HomeMy WebLinkAboutP-21-043 Tarzana Treatment Centers.pdf333 W. Pontiac Way, Clovis, CA 93612 / (559) 600-7110
* The County of Fresno is an Equal Employment Opportunity Employer *
County of Fresno
INTERNAL SERVICES DEPARTMENT
Facilities • Fleet • Graphics • Purchasing • Security • Technology
PROCUREMENT AGREEMENT
Agreement Number P-21-043
February 16, 2021
Tarzana Treatment Centers, Inc.
18646 Oxnard St.
Tarzana, CA 91356
The County of Fresno (County) hereby contracts with Tarzana Treatment Centers, Inc. (Contractor) to
provide Residential Substance Use Disorder (SUD) services for adolescents age 12-17 in accordance with
the text of this agreement and Attachment “A” by this reference made a part hereof.
TERM: This Agreement shall become effective February 15, 2021 and shall remain in effect through
February 14, 2024.
EXTENSION: This Agreement may be extended for two (2) additional one (1) year periods by the mutual
written consent of all parties.
MINIMUM ORDERS: Unless stated otherwise there shall be no minimum order quantity. The County
reserves the right to increase or decrease orders or quantities.
CONTRACTOR'S SERVICES: Contractor shall perform the services as described in Attachment “A”
attached, at the rates set forth in Attachment “A”.
ORDERS: Orders will be placed on an as-needed basis by Department of Behavioral Health under this
contract.
PRICES: Prices shall be firm for the contract period. Any pricing changes which may take place during the
life of the contract must be submitted in writing to the County of Fresno Purchasing Manager and received no
less than thirty (30) days prior to becoming effective.
MAXIMUM: In no event shall services performed and/or fees paid under this Agreement be in excess of One
Hundred Fifty Thousand Dollars ($150,000.00).
ADDITIONAL ITEMS: The County reserves the right to negotiate additional items to this Agreement as
deemed necessary. Such additions shall be made in writing and signed by both parties.
DEFAULT: In case of default by Contractor, the County may procure the articles/services from another
source and may recover the loss occasioned thereby from any unpaid balance due the Contractor or by any
other legal means available to the County. The prices paid by County shall be considered the prevailing
market price at the time such purchase is made. Inspection of deliveries or offers for delivery, which do not
meet specifications, will be at the expense of Contractor.
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INVOICING: An itemized invoice shall be mailed to requesting County department in accordance with
invoicing instructions included in each order referencing this Agreement. The Agreement number must
appear on all shipping documents and invoices. Invoice terms shall be Net 45 Days.
INVOICE TERMS: Net forty-five (45) days from the receipt of invoice.
TERMINATION: The County reserves the right to immediately terminate this Agreement upon written notice
to the Contractor. In the event of such termination, the Contractor shall be paid for satisfactory services or
supplies provided to the date of termination.
LAWS AND REGULATIONS: The Contractor shall comply with all laws, rules and regulations whether they
be Federal, State or municipal, which may be applicable to Contractor's business, equipment and personnel
engaged in service covered by this Agreement.
AUDITS AND RETENTION: Terms and conditions set forth in the agreement associated with the purchased
goods are incorporated herein by reference. In addition, the Contractor shall maintain in good and legible
condition all books, documents, papers, data files and other records related to its performance under this
contract. Such records shall be complete and available to Fresno County, the State of California, the federal
government or their duly authorized representatives for the purpose of audit, examination, or copying during
the term of the contract and for a period of at least three years following the County's final payment under the
contract or until conclusion of any pending matter (e.g., litigation or audit), whichever is later. Such records
must be retained in the manner described above until all pending matters are closed.
LIABILITY: The Contractor agrees to:
Pay all claims for damage to property in any manner arising from Contractor's operations under this
Agreement.
Indemnify, save and hold harmless, and at County's request defend the County, its officers, agents and
employees from any and all claims for damage or other liability, including costs, expenses (including
attorney’s fees and costs), causes of action, claims or judgments resulting out of or in any way connected
with Contractor's performance or failure to perform by Contractor, its agents, officers or employees under this
Agreement, and from any and all costs and expenses (including attorney’s fees and costs), damages,
liabilities, claims, and losses occurring or resulting to any 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.
INSURANCE: Without limiting the 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 or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A. Commercial General Liability: Commercial General Liability Insurance with limits of not less than Two
Million Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars
($4,000,000.00). This policy shall be issued on a per occurrence basis. County may require specific
coverage including completed operations, product liability, contractual liability, Explosion-Collapse-
Underground, fire legal liability or any other liability insurance deemed necessary because of the nature
of the contract.
B. Automobile Liability: Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
C. Professional Liability: If Contractor employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D. Worker's Compensation: A policy of Worker's Compensation insurance as may be required by the
California Labor Code.
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Additional Requirements Relating to Insurance:
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 County, its officers,
agents and employees shall be excess only and not contributing with insurance provided under 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.
Contractor hereby waives its right to recover from County, its officers, agents, and employees any amounts
paid by the policy of worker’s compensation insurance required by this Agreement. Contractor is solely
responsible to obtain any endorsement to such policy that may be necessary to accomplish such waiver of
subrogation, but Contractor’s waiver of subrogation under this paragraph is effective whether or not
Contractor obtains such an endorsement.
Within Thirty (30) days from the date Contractor signs and executes this Agreement, Contractor shall provide
certificates of insurance and endorsement as stated above for all of the foregoing policies, as required
herein, to the County of Fresno, Department of Behavioral Health – Contracts, 3151 N. Millbrook Ave.,
Fresno, CA 93703, stating that such insurance coverage 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 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, the 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 purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
COMING ON COUNTY PROPERTY TO DO WORK: Contractor agrees to provide maintain and furnish
proof of Comprehensive General Liability Insurance with limits of not less than $500,000 per occurrence.
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 the 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 the subject thereof.
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, including compliance with Social Security, withholding, and all other regulations governing such
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matters. It is acknowledged that during the term of this Agreement, Contractor may be providing services to
others unrelated to the County or to this Agreement.
NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
duties under this Agreement without the written consent of the other party.
AMENDMENTS: This Agreement constitutes the entire Agreement between the Contractor and the County
with respect to the subject matter hereof and supersedes all previous negotiations, proposals, commitments,
writings, advertisements, publications, Request for Proposals, Bids and understandings of any nature
whatsoever unless expressly included in this Agreement. This Agreement supersedes any and all terms set
forth in Contractor's invoice. This Agreement may be amended only by written addendum signed by both
parties.
INCONSISTENCIES: In the event of any inconsistency in interpreting the documents which constitute this
Agreement, the inconsistency shall be resolved by giving precedence in the following order of priority: (1) the
text of this Agreement (excluding Attachment "A") and (2) Attachment "A".
GOVERNING LAWS: This Agreement shall be construed, interpreted and enforced under the laws of the
State of California. Venue for any action shall only be in County of Fresno.
ELECTRONIC SIGNATURES: The parties agree that this Agreement may be executed by electronic
signature as provided in this section.
A. An “electronic signature” means any symbol or process intended by an individual signing this Agreement
to represent their signature, including but not limited to (1) a digital signature; (2) a faxed version of an
original handwritten signature; or (3) an electronically scanned and transmitted (for example by PDF
document) of a handwritten signature.
B. Each electronic signature affixed or attached to this Agreement (1) is deemed equivalent to a valid
original handwritten signature of the person signing this Agreement for all purposes, including but not
limited to evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and
effect as the valid original handwritten signature of that person.
C. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in
the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section
1633.1).
D. Each party using a digital signature represents that it has undertaken and satisfied the requirements of
Government Code section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other
party may rely upon that representation.
This Agreement is not conditioned upon the parties conducting the transactions under it by electronic means
and either party may sign this Agreement with an original handwritten signature.
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Please acknowledge your acceptance by returning all pages of this Agreement to my office via email or
USPS.
Please refer any inquiries in this matter to Bryan Hernandez, Purchasing Analyst, at 559 600-7117 or
bhernandez@fresnocountyca.gov.
FOR THE COUNTY OF FRESNO
Gary E. Cornuelle
Purchasing Manager
333 W. Pontiac Way
Clovis, CA 93612
GEC:BH
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CONTRACTOR TO COMPLETE:
Company:
Type of Entity:
Individual Limited Liability Company
Sole Proprietorship Limited Liability Partnership
Corporation General Partnership
Address City State Zip
TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS
Print Name &
Title:
Print Name & Title:
Signature:
Signature:
ACCOUNTING USE ONLY
ORG No.: 56302081
Account No.: 7295
Requisition No.: 5632110028
(01/2020)
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ATTACHMENT "A"
Youth Substance Use Disorder Residential Treatment
Scope of Work
I. Overview
The County of Fresno on behalf of the Department of Behavioral Health Contracted Services
Division-Substance Use Disorder Services (DBH-SUD Services) is contracting with Tarzana Treatment
Centers, Inc. (TTC) to provide the non-hospital based residential SUD treatment services for
adolescents ages 12-17, congruent with the Drug Medi-Cal Organized Delivery System (DMC-ODS)
requirements. The DMC-ODS Pilot program, authorized under California’s Section 1115(a) Medicaid
Bridge to Reform Demonstration Project, seeks to: (a) test a new paradigm for the organized
delivery of health care services for Medi-Cal eligible beneficiaries with a substance use disorder and
(b) demonstrate how an organized SUD system of care increases the success of DMC beneficiaries
while decreasing other system health care costs. Under DMC-ODS, counties are required to provide
the full continuum of care for SUD services including residential SUD treatment services for
adolescents ages 12-17.
II. Background
Currently, adolescent SUD Residential Treatment programs are not available in Fresno County. This
is a service that is mandated by the Department of Health Care Services (DHCS). Fresno County DBH
previously issued a RFP and RFSQ that resulted in no vendor being awarded. Fresno County reached
out to an existing vendor in Los Angeles County, Tarzana Treatment Centers, Inc. which agreed to
provide this service for Fresno County DBH. This is a service that Fresno County is mandated to
provide and utilizing Tarzana will allow Fresno County to be in compliance with DHCS requirements.
III. Contract Start Date/Term
Effective upon execution through the term stated within the description of this agreement.
IV. Target Population
Adolescents ages 12-17 who meet medical necessity and Adolescent American Society of Addiction
Medicine (ASAM) criteria for residential levels of care 3.1 and 3.5.
• DMC - ODS Program Eligibility Criteria
o In order to receive services through the DMC-ODS, clients must be Fresno County
beneficiaries and meet the following medical necessity criteria:
Have at least one diagnosis from the Diagnostic and Statistical Manual of
Mental Disorders (DSM) 5 for Substance-Related and Addictive Disorders, with
the exception of Tobacco-Related Disorders and Non-Substance-Related
Disorders, OR
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Be assessed to be at risk for developing substance use disorder (for youth and
young adults under 21). Youth or young adults may be determined to be “at-
risk” if they meet the following criteria:
• The substance use does NOT meet the minimum criteria for a SUD
from the DSM 5; and they are determined to be at-risk of developing
a SUD based on reports of experimental or early-phase substance
use, associated biopsychosocial risk factors, and information
gathered from the full Fresno County SUD Adolescent assessment
and the Fresno County SUD Screening Tool
• Meet ASAM criteria and medical necessity for services.
Clients under age 21 are eligible to receive Medicaid services pursuant to the Early Periodic Screening,
Diagnostic and Treatment (EPSDT) mandate. Nothing in the DMC-ODS overrides EPSDT requirements
V. Location of Services
Tarzana Treatment Centers, Inc.
44447 North 10th Street West, Building C
Tarzana, CA 93534
VI. Description of Services
Reporting Requirements
The following reporting requirements must be met. Where possible Fresno County will accept reports
that are provided to Los Angeles County that satisfy DMC ODS reporting requirements
• Monthly Status Reports
o From Provider Report document attached hereto as Exhibit A
Includes information regarding language line usage, participation in DMC program,
staff training, and clinical changes such as promotions and terminations.
• Drug and Alcohol Treatment Access Report (DATAR)
o DATAR reports shall be submitted in an electronic format provided by the State and due
no later than five (5) days after the preceding month
Provides capacity and utilization information on publicly funded SUD programs
• Access Form
o Complete form at the time that an individual requests SUD treatment. Instructions are
posted at Fresno County DBH’s SUD Services Provider Page. If Tarzana staff cannot
complete the form, TTC staff will provide the necessary information to Fresno county so
that the information is captured and recorded.
Collects timeliness data
• CalOMS
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o Provider must submit CalOMS treatment admission, discharge, annual update, and
“provider activity report” record in an electronic format through DBH’s information
system, and on a schedule as determined by DBH 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 DBH’s CalOMS system
within twenty-four (24) hours of occurrence. If Tarzana cannot enter the information
directly into DBH’s CalOMS system, the information will be provided to Fresno County
DBH so that the information can be captured and recorded.
o Fresno County will accept paper version currently in use by Tarzana. Tarzana will provide a
copy of the paper form they currently use.
Collects data on SUD treatment services
• ASAM Level of Care (LOC)
o Submit ASAM LOC data in an electronic format through DBH’s information system every
time an ASAM LOC is determined. This can occur during screening, assessment, and re-
assessment. This requirement complies with State mandates and is provided in a form
that is issued by DHCS.
Tracks level of care determined at screening, assessment, and reassessment and
actual LOC referred to.
• Americans with Disabilities (ADA) Self-Assessment
o This survey is required annually, upon request by DBH. Provider 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
Used to monitor compliance with legislation that prohibits discrimination against
people with disabilities.
• Culturally and Linguistically Appropriate Services (CLAS)
o This report is required annually, upon request by DBH. Providers shall complete an agency
CLAS survey in a format determined by DBH and shall submit a CLAS Self-Assessment,
including an Implementation Plan
Used to monitor adherence to the National CLAS Standards which are intended to
advance health equity, improve quality, and help eliminate health care disparities.
• Risk Assessment
o This report is required annually, upon request by DBH. Providers shall submit a Risk
Assessment on a form and in a format to be provided by DBH. The Assessment must be
submitted to DBH in hard copy as well as electronically by the due date set by DBH
Mandated questionnaire used to determine a provider's risk category
classification
• Network Adequacy Certification Tool (NACT)
o Provider shall submit the NACT as requested by DBH
Used to monitor network adequacy standards set by DHCS
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• Ineligible Persons Screening Report
o Provider shall submit the Ineligible Person Screening Report by the 30th of every month
on the Ineligible Persons Screening Monthly Report Template
Checks for staff eligibility to provide services based on sanctions or exclusion
status from state and federally funded programs
• Cost Reports
o On an annual basis for each fiscal year ending June 30th providers shall submit a complete
and accurate detailed cost report(s). Cost reports must be submitted to DBH 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 and detailed
electronic (e.g. Excel) schedules demonstrating how costs were allocated both within
programs, if provider has multiple funding sources (e.g. DMC and SAPT), and between
programs, if the provider provides multiple SUD modalities (e.g. residential, detox, sober
living, outpatient, etc.).
Identifies costs and charges related to program.
Tarzana Treatment Centers, Inc. will meet all requirements of the Substance Abuse Prevention and
Treatment (SAPT) Specific Requirements, attached hereto as Exhibit B.
Tarzana Treatment Centers, Inc. will meet all requirements of the Drug Medi-Cal Intergovernmental
Agreement Requirements, attached hereto as Exhibit C.
SERVICE COMPONENTS
Treatment will include individual, group, case management, recovery services and family components.
Services should vary based on medical necessity and individual needs. Services shall be culturally
appropriate and include beneficiary participation.
• The adolescent residential treatment program shall include, but not be limited to, the
following components:
o Intake
o Individual and Group Counseling
o Patient Education
o Family Therapy
o Safeguarding Medications: Facilities will store all resident medication and facility staff
members may assist with resident’s self-administration of medication.
o Collateral Services
o Crisis Intervention Services
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o Treatment Planning
o Case Management and Care Coordination
o Recovery Services
o Transportation Services
o Discharge Services
o Structured environment
o Room and board
o Leisure time activities, exercise program
o Self-help groups
• Comply with DHCS Youth Treatment Guidelines and integrate youth development approaches
into treatment and family interventions and support systems.
• Tarzana Treatment Centers, Inc. shall provide structured recovery related activities which shall
include therapeutic and diversionary recreation.
• Provide educational and vocational activities in alignment with Youth Treatment Guidelines.
• Each beneficiary’s family or guardian will be contacted at least one (1) time per week either in
person, by phone or by email to update them on beneficiary’s progress.
• Provide, on-site or by referral, timely linkages to appropriate medication assisted treatment;
specialty and ancillary services such as mental health services, vocational and educational
resources, social services, HIV/AIDS and Hepatitis C virus (HCV) testing and treatment; and
primary care services in order to provide an integrated, coordinated, and comprehensive
treatment experience
• Intake/Assessment/Reassessment
o Intake will be completed within ten (10) business days from the date of first contact
with Tarzana Treatment Centers, Inc.
o Assessment is to be completed and signed within three (3) calendar days of the
beneficiary’s admission. Treatment plan is to be completed within ten (10) days of
beneficiary’s admission.
o Tarzana Treatment Centers, Inc. will be required to complete reassessment at a
minimum within 30 days unless medical necessity warrants more frequent
reassessments as documented by the individualized treatment plan.
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• SUD Treatment Authorization Requests
o Tarzana Treatment Centers, Inc. shall contact county’s Administrative Service
Organization (ASO) for prior authorization to begin services. If the treatment
authorization request is denied, TTC shall work with beneficiary to refer him/her to a
provider offering services with the appropriate level of care. These requests are
currently conducted by phone and can take approximately 30 mins for initial
assessment and approximately 20 minutes for reassessments. Authorization requests
can be made by any staff member involved in the beneficiary’s care and familiar with
the case. This process is subject to change in the future.
o In cases of denied admissions by our ASO (Beacon Health Options), Fresno County will
work with current provider network to refer person to the appropriate level of care.
Fresno County will ask that Tarzana help facilitate this process should it occur.
• Evidence Based Practices
o Tarzana Treatment Centers, Inc. is required to utilize the ASAM Criteria and
Motivation Interviewing (MI) and at least two of the following evidence-based
practices (EBP’s): Psycho-education; Trauma Informed Treatment; Cognitive
Behavioral Therapy; Relapse Prevention.
• Movement Through Levels of Care/Case Management
o Tarzana Treatment Centers, Inc. is responsible to ensure that transitions through
appropriate levels of care are made as necessary and within allowable timeframes.
Tarzana Treatment Centers, Inc. is required to facilitate care coordination and
effective communication (provider-to-provider, provider-to-County) to coordinate
timely and seamless transitions between levels of care. Additionally, Tarzana
Treatment Centers, Inc. is required to facilitate an alternate referral for beneficiaries
in the event that the provider cannot provide a timely intake appointment. Case
management for the care coordination activities above and for assisting beneficiaries
and families to navigate needed supports is also an essential function. Case managers
will assist beneficiaries to help access all needed ancillary services including
coordination of SUD care with other services.
• Care Coordination
o Tarzana Treatment Centers, Inc. shall screen for both mental health disorders and
physical health concerns. One of the goals for DMC-ODS is to better integrate SUD
treatment into healthcare and social service systems, and vice versa. Greater
organization and coordination would enable beneficiaries to more effectively access
the full continuum of SUD services and levels of care available.
o Tarzana Treatment Centers, Inc. shall provide care coordination to ensure that the
needs of the beneficiary are addressed. Care coordination services will be individual-
centered. The goal of the services will be to ensure that while there may be multiple
health and social service providers involved in an beneficiary’s care, the services being
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provided are all organized and coordinated such that involved entities are aware of all
the beneficiary’s needs and preferences and are performing activities that collectively
contribute to the shared goal of providing comprehensive, appropriate, and effective
care to the beneficiary.
o Tarzana Treatment Centers shall provide and/or ensure linkages to outreach, personal
services coordination, food, clothing, housing, daily living skills, mental and physical
health treatment, supported education, transportation, advocacy, family and peer
support.
The resulting program, services, and practices must align with DBH’s vision, mission, and
Guiding Principles of Care Delivery, attached hereto as Exhibit D. DBH’s principles of care
delivery define and guide a system that strives for excellence in the provision of behavioral
health services where the values of wellness, resiliency, and recovery are central to the
development of programs, services, and workforce. The principles provide the clinical
framework that influences decision-making on all aspects of care delivery including program
design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
General Requirements
• Residential facility must be licensed by the California Department of Social Services, a copy of
which must be provided to Fresno County DBH. The facility must have an ASAM designation
from DHCS for the levels of care provided.
• Services must be performed within applicable regulations, standards and contracts, including
but not limited to:
o CCR Title 9;
o CCR Title 22;
o 42 CFR Part 438 Managed Care;
o AOD Certification Standards;
o Early, Periodic, Screening, Diagnosis and Treatment (EPSDT);
o 2 CFR Part 225 “Cost Principles for State, Local and Indian Tribal Governments”;
o 2 CFR Part 230 “Cost Principles for Non-Profit Organizations”;
o Americans with Disabilities Act (ADA) 42 USC 12101 and Section 504 of the
Rehabilitation Act;
o DHCS Mental Health Substance Use Disorder Services (MHSUDS) Notices;
o Fresno County SUD Bulletins;
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o Drug Medi-Cal Organized Delivery System Special Terms and Conditions and
Conditions https://www.dhcs.ca.gov/provgovpart/Pages/Special-Terms-and-
Conditions.aspx
o The Fresno County Department of Behavioral Health DMC-ODS Implementation Plan
https://www.co.fresno.ca.us/home/showdocument?id=20850
o The State-County Intergovernmental Agreement (IA)
DMC – http://www.co.fresno.ca.us/home/showdocument?id=20633
SAPT - https://www.co.fresno.ca.us/home/showdocument?id=25885
o Youth Treatment Guidelines
http://www.dhcs.ca.gov/beneficiarys/Documents/Youth_Treatment_Guidelines.pdf)
o Fresno County Substance Use Disorder Provider Manual
https://www.co.fresno.ca.us/home/showdocument?id=32818
• Be flexible in meeting unique participant needs by including equal access to those with
disabilities and by providing gender-specific and culturally sensitive services that adhere to
the National Standards on Culturally and Linguistically Appropriate Services (CLAS). (URL:
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53)
A CLAS plan stating how providers will address the 15 national CLAS standards, attached here
as Exhibit E, shall be submitted to the County within 30 days of contract execution.
• Any and all documentation as required by Title 9 and any other applicable regulations and
requirements must be included in each beneficiary file, including parental consent forms.
Tarzana will also be held to CCR Title 22 regulations.
• Incorporate evidence-based, outcome-informed treatment methods.
• Demonstrate an ability to work in cooperation with other agencies to provide linkages to
beneficiary and family supportive services.
• Be prepared to meet quality assurance standards.
• Must have protocols in place for Emergency Response situations.
• TTC will be responsible for release of information requests for the program and shall adhere
to applicable federal and state regulations and comply with 42 CFR Part 2.
• Comply with State and County data collection and reporting requirements:
o TTC shall maintain a daily census of all participants served, and all statistical
information required by Fresno County, including but not limited to date participant
entered into treatment, date of discharge, and have a computer system compatible
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Tarzana Treatment Centers, Inc.
February 12, 2021
with the County’s billing system. Applicant will submit all information and data
required by the State, including but not limited to CalOMS Treatment submissions,
DATAR, and cost reports for each fiscal year. Applicant shall have the ability to send
and receive encrypted electronic communications for transfer of PHI.
o Tarzana Treatment Centers, Inc. shall log all grievances, appeals and complaints
according to the state and federal regulations and comply with DBH’s protocols.
• Attest to not being under investigation for Medi-Cal fraud and must sign a confidentiality
release to allow County to communicate with DHCS regarding open fraud investigations.
• Accept additional specific award conditions as needed in accordance with 2 CFR 200.207 (b)
and (c). The special conditions may be imposed under the following circumstances: (1) Based
on the criteria set forth in section 200.205; (2) When an applicant or recipient has a history of
failure to comply with the general or specific terms and conditions of an award; (3) When an
applicant or recipient fails to meet expected performance goals as described in 2 CFR 200.210;
or (4) When an applicant or recipient is not otherwise responsible.
• Protect the privacy and provide for the security of Protected Health Information in compliance
with the Health Insurance Portability and Accountability Act (HIPAA), the Health Information
Technology for Economic and Clinical Act, Public Law 111-005 (HITECH), regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations), 42 Code of Federal Regulations (CFR) Part II, 45 CFR and other applicable laws.
• TTC shall be fully knowledgeable of all Medi-Cal regulations, policies, and procedures as they
pertain to the proposed program and services described in this RFP. Agency shall be fully
knowledgeable of all other applicable state and federal regulations pertaining to the proposed
program and services described herein. Agency shall be fully knowledgeable regarding Drug
Medi-Cal and private insurance billing.
• Obtain a fire clearance for all residential facilities
• Policies and procedures must be developed and implemented for all the following:
o MAT Services*
including offering or facilitating access to MAT services, and, may not exclude
beneficiaries concurrently enrolled in MAT
o Safety and Effectiveness of Medication Practices
o Case Management
o Coordination with Physical and Mental Health
o Continuous Quality Improvement/Management
o Quality Assurance
o Grievances
o Compliance/Fraud, Waste and Abuse
o Continuity of Care/Care Coordination
o Fidelity
o Field based and/or Telehealth (if offered)
o CLAS
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Tarzana Treatment Centers, Inc.
February 12, 2021
o Interim Services
o Personnel (in accordance with the DHCS “Minimum Quality Drug Treatment Standards”)
– see Exhibit F
• A Financial Risk Assessment must be completed prior to the program start date using Fresno
County DBH-SUD’s tool or a tool approved by Fresno County DBH.
• County DBH will conduct site reviews on at least an annual basis. In the event that services are
deemed to be recoupable as a result of these site reviews, recoupment will be made at the
contractual rate.
VII. Staffing
TTC shall determine staffing levels needed to implement and maintain the program; however, the
agency must comply with CCR Title 9 regulations and any other federal, state, or local requirements as
applied to staff qualifications.
• TTC shall provide appropriate numbers of trained staff dedicated to the program.
• At least thirty percent (30%) of staff providing counseling services shall be certified or licensed
under California Code of Regulations (CCR) Title 9 §13010. All other counseling staff shall be
registered to obtain certification with a certifying organization as required by Title 9.
• Professional staff must be licensed, registered, certified, or recognized under California State
scope of practice statutes. Professional staff shall provide services within their individual
scope of practice and receive supervision required under their scope of practice laws. Licensed
Practitioner of the Healing Arts includes: Physician, Nurse Practitioners, Physician Assistants,
Registered Nurses, Registered Pharmacists, Licensed Clinical Psychologist (LCP), Licensed
Clinical Social Worker (LCSW), Licensed Professional Clinical Counselor (LPCC), and Licensed
marriage and Family Therapist (LMFT) and licensed-eligible practitioners working under the
supervision of licensed clinicians.
• Staff shall meet all requirements for certification for individuals providing counseling services
in alcohol and other drug (AOD) recovery and treatment programs per the California Code of
Regulations (CCR), Title 9, Division 4, Chapter 8 and the Mental Health and Substance Use
Disorder Services (MHSUDS) Information Notice 16-058. All non-licensed or non-certified
individuals providing counseling services must be registered to obtain certification as an
alcohol and other drug counselor by one of the DHCS-approved certifying organizations
(Health and Safety Code, Section 11833).
• Non-professional staff shall receive appropriate on-site orientation and training prior to
performing assigned duties. Non-professional staff will be supervised by professional and/or
administrative staff.
• All staff serving or interacting with adolescents must submit to a Live-Scan criminal background
check and provider shall document clearance in personnel files.
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Tarzana Treatment Centers, Inc.
February 12, 2021
• All staff providing services to beneficiaries must attend required trainings annually as indicated
on DBH-SUD’s Annual Provider Training Plan attached hereto as Exhibit G. Trainings must be
documented on annual staff training plans and training certificates must be made available
upon request by DBH. Where possible, Fresno County DBH will accept trainings required by Los
Angeles County.
• All facility staff, who provide individual care or perform administrative functions, must meet the
requirements of the Behavioral Health Compliance Program. This includes the screening for
excluded persons and entities by accessing or querying the applicable licensing board(s), the
National Practitioner Data Bank (NPDB), Office of Inspector General’s List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended and
Ineligible List prior to hire and monthly thereafter.
• All licensed/registered/waivered staff must complete a Fresno County Behavioral Health System
of Care Organizational Provider Credentialing application and be credentialed by the Fresno
County Behavioral Health System of Care Credentialing Committee and comply with all
mandatory initial and ongoing training requirements including General Compliance and
Documentation and Billing. The credentialing application can be found on DBH’s Managed Care
Division webpage: https://www.co.fresno.ca.us/departments/behavioral-health/managed-
care/become-a-contract-provider. If possible, Fresno County may accept Los Angeles County’s
credentialing to fulfill this requirement.
• Professional and counseling staff shall be trained in the ASAM criteria.
VIII. Hours of Operation
TTC will be required to provide services twenty-four (24) hours per day, seven (7) days per week
throughout the year.
IX. Average Client Length of Stay
Adolescents between the ages of 12-17 may receive up to two 30-day non continuous stays per year.
Adolescents may receive one 30-day extension if medically necessary. Adolescents are limited to one
extension per 365-day period.
Under EPSDT, adolescents may receive a longer stay based on medically necessity.
If determined to be medically necessary, perinatal beneficiaries may receive a longer length of stay than
what is described above. Typically, this is from the time they become pregnant until 60 days
postpartum.
X. Outcomes/Reporting
The Department of Behavioral Health is dedicated to supporting the wellness of beneficiaries, families
and communities in Fresno County who are affected by, or at the risk of, mental illness and/or
PROCUREMENT AGREEMENT NUMBER: P-21-043 Attachment Page 12 of 13
Tarzana Treatment Centers, Inc.
February 12, 2021
substance use disorders through the cultivation of strengths toward promoting recovery in the least
restrictive environment.
TTC shall provide either existing or sample measurable outcomes reports. The selected Tarzana
Treatment Centers, Inc. will be required to submit measurable outcomes on an annual basis, as
identified in the Departments Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes
Measures, attached hereto as Exhibit H. Performance outcomes measures must be approved by the
Department and satisfy all State and local mandates. The Department will provide technical assistance
and support in defining measurable outcomes. All performance indicators will reflect the four
domains identified by the Commission Accreditation of Rehabilitation Facilities (CARF). The domains
are Effectiveness, Efficiency, Access, and Satisfaction. These are defined and listed below.
The Fresno County Department of Behavioral Health collects data about the characteristics of the
persons served and measures service delivery performance indicators in each of the following CARF
DOMAINS: At minimum, one performance indicator will be identified for each of the four CARF
domains listed below.
• Effectiveness: A performance dimension that assesses the degree to which an intervention or
services have achieved the desired outcome/result/quality of care through measuring change
over time. The results achieved and outcomes observed are for persons served.
o Examples of indicators include: Percentage of beneficiaries who transition to lower
level of care, or plan of care goal attainment, average length of stay.
• Efficiency: Relationship between results and resources used, such as time, money, and staff.
The demonstration of the relationship between results and the resources used to achieve
them. A performance dimension addressing the relationship between the outputs/results and
the resources used to deliver the service.
o Examples of indicators include: Direct staff cost per person served, amount of time it
takes to achieve an outcome, gain in scores per days of service, service hours per
person achieving some positive outcome, total budget (actual cost) per person served,
length of stay and direct service hours of clinical and medical staff.
• Access: Organizations’ capacity to provide services of those who desire or need services.
Barriers or lack thereof for persons obtaining services. The ability of beneficiaries to receive
the right service at the right time. A performance dimension addressing the degree to which a
person needing services is able to access those services.
o Examples of indicators include: Timeliness of program entry (From 1st request for
service to 1st service), ongoing wait times/wait lists, minimizing barriers to getting
services, and no-show/cancellation rates.
• Satisfaction: Satisfaction Measures are usually orientated towards consumers, family, staff,
and stakeholders. The degree to which beneficiaries, the County and other stakeholders are
satisfied with services. A performance dimension that describes reports or ratings from
persons served about services received from an organization.
o Examples of indicators include: opinion of persons served or other key stakeholders in
PROCUREMENT AGREEMENT NUMBER: P-21-043 Attachment Page 13 of 13
Tarzana Treatment Centers, Inc.
February 12, 2021
regard to access, process, or outcome of services received, Consumer and/or
Treatment Perception Survey.
• Final selected measures will be agreed upon in contract negotiations along with liquidated
damages. Tarzana Treatment Centers, Inc. must address each of the categories referenced
above and may additionally propose other performance and outcome measures that are
deemed best to evaluate the services provided to beneficiaries and/or to evaluate overall
program performance. DBH may adjust the performance and outcome measures periodically
throughout the duration of the agreement, as needed, to best measure the program as
determined by County. Tarzana Treatment Centers, Inc. will be required to utilize and
integrate clinical tools as directed by DBH.
• Additionally, Tarzana Treatment Centers, Inc. will be required to the following data collection
and reporting requirements:
o Meet DBH and State standards for timely access to care and services as specified in
the County Waiver implementation plan and state-county intergovernmental
agreement.
o Conduct post-discharge beneficiary surveys for a period of time to be determined by
County and in a format provided by County.
o Provide to DBH data regarding appeals, grievances, timeliness of access to care, access
to after-hours care, assessment of beneficiaries’ experiences, provision of services in
the beneficiary’s preferred language, and data for the UCLA evaluation on the
effectiveness of services.
XI. Payment/Funding
These services will be funded at the rates indicated below for the length of the resulting agreement.
Any Drug Medi-Cal and other estimated revenue will offset program costs. Tarzana Treatment
Centers, Inc. will submit information that indicates which portion of the Residential SUD services are
related to treatment costs and which portion is related to Room & Board costs for purposes of billing
Drug Medi-Cal and cost reporting.
Length of contract is up to 5 years or until the contract is fully expended up to $150,000.00, or upon
earlier termination by either party.
Description Frequency Rate
Unoccupied Bed Daily $38.00
Residential SUD Services
(Individual placed at the
facility)
Daily $276.72
Medical Primary Care Services
(In Case Adolescents Need
Primary Care)
Daily $166.00
PROVIDER REPORTSFresno CountyDepartment of Behavioral HealthSubstance Use Disorder ServicesReportPurposeSubmit toNotesWeekly Monthly AnnuallyAs NeededASAM Level of Care (LOC) Tracks level of care determined at screening, assessment, and reassessment and actual LOC referred to.sas@fresnocountyca.govSubmit reports by Monday for the previous week; ensure that reports are password protected or encrypted.MondayDATARProvides capacity and utilization information on publicly‐funded SUD programs.DHCS Webpage5thMonthly Status Report (MSR)Managed care requirement. Used to monitor network adequacy standards. Provides status on DMC programs and is used to update provider directory. Avatar*Provider shall enter information permodality. If provider offers multiple levelsof care within a modality, provider is touse the program ID with the lowest LOC(e.g., for residential, enter info under 3.1instead of 3.5).**Providers are asked to reportdeparting counselors via MSR as soon asthey become aware of the upcomingchange.15thWait List Provides information on length of wait time for admission into a residential program.sas@fresnocountyca.govApplicable to residential providers only15thIneligible Persons Screening Checks for clinicians' eligibility to provide services based on sanctions or exclusion status.sas@fresnocountyca.govTemplate provided by DBH15thOperational Expense Review (OER)Tracks provider expenses and monitors whether reported costs are allowable.sas@fresnocountyca.govTemplate provided by DBH25thNetwork Adequacy Certification Tool (NACT)Used to monitor network adequacy standards.sas@fresnocountyca.govTemplate provided by DBHFeb 1st2/26/20Page 1Exhibit A
PROVIDER REPORTSFresno CountyDepartment of Behavioral HealthSubstance Use Disorder ServicesReportPurposeSubmit toNotesWeekly Monthly AnnuallyAs NeededCulturally and Linguistically Appropriate Services (CLAS) self‐assessment and CLAS planUsed to monitor adherence to the National CLAS Standards which are intended to advance health equity, improve quality, and help eliminate health care disparities.sas@fresnocountyca.govTemplate provided by DBHTBDAmericans with Disabilities Act (ADA) self‐assessmentUsed to monitor compliance with legislation that prohibits discrimination against people with disabilities.sas@fresnocountyca.govTemplate provided by DBHTBDCost ReportIdentifies costs and charges related to program.sas@fresnocountyca.govDue annually; date set by DHCS and DBHTBDRisk AssessmentMandated questionnaire used to determine a provider's risk category classification.Electronic copy:sas@fresnocountyca.govHard copy:Department of Behavioral HealthSubstance Use Disorder ServicesAttn: Fiscal Analyst3133 N Millbrook AveFresno, CA 93703Due annually; date set by DBHTBDAdditional ReportsCalOMSCollects data on SUD treatment services.AvatarWithin 24 hours of admission or discharge; annual updates before the one‐year admission mark has passedXAccess FormCollects timeliness data.Avatar*Complete form at the time that anindividual requests SUD treatment**Instructions are posted at our SUDServices Provider PageX2/26/20Page 2Exhibit A
PROVIDER REPORTSFresno CountyDepartment of Behavioral HealthSubstance Use Disorder ServicesResidential CapacityPer SABG State‐County Contract, informs County and State when a residential program is at 90% capacity and follows up to inform when the program is back under 90%sas@fresnocountyca.gov*When program reaches 90% capacity,the provider shall use the email templateissued by County and submit report toSAS mailbox within 72 hours.*When capacity falls back under 90%,provider shall use the other template toinform of the change within 72 hours,again to SAS mailbox.x2/26/20Page 3Exhibit A
Exhibit B
1
Revised 11/14/18
SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT)
SPECIFIC REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes substance
use disorder treatment services available throughout the county to Medi-Cal
eligible beneficiaries through funds provided under an Intergovernmental
Agreement with the California Department of Health Care Services. The County,
and all contracted providers, must comply with the terms of the Intergovernmental
Agreement, and any amendments thereto, including but not limited to the
following:
1.RESTRICTIONS ON USE OF SABG FUNDS TO PAY FOR SERVICES
REIMBURSABLE BY MEDI-CAL
CONTRACTOR shall ensure that billing SABG funds only occurs for
services that are not reimbursable by Medi-Cal. If CONTRACTOR utilizes SABG funds to
pay for a service included in the DMC-ODS, CONTRACTOR shall maintain
documentation sufficient to demonstrate that Medi-Cal reimbursement was not available.
This documentation shall be provided to COUNTY at the time of billing and retained in the
beneficiary file for review.
2.STATE ALCOHOL AND DRUG REQUIREMENTS
A.INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless
the State, its officers, agents and employees from any and all claims and losses accruing
or resulting to any and all contractors, subcontractors, materialmen, laborers and any
other person, firm or corporation furnishing or supplying work, services, materials or
supplies in connection with the performance of this Agreement and from any and all
claims and losses accruing or resulting to any person, firm or corporation who may be
injured or damaged by the CONTRACTOR in the performance of this Agreement.
B.INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of
CONTRACTOR, in the performance of this Agreement, shall act in an independent
capacity and not as officers or employees or agents of State of California.
C.CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws,
regulations and standards. CONTRACTOR(S) shall establish written procedures
consistent with State-County Contract requirements. The provisions of this Agreement
are not intended to abrogate any provisions of law or regulation existing or enacted during
the term of this Agreement.
D.CONFIDENTIALITY
Exhibit B
2
Revised 11/14/18
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
Part 2, Title 42, Code of Federal Regulations; 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.
E.REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures
regarding revenue collection issued by the State under the provisions of the Health and
Safety Code, Division 10.5.
F.EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be
used exclusively for providing alcohol and/or drug program services, administrative costs,
and allowable overhead.
G.ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H.REPORTS
CONTRACTOR agrees to participate in surveys related to the
performance of this Agreement and expenditure of funds and agrees to provide any such
information in a mutually agreed upon format.
I.AUDITS
All State and Federal funds furnished to the CONTRACTOR(S)
pursuant to this Agreement along with related patient fees, third party payments, or other
related revenues and funds commingled with the foregoing funds are subject to audit by
the State. The State may audit all alcohol and drug program revenue and expenditures
contained in this Agreement for the purpose of establishing the basis for the subsequent
year's negotiation.
J.RECORDS MAINTENANCE
1)CONTRACTOR shall maintain books, records, documents,
and other evidence necessary to monitor and audit this Agreement.
2)CONTRACTOR shall maintain adequate program and fiscal
records relating to individuals served under the terms of this Agreement, as required, to
meet the needs of the State in monitoring quality, quantity, fiscal accountability, and
accessibility of services. Information on each individual shall include, but not be limited
Exhibit B
3
Revised 11/14/18
to, admission records, patient and participant interviews and progress notes, and records
of service provided by various service locations, in sufficient detail to make possible an
evaluation of services provided and compliance with this Agreement.
3.FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED
TRANSACTIONS
A.DBH and CONTRACTOR recognize that Federal assistance funds
will be used under the terms of this Agreement. For purposes of this section, DBH will be
referred to as the "prospective recipient".
B.This certification is required by the regulations implementing
Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510,
Participants' responsibilities. The regulations were published as Part VII of the May 26,
1988 Federal Register (pages 19160-19211).
1)The prospective recipient of Federal assistance funds certifies
by entering this Agreement, that neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.
2)The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a
person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the Federal department or
agency with which this transaction originated.
3)Where the prospective recipient of Federal assistance funds is
unable to certify to any of the statements in this certification, such prospective participant
shall attach an explanation to this Agreement.
4)The CONTRACTOR shall provide immediate written notice to
DBH if at any time CONTRACTOR learns that its certification in this clause of this
Agreement was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5)The prospective recipient further agrees that by entering into
this Agreement, it will include a clause identical to this clause of this Agreement, and titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions", in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
6)The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction
was entered into.
Exhibit B
4
Revised 11/14/18
C.CONTRACTOR shall not employ or subcontract with any party listed
in the government wide exclusions in the System for Award Management (SAM) in
accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders
12549 (3 CFR part 1986 Comp. p. 189) and 12689 (3 CFR part 1989., p. 235),
“Debarment and Suspension.” SAM exclusions contain the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible
under statutory or regulatory authority other than Executive Order 12549. If
CONTRACTOR employs or subcontracts an excluded party, DHCS has the right to
withhold payments, disallow costs, or issue a CAP, as appropriate, pursuant to HSC
Code 11817.8(h).
4.SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR 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.
5.CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written
confidentiality oath, attached hereto as Attachment A, before they begin employment
with CONTRACTOR and shall renew said document annually thereafter.
CONTRACTOR shall retain each employee’s written confidentiality oath for COUNTY
and DHCS inspection for a period of six (6) years following the termination of this
agreement.
6.CULTURALLY COMPETENT SERVICES
CONTRACTOR shall ensure equal access to quality care by diverse
populations by adopting the federal Office of Minority Health Culturally and
Linguistically Appropriate Service (CLAS) national standards and complying with 42
CFR 438.206(c)(2). CONTRACTOR shall promote the delivery of services in a
culturally competent manner to all beneficiaries, including those with limited English
proficiency and diverse cultural and ethnic backgrounds, disabilities, and regardless of
gender, sexual orientation or gender identity.
7.ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable
accommodations, and accessible equipment for Medicaid beneficiaries with physical or
mental disabilities are provided to all beneficiaries.
8.ADDITIONAL CONTRACT RESTRICTIONS
This Contract is subject to any additional restrictions, limitations, or conditions
enacted by the Congress, or any statute enacted by the Congress, as well as federal or
Exhibit B
5
Revised 11/14/18
state governments which may affect the provisions, terms, or funding of this Contract in
any manner.
9.HATCH ACT
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5
USC, Sections 1501-1508), which limit the political activities of employees whose
principal employment activities are funded in whole or in part with federal funds.
10.UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE
MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds
pertaining to drug and alcohol related programs contains a clearly written statement that
there shall be no unlawful use of drugs or alcohol associated with the program.
Additionally, CONTRACTOR shall ensure that no aspect of the program includes any
message in materials, curricula, teachings, or promotion of the responsible use, if the use
is unlawful, of drugs or alcohol pursuant to Health and Safety Code (HSC) 11999-
11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol
Certification, attached hereto as Attachment B, incorporated herein by reference and
made part of this Agreement agreeing to uphold the obligations of HSC 11999 – 11999.3.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR
or a subcontractor that is a private entity is determined to have violated a prohibition of
the Unlawful Use of Drugs and Alcohol message or has an employee who is determined
by the DBH Director or her designee to have violated a prohibition of the Unlawful Use of
Drugs and Alcohol message.
11.LIMITATION ON USE OF FUNDS FOR PROMOTION OF
LEGALIZATION OF CONTROLLED SUBSTANCES
CONTRACTOR shall ensure that none of the funds made available
through this Agreement with COUNTY may be used for any activity that promotes the
legalization of any drug or other substance included in Schedule I of Section 202 of the
Controlled Substances Act (21 USC 812).
12.NONDISCRIMINATION AND INSTITUTIONAL SAFEGUARDS FOR
RELIGIOUS CONTRACTORS
CONTRACTOR shall establish such processes and procedures as
necessary to comply with the provisions of Title 42, USC, Section 300x-65 and Title 42,
CFR, Part 54 to prohibit discrimination against nongovernmental organizations and
certain individuals on the basis of religion in the distribution of government funds to
provide substance abuse services and to allow the organizations to accept the funds to
provide the services to the individuals without impairing the religious character of the
organizations or the religious freedom of the individuals.
Exhibit B
6
Revised 11/14/18
13.COUNSELOR CERTIFICATION
CONTRACTOR shall ensure that any counselor or registrant providing
intake, assessment of need for services, treatment or recovery planning, individual or
group counseling to participants, patients, or residents in a DHCS licensed or certified
program is required to be certified as defined in Title 9, Division 4, Chapter 8.
14.INTRAVENOUS DRUG USE (IVDU) TREATMENT
CONTRACTOR shall ensure that beneficiaries in need of IVDU treatment
shall be encouraged to undergo AOD treatment adhering to provisions in 42 USC 300x-
23 and 45 CFR 96.126(e). DHCS shall monitor programs for compliance with this
requirement.
15.TUBERCULOSIS TREATMENT
CONTRACTOR shall ensure the following related to Tuberculosis (TB):
A.Routinely make available TB services to each individual receiving
treatment for AOD use and/or abuse.
B.Reduce barriers to patients’ accepting TB treatment.
C.Develop strategies to improve follow-up monitoring, particularly
after patients leave treatment, by disseminating information through
educational bulletins and technical assistance.
16.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) as amended by Section 1702.
CONTRACTOR, CONTRACTOR’s employees, subrecipients, and
subrecipients’ employees may not:
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
Exhibit B
7
Revised 11/14/18
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.
CONTRACTOR must sign a certification annually acknowledging the
Trafficking Victims Protection Act of 2000 requirements (TVPA Certification), attached
hereto as Attachment C, incorporated herein by reference and made part of this
Agreement and must require all employees to complete annual TVPA training.
17.BYRD ANTI-LOBBYING AMENDMENT
CONTRACTOR certifies that it will not and has not used Federal
appropriated funds to pay any person or organization for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, officer or
employee of Congress, or an employee of a member of Congress in connection with
obtaining any Federal contract, grant or any other award covered by 31 USC 1352.
CONTRACTOR shall also disclose to DHCS any lobbying with non-Federal funds that
takes place in connection with obtaining any Federal award.
18.NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
CONTRACTOR certifies that under the laws of the United States and the
State of California, incorporated into the State-County Intergovernmental Agreement,
CONTRACTOR shall not unlawfully discriminate against any person.
19.FEDERAL LAW REQUIREMENTS
CONTRACTORS shall comply with the following Federal law
requirements:
A.Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in
federally funded programs.
B.Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
prohibiting discrimination on the basis of race, color, religion, sex,
handicap, familial status or national origin in the sale or rental of
housing.
C.Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42
USC Sections 6101 – 6107), which prohibits discrimination on the
basis of age.
D.Age Discrimination in Employment Act (29 CFR Part 1625).
Exhibit B
8
Revised 11/14/18
E.Title I of the Americans with Disabilities Act (29 CFR Part 1630)
prohibiting discrimination against the disabled in employment.
F.Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities.
G.Title III of the Americans with Disabilities Act (28 CFR Part 36)
regarding access.
H.Rehabilitation Act of 1973, as amended (29 USC Sectio n 794),
prohibiting discrimination on the basis of individuals with disabilities.
I.Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part
60) regarding nondiscrimination in employment under federal
contracts and construction contracts greater than $10,000 funded
by federal financial assistance.
J.Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
K.The Drug Abuse Office and Treatment Act of 1972, as amended,
relating to nondiscrimination on the basis of drug abuse.
L.The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
amended, relating to nondiscrimination on the basis of alcohol
abuse or alcoholism.
20.STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A.Fair Employment and Housing Act (Government Code Section
12900 et seq.) and the applicable regulations promulgated
thereunder (California Administrative Code, Title 2, Section 7285.0
et seq.).
B.Title 2, Division 3, Article 9.5 of the Government Code,
commencing with Section 11135.
C.Title 9, Division 4, Chapter 8, commencing with Section 10800.
D.No state or Federal funds shall be used by COUNTY, or
CONTRACTOR, for sectarian worship, instruction, and/or
proselytization. No state funds shall be used by CONTRACTOR, or
CONTRACTOR, to provide direct, immediate, or substantial
support to any religious activity.
E.Noncompliance with the requirements of nondiscrimination in
services shall constitute grounds for state to withhold payments
Exhibit B
9
Revised 11/14/18
under this Agreement or terminate all, or any type, of funding
provided hereunder.
21.INFORMATION ACCESS FOR INDIVIDUALS WITH LIMITED ENGLISH
PROFICIENCY
CONTRACTOR shall comply with all applicable provisions of the Dymally-
Alatorre Bilingual Services Act (Government Code sections 7290 -7299.8) regarding
access to materials that explain services available to the public as well as providing
language interpretation services.
CONTRACTOR shall comply with the applicable provisions of Section
1557 of the Affordable Care Act (45 CFR Part 92), including, but not limited to, 45 CFR
92.201, when providing access to:
A.Materials explaining services available to the public,
B.Language assistance,
C.Language interpreter and translation services, and
D.Video remote language interpreting services.
22.INTERIM SERVICES
CONTRACTOR must adhere to the State-County Contract requirement to
provide Interim Services in the event that an individual must wait to be placed in
treatment.
Interim Substance Abuse Services means services that are provided until an
individual is admitted to a substance abuse treatment program. The purposes of the
services are to reduce the adverse health effects of such abuse, promote the health of the
individual, and reduce the risk of transmission of disease. At a minimum, interim services
include counseling and education about HIV and tuberculosis (TB), about the risks of
needle-sharing, the risks of transmission to sexual partners and infants, and about steps
that can be taken to ensure the HIV and TB transmission does not occur, as well as
referral for HIV or TB treatment services if necessary. For pregnant women, interim
services also include counseling on the effects of alcohol and drug use on the fetus, as
well as referral for prenatal care.
Records must indicate evidence that Interim Services have been provided
and documentation will be reviewed for compliance.
23.CHARITABLE CHOICE
CONTRACTOR 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 must be voluntary
as well as separate in time and location from County funded activities and services.
CONTRACTOR shall inform County as to whether it is faith-based. If CONTRACTOR
Exhibit B
10
Revised 11/14/18
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 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 report
to SUD Services the number of individuals who requested referrals to alternate providers
based on religious objection. In addition, CONTRACTOR shall comply with the
provisions of Title 42, USC, Section 300x-65 and Title 42, CFR, Part 54.
24.MINIMUM QUALITY DRUG TREATMENT STANDARDS
CONTRACTOR shall comply with the Minimum Quality Drug Treatment
Standards for SABG for all Substance Use Disorder (SUD) treatment programs. The
Minimum Quality Drug Treatment Standards are attached hereto and by this reference
incorporated herein as Attachment D.
25.RISK ASSESSMENT
CONTRACTOR shall comply with the sub-recipient pre-award risk assessment
requirements contained in 2 CFR Part 200 Uniform Administrative Requirements, Cost
Principles and Audit Requirements for Federal Awards. COUNTY, as the SABG first-tier sub-
recipient, shall review the merit and risk associated with all potential grant second-tier sub-
recipients (CONTRACTOR) annually prior to making an award. COUNTY shall perform and
document annual subrecipient pre-award risk assessments for each CONTRACTOR and retain
documentation for audit purposes.
26.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 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 failur e to comply
with these requirements. These requirements include, but may not be limited to, those
set forth in this Agreement, and:
A.HSC, Division 10.5, Part 2 commencing with Section 11760.
B.Title 9, California Code of Regulations (CCR) (herein referred to as
Title 9), Division 4, commencing with Section 9000.
C.Government Code, Title 2, Division 4, Part 2, Chapter 2, Article 1.7.
D.Government Code, Article 7, Federally Mandated Audits of Block
Grant Funds Allocated to Local Agencies, Chapter 1, Part 1, Divisio n 2, Title 5,
commencing at Section 53130.
E.Title 42 United State Code (USC), Sections 300x-21 through 300x-
31, 300x-34, 300x-53, 300x-57, and 330x-64 through 66.
Exhibit B
11
Revised 11/14/18
F.Title 2, CFR 200 -The Uniform Administration Requirements, Cost
Principles and Audit Requirements for Federal Awards.
G.Title 45, Code of Federal Regulations (CFR), Sections 96.30
through 96.33 and Sections 96.120 through 96.137.
H.Title 42, CFR, Sections 8.1 through 8.6.
I.Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR
Part 2, Subparts A - E).
J.Title 21, CFR, Sections 1301.01 through 1301.93, Department of
Justice, Controlled Substances.
K.State Administrative Manual (SAM), Chapter 7200 (General Outline
of Procedures).
27.DRUG FREE WORKPLACE
CONTRACTOR shall comply with the requirements of the Drug-Free Work
Place Act of 1990 (California Government Code section 8350).
28.YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the “Youth Treatment Guidelines,” available at
the DHCS web address at:
http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and by this reference
incorporated herein, in developing and implementing youth treatment programs funded
under this Agreement until such time new Youth Treatment Guidelines are established
and adopted. No formal amendment of this contract is required for new guidelines to
apply.
29.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(HIPAA) OF 1996
If any of the work performed under this Agreement is subject to the
HIPAA, CONTRACTOR shall perform the work in compliance with all applicable
provisions of HIPAA. As identified in Exhibit F of the State County Intergovernmental
Agreement, DHCS, COUNTY and CONTRACTOR shall cooperate to assure mutual
agreement as to those transactions between them, to which this Provision applies.
Refer to Exhibit F for additional information.
A.Trading Partner Requirements
1)No Changes: CONTRACTOR hereby agrees that for the
personal health information (PHI), it shall not change any definition, data condition or
use of a data element or segment as proscribed in the federal Health and Human
Services Transaction Standard Regulation [45 CFR Part 162915(a)].
2)No Additions: CONTRACTOR hereby agrees that for PHI, it
shall not add any data elements or segments to the maximum data set as proscribed in
the HHS Transaction Standard Regulation [45CFR Part 162.915 (b)].
Exhibit B
12
Revised 11/14/18
3)No Unauthorized Uses: CONTRACTOR hereby agrees that
for PHI, it shall not use any code or data elements that are marked ‘not used” in the in
the HHS Transactions Implementation specification or are not in the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (c)].
4)No Changes to Meaning or Intent: CONTRACTOR hereby
agrees that for PHI, it shall not change the meaning or intent of the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (d)].
B.Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility
that DHCS or others may request an extension from the uses of a standard in the HHS
Transaction Standards. If this occurs, CONTRACTOR agrees that it shall participate in
such test modifications.
C.Adequate Testing
CONTRACTOR is responsible to adequately test all business rules
appropriate to their types and specialties. If the CONTRACTOR is acting as a
clearinghouse for enrolled providers, CONTRACTOR has obligations to adequately test
all business rules appropriate to each and every provider type and specialty for which
they provide clearinghouse services.
D.Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies
identified by DHCS, and transactions errors or deficiencies identified by an enr olled
CONTRACTOR if the COUNTY is acting as a clearinghouse for that CONTRACTOR. If
the CONTRACTOR is a clearinghouse, the CONTRACTOR agrees to properly
communicate deficiencies and other pertinent information regarding electronic
transactions to enrolled CONTRACTORS for which they provide clearinghouse
services.
E.Code Set Retention
Both Parties understand and agree to keep open code sets being
processed or used in this Agreement for a least the current billing period or any appeal
period, whichever is longer.
F.Data Transmission Log
Both Parties shall establish and maintain a Data Transmission Log, which
shall record any and all data transmissions taking place between the Parties during the
term of this Agreement. Each Party shall take necessary and reasonable steps to
ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be
retained by each Party for no less than twenty-four (24) months following the date of
the Data Transmission. The Data Transmission Log may be maintained on computer
Exhibit B
13
Revised 11/14/18
media or other suitable means provided that, if necessary to do so, the information
contained in the Data Transmission Log may be retrieved in a timely manner and
presented in readable form.
Attachment A
Page 1 of 1
3133 N Millbrook, Fresno, California 93703
FAX (559) 600-7673 www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH (DBH) EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information (PHI) that is necessary to carry
out my function with DBH, I ___________________________, agree to not divulge any PHI to
unauthorized persons. Furthermore, I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel, subcontractors, and
subcontractors’ personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath, I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH, surveillance and safeguarding announcements
issued by DHCS, and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
1.Exercise due care to preserve data integrity and confidentiality.
2.Treat passwords and user accounts as confidential information.
3.Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4.Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a “Privacy Incident Report” at:
http://www.dhcs.ca.gov/formsandpubs/laws/priv/Pages/DHCSBusinessAssociatesOnly.aspx and
return the completed form to: privacyofficer@dhcs.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq. and the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name:
Signature:
____________________________________
Date:
____________________________________
Attachment B
Page 1 of 1
UNLAWFUL USE OF DRUGS AND ALCOHOL
CERTIFICATION
I, ______________________________________, as an authorized agent of
(Print Name)
________________________________________, acknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
All aspects of a drug- or alcohol-related program are consistent with the “no
unlawful use” message, including, but not limited to, program standards,
curricula, materials, and teachings; and
The “no unlawful use” of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. If this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminated.
Signature:_____________________________ Date:______________________
Title:_________________________________
Attachment C
Page 1 of 1
TRAFFICKING VICTIMS PROTECTION ACT OF 2000
CERTIFICATION
I, ______________________________________, as an authorized agent of
(Print Name)
________________________________________, acknowledge the requirement to
(Organization Name)
comply with the Trafficking Victims Protection Act of 2000 (TVPA), specifically Section
106(g), which authorizes the County of Fresno to terminate a contract, without penalty,
if this organization or its employees, or a subcontractor or its employees:
Engages in severe forms of trafficking in persons during the period of time that
the award is in effect;
Procures a commercial sex act during the period of time that the award in in
effect; or
Uses forced labor in the performance of the award or subawards under the
award.
I understand that the TVPA establishes human trafficking and related offenses
as federal crimes and attaches severe penalties to them. I will immediately inform the
County of Fresno, Department of Behavioral Health, Contracts Division – Substance
Use Disorder (SUD) Services immediately of any information received from any
source alleging a violation of the TVPA by either this organization or its employees, or
a subcontractor or its employees during the term of this contract.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of the TVPA and, if found in violation, will be immediately
terminated. I agree to submit this signed certification annually on behalf of the
organization acknowledging requirements under the TVPA and attesting that all
employees will receive annual TVPA training, and that documentation of training will
be placed in personnel files.
Signature:_____________________________ Date:______________________
Title:_________________________________
Attachment D
Revised 9/20/18 Page 1 of 5
Minimum Quality Drug Treatment Standards
Compliance with the following Minimum Quality Treatment Standards is required for all SUD
treatment programs (contractors and sub-contractors).
A.Personnel Policies
1.Personnel files shall be maintained on all employees and volunteers/interns and shall
contain the following:
a) Application for employment and/or resume;
b) Signed employment confirmation statement/duty statement;
c) Job description;
d) Performance evaluations;
e) Health records/status as required by program or Title 9;
f) Other personnel actions (e.g., commendations, discipline, status change,
employment incidents and/or injuries);
g) Training documentation relative to substance use disorders and treatment;
h) Current registration, certification, intern status, or licensure;
i) Proof of continuing education required by licensing or certifying agency and program;
j) Program Code of Conduct and for registered, certified, and licensed staff, a copy of
the certifying/licensing body’s code of conduct as well; and
k) Salary schedule and salary adjustment information.
2.Job descriptions shall be developed, revised as needed, and approved by the Program’s
governing body. The job descriptions shall include:
a) Position title and classification;
b) Duties and responsibilities;
c) Lines of supervision; and
d) Education, training, work experience, and other qualifications for the position.
Attachment D
Revised 9/20/18 Page 2 of 5
3.Written code of conduct for employees and volunteers/interns shall be established which
address at least the following:
a) Use of drugs and/or alcohol;
b) Prohibition of social/business relationship with clients or their family members for
personal gain;
c) Prohibition of sexual contact with clients;
d) Conflict of interest;
e) Providing services beyond scope;
f) Discrimination against clients or staff;
g) Verbally, physically, or sexually harassing, threatening, or abusing clients, family
members or other staff;
h) Protection of client confidentiality;
i) The elements found in the code of conduct(s) for the certifying organization(s) the
program’s counselors are certified under; and
j) Cooperation with complaint investigations.
4.If a program utilizes the services of volunteers and or interns, procedures shall be implemented
which address:
a) Recruitment;
b) Screening;
c) Selection;
d) Training and orientation;
e) Duties and assignments;
f)Scope of practice;
g) Supervision;
h) Evaluation;
i)Protection of client confidentiality; and
j) Code of Conduct
Attachment D
Revised 9/20/18 Page 3 of 5
5. Written roles and responsibilities and a code of conduct for the medical director (if
applicable) shall be clearly documented, signed and dated by an authorized program
representative and the medical director.
B.Program Management
1. Admission or Readmission
a) Each program shall include in its policies and procedures written admission and
readmission criteria for determining client’s eligibility and suitability for treatment.
These criteria shall include, at minimum:
i.Use of alcohol/drugs of abuse;
ii. Physical health status;
iii. Documentation of social and psychological problems; and
iv.A statement of nondiscrimination requiring that admission shall not be
denied on the basis of ethnic group identification, religion, age, gender,
race, disability, or sexual orientation. The above shall not preclude
programs from emphasizing services for specific populations.
b) If a potential client does not meet the admission criteria, the client shall be referred to
an appropriate service provider.
c) If a client is admitted to treatment, a consent to treatment form shall be signed by the
client.
d) All referrals made by the program shall be documented in the client record.
e) Copies of the following documents shall be provided to the client upon admission:
i. Client rights, client fee policies, and consent to treatment.
f) Copies of the following shall be provided to the client or posted in a prominent place
accessible to all clients:
i.A statement of nondiscrimination by race, religion, sex, gender identity, ethnicity,
age, disability, sexual preference, and ability to pay;
ii.Grievance procedures;
iii.Appeal process for involuntary discharge; and
iv.Program rules, expectations and regulations.
Attachment D
Revised 9/20/18 Page 4 of 5
g) Where drug screening by urinalysis is deemed appropriate the program shall:
i. Establish procedures which protect against the falsification and/or
contamination of any urine sample; and
ii. Document urinalysis results in the client’s file.
2. Treatment
a) Assessment for all clients shall include:
i. Drug/Alcohol use history;
ii. Medical history;
iii.Family history;
iv. Psychiatric history;
v. Social/recreational history;
vi.Financial status/history;
vii. Educational history;
viii. Employment history;
ix. Criminal history, legal status; and
x. Previous SUD treatment history.
b) Treatment plans shall be developed with the client within 30 days of admission and
include:
i.A problem statement for all problems identified through the assessment
whether addressed or deferred;
ii. Goals to address each problem statement (except when deferred);
iii. Action steps to meet the goals that include who is responsible for the action
and the target date for completion; and
iv. Signature of primary counselor and client.
All treatment plans shall be reviewed periodically and updated to accurately reflect
the client’s progress or lack of progress in treatment.
Attachment D
Revised 9/20/18 Page 5 of 5
c) Progress notes shall document the client’s progress toward completion of activities
and achievement of goals on the treatment plan.
d) Discharge documentation shall be developed with the client, if possible and include:
i. Description of the treatment episode;
ii.Prognosis;
iii. Client’s plan for continued recovery including support systems and plans for
relapse prevention;
iv. Reason and type of discharge;
v. Signature of primary counselor and client;
vi. A copy of the discharge documentation shall be given to the client;
vii. Current alcohol and/or other drug usage;
viii. Vocational and educational achievements;
ix.Transfers and referrals; and
x.Client comments.
Exhibit C
1
Revised 10/16/18
DRUG MEDI-CAL INTERGOVERNMENTAL AGREEMENT
REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes substance
use disorder treatment services available throughout the county to Medi-Cal
eligible beneficiaries through funds provided under an Intergovernmental
Agreement with the California Department of Health Care Services. The County,
and all contracted providers, must comply with the terms of the Intergovernmental
Agreement, and any amendments thereto, including but not limited to the
following:
1. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless
the State, its officers, agents and employees from any and all claims and losses accruing
or resulting to any and all contractors, subcontractors, materialmen, laborers and any
other person, firm or corporation furnishing or supplying work, services, materials or
supplies in connection with the performance of this Agreement and from any and all
claims and losses accruing or resulting to any person, firm or corporation who may be
injured or damaged by the CONTRACTOR in the performance of this Agreement.
B. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of
CONTRACTOR, in the performance of this Agreement, shall act in an independent
capacity and not as officers or employees or agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws,
regulations and standards. CONTRACTOR(S) shall establish written procedures
consistent with State-County Contract requirements. The provisions of this Agreement
are not intended to abrogate any provisions of law or regulation existing or enacted during
the term of this Agreement.
D. 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
Part 2, Title 42, Code of Federal Regulations; 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.
E. REVENUE COLLECTION POLICY
Exhibit C
2
Revised 10/16/18
CONTRACTOR shall conform to all policies and procedures
regarding revenue collection issued by the State under the provisions of the Health and
Safety Code, Division 10.5.
F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be
used exclusively for providing alcohol and/or drug program services, administrative costs,
and allowable overhead.
G. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H. REPORTS
CONTRACTOR agrees to participate in surveys related to the
performance of this Agreement and expenditure of funds and agrees to provide any such
information in a mutually agreed upon format.
I. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S)
pursuant to this Agreement along with related patient fees, third party payments, or other
related revenues and funds commingled with the foregoing funds are subject to audit by
the State. The State may audit all alcohol and drug program revenue and expenditures
contained in this Agreement for the purpose of establishing the basis for the subsequent
year's negotiation.
J. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents,
and other evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal
records relating to individuals served under the terms of this Agreement, as required, to
meet the needs of the State in monitoring quality, quantity, fiscal accountability, and
accessibility of services. Information on each individual shall include, but not be limited
to, admission records, patient and participant interviews and progress notes, and records
of service provided by various service locations, in sufficient detail to make possible an
evaluation of services provided and compliance with this Agreement.
2. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED
TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds
Exhibit C
3
Revised 10/16/18
will be used under the terms of this Agreement. For purposes of this section, DBH will be
referred to as the "prospective recipient".
B. This certification is required by the regulations implementing
Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510,
Participants' responsibilities. The regulations were published as Part VII of the May 26,
1988 Federal Register (pages 19160-19211).
1) The prospective recipient of Federal assistance funds certifies
by entering this Agreement, that neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a
person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the Federal department or
agency with which this transaction originated.
3) Where the prospective recipient of Federal assistance funds is
unable to certify to any of the statements in this certification, such prospective participant
shall attach an explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to
DBH if at any time CONTRACTOR learns that its certification in this clause of this
Agreement was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5) The prospective recipient further agrees that by entering into
this Agreement, it will include a clause identical to this clause of this Agreement, and titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions", in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction
was entered into.
3. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR 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.
4. 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
Exhibit C
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Revised 10/16/18
not limited to the trafficking of persons provisions in Section 106(g) of the Trafficking
Victims Protection Act of 2000 (TVPA) as amended by Section 1702.
CONTRACTOR, CONTRACTOR’s employees, subrecipients, and
subrecipients’ employees may not:
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.
CONTRACTOR must sign a certification annually acknowledging the
Trafficking Victims Protection Act of 2000 requirements (TVPA Certification), attached
hereto as Attachment A, incorporated herein by reference and made part of this
Agreement and must require all employees to complete annual TVPA training.
5. UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE
MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds
pertaining to drug and alcohol related programs contains a clearly written statement that
there shall be no unlawful use of drugs or alcohol associated with the program.
Additionally, CONTRACTOR shall ensure that no aspect of the program includes any
message in materials, curricula, teachings, or promotion of the responsible use, if the use
is unlawful, of drugs or alcohol pursuant to Health and Safety Code (HSC) 11999-
11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol
Certification, attached hereto as Attachment B, incorporated herein by reference and
made part of this Agreement agreeing to uphold the obligations of HSC 11999 – 11999.3.
Exhibit C
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Revised 10/16/18
This agreement may be unilaterally terminated, without penalty, if
CONTRACTOR or a subcontractor that is a private entity is determined to have violated a
prohibition of the Unlawful Use of Drugs and Alcohol message or has an employee who is
determined by the DBH Director or her designee to have violated a prohibition of the
Unlawful Use of Drugs and Alcohol message.
6. CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written
confidentiality oath, attached hereto as Attachment C, before they begin employment
with CONTRACTOR and shall renew said document annually thereafter.
CONTRACTOR shall retain each employee’s written confidentiality oath for COUNTY
and DHCS inspection for a period of six (6) years following the termination of this
agreement.
7. 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 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. 2CFR Part 200 (Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards); and
G. Title 45, Part 96, Subparts B, C and L of the Code of Federal
Regulations (Block Grants).
8. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall ensure equal access to quality care by diverse
populations by adopting the federal Office of Minority Health Culturally and
Linguistically Appropriate Service (CLAS) national standards and complying with 42
Exhibit C
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Revised 10/16/18
CFR 438.206(c)(2). CONTRACTOR’s policies, procedures, and practices must be
consistent with the principles outlined and are embedded in the organizational
structure, as well as being upheld in day-to-day operations. CONTRACTOR shall
promote the delivery of services in a culturally competent manner to all beneficiaries,
including those with limited English proficiency and diverse cultural and ethnic
backgrounds, disabilities, and regardless of gender, sexual orientation or gender
identity.
9. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable
accommodations, and accessible equipment are available for Medicaid beneficiaries
with physical or mental disabilities.
10. ADDITIONAL INTERGOVERNMENTAL AGREEMENT RESTRICTIONS
This Agreement is subject to any additional restrictions, limitations,
conditions, or statutes enacted or amended by the federal or state governments, which
may affect the provisions, terms, or funding of this Agreement in any manner.
11. NULLIFICATION OF DMC-ODS SERVICES
The parties agree that failure of COUNTY, or CONTRACTOR, to comply
with W&I section 14124.24, the Special Terms and Conditions, and this Agreement,
shall be deemed a breach that results in the termination of the State-County
Intergovernmental Agreement for cause. In the event of a breach, the DMC-ODS
services shall terminate. The COUNTY shall immediately begin providing DMC services
to the beneficiaries in accordance with the State Plan.
12. HATCH ACT
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5
USC, Sections 1501-1508), which limit the political activities of employees whose
principal employment activities are funded in whole or in part with federal funds.
13. LIMITATION ON USE OF FUNDS FOR PROMOTION OF
LEGALIZATION OF CONTROLLED SUBSTANCES
CONTRACTOR is prohibited from using funds made available through this
Agreement for any activity that promotes the legalization of any drug or other
substance included in Schedule I of Section 202 of the Controlled Substances Act (21
USC 812).
14. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
CONTRACTOR certifies that under the laws of the United States and the
State of California, incorporated into this Agreement by reference and made a part
Exhibit C
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Revised 10/16/18
hereof as if set forth in full, CONTRACTOR shall not unlawfully discriminate against
any person.
15. FEDERAL LAW REQUIREMENTS
CONTRACTOR shall comply with the following Federal law requirements:
A. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in
federally funded programs.
B. Title IX of the education amendments of 1972 (regarding education
and programs and activities), if applicable.
C. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
prohibiting discrimination on the basis of race, color, religion, sex,
handicap, familial status or national origin in the sale or rental of
housing.
D. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42
USC Sections 6101 – 6107), which prohibits discrimination on the
basis of age.
E. Age Discrimination in Employment Act (29 CFR Part 1625).
F. Title I of the Americans with Disabilities Act (29 CFR Part 1630)
prohibiting discrimination against the disabled in employment.
G. Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities.
H. Title III of the Americans with Disabilities Act (28 CFR Part 36)
regarding access.
I. Rehabilitation Act of 1973, as amended (29 USC Section 794),
prohibiting discrimination on the basis of individuals with disabilities.
J. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part
60) regarding nondiscrimination in employment under federal
contracts and construction contracts greater than $10,000 funded
by federal financial assistance.
K. Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
L. The Drug Abuse Office and Treatment Act of 1972, as amended,
relating to nondiscrimination on the basis of drug abuse.
M. The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
Exhibit C
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Revised 10/16/18
amended, relating to nondiscrimination on the basis of alcohol
abuse or alcoholism.
16. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A. Fair Employment and Housing Act (Government Code Section
12900 et seq.) and the applicable regulations promulgated
thereunder (California Administrative Code, Title 2, Section 7285.0
et seq.).
B. Title 2, Division 3, Article 9.5 of the Government Code,
commencing with Section 11135.
C. Title 9, Division 4, Chapter 8, commencing with Section 10800.
D. No state or Federal funds shall be used by COUNTY, or
CONTRACTOR, for sectarian worship, instruction, and/or
proselytization. No state funds shall be used by CONTRACTOR, or
CONTRACTOR, to provide direct, immediate, or substantial
support to any religious activity.
E. Noncompliance with the requirements of nondiscrimination in
services shall constitute grounds for state to withhold payments
under this Agreement or terminate all, or any type, of funding
provided hereunder.
17. INVESTIGATIONS AND CONFIDENTIALITY OF ADMINISTRATIVE
ACTIONS
COUNTY acknowledges that if a DMC provider is under investigation by
DHCS or any other state, local or federal law enforcement agency for fraud or abuse,
DHCS may temporarily suspend CONTRACTOR from the DMC program, pursuant to
W&I Code, Section 14043.36(a). Information about CONTRACTOR’s administrative
sanction status is confidential until such time as the action is either completed or
resolved. The DHCS may also issue a Payment Suspension to a provider pursuant to
W&I Code, Section 14107.11 and Code of Federal Regulations, Title 42, section
455.23. The COUNTY is to withhold payments from a DMC provider during the time a
Payment Suspension is in effect. COUNTY has executed a Confidentiality Agreement
that permits DHCS to communicate with COUNTY concerning CONTRACTOR(S) that
are subject to administrative sanctions.
18. COUNSELOR CERTIFICATION
CONTRACTOR shall ensure that any counselor or registrant providing
intake, assessment of need for services, treatment or recovery planning, individual or
Exhibit C
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Revised 10/16/18
group counseling to participants, patients, or residents in a DHCS licensed or certified
program is required to be certified as defined in Title 9, Division 4, Chapter 8.
19. ADMISSION DISCRIMINATION
CONTRACTOR shall accept individuals eligible for admission in the order
in which they apply without restriction, up to the limits set under the State-County
Intergovernmental Agreement. CONTRACTOR shall not, based on health status or
need for health care services, discriminate against individuals eligible for admission.
CONTRACTOR shall not discriminate against individuals eligible for admission based
on race, color, national origin, ancestry, religion, sex, marital status, sexual orientation,
gender, gender identity, age, or disability and will not use any policy or practice that
has the effect of discriminating on the basis of race, color, or national origin, ancestry,
religion, sex, marital status, sexual orientation, gender, gender identity, age, or
disability. CONTRACTOR shall ensure that beneficiaries that meet medical necessity
for Medication Assisted Treatment (MAT) receive the same access to care as non-MAT
beneficiaries.
CONTRACTOR shall provide information on how to file a discrimination
complaint with the United States Department of Health and Human Services Office of
Civil Rights if there is a concern of discrimination based on race, color, national origin,
age, disability or sex.
20. SUBCONTRACTUAL REQUIREMENTS
CONTRACTOR shall fulfill contractual requirements of delegated services
or activities in accordance with 42 CFR §438.230 and shall perform the delegated
activities and reporting responsibilities in compliance with COUNTYs State-County
Intergovernmental Agreement obligations. CONTRACTOR shall comply with all
applicable Medicaid laws and regulations, including applicable sub-regulatory guidance
and contract provisions.
CONTRACTOR shall not bill beneficiaries for covered services under this
agreement in excess of the amount that would be owed by the individual if the
COUNTY had directly provided the services (42 U.S.C. 1396u-2(b)(6)(C)).
21.INSPECTION AND AUDIT OF RECORDS AND ACCESS TO
FACILITIES
CONTRACTOR agrees that COUNTY, DHCS, CMS, the HHS Inspector
General, the Comptroller General, or their designees have the right to audit, evaluate,
and inspect any books, records, contracts, computer or other electronic systems of
CONTRACTOR, or of the CONTRACTOR’s sub-contractor, that pertain to any aspect of
services and activities performed, or determination of amounts payable under
COUNTY’s contract with DHCS. CONTRACTOR shall make available, at any time, for
purposes of an audit, evaluation, or inspection, its premises, physical facilities,
equipment, books, records, contracts, computer or other electronic systems relating to
Exhibit C
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Revised 10/16/18
its Medicaid enrollees. The right to audit will exist through 10 years from the final date of
the contract period or from the date of completion of any audit, whichever is later.
22. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the
State-County Intergovernmental Agreement, the Provider Manual and the Consumer
Handbook.
CONTRACTOR shall make the following grievance information available
to all beneficiaries:
A. Beneficiary’s right to a State Fair Hearing and how to obtain a
hearing as well as representation rules.
B. Beneficiary’s right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Beneficiary’s right to give written consent to allow CONTRACTOR
or legal representative, acting on behalf of the beneficiary, to file an appeal.
D. Beneficiary may file a grievance orally or in writing to DHCS or
COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
G. Beneficiary’s right to request continuation of benefits during an
appeal or state fair hearing filing although the beneficiary may be liable for the cost of
any continued benefits if the action is upheld.
H. Any state determined contractor’s appeal rights to challenge the
failure of the COUNTY to cover a service.
23. GREIVANCE AND APPEALS RECORDKEEPING REQUIREMENTS
CONTRACTOR shall retain beneficiary grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Beneficiary
grievance and appeal data shall include a general description of the reason for the
grievance or appeal, the date the grievance or appeal was received, the date of each
review or, if applicable, review meeting, the resolution and date of resolution at each
level of the grievance or appeal and the name of the covered person for whom the
grievance or appeal was filed. The record must be accurately maintained in a manner
accessible to DHCS and available upon request to CMS.
24. BENEFICIARY INFORMING AND TRANSLATION SERVICES
CONTRACTOR shall make written and verbal information available to
beneficiaries in their language of choice.
Exhibit C
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Revised 10/16/18
Written material: CONTRACTOR shall use COUNTY’s written/translated
materials that are critical to obtaining services, including the provider directory,
beneficiary handbook, appeal and grievance notices, and denial and termination
notices, available in the prevalent non–English languages. All other CONTRACTOR
specific written materials must be made available in the prevalent non-English
languages. CONTRACTOR shall ensure that written materials are made available in
alternative formats upon request of the potential beneficiary or beneficiary at no cost.
Written materials shall include taglines in the prevalent non-English languages, as well
as large print, explaining the availability of written translation or oral interpretation to
understand the information provided.
Auxiliary aids: CONTRACTOR shall ensure auxiliary aids and services
shall also be made available upon request of the potential beneficiary or beneficiary at
no cost.
Interpretation services: CONTRACTOR shall make interpretation services
available free of charge to each beneficiary. This includes oral interpretation and the
use of auxiliary aids (such as TTY/TDY and American Sign Language) and services
including qualified interpreters for individuals with disabilities. Oral interpretation
requirements apply to all non–English languages, not just those that DHCS identifies
as prevalent. Pursuant to WIC 14029.91(a)(1)(B), Oral interpretation services shall be
provided by an interpreter that, at a minimum, meets all of the following qualifications:
A. Demonstrated proficiency in both English and the target language;
B. Knowledge in both English and the target language of health care
terminology and concepts relevant to health care delivery systems; and
C. Adheres to generally accepted interpreter ethics principle, including
client confidentiality.
CONTRACTOR shall notify its beneficiaries that oral interpretation is
available for any language and written translation is available in prevalent languages
and that auxiliary aids and services are available upon request, at no cost and in a
timely manner for non-English speaking/reading/writing beneficiaries and beneficiaries
with disabilities.
Pursuant to 14029.91(a)(1)(C), CONTRACTOR shall not require a
beneficiary with limited English proficiency to provide his or her own interpreter or rely
on a staff member who does not meet the qualifications described above.
CONTRACTOR shall not rely on an adult or minor child accompanying the
limited-English-proficient beneficiary to interpret or facilitate communication except
under the circumstances described in WIC Section 14029.91(a)(1)(D) for emergencies
and upon request that the accompanying adult provide assistance.
Exhibit C
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Revised 10/16/18
Pursuant to 45 CFR 92.201, CONTRACTOR shall not require a
beneficiary with limited English proficiency to accept language assistance services.
25. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and
issue to beneficiaries at intake. Member handbooks can also be made available by
mailing a printed copy of the information to the beneficiary’s mailing address, emailing
after obtaining the beneficiary’s agreement to receive information by email, providing
direction in paper or electronic form to the COUNTY website or any other method that
can reasonably be expected to result in the beneficiary receiving that information.
26. TIMELY ACCESS REQUIREMENTS
CONTRACTOR shall meet DHCS and COUNTY standards for timely
access to care and services, taking into account the urgency of the need for services.
CONTRACTORs must offer hours of operation that are no less than the hours of
operation offered to commercial beneficiaries or comparable to Medicaid FFS, if
CONTRACTOR services only Medicaid beneficiaries. Timeliness standards include,
but are not limited to:
A. Initial contact to first face-to-face appointment – 10 business days
B. Initial contact to first dose of NTP – 3 business days
C. Timeliness of services for Urgent Conditions – 1 business day
CONTRACTOR shall ensure that medical attention for emergency and
crisis medical conditions are provided immediately.
27. CARE COORDINATION
CONTRACTOR and COUNTY shall comply with the care and coordination
requirements of the State-County Intergovernmental Agreement, Exhibit A, Attachment
I, II.E.3. CONTRACTOR shall ensure that each beneficiary has an ongoing source of
care appropriate to his or her needs and shall ensure a person or entity within their
organization is formally designated as primarily responsible for coordinating the
services accessed by the beneficiary. The beneficiary shall be provided information on
how to contact their case manager. CONTRACTOR shall coordinate services between
levels of care, with services the beneficiary receives from any other managed care
organization and the services the beneficiary receives from community and social
support providers. Care coordination efforts shall be accurately documented in
beneficiary’s chart to be verified during COUNTY chart audits conducted at least
annually.
CONTRACTOR shall make a best effort to conduct an initial screening of
each beneficiary’s ancillary needs, within thirty (30) calendar days of the effective date
of admission for all new beneficiaries, including subsequent attempts if the initial
attempt to contact the beneficiary is unsuccessful.
Exhibit C
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Revised 10/16/18
CONTRACTOR shall ensure that it maintains and shares, as appropriate,
a beneficiary health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each
beneficiary’s privacy is protected in accordance with the privacy requirements in 45
CFR parts 160 and 164 subparts A and E and 42 CFR Part 2, to the extent that they
are applicable.
CONTRACTOR shall ensure that beneficiaries are aware of and are
referred to, when appropriate, recovery supports and services immediately after
discharge or upon completion of an acute care stay.
28. AUTHORIZATION OF SERVICES
CONTRACTOR shall adhere to COUNTY’s written policies and
procedures, outlined in the Provider Manual, for authorization of services.
29. PERFORMANCE IMPROVEMENT PROJECTS
CONTRACTOR shall assist, when requested by COUNTY, in developing
and reviewing annual Performance Improvement Projects including but not limited to
identifying a clinical and a non-clinical problem, brainstorming causes and barriers,
implementation of interventions for the identified problems, and analysis of
interventions. CONTRACTOR shall assist in planning and initiation of activities for
increasing or sustaining improvement.
30. CONTRACTOR DMC CERTIFICATION
DMC certified contractors must revalidate DMC certification with DHCS
every five (5) years. Failure to revalidate DMC certification within 120 days following
the expiration of every five (5) year period will result in contract termination. COUNTY
shall terminate CONTRACTOR immediately upon notification from DHCS that the
CONTRACTOR cannot be enrolled, or the expiration of one 120-day period without
enrollment of CONTRACTOR, and shall notify affected beneficiaries. CONTRACTOR
shall ensure enrollment with DHCS as a Medicaid provider consistent with the provider
disclosure, screening and enrollment requirements.
DMC certified CONTRACTORs shall be subject to continuing certification
requirements at least once every five years. DHCS may allow the CONTRACTOR to
continue delivering covered services to beneficiaries at a site subject to on-site review
by DHCS as part of the recertification process prior to the date of the on-site review,
provided the site is operational, the certification remains valid, and has all required fire
clearances. DHCS shall conduct unannounced certification and recertification site visits
at clinics pursuant to W&I Code, Section 14043.7.
Exhibit C
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31. PROGRAM INTEGRITY REQUIREMENTS
CONTRACTOR shall implement and maintain arrangements or procedures
that are designed to detect and prevent fraud, waste, and abuse. CONTRACTOR shall
maintain written policies, procedures, and standards of conduct that articulate
CONTRACTORs commitment to comply with all applicable requirements and
standards under the State-County Intergovernmental Agreement, and all applicable
Federal and State requirements. CONTRACTOR shall establish and implement
procedures and a system with dedicated staff for routine internal monitoring and
auditing of compliance risks, prompt response to compliance issues as they are raised,
investigation of potential compliance problems as identified in the course of self-
evaluation and audits, correction of such problems promptly and thoroughly (or
coordination of suspected criminal acts with law enforcement agencies) to reduce the
potential for recurrence, and ongoing compliance.
CONTRACTOR shall provide reports to COUNTY within 60 calendar days
when it has identified an overpayment. COUNTY shall provide a mechanism for
reporting and collecting overpayment.
CONTRACTOR shall retain information regarding data, information, and
documentation for beneficiary encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years. (INTERGOVERNMENTAL
AGREEMENT P.5)
CONTRACTOR shall not knowingly have a relationship with a director,
officer or partner of CONTRACTOR, a subcontractor of CONTRACTOR, a person with
beneficial ownership of five (5) percent or more of CONTRACTOR’s equity or a
network provider or person with an employment, consulting or other arrangement with
the CONTRACTOR for the provision of items and services that are significant and
material to the CONTRACTOR’s obligations under this Agreement with the following:
A. An individual or entity that is debarred, suspended, or otherwise
excluded from participating in procurement activities under the
Federal Acquisition Regulation or from participating in non-
procurement activities under regulations issued under Executive
Order No. 12549 or under guidelines implementing Executive Order
No. 12549.
B. An individual or entity who is an affiliate, as defined in the Federal
Acquisition Regulation at 48 CFR 2, Section 101, of a person
described above.
CONTRACTOR shall not have a relationship with an individual or entity
that is excluded from participation in any Federal Health Care Program under section
1128 or 1128A of the Act.
Exhibit C
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Revised 10/16/18
32. CONTRACTOR SPECIFICATIONS
CONTRACTOR shall ensure that professional staff shall be licensed,
registered, certified or recognized under California scope of practice statutes.
Professional staff shall provide services within their individual scope of practice and
receive supervision required under their scope of practice laws. CONTRACTOR shall
ensure that professional staff (LPHAs) receive a minimum of five (5) hours of
continuing education related to addiction medicine each year. Copies of these
certifications and licenses shall be maintained in staff’s personnel files and records
shall be made available to COUNTY upon request.
CONTRACTOR shall ensure that non-professional staff receive
appropriate onsite orientation and training prior to performing assigned duties. A
professional and/or administrative staff shall supervise non-professional staff.
Professional and non-professional staff are required to have appropriate experience
and any necessary training at the time of hiring. Documentation of trainings,
certifications and licensure shall be contained in personnel files. Registered and
certified SUD counselors shall adhere to all requirements in Title 9, Chapter 8.
33. CREDENTIALING/RECREDENTIALING
CONTRACTOR shall follow the COUNTY’s established credentialing and
re-credentialing process for all licensed and/or certified staff. Initial credentialing must
be completed prior to providing treatment services. Re-credentialing must be
completed every three (3) years.
34. MEDICAL DIRECTOR REQUIREMENTS
CONTRACTOR’s Medical Director must, prior to the delivery of services
under this Contract, be enrolled with DHCS under applicable state regulations,
screened in accordance with 42 CFR 455.450(a) as a “limited” categorical risk within a
year prior to serving as a Medical Director under this Agreement, and have a signed
Medicaid provider agreement with DHCS as required by 42 CFR 431.107.
Medical Directors shall receive a minimum of five (5) hours of continuing
medical education related to addiction medicine annually.
35. ASAM REQUIREMENTS
CONTRACTOR shall use COUNTY’s American Society of Addiction
Medicine (ASAM) criteria assessment and re-assessment tools to determine the
beneficiary’s level of care. CONTRACTOR shall ensure that assessment of services for
adolescents will follow the ASAM adolescent treatment criteria.
CONTRACTOR and CONTRACTOR’s staff shall comply with obtaining
ASAM Criteria training prior to providing services. CONTRACTOR shall ensure that, at
minimum, staff conducting assessments complete the two e-Training modules entitled
“ASAM Multidimensional Assessment” and “From Assessment to Service Planning and
Exhibit C
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Revised 10/16/18
Level of Care”. The CIBHS ASAM webinars or in person trainings may be completed
in lieu of the e-Training modules. CONTRACTOR shall maintain records of ASAM
trainings in personnel files and will make these records available to COUNTY upon
request.
Residential care CONTRACTORs must meet the established ASAM
criteria for each level of residential care provided and receive an ASAM Designation
prior to providing DMC-ODS services.
36. MEDICAL NECESSITY
CONTRACTOR shall ensure that an initial medical necessity
determination, for an individual to receive a DMC-ODS benefit, is performed through a
face-to-face review or telehealth by a Medical Director or a LPHA. The Medical
Director or LPHA shall evaluate each beneficiary’s assessment and intake information,
if completed by a counselor, through a face-to-face review or telehealth with the
counselor to establish that a beneficiary meets medical necessity criteria. After
establishing a diagnosis and documenting the basis for diagnosis, the ASAM Criteria
shall be applied to determine placement into the level of assessed services.
CONTRACTOR shall ensure that all ADULT beneficiaries receive at a
diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth
Edition for Substance-Related and Addictive Disorders. After establishing a diagnosis
and documenting the basis for diagnosis, the American Society of Addiction Medicine
(ASAM) Placement Criteria shall be applied by the diagnosing individual to for
placement into the correct level of care.
CONTRACTOR shall periodically as directed by COUNTY, and at a
minimum of every six (6) months, reassess for continued medical necessity of an
ongoing treatment. The reassessment determination must be documented by the
Medical Director, licensed physician or LPHA as clinically appropriate.
For Medical Necessity definition and Assessment and Reassessment
timeframes CONTRACTOR shall refer to the Provider Manual.
Individuals under age 21 are eligible to receive Medicaid services
pursuant to the Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate.
Under the EPSDT mandate, beneficiaries under the age 21 are eligible to receive all
appropriate and medically necessary services needed to correct and ameliorate health
conditions that are coverable under section 1905(a) Medicaid authority. Nothing in the
DMC-ODS shall override any EPSDT requirements. Medical necessity for an
adolescent individual (an individual under the age of 21) is determined using the
following criteria:
A. The adolescent individual may be assessed to be at-risk for
developing a SUD based on the following criteria:
Exhibit C
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Revised 10/16/18
i. Substance use does NOT meet the minimum diagnosis
criteria per the DSM 5 ; and
ii. Reports of experimental or early-phase substance use,
associated biopsychosocial risk factors, and information
gathered from the full ASAM assessment and the At-Risk
Determination Tool indicate risk of developing an SUD.
B. The adolescent individual must meet the ASAM adolescent
treatment criteria.
37. MEDI-CAL ELIGIBILITY VERIFICATION
CONTRACTOR shall be responsible for verifying the Medi-Cal eligibility of
each beneficiary for each month of service prior to billing for DMC services for that
month. Medi-Cal eligibility verification should be performed prior to rendering service, in
accordance with and as described in the DHCS DMC Provider Billing Manual. Options
for verifying the eligibility of a Medi-Cal beneficiary are described in the DHCS DMC
Provider Billing Manual at the following web address and by this reference incorporated
herein. http://www.dhcs.ca.gov/formsandpubs/Documents/DMC_Billing_Manual_2017-
Final.pdf.
38. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a beneficiary has Other Health Coverage (OHC),
CONTRACTOR shall bill the OHC prior to billing DMC to receive either payment from
the OHC, or a notice of denial from the OHC indicating that either the recipient’s OHC
coverage has been exhausted or that the specific service is not a benefit of the OHC.
39. DMC REIMBURSEMENT RATE SETTING
CONTRACTOR shall submit financial and service data to COUNTY on an
annual basis in a format provide by, and by a deadline set by, COUNTY for
reimbursement rate setting purposes. COUNTY shall approve contractor-specific
reimbursement rates for each modality except NTPs. CONTRACTORs that do not
comply with the requirements of the rate setting process will be considered out of
compliance with contractual requirements and will not receive annual reimbursement
rates CONTRACTORs that are non-compliant are subject to contract termination.
Annual reimbursement rates for NTP services shall be set by DHCS
pursuant to the process set forth in W&I Code, Section 14021.51.
40. DMC CERTIFICATION AND ENROLLMENT
Prior to delivering SUD services CONTRACTOR shall obtain any licenses,
registrations, DMC certifications or approval to operate a SUD program or provide a
covered service in accordance with applicable laws and regulations. CONTRACTOR
shall continuously maintain any licenses, registrations, DMC certifications or approval
Exhibit C
18
Revised 10/16/18
to operate a SUD program or provide a covered service in accordance with applicable
laws and regulations for the duration of this Contract. CONTRACTOR and any
subcontractors shall comply with the following regulations and guidelines:
A. Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
B. Title 22, Sections 51490.1(a);
C. Exhibit A, Attachment I, Article III.PP – Requirements for Services;
D. Title 9, Division 4, Chapter 4, Subchapter 1, Sections 10000, et
seq.; and
E. Title 22, Division 3, Chapter 3, sections 51000 et. seq.
41. PERINATAL CERTIFICATION REQUIREMENTS
CONTRACTORs of perinatal DMC services shall be properly certified to
provide these services and comply with the applicable requirements below:
A. Perinatal services shall address treatment and recovery issues
specific to pregnant and postpartum women, such as relationships,
sexual and physical abuse, and development of parenting skills.
B. Perinatal services shall include:
1) Mother/child habilitative and rehabilitative services (i.e.,
development of parenting skills, training in child
development, which may include the provision of cooperative
child care pursuant to Health and Safety Code Section
1596.792);
2) Service access (i.e., provision of or arrangement for
transportation to and from medically necessary treatment);
3) Education to reduce harmful effects of alcohol and drugs on
the mother and fetus or the mother and infant; and
4) Coordination of ancillary services (i.e., assistance in
accessing and completing dental services, social services,
community services, educational/vocational training and
other services which are medically necessary to prevent risk
to fetus or infant).
C. Medical documentation that substantiates the beneficiary's
pregnancy and the last day of pregnancy shall be maintained in the
beneficiary file.
42. YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the “Youth Treatment Guidelines,” available at
the DHCS web address at:
http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and by this reference
incorporated herein, in developing and implementing youth treatment programs funded
under this Agreement until such time new Youth Treatment Guidelines are established
Exhibit C
19
Revised 10/16/18
and adopted. No formal amendment of this contract is required for new guidelines to
apply.
43. CONTRACTOR CHANGE IN SERVICE OR LOCATION
CONTRACTOR shall ensure that any reduction of covered services or
relocations are not implemented until approval is issued by DHCS. CONTRACTOR
must submit a new DMC certification application to the DHCS Provider Enrollment
Division (PED). The DMC certification application shall be submitted to PED 60 days
prior to the desired effective date of the reduction of covered services or relocation.
CONTRACTOR shall notify COUNTY when its license, registration,
certification, or approval to operate a SUD program or provide a covered service is
revoked, suspended, modified, or not renewed by entities other than DHCS.
44. MEDICATION ASSISTED TREATMENT
CONTRACTORs that do not provide medication assisted treatment shall
have procedures for linkage/integration for beneficiaries requiring medication assisted
treatment. CONTRACTOR staff will regularly communicate with physicians of
beneficiaries who are prescribed these medications unless the beneficiary refuses to
consent to sign 42 CFR part 2 Compliant Releases of Information for this purpose.
45. EVIDENCE BASED PRACTICES (EBP)
CONTRACTOR shall implement Motivational Interviewing and at least two
EBPs prescribed by DHCS based on the timeline established by COUNTY as outlined
in the Provider Manual. The two additional required EBPs may be selected from the
following: Cognitive-Behavioral Therapy, Relapse Prevention, Trauma-Informed
Treatment and Psycho-Education. Three EBPs shall be utilized per service modality.
COUNTY and DHCS will monitor the implementation and regular training of EBPs to
staff during reviews. CONTRACTOR shall ensure that staff are internally monitored for
training, quality of delivery and fidelity of Evidence Based Practices.
46. COORDINATION AND CONTINUITY OF CARE WITH MANAGED CARE
PLANS
CONTRACTOR shall coordinate with the Managed Care Plans, Anthem
and CalVIVA Health, when appropriate, for comprehensive physical and behavioral
health screening and collaborative treatment planning. COUNTY shall maintain MOUs
with the managed care plans to facility beneficiary care coordination and will monitor
CONTRACTORs with regard to the effectiveness of physical health care coordination.
47. POSTSERVICE POSTPAYMENT AND POSTSERVICE PREPAYMENT
(PSPP)
DHCS shall conduct Postservice Postpayment and Postservice
Prepayment (PSPP) Utilization Reviews of contracted DMC providers to determine
Exhibit C
20
Revised 10/16/18
whether the DMC services were provided. DHCS shall issue the PSPP report to the
COUNTY with a copy to CONTRACTOR. CONTRACTOR shall ensure any deficiencies
are remediated and COUNTY shall attest the deficiencies have been remediated.
All CONTRACTOR shall submit a COUNTY-approved corrective action
plan (CAP) to DHCS within 60 days of the date of the PSPP report. CONTRACTOR(S)
that do not comply with the CAP submittal requirements or fail to implement the
approved CAP provisions within the designated timeline are subject to payment
withholding until compliance is determined.
48. DRUG SCREENING
Where drug screening by urinalysis is deemed medically appropriate,
CONTRACTOR shall establish procedures which protect against the falsification and/or
contamination of any urine sample and document urinalysis results in the beneficiary’s
file.
49. TREATMENT RECORDING REQUIREMENTS
CONTRACTOR shall comply with the requirements outlined in the
Intergovernmental Agreement, Exhibit A, Attachment I, Section PP, regarding
admission, assessment, beneficiary record, medical necessity and diagnosis, physical
examination, treatment plan, sign-in sheets, progress notes, continuing services, and
discharge.
50. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(HIPAA) OF 1996
If any of the work performed under this Agreement is subject to the
HIPAA, CONTRACTOR shall perform the work in compliance with all applicable
provisions of HIPAA. As identified in Exhibit F of the State County Intergovernmental
Agreement, DHCS, COUNTY and CONTRACTOR shall cooperate to ensure mutual
agreement as to those transactions between them, to which this Provision applies.
Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the
personal health information (PHI), it shall not change any definition, data condition or
use of a data element or segment as proscribed in the federal Health and Human
Services Transaction Standard Regulation [45 CFR Part 162915(a)].
2) No Additions: CONTRACTOR hereby agrees that for PHI, it
shall not add any data elements or segments to the maximum data set as proscribed in
the HHS Transaction Standard Regulation [45CFR Part 162.915 (b)].
3) No Unauthorized Uses: CONTRACTOR hereby agrees that
for PHI, it shall not use any code or data elements that are marked ‘not used” in the in
the HHS Transactions Implementation specification or are not in the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (c)].
Exhibit C
21
Revised 10/16/18
4) No Changes to Meaning or Intent: CONTRACTOR hereby
agrees that for PHI, it shall not change the meaning or intent of the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (d)].
B. Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility
that DHCS or others may request an extension from the uses of a standard in the HHS
Transaction Standards. If this occurs, CONTRACTOR agrees that it shall participate in
such test modifications.
C. Adequate Testing
CONTRACTOR is responsible to adequately test all business rules
appropriate to their types and specialties. If the CONTRACTOR is acting as a
clearinghouse for enrolled providers, CONTRACTOR has obligations to adequately test
all business rules appropriate to each and every provider type and specialty for which
they provide clearinghouse services.
D. Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies
identified by DHCS, and transactions errors or deficiencies identified by an enrolled
CONTRACTOR if the COUNTY is acting as a clearinghouse for that CONTRACTOR. If
the CONTRACTOR is a clearinghouse, the CONTRACTOR agrees to properly
communicate deficiencies and other pertinent information regarding electronic
transactions to enrolled CONTRACTORS for which they provide clearinghouse
services.
E. Code Set Retention
Both Parties understand and agree to keep open code sets being
processed or used in this Agreement for a least the current billing period or any appeal
period, whichever is longer.
F. Data Transmission Log
Both Parties shall establish and maintain a Data Transmission Log, which
shall record any and all data transmissions taking place between the Parties during the
term of this Agreement. Each Party shall take necessary and reasonable steps to
ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be
retained by each Party for no less than twenty-four (24) months following the date of
the Data Transmission. The Data Transmission Log may be maintained on computer
media or other suitable means provided that, if necessary to do so, the information
contained in the Data Transmission Log may be retrieved in a timely manner and
presented in readable form.
Exhibit C
22
Revised 10/16/18
51. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER
BENEFITS
A. General Parity Requirement
CONTRACTOR shall not impose any financial requirements,
Quantitative Treatment Limitations, or Non-Quantitative Treatment Limitations in any
classification of benefit (inpatient, outpatient, emergency care, or prescription drugs)
other than those limitations permitted and outlined in the State-County Contract.
CONTRACTOR shall not apply any financial requirement or
treatment limitation to substance use disorder services in any classification of benefit
that is more restrictive than the predominant financial requirement or treatment limitation
of that type applied to substantially all medical/surgical benefits in the same
classification of benefit furnished to beneficiaries (whether or not the benefits are
furnished by the CONTRACTOR). (42 CFR 438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to
beneficiaries in every classification in which medical/surgical benefits are provided. (42
CFR 438.910(b)(2))
B. Quantitative Limitations
CONTRACTOR shall not apply any cumulative financial
requirement for substance use disorder services in a classification that accumulates
separately from any established for medical/surgical services in the same classification.
(42 CFR 438.910(c)(3))
C. Non-Quantitative Limitations
CONTRACTOR shall not impose a non-quantitative treatment
limitation for substance use disorder benefits in any classification unless, under the
policies and procedures of CONTRACTOR as written and in operation, any processes,
strategies, evidentiary standards, or other factors used in applying the non-quantitative
treatment limitation to substance use disorder benefits in the classification are
comparable to, and are applied no more stringently than, the processes, strategies,
evidentiary standards, or other factors used in applying the limitation for
medical/surgical benefits in the classification. (42 CFR §438.910(d))
CONTRACTOR shall use processes, strategies, evidentiary
standards, or other factors in determining access to out-of-network providers for
substance use disorder services that are comparable to, and applied no more
stringently than, the processes, strategies, evidentiary standards, or other factors in
determining access to out-of-network providers for medical/surgical benefits. (42 CFR
§438.910(d)(3))
Exhibit C
23
Revised 10/16/18
52. ACCESSIBILITY CONSIDERATIONS
CONTRACTOR shall ensure that their health programs or activities
provided through electronic and information technology are accessible to beneficiaries
with disabilities, unless doing so would result in undue financial and administrative
burdens or a fundamental alteration in the nature of the health programs or activities.
When undue financial and administrative burdens or a fundamental alteration exist,
CONTRACTOR shall provide information in a format other than an electronic format that
would not result in such undue financial and administrative burdens or a fundamental
alteration but would ensure, to the maximum extent possible, that beneficiaries with
disabilities receive the benefits or services of the health program or activity that are
provided through electronic and information technology.
CONTRACTOR shall make reasonable modifications to policies,
practices, or procedures when such modifications are necessary to avoid discrimination
on the basis of disability, unless CONTRACTOR can demonstrate that making the
modifications would fundamentally alter the nature of the health program or activity. For
the purposes of this section, the term ‘‘reasonable modifications’’ shall be interpreted in
a manner consistent with the term as set forth in the ADA Title II regulation at 28 CFR
35.130(b)(7).
Attachment A
Page 1 of 1
TRAFFICKING VICTIMS PROTECTION ACT OF 2000
CERTIFICATION
I, ______________________________________, as an authorized agent of
(Print Name)
________________________________________, acknowledge the requirement to
(Organization Name)
comply with the Trafficking Victims Protection Act of 2000 (TVPA), specifically Section
106(g), which authorizes the County of Fresno to terminate a contract, without penalty,
if this organization or its employees, or a subcontractor or its employees:
Engages in severe forms of trafficking in persons during the period of time that
the award is in effect;
Procures a commercial sex act during the period of time that the award in in
effect; or
Uses forced labor in the performance of the award or subawards under the
award.
I understand that the TVPA establishes human trafficking and related offenses
as federal crimes and attaches severe penalties to them. I will immediately inform the
County of Fresno, Department of Behavioral Health, Contracts Division – Substance
Use Disorder (SUD) Services immediately of any information received from any
source alleging a violation of the TVPA by either this organization or its employees, or
a subcontractor or its employees during the term of this contract.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of the TVPA and, if found in violation, will be immediately
terminated. I agree to submit this signed certification annually on behalf of the
organization acknowledging requirements under the TVPA and attesting that all
employees will receive annual TVPA training, and that documentation of training will
be placed in personnel files.
Signature:_____________________________ Date:______________________
Title:_________________________________
Attachment B
Page 1 of 1
UNLAWFUL USE OF DRUGS AND ALCOHOL
CERTIFICATION
I, ______________________________________, as an authorized agent of
(Print Name)
________________________________________, acknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
The program contains a component that clearly explains in written materials that
there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or alcohol-
related program shall include any message on the responsible use, if the use is
unlawful, of drugs or alcohol;
All aspects of a drug- or alcohol-related program are consistent with the “no
unlawful use” message, including, but not limited to, program standards,
curricula, materials, and teachings; and
The “no unlawful use” of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in which
there is zero tolerance for promoting the unlawful use of and drugs or alcohol in an AOD
treatment facility. If this organization fails to satisfy the guidelines adopted by the State
of California, the drug or alcohol program shall not receive state funds and their contract
with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminated.
Signature:_____________________________ Date:______________________
Title:_________________________________
Attachment C
Page 1 of 1
3133 N Millbrook, Fresno, California 93703
FAX (559) 600-7673 www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH (DBH) EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information (PHI) that is necessary to carry
out my function with DBH, I ___________________________, agree to not divulge any PHI to
unauthorized persons. Furthermore, I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel, subcontractors, and
subcontractors’ personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath, I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH, surveillance and safeguarding announcements
issued by DHCS, and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
1.Exercise due care to preserve data integrity and confidentiality.
2.Treat passwords and user accounts as confidential information.
3.Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4.Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a “Privacy Incident Report” at:
http://www.dhcs.ca.gov/formsandpubs/laws/priv/Pages/DHCSBusinessAssociatesOnly.aspx and
return the completed form to: privacyofficer@dhcs.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq. and the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name:
Signature:
____________________________________
Date:
____________________________________
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 01-02-2020
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
•Deliver quality care
•Maximize resources while focusing on efficiency
•Provide an excellent care experience
•Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1.Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit D
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 01-02-2020
2.Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3.Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4.Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5.Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit D
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 01-02-2020
6.Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7.Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8.Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9.Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit D
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 01-02-2020
10.Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11.Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit D
Exhibit E
Page 1 of 2
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES
CONTRACTOR shall adhere to and develop written procedures in accordance with the below standards
adapted from the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in
Health Care:
Culturally Competent Care:
1.Organizations must ensure that beneficiaries receive from all staff members effective,
understandable, and respectful care that is provided in a manner compatible with
their cultural health beliefs and practices and preferred language.
2.Organizations must implement strategies to recruit, retain, and promote at all levels
of the organization a diverse staff and leadership that are representative of the
demographic characteristics of the service area.
3.Organizations must ensure that staff at all levels and across all disciplines receive
ongoing education and training in culturally and linguistically appropriate service
delivery.
Language Access Services:
4.Organizations must offer and provide language assistance services, including bilingual
staff and interpreter services, at no cost to beneficiaries with limited English
proficiency at all points of contact, in a timely manner during all hours of operation.
5.Organizations must provide to beneficiaries in their preferred language both verbal
offers and written notices informing them of their right to receive language assistance
services.
6.Organizations must assure the competence of language assistance provided to limited
English proficient beneficiaries by interpreters and bilingual staff. Family and friends
should not be used to provide interpretation services (except on the request of the
beneficiary).
7.Organizations must make available easily understood beneficiary‐related materials
and post signage in the languages of the commonly encountered groups and/or
groups represented in the service area.
Organizational Supports:
8.Organizations must develop, implement, and promote a written strategic plan that
outlines clear goals, policies, operational plans, and management
accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
Exhibit E
Page 2 of 2
9.Organizations must conduct initial and ongoing organizational self‐assessments of
CLAS related activities and are encouraged to integrate cultural and linguistic
competence‐related measures into their internal audits, performance improvement
programs, beneficiary satisfaction Assessments, and Outcomes‐Based Evaluations.
10.Organizations must ensure that data on the individual beneficiary’s race, ethnicity,
and spoken and written language are collected in program records, integrated into the
organizations management information systems, and periodically updated.
11.Organizations must maintain a current demographic, cultural, and epidemiological
profile of the community as well as a needs assessment to accurately plan for and
implement services that respond to the cultural and linguistic characteristics of the
service area.
12.Organizations must develop participatory, collaborative partnerships with
communities and utilize a variety of formal and informal mechanisms to facilitate
community and beneficiary involvement in designing and implementing CLAS‐related
activities.
13.Organizations must ensure that conflict and grievance resolution processes are
culturally and linguistically sensitive and capable of identifying, preventing, and
resolving cross‐cultural conflicts or complaints by beneficiaries.
14.Organizations must regularly make available to the public information about their
progress and successful innovations in implementing these standards and to provide
public notice in their communities about the availability of this information.
15.Organizations must ensure communication regarding the organization’s progress in
implementing and sustaining CLAS to all stakeholders, constituents, and general
public.
CONTRACTOR shall develop written procedures in accordance with the above standards. The
provisions of this Agreement are not intended to abrogate any provisions of law or regulation existing
or enacted during the term of this Agreement.
Page 1 of 5 10/25/16
Minimum Quality Drug Treatment Standards
Compliance with the following Minimum Quality Treatment Standards is required for all SUD
treatment programs (contractors and sub-contractors).
A.Personnel Policies
1.Personnel files shall be maintained on all employees and volunteers/interns and shall
contain the following:
a) Application for employment and/or resume;
b) Signed employment confirmation statement/duty statement;
c) Job description;
d) Performance evaluations;
e) Health records/status as required by program or Title 9;
f) Other personnel actions (e.g., commendations, discipline, status change,
employment incidents and/or injuries);
g) Training documentation relative to substance use disorders and treatment;
h) Current registration, certification, intern status, or licensure;
i) Proof of continuing education required by licensing or certifying agency and program;
j) Program Code of Conduct and for registered, certified, and licensed staff, a copy of
the certifying/licensing body’s code of conduct as well; and
k) Salary schedule and salary adjustment information.
2.Job descriptions shall be developed, revised as needed, and approved by the Program’s
governing body. The job descriptions shall include:
a) Position title and classification;
b) Duties and responsibilities;
c) Lines of supervision; and
d) Education, training, work experience, and other qualifications for the position.
Exhibit F
Page 2 of 5 10/25/16
3.Written code of conduct for employees and volunteers/interns shall be established which
address at least the following:
a) Use of drugs and/or alcohol;
b) Prohibition of social/business relationship with clients or their family members for
personal gain;
c) Prohibition of sexual contact with clients;
d) Conflict of interest;
e) Providing services beyond scope;
f) Discrimination against clients or staff;
g) Verbally, physically, or sexually harassing, threatening, or abusing clients, family
members or other staff;
h) Protection of client confidentiality;
i) The elements found in the code of conduct(s) for the certifying organization(s) the
program’s counselors are certified under; and
j) Cooperation with complaint/grievance investigations.
4.If a program utilizes the services of volunteers and or interns, procedures shall be implemented
which address:
a) Recruitment;
b) Screening;
c) Selection;
d) Training and orientation;
e) Duties and assignments;
f) Scope of practice;
g) Supervision;
h) Evaluation;
i) Protection of client confidentiality; and
j) Code of Conduct
Exhibit F
Page 3 of 5 10/25/16
5. Written roles and responsibilities and a code of conduct for the medical director (if
applicable) shall be clearly documented, signed and dated by an authorized program
representative and the medical director.
B.Program Management
1. Admission or Readmission
a) Each program shall include in its policies and procedures written admission and
readmission criteria, for determining client’s eligibility and suitability (determined
using ASAM criteria) for treatment. These criteria shall include, at minimum:
i. Use of alcohol/drugs of abuse;
ii. Physical health status;
iii. Documentation of social and psychological problems; and
iv.A statement of nondiscrimination requiring that admission shall not be
denied on the basis of ethnic group identification, religion, age, gender,
race, disability, or sexual orientation. The above shall not preclude
programs from emphasizing services for specific populations.
b) If a potential client does not meet the admission criteria, the client shall be referred to
an appropriate service provider.
c) If a client is admitted to treatment, a consent to treatment form shall be signed by the
client.
d) All referrals made by the program shall be documented in the client record.
e) Copies of the following documents shall be provided to the client upon admission:
i. Client rights, client fee policies, and consent to treatment.
f) Copies of the following shall be provided to the client or posted in a prominent place
accessible to all clients:
i.A statement of nondiscrimination by race, religion, sex, gender identity, ethnicity,
age, disability, sexual preference, and ability to pay;
ii.Grievance procedures;
iii.Appeal process for involuntary discharge; and
iv.Program rules, expectations and regulations.
g) Where drug screening by urinalysis is deemed appropriate the program shall:
Exhibit F
Page 4 of 5 10/25/16
i.Establish procedures which protect against the falsification and/or
contamination of any urine sample; and
ii. Document urinalysis results in the client’s file.
2. Treatment
a) Assessments shall utilize the ASAM placement criteria and must include:
i. Drug/Alcohol use history;
ii. Medical history;
iii. Family history;
iv. Psychiatric history;
v. Social/recreational history;
vi. Financial status/history;
vii. Educational history;
viii. Employment history;
ix. Criminal history, legal status; and
x. Previous SUD treatment history.
b) Treatment plans shall be developed with the client within 10 days of admission and
include:
i. A problem statement (addressing the clients substance use and its impact on
identified ASAM dimensions) for all problems identified through the assessment
whether addressed or deferred;
ii. The specific intervention that will be utilized to amelionate each identified
problem
iii. Goals to address each problem statement (except when deferred);
iv. Action steps to meet the goals that include who is responsible for the action
and the target date for completion; and
v. Signature of primary counselor and client.
All treatment plans shall be reviewed periodically and updated to accurately reflect
the client’s progress or lack of progress in treatment.
Exhibit F
Page 5 of 5 10/25/16
c) Progress notes shall document the client’s progress toward completion of activities
and achievement of goals on the treatment plan.
d) Discharge documentation shall be developed with the client, if possible and include:
i. Description of the treatment episode;
ii. Prognosis;
iii. Client’s plan for continued recovery including support systems and plans for
relapse prevention;
iv. Reason and type of discharge;
v. Signature of primary counselor and client;
vi. A copy of the discharge documentation shall be given to the client;
vii. Current alcohol and/or other drug usage;
viii. Vocational and educational achievements;
ix. Transfers and referrals; and
x. Client comments.
Exhibit F
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 1 OF 5
County of Fresno Department of Behavioral Health
SUD ANNUAL PROVIDER TRAINING PLAN
This training plan along with documentation of completion for each training, if applicable, must be utilized and kept in every employee’s personnel file. If the
training does not provide any type of certificate or confirmation of completion, the staff member’s supervisor is required to certify the training was completed
by signing and dating in the last column of the tables below.
If a provider wishes to utilize a source that isn’t listed as an approved trainer below, the training curriculum must be sent to SAS@fresnocountyca.gov for
consideration. The request will be reviewed, and the provider will be notified whether or not it’s approved. Any trainings that aren’t approved will not satisfy
DBH’s training requirements. Unless as otherwise noted, annually is defined as a rolling 365 calendar days after the date of hire.
EMPLOYEE NAME
JOB TITLE
DATE OF HIRE
YEAR
REQUIRED TRAINING: ALL STAFF
Compliance
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter.
APPROVED TRAINER(S)
Fresno County DBH*
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This training is provided to promote additional awareness and reinforcement of Fresno County’s Compliance Program, and address relevant changes to any
applicable laws, regulations, policies or Fresno County’s Code of Ethics and Code of Conduct. For training dates and how to register, please visit the DBH
Compliance website: https://www.co.fresno.ca.us/departments/behavioral-health/mental-health-compliance.
HIPAA
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter.
APPROVED TRAINER(S)
Trainer and duration are at the provider’s discretion.
Relias
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 2 OF 5
As a covered entity, providers must meet the training requirements described in the HIPAA Privacy Rule 45 CFR § 164.530(b)(1) and the HIPAA Security Rule
45 CFR § 164.308(a)(5). HIPAA training is currently available as a module in Relias.
Cultural
Competency
Training
FREQUENCY
One training must be completed every fiscal year.
APPROVED TRAINER(S)
Topic, trainer and duration are at the provider’s
discretion.
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
If a provider wishes to utilize another training source, it must be sent to: DBHStaffDevelopment@fresnocountyca.gov for approval prior to implementation.
Ethics &
Confidentiality
FREQUENCY
As required by the applicable licensing or certifying board based on
staff member’s qualifications and position
DHCS requires this training at least every 2 years
APPROVED TRAINER(S)
Approved training through the licensing or certifying
body
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This training should review California laws directly impacting behavioral health care staff, facilities, and/or patients including but not limited to information
on: access to records, mandated reporters, review of confidentiality laws including 42 CFR Part 2, confidentiality, ethical Issues, and boundary issues.
REQUIRED TRAINING: ADMINISTRATIVE & BILLING STAFF
AVATAR – CalOMS,
DMC Billing
FREQUENCY
Complete DMC Billing and Caloms training prior to performing any
billing activities and the use of AVATAR.
APPROVED TRAINER(S)
Fresno County DBH / AVATAR “How-To” Videos*
COMPLETION DATE PROOF OF COMPLETION ON FILE SUPERVISOR SIGNATURE / DATE
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 3 OF 5
Yes/No
This training course will show provider administrative and billing staff how to navigate through AVATAR and enter billing information as well as CalOMS and
DMC parameters for billable services.
REQUIRED TRAINING: CLINICAL STAFF
Documentation &
Billing
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter
APPROVED TRAINER(S)
Fresno County DBH*
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This training will help staff to better understand the documentation components from intake to discharge as required by the DMC-ODS Waiver as well as how
to obtain the necessary information during the assessment process in order for an LPHA to make an SUD diagnosis. Staff will learn about the specific criteria
listed in the DSM-5 and how to effectively document the necessary information pertaining to SUD impairments.
ASAM A (DBH)
-OR-
ASAM Module 1:
Multidimensional
Assessment (The
Change Companies)
FREQUENCY
Prior to providing any services
APPROVED TRAINER(S)
The Change Companies
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This effective and accessible solution for training will help practitioners understand, assess and implement the six dimensions of the American Society of
Addiction Medicine's The ASAM Criteria. Each section is devoted to a certain component of The ASAM Criteria, and information is reinforced through
knowledge checks and a final exam that learners must pass in order to receive credit. Skills that reinforce the module's learning objectives are practiced and
applied through interactive case studies and followed up with review from Chief Editor of The ASAM Criteria, Dr. David Mee-Lee.
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 4 OF 5
ASAM B (DBH)
-OR-
ASAM Module 2:
From Assessment to
Service Planning and
Level of Care (The
Change Companies)
FREQUENCY
Prior to providing any services
APPROVED TRAINER(S)
The Change Companies
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This course helps practitioners understand how to work with a participant's assessment and service planning to identify the best level of care in which to
provide his or her services. Skills that reinforce the module's learning objectives are practiced and applied through interactive case studies and Dr. Mee-Lee
provides real-world application and description via brief video clips throughout the module.
ASAM C (DBH)
-OR-
ASAM Module 3:
Introduction to the
ASAM Criteria (The
Change Companies)
FREQUENCY
Prior to July 1, 2021
APPROVED TRAINER(S)
The Change Companies
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This effective and accessible solution for training will serve as a quick orientation and reference guide for the new edition of the American Society of Addiction
Medicine's criteria for patient assessment, service planning and level of care placement. The ASAM Criteria (2013), now in its Third Edition, introduces new
context and content key to the field of addiction treatment.
Evidence-Based
Practices (EBP):
Motivational
Interviewing
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter
APPROVED TRAINER(S)
Fresno County Managed Care Plans /
Relias
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
Motivational Interviewing (MI) is an EBP (Evidenced Based Practice) that is a method that works on facilitating and engaging intrinsic motivation within the
client/member/consumer in order to change behavior. MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and
resolve ambivalence. A Motivational Interviewing training module is available in Relias.
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 5 OF 5
EBP #2:
Choose an item.
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter
APPROVED TRAINER(S)
Fresno County Managed Care Plans /
Relias
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
Clinical provider staff who provide direct services are required to be trained in Motivational Interviewing and at least two additional Evidence-Based Practices as follows:
Psycho-Education, Trauma-Informed Treatment, Cognitive Behavioral Therapy and Relapse Prevention.
EBP #3:
Choose an item.
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter
APPROVED TRAINER(S)
Fresno County Managed Care Plans / Relias
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
Clinical provider staff who provide direct services are required to be trained in Motivational Interviewing and at least two additional Evidence-Based Practices as follows:
Psycho-Education, Trauma-Informed Treatment, Cognitive Behavioral Therapy and Relapse Prevention.
Medication
Assisted Treatment
(MAT)
FREQUENCY
Within 30 days of contract execution or hire and annually thereafter
APPROVED TRAINER(S)
DBH / Fresno County Managed Care Plans / SAMHSA
COMPLETION DATE
PROOF OF COMPLETION ON FILE
Yes/No
SUPERVISOR SIGNATURE / DATE
This training course will provide a general overview of the medication used in MAT that are available through the DMC-ODS Waiver. The overview shall address each specific
medication, including the primary use of treatment and the relationship, if any, with other medications available for treatment. As part of the MAT training content,
participants will learn the theory of MAT and how MAT can be utilized to treat substance use disorders.
*These trainings do not have an alternate source.
Exhibit G
SUD ANNUAL PROVIDER TRAINING PLAN – Updated 12/24/20 6 OF 5
RECOMMENDED & OPTIONAL TRAININGS
Aside from the required trainings listed above, DBH encourages its providers to explore additional training opportunities as necessary and appropriate. This
section can be used to document the training courses DBH recommends as well as other courses taken throughout the year.
Training Description Completion Date Proof of Completion on File Supervisor Signature & Date
Case Management/Care Coordination Yes / No
Co-Occurring Disorders Yes / No
Recovery Services Yes / No
42 CFR Part 2 SUD Confidentiality Yes / No
Telehealth Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Section: Administration, DBH Policies & Procedures
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo (Sr. Staff Analyst - QA), Kannika
Toonnachat (Division Manager - Technology and Quality Management)
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MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and communities in Fresno County who are affected by, or are at risk
of, mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3/28/16
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.7
POLICY: It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE:To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals’ satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1.Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
Exhibit H
Page 1 of 3
2 | P a g e
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.7
Policy Title: Performance Outcome Measures
Section: Administration, DBH Policies & Procedures
2.Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3.Fresno County Mental Health Plan (FCMHP): Fresno County’s contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4.Objective (Goal): Intended results or the impact of learning, programs, or activities.
5.Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
III. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
Exhibit H
Page 2 of 3
3 | P a g e
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.7
Policy Title: Performance Outcome Measures
Section: Administration, DBH Policies & Procedures
a. Effectiveness of services – How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services – The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access – Changes or improvements in the program/provider’s capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders– Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
Exhibit H
Page 3 of 3