HomeMy WebLinkAboutAgreement A-21-029 Medi-Cal Cost Avoidance Program.pdfAgreement No . 21-029
CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
Annual Medi-Cal Cost Avoidance Program Certificate of Compliance
Fiscal Year 2020/2021
_F_r_e_s_n_o ______ COUNTY
I certify that Fresno County has appointed a County Veterans Service
Officer (CVSO) in compliance with California Code of Regulations, Title 12 , Subchapter 4.
Please consider this as our application to participate in the Medi-Cal Cost Avoidance Program
authorized by Military and Veterans Code Section 972.5 .
I understand and will comply with the following:
1. All activities of the CVSO for which payment is made b y the Cal Vet under this
agreement will reasonably benefit the Department of Health Care Services
(DHCS) or realize cost avoidance to the Medi-Cal program. All State and
County Medi-Cal Eligibility Workers who generate a Form MC 05 (Military
Verification and Referral form) will be instructed to indicate the applicant's Aid
Code on the face of the form.
2 . All monies received under this agreement shall be allocated to and spent on
the salaries and expenses of the CVSO.
3. This agreement is binding only if federal funds are available to CalVet from the
DHCS .
4. The CVSO is responsible for administering this program in accordance with
California Code of Regulations , Title 12 , Subchapter 4 and the Ca/Vet Procedure
Manual for Subvention and Medi-Cal Co s t Avoidance for the current state fiscal
year. L
Steve ~. Chairman of
Board of Supervisors of
County of Fresno
the
the
Date
ATTEST:
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
County of Fresno , State of California
By &/)L ~ Deputy
SCAN AND UPLOAD THIS COMPLETED FORM VIA THE
AGENCY ATTACHMENTS IN VETPRO
(Rev 6/20)
Agreement California Department of Veterans Affairs: Medi-Cal Certificate of Compliance (FY
2019-20), and Subvention Certificate of Compliance (FY 2019-20)
County of Fresno
Fund/Subclass: 0001/10000
Organization: 7110
Account/Program: 3560/0