized services. The report will serve as a
source document to determine their usual and customary charge prevalent in the public mental health
sector that is used to bill the general public, insurers or other non-Medi-Cal third party payers during
the course of business operations. CONTRACTOR must report all collections for Medi-
Cal/Medicare services and collections. The CONTRACTOR shall also submit with the cost report a
copy of the CONTRACTOR’s general ledger that supports revenues, expenditures, and a reconciled
detailed report of reported total units of services rendered under this Agreement compared to the units
of services reported by CONTRACTOR to COUNTY’s electronic information system.
Each fiscal year ending June 30, CONTRACTOR shall remit a hard copy of their
annual cost report with a signed cover letter and requested support documents to County of Fresno,
Attention: DBH Cost Report Team, P.O. Box 45003, Fresno, CA 93718. In addition,
CONTRACTOR shall remit an electronic copy of any inquiries to
DBHcostreportteam@co.fresno.ca.us. COUNTY shall provide instructions of the cost report, cost
report training, State DHCS cost report template worksheets, and deadlines to submit the cost reports
as determined by the State each fiscal year.
All cost reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
report and invoice reimbursements.
If the CONTRACTOR does not submit the cost report by the deadline, including
any extension period granted by the COUNTY, the COUNTY may withhold payments of pending
invoicing under compensation until the cost report has been submitted and clears COUNTY desk
audit for completeness.
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G. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and
CONTRACTOR agree to settle dollar amounts disallowed or settled in accordance with DHCS and
COUNTY audit settlement findings related to the reimbursements provided under this Agreement.
CONTRACTOR will participate in the several phases of settlements between COUNTY,
CONTRACTOR and DHCS. The phases of initial cost reporting for settlement according to State
reconciliation of records for paid Medi-Cal services and audit settlement are: DHCS audit: 1) initial
cost reporting - after an internal review by COUNTY, the COUNTY files cost report with State
DHCS on behalf of the CONTRACTOR’s legal entity for the fiscal year; 2) Settlement –State
reconciliation of records for paid Medi-Cal services, approximately eighteen (18) to thirty-six (36)
months following the State close of the fiscal year, DHCS will send notice for any settlement under
this provision will be sent to the COUNTY; and 3) Audit Settlement-State DHCS audit. After final
reconciliation and settlement, COUNTY and/or DHCS may conduct a review of medical records, cost
report along with support documents submitted to COUNTY in initial submission to determine
accuracy and may disallow costs and/or units of service reported on the CONTRACTOR’s legal
entity cost report. COUNTY may choose to appeal and therefore reserves the right to defer payback
settlement with CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal
Medicaid procedures for managing overpayments.
If at the end of the Audit Settlement, the COUNTY determines that it overpaid
the CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related
overpayment back to the COUNTY.
///
Funds owed to COUNTY will be due within forty-five (45) days of notification
by the COUNTY, or COUNTY shall withhold future payments until all excess funds have been
recouped by means of an offset against any payments then or thereafter owing to CONTRACTOR
under this or any other Agreement.
///
Substance Use Disorder Services
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CONTRACTOR(S) shall submit all information and data required by State, including, but not
limited to the following:
1. Drug and Alcohol Treatment Access Report (DATAR) and Provider Waiting
List Record (WLR) in an electronic format provided by the State and due no later than five (5) days
after the preceding month; and
2. CalOMS Treatment – Submit CalOMS treatment admission, discharge, annual
update, and “provider activity report” record in an electronic format through COUNTY’s SAIS
system, and on a schedule as determined by the COUNTY which complies with State requirements
for data content, data quality, reporting frequency, reporting deadlines, and report method and due no
later than five (5) days after the preceding month. All CalOMS admissions, discharges, and annual
updates must be entered into the COUNTY’s CalOMS system within twenty-four (24) hours of
occurrence; and
3. CONTRACTOR(S) shall submit to COUNTY monthly fiscal and all program
reports within twenty (20) days of the end of each month.
4. Americans with Disabilities (ADA) – Annually, upon request by DBH,
CONTRACTOR(S) shall complete a system-wide accessibility survey in a format determined by
DBH for each service location and modality and shall submit an ADA Accessibility Certification and
Self-Assessment, including an Implementation Plan, for each service location.
5. Cost Reports – On an annual basis for each fiscal year ending June 30th
CONTRACTOR(S) shall submit a complete and accurate detailed cost report(s). Cost reports must be
submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the
due date. Submittal must also include any requested support documents such as general ledgers. All
reports submitted by CONTRACTOR(S) to COUNTY must be typewritten. COUNTY will issue
instructions for completion and submittal of the annual cost report, including the relevant cost report
template(s) and due dates within forty-five (45) days of each fiscal year end. All cost reports must be
prepared in accordance with Generally Accepted Accounting Principles. Unallowable costs such as
lobbying or political donations must be deducted from the cost report and all invoices. If the
CONTRACTOR(S) does not submit the cost report by the due date, including any extension period
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granted by the COUNTY, the COUNTY may withhold payment of pending invoices until the cost
report(s) has been submitted and clears COUNTY desk audit for completeness and accuracy.
A. DMC - A DMC cost report must be submitted in a format prescribed by
the DHCS for the purposes of Short Doyle Medi-Cal reimbursement of total costs for all programs.
CONTRACTOR(S) shall report costs under their approved legal entity number established during the
DMC certification process. Total units of service reported on the cost report will be compared to the
units of services entered by CONTRACTOR(S) into COUNTY’s data system. CONTRACTOR(S)
will be required to correct discrepancies and resubmit to COUNTY prior to COUNTY’s final
acceptance of the cost report.
B. OTHER FUNDING SOURCES – CONTRACTOR(S) will be required to
submit a cost report on a form(s) approved and provided by the COUNTY to reflect actual costs and
reimbursement for services provided through funding sources other than DMC. Contracts that include
a negotiated rate per unit of service will be reimbursed only for the costs of approved units of service
up to the negotiated unit of service rate approved in the Agreement, regardless of the contract
maximum. If the cost report indicates an amount due to COUNTY, CONTRACTOR(S) shall submit
payment with the report. If an amount is due to CONTRACTOR(S) COUNTY shall reimburse
CONTRACTOR within forty-five (45) days of receiving and accepting the year-end cost report.
C. MULTIPLE FUNDING SOURCES – CONTRACTOR(S) who has
multiple agreements for the same services provided at the same location where at least one of the
Agreements is funded through DMC and the other funding is other federal or county realignment
funding will be required to complete DMC cost reports and COUNTY approved cost reports. Such
Agreements will be settled for actual costs in accordance with Medicaid reimbursement requirements
as specified in Title XIX or Title XXI of the Social Security Act; Title 22, and the State’s Medicaid
Plan.
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR(S)
agree to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit
settlement findings related to the DMC and realignment reimbursements. DHCS audit process is
approximately eighteen (18) to thirty-six (36) months following the close of the State fiscal year.
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COUNTY may choose to appeal DHCS settlement results and therefore reserves the right to defer
payback settlement with CONTRACTOR(S) until resolution of the appeal.
In the event that CONTRACTOR(S) fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly
payments until there is compliance. In addition, the CONTRACTOR shall provide written
notification and explanation to the COUNTY within fifteen (15) days of any funds received from
another source to conduct the same services covered by this Agreement.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director and
DHCS, or their designees, the right to review and monitor records, programs or procedures, at any
time, in regard to clients, as well as the overall operation of CONTRACTOR’s programs, in order to
ensure compliance with the terms and conditions of this Agreement.
Outcomes – COUNTY’s DBH Director, or her designee, and the California Department
of Health Care Services (DHCS), or their designees shall monitor and evaluate the performance of
CONTRACTOR(S) under this Agreement to determine to the best possible degree the success or
failure of the services provided under this Agreement. At the discretion of the COUNTY, a
subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of the
program at least quarterly or more frequently as needed, at the discretion of COUNTY.
COUNTY shall recapture from CONTRACTOR the value of any services or other
expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
discretion of the COUNTY, recoupment can be made through a future invoice reduction or
reimbursement by the CONTRACTOR.
///
CONTRACTOR shall participate in a program review of the program at least yearly or
more frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply
all information requested by the COUNTY, DHCS and/or the subcontractor during the program
evaluation, monitoring, and/or review.
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15. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under
an agreement with DHCS, and that under said agreement the State imposes certain requirements on
COUNTY and its subcontractors. CONTRACTOR shall adhere to all State requirements, including
those identified in Exhibit G “State Mental Health Requirements”, attached hereto and by this
reference incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by
Fresno County. CONTRACTOR must meet Medi-Cal organization provider standards as listed in
Exhibit H, “Medi-Cal Organizational Provider Standards,” attached hereto and by this reference
incorporated herein and made part of this Agreement. It is acknowledged that all references to
Organizational Provider and/or Provider in Exhibit H, “Medi-Cal Organizational Provider Standards,”
shall refer to CONTRACTOR. In addition, CONTRACTOR shall inform every client of their rights
under the COUNTY’s Mental Health Plan as described in Exhibit I, “Fresno County Mental Health
Plan,” attached hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients, following the
protocol and using the “Incident Report Worksheet” identified in Exhibit O, “Grievances and Incident
Reporting,” attached hereto and by this reference incorporated herein and made part of this
Agreement, or a protocol and worksheet presented by CONTRACTOR that is accepted by
COUNTY’s DBH Director, or designee.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and /or local laws and regulations relating
to confidentiality.
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19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
Law 104-191(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required
by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the
security of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of
PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
Code of Federal Regulations (CFR).
20. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent
access, viewing, use or disclosure of COUNTY data including sensitive or personal client information;
abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies
that enter into a contractual relationship with the COUNTY for the purpose of providing services
under this Agreement must employ adequate data security measures to protect the confidential
information provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1. CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
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2. Current virus protection software is in place;
3. Mobile device has the remote wipe feature enabled; and
4. A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR, including its subcontractors and employees, may not use
COUNTY computers or computer peripherals on non-COUNTY premises without prior authorization
from the COUNTY’s Chief Information Officer, and/or designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information,
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or externally.
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H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information
provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to
affected individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR will be responsible for all costs incurred as a result of providing the required
notification.
21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one (1) year. Depreciation of the qualified
items will be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1. Asset must have life span of over one year.
2. The asset is not a repair part.
3. The asset must be valued at or greater than the capitalization thresholds
for the asset type:
Asset type Threshold
• land $0
• buildings and improvements $100,000
• infrastructure $100,000
• be tangible $5,000
o equipment
o vehicles
• or intangible asset $100,000
o Internally generated software
o Purchased software
o Easements
o Patents
///
Qualified fixed asset equipment is to be reported and approved by COUNTY. If
it is approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed
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Asset Log will be maintained by COUNTY’s Asset Management System and inventoried annually
until the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR’s fixed
assets may be inventoried in comparison to COUNTY’s DBH Asset Inventory System.
B. Certain purchases under Five Thousand and No/100 Dollars ($5,000.00) with
over one (1) year life span, and are mobile and high risk of theft or loss are sensitive assets. Such
sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive items as
determined by COUNTY’s DBH Director or designee. CONTRACTOR maintains a tracking system
on the items and is not required to be capitalized or depreciated. The items are subject to annual
inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate
in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination of this
Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear excepted;
2. To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
where and how the equipment is being used in accordance with procedures developed by COUNTY.
All such lists shall be submitted to COUNTY within ten (10) days of any request therefore;
3. To report in writing to COUNTY immediately after discovery, the loss or
theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
and a copy of the police report submitted to COUNTY.
A. The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH Director or designee, shall fulfill
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the provisions of this Agreement as appropriate, and must be directly related to CONTRACTOR’s
services or activity under the terms of this Agreement. COUNTY’s DBH may refuse reimbursement for
any costs resulting from equipment purchased, which are incurred by CONTRACTOR, if prior written
approval has not been obtained from COUNTY’s DBH Director or designee.
B. CONTRACTOR must obtain prior written approval form COUNTY’s DBH
whenever there is any modification or change in the use of any property acquired or improved, in whole
or in part, using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which does not
qualify under this program, CONTRACTOR shall reimburse COUNTY in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of non-
program funds. These requirements shall continue in effect for the life of the property. In the event the
program is closed out, the requirements for this Section shall remain in effect for activities or property
funded with said funds, unless action is taken by the State government to relieve COUNTY of these
obligations.
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
sexual orientation, or military or veteran status pursuant to all applicable State and Federal statutes and
regulations.
A. Eligibility for Services - CONTRACTOR(S) shall prepare, prominently post in its
facility, and make available to the DBH Director or her designee and to the public all eligibility
requirements to participate in the program funded under this Agreement. CONTRATOR(S) shall not
unlawfully discriminate in the provision of services because of race, religious creed, color, national
origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military or veteran
status as provided by State of California and Federal law in accordance with Title VI of the Civil
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Rights Act of 1964 (42 USC section 2000(d)); Age Discrimination Act of 1975 (42 USC section
1681); Rehabilitation Act of 1973 (29 USC section 794); Education Amendments of 1972 (20 USC
section 1681); Americans with Disabilities Act of 1990 (42 USC section 12132); Title 45, Code of
Federal Regulations, Part 84; provisions of the Fair Employment and Housing Act (California
Government Code section 12900); and regulations promulgated thereunder (Title 2, CCR, section
7285.0); Title 2, Division 3, Article 9.5 of the California Government Code commencing with section
11135; and Title 9, Division 4, Chapter 6 of the California Code of Regulations commencing with
section 10800.
B. Equal Opportunity - CONTRACTOR(S) shall comply with California
Government Code, section 12990 and California Code of Regulations, Title II, Division 4, Chapter 5,
in matters related to the development, implementation, and maintenance of a nondiscrimination
program. CONTRACTOR(S) shall not discriminate against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender, gender identity,
gender expression, age, sexual orientation, or military or veteran status. Such practices include
retirement, recruitment, advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates of
pay or other forms of compensation, use of facilities, and other terms and conditions of employment.
CONTRACTOR(S) agrees to post in conspicuous places, notices available to all employees and
applicants for employment setting forth the provisions of the Equal Opportunity Act (42 USC section
2000(e)) in conformance with Federal Executive Order No. 11246. CONTRACTOR (S) agrees to
comply with the provisions of the Rehabilitation Act of 1973 (29 USC section 794).
C. Suspension of Compensation - If an allegation of discrimination occurs, DBH
may withhold all further funds, until CONTRACTOR(S) can show by clear and convincing evidence
to the satisfaction of DBH that funds provided under this Agreement were not used in connection with
the alleged discrimination.
D. Nepotism - Except by consent of the DBH Director or her designee, no person
shall be employed by CONTRACTOR(S) who is related by blood or marriage to or who is a member
of the Board of Directors or an officer of CONTRACTOR.
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E. New Facilities and Disability Access - New facilities shall be wheelchair
accessible and provide access to the disabled, consistent with Title 9, California Code of Regulations,
section 10820. If a new facility will be utilized, a plan ensuring accessibility to the disabled must be
developed. DBH shall assess, monitor, and document CONTRACTOR(S)’ compliance with the
Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without
regard to physical or mental disability and that CONTRACTOR(S) has provided a facility accessible
to the physically disabled.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R.
Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
from discriminating against persons based on race, color, national origin, sex, disability or religion.
This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access
and participation in federally funded programs through the provision of comprehensive and quality
bilingual services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to, assessing
the cultural and linguistic needs of its clients, training of staff on the policies and procedures, and
monitoring its language assistance program. The CONTRACTOR’s procedures must include ensuring
compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
and benefits provided by CONTRACTOR. Interpreter and translation services, including translation
of CONTRACTOR’s “vital documents” (those documents that contain information that is critical for
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accessing CONTRACTOR’s services or are required by law) shall be provided to participants at no
cost to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or
partners who interpret or translate for a program participant, or who directly communicate with a
program participant in a language other than English, demonstrate proficiency in the participant's
language and can effectively communicate any specialized terms and concepts peculiar to
CONTRACTOR’s services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
COUNTY for approval, within sixty (60) days from date of contract execution, CONTRACTOR’s
plan to address all fifteen national cultural competency standards as set forth in Exhibit N, “National
Standards for Culturally and Linguistically Appropriate Services in Health and Heath Care,” attached
hereto and incorporated by this reference. COUNTY’s annual on-site review of CONTRACTOR shall
include collection of documentation to ensure all national standards are implemented. As the national
competency standards are updated, CONTRACTOR’s plan must be updated accordingly.
24. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)
(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTOR shall make available,
upon written request of the Secretary of the United States Department of Health and Human Services,
or upon request of the Comptroller General of the United States General Accounting Office, or any of
their duly authorized representatives, a copy of this Agreement and such books, documents, and
records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR under this Agreement. CONTRACTOR further agrees that in the event
CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a value
or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period,
with a related organization, such Agreement shall contain a clause to the effect that until the expiration
of four (4) years after the furnishing of such services pursuant to such subcontract, the related
organizations shall make available, upon written request of the Secretary of the United States
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Department of Health and Human Services, or upon request of the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify
the nature and extent of such costs.
25. SINGLE AUDIT CLAUSE
A. If any CONTRACTOR expends Seven Hundred Fifty Thousand Dollars
($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct
an annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office
of Management and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and
management letter to COUNTY. The audit must include a statement of findings or a statement that
there were no findings. If there were negative findings, CONTRACTOR shall include a corrective
action plan signed by an authorized individual. CONTRACTOR agrees to take action to correct any
material non-compliance or weakness found as a result of such audit. Such audits shall be delivered to
COUNTY’s DBH Business Office for review within nine (9) months of the end of any fiscal year in
which funds were expended and/or received for the program. Failure to perform the requisite audit
functions as required by this Agreement may result in COUNTY performing the necessary audit tasks,
or at COUNTY’s option, contracting with a public accountant to perform said audit, or may result in the
inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs related to
this Agreement are the sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s
only funding is through Medi-Cal. If a single audit is not applicable, a program audit must be
performed and a program audit report with management letter shall be submitted by CONTRACTOR
to COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit reports
shall be delivered to COUNTY’s DBH Business Office for review no later than nine (9) months after
the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure
to comply with this Act may result in COUNTY performing the necessary audit tasks or contracting
with a qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
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responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY
under this Section shall be billed to the CONTRACTOR at COUNTY’s cost, as determined by
COUNTY’s Auditor-Controller/ Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all
other pending matters, whichever is later.
26. COMPLIANCE
CONTRACTOR agrees to comply with COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit D, “Fresno County
Mental Health Plan Compliance Program.” Within thirty (30) days of entering into this Agreement
with the COUNTY, CONTRACTOR shall have all of CONTRACTOR’s employees, agents and
subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
shall ensure that within thirty (30) days of hire, all new employees, agents and subcontractors
providing services under this Agreement shall certify in writing that he or she has received, read,
understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
understand that the promotion of and adherence to the code of Conduct and Ethics is an element in
evaluating the performance of CONTRACTOR and its employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agent and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual
required to attend training shall certify in writing that he or she has received the required training.
The certification shall specify the type of training received and the date received. The certification
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shall be provided to the COUNTY’s Compliance Officer at 3133 N. Millbrook, Fresno, California
93703. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed
upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of the terms of
this Agreement.
27. ASSURANCES
In entering into this Agreement, CONTRATOR certifies that it nor any of its officers are
not currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs: that it or any of its officers have not been convicted of a criminal offense
related to the provision of health care items or services; nor have they been reinstated to participate in
the Federal Health Care Programs after a period of exclusion, suspension, debarment, or ineligibility.
If COUNTY learns, subsequent to entering into this Agreement, that CONTRACTOR is ineligible on
these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement with,
COUNTY’s business operations related to the Federal Health Care Programs and shall remove such
CONTRACTOR from any position in which CONTRACTOR’s compensation, or the items or services
rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or
indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time
as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR has been charged with a criminal
offense related to any Federal Health Care Programs, or proposed for exclusion during the term on any
contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of
any claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
COUNTY may request that CONTRACTOR cease providing services until resolution of the charges
or the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
they have been convicted of criminal offense related to the provision of health care items or services;
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and or (3) they have been reinstated to participate in the Federal Health Care Programs after a period
of exclusion, suspension, debarment, or ineligibility.
1. In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
hires or engages such potential employee or subcontractor, the CONTRACTOR will
ensure that said employee or subcontractor does no work, either directly or indirectly relating to
services provided to COUNTY.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3), TERMINATION, of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
employee of CONTRACTOR will perform work, either directly or indirectly, relating to services
provided to
COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
determined by COUNTY to protect the interests of COUNTY clients.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement: (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have
not been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs a
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate
in the Federal Health Care Programs, or has been convicted of a criminal offense relating to the
provision of heath care services, CONTRACTOR will ensure that said employee or subcontractor
does no work, either direct or indirect, relating to services provided to COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term
of this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
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case, is providing professional services under Section One (1), SERVICES, of this Agreement is
excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care
Programs, or is convicted of a criminal offense relating to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3), TERMINATION, of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating
to services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
frame to be determined by COUNTY to protect the interests of COUNTY clients.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits
relating to CONTRACTOR’s compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
28. PROHIBITION ON PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1), SERVICES, of this
Agreement shall be allowed as necessary to raise public awareness about the availability of such
specific services when approved in advance by COUNTY’s DBH Director or designee and at a cost to
be provided in Section Four (4), COMPENSATION, of this Agreement for such items as
written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
expense(s).
29. SUBCONTRACTS
CONTRACTOR shall be required to assume full responsibility for all services and
activities covered by this Agreement, whether or not the CONTRACTOR is providing services
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directly. Further, CONTRACTOR shall be the sole point of contact with regard to contractual matters,
including payment of any and all charges resulting from this Agreement.
CONTRACTOR shall execute a Memorandum of Understanding (MOU) with each
contacted provider for the specific services outlined in Exhibit J, “Intensive/Residential Substance Use
Disorder Services,” at the COUNTY contracted rate(s). CONTRACTOR shall submit copies of
executed MOUs to the Department of Behavioral Health, Contracts Division: SAS@co.fresno.ca.us,
subject: Attention: AB109 Outpatient Services. Upon approval of the MOU by COUNTY’s DBH
Director, or designee, COUNTY will approve reimbursement for claims submitted under line items:
INTENSIVE SUBSTANCE USE DISORDER SERVICES and RESIDENTIAL SUBSTANCE USE
DISORDER SERVICES, of Exhibit C, “Budget.”
If CONTRACTOR should propose to subcontract with one or more third parties to carry out a
portion of services covered by this Agreement, any such subcontract shall be in writing and approved
as to form and context by COUNTY’s DBH Director, or designee prior to execution and
implementation. COUNTY’s DBH Director, or designee, shall have the right to reject any such
proposed subcontract. Any such subcontract together with all activities by or caused by
CONTRACTOR shall not require compensation greater than the total budget contained herein. An
executed copy of any such subcontract shall be received by COUNTY before any implementation and
shall be retained by COUNTY, CONTRACTOR shall be responsible to COUNTY for the proper
performance of any subcontract. Any subcontractor shall be subject to the same terms and conditions
that CONTRACTOR is subject to under this Agreement.
It is expressly recognized that CONTRACTOR cannot engage in the practice of
medicine. If any medical services are to be provided in connection with the services under this
Agreement, such medical services shall be performed by an independent contact physician. In this
instance, the requirements of the Confidential Medical Information Act (Civil Code 56 et. seq.) shall
be met.
If CONTRACTOR hires an independent physician, CONTRACTOR shall require and
ensure that such independent contract physician carries Professional Liability (Medical Malpractice)
Insurance, with limits of not less than One Million Dollars ($1,000,000.00) per occurrence, Three
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Million Dollars ($3,000,000.00) annual aggregate.
30. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State laws,
regulations and standards. In accepting the State drug and alcohol combined program allocation
pursuant to California Health and Safety Code section 11757, CONTRACTOR(S) shall establish
written accounting procedures consistent with applicable Federal and State laws, regulations and
standards, and shall be held accountable for audit exceptions taken by the State or COUNTY for
failure to comply with these requirements. These requirements include, but may not be limited to,
those set forth in this Agreement, and:
A. Division 10.5 of the California Health and Safety Code;
B. California Government Code sections 16366.1 through 16367.9 and 53130
through 53138;
C. Title 9, Division 4 of the California Code of Regulations;
D. 42 United States Code (U.S.C.) section 300x-5;
E. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single
Audit Act Amendments of 1996);
F. Office of Management and Budget (OMB) Circular A-133 (Audits
of States, Local Governments and Non-Profit Organizations); and
G. Title 45, Part 96, Subparts B, C and L of the Code of Federal Regulations (Block
Grants).
CONTRACTOR(S) shall submit, if applicable, a copy of its single audit report and management letter,
performed in accordance to the Single Audit Act of 1984 (31 USC section 7502) and subject to the
terms of OMB A-133 to the County of Fresno. A single audit report is not applicable if all of
CONTRACTOR(S)’ federal contracts do not exceed Seven Hundred Thousand and No/100 Dollars
($750,000.00) or CONTRACTOR(S)’ only funding is through Drug related Medi-Cal. If a single audit
is not applicable, a program audit must be performed and a program audit report with management
letter shall be submitted. Such audit report shall be delivered to COUNTY’s DBH-SUD Services for
review no later than nine (9) months after the close of the subrecipient’s fiscal year in which the funds
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supplied through this Agreement are expended. Failure to comply with this Act may result in
COUNTY performing the necessary audit tasks or contracting with a qualified accountant to perform
the audit. All audit cost related to this Agreement are the sole responsibility of CONTRACTOR(S)
who agrees to take corrective action to eliminate any material noncompliance or weakness found as a
result of such audit. Audit work performed by COUNTY under this paragraph shall be billed to
CONTRACTOR(S) at COUNTY’s cost as determined by COUNTY’s Auditor-Controller/Treasurer-
Tax Collector. To maintain the integrity of the audits, CONTRACTOR(S) is required to change its
auditor (Certified Public Accountant) at least every three (3) years.
31. CHANGE OF LEADERSHIP / MANAGEMENT
Any and all notices between COUNTY and CONTRACTOR(S) provided for or
permitted under this Agreement or by law, shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
United States Mail, postage prepaid, addressed to such party.
In the event of any change in the status of CONTRACTOR(S)’ leadership or
management, CONTRACTOR(S) shall provide written notice to COUNTY within thirty (30) days
from the date of change. Such notification shall include any new leader or manager’s name, address
and qualifications. “Leadership or management” shall include any employee, member, or owner of
CONTRACTOR who either:
a) directs individuals providing services pursuant to this
Agreement,
b) exercises control over the manner in which services are
provided,
c) has authority over CONTRACTOR(S)’ finances.
32. CHILD ABUSE REPORTING
CONTRACTOR(S) shall utilize a procedure acceptable to the COUNTY to ensure
that all of CONTRACTOR(S)’ employees, volunteers, consultants, subcontractors or agents
performing services under this Agreement shall report all known or suspected child abuse or neglect to
one or more of the agencies set forth in Penal Code section 11165.9. This procedure shall include
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having all of CONTRACTOR(S)’ employees, volunteers, consultants, subcontractors or agents
performing services under this Agreement sign a statement that he or she knows of and will comply
with the reporting requirements set forth in Penal Code section 11166. The statement to be utilized by
CONTRACTOR(S) for reporting is set forth in Exhibit P, “Notice of Child Abuse Reporting Law,”
attached hereto and by this reference incorporated herein.
33. CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or
responsibility for planning and carrying out the services provided under this Agreement shall have any
direct or indirect personal financial interest in this Agreement. CONTRACTOR(S) shall comply with
all Federal, State of California, and local conflict of interest laws, statutes, and regulations, which shall
be applicable to all parties and beneficiaries under this Agreement and any officer, agent, or employee
of COUNTY.
34. DRUG-FREE WORKPLACE
CONTRACTOR(S) shall comply with the requirements of the Drug-Free Work Place
Act of 1990 (California Government Code section 8350).
35. CHARITABLE CHOICE
CONTRACTOR(S) may not discriminate in its program delivery against a client or
potential client on the basis of religion or religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice. Any specifically religious activity or service made
available to individuals by the CONTRACTOR(S) must be voluntary as well as separate in time and
location from County funded activities and services. CONTRACTOR(S) shall inform County as to
whether it is faith-based. If CONTRACTOR(S) identifies as faith-based it must submit to DBH
Contracts Division - SUD Services a copy of its policy on referring individuals to alternate treatment
CONTRACTOR, and include a copy of this policy in its client admission forms. The policy must
inform individuals that they may be referred to an alternative provider if they object to the religious
nature of the program, and include a notice to DBH Contracts Division - SUD Services. Adherence to
this policy will be monitored during annual site reviews, and a review of client files. If
CONTRACTOR identifies as faith-based, by July 1 of each year CONTRACTOR will be required to
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report to SAS the number of individuals who requested referrals to alternate providers based on
religious objection.
36. AOD CERTIFICATION
A. The COUNTY requires all COUNTY contracted providers of Alcohol and Other
Substance Use Disorder treatment services to obtain the California Department of Health Care
Services (DHCS) Alcohol and Other Drug Program (AOD) Certification. The AOD Certification
Standards will apply to all residential and outpatient treatment modalities. The purpose of the AOD
Certification Standards is to ensure an acceptable level of service quality is provided to program
participants.
B. CONTRACTOR(S) shall provide proof of a completed application for AOD
Certification to the County within Thirty (30) days from the execution date of this Amendment to the
current Agreement with the COUNTY. A copy of the AOD Certification shall be submitted to the
COUNTY when approved by the DHCS.
C. This AOD Certification requirement applies to every primary treatment facility
operated by the CONTRACTOR(S). CONTRACTOR(S) is not required to obtain a separate AOD
Certification for satellite sites associated with CONTRACTOR(S)’ primary treatment facility.
Satellite sites are expected to operate within the same AOD Certification guidelines and maintain the
same standards as the CONTRACTOR(S)’ related primary site. CONTRACTOR(S)’ whose agencies
are nationally accredited with the Joint Commission on Accreditation of Health Care Organizations
(JCAHO) or the Commission on Accreditation of Rehabilitative Facilities (CARF) are exempt from
this requirement of AOD Certification. CONTRACTOR(S) shall submit a copy of their JCAHO or
CARF accreditation to the COUNTY within Thirty (30) days from the date this Amendment is
executed. CONTRACTOR(S) shall notify COUNTY if at any time their JCAHO or CARF
accreditation lapses or becomes invalid due to any reason during the term of this Agreement.
CONTRACTOR(S) shall apply with DHCS for AOD Certification if their JCAHO or CARF
accreditation lapses or becomes invalid and shall submit a copy of the completed application for AOD
Certification to the COUNTY within Thirty (30) days from the date the JCAHO or CARF
accreditation lapses or becomes invalid.
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D. COUNTY shall terminate this Agreement immediately in the event any of the
following occurs:
a) CONTRACTOR(S) fails to submit a copy of the completed application
for AOD Certification, or a copy of either their JCAHO or CARF accreditation within Thirty (30) days
from the execution date of this Amendment to the current Agreement with the COUNTY.
b) CONTRACTOR(S)’ application for AOD Certification is denied by the
DHCS.
c) CONTRACTOR(S) fails to submit to the COUNTY a copy of the AOD
Certification within Thirty (30) days after being approved by the DHCS, or certification is not
maintained throughout the contract period.
d) CONTRACTOR(S) fails to apply for AOD Certification with DHCS or
fails to submit to the COUNTY a copy of the completed application for AOD Certification within
Thirty (30) days after the JCAHO or CARF accreditation lapses or becomes invalid.
37. NO THIRD PARTY BENEFICIARIES
It is understood and agreed by and between the parties that the services provided by
CONTRACTOR(S) for COUNTY herein are solely for the benefit of the COUNTY, and that nothing
in this Agreement is intended to confer on any person other than the parties hereto any right under or
by reason of this Agreement.
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38. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR(S) shall comply with Public Law 103-227, also known as the Pro-
Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5,
the California Smoke-Free Workplace Law.
39. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client
or a client’s family. CONTRACTOR shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of
the following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall
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provide details and attach documentation of each complaint with the log. CONTRACTOR shall post
signs informing clients of their right to file a complaint or grievance. CONTRACTOR shall notify
COUNTY of all incidents reportable to State licensing bodies that affect COUNTY clients within
twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR’s disposition of, or
corrective action taken to resolve the complaint. In addition, CONTRACTOR shall inform every client
of their rights as set forth in Exhibit I, “Fresno County Mental Health Plan.”
40. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent,
or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
455.104, and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit K,
“Disclosure of Ownership and Control Interest Statement,” attached hereto and by this reference
incorporated herein and made part of this Agreement. CONTRACTOR shall submit this form to
COUNTY’s DBH within thirty (30) days of the effective date of this Agreement. Additionally,
CONTRACTOR shall report any changes to this information within thirty-five (35) days of
occurrence by completing a new Exhibit K, “Disclosure of Ownership and Control Interest
Statement.” Submissions shall be scanned pdf copies and are to be sent via email to
DBHAdministration@co.fresno.ca.us attention: Contracts Administration:
A) Name and address of any person(s) whether it be an individual or corporation with
an ownership or controlling interest in the disclosing entity or managed care entity
a) Address must include the primary business address, every business location and
P.O . Box address(es)
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b) Date of birth and Social Security Number for individuals
c) Tax identification number for other corporations or entities with ownership or
controlling interest in the disclosing entity
B) Any subcontractor(s) in which the disclosing entity has five (5) percent or more
interest
C) Whether the person(s) with an ownership or controlling interest of the disclosing
entity is related to another person having ownership or controlling interest as a
parent, spouse, sibling or child. Including whether the person(s) with ownership or
controlling interest of the disclosing entity is related to a person (parent, spouse,
sibling or child) with ownership or has five (5) percent or more interest in any of its
subcontractors
D) Name of any other disclosing entity in which an owner of the disclosing entity has
an ownership or control interest.
E) The ownership of any subcontractor with whom the provider has had business
transactions totaling more than $25,000 during the 12-month period ending on the
date of the request; and
F) Any significant business transactions between the provider and any wholly owned
supplier, or between the provider and any subcontractor, during the 5-year period
ending on the date of the request.
G) Any person(s) with an ownership or control interest in the provider, or agent or
managing employee of the provider; and
a) Has been convicted of a criminal offense related to that person's involvement in
any program under Medicare, Medicaid, or the title XX services program since
the inception of those programs.
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H) The ownership of any subcontractor with whom the provider has had business
transactions totaling more than $25,000 during the 12-month period ending on the
date of the request; and
I) Any significant business transactions between the provider and any wholly owned
supplier, or between the provider and any subcontractor, during the 5-year period
ending on the date of the request.
41. DISCLOSURE OF CRIMINAL HISTORY & CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them,
their owners, officers, corporate managers or partners (hereinafter collectively referred to as
“CONTRACTOR”):
A. Within the three-year period preceding the Agreement award, CONTRACTOR
has been convicted of, or had a civil judgment tendered against it for:
1. Fraud or criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract under a public
transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, CONTRACTOR
has had a public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR
from further business consideration. The information will be considered as part of the determination
of whether to continue and/or renew the Contract and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later
determined that the CONTRACTOR failed to disclose required information, any contract awarded to
such CONTRACTOR may be immediately voided and terminated for material failure to comply with
the terms and conditions of the award.
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CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and
Other Responsibility Matters – Primary Covered Transactions” in the form set forth in Exhibit L
attached hereto and by this reference incorporated herein. Additionally CONTRACTOR must
immediately advise the COUNTY in writing if, during the term of the Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or
state funded programs or from receiving federal funds as listed in the excluded parties list system
(http://www.sam.gov); or (2) any of the above listed conditions become applicable to
CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any
loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in
the signed “Certification Regarding Debarment, Suspension, and other Responsible Matters.
42. DISCLOSURE OF SELF DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
by completing and signing a “Self-Dealing Transaction Disclosure Form,” attached hereto as Exhibit
M and by this reference incorporated herein and made part of this Agreement, and submitting it to the
COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
43. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request
by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to
ensure CONTRACTOR's compliance with the terms of this Agreement.
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If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor for a period of
three (3) years after final payment under contract (Government Code section 8546.7).
44. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County Chief Executive Officer
Department of Behavioral Health Turning Point of Central California
4441 E. Kings Canyon Rd P.O. Box 7447
Fresno, CA 93702 Visalia, CA 93290-7447
Any and all notices between the COUNTY and the CONTRACTOR provided for or
permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
United States Mail, postage prepaid, addressed to such party.
45. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno County,
California.
The rights and obligations of the parties and all interpretation and performance of this Agreement
shall be governed in all respects by the laws of the State of California.
46. TRAFFICKING IN PERSONS PROVISIONS – PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations prohibiting
trafficking in persons, as well as trafficking-related activities, including, but not limited to the
trafficking of persons provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000
(TVPA).
CONTRACTOR, CONTRACTOR’s employees, subrecipients, and subrecipients’
employees may not:
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A) Engage in severe forms of trafficking in persons during the period of time that
the award is in effect;
B) Procure a commercial sex act during the period of time that the award is in
effect; or
C) Use forced labor in the performance of the award or subawards under the award.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR or a
subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or has an
employee who is determined by the DBH Director or her designee to have violated a prohibition of the
TVPA through conduct that is either associated with performance under the award or imputed to the
CONTRACTOR or their subrecipient using the standards and due process for imputing the conduct of
an individual to an organization that are provided in 2 C.F.R. Part 180, “OMB Guidelines to Agencies
on Government-wide Debarment and Suspension (Nonprocurement).
CONTRACTOR must inform the DBH Director or her designee immediately of any
information received from any source alleging a violation of a prohibition of the TVPA.
47. ENTIRE AGREEMENT
This Agreement, including all Exhibits between CONTRACTOR and COUNTY, RFP No.
962-5011, and response to RFP No. 962-5011 with respect to the subject matter hereof and supersedes all
previous agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
48. COUNTY and CONTRACTOR agree that this Fifth Amended and Restated Agreement is
sufficient to amend the Agreement; and that this Fifth Amended and Restated Agreement shall supersede
Agreement 12-184, including Amendment I, Amendment II, Amendment III, and Amendment IV.
///
///
///
///
///
1 IN WI1NESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first
2 hereinabove written.
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ATIEST:
CONTRACTOR:
TURNING POINT OF CENTRAL
CALIFORNIA, INC.
By :~
Print Name: ,{!Ay~IJ.IVL? fR<IfJA/6.5
COUNTY OF FRESNO
By:f:_~~~
Chairperson, Board of upervtsors
Title: ~ ie,fC d6.xes:..v7jl/fr OPF~ Date: ~-e. d-\. ¢.0\l o
• Chairman of Board, or President,
or any Vice President
By:_~_••_• •_• -_~ __ <v __ _
Print Name: ;'$-,-~ e-e, ~ (._;--
----------~--------
Title: ------------------------Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
Mailing Address:
P. 0. Box 7447
Visalia, CA 93290-7447
Contact: Executive Director
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By:~~~<>+>··~~
Date : :r~ a.\., aDU.o
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-50 -COUNTY OF FRESNO
Fresno, CA
EXHIBIT A
Page 1 of 13
AB 109
SCOPE OF WORK
Section 1: Outpatient Mental Health and Substance Use Disorders Services
Section 2: Full Service Partnership Services
ORGANIZATION: Turning Point of Central California
MAILING ADDRESS: P.O. Box 7447, Visalia CA 93290
SERVICE ADDRESS: 3636 N. First Street, Suites 135 and 162, Fresno, CA 93726
SERVICES: Mental health outpatient (OP) services, substance use disorders
(SUD) treatment services, and full service partnership (FSP) services
as required by AB109 Public Safety Realignment and the Post-release
Community Supervision Act of 2011.
SUBSTANCE USE DISORDERS OUTPATIENT SERVICES
SU/OP Director: Daisy Obong, (559) 906-8673
Regional Director: Sharon Ross, (559) 221-5191
MENTAL HEALTH OUTPATIENT SERVICES
MH/OP Director: Daisy Obong, (559) 906-8673
Regional Director: Sharon Ross, (559) 221-5191
FULL SERVICE PARTERNERSHIP SERVICES
FSP Director: Mitch Collins, (559) 906-8673
Regional Director: Ryan Banks, (559) 476-2176
CONTRACT PERIOD: July 1, 2016 through June 30, 2017
CONTRACT AMOUNT:
Total Substance Use Full Service
Term Budget and Outpatient Partnership
FY 16-17 $4,280,884 $ 2,724,981 $1,555,903
EXHIBIT A
Page 2 of 13
SECTION 1
Outpatient Mental Health and Substance Use Disorders Services
OUTPATIENT SERVICES:
In anticipation of a large percentage of the Fresno County's AB-109 population requiring outpatient
substance use treatment and mental health services, First Street Center (FSC) Outpatient Program aims
to assist. FSC Outpatient Program will provide services that have been personalized to the client's
needs. The First Street Center Outpatient program will emphasize a broad and cohesive substance
abuse and co-occurring treatment approach for all clients with the following essential components
being established:
• The FSC Outpatient Program will be open for morning, early afternoon, late afternoon, and
evening classes for its clients. The FSC Outpatient Program will be available for individual
Substance Use Disorder Counseling sessions and/or Case Management sessions primarily
between the hours of 8am and 5pm, Monday through Friday and at various scheduled times
that have been scheduled by the Case Manager/Substance Use Disorder Counselor and the
client.
• When a client presents to the FSC Outpatient Program with a substance use disorder as well
as a mental health need, each disorder will be considered primary thus allowing the client to
embrace an integrated plan for their individual treatment.
• The FSC Outpatient Program understand the need for psychiatric services with the co-
occurring population thus the FSC Outpatient Program will work on a direct treatment
approach that emphasizes the need of the client while focusing on the integrated care of the
client.
• The FSC will focus on a "treatment on demand" approach that utilizes a "whatever it takes"
component. The FSC Outpatient Program will also focus on cultural/linguistic awareness while
taking on an empathic, non-judgmental, evidenced based, person-centered approach that is
not only built for substance use disorders but one that is also built around the needs of the co-
occurring and mental health client.
• The team at the FSC Outpatient Program will use an approach that focuses on the client's
strengths and current skills with the belief that all clients should participate in their own
treatment plans.
• The FSC Outpatient Program will strive to become Medi-Cal compliant.
Further, the FSC Outpatient Program will provide treatment services to adults aged 18-years old and
up and their families. The FSC Outpatient Program will work under the "treatment on demand"
approach where no client is given priority over the next. The FSC Outpatient Program will work
directly with the AB-109 probationary department for all referrals and complete the screening process
for all clients directly at the AB-109 probationary department.
The FSC Outpatient Program is available from 8am to 5pm regularly with evening classes and Case
Management/Substance Use Disorder Counseling/Mental Health sessions as scheduled. The FSC
Outpatient Program will also have telephone contact with their clients as needed and crisis
management as needed. The following crisis response measures shall also be followed by the staff at
the FSC Outpatient Program:
1. The FSC Outpatient Program will follow the direct lead of the Program Director and/or
Supervisor during the crisis.
2. The FSC Outpatient Program will respond to all crises in a rapid and flexible manner.
EXHIBIT A
Page 3 of 13
3. The FSC Outpatient Program understands that there are several types of crisis situations that
can occur with the clients who are involved in the outpatient program, which may include:
housing crisis, suicidal ideation, homicidal ideation, relapse, decompensation, and others.
4. Due to the FSC Outpatient Program understanding that there will undoubtedly be different
types of crises, the FSC Outpatient Program will be fully aware of all crisis situations that occur
within the Outpatient Program through a staffing that will immediately follow the crisis
situations.
5. When a housing crisis occurs at the FSC Outpatient Program, the Program Director, the FSC
Supervisor, and the FSC Case Manager will be notified immediately of said housing crisis.
a. The FSC Outpatient Program will take every measure to ensure that the FSC
clients have housing, whether in a sober living environment or in inpatient treatment
(either voluntary or involuntary).
b. When such a need for housing has been acknowledged, the FSC Outpatient
Program staff shall collaborate with the treatment staff in such facilities.
6. The FSC Outpatient Program believes that all crisis services shall be monitored to ensure that
all interventions have begun appropriately and that will be commenced with a discharge plan
that will take place in collaboration with staff at the appropriate agency.
All staff at the FSC Outpatient Program will be trained on the housing situations in Fresno County as a
way to assist clients in locating, securing, and inhabiting appropriate housing that has been deemed
appropriate for their exact level of care. Further, the FSC Outpatient Program will provide housing
options to all clients in need as well as maintain clients in independent living by providing needed
services to all clients, accessing appropriate resources for each client, and encouraging all clients to
live responsible and productive lives in an independent setting.
The FSC Outpatient Program will provide a variety of services in the area of psychotropic medication
management, which will include: tele-psychiatry, the prescribing of psychotropic medications, the
administration of psychotropic medications by way of injectable medications, monitoring the client
after they have begun psychotropic medications, and the documentation of all avenues leading to the
course of medication management and further by completing the following:
1. The tele-psychiatrist working with through the FSC Outpatient Program shall assess each
client's mental illness thereby prescribing any appropriate medication that the client is in need
of; regularly review and documents that client's symptoms and response to their mediation;
educate the client on how their medications work; treat and documents any adverse reactions
that come from the client's medication.
2. The FSC Program Nurse shall establish medication policies and procedures which will train
the client in the knowledge of their own medication as well as all staff. The FSC Program
Nurse will provide necessary training to all FSC staff that is required for their overall learning.
3. All FSC staff will document their client's mental illness symptoms and how the client responds
to their medication. All FSC staff will observe the side effects of their client's medication and
discuss any concerns that they have with the Lead Mental Health Clinician as well as the FSC
Program Nurse.
The FSC Outpatient Program will provide substance use disorder treatment that is not only intensive
and comprehensive but also level appropriate for the client. The FSC Outpatient Program will work
under the lens of "treatment on demand" where clients are served according to their need and not
upon the timeline of the treatment program. The FSC Outpatient Program will work under the needs of
EXHIBIT A
Page 4 of 13
the clients whether the client is being seen for their substance use disorder, co-occurring disorder, or
mental health disorder.
The FSC Outpatient Program team will have access to several resources for their clients, including
the ability to make emergency purchases of food, clothing, prescriptions, and other basic needs for
their clients. The FSC Outpatient Program will have sound practices for tracking these purchases.
The FSC Outpatient Program shall provide training and instruction to support and assist all clients in
learning the skills of personal hygiene, job-readiness skills, resume writing, mock-interview sessions,
"how to dress to impress", provide suits and ties to male clients and dresses to females after courses,
linkage services that apply to general relief, SSI, and others. The FSC Outpatient Case Managers
assist clients with scheduling doctor appointments and the follow-through with appointments as well
as court services. FSC Case Managers also provide linkage services between clients and the FSC
Mental Health team for additional support.
The FSC Outpatient Program shall provide initial support of all clients with scheduling activities that
are built around the client's level of care. FSC Substance Use Disorder Counselors will facilitate group
processes and the educational building in the client through the delivery of all SUD Educational
Classes that are focus-driven and psychoeducational in manner. The FSC Substance Use Disorder
(SUD) Counselors will provide a key focus to all AB-109 clients that aim at the Criminal and Addictive
Thinking process of the client and how to overcome past barriers. The FSC SUD Counselors will
teach socialization skills to clients that are in need, while also focusing on the relapse prevention
model. FSC SUD Counselors will also emphasize the importance of Familial systems in the client's
recovery by assigning the client on a needs basis to family group or familial therapy with a Mental
Health Clinician through First Street Center. FSC SUD Counselors will provide UA testing (both on 5-
panel and 10-panel, as needed) of all clients. The FSC SUD Counselors will test clients at time of
DISCHARGE and during the discharge planning. Referrals will be made to clients in the level of care
3 and 4 to Aftercare treatment. FSC Substance Use Disorder Counselors will be available 24/7 for
crisis management at an on-call basis.
The FSC Outpatient Program will provide an integrated approach for all co-occurring clients. The FSC
Outpatient Program will work with a "treatment on demand" principle that is empathic, nonjudgmental,
unique, and having a positive regard that focuses on the client's individual needs.
The FSC Outpatient Program will work to minimize the client's involvement in the criminal justice
system, whether it is in the Fresno County Jail or elsewhere within the California Department of
Corrections and Rehabilitation by means of classes, groups, or individual sessions between the client
and their assigned SUD Counselor, Case Manager, or Mental Health Clinician.
STAFFING REQUIREMENTS:
One of the most critical features of the FSC Outpatient Program is the team delivery method, which
shall be the unified team approach with the client and their families at its focus. With this client/family
approach, the FSC Outpatient Program will unify their team in an effort to build a unified focus that
strengthens each FSC staff member's diverse skills. Due to the FSC Outpatient Program working
under a "treatment on demand" lens, the FSC Outpatient Program will have no exact staff to client
ratio. Designated staff shall be on-call during the off-hour periods, on a rotating basis in order to
respond to the exact needs of the clients. The AB-109 psychiatrist (or Licensed Psychiatric Nurse
Practitioner) will be available during regular business hours.
GREIVANCES AND INCIDENT REPORTS:
EXHIBIT A
Page 5 of 13
The FSC Outpatient Program understands that there will be times of grievances and incident reports.
The FSC Outpatient Program will notify Fresno County of all incidents or unusual occurrences
reportable to state licensing bodies that affect Fresno County clients within (24) twenty-four hours of
the incident. The FSC Outpatient Program will within (15) fifteen days after each grievance or incident
affecting the Fresno County sponsored clients inform provide the Fresno County with the corrective
action that will be taken to resolve the complaint or incident.
REPORTING REQUIREMENTS:
The FSC Outpatient Program will maintain an up-to-date caseload record of all clients who are
participants in the FSC Outpatient Program. The FSC Outpatient Program will provide Fresno County
with client, programmatic, and other demographic information upon request.
PROGRAM OUTCOMES
The following items listed below represent program outcomes to be tracked by the vendor
during the term of the contract:
A. Engagement:
1. 95 percent of all referrals will receive intake/assessment within one week of referral.
Average number of days can be calculated with a goal of reducing the average.
2. 25 percent of cases will engage the families of the offender in the offender’s treatment.
B. Retention:
1. The number and percentage of offenders who complete each of the five levels of
treatment will be calculated with the following percentage as goals for each level: Level
1 – 70 percent; Level 2 – 65 percent; Level 3 – 60 percent; Level 4 – 55 percent; Level
5 – 65 percent, and voluntary aftercare – 30 percent.
2. The average length of treatment episode for offenders participating per level.
C. Abstinence/Sobriety:
1. A goal of 90 percent of all urine tests for drug alcohol use (random, scheduled and for
cause) will be negative.
2. 70 percent of discharges completing treatment with no alcohol or drug use detected by
urine testing.
3. 95 percent of discharges completing treatment with no alcohol or drug use detected
during the month prior to discharge.
4. 70 percent achieving progress as determined by Addiction Severity Index drug and
alcohol use subscales.
D. Treatment Objectives/Achievements:
1. Number and percentage of offenders achieving 75 percent of their individual treatment
goals.
EXHIBIT A
Page 6 of 13
2. Number and percentage of offenders attaining essential treatment/recovery information
and skills as determined by post-activity written test (goal of 80 percent).
3. 75 percent of all participants will develop ongoing recovery support network of family,
friends, and sobriety communities, or mainstream resources.
E. Mental Health:
1. Number and percentage of mentally ill offenders who substitute illicit drugs with
authorized medications.
2. Number and percentage (goal – 85 percent) of mentally ill or dually diagnosed who
evidence no hospitalization, incarceration, or use of County Crisis services (include
hospital emergency departments) as result of their mental illness during their program
participation.
3. Number and percentage who develop a wellness/recovery plan (goal – 85 percent).
4. Number and percentage of mentally ill participants who have adequate ongoing
housing, income, medication, social supports, mental health treatment services, and
ongoing mainstream resources at the time of program discharge.
5. Percent of participant and families that self-report wellness and recovery at the time of
program discharge.
F. Consumer Satisfaction:
1. Client perception of care is rated as satisfactory or better in pre- and post-discharge
survey (goal of 75 percent).
G. Law-Abiding Lifestyle:
1. Post-discharge recidivism for new crimes, and violation of terms of community
supervision.
EXHIBIT A
Page 7 of 13
SECTION 2
AB 109 Full Service Partnership
FULL SERVICE PARTNERSHIP PROGRAM DESCRIPTION
The AB 109 Full Service Partnership (FSP) program shall provide innovative and evidence-based
mental health services specifically tailored to meet the unique needs of the seriously mentally ill (SMI)
population identified among the AB109 post-release adult male and female offenders. This project
shall include the use of innovative approaches resulting in increased access to services for the
underserved criminal justice clients thereby encouraging and assisting this population in transition
towards growth, stability, wellness, and recovery. Services shall be delivered with a focus of “meeting
the clients where they are” utilizing a “whatever it takes” approach. Services shall be culturally and
linguistically competent, values-driven, evidence-based and co-occurring capable. An important
element of this project will be close and constant communication and collaboration between
CONTRACTOR, the criminal justice system, Fresno County Probation Department, and Fresno
County Department of Behavioral Health, Mental Health Services Act.
SCHEDULE OF SERVICES
CONTRACTOR staff shall be available to provide FSP services to a 105 consumers 24 hours per
day, 7 days per week including telephone and face-to-face contact as needed; and spend at least
75% of their time on billable activities on behalf of the consumers.
TARGET POPULATION
The target population is comprised of AB109 post-release adult male and female offenders, age 18
and older and their families, who have a serious mental illness (SMI) such as schizophrenia major
depression with psychotic features or bi-polar disorders. This program will serve 105 AB109 transfer
consumers referred by the Probation Department at any given point in time.
STAFFING REQUIREMENTS
1. CONTRACTOR shall implement and support the use of a team delivery method, which shall
be the unified team approach with a consumer/family centered focus. With this approach,
the multiple staff members that make up the team shall “unify” their diverse skills in order to
address each consumer’s mental health and substance abuse needs. Staffing responses
and program design should show evidence of consumer/family support as provided through
consumer/family specialists
2. The FSP AB 109 Team staff to consumer ratio shall be set at or between 1:10 to 1:15, or
one staff serving no more than ten to fifteen consumers. All treatment staff will be included
in the ratio. The FSP AB 109 Team must meet the ratio requirements.
3. The FSP AB 109 Team shall be available twenty-four (24) hours per day, seven (7) days per
week. The staff shall have hours that allow them to work evenings and weekends. Staff
shall be on-call during off-hour periods, on a rotating basis in order to respond immediately
to consumers by telephone or in person, as dictated by consumer needs. The Psychiatrist,
or Psychiatric Nurse Practitioner, shall be available during normal business hours and on-
call during off-hours periods.
CONTRACTOR’S RESPONSIBILITIES
CONTRACTOR shall ensure that:
EXHIBIT A
Page 8 of 13
1. Staff be available to provide intensive case management and crisis outreach services 24
hours a day, 7 days a week;
2. Staff spend a minimum of 75% of their time on billable activities on behalf of FSP program
consumers;
3. When substance disorder and psychiatric disorder co-exist, each disorder should be
considered primary; an integrated dual treatment approach is recommended, where each
disorder receives appropriately intensive diagnosis-specific treatment;
4. Services are delivered with a focus of “meeting the client where they are” utilizing a
“whatever it takes” approach;
5. Services shall be culturally/linguistically competent, values-driven, evidence-based and co-
occurring capable;
6. A strength-based approach is implemented which will help consumers build on their current
skills and the consumer will actively participate in their individual treatment planning; the
goal being to help the consumer towards growth, stability, wellness, and recovery;
7. Highest priority for FSP services is given to individuals in a complex crisis;
8. FSP services offer an array of integrated mental health and substance abuse services that
are need driven, not appointment driven, and that involve case management and recovery
based peer support as well as community and family support;
9. FSP AB 109 Team and services adhere to the following crisis response measures:
a. Response to crisis shall be rapid and flexible;
b. When crisis housing is necessary for short-term care and inpatient treatment (either
voluntary or involuntary), the staff shall collaborate with the treatment staff in such
facilities. Support shall be provided, including accompanying the consumer to the
facility, remaining with the consumer during assessment, and beginning the process
of planning with the consumer for discharge to the community as soon as possible;
c. Usage of crisis services and hospitalizations shall be monitored to ensure that
interventions were initiated and that discharge planning took place in collaboration
with the admitting facility. Monitoring can include and lead into costs to the service
provider for inpatient days in the event discharge is delayed due to lack of response
or discharge options for enrollees.
10. FSP AB 109 Team make available/coordinate housing services for each consumer as
follows:
a. Training and assistance to consumers in locating, securing and inhabiting housing
which is appropriate to their level of functioning;
b. Providing housing options and maintain clients in independent living by providing
needed services, accessing resources and encouraging consumers to be
independent, productive and responsible;
c. Assisting consumers in securing supported independent and permanent housing as
appropriate for consumers in their community throughout the metropolitan, and rural
(western and eastern areas) of Fresno County where consumers prefer to reside;
EXHIBIT A
Page 9 of 13
d. Assisting consumers in securing emergency housing voucher.
11. The FSP AB 109 Team provide services in the areas of medication prescription,
administration, monitoring, and documentation as indicated below.
a. The team psychiatrist shall assess each consumer’s mental illness and prescribe
appropriate medication, regularly review and document symptoms as well as the
consumer’s response to the prescribed medications, educate the consumer and
family members, and monitor, treat and document any medication side effects.
b. The nurse shall establish medication policies and procedures which identify
processes to administer medications, train other team members, and assess
regularly other team members’ competency in this area.
c. All team staff shall document consumer’s mental illness symptoms and behavior in
response to medication and shall monitor for medication side-effects during the
provision of observed self-administration and during ongoing face-to-face contacts.
d. Medication provision and psychiatric services are the full responsibility of the selected
provider.
12. The FSP AB 109 Team provide whatever direct assistance is necessary and reasonable to
ensure that the consumer obtains the basic necessities of daily life, such as food, housing,
clothing, medical/mental health/substance abuse services, and other financial support.
13. The FSP AB 109 Team provide intensive and comprehensive alcohol, tobacco and drug
abuse treatment services in accordance with harm reduction principles. The provision of
integrated dual recovery substance abuse/mental health services is a key ingredient in the
FSP service delivery model.
14. The FSP AB 109 Team members have access to resources in order to make emergency
purchases of food, shelter, clothing, prescriptions, transportation, or other items for
consumers, as needed. The team shall also have access to larger sums of client assistance
funds for deposits, furniture purchases, and other items. The FSP will utilize sound
accounting practices for recording and monitoring the use of these funds.
15. The FSP AB 109 Team may serve as “representative payee” or work with an organization
which provides such services, for some consumers. The FSP will utilize sound accounting
practices to monitor these situations. The team may utilize client assistance funds to assist
consumers with short-term loans or grants, as necessary. The team shall link consumers to
appropriate social services, provide transportation as necessary, and link the client to
appropriate legal advocacy representation.
16. The FSP AB 109 Team provide training and instruction to support and assist the client in
developing personal skills and assist in the identification of and participation in community
based recreational and social activities.
17. The FSP AB 109 Team provide integrated, co-occurring capable alcohol, tobacco and drug
abuse services as needed, in accordance with harm reduction principles. The provision of
substance abuse/mental health services is a key ingredient in FSP services.
18. The FSP AB 109 Team work to minimize the consumer’s involvement in the criminal justice
system and will service as program representative during any contact with local law
enforcement agencies.
EXHIBIT A
Page 10 of 13
19. CONTRACTOR shall develop a satisfaction survey, approved by DBH that complies with the
mandated State performance outcome and quality improvement reports/outcomes. At a
minimum, seventy-five percent (75%) of consumers will report satisfaction with the program
services.
PROGRAM REPORTS AND OUTCOMES
1. FSP Requirements - As required by the Mental Health Services Act, CONTRACTOR shall be
responsible for correctly completing the following Full Service Partnership Forms into the
State web-based database on a monthly basis:
a. Partnership Assessment Forms (PAF) - completed once, when partnership is
established with a client (baseline).
b. Key Event Tracking Form (KET) - completed when change occurs in key areas.
c. Quarterly Assessment Form (3M) - completed every 3 (three) months.
These forms can be viewed at http://www.dmh.ca.gov/POQI, then select “Forms” under the
“MHSA Full Service Partnership Evaluation”. CONTRACTOR shall complete all Full Services
Partnership Reporting according to DMH regulations.
2. Grievances
a. CONTRACTOR shall log all grievances and the disposition of all grievances received
from a consumer or a consumer’s family in accordance with Fresno County Mental
Health Plan policies and procedures (Exhibit I).
b. CONTRACTOR shall provide a summary of the grievance log entries concerning
County-sponsored consumers to the Department of Behavioral Health Director or
designee at monthly intervals, by the tenth (20th) day of the following month, in a
County approved format.
c. CONTRACTOR shall post signs, provided by the County, informing consumers of
their right to file a grievance and appeal.
d. Within fifteen (15) days after each grievance or incident affecting County-sponsored
consumers, CONTRACTOR shall provide County with the complaint and
CONTRACTOR’s disposition of, or corrective action taken to resolve the complaint or
incident.
e. Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a
California State licensing and/or accrediting body concerning any sentinel event, as
the term is defined by the licensing or accrediting agency, and within fifteen (15) days
after CONTRACTOR receives a corrective action order from a California State
licensing and/or accrediting body to address a sentinel event, CONTRACTOR shall
provide a summary of such plans and orders to County.
3. Incident Reports
a. CONTRACTOR will notify County of all incidents or unusual occurrences reportable
to state licensing bodies that affect County consumers within twenty-four (24) hours.
CONTRACTOR shall use the CONTRACTOR specific form for such reporting.
EXHIBIT A
Page 11 of 13
b. Within fifteen (15) days after each grievance or incident affecting County-sponsored
consumers, CONTRACTOR shall provide County with the complaint and
CONTRACTOR’s disposition of, or corrective action taken to resolve the complaint or
incident.
c. Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a
California State licensing and/or accrediting body concerning any sentinel event, as
the term is defined by the licensing or accrediting agency, and within fifteen (15) days
after CONTRACTOR receives a corrective action order from a California State
licensing and/or accrediting body to address a sentinel event, CONTRACTOR shall
provide a summary of such plans and orders to County.
4. Report Delivery and Content Requirements
CONTRACTOR shall deliver all MHSA required reporting in data collection format that
reflects MHSA and Data Infrastructure Grant (DIG) requirements in a timely and accurate
manner. Reporting information should include demographics and attendance, as well as
track unduplicated and duplicated consumer counts as required by DMH reporting
standards.
5. Billable Services
CONTRACTOR shall ensure billable Mental Health Specialty Services meet any/all County,
State, Federal regulations including any utilization review and quality assurance standards,
and provide all pertinent and appropriate information in a timely manner to County to bill
Medi-Cal for services rendered.
6. Utilization of Services
CONTRACTOR may be required to closely monitor and report monthly the utilization of
services by consumers to ensure the dollars available during each term of this Agreement
provide the level of program services as identified this Agreement. CONTRACTOR shall
submit a monthly report to the COUNTY of the units of service provided by service function
code and dollars billed, actual expenses, revenues generated from non Medi-Cal billed
services (such as collecting consumer rents), the number of consumers served and waiting
list for the purpose of contract monitoring within 30 days after the last day of the previous
month. CONTRACTOR may be required to submit Quality Improvement reports within the
timeframe as specified by the Fresno County Mental Health Plan.
7. Short/Doyle Medi-Cal Cost Report
CONTRACTOR shall submit a complete and accurate State of California Department of
Mental Health (DMH) Short/Doyle Medi-Cal Cost Report for each fiscal year ending June
30th affected by this Agreement. The cost report must be submitted to the County’s DBH
Business Office within 90 days following the end of each fiscal year. All cost reports must be
prepared in accordance with general accounting principles and the standards set forth by the
DMH and the County.
8. Caseload Records
CONTRACTOR shall maintain an up to date caseload record of all clients receiving services
from the AB 109 FSP program, and provide consumer, programmatic, and other
demographic information to the COUNTY. Reports are to be submitted to the DBH MHSA
EXHIBIT A
Page 12 of 13
Administrative Staff Analyst or the DBH Director or designee by the 20th of each month
unless otherwise directed by DBH Director or designee.
9. Outcome Measurements and Reporting
Outcomes are to be reported annually on the Outcomes Template included in Invoices and
Reports (Exhibit D). Outcomes to be tracked include, but may not be limited to,
increases/decreases in: LOCUS scores, hospitalization/crisis, homelessness, and
incarceration. In addition, consumer progress with education, employment, socialization and
other life skills may be used to determine Program success and effectiveness. Annual
recommendations to the County Board of Supervisors for Agreement renewals will be based
upon CONTRACTOR’s successful delivery, maintenance, tracking, and reporting of program
services and outcomes. Outcome reporting will be requested by DBH annually (typically in
January for the previous calendar year).
10. Consumer Satisfaction Survey
Consumer Satisfaction Survey shall be tracked and reported on at a minimum annually and
shall be submitted with Outcome Measures when requested by DBH (typically in January for
previous calendar year). At a minimum, seventy-five percent (75%) of consumers will report
satisfaction with the program services.
COUNTY’S RESPONSIBILITIES
COUNTY shall:
1. Provide oversight (through the County Department of Behavioral Health (DBH), Adult
System of Care, and the Mental Health Services Act, Division Managers or designees) of the
CONTRACTOR’s FSP program. In addition to contract monitoring of program, oversight
includes, but not limited to, coordination with the State Department of Mental Health, Mental
Health Services Act in regard to program administration and outcomes.
2. Assist CONTRACTOR in making linkages with the total mental health system. This will be
accomplished through regularly scheduled meetings as well as formal and informal
consultation
3. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the CONTRACTOR for
ongoing consultation.
4. Receive and analyze statistical data outcome information from CONTRACTOR throughout
the term of contract on a monthly basis. DBH will notify the CONTRACTOR when additional
participation is required. The performance outcome measurement process will not be limited
to survey instruments but will also include, as appropriate, client and staff interviews, chart
reviews, and other methods of obtaining required information.
5. Recognize that cultural competence is a goal toward which professionals, agencies, and
systems should strive. Becoming culturally competent is a developmental process and
incorporates at all levels the importance of culture, the assessment of cross-cultural
relations, vigilance towards the dynamics that result from cultural differences, the expansion
of cultural knowledge, and the adaptation of services to meet culturally-unique needs.
Offering those services in a manner that fails to achieve its intended result due to cultural
and linguistic barriers is not cost effective. To assist the CONTRACTOR efforts towards
EXHIBIT A
Page 13 of 13
cultural and linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
a. Technical assistance to CONTRACTOR regarding cultural competency requirements
and sexual orientation training.
b. Mandatory cultural competency training including sexual orientation and sensitivity
training for DBH and CONTRACTOR or personnel, at minimum once per year.
COUNTY will provide mandatory training regarding the special needs of this diverse
population and will be included in the cultural competence training(s). Sexual
orientation and sensitivity to gender differences is a basic cultural competence
principle and shall be included in the cultural competency training. Literature
suggests that the mental health needs of lesbian, gay, bisexual, transgender,
questioning (LGBTQ) individuals may be at increased risk for mental disorders and
mental health problems due to exposure to societal stressors such as stigmatization,
prejudice and anti-gay violence. Social support may be critical for this population.
Access to care may be limited due to concerns about providers’ sensitivity to
differences in sexual orientation.
c. Technical assistance for CONTRACTOR in translating behavioral health and
substance abuse services information into DBH’s threshold languages (Spanish,
Laotian, Cambodian, and Hmong). Translation services and costs associated will be
the responsibility of CONTRACTOR.
PROGRAM OBJECTIVES (FSP Program)
The items listed below represent program objectives to be tracked and achieved by CONTRACTOR
during the contract terms.
1. Reduce frequency of hospitalization for each consumer served.
2. Reduce frequency of homelessness for each consumer served.
3. Reduce frequency of access to crisis services provided by the DBH Intensive Services Division.
4. Reduce frequency of incarceration for each consumer served.
5. Improve LOCUS scores for each consumer served;
6. Improve socialization and life skill for each consumer served
7. Direct service productivity rate shall be a minimum of eighty Percent (80%)
8. At a minimum, seventy-five percent (75%) of consumers will report satisfaction with the
program services.
SUD
FTE
%
MH
FTE %
SUD
Admin
MH
Admin SUD MH Total
PERSONNEL SALARIES:
0001 Program Director 0.83 0.17 63,210 12,947 $76,157
0002 Administrative Technician 0.83 0.17 31,267 6,404 $37,671
0003 Casework Supervisor 0.83 0.17 38,055 7,794 $45,849
0004 Substance Abuse Counselor 6.00 224,915 $224,915
0005 Driver 1.00 27,589 $27,589
0006 Nurse 0.60 26,984 $26,984
0007 Case Manager 1.00 0.00 33,738 $33,738
0008 Secretary 1.24 0.26 31,594 6,471 $38,065
0009 Billing Clerk 0.83 0.17 25,902 5,305 $31,207
0010 Mental Health Professional/Team Leader 3.00 201,552 $201,552
0011 Intake Specialist 0.83 0.17 38,055 7,794 $45,849
SALARY TOTAL 13.39 4.71 $514,325 $275,251 $789,576
PAYROLL TAXES:
0031 Accrued Paid Leave 21,430 11,469 $32,899
0032 OASDI/FICA/MEDICARE 40,985 21,934 $62,919
0033 SUI 9,967 5,334 $15,301
PAYROLL TAX TOTAL $72,382 $38,737 $111,119
EMPLOYEE BENEFITS:
0040 Retirement 7,929 4,243 $12,172
0041 Workers Compensation 5,130 2,746 $7,876
0042 Health Insurance (medical, vision, life, dental)125,868 67,360 $193,228
EMPLOYEE BENEFITS TOTAL $138,927 $74,349 $213,276
SALARY & BENEFITS GRAND TOTAL $725,634 $388,337 $1,113,971
Line Item Description (Must be itemized)
AB 109 - SUD & MH OP
Turning Point of Central California
July 1, 2016 - June 30, 2017
Budget Categories - Total Proposed Budget
$0
$0
$0
$0
Exhibit C
Page 1 of 7
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building 58,452 10,910 $69,362
1011 Rent/Lease Equipment - $0
1012 Utilities 10,612 2,173 $12,785
1013 Building Maintenance 4,778 979 $5,757
1014 Equipment Maintenance 1,423 291 $1,714
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $75,265 $14,353 $89,618
OPERATING EXPENSES:
1060 Telephone 4,980 1,020 $6,000
1061 Answering Service -
1062 Postage 415 85 $500
1063 Printing & Reproduction 1,038 213 $1,251
1064 Publications 249 82 $331
1065 Legal Notices/Advertising -
1066 Office Supplies & Equipment 16,280 2,720 $19,000
1067 Household Supplies 1,868 383 $2,251
1068 Food - $0
1069 Program Supplies - Therapeutic 11,395 255 $11,650
1070 Program Supplies - Medical 8,000 5,213 $13,213
1071 Transportation of Clients 7,315 1,498 $8,813
1072 Staff Mileage/vehicle maintenance 7,850 1,124 $8,974
1073 Staff Travel (Out of County)-
1074 Staff Training/Registration 4,150 2,500 $6,650
1075 Lodging 500 500 $1,000
1076 Other - (Vehicle Insurance/ Vehicle Lease)1,135 2,346 $3,481
1076 Other - (Client Activities)3,854 566 $4,420
1076 Other - (Depreciation)1,245 150 $1,395
1076 Other - (Recruitment)539 102 $641
1077 Licenses 13,280 20,720 $34,000
1078 O/S Labor Clinical - Therapist 5,000 $5,000
1078 O/S Labor Clinical - Psychiatrist 12,000 53,280 $65,280
OPERATING EXPENSES TOTAL $96,093 $97,757 $193,850
FINANCIAL SERVICES EXPENSES:
1080 Accounting Bookkeeping - $0
1081 External Audit 500 $500
1082 Liability Insurance 1,494 306 $1,800
1083 Administrative Overhead 135,452 83,189 $218,641
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $137,446 $83,495 $220,941
TotalSUDMH
TotalSUDMH
Exhibit C
Page 2 of 7
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant - Network & Data Management - - $0
1091 Translation Services 4,130 846 $4,976
1092 Medication Supports - 50,000 $50,000
SPECIAL EXPENSES TOTAL $4,130 $50,846 $54,976
FIXED ASSETS:
1190 Computers & Software 3,000 $3,000
1191 Furniture & Fixtures
1192 Other - (Identify)
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0 $3,000 $3,000
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Intensive Substance Use Disorder Services (SFC 70)200,000 $200,000
2001 Residential Services ( SFC 71)848,625 $848,625
2002.1 Clothing, Food & Hygiene (SFC 72)
2002.2 Client Transportation & Support (SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items (SFC 72)
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
FIXED ASSETS TOTAL $1,048,625 $0 $1,048,625
TOTAL PROGRAM EXPENSES $2,087,193 $637,788 $2,724,981
DRUG MEDI-CAL REVENUE:Rate Amount Amount Total
26.23 $251,178.48 $251,178
67.38 $97,768.38 $97,768
$348,947 $348,947
61.59%
0.00%
$348,947 $348,947
Units of Service
9576
1451
11027
Estimated % of Federal Financial Participation Reimbursement
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL
Group Contacts
Individual Contacts
Estimated Medi-Cal Billing Totals
Exhibit C
Page 3 of 7
MEDI-CAL REVENUE:Rate Amount Amount Total
3000 2.40 $133,195 $133,195
3100 1.80 $32,400 $32,400
3200 2.95 $9,770 $9,770
3300 3.75 $168,750 $168,750
3400 Collateral 2.40 $19,558 $19,558
3500 Plan Development 2.40 $81,600 $81,600
3600 Assessment 2.40 $12,000 $12,000
3700 2.40 $62,400 $62,400
$0 $519,673 $519,673
50.00%$181,886 $181,886
100.00%$155,902 $155,902
0.00%
$337,788 $337,788
OTHER REVENUE (SUD):
4000 Other - (AB 109 Funds)$1,538,246 $1,538,246
4100 Other - (SAPT Funds)$200,000 $200,000
4200 Other - Client Fees $0
4300 Other - Client Insurance $0
$1,738,246 $1,738,246
OTHER REVENUE (MH):
5000 AB 109 Funds
5100 Mental Health Realignment Funds $300,000 $300,000
$300,000 $300,000
$2,087,193 $637,788 $2,724,981
OTHER REVENUE (MH) TOTALS
TOTAL PROGRAM REVENUE
Mental Health Services
(Individual/Family/GroupTherapy 55,498
Case Management 18,000
Rehabilitation 26,000
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL
Crisis Services 3,312
Medication Support
Estimated % of MAGI Federal Financial Participation Reimbursement
Units of Service
5,000
OTHER REVENUE TOTAL
Estimated % of Federal Financial Participation Reimbursement
Estimated Medi-Cal Billing Totals 194,959
8,149
34,000
45,000
Exhibit C
Page 4 of 7
FTE %Admin.
1 PSC B 700
2 Peer Support -PSC 50
3 MH Professional 100
4 Program Director 100
5 Nurse 100
6 Billing Clerk 50
7 Secretary 100
8 PSC C 100
9 Title 0
10 Title 0
11 Title 0
12 Title 0
SALARY TOTAL 1300 $0
30 OASDI
31 FICA/MEDICARE
32 SUI
PAYROLL TAX TOTAL $0
40 Retirement
41 Workers Compensation
42
Health Insurance
(medical, vision, life,
dental, PTO)
EMPLOYEE BENEFITS TOTAL $0
SALARY & BENEFITS GRAND TOTAL
1010 Rent/Lease Building
1011 Rent/Lease Equipment
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
PERSONNEL SALARIES:
$250,055 $250,055
$14,593 $14,593
$58,605 $58,605
Mental Health & Substance Use Disorder Services (AB109) - FSP Portion
Turning Point Of Central CA, Inc.
July 2016 - June 2017
Budget Categories -Total Proposed Budget
Line Item Description (Must
be itemized)Direct Total
$76,787
$43,966 $43,966
$22,152 $22,152
$32,212 $32,212
$49,086 $49,086
$76,787
$0
$0
$0
$0
$547,456 $547,456
PAYROLL TAXES:
$4,900 $4,900
$42,000 $42,000
$11,275 $11,275
$58,175 $58,175
EMPLOYEE BENEFITS:
$14,390 $14,390
$5,300 $5,300
$139,597 $139,597
$159,287 $159,287
$764,918
FACILITIES/EQUIPMENT EXPENSES:
$46,000
$1,500
$12,500
$9,500
$0
$69,500
Exhibit C
Page 5 of 7
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies - Therapeutic
1070 Program Supplies - Medical
1071 Transportation of Clients
1072 Staff Mileage/Vehicle Maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other – (Vehicle Lease & Vehicle Insurance)
1076 Other – (Client Activities)
1076 Other – (Depreciation)
1077 Other – (Recruitment)
OPERATING EXPENSES TOTAL
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional Liability Insurance
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)
1091 Translation Services
O/S Psychiatrist
1092 Medication Supports
SPECIAL EXPENSES TOTAL
1190 Computers & Software
1191 Furniture & Fixtures
1192 Other – (Identify)
1193 Other – (Identify)
FIXED ASSETS TOTAL
OPERATING EXPENSES:
$7,000
$0
$500
$1,000
$250
$0
$21,500
$1,000
$0
$1,800
$0
$0
$24,250
$0
$2,400
$1,500
$25,500
$1,580
$93,930
FINANCIAL SERVICES EXPENSES:
$4,000
$1,650
$0
$0
$3,800
$201,000
$0
$0
$204,800
$0
$0
$128,304
$39,000
$167,304
FIXED ASSETS:
$16,000
$0
$0
$0
$16,000
Exhibit C
Page 6 of 7
2000
2001
2002.1
2002.2
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers (SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
3000
3100 Case Management
3200 Crisis Services
3300 Medication Support
3400 Collateral
3500 Plan Development
3600 Assessment
3700 Rehabilitation
MEDI-CAL REVENUE TOTAL
4000 Other – (Client Rents)
4100 Other – (Identify)
4200 Other – (Identify)
4300 Other – (Identify)
OTHER REVENUE TOTAL
MHSA FUNDS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
Client Housing Support Expenses (SFC 70)$220,000
Client Housing Operating Expenses (SFC 71)$3,351
Clothing, Food & Hygiene (SFC 72)$10,000
Client Transportation & Support (SFC 72)$5,000
$500
$500
$0
$0
$0
$100
$239,451
TOTAL PROGRAM EXPENSES $1,555,903
MEDI-CAL REVENUE:Units of Service Rate $ AmountMental Health Services
(Individual/Family/Group Therapy)45328 $2.61 $118,306
28007 $2.02 $56,574
3731 $3.88 $14,476
36305 $4.82 $174,990
8466 $2.61 $22,096
3840 $2.61 $10,022
11047 $2.61 $28,833
220766 $2.61 $576,199
Estimated Medi-Cal Billing Totals 357490 $1,001,497
Estimated % of Federal Financial Participation Reimbursement 50.00%$150,594
Estimated % of Clients Served that will be Medi-Cal Eligible - SD 40.00%
Estimated % of Federal Financial Participation Reimbursement 100.00%$700,309
Estimated % of Clients Served that will be Medi-Cal Eligible - ACA 60.00%
$850,903
OTHER REVENUE:
$5,000
$0
$0
$0
$350,000
$5,000
MHSA FUNDS:
$700,000
TOTAL PROGRAM REVENUE $1,555,903
5000 Prevention & Early Intervention Funds
5100 Mental Health Services Act Community Services & Supports Funds
5100 AB109 Realignment Funds
$0
$350,000
Exhibit C
Page 7 of 7
Exhibit D
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor’s employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1.Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2.Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3.Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4.NOT engage in any activity in violation of the County’s Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5.Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6.Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7.Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit D
Page 2 of 3
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person
making a report. Any person engaging in any form of retaliation will be subject to disciplinary
or other appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit D
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
Exhibit E
Page 1 of 3
0374 d dbh
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified and
updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and mental
health status will be documented, for example: living situation, daily activities, and social
support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently documented
and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates, providers,
therapeutic interventions and responses, sources of clinical data, relevant family information and
relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as well as
illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A five axis diagnosis from the most current DSM, or a diagnosis from the most current ICD,
will be documented, consistent with the presenting problems, history mental status evaluation
and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in the
client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1. Client plans will:
Exhibit E
Page 2 of 3
0374 d dbh
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
* the person providing the service(s), or
* a person representing a team or program providing services, or
* a person representing the MHP providing services
* when the client plan is used to establish that the services are provided under the direction of an
approved category of staff, and if the below staff are not the approved category,
* a physician
* a licensed/ “waivered” psychologist
* a licensed/ “associate” social worker
* a licensed/ registered/marriage and family therapist or
* a registered nurse
• In addition,
* client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s participation
in and agreement with the plan. Examples of the documentation include, but are not limited to,
reference to the client’s participation and agreement in the body of the plan, client signature on
the plan, or a description of the client’s participation and agreement in progress notes.
* client signature on the plan will be used as the means by which the CONTRACTOR(S)
documents the participation of the client
* when the client’s signature is required on the client plan and the client refuses or is unavailable
for signature, the client plan will include a written explanation of the refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the individual
elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the service (or
electronic equivalent); the person’s professional degree, licensure or job title; and the relevant
identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
Exhibit E
Page 3 of 3
0374 d dbh
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
Mental Health Services
Medication Support Services
Crisis Intervention
Exhibit F
Page 1 of 1
Electronic Health Records Software Charges
CONTRACTOR understands that COUNTY utilizes Netsmart’s Avatar for its Electronic Health Records management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing Netsmart’s Avatar, as set forth below:
Description Effective Fee Per
User
NetSmart Avatar Monthly
Hosting Service
(per named user per month)
02/01/2016 $37.00
NetSmart Avatar Annual
Maintenance/License
(per named license per year)
02/01/2016 $249.95
OrderConnect License 1 (per
named license per year) 02/01/2016 $1,278.00
Reaching Recovery Upon first
use of tools $10.00
*Annual maintenance increases 3% each FY on July 1st
Should CONTRACTOR choose not to utilize Netsmart’s Avatar for its Electronic Health Records management, CONTRACTOR
will be responsible for obtaining its own system for Electronic Health Records management.
1 Includes 100 faxed pages per month. An additional fee of $0.20 per faxed page will apply, thereafter.
Exhibit G
Page 1 of 2
0374 f dbh
STATE MENTAL HEALTH REQUIREMENTS
1.CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2.PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3.CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4.NON-DISCRIMINATION
A.Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B.Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit G
Page 2 of 2
0374 f dbh
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
C.Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under this
Agreement were not used in connection with the alleged discrimination.
D.Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5.PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights
EXHIBIT H
Page 1 of 2
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable, and any
required certification.
2. The space owned, leased or operated by the provider and used for services or staff meets
local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any site
owned, leased, or operated by the provider and used for services or staff to ensure the safety
and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes: personnel
policies and procedures, general operating procedures, service delivery policies, and
procedures for reporting unusual occurrences relating to health and safety issues.
6.The organizational provider maintains client records in a manner that meets applicable state
and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as described in
Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8.The organizational provider has written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10.For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A.All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B.Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C.All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F
and refrigerated drugs at 36-46 degrees F.
EXHIBIT H
Page 2 of 2
D.Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E.Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F.A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G.Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation,
the provider must have a written description of the day treatment intensive and/or day
treatment rehabilitation program that complies with State Department of Health Care
Service’s day treatment requirements. The COUNTY shall review the provider’s written
program description for compliance with the State Department of Health Care Service’s
day treatment requirements.
12. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may also
conduct additional certification reviews when:
•The provider makes major staffing changes.
•The provider makes organizational and/or corporate structure changes (example: conversion
from a non-profit status).
•The provider adds day treatment or medication support services when medications shall be
administered or dispensed from the provider site.
•There are significant changes in the physical plant of the provider site (some physical plant
changes could require a new fire clearance).
•There is change of ownership or location.
•There are complaints against the provider.
•There are unusual events, accidents, or injuries requiring medical treatment for clients, staff or
members of the community.
Exhibit I
Page 1 of 2
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
•How to access specialty mental health services
•How to file a grievance about services
•How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers’ offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit I
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process – the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider’s claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints – if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
EXHIBIT J
Page 1 of 1
INTENSIVE/RESIDENTIAL SUBSTANCE USE DISORDER
SERVICES
Line item #2000, Intensive Substance Use Disorder Services, shall be defined
as any of the following options:
Medication-Assisted Treatment (MAT) at a Licensed Narcotic Treatment
Program
Residential Detoxification/Stabilization
Residential Perinatal
Residential for Males/Females
Monolingual Male Residential Services
These services may be performed by Turning Point, or they may be
outsourced to any contracted County provider at the County's contracted
rates. Turning Point must have a signed MOU in place with the County
contracted provider and a copy of all MOU's approved by the County Alcohol
and Drug Program Administrator must be on file with Fresno County
Substance Abuse Services. Maximum compensation for these services is Two
Hundred Thousand and No/100 Dollars ($200,000.00).
Line Item #2001 Residential Services, shall be defined as
Residential services for Males/Females
Residential Perinatal
•Residential Detoxification/Stabilization,
Sober Living Environment
Monolingual Male Residential Services
These services may be performed by Turning Point or they may be
outsourced to any contracted County provider at the County 's contracted
rates. Turning Point must have a signed MOU in place with the County
contracted provider and a copy of all MOU's approved by the County Alcohol
and Drug Program Administrator must be on file with Fresno County
Substance Abuse Services. Maximum compensation for these services is
Eight Hundred Forty-Eight Thousand Six Hundred Twenty-Five and No/100
Dollars ($848,625.00)
Exhibit K
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I.Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II.Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A.Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B.Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C.Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III.A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B.Type of entity:❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C.If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D.Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. .......................................................................................................... ❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit K
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V.Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI.Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B.If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit L
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2.The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4.The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6.Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit L
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c)(d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit M
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the transaction; and
b.The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit M
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure (Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5)Authorized Signature
Signature: Date:
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1.Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2.Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3.Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4.Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5.Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6.Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7.Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8.Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9.Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization’s planning and operations.
10.Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11.Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12.Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13.Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14.Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15.Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
— Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization’s ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach, M. C., Cooper, L. A., Robinson, K. A., Price, E. G., Gary, T. L., Jenckes, M. W., Powe, N.R. (2004). Strategies for improving minority healthcare quality. (AHRQ
Publication No. 04-E008-02). Retrieved from the Agency of Healthcare Research and Quality website:
http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf
Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. (Commonwealth Fund Publication No. 962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist, T. A., Gaskin, D. J., & Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities. (2011). National stakeholder strategy for achieving health equity. Retrieved from U.S. Department of Health and
Human Services, Office of Minority Health website: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
U.S. Department of Health and Human Services, Office of Minority Health (2011). National Partnership for Action to End Health Disparities. Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization. (2012). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
Exhibit O
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
•The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
•When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
•Incident Report should be sent to:
DBH Program Supervisor
Exhibit O
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1.Background information of the incident:
2.Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3.Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4.Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
Exhibit P
Page 1 of 1
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section (§) 11165.9.
For purposes of the undersigned’s child abuse reporting requirements, “child
abuse or neglect” includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.C §11166.) The child abuse report shall be made to any
police department or sheriff’s department (not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services’ 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a “reasonable suspicion” means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
__________________________________ ________________________
SIGNATURE DATE
0980fadx