HomeMy WebLinkAbout30403Agreement No. 17-545
CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
Annual Medi-Cal Cost Avoidance Program Certificate of Compliance
Fiscal Year 2017/2018
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 by the CalVet 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 CW-5 (Veterans
Benefits Referral) and/or 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 CalVet Procedure
Manual for Subvention and Medi-Cal Cost Avoidance for the current state fiscal
year.
Brian Pacheco, Chairman
County Board of Supervisors ATTEST:
BERNICE E. SEIDEL
Clerk to the Board of Supervisors
Co~o, ate of California
. By
SCAN AND UPLOAD THIS COMPLETED FORM VIA THE AGENCY
ATTACHMENTS IN VETPRO
(Rev 6117)