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Agreement No. 18-365
MASTER AGREEMENT
This Agreement is made and entered into this 10th day of_--=J=ulc.,....y ___ , 2018, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and each SCHOOL DISTRICT listed in Exhibit A, attached hereto and by
5 this reference incorporated herein, and collectively hereinafter referred to as "SCHOOL DISTRICTS",
6 and such additional SCHOOL DISTRICTS as may, from time to time during the term of this
7 Agreement, be added by COUNTY, with the Department of Behavioral Health (DBH) Director or
8 designee approval. Reference in this Agreement to "parties" shall be understood to refer to COUNTY
9 and each individual SCHOOL DISTRICT, unless otherwise specified.
10 WI T N E S S E T H:
11 WHEREAS, COUNTY, through its DBH, recognizes the need to provide COUNTY DBH staff,
12 and contracted provider staff, for both Metropolitan (metro) and Rural areas to provide services related
13 to mental well-being for children and youth enrolled in school grades, Kindergarten through High
14 School; and
15 WHEREAS, children/youth with Serious Emotional Disturbance (SED) who also experience
16 co-occurring mental health and alcohol/substance abuse and/or discipline issues will be included
1 7 among those served.
18 WHEREAS, the SCHOOL DISTRICTS are public schools districts which also coordinate their
19 own mental health services within the jurisdictional boundaries specific to each SCHOOL DISTRICT.
2 0 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
21 hereto agree as follows:
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1. DEFINITIONS
A. . For purposes of this Agreement, the parties agree that the definitions set forth at
California Code of Regulations (CCR) Title 9., Division 1, Ch. 1., Article 1, §1810.100 and §1810.247
shall govern the meaning of all terms utilized in this Agreement.
1. "Children's mental health services" shall be defined as outpatient mental
health services, case management, crisis intervention, and rehabilitative services. This includes
individual, group and family therapy.
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2. “Pupils” shall refer to all children with mental health needs who are
eligible or are receiving children’s mental health services from or through the COUNTY at schools
within the jurisdictional boundaries of the SCHOOL DISTRICTS. But, this definition shall exclude
pupils as defined in CCR Title 2, Division 9, Chapter 1, Article 1, §60010 and §60020 for which mental
health services are required to be provided or arranged by the school as a service component of a
pupil’s Individualized Education Program (IEP).
3. “Medically necessary mental health services” refer to the criteria in
accordance with CCR, Title 9, Division 1, Chapter 11, Article 2, §1830.205.
2. OBLIGATIONS OF SCHOOL DISTRICTS AND COUNTY
A. SCHOOL DISTRICTS shall provide the following:
1. Identify an educational coordinator to work collaboratively with
COUNTY DBH staff to identify school sites to be served;
2. Provide confidential office/space large enough to conduct individual and
family sessions;
3. Provide a telephone in the confidential office/space used by DBH staff (if
no phones are available, a hand-held two-way radio will be provided);
and
4. Generate client referrals for COUNTY DBH staff.
B. COUNTY shall provide the following:
1. Work collaboratively with SCHOOL DISTRICT staff to assign
COUNTY DBH staff, and its contracted providers, to provide mental
health services to students;
2. Monitor the number and outcome of referrals and students engaged in
mental health services; and
3. Participate in meetings with SCHOOL DISTRICT staff to discuss student
progress toward meeting mental health treatment goals and access other
supportive services that may be needed.
3. COVERED SERVICES
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A. The parties agree to the terms and conditions set forth in Exhibit B “Inter-
Agency Agreement – Purpose and Intent” attached hereto and by this reference incorporated herein
and made part of this Agreement.
B. SCHOOL DISTRICTS agree that mental health services provided by COUNTY,
and its contracted providers, under this Agreement are not intended to serve Special Education
students determined to be “Emotionally Disturbed” as defined by the Individuals with Disability Act;
have an Individualized Education Program (IEP); and that COUNTY is not providing these mental
health services as a contractor of SCHOOL DISTRICTS. Each SCHOOL DISTRICT shall be solely
responsible for the mental health treatment requirements of the IEP.
4. TERM
This Agreement shall become effective on the 1st day of July, 2018 and shall terminate
on the 30th day of June, 2021.
This Agreement may be extended for two (2) additional twelve (12) month periods upon
the written approval of both parties not later than sixty (60) days prior to the close of the then current
Agreement term. The COUNTY’s DBH Director or designee is authorized to execute such written
approval on behalf of COUNTY based on CONTRACTOR’s satisfactory performance.
5. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving the SCHOOL DISTRICTS sixty (60) days advance written notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the
COUNTY;
4) Improperly performed service.
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In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default which may then exist on the part of any SCHOOL DISTRICT.
Neither shall such payment impair or prejudice any remedy available to the COUNTY with respect to
the breach or default. The COUNTY shall have the right to demand of the SCHOOL DISTRICT the
repayment to the COUNTY of any funds disbursed to the CONTRACTOR under this Agreement,
which in the judgment of the COUNTY were not expended in accordance with the terms of this
Agreement. The CONTRACTOR shall promptly refund any such funds upon demand.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by SCHOOL DISTRICT or COUNTY or COUNTY’s DBH Director, or
designee, upon the giving of sixty (60) days advance written notice of an intention to terminate.
6. COMPENSATION
The services and obligations conducted pursuant to the terms and conditions of this
Agreement shall be performed without payment of any monetary consideration by any of the parties,
one to the other.
7. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by SCHOOL DISTRICT
under this Agreement, it is mutually understood and agreed that SCHOOL DISTRICT, including any
and all of SCHOOL DISTRICT’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, and its contracted providers, shall have no right to control or supervise or direct the
manner or method by which SCHOOL DISTRICT shall perform its work and function. However,
COUNTY shall retain the right to administer this Agreement so as to verify that each SCHOOL
DISTRICT is performing its obligations in accordance with the terms and conditions thereof.
SCHOOL DISTRICTS, COUNTY, and COUNTY’s contracted providers, shall comply with all
applicable provisions of law and the rules and regulations, if any, of governmental authorities having
jurisdiction over matters which are directly or indirectly the subject of this Agreement.
Because of their status as independent contractors, SCHOOL DISTRICTS shall have
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absolutely no right to employment rights and benefits available to COUNTY employees. SCHOOL
DISTRICTS shall be solely liable and responsible for providing to, or on behalf of, their employees all
legally-required employee benefits. In addition, SCHOOL DISTRICTS shall be solely responsible
and save COUNTY harmless from all matters relating to payment of SCHOOL DISTRICTS’
employees, including compliance with Social Security, withholding, and all other regulations
governing such matters. It is acknowledged that during the term of this Agreement, SCHOOL
DISTRICTS may be providing services to others unrelated to the COUNTY or to this Agreement.
8. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all the parties without, in any way, affecting the remainder.
It is mutually understood that the parties agree to review this Agreement annually and to
revise this Agreement as appropriate so as to assure services are delivered to the satisfaction of the
parties.
9. ADDITIONS/DELETIONS OF SCHOOLS
COUNTY’s DBH Director, or designee, reserves the right at any time during the term of
this Agreement to add SCHOOL DISTRICTS to Exhibit A attached hereto. These same provisions
shall apply to the deletion of any SCHOOL DISTRICTS contained in Exhibit A attached hereto, except
that deletions shall be by mutual written agreement between COUNTY’s DBH Director and the
particular SCHOOL DISTRICTS to be deleted or shall be in accordance with the provisions of
Paragraph Four (4) of this Agreement.
10. NON-ASSIGNMENT
Neither party shall assign, transfer or subcontract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
11. HOLD-HARMLESS
Each SCHOOL DISTRICT agrees to indemnify, save, hold harmless, and at COUNTY's
request, defend the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by each SCHOOL DISTRICT, its
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officers, agents or employees under this Agreement, and from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to any
person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of SCHOOL DISTRICT, its officers, agents or employees under this Agreement.
Each SCHOOL DISTRICT agrees to indemnify COUNTY for Federal, State of California
and/or local audit exceptions resulting from noncompliance herein on the part of the SCHOOL
DISTRICT.
COUNTY agrees to indemnify, save, hold harmless, and at a SCHOOL DISTRICT’S
request, defend the SCHOOL DISTRICT, its officers, agents and employees from any and all costs and
expenses, including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to the SCHOOL DISTRICT in connection with the performance, or failure to perform, by
COUNTY, its officers, agents, or employees under this Agreement, and from any and all costs and
expenses, including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to any person, firm or corporation who may be injured or damaged by the performance, or
failure to perform, of COUNTY, its officers, agents, or employees under this Agreement.
12. CONFIDENTIALITY
All services performed by SCHOOL DISTRICTS under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
Confidentiality of Pupil Records - The COUNTY, and its contracted providers, agree to
obtain the written consent of the pupil’s parent/legal guardian or other person lawfully charged with the
care and custody of the pupil to allow the exchange of necessary educational and medical information
while insuring the confidentiality of each pupil’s record. A copy of the parent/legal guardian’s written
consent form will be kept on file at COUNTY’s DBH client file. No Protected Health Information
(PHI) or other confidential information shall be disclosed by COUNTY, or its contracted providers, to
SCHOOL DISTRICTS without such written consent, or in the event that such written consent is
withdrawn.
13. REFERENCES TO LAWS AND RULES
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In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
14. COMPLIANCE WITH STATE REQUIREMENTS
SCHOOL DISTRICTS recognize that COUNTY operates its mental health programs
under an agreement with the State of California Department of Health Care Services, and that under
said agreement the State imposes certain requirements on COUNTY and its SCHOOL DISTRICTS.
SCHOOL DISTRICTS shall adhere to all State Requirements, including those identified in Exhibit C
“State Mental Health Requirements”, attached hereto and by this reference incorporated herein.
15. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A. The parties to this Agreement shall be in strict conformance with all applicable
Federal and State of California laws and regulations, including but not limited to Sections 5328, 10850,
and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of Title 42,
Code of Federal Regulations (CFR), Section 56 et seq. of the California Civil Code, Sections 11977
and 11812 of Title 22 of the California Code of Regulations, and the Health Insurance Portability and
Accountability Act (HIPAA), including but not limited to Section 1320 D et seq. of Title 42, United
States Code (USC) and its implementing regulations, including, but not limited to Title 45, CFR,
Sections 142, 160, 162, and 164, and The Health Information Technology for Economic and Clinical
Health Act (HITECH) regarding the confidentiality and security of patient information, and the Genetic
Information Nondiscrimination Act (GINA) of 2008 regarding the confidentiality of genetic
information.
Except as otherwise provided in this Agreement, SCHOOL DISTRICTS, as a
Business Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform
functions, activities or services for or on behalf of COUNTY, as specified in this Agreement, provided
that such use or disclosure shall not violate the HIPAA, USC 1320d et seq. The uses and disclosures of
PHI may not be more expansive than those applicable to COUNTY, as the “Covered Entity” under the
HIPAA Privacy Rule (45 CFR 164.500 et seq), except as authorized for management, administrative or
legal responsibilities of the Business Associate.
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B. SCHOOL DISTRICTS shall protect, from unauthorized access, use, or
disclosure of names and other identifying information concerning persons receiving services pursuant
to this Agreement, except where permitted in order to carry out data aggregation purposes for health
care operations [45 CFR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This
pertains to any and all persons receiving services pursuant to a COUNTY funded program. This
requirement applies to electronic PHI. SCHOOL DISTRICTS shall not use such identifying
information for any purpose other than carrying out SCHOOL DISTRICTS obligations under this
Agreement.
C. SCHOOL DISTRICTS shall not disclose any such identifying information to any
person or entity, except as otherwise specifically permitted by this Agreement, authorized by law, or
authorized by the client/patient.
D. For purposes of the above sections, identifying information shall include, but not
be limited to name, identifying number, symbol, or other identifying particular assigned to the
individual, such as finger or voice print, or a photograph.
E. SCHOOL DISTRICTS shall provide access, at the request of COUNTY, and in
the time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR
Section 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR
Section164.524 regarding access by individuals to their PHI.
SCHOOL DISTRICTS shall make any amendment(s) to PHI in a designated
record set at the request of COUNTY, and in the time and manner designated by COUNTY in
accordance with 45 CFR Section 164.526.
SCHOOL DISTRICTS shall provide to COUNTY or to an individual, in a time and
manner designated by COUNTY, information collected in accordance with 45 CFR Section 164.528, to
permit COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in
accordance with 45 CFR Section 164.528.
F. SCHOOL DISTRICTS shall report to COUNTY, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, or breach of
Protected Information not permitted by this Agreement, and any breach of unsecured PHI of which it
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becomes aware, immediately and without reasonable delay and in no case later than two (2) business
days of discovery. Immediate notification shall be made to COUNTY’s Information Security Officer
and Privacy Officer and COUNTY’s DBH HIPAA Representative, within two (2) business days of
discovery. The notification shall include, to the extent possible, the identification of each individual
whose unsecured PHI has been, or is reasonably believed to have been, accessed, acquired, used,
disclosed, or breached. SCHOOL DISTRICTS shall take prompt corrective action to cure any
deficiencies and any action pertaining to such unauthorized disclosure required by applicable Federal
and State Laws and regulations. SCHOOL DISTRICTS shall investigate such breach and is
responsible for all notifications required by law and regulation or deemed necessary by COUNTY and
shall provide a written report of the investigation and reporting required to COUNTY’s Information
Security Officer and Privacy Officer and COUNTY’s DBH HIPAA Representative. This written
investigation and description of any reporting necessary shall be postmarked within the thirty (30)
working days of the discovery of the breach to the addresses below:
County of Fresno County of Fresno County of Fresno
Department of Behavioral Health Dept. of Public Health Information Technology Services
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6798 (559) 600-6405 (559) 600-5800
3147 N. Millbrook Ave P.O. Box 11867 2048 N. Fine Ave
Fresno, CA 93703 Fresno, CA 93775 Fresno, CA 93727
G. Each SCHOOL DISTRICT shall make its internal practices, books, and records
relating to the use and disclosure of PHI received from COUNTY, or created or received by the
SCHOOL DISTRICTS on behalf of COUNTY, available to the United States Department of Health
and Human Services upon demand.
H. Safeguards
SCHOOL DISTRICTS shall implement administrative, physical, and technical
safeguards as required by 45 CFR 164.308, 164.310, and 164.312 that reasonably and appropriately
protect the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates,
receives, maintains or transmits on behalf of COUNTY; and to prevent access, use or disclosure of PHI
other than as provided for by this Agreement. SCHOOL DISTRICTS shall develop and maintain a
written information privacy and security program that includes administrative, technical and physical
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safeguards appropriate to the size and complexity of each SCHOOL DISTRICT’S operations and the
nature and scope of its activities. Upon COUNTY’s request, SCHOOL DISTRICTS shall provide
COUNTY with information concerning such safeguards.
SCHOOL DISTRICTS shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include the
following administrative and technical password controls for all systems used to process or store
confidential, personal, or sensitive data:
1. Passwords must not be:
a. Shared or written down where they are accessible or recognizable
by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area;
b. A dictionary word; or
c. Stored in clear text
2. Passwords must be:
a. Eight (8) characters or more in length;
b. Changed every ninety (90) days;
c. Changed immediately if revealed or compromised; and
d. Composed of characters from at least three of the following four
groups from the standard keyboard:
1) Upper case letters (A-Z);
2) Lowercase letters (a-z);
3) Arabic numerals (0 through 9); and
4) Non-alphanumeric characters (punctuation symbols).
SCHOOL DISTRICTS shall implement the following security controls on each
workstation or portable computing device (e.g., laptop computer) containing confidential,
personal, or sensitive data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
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3. Patch management process including installation of all operating
system/software vendor security patches.
SCHOOL DISTRICTS shall utilize a commercial encryption solution that has
received FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
SCHOOL DISTRICTS shall not transmit confidential, personal, or sensitive data
via e-mail or other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the Advanced
Encryption Standard (AES) Algorithm.
I. Mitigation of Harmful Effects
SCHOOL DISTRICTS shall mitigate, to the extent practicable, any harmful effect
that is known to SCHOOL DISTRICTS of an unauthorized access, viewing, use, disclosure, or breach
of PHI by SCHOOL DISTRICTS or their Subcontractors in violation of the requirements of these
provisions.
J. CONTRACTORS’S SUBCONTRACTORS
SCHOOL DISTRICTS shall ensure that any of their contractors, including
Subcontractors, if applicable, to whom SCHOOL DISTRICTS provide PHI received from or created or
received by SCHOOL DISTRICTS on behalf of COUNTY, agree to the same restrictions and
conditions that apply to SCHOOL DISTRICTS with respect to such PHI; and to incorporate, when
applicable, the relevant provisions of these provisions into each subcontract or sub-award to such
agents or SCHOOL DISTRICTS.
K. Employee Training and Discipline
SCHOOL DISTRICTS shall train and use reasonable measures to ensure
compliance with the requirements of these provisions by employees who assist in the performance of
functions or activities on behalf of COUNTY under this Agreement and use or disclose PHI and
discipline such employees who intentionally violate any provisions of these provisions, including
termination of employment.
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L. Termination for Cause
Upon COUNTY’s knowledge of a material breach of these provisions by a SCHOOL
DISTRICT, COUNTY shall either:
1. Provide an opportunity for SCHOOL DISTRICT to cure the breach or
end the violation and terminate this Agreement if SCHOOL DISTRICT does not cure the breach or end
the violation within the time specified by COUNTY; or
2. Immediately terminate this Agreement if SCHOOL DISTRICT has
breached a material term of these provisions and cure is not possible.
3. If neither cure nor termination is feasible, the COUNTY Privacy Officer
shall report the violation to the Secretary of the U.S. Department of Health and Human Services.
M. Judicial or Administrative Proceedings
COUNTY may terminate this Agreement in accordance with the terms and
conditions of this Agreement as written hereinabove, if: (1) A SCHOOL DISTRICTS is found guilty
in a criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or
(2) a finding or stipulation that the SCHOOL DISTRICT has violated a privacy or security standard or
requirement of the HITECH Act, HIPAA; or other security or privacy laws in an administrative or civil
proceeding in which the SCHOOL DISTRICT is a party.
N. Effect of Termination
Upon termination or expiration of this Agreement for any reason, SCHOOL
DISTRICT shall return or destroy all PHI received from COUNTY (or created or received by
SCHOOL DISTRICTS on behalf of COUNTY) that SCHOOL DISTRICT still maintains in any form,
and shall retain no copies of such PHI. If return or destruction of PHI is not feasible, it shall continue
to extend the protections of these provisions to such information, and limit further use of such PHI to
those purposes that make the return or destruction of such PHI infeasible. This provision shall apply to
PHI that is in the possession of SCHOOL DISTRICTS or agents, if applicable, of SCHOOL
DISTRICTS. If SCHOOL DISTRICT destroys the PHI data, a certification of date and time of
destruction shall be provided to the COUNTY by SCHOOL DISTRICTS.
O. Disclaimer
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COUNTY makes no warranty or representation that compliance by SCHOOL
DISTRICTS with these provisions, the HITECH Act, HIPAA or the HIPAA regulations will be
adequate or satisfactory for SCHOOL DISTRICTS own purposes or that any information in SCHOOL
DISTRICTS possession or control, or transmitted or received by SCHOOL DISTRICTS, is or will be
secure from unauthorized access, viewing, use, disclosure, or breach. SCHOOL DISTRICTS are solely
responsible for all decisions made by SCHOOL DISTRICTS regarding the safeguarding of PHI.
P. Amendment
The parties acknowledge that Federal and State laws relating to electronic data
security and privacy are rapidly evolving and that amendment of these provisions may be required to
provide for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards and
requirements of HIPAA, the HIPAA regulations, the HITECH Act and other applicable laws relating to
the security or privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days written
notice in the event that SCHOOL DISTRICTS does not enter into an amendment providing assurances
regarding the safeguarding of PHI that COUNTY in its sole discretion deems sufficient to satisfy the
standards and requirements of HIPAA, the HIPAA regulations and the HITECH Act.
Q. No Third-Party Beneficiaries
Nothing express or implied in the terms and conditions of these provisions is
intended to confer, nor shall anything herein confer, upon any person other than COUNTY or
SCHOOL DISTRICTS and their respective successors or assignees, any rights, remedies, obligations
or liabilities whatsoever.
R. Interpretation
The terms and conditions in these provisions shall be interpreted as broadly as
necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws.
The parties agree that any ambiguity in the terms and conditions of these provisions shall be resolved in
favor of a meaning that complies and is consistent with HIPAA and the HIPAA regulations.
S. Regulatory References
A reference in the terms and conditions of these provisions to a section in the
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HIPAA regulations means the section as in effect or as amended.
T. Survival
The respective rights and obligations of SCHOOL DISTRICTS as stated in this
Section shall survive the termination or expiration of this Agreement.
U. No Waiver of Obligations
No change, waiver or discharge of any liability or obligation hereunder on any
one or more occasions shall be deemed a waiver of performance of any continuing or other obligation,
or shall prohibit enforcement of any obligation on any other occasion.
16. NON-DISCRIMINATION
During the performance of this Agreement SCHOOL DISTRICTS shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religion, color, national origin, ancestry, physical disability, medical condition, marital status, age
or gender, pursuant to all applicable State of California and Federal statutes and regulations.
17. SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among SCHOOL DISTRICTS. By execution of this Agreement, SCHOOL
DISTRICTS understand that a separate Agreement is formed between each individual SCHOOL
DISTRICT and COUNTY.
18. ENGLISH PROFICIENCY
COUNTY shall provide interpreting and translation services to persons participating in
COUNTY mental health services who have limited or no English language proficiency, including
services to persons who are deaf or blind. Interpreter and translation services shall be provided as
necessary to allow such participants meaningful access to the program, services and benefits provided
by COUNTY, and its contracted providers. Interpreter and translation services, including translation of
COUNTY “vital documents” (those documents that contain information that is critical for accessing
COUNTY services or are required by law) shall be provided to participants at no cost to the participant.
COUNTY, and its contracted providers, shall ensure that any employees, agents, schools, or partners
who interpret or translate for a program participant, or who directly communicate with a program
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participant in a language other than English, demonstrate proficiency in the participant’s language and
can effectively communicate any specialized terms and concepts peculiar to COUNTY mental health
services.
19. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
SCHOOL DISTRICTS are required to disclose if any of the following conditions apply
to them, their owners, officers, corporate managers and partners:
A. Within the three-year pe riod preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract under a public
transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate SCHOOL
DISTRICTS from further business consideration. The information will be considered as part of the
determination of whether to continue and/or renew the contract and any additional information or
explanation that a SCHOOL DISTRICTS elects to submit with the disclosed information will be
considered. If it is later determined that the SCHOOL DISTRICTS failed to disclose required
information, any contract awarded to such SCHOOL DISTRICTS may be immediately voided and
terminated for material failure to comply with the terms and conditions of the award.
SCHOOL DISTRICTS must sign an appropriate “Certification Regarding Debarment,
Suspension, and Other Responsibility Matters”, Exhibit D attached hereto and by this reference
incorporated herein. Additionally, SCHOOL DISTRICTS must immediately advise the COUNTY in
writing if, during the term of the agreement: (1) SCHOOL DISTRICTS becomes suspended, debarred,
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excluded or ineligible for participation in federal or state funded programs or from receiving federal
funds as listed in the excluded parties list system (http://www/epls/gov); or (2) any of the above listed
conditions become applicable to SCHOOL DISTRICTS. The SCHOOL DISTRICTS will indemnify,
defend and hold the COUNTY harmless for any loss or damage resulting from a conviction,
debarment, exclusion, ineligibility or other matter listed in the signed Certification Regarding
Debarment, Suspension, and Other Responsibility Matters.
20. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the SCHOOL DISTRICTS is operating as a
corporation (a for-profit or non-profit corporation) or if during the term of this Agreement, the
SCHOOL DISTRICTS changes its status to operate as a corporation.
Members of the SCHOOL DISTRICTS’s Board of Directors shall disclose any self-
dealing transactions that they are a party to while SCHOOL DISTRICTS is providing goods or
performing services under this agreement. A self-dealing transaction shall mean a transaction to which
the SCHOOL DISTRICT is a party and in which one or more of its directors has a material financial
interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are a
party to by completing and signing a Self-Dealing Transaction Disclosure Form Exhibit E and
submitting it to the COUNTY prior to commencing with the self-dealing transaction or immediately
thereafter.
21. AUDITS AND INSPECTIONS
The SCHOOL DISTRICTS shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. The SCHOOL DISTRICTS shall, upon
request by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary
to ensure SCHOOL DISTRICTS compliance with the terms of this Agreement.
22. COMPLAINTS
SCHOOL DISTRICTS shall log complaints and the disposition of all complaints from a
client or a client’s family. SCHOOL DISTRICTS shall provide a copy of the detailed complaint log
entries concerning COUNTY-sponsored clients to COUNTY DBH at monthly intervals by the tenth
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(10th) day of the following month, in a format that is mutually agreed upon. In addition, SCHOOL
DISTRICTS shall provide details and attach documentation of each complaint with the log. SCHOOL
DISTRICTS shall post signs informing clients of their right to file a complaint or grievance. SCHOOL
DISTRICTS shall notify COUNTY DBH of all incidents reportable to State licensing bodies that affect
COUNTY clients within twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY clients,
SCHOOL DISTRICTS shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and SCHOOL DISTRICT’s disposition of, or
corrective action taken to resolve the complaint. In addition, SCHOOL DISTRICT shall inform every
client of their rights as set forth in Exhibit F. SCHOOL DISTRICT shall file an incident report for all
incidents involving clients, following the protocol and using the worksheet identified in Exhibit G and
incorporated herein by reference and made part of this Agreement.
23. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY SCHOOL DISTRICTS
Director, Fresno County (See Exhibit A)
Department of Behavioral Health
3133 N Millbrook Ave
Fresno, CA 93703
All notices between the COUNTY and CONTRACTOR provided for or permitted under
this Agreement must be in writing and delivered either by personal service, by first-class United States
mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A notice
delivered by personal service is effective upon service to the recipient. A notice delivered by first-class
United States mail is effective three COUNTY business days after deposit in the United States mail,
postage prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service
is effective one COUNTY business day after deposit with the overnight commercial courier service,
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if
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such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed to
be effective at the next beginning of a COUNTY business day), provided that the sender maintains a
machine record of the completed transmission. For all claims arising out of or related to this Agreement,
nothing in this section establishes, waives, or modifies any claims presentation requirements or procedures
provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the
Government Code, beginning with section 810).
24. GOVERNING LAW
The parties agree, that for the purposes of venue, performance under this Agreement is
to be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
25. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire Agreement between the
SCHOOL DISTRICTS and COUNTY with respect to the subject matter hereof and supersedes all
previous agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
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IN WITNESS WH EREOF, the parti es h e re to have execute d thi s Agreem e nt as of the day and
year firs t he re ina b ove writte n.
ATT EST:
SCHOOL DISTRICTS
PLEASE SEE ADDITIONAL
SIGNATURES PAGES ATTACHED
Fu nd/S u bclass: 000 1/10 0 00
Organi zati on : 56304 3 1 1/563 0 43 12
Accoun t/Program: 7295 /0
COUNTY OF FRESNO
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Sal m r
C ha irperson o th e Board of S uperv isors
of th e County of F res no
Date: 7-10-1~
ATTEST:
BERNICE E. SEID E L ,
C le rk of the B oard of S upervisors
County o f F res no, State of Cali fo rni a
B y ~.-\S 1td\-~3bDf
D eput y
Date: _7_,__-~) D=---...:.....:\ fr:><--_
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PLEASE SEE ADDITIONAL
SIGNATU RE PAGES ATTACHED
C:OUN'IY O F FRES 0
Fresno, CJ\
Exhibit A
Page 1 of 1
SCHOOL DISTRICTS
The following is the list of SCHOOL DISTRICTS, where the COUNTY will be
providing children’s mental health services:
CENTRAL UNIFIED SCHOOL DISTRICT
4605 N. Polk Avenue
Fresno, CA 93722
Phone No.: (559) 274-4700
Contact: Superintendent
http://www.centralunified.org/home
FIREBAUGH-LAS DELTAS JOINT UNIFIED
1976 Morris Kyle Drive
Firebaugh, CA 93622-9711
Phone No.: (559) 659-1476
Contact: Superintendent
https://www.fldusd.org/
FOWLER UNIFIED
658 E. Adams Ave
Fowler, CA 93625
Phone No.: (559) 834-6080
http://www.fowler.k12.ca.us./
FRESNO UNIFIED SCHOOL DISTRICT
2309 Tulare Street
Fresno, CA 93721
Phone No.: (559) 457-3882
Contact: Superintendent
http://www.fresno.k12.ca.us
KERMAN UNIFIED SCHOOL DISTRICT
151 South First
Kerman, CA 93630-1029
Phone No.: (559) 846-5383
Contact: Superintendent
www.kermanusd.k12
PARLIER UNIFIED SCHOOL DISTRICT
900 Newmark Ave.
Parlier, CA 93648-2034
Phone No.: (559) 646-2731
Fax: (559) 888-0210
Contact: Esperanza Zendejas, Ed. D., Superintendent
www.parlierunified.org
Exhibit B
Page 1 of 4
Inter-Agency Agreement – Purpose and Intent
School Collaboration with the Fresno County Department of Behavioral Health
for On-Site Children’s Mental Health Services
This Agreement formalizes a partnership between Fresno County (County) and
various School Districts in Fresno County to increase access to mental health
services for students of the Districts by having Children’s Mental Health Services
on school sites in Fresno, Clovis and in the rural communities of Fresno County.
The target population of school-based mental health treatment services is Medi-
Cal and uninsured students who are un-served or underserved through
traditional mental health programs. Services are provided by the Department of
Behavioral Health, School Based Team (SBT), and its contracted providers, for
both metropolitan (metro) and rural areas. The selection of school sites is a
collaborative decision by the Districts and Department of Behavioral Health
(DBH) with priority given to those with a high percentage of Medi-Cal and
uninsured pupils and where there are little or no mental health resources on their
campuses.
The County’s Department of Behavioral Health Director, or designee, or the
school districts, may request to convene for review and revision of the program
design as policies and regulations change.
A. Selection of School Sites:
The School District will identify an educational coordinator to work collaboratively
with DBH staff to identify school sites to be served prior to school year based on:
1. The degree of unmet mental health needs and lack of mental health
resources available on campus.
2. The number of referrals received from the school during the current school
year and the caseload capacity and amount of direct client services
provided by the DBH clinician at each of his/her assigned school site.
3. The ability of the school to provide a confidential space for the DBH staffs
to meet with children and families that include a telephone, electrical outlet
for a computer lap top and printer. School sites that do not have
appropriate confidential space will not continue to receive SBT services.
The number of designated school sites per District will be determined by a
review of the previous school year’s referral rate and access to
appropriate confidential space.
4. Support by school staffs to facilitate attendance to scheduled mental
health appointments.
5. Determine the plan for continuation of mental health services during
school holidays, State testing, summer breaks, etc.
Exhibit B
Page 2 of 4
6. Determine the transition of mental health services when school-based
mental health services are discontinued.
7. The District Coordinator/ school administrative staff and DBH will develop
guidelines as to the selection/de-selection process of designated school
sites within each school district.
In order to avoid a disruption in the therapeutic relationship between the student
and DBH clinician, it is advisable that the Districts and DBH mutually agree to
changes in the schools to be served no later than 30 days prior to the end of the
school year. This early identification of schools will enable mental health
services to begin during the summer in advance of the start of the school year.
Rural: schools under each district will be included in the MOU, to allow for
flexibility of the assigned rural clinical staff to be able to meet the needs of rural
clients in various school sites, based on current caseload need. The need will be
monitored by the Clinical Supervisor and clinical staff, and they will have ongoing
contact to meet the needs of the rural communities.
Confidential Space:
1. Ensures children’s mental health services can be conducted in the manner
that fulfills State and Federal confidentiality requirements.
2. Does not allow the conversation between the student, therapist and/or
family to be heard outside of the confidential space.
3. Will not be accessed by school staffs during therapy sessions.
4. If there are windows that are viewable by anyone outside of the
confidential area/room, then the district will provide blinds, curtains or
other coverings to protect the confidentiality of each student in treatment
in accordance with the school and DBH policies.
5. Promotes the safety and well-being of each student and be maintained in
good working order.
6. Room size: large enough to conduct individual and family sessions.
Telephones: The schools shall provide a telephone in the confidential
office/space used by the DBH clinician or case manager for their day-to-day
work, consultations and collaborations regarding their clients/students. If no
phones are available, a hand-held two-way radio will be provided to the DBH
clinician with training on how to use it for the clinician’s safety and that of the
students.
B. Referral Process:
For Central, Clovis and Fresno Unified School Districts (Metro SBT): The
Administration of the school sites shall educate school staff regarding referrals
for mental health services by the second week of the fall semester. Each school
site will designate a staff person to coordinate the referral process. The staff
coordinator shall be responsible for speaking with the parent or legal guardian of
Exhibit B
Page 3 of 4
the student (if student is a minor) and the student that a referral for children’s
mental health services has been made. If the parent objects to the mental health
referral, the referral process will not proceed. The mental health (MH) clinician
will determine the student’s insurance eligibility obtain parental consent before
determining the medical necessity of each referral. The MH clinician will keep
track of each referral and provide the Staff coordinator of the status of each
referral on a monthly basis. The Staff coordinator and the MH clinician will
convene monthly with associated staff to discuss stability and well-being of each
referred student.
Meetings to increase communication and collaboration between appropriate
school staffs and the DBH school-based clinicians will be held as needed to
discuss the student’s progress toward meeting mental health treatment goals and
other supportive services that may be needed.
Rural School Districts (Rural SBT): Referrals will be generated by school staff,
parents/legal guardians, Department of Social Services - Social Workers,
community agencies, County, DBH in-house programs, contract providers, self-
referrals, etc. The referrals will be given to the assigned rural clinical staff. For
each rural school campus, the DBH clinical staff will interface with school staff on
each campus in which they utilize space, as needed.
DBH Procedures and timeliness of services:
1. Upon receipt of a referral from the school, the DBH staff shall review the
appropriateness of the referral and begin the intake process within five (5)
working days by contacting the parent/legal guardian.
2. Upon completion of the intake process, a mental health assessment will
be scheduled.
3. It is understood that the provision of mental health services is voluntary
and the families may decline services at any point in the treatment
process.
4. Parents who do not keep their scheduled appointment will be contacted
and rescheduled based on scheduling availability and acuity of
impairment experienced by the student receiving services.
5. Each student’s access to treatment services will be triaged based on
acuity and urgency to initiate mental health services.
6. Parent/legal guardian are expected to participate in assessment,
treatment planning and ongoing treatment services as determined by the
MH clinician,
7. The Parent/legal guardian will be advised at the conclusion of the
assessment interview whether or not their child’s symptoms meet Medi-
Cal medical necessity criteria and when treatment services will begin.
8. If no services are warranted, the rationale will be explained to both the
parent/legal guardian and the Staff Coordinator.
Exhibit B
Page 4 of 4
9. The DBH Clinician will inform the Staff Coordinator when program
capacity has been reached, services can be provided, and/or other
options that may be available.
C. Monitoring:
DBH will monitor the number and outcome of referrals and students engaged in
mental health services and communicate with school staff to determine if any
changes in the day-to-day operations are needed. Rural school sites within a
community will be monitored by the clinical staff and Clinical Supervisor and
changes will be made based on the need of the clients and communities
involved. Staff will determine school sites based on caseload need.
D. DBH procedures for ongoing treatment:
1. The DBH clinician will work collaboratively with school staff to determine
an appropriate schedule for ongoing services that will not negatively
impact the student’s educational needs
2. At the beginning of the day, DBH staff will provide the office manager or
other designee with a list of students who are scheduled to be seen will be
seen that day.
3. School staff will advise DBH staff whether or not the student is present
and assist with having the student summoned for his/her appointment.
4. At Rural school sites, assigned clinical staff will be responsible to work
with each individual school staff on each campus or agencies regarding
appointments and availability of the students on campus.
Exhibit C
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit C
Page 2 of 6
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under this
Agreement were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with
the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and CCR, Title 2,
Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and,
Exhibit C
Page 3 of 6
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et
seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies
that no more than one (1) final unappealable finding of contempt of court by a Federal
court has been issued against Contractor within the immediately preceding two-year
period because of Contractor's failure to comply with an order of a Federal court, which
orders Contractor to comply with an order of the National Labor Relations Board. (Pub.
Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January 1,
2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30
multiplied by the number of full time attorneys in the firm’s offices in the State, with the
number of hours prorated on an actual day basis for any contract period of less than a full
year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or
corresponding accessories, or the procurement of equipment, materials, or supplies, other
than procurement related to a public works contract, declare under penalty of perjury that
no apparel, garments or corresponding accessories, equipment, materials, or supplies
furnished to the state pursuant to the contract have been laundered or produced in whole
or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal
sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or
with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under
Exhibit C
Page 4 of 6
penal sanction, abusive forms of child labor or exploitation of children in sweatshop
labor. The contractor further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial
Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The contractor agrees to cooperate fully in providing reasonable access to the
contractor’s records, documents, agents or employees, or premises if reasonably required
by authorized officials of the contracting agency, the Department of Industrial Relations,
or the Department of Justice to determine the contractor’s compliance with the
requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and
which is sponsored or funded by any state agency, unless the employment, activity or
enterprise is required as a condition of regular state employment.
2). No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
1). For the two-year period from the date he or she left state employment, no former state
officer or employee may enter into a contract in which he or she engaged in any of the
negotiations, transactions, planning, arrangements or any part of the decision-making
process relevant to the contract while employed in any capacity by any state agency.
2). For the twelve-month period from the date he or she left state employment, no former
state officer or employee may enter into a contract with any state agency if he or she was
Exhibit C
Page 5 of 6
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the
State with a copy of a resolution, order, motion, or ordinance of the local governing body
Exhibit C
Page 6 of 6
which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor
shall not be: (1) in violation of any order or resolution not subject to review promulgated
by the State Air Resources Board or an air pollution control district; (2) subject to cease
and desist order not subject to review issued pursuant to Section 13301 of the Water
Code for violation of waste discharge requirements or discharge prohibitions; or (3)
finally determined to be in violation of provisions of federal law relating to air or water
pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for 10 years from the final date of the contract
period or from the date of completion of any audit, whichever is later.
Federal database checks. Consistent with the requirements at § 455.436 of this chapter,
the State must confirm the identity and determine the exclusion status of
CONTRACTOR, any subcontractor, as well as any person with an ownership or control
interest, or who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the List of
Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and
any other databases as the State or Secretary may prescribe. These databases must be
consulted upon contracting and no less frequently than monthly thereafter. If the State
finds a party that is excluded, it must promptly notify the CONTRACTOR and take
action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this part
is not located outside of the United States and that no claims paid by a CONTRACTOR
to a network provider, out-of-network provider, subcontractor or financial institution
located outside of the U.S. are considered in the development of actuarially sound
capitation rates.
Exhibit D
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED
TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
Exhibit D
Page 2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)”
Exhibit E
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit E
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature: Date:
Exhibit F
Page 1 of 2
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers’ offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit F
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process – the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider’s claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints – if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
Exhibit G
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit G
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date