HomeMy WebLinkAboutAgreement A-22-176.pdf Agreement No. 22-176
1 AGREEMENT
2
3 THIS AGREEMENT is made and entered into this V day of May, 2022, by and between the
4 COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
5 "COUNTY", and each Contractor listed in Exhibit A, "Drug Medi-Cal Services Vendor List," attached hereto
6 and by this reference incorporated herein, collectively herein after referred to as "CONTRACTOR", and
7 such additional CONTRACTOR as may, from time to time during the term of this Agreement, be added by
8 COUNTY. Reference in this Agreement to "party" or"parties" shall be understood to refer to COUNTY and
9 each CONTRACTOR, unless otherwise specified.
10 WITNESSETH:
11 WHEREAS, COUNTY is authorized through its Intergovernmental Agreement with the California
12 Department of Health Care Services, hereinafter referred to as State or DHCS, to subcontract for Drug
13 Medi-Cal services (DMC) in Fresno County; and
14 WHEREAS, COUNTY is authorized to contract with privately operated agencies for the provision
15 of alcohol and other drug treatment services, pursuant to Title 9, Division 4 of the California Code of
16 Regulations and Division 10.5 (commencing with Section 11750) of the California Health and Safety
17 Code; and
18 WHEREAS, CONTRACTOR(S) are certified by the State to provide services required by the
19 COUNTY, pursuant to the terms and conditions of this Agreement.
20 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
21 contained, the parties hereto agree as follows:
22 1. SERVICES
23 A. CONTRACTOR shall fulfill all the responsibilities of providing Drug Medi-Cal
24 substance use disorder treatment services at State certified locations to eligible persons served of Fresno
25 County, as identified in this Agreement, including all Exhibits, incorporated herein by reference and made
26 part of this Agreement.
27
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1 B. CONTRACTOR shall provide services as described in Exhibit B, Modality of Service
2 Descriptions, attached hereto and incorporated by this reference.
3 C. CONTRACTOR shall comply with requirements stated within the Intergovernmental
4 Agreement as listed in Exhibit C, Drug Medi-Cal Specific Requirements, attached hereto and by this
5 reference incorporated herein; and with all other provisions set forth in the Intergovernmental Agreement,
6 made available by the Department of Behavioral Health (DBH) at the following web address and by this
7 reference incorporated herein: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
8 providers/contract-providers/substance-use-disorder-providers. CONTRACTOR is referred to therein as
9 "Subcontractor" and COUNTY is referred to therein as "Contractor."
10 D. CONTRACTOR shall comply with the Fresno County Substance Use Disorder
11 (FCSUD) Provider Manual, herein after referred to as the "Provider Manual" and by this reference
12 incorporated herein, available at the DBH website at:
13 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
14 providers/substance-use-disorder-providers. No formal amendment of this agreement is required for
15 changes to the Provider Manual to apply.
16 E. CONTRACTOR shall align program, services, and practices with the vision and
17 mission within Exhibit D, DBH Guiding Principles of Care Delivery, attached hereto and by this reference
18 incorporated herein. Contractor may be required to utilize and integrate clinical tools such as Reaching
19 Recovery at DBH's discretion.
20 Employees involved in a crisis incident should be offered appropriate Employee
21 Assistance Program (EAP) or similar related wellness and recovery assistance. In conjunction with the
22 County DBH's Principles of Care delivery and wellness of the workforce, Contractors shall align their
23 practices around this vision and ensure needed debriefing services are offered to all employees involved
24 in a crisis incident. Employees shall be afforded all services to strengthen their recovery and wellness
25 related to the crisis incident. Appropriate follow-up with the employee shall be carried out and a plan for
26 workforce wellness shall be submitted to the County's DBH.
27 F. CONTRACTORs must complete intake for all persons served (including persons
28 served referred by Drug Court or Probation) within timeframes specified below from initial contact:
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1 1) Outpatient and Intensive Outpatient within ten (10) business days;
2 2) Opioid Treatment Programs (OTP) within three (3) business days; and
3 3) Residential services within ten (10) business days.
4 4) Contractors shall comply with reporting requirements of Court or Probation
5 relating to beneficiary status change and treatment progress if an appropriate Release of Information
6 (ROI) is in place.
7 G. CONTRACTOR shall maintain, at CONTRACTOR's cost, a computer system
8 compatible with COUNTY's current billing and electronic health record (EHR) system for the provision of
9 submitting information required under the terms and conditions of this Agreement. CONTRACTOR shall
10 complete billing and EHR data entry as follows: initial contact, when applicable; admissions; California
11 Outcomes Measurement System (CaIOMS) reporting; American Society of Addiction Medicine (ASAM)
12 level of care reporting; discharge; and no show/missed appointments and referrals.
13 H. CONTRACTOR's staff will be required to attend regularly occurring meetings such
14 as Cultural Humility Committee and All-Provider Meetings and trainings on an as-needed basis, which
15 includes but is not limited to, trainings related to SUD treatment, fiscal processes, cultural competency,
16 compliance and reporting requirements. Refer to the Annual Provider Training Plan available on the
17 provider webpage at: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
18 providers/contract-providers/substance-use-disorder-providers.
19 2. ADDITIONS/DELETIONS OF CONTRACTOR(S)
20 COUNTY's DBH Director, or his or her designee, reserves the right at any time during the
21 term of this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A, "DMC Services Vendor
22 List." It is understood any such additions will not affect compensation paid to the other CONTRACTOR(S),
23 and therefore such additions may be made by COUNTY without notice to or approval from other
24 CONTRACTOR(S) under this Agreement. These same provisions shall apply to the deletion of any
25 CONTRACTOR listed in Exhibit A, "DMC Services Vendor List," except that deletions shall be made by
26 written mutual agreement between the COUNTY and the particular CONTRACTOR to be deleted or shall
27 be in accordance with the provisions of Section Four (4), TERMINATION, of this Agreement.
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1 3. TERM
2 The term of this Agreement shall be for a period of three (3) years, commencing on July 1,
3 2022 through and including June 30, 2025. This Agreement may be extended for two (2) additional
4 consecutive twelve (12) month periods upon written approval of both parties no later than thirty(30)days
5 prior to the first day of the next twelve (12) month extension period. The DBH Director, or his or her
6 designee, is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR's
7 satisfactory performance.
8 4. TERMINATION
9 A. Non-Allocation of Funds-The terms of this Agreement, and the services to be
10 provided hereunder, are contingent on the approval of funds by the appropriating government agency.
11 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
12 terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
13 B. Breach of Contract- The COUNTY may immediately suspend or terminate this
14 Agreement in whole or in part, wherein the determination of the COUNTY there is:
15 1) An illegal or improper use of funds;
16 2) A failure to comply with any term of this Agreement;
17 3) A substantially incorrect or incomplete report submitted to the COUNTY; or
18 4) Improperly performed service.
19 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
20 breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
21 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
22 default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
23 COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
24 the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
25 shall promptly refund any such funds upon demand.
26 C. Without Cause - Under circumstances other than those set forth above, this
27 Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of
28 an intention to terminate to CONTRACTOR.
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1 D. Voluntary Termination of Intergovernmental Agreement - The COUNTY may
2 terminate its Agreement with DHCS at any time, for any reason, by giving sixty (60) days written notice
3 to DHCS. In the event the Intergovernmental Agreement is terminated, COUNTY may terminate this
4 contractor agreement. CONTRACTOR shall be paid for services provided to beneficiaries up to the date
5 of termination.
6 5. COMPENSATION
7 A. COMPENSATION - In no event shall services performed under this Agreement be
8 in excess of annually negotiated reimbursement rates agreed upon by COUNTY and CONTRACTOR
9 during the term of this Agreement and approved by DHCS, incorporated herein as Exhibit E, "Fresno
10 County Drug Medi-Cal Rates" as updated annually. In no event will the negotiated reimbursement rates
11 be in excess of the COUNTY's maximum rate approved by DHCS. It is understood that all expenses
12 incidental to CONTRACTOR's performance of services under this Agreement shall be borne by
13 CONTRACTOR.
14 1) COUNTY shall reimburse non-NTP CONTRACTOR(S) the negotiated
15 contractor-specific rates. Contractor rates cannot exceed the DHCS-approved county maximum rates
16 established in the annual fiscal plan.
17 2) COUNTY shall reimburse NTP CONTRACTOR(S) the lesser of the
18 uniform statewide daily reimbursement rate, as published annually by DHCS and incorporated in to
19 Exhibit E, or the CONTRACTOR's usual or customary charge to the public.
20 3) Payments by COUNTY shall be in arrears, based on CONTRACTOR's
21 monthly invoices submitted for services provided during the preceding month, within forty-five (45) days
22 after receipt, verification and approval of CONTRACTOR's monthly invoices by COUNTY's DBH. If
23 payment for services is denied or disallowed by State, and subsequently resubmitted to COUNTY by
24 CONTRACTOR, disallowed portion will be withheld from the next reimbursement to CONTRACTOR
25 until COUNTY has received reimbursement from State for said services. If CONTRACTOR is not in
26 compliance with periodic reporting requirements as described in Exhibit F, Provider Reporting
27 Requirements, then payments shall be held until compliance is achieved.
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1 4) CONTRACTOR must accept, as payment in full, the amounts paid by
2 DHCS in accordance with the Intergovernmental Agreement. CONTRACTOR may not demand any
3 additional payments from DHCS, person served, or other third-party payers.
4 5) CONTRACTOR shall comply with 45 CFR 162.410(a)(1) for any subpart
5 that would be a covered health care provider if it were a separate legal entity. For purposes of this
6 paragraph, a covered health care provider shall have the same definition as set forth in 45 CFR
7 160.103. DHCS shall make payments for covered services only if CONTRACTOR is in compliance with
8 federal regulations.
9 B. COMPLIANCE — If CONTRACTOR should fail to comply with any provision of this
10 Agreement, COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR's and
11 COUNTY's obligations under this section shall survive the termination of this Agreement with respect to
12 services provided during the term of this Agreement without regard to the cause of termination of this
13 Agreement.
14 C. QUALITY ASSURANCE — For services rendered herein, CONTRACTOR shall
15 assure that an on-going quality assurance component is in place and is occurring. CONTRACTOR shall
16 assure that clinical records for each participant are of such detail and length that a review of said record
17 will verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates
18 that appropriate services were not provided, COUNTY reserves the right to withhold payment for the
19 applicable unit(s) of service.
20 D. PUBLIC INFORMATION — CONTRACTOR shall disclose its funding source in all
21 public information. Communication products must follow DBH graphic standards, including typefaces
22 and colors, to communicate our authority and project a unified brand. This includes all media types and
23 channels and all materials on and offline that are created as part of DBH's efforts to provide information
24 to the public. Communication products must include a funding acknowledgement determined by the
25 level of funding provided by DBH as follows:
26 1) A Program of Fresno County Department of Behavioral Health (100%
27 funded);
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1 2) Funding provided by Fresno County Department of Behavioral Health
2 (50% or more funded);
3 3) Funded, in part, by County of Fresno Department of Behavioral Health
4 (less than 50% funded); and
5 4) A partnership, with funding by Fresno County department of Behavioral
6 Health (any funding amount).
7 E. LOBBYING ACTIVITY— CONTRACTOR shall not directly or indirectly use any of
8 the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
9 support or defeat legislation pending before the Congress of the United States or the Legislature of the
10 State of California.
11 F. POLITICAL ACTIVITY— CONTRACTOR shall not directly or indirectly use any of
12 the funds under this Agreement for any political activity or to further the election or defeat of any
13 candidate for public office.
14 6. INVOICING
15 A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
16 compensation at negotiated Drug Medi-Cal rates. CONTRACTOR shall enter billing information into the
17 COUNTY's designated information system by the fifteenth (15th) of every month. Billing process shall be
18 in accordance with the DHCS DMC Billing Manual, and by this reference incorporated herein, available
19 at the DBH website at https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
20 providers/contract-providers/substance-use-disorder-providers. In addition to billing, non-NTP
21 CONTRACTOR(S) shall submit on a monthly basis by the twenty-fifth (25th), an Operational Expense
22 Report, per modality of service, along with a general ledger, payroll register and supporting
23 documentation for any line items selected. For the purposes of verifying that costs are allowable and
24 equitable, CONTRACTOR shall submit any additional documentation as deemed necessary by DBH.
25 Non-NTP CONTRACTORs are all CONTRACTORs that are not DEA licensed Narcotic Treatment
26 Programs.
27 B. CONTRACTORs that elect to use the COUNTY's electronic health records
28 system (EHR) shall be invoiced in arrears by the fifth (5th) day of the month for the prior month's hosting
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1 fee for access to COUNTY's EHR in accordance with the fee schedule set forth in Exhibit G, "Electronic
2 Health Records Software Charges," attached hereto and incorporated herein by this reference and
3 made part of this Agreement. COUNTY shall invoice CONTRACTOR(S) annually for the annual
4 maintenance and licensing fee for access to COUNTY's electronic information system in accordance
5 with the fee schedule as set forth in Exhibit G. CONTRACTOR shall provide payment for these
6 expenditures to COUNTY's Department of Behavioral Health, Accounts Receivable, P.O. Box 712,
7 Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of receipt
8 by CONTRACTOR of the invoicing provided by COUNTY.
9 C. COUNTY's DBH shall invoice CONTRACTOR on an annual basis the amount of
10 $75 per clinical position to access The Change Companies ASAM training modules which are required
11 to be completed upon hire and prior to delivering clinical services then annually thereafter.
12 7. LICENSING-CERTIFICATES
13 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall
14 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
15 provision of the services hereunder and required by the laws and regulations of the United States of
16 America, State of California, the County of Fresno, and any other applicable governmental agencies.
17 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
18 licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
19 appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
20 applicable laws, rules or regulations, as may now exist or be hereafter changed.
21 8. RESIDENTIAL AOD CERTIFICATION
22 A. The COUNTY requires CONTRACTOR(S) of residential Alcohol and Other
23 Substance Use Disorder treatment services to obtain the DHCS Alcohol and Other Drug Program (AOD)
24 Certification, including the program's American Society of Addiction Medicine (ASAM) level of care
25 designation or certification.
26 B. Residential CONTRACTOR(S) shall maintain a current AOD Certification during the
27 term of this Agreement.
28 C. COUNTY shall terminate this Agreement immediately in the event any of the
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1 following occurs:
2 1) CONTRACTOR fails to submit to the COUNTY a copy of the AOD
3 Certification within thirty (30) days after being approved by the DHCS, or
4 2) Certification is not maintained throughout the contract term.
5 9. PERINATAL SERVICES
6 CONTRACTOR shall comply with the requirements of the "Perinatal Practice Guidelines,"
7 available at the DHCS web address at: https://www.dhcs.ca.gov/individuals/Pages/Perinatal-
8 Services.aspx and by this reference incorporated herein, until such time new Perinatal Practice
9 Guidelines are updated and adopted. No formal amendment of this contract is required for new
10 guidelines to apply. Additionally, CONTRACTOR shall comply with the perinatal requirements stated in
11 Exhibit C, "Drug Medi-Cal Specific Requirements" and the FCSUD Provider Manual. No formal
12 amendment of this contract is required for new guidelines or amendments to Exhibit C or the FCSUD
13 Provider Manual to apply.
14 CONTRACTOR shall comply with federal and state mandates to provide alcohol and
15 other drug treatment services deemed medically necessary for Medi-Cal eligible: (1) pregnant and
16 postpartum women, and (2) youth under age 21 who are eligible under the Early and Periodic
17 Screening, Diagnostic, and Treatment (EPSDT) Program.
18 CONTRACTOR shall require that counselors of perinatal DMC services are properly
19 certified to provide these services and comply with the requirements contained in Title 22, § 51341.1,
20 Services for Pregnant and Postpartum Women and Title 9 commencing with section 10360.
21 10. PROHIBITION ON PUBLICITY
22 None of the funds, materials, property or services provided directly or indirectly under this
23 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
24 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the above,
25 publicity of the services described in Section One (1), SERVICES, of this Agreement shall be allowed as
26 necessary to raise public awareness about the availability of such specific services when approved in
27 advance by the DBH Director, or his or her designee, and at a cost to be provided for such items as
28 written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
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1 expense(s). Communication products must follow DBH graphic standards, including typefaces and
2 colors, to communicate our authority and project a unified brand. This includes all media types and
3 channels and all materials on and offline that are created as part of DBH's efforts to provide information
4 to the public.
5 11. NO THIRD-PARTY BENEFICIARIES
6 It is understood and agreed by and between the parties that the services provided by
7 CONTRACTOR for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
8 Agreement is intended to confer on any person other than the parties hereto any right under or by reason of
9 this Agreement.
10 12. INDEPENDENT CONTRACTOR
11 In performance of the work, duties and obligations assumed by CONTRACTOR under this
12 Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
13 CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
14 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
15 employee,joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
16 to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
17 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
18 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
19 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
20 rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
21 thereof.
22 Because of its status as an independent contractor, CONTRACTOR shall have absolutely
23 no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
24 solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
25 benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
26 matters relating to payment of CONTRACTOR'S employees, including compliance with Social Security
27 withholding and all other regulations governing such matters. It is acknowledged that during the term of this
28 Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or to this
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1 Agreement.
2 13. NON-ASSIGNMENT/SUBCONTRACTS
3 Neither party shall assign, transfer or sub-contract this Agreement nor their rights or duties
4 under this Agreement without the prior written consent of the other party.
5 CONTRACTOR shall be required to assume full responsibility for all services and activities
6 covered by this Agreement, whether or not CONTRACTOR is providing services directly. Further,
7 CONTRACTOR shall be the sole point of contact with regard to contractual matters, including payment of
8 any and all charges resulting from this Agreement.
9 If CONTRACTOR should propose to subcontract with one or more third parties to carry out
10 a portion of services covered by this Agreement, any such subcontract shall be in writing and approved as
11 to form and content by COUNTY's DBH Director, or his or her designee, prior to execution and
12 implementation. COUNTY's DBH Director, or his or her designee, shall have the right to reject any such
13 proposed subcontract. Any such subcontract together with all activities by or caused by CONTRACTOR
14 shall not require compensation greater than the total budget contained herein. An executed copy of any
15 such subcontract shall be received by COUNTY before any implementation and shall be retained by
16 COUNTY. CONTRACTOR shall be responsible to COUNTY for the proper performance of any
17 subcontract. Any subcontractor shall be subject to the same terms and conditions that CONTRACTOR is
18 subject to under this Agreement.
19 It is expressly recognized that CONTRACTOR cannot engage in the practice of physical
20 health medicine. If any medical services outside of the scope of the CONTRACTOR's medical director are
21 provided in connection with the services under this Agreement, such medical services shall be performed
22 by an independent contract physician. In this instance, the requirements of the Confidential Medical
23 Information Act (Civil Code 56 et seq.) shall be met.
24 If CONTRACTOR hires an independent contract physician, CONTRACTOR shall require
25 and ensure that such independent contract physician carries at least the following insurance coverages:
26 A. Professional Liability
27 Professional Liability (Medical Malpractice) Insurance, with limits of not less than One Million
28 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
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1 B. Cyber Liability
2 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim,
3 $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is
4 undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to, claims involving
5 infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade
6 dress, invasion of privacy violations, information theft, damage to or destruction of electronic information,
7 release of private information, alteration of electronic information, extortion and network security. The policy
8 shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit
9 monitoring expenses with limits sufficient to respond to these obligations.
10 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
11 Breaches, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii) breach
12 of any of the Contractor's obligations under Section#of this Agreement; (iii) infringement of intellectual
13 property, including but not limited to infringement of copyright, trademark, and trade dress; (iv) invasion of
14 privacy, including release of private information; (v) information theft; (vi) damage to or destruction or
15 alteration of electronic information; (vii) extortion related to the Contractor's obligations under this
16 Agreement regarding electronic information, including Personal Information; (viii) network security; (ix)data
17 breach response costs, including Security Breach response costs; (x) regulatory fines and penalties related
18 to the Contractor's obligations under this Agreement regarding electronic information, including Personal
19 Information; and (xi) credit monitoring expenses.
20 C. Molestation
21 Sexual abuse/molestation liability insurance with limits of not less than One Million Dollars
22 ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy shall be
23 issued on a per occurrence basis.
24 CONTRACTOR will also ensure that the independent contract physician shall maintain, at
25 their sole expense, in full force and effect for a period of three (3) years following the termination of this
26 Agreement, one or more policies of professional liability insurance with limits of coverage as specified
27 herein.
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1 14. CONFLICT OF INTEREST
2 No officer, agent, or employee of COUNTY who exercises any function or responsibility for
3 planning and carrying out the services provided under this Agreement shall have any direct or indirect
4 personal financial interest in this Agreement. CONTRACTOR shall comply with all Federal, State of
5 California, and local conflict of interest laws, statutes, and regulations, which shall be applicable to all
6 parties and persons served under this Agreement and any officer, agent, or employee of COUNTY.
7 15. DISCLOSURE OF SELF-DEALING TRANSACTIONS
8 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
9 for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes
10 its status to operate as a corporation.
11 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
12 transactions that they are a party to while CONTRACTOR is providing goods or performing services
13 under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
14 is a party and in which one or more of its directors has a material financial interest. Members of the
15 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
16 signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit H, and incorporated
17 herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
18 transaction or immediately thereafter.
19 16. ASSURANCES
20 In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
21 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; that it has
22 not been convicted of a criminal offense related to the provision of health care items or services; nor has it
23 been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
24 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
25 CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
26 for, or involvement with, COUNTY's business operations related to the Federal Health Care Programs and
27 shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or the
28 items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly
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1 or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time as
2 CONTRACTOR is reinstated into participation in the Federal Health Care Programs. Further the
3 CONTRACTOR agrees to the Disclosure of Criminal History and Civil Actions and Certification regarding
4 debarment suspension and other responsibility matters primary covered transactions; CONTRACTOR
5 must sign an appropriate Certification regarding debarment, suspension, and other responsibility matters,
6 attached hereto as Exhibit I, incorporated herein by reference and made part of this Agreement.
7 A. If COUNTY has notice that CONTRACTOR has been charged with a criminal
8 offense related to any Federal Health Care Program or is proposed for exclusion during the term on any
9 contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
10 claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
11 COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or the
12 proposed exclusion.
13 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
14 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
15 this Agreement, will be queried as to whether(1)they are now or ever have been excluded, suspended,
16 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
17 convicted of a criminal offense related to the provision of health care items or services; and or(3)they have
18 been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
19 suspension, debarment, or ineligibility.
20 1) In the event the potential employee or subcontractor informs
21 CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
22 convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
23 or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
24 subcontractor does not work, either directly or indirectly relating to services provided to COUNTY.
25 2) Notwithstanding the above, COUNTY at its discretion may terminate this
26 Agreement in accordance with Section Four (4), TERMINATION, of this Agreement, or require adequate
27 assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or
28 subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to services provided
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1 to COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
2 by COUNTY to protect the interests of COUNTY persons served.
3 C. CONTRACTOR shall verify (by asking the applicable employees and
4 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
5 perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
6 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
7 criminal offense related to the provision of health care items or services; and (3) have not been reinstated to
8 participation in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
9 ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
10 excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs,
11 or has been convicted of a criminal offense relating to the provision of health care services,
12 CONTRACTOR will ensure that said employee or subcontractor does not work, either direct or indirect,
13 relating to services provided to COUNTY.
14 1) CONTRACTOR agrees to notify COUNTY immediately during the term of
15 this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
16 providing professional services under this Agreement is excluded, suspended, debarred or otherwise
17 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating to
18 the provision of health care services.
19 2) Notwithstanding the above, COUNTY at its discretion may terminate this
20 Agreement in accordance with the Section Four (4), TERMINATION, of this Agreement, or require
21 adequate assurance (as defined by COUNTY)that no excluded, suspended or otherwise ineligible
22 employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
23 services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time frame
24 to be determined by COUNTY to protect the interests of COUNTY persons served.
25 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
26 information from COUNTY which may be necessary to complete any internal or external audits relating to
27 this Agreement.
28 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
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1 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of the terms
2 of this Agreement.
3 17. MODIFICATION
4 Any matters of this Agreement may be modified from time to time by the written consent of
5 all the parties without, in any way, affecting the remainder.
6 Notwithstanding the above, changes to Section One (1), SERVICES, as needed to
7 accommodate changes in State and Federal Law relating to SUD treatment may be made with the signed
8 written approval of COUNTY's DBH Director, or his or her designee, and respective CONTRACTOR(S)
9 through an amendment approved by County Counsel and Auditor.
10 18. INSURANCE
11 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
12 third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
13 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
14 arrangement or Joint Powers Agreement (JPA)throughout the term of the Agreement:
15 A. Commercial General Liability
16 Commercial General Liability Insurance with limits of not less than Two Million
17 Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00).
18 This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
19 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
20 liability or any other liability insurance deemed necessary because of the nature of this contract.
21 B. Automobile Liability
22 Comprehensive Automobile Liability Insurance with limits of not less than One
23 Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
24 include any auto used in connection with this Agreement.
25 C. Professional Liability
26 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
27 M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
28 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
DMC Master Agreement -16-
1 D. Worker's Compensation
2 A policy of Worker's Compensation insurance as may be required by the California Labor
3 Code.
4 E. Molestation
5 Sexual abuse/ molestation liability insurance with limits of not less than One Million Dollars
6 ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy shall be
7 issued on a per occurrence basis.
8 F. Cyber Liability
9 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim,
10 $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is
11 undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to, claims involving
12 infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade
13 dress, invasion of privacy violations, information theft, damage to or destruction of electronic information,
14 release of private information, alteration of electronic information, extortion and network security. The policy
15 shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit
16 monitoring expenses with limits sufficient to respond to these obligations.
17 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
18 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional
19 insured, but only insofar as the operations under this Agreement are concerned. Such coverage for
20 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained
21 by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance
22 provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without
23 a minimum of thirty(30) days advance written notice given to COUNTY.
24 CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
25 employees any amounts paid by the policy of worker's compensation insurance required by this
26 Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
27 necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under
28 this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
DMC Master Agreement -17
1 Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
2 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
3 foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of
4 Behavioral Health, Contracts Division —SUD Services at 3133 N Millbrook Avenue, Fresno, California,
5 93703, stating that such insurance coverages have been obtained and are in full force; that the County of
6 Fresno, its officers, agents and employees will not be responsible for any premiums on the policies; that for
7 such worker's compensation insurance the CONTRACTOR has waived its right to recover from the
8 COUNTY, its officers, agents, and employees any amounts paid under the insurance policy and that waiver
9 does not invalidate the insurance policy; that such Commercial General Liability insurance names the
10 County of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but
11 only insofar as the operations under this Agreement are concerned; that such coverage for additional
12 insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by
13 COUNTY, its officers, agents and employees, shall be excess only and not contributing with insurance
14 provided under CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed
15 without a minimum of thirty (30) days advance, written notice given to COUNTY.
16 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
17 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
18 Agreement upon the occurrence of such event.
19 All policies shall be issued by admitted insurers licensed to do business in the State of
20 California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
21 rating of A FSC VII or better.
22 19. HOLD HARMLESS
23 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request,
24 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
25 attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in
26 connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
27 employees under this Agreement, and from any and all costs and expenses (including attorney's fees and
28 costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who
DMC Master Agreement -18
1 may be injured or damaged by the performance, or failure to perform, of CONTRACTOR, its officers,
2 agents, or employees under this Agreement.
3 CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit
4 exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
5 The provisions of this Section Nineteen (19), HOLD HARMLESS, shall survive
6 termination of this Agreement.
7 20. SINGLE AUDIT
8 A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or
9 more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit in
10 accordance with the requirements of the Single Audit Standards as set forth in 2 Code of Federal
11 Regulations (CFR) Part 200. CONTRACTOR shall submit said audit and management letter to COUNTY.
12 The audit must include a statement of findings or a statement that there were no findings. If there were
13 negative findings, CONTRACTOR must include a corrective action plan signed by an authorized individual.
14 CONTRACTOR agrees to take action to correct any material non-compliance or weakness found as a
15 result of such audit. Such audit shall be delivered to COUNTY's Department of Behavioral Health, Business
16 Office for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
17 received for the program. Failure to perform the requisite audit functions as required by this Agreement may
18 result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a public
19 accountant to perform said audit, or may result in the inability of COUNTY to enter into future agreements
20 with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
21 CONTRACTOR.
22 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
23 exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR's only
24 funding is through Drug Medi-Cal. If a single audit is not applicable, a program audit must be performed and
25 a program audit report with management letter shall be submitted by CONTRACTOR to COUNTY as a
26 minimum requirement to attest to CONTRACTOR's solvency. Said audit report shall be delivered to
27 COUNTY's Department of Behavioral Health, Business Office for review, no later than nine (9) months after
28 the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
DMC Master Agreement -19
1 comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
2 qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
3 responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
4 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
5 section shall be billed to the CONTRACTOR at COUNTY's cost, as determined by COUNTY's Auditor-
6 Controller/Treasurer-Tax Collector.
7 C. CONTRACTOR shall make available all records and accounts for inspection by
8 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
9 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a minimum of
10 ten (10) years, in accordance with 42 CFR Part 438.3(h), from the finalized cost settlement process or, if an
11 audit by the Federal government or DHCS has been started before the expiration of the ten (10) year
12 period, records shall be maintained until completion of the audit and final resolution of all findings.
13 21. AUDITS AND INSPECTIONS
14 The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
15 may deem necessary, make available to the COUNTY for examination all of its records and data with
16 respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
17 COUNTY, permit the COUNTY to audit and inspect all electronic or print books and records as well as
18 inspection of the premises, physical facilities and equipment where Medicaid-related activities are
19 conducted to ensure CONTRACTOR'S compliance with the terms of this Agreement.
20 The refusal of CONTRACTOR to permit access to, and inspection of, electronic or print
21 books and records, physical facilities, and/or refusal to permit interviews with employees, as described in
22 this part, constitutes an express and immediate material breach of this Agreement and will be sufficient
23 basis to terminate the Agreement for cause or default.
24 The right to audit under this section exists for ten (10) years from the final date of the
25 agreement period or from the date of completion of any audit, whichever is later.
26 Notwithstanding the provisions stated in Section Three (3), TERM, of this Agreement, it is
27 acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all audit
28 procedures and requirements as stated in this Agreement have been completed to the review and
DMC Master Agreement -20
1 satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or resulting from any audit
2 and/or inspections including, but not limited to, actual costs incurred and the payment of any expenditures
3 disallowed by either COUNTY, State, or Federal governmental entities, including any assessed interest and
4 penalties.
5 If CONTRACTOR, through an audit by the STATE or COUNTY, is found to be in violation of
6 this contract which results in the recoupment of funds paid to CONTRACTOR, COUNTY may, upon mutual
7 consent between CONTRACTOR and COUNTY, enter into a repayment agreement with the
8 CONTRACTOR, with total monthly payments not to exceed twelve (12) months from the date of the
9 repayment agreement, to recover the amount of funds to be recouped. The monthly repayment amounts
10 shall be netted against the CONTRACTOR's monthly billing for services rendered during the month.
11 COUNTY reserves the right to forgo a repayment agreement and recoup all funds immediately.
12 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be
13 subject to the examination and audit of the California State Auditor for a period of three (3) years after final
14 payment under contract (Government Code Section 8546.7).
15 22. EVALUATION — MONITORING
16 CONTRACTOR shall participate in a review of the program at least yearly or more
17 frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
18 information requested by the COUNTY, DHCS, and/or the subcontractor during the program evaluation,
19 monitoring, and/or review.
20 COUNTY's DBH Director, or his or her designee, and DHCS or their designees shall
21 monitor and evaluate the performance of CONTRACTOR under this Agreement to determine to the best
22 possible degree the success or failure of the services provided under this Agreement. At the discretion of
23 the COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
24 performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of the program as
25 needed, at the discretion of COUNTY.
26 COUNTY shall recapture from CONTRACTOR the value of any services or other
27 expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
28 discretion of the COUNTY, CONTRACTOR shall enter into a repayment agreement with the COUNTY, with
DMC Master Agreement -21
1 total monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to
2 recover the amount of funds to be recouped. The monthly repayment amounts shall be netted against the
3 CONTRACTOR's monthly billing for services rendered during the month. COUNTY reserves the right to
4 forgo a repayment agreement and recoup all funds immediately.
5 23. REPORTS—SUBSTANCE USE DISORDER SERVICES
6 CONTRACTOR(S) shall submit all information and data required by COUNTY and State
7 in accordance with Exhibit F — Provider Reporting Requirements, incorporated in this Agreement and
8 also available on the DBH website at: https://www.co.fresno.ca.us/departments/behavioral-
9 health/home/for-providers/contract-providers/substance-use-disorder-providers. Reporting requirements
10 may be revised periodically to reflect changes to State mandated reporting. CONTRACTOR(S) that are
11 not in compliance with reporting deadlines are subject to payment withholding until reporting compliance
12 is achieved. Reporting requirements include, but are not limited to, the following:
13 A. Drug and Alcohol Treatment Access Report (DATAR) in an electronic format
14 provided by the State and due no later than five (5) days after the preceding month;
15 B. CalOMS Treatment— Submit CalOMS treatment admission, discharge, annual
16 update, and "provider activity report" record in an electronic format through COUNTY's information
17 system, and on a schedule as determined by the COUNTY which complies with State requirements for
18 data content, data quality, reporting frequency, reporting deadlines, and report method and due no later
19 than five (5) days after the preceding month. All CalOMS admissions, discharges, and annual updates
20 must be entered into the COUNTY's CalOMS system within twenty-four (24) hours of occurrence;
21 C. ASAM Level of Care (LOC) — Submit ASAM LOC data in a format determined by
22 DBH, on a schedule as determined by the COUNTY which complies with State requirements;
23 D. Access Form — CONTRACTOR shall enter access information into COUNTY's
24 EHR at time of first contact with person served;
25 E. Ineligible Person Screening Report—format provided by COUNTY DBH and due
26 by the fifteenth (15th) day of each month to comply with State requirements;
27 F. Logic Manager Incident Reporting —as needed, when incidents occur and as
28 instructed in Exhibit J, Protocol for Completion of Incident Report.
DMC Master Agreement -22
1 G. Monthly Status Report—format provided by COUNTY DBH and due by the fifteen
2 (15th) day of each month;
3 H. Wait list— required by residential providers only and due by the fifteen (15th) day
4 of each month;
5 I. Grievance Log - due by the fifteen (15th) day of each month;
6 J. Missed appointments — CONTRACTOR shall enter all missed appointments into
7 COUNTY's EHR by the fifteenth (15th) of the following month;
8 K. Cultural Competency Survey — completed annually in a format to be determined
9 by DBH;
10 L. Americans with Disabilities (ADA) —Annually, upon request by COUNTY DBH,
11 CONTRACTOR(S) shall complete a system-wide accessibility survey in a format determined by DBH for
12 each service location and modality and shall submit an ADA Accessibility Certification and Self-
13 Assessment, including an Implementation Plan, for each service location;
14 M. Culturally and Linguistically Appropriate Services (CLAS) -Annually, upon request
15 by COUNTY DBH, CONTRACTOR(S) shall complete an agency CLAS survey in a format determined by
16 COUNTY DBH and shall submit a CLAS Self-Assessment, including an Implementation Plan;
17 N. Risk Assessment—Annually, upon request by COUNTY DBH, CONTRACTOR shall
18 submit a Risk Assessment on a form and in a format to be provided by DBH. The Assessment must be
19 submitted to the COUNTY in hard copy as well as electronically by the due date set by COUNTY;
20 O. Network Adequacy Certification Tool (NACT)—Annually, upon request,
21 CONTRACTOR shall submit NACT data as requested by COUNTY DBH;
22 P. Operating Expense Report— CONTRACTOR shall submit expenses by the 25th of
23 each month on a form provided by COUNTY DBH, including a general ledger, payroll register and other
24 supporting documentation as request; and
25 Q. Cost Reports— On an annual basis for each fiscal year ending June 30th non-
26 NTP CONTRACTOR(S) shall submit a complete and accurate detailed cost report(s). Refer to Section
27 Twenty-four (24), Cost Reporting, for cost reporting requirements.
28
DMC Master Agreement -23
1 24. COST REPORTING
2 Cost reports must be submitted to the COUNTY as a hard copy with a signed cover letter
3 and an electronic copy by the due date. Submittal must also include any requested support documents
4 such as general ledgers and detailed electronic (e.g. Excel) schedules demonstrating how costs were
5 allocated both within programs, if provider has multiple funding sources (e.g. DMC and SABG), and
6 between programs, if CONTRACTOR provides multiple SUD treatment modalities. Provider shall
7 maintain general ledgers that reflect the original transaction amounts where each entry in their
8 accounting records represents one-hundred percent (100%) of the total transaction cost and can be
9 supported with the original source documentation (i.e. receipts, bills, invoices, payroll registers, etc.).
10 Bank statements reflecting purchases are not original source documents and will not be accepted as
11 such. All costs found to not be supported by original source documentation will be disallowed. Total
12 unallowable costs shall be allocated their percentage share of the indirect Costs along with the
13 Contractor's direct costs. All reports submitted by CONTRACTOR(S) to COUNTY must be typewritten.
14 COUNTY will issue instructions for completion and submittal of the annual cost report, including the
15 relevant cost report template(s) and due dates within forty-five (45) days of each fiscal year end. All cost
16 reports must be prepared in accordance with Generally Accepted Accounting Principles. Unallowable
17 costs such as those denoted in 2 CFR 200 Subpart E, Cost Principles, 41 U.S.C. 4304, and the Center for
18 Medicare and Medicaid Studies (CMS) Provider Reimbursement Manual (PRM) 15-1, must not be
19 included as an allowable cost on the cost report and all invoices. Unallowable costs must be kept in the
20 provider's General Ledger in accounts entitled Unallowable followed by name of the account (e.g.
21 Unallowable— Food) or in some other appropriate form of segregation in the provider's accounting
22 records. For further information on unallowable costs refer to regulations provided above. If the
23 CONTRACTOR(S) does not submit the cost report by the due date, including any extension period
24 granted by the COUNTY, the COUNTY may withhold payment of pending invoices until the cost
25 report(s) has been submitted and clears COUNTY desk audit for completeness and accuracy. Once the
26 cost reports have been approved by the County, originally-executed signed certification pages attesting
27 to the accuracy of the information contained in cost reports shall be submitted to the County.
28
DMC Master Agreement -24
1 1) DMC - A DMC cost report must be submitted in a format prescribed by the
2 DHCS for the purposes of Short Doyle Medi-Cal reimbursement of total costs for all programs.
3 CONTRACTOR(S) shall report costs under their approved legal entity number established during the
4 DMC certification process. Total units of service reported on the cost report will be compared to the units
5 of services entered by CONTRACTOR(S) into COUNTY's data system. CONTRACTOR(S) will be
6 required to correct discrepancies and resubmit to COUNTY prior to COUNTY's final acceptance of the
7 cost report.
8 2) OTHER FUNDING SOURCES — CONTRACTOR(S) will be required to
9 submit a cost report on a form approved and provided by the COUNTY to reflect actual costs and
10 reimbursement for services provided through funding sources other than DMC. Contracts that include a
11 negotiated rate per unit of service will be reimbursed for actual costs incurred (the sum of both direct
12 costs as defined in 2 CFR 200.413, and allocated indirect costs as defined in 2 CFR 200.414) not to
13 exceed the contract maximum. If the cost report indicates an amount due to COUNTY,
14 CONTRACTOR(S) shall submit payment with the report. If an amount is due to CONTRACTOR(S)
15 COUNTY shall reimburse CONTRACTOR within forty-five (45) days of receiving and accepting the year-
16 end cost report.
17 3) MULTIPLE FUNDING SOURCES — CONTRACTOR(S) with multiple
18 agreements for the same services (e.g. Outpatient, Residential) provided at the same location where at
19 least one of the Agreements is funded through DMC and the other funding is other federal or county
20 realignment funding will be required to complete DMC cost reports and COUNTY approved cost reports.
21 Such Agreements will be settled for actual allowable costs in accordance with Medicaid reimbursement
22 requirements as specified in Title XIX or Title XXI of the Social Security Act; Title 22, and the State's
23 Medicaid Plan. Within forty-five (45) days of the reconciliation by COUNTY, CONTRACTOR shall make
24 payment to COUNTY or COUNTY shall reimburse CONTRACTOR as appropriate.
25 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR(S)
26 agree to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit
27 settlement findings. DHCS audit process is approximately eighteen (18) to thirty-six (36) months
28 following the close of the State fiscal year. COUNTY may choose to appeal DHCS settlement results
DMC Master Agreement -25
1 and therefore reserves the right to defer payback settlement with CONTRACTOR(S) until resolution of
2 the appeal.
3 CONTRACTOR shall furnish to COUNTY such statements, records, reports, data, and
4 information as COUNTY may request pertaining to matters covered by this Agreement. All reports
5 submitted to the COUNTY must be typewritten.
6 In the event that CONTRACTOR(S) fails to provide such reports or other information
7 required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments
8 until there is compliance. In addition, the CONTRACTOR shall provide written notification and
9 explanation to the COUNTY within fifteen (15) days of any funds received from another source to
10 conduct the same services covered by this Agreement.
11 25. PROPERTY OF COUNTY
12 A. CONTRACTOR shall submit purchase invoices for the purchase of any fixed assets
13 with their monthly invoices. All purchases over Five Thousand and No/100 Dollars ($5,000.00), and certain
14 purchases under Five Thousand and No/100 Dollars ($5,000.00) such as fans, calculators, cameras,
15 VCRs, DVDs and other sensitive items as determined by COUNTY's DBH Director, or his or her designee,
16 made during the life of this Agreement shall be identified as assets that can be inventoried and maintained
17 in COUNTY's DBH Asset Inventory System. These assets shall be retained by COUNTY, as COUNTY
18 property, in the event this Agreement is terminated or upon expiration of this Agreement. CONTRACTOR
19 agrees to participate in an annual inventory of all COUNTY fixed assets and shall be physically present
20 when fixed assets are returned to COUNTY's possession at the termination or expiration of this Agreement.
21 CONTRACTOR is responsible for returning to COUNTY all COUNTY owned fixed assets, or the monetary
22 value of said fixed assets if unable to produce the fixed assets at the expiration or termination of this
23 Agreement.
24 B. The purchase of any equipment by CONTRACTOR with funds provided
25 hereunder shall require the prior written approval of COUNTY's DBH Director or his or her designee,
26 shall fulfill the provisions of this Agreement as appropriate, and must be directly related to
27 CONTRACTOR's services or activity under the terms of this Agreement. COUNTY's DBH Director, or
28
DMC Master Agreement -26
1 his or her designee, may refuse reimbursement for any costs resulting from equipment purchased,
2 which are incurred by CONTRACTOR, if prior written approval has not been obtained from COUNTY.
3 C. The terms and conditions described in this Section are not applicable to the
4 leasing of vehicles by CONTRACTOR with the funds provided under this Agreement.
5 26. RECORDS
6 A. RECORD ESTABLISHMENT AND MAINTENANCE —CONTRACTOR shall
7 establish and maintain records in accordance with State and Federal rules and regulations in addition to
8 those requirements prescribed by COUNTY with respect to all matters covered by this Agreement.
9 Except as otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period
10 of ten (10) years from the finalized cost settlement process, or from the date of completion of any audit,
11 whichever is later.
12 B. DOCUMENTATION — CONTRACTOR shall maintain adequate records in
13 sufficient detail to make possible an evaluation of services and contain all the data necessary in
14 reporting to the State of California and/or Federal agency. All persons served records shall be
15 maintained pursuant to applicable State of California and Federal requirements concerning
16 confidentiality. In the event of contract termination or expiration, all original copies of clinical records,
17 including clinical charts, group sign-in sheets, and fiscal records, including original receipts, for a period
18 of ten (10) years shall be delivered to COUNTY.
19 C. REPORTS — CONTRACTOR shall submit to COUNTY periodic fiscal and all
20 program reports as further described in Section Twenty-Three (23) REPORTS — Substance Use
21 Disorder Services. CONTRACTOR shall submit a complete and accurate year-end cost report for each
22 fiscal year affected by this Agreement, following the end of each fiscal year affected by this Agreement.
23 CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and information
24 as COUNTY may request pertaining to matters covered by this Agreement. All reports submitted by
25 CONTRACTOR to COUNTY must be typewritten.
26 D. SUSPENSION OF COMPENSATION — In the event that CONTRACTOR fails to
27 provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
28 payments until there is compliance.
DMC Master Agreement -27
1 E. PERSON SERVED CONFIDENTIALITY— CONTRACTOR shall conform to and
2 COUNTY shall monitor compliance with all State and Federal statutes and regulations regarding
3 confidentiality, including but not limited to confidentiality of information requirements of 42 CFR § 2.1 et
4 seq., Welfare and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety Code §§ 11977
5 and 11812, Civil Code, Division 1, Part 2.6, and CCR Title 22 § 51009.
6 27. DATA SECURITY
7 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
8 viewing, use or disclosure of COUNTY data including sensitive or personal person served information;
9 abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
10 enter into a contractual relationship with the COUNTY for the purpose of providing services under this
11 Agreement must employ adequate data security measures to protect the confidential information provided
12 to CONTRACTOR by the COUNTY, including but not limited to the following:
13 A. CONTRACTOR-OWNED MOBILE, WIRELESS, OR HANDHELD DEVICES
14 CONTRACTOR may not connect to COUNTY networks via personally-owned
15 mobile, wireless or handheld devices, unless the following conditions are met:
16 1) CONTRACTOR has received authorization by COUNTY for telecommuting
17 purposes;
18 2) Current virus protection software is in place;
19 3) Mobile device has the remote wipe feature enabled; and
20 4) A secure connection is used.
21 B. CONTRACTOR-OWNED COMPUTERS OR COMPUTER PERIPHERALS
22 CONTRACTOR may not bring CONTRACTOR-owned computers or computer
23 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief Information
24 Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
25 transferred, data must be stored on a secure server approved by the COUNTY and transferred by means of
26 a Virtual Private Network (VPN) connection, or another type of secure connection. Said data must be
27 encrypted.
28
DMC Master Agreement -28
1 C. COUNTY-OWNED COMPUTER EQUIPMENT
2 CONTRACTOR or anyone having an employment relationship with the COUNTY
3 may not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
4 authorization from the COUNTY's Chief Information Officer, and/or designee(s).
5 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on
6 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
7 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
8 and security of COUNTY's confidential information and to prevent unauthorized access, viewing, use or
9 disclosure of data maintained in computer files, program documentation, data processing systems, data
10 files and data processing equipment which stores or processes COUNTY data internally and externally.
11 F. Confidential person served information transmitted to one party by the other by
12 means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
13 of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
14 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
15 breaches or potential breaches of security related to COUNTY's confidential information, data maintained in
16 computer files, program documentation, data processing systems, data files and data processing
17 equipment which stores or processes COUNTY data internally or externally.
18 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
19 arising from a possible breach of security related to COUNTY's confidential person served information
20 provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
21 individuals as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR
22 will be responsible for all costs incurred as a result of providing the required notification.
23 28. EHR CERTIFICATION
24 CONTRACTOR shall obtain certification from the Certification Commission for Healthcare
25 Information Technology (CCHIT) for Security Access Control, Audit, and Authentication if using a non-
26 Avatar electronic health record (EHR) and shall provide a copy of the certification to COUNTY.
27 Additionally, CONTRACTOR shall recertify their EHR annually and provide a copy of the recertification
28 to COUNTY. CONTRACTOR shall ensure all employees who use an EHR other than Avatar sign an
DMC Master Agreement -29
1 Electronic Signature Agreement (See example, Exhibit K) and maintain a copy in the employee's
2 personnel file.
3 29. COMPLIANCE WITH LAWS, POLICIES AND RULES
4 CONTRACTOR shall comply with all applicable rules and regulations set forth in CCR Titles
5 9 and 22, and California Health and Safety Code § 11750 et seq., with the exception of regulations waived
6 by the Centers for Medicare and Medicaid Services and DHCS, as stated within the DMC-Organized
7 Delivery System (ODS) Special Terms and Conditions (STCs) and the DMC Intergovernmental Agreement.
8 CONTRACTOR shall comply with any other Federal and State laws or guidelines applicable to
9 CONTRACTOR's performance under this Agreement or any local ordinances, regulations, or policies
10 applicable. Such provisions include, but are not restricted to:
11 A. CONTRACTOR shall comply with 42 CFR Part 438.
12 B. CONTRACTOR shall comply with Early and Periodic Screening, Diagnostic and
13 Treatment (EPSDT) statutes and regulations.
14 C. CONTRACTOR shall ensure that each person served's ability to pay for services is
15 determined by the use of the method approved by COUNTY.
16 D. CONTRACTOR shall establish and use COUNTY's approved method of
17 determining and collecting fees from persons served.
18 E. CONTRACTOR shall furnish person served records in accordance with the
19 applicable Federal, State and local regulations and requirements, including in such records a treatment
20 plan for each person served, and evidence of each service rendered.
21 F. CONTRACTOR shall submit accurate, complete and timely claims and cost reports,
22 reporting only allowable costs.
23 G. CONTRACTOR shall comply with statistical reporting and program evaluation
24 systems as provided in State of California regulations and in this Agreement.
25 H. CONTRACTOR shall comply with requirements contained in the DMC
26 Intergovernmental Agreement with DHCS by this reference incorporated herein, until such time that a new
27 DMC Intergovernmental Agreement is established. Upon amendment of the DMC Intergovernmental
28 Agreement, the terms of the amended Contract shall automatically be incorporated into this Agreement.
DMC Master Agreement -30-
1 I. CONTRACTOR shall inform every person served of their rights regarding Grievance
2 and Appeals as described in the Provider Manual, attached hereto and by this reference incorporated.
3 J. CONTRACTOR shall file an incident report for all incidents involving persons served
4 and CONTRACTOR staff, using COUNTY's Incident Reporting System, following the Protocol for
5 Completion of Incident Report described in the Provider Manual, attached hereto and by this reference
6 incorporated.
7 K. In the event any law, regulation, or policy referred to in this Agreement is amended
8 during the term thereof, the parties hereto agree to comply with the amended provision as of the effective
9 date of such amendment. Exhibits will be updated as needed and no formal amendment of this contract is
10 required for new rules to apply.
11 30. NON-DISCRIMINATION PROVISION
12 ELIGIBILITY FOR SERVICES — CONTRACTOR shall prepare, prominently post in its
13 facility, and make available to the DBH Director, or his or her designee, and to the public all eligibility
14 requirements to participate in the program funded under this Agreement. CONTRACTOR shall not
15 unlawfully discriminate in the provision of services because of sex, race, religion, color, national origin,
16 ancestry, ethnic group identification, physical disability, mental disability, medical condition, genetic
17 information, sexual orientation, marital status, age, gender, gender identity, gender expression, or
18 military or veteran status as provided by State of California and Federal law in accordance with Title VI
19 of the Civil Rights Act of 1964 (42 USC § 2000(d)); Age Discrimination Act of 1975 (42 USC § 1681);
20 Rehabilitation Act of 1973 (29 USC § 794); Education Amendments of 1972 (20 USC § 1681);
21 Americans with Disabilities Act of 1990 (42 USC § 12132); 45 CFR, Part 84; provisions of the Fair
22 Employment and Housing Act (California Government Code § 12900); and regulations promulgated
23 thereunder (CCR Title 2, § 7285.0); Title 2, Division 3, Article 9.5 of the California Government Code
24 commencing with section 11135; and CCR Title 9, Division 4, Chapter 6 commencing with section
25 10800.
26 A. EQUAL OPPORTUNITY— CONTRACTOR shall comply with California Government
27 Code, § 2990 and CCR Title 2, Division 4, Chapter 5, in matters related to the development,
28 implementation, and maintenance of a nondiscrimination program. CONTRACTOR shall not discriminate
DMC Master Agreement -31-
1 against any employee or applicant for employment because sex, race, religion, color, national origin,
2 ancestry, ethnic group identification, physical disability, mental disability, medical condition, genetic
3 information, sexual orientation, marital status, age, gender, gender identity, gender expression, or military
4 or veteran status. Such practices include retirement, recruitment, advertising, hiring, layoff, termination,
5 upgrading, demotion, transfer, rates of pay or other forms of compensation, use of facilities, and other terms
6 and conditions of employment. CONTRACTOR agrees to post in conspicuous places, notices available to
7 all employees and applicants for employment setting forth the provisions of the Equal Opportunity Act (42
8 USC § 2000(e)) in conformance with Federal Executive Order No. 11246. CONTRACTOR agrees to
9 comply with the provisions of the Rehabilitation Act of 1973 (29 USC § 794).
10 B. SUSPENSION OF COMPENSATION — If an allegation of discrimination occurs,
11 DBH may withhold all further funds, until CONTRACTOR can show by clear and convincing evidence to the
12 satisfaction of DBH that funds provided under this Agreement were not used in connection with the alleged
13 discrimination.
14 C. NEPOTISM — Except by consent of the DBH Director, or his or her designee, no
15 person shall be employed by CONTRACTOR who is related by blood or marriage to or who is a member of
16 the Board of Directors or an officer of CONTRACTOR.
17 D. NEW FACILITIES AND DISABILITY ACCESS— New facilities shall be wheelchair
18 accessible and provide access to the disabled, consistent with CCR Title 9, § 10820. If a new facility will be
19 utilized, a plan ensuring accessibility to the disabled must be developed. DBH shall assess, monitor, and
20 document CONTRACTOR's compliance with the Rehabilitation Act of 1973 and Americans with Disabilities
21 Act of 1990 to ensure that recipients/persons served and intended recipients/beneficiaries of services are
22 provided services without regard to physical or mental disability and that CONTRACTOR has provided a
23 facility accessible to the physically disabled.
24 31. COMPLIANCE
25 CONTRACTOR(S) shall comply with all requirements of the "Fresno County Behavioral
26 Health Compliance Program Contractor Code of Conduct and Ethics" as set forth in Exhibit L. Within
27 thirty (30) days of entering into this Agreement with the COUNTY, new CONTRACTOR(S) shall have all
28 of CONTRACTOR(S) employees, agents and subcontractors providing services under this Agreement
DMC Master Agreement -32
1 complete General Compliance training and certify in writing, that they have received, read, understood,
2 and shall abide by the requirements set forth in Exhibit L. CONTRACTOR(S) shall ensure that within
3 thirty (30) days of hire, all new employees, agents and subcontractors providing services under this
4 Agreement complete General Compliance training and certify in writing that they have received, read,
5 understood, and shall abide by the requirements set forth in Exhibit L.
6 CONTRACTOR(S) will require all employees, agents and subcontractors providing
7 services under this Agreement to complete General Compliance training annually thereafter and
8 appropriate employees, agents and subcontractors shall complete Substance Use Disorder
9 Documentation Billing or billing/reimbursement training. CONTRACTOR(S) understands that the
10 promotion of and adherence to such requirements is an element in evaluating the performance of
11 CONTRACTOR(S) and its employees, agents and subcontractors.
12 CONTRACTOR(S) employees, agents and subcontractors will submit written
13 certifications upon completion of General Compliance training to the COUNTY's Compliance Officer.
14 CONTRACTOR(S) and its employees, agents and subcontractors will promptly report
15 any suspected violation(s) of the Code of Conduct and Ethics or report any activity that they believe may
16 violate the standards of the Compliance Program through the DBH Compliance Hotline: (888) 262-4174.
17 CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty
18 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S) violation of the
19 terms of this Agreement.
20 32. COMPLAINTS
21 CONTRACTOR shall log complaints and the disposition of all complaints from a persons
22 served or a person served's family. CONTRACTOR shall provide a summary of the complaint log entries
23 concerning COUNTY-sponsored persons served to COUNTY at monthly intervals by the fifteenth (15th)
24 day of the following month, in a format that is mutually agreed upon. CONTRACTOR shall post signs
25 informing person served of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY
26 of all incidents reportable to state licensing bodies that affect COUNTY persons served within twenty-four
27 (24) hours of receipt of a complaint.
28 Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
DMC Master Agreement -33-
1 persons served, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
2 investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or corrective
3 action taken to resolve the complaint.
4 33. CULTURAL COMPETENCY
5 As related to Cultural and Linguistic Competence:
6 A. Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d, and 45
7 CFR Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
8 from discriminating against persons based on race, color, national origin, sex, disability or religion. This is
9 interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
10 participation in federally funded programs through the provision of comprehensive and quality bilingual
11 services.
12 B. Policies and procedures for ensuring access and appropriate use of trained
13 interpreters and material translation services for all LEP persons served, including, but not limited to,
14 assessing the cultural and linguistic needs of its persons served, training of staff on the policies and
15 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
16 include ensuring compliance of any sub-contracted providers with these requirements.
17 C. CONTRACTOR assurance that minors shall not be used as interpreters.
18 D. CONTRACTOR shall provide and pay for interpreting and translation services to
19 persons participating in CONTRACTOR's services who have limited or no English language proficiency,
20 including services to persons who are deaf or blind. Interpreter and translation services shall be provided as
21 necessary to allow such participants meaningful access to the programs, services and benefits provided by
22 CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR's "vital
23 documents" (those documents that contain information that is critical for accessing CONTRACTOR's
24 services or are required by law) shall be provided to participants at no cost to the participant.
25 CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
26 translate for a program participant, or who directly communicate with a program participant in a language
27 other than English, demonstrate proficiency in the participant's language and can effectively communicate
28 any specialized terms and concepts peculiar to CONTRACTOR's services.
DMC Master Agreement -34-
1 E. In compliance with the State-mandated Culturally and Linguistically Appropriate
2 Services standards as published by the Office of Minority Health, new CONTRACTOR must submit to
3 COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR's plan to address
4 all fifteen national cultural competency standards as set forth in the "National Standards on Culturally and
5 Linguistically Appropriate Services" (CLAS), attached hereto as Exhibit M, and incorporated herein by this
6 reference. County's annual on-site review of CONTRACTOR shall include collection of documentation to
7 ensure all national standards are implemented. As the national competency standards are updated,
8 CONTRACTOR's plan must be updated accordingly.
9 F. CONTRACTOR shall complete and submit county-issued CLAS self-assessment
10 annually. CONTRACTOR shall update CLAS plan as necessary.
11 34. CLEAN AIR AND WATER
12 In the event funding under this Agreement exceeds one hundred thousand dollars
13 ($100,000.00), the CONTRACTOR must comply with all applicable standards, orders, or requirements
14 issued under section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), section 506 of the Clean Water Act (33
15 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR part 32).
16 35. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
17 COUNTY and CONTRACTOR each consider and represent themselves as covered
18 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
19 104-191(HIPAA) and agree to use and disclose protected health information as required by law.
20 COUNTY and CONTRACTOR acknowledge that the exchange of protected health
21 information between them is only for treatment, payment, and health care operations.
22 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
23 Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
24 Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
25 regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
26 Regulations) and other applicable laws.
27 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
28 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
DMC Master Agreement -35-
1 as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code
2 of Federal Regulations (CFR).
3 Additionally, CONTRACTOR shall comply with the HIPAA requirements stated in Exhibit
4 C, "Drug Medi-Cal Specific Requirements."
5 36. CHILD ABUSE REPORTING
6 CONTRACTOR shall utilize a procedure acceptable to the COUNTY to ensure that all of
7 CONTRACTOR's employees, volunteers, consultants, subcontractors or agents performing services under
8 this Agreement shall report all known or suspected child abuse or neglect to one or more of the agencies
9 set forth in Penal Code § 11165.9. This procedure shall include having all of CONTRACTOR's employees,
10 volunteers, consultants, subcontractors or agents performing services under this Agreement sign a
11 statement that he or she knows of and will comply with the reporting requirements set forth in Penal Code §
12 11166. The statement to be utilized by CONTRACTOR for reporting is set forth in Exhibit N, "Notice of
13 Child Abuse Reporting," attached hereto and by this reference incorporated herein.
14 37. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
15 CONTRACTOR shall adhere to the requirement that no funds shall be used to carry out any
16 program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug unless
17 DHCS chooses to implement a demonstration syringe services program for intravenous drug users.
18 38. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
19 INFORMATION
20
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
21
managed care entity as defined in 42 CFR § 455.101, 455.104, and 455.106(a)(1)(2).
22
In accordance with 42 CFR §§ 455.101, 455.104, 455.105 and 455.106(a)(1)(2), the
23
following information must be disclosed by CONTRACTOR by completing Exhibit O "Disclosure of
24
Ownership and Control Interest Statement," attached hereto and by this reference incorporated herein.
25
CONTRACTOR shall submit this form to COUNTY DBH within thirty (30) days of the effective date of
26
this Agreement and at any time in which the status changes. Submissions shall be scanned pdf copies
27
and are to be sent via email to SAS(o-)fresnocountyca.gov and the assigned analyst at the County of
28
DMC Master Agreement -36-
1 Fresno, Department of Behavioral Health, Contracts Division.
2 A. Name and address of any person(s) whether it be an individual or corporation with
3 an ownership or controlling interest in the disclosing entity or managed care entity.
4 1) Address must include the primary business address, every business
5 location and P.O. Box address(es).
6 2) Date of birth and Social Security Number for individuals.
7 3) Tax identification number for other corporations or entities with ownership
8 or controlling interest in the disclosing entity.
9 B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
10 interest.
11 C. Whether the person(s) with an ownership or controlling interest of the disclosing
12 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling or
13 child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
14 related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
15 interest in any of its subcontractors.
16 D. Name of any other disclosing entity in which an owner of the disclosing entity has
17 an ownership or control interest.
18 E. The ownership of any subcontractor with whom CONTRACTOR has had business
19 transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month period
20 ending on the date of the request; and
21 F. Any significant business transactions between CONTRACTOR and any wholly
22 owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
23 ending on the date of the request.
24 G. Any person(s) with an ownership or control interest in CONTRACTOR, or agent or
25 managing employee of CONTRACTOR; and
26 1) Has been convicted of a criminal offense related to that person's
27 involvement in any program under Medicare, Medicaid, or the Title XX services program since the
28 inception of those programs.
DMC Master Agreement -37
1 H. The ownership of any subcontractor with whom CONTRACTOR has had
2 business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
3 period ending on the date of the request; and
4 I. Any significant business transactions between CONTRACTOR and any wholly
5 owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
6 ending on the date of the request.
7 39. CHANGE OF LEADERSHIP/MANAGEMENT
8 Any and all notices between COUNTY and CONTRACTOR(S) provided for or permitted
9 under this Agreement or by law, shall be in writing and shall be deemed duly served when personally
10 delivered to one of the parties, or in lieu of such personal service, when deposited in the United States Mail,
11 postage prepaid, addressed to such party.
12 In the event of any change in the status of CONTRACTOR's leadership or management,
13 CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of change.
14 Such notification shall include any new leader or manager's name, address and qualifications. "Leadership
15 or management" shall include any employee, member, or owner of CONTRACTOR who either a) directs
16 individuals providing services pursuant to this Agreement; b) exercises control over the manner in which
17 services are provided; or c) has authority over CONTRACTOR's finances.
18 40. NOTICES
19 The persons and their addresses having authority to give and receive notices under this
20 Agreement include the following:
21 COUNTY CONTRACTOR
Director, Fresno County See Exhibit A
22 Department of Behavioral Health
23 1925 E Dakota Ave
Fresno, CA 93726
24 All notices between the COUNTY and CONTRACTOR provided for or permitted under this
25 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
26 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
27 personal service is effective upon service to the recipient. A notice delivered by first-class United States
28 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
DMC Master Agreement -38
1 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
2 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
3 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
4 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
5 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
6 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
7 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
8 establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
9 including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
10 beginning with section 810).
11 41. SEPARATE AGREEMENT
12 It is mutually understood by the parties that this Agreement does not, in any way, create
13 a joint venture among CONTRACTOR(S). By execution of this Agreement, CONTRACTOR(S)
14 understands that a separate Agreement is formed between each individual CONTRACTOR and
15 COUNTY.
16 42. GOVERNING LAW
17 Venue for any action arising out of or related to this Agreement shall only be in Fresno
18 County, California.
19 The rights and obligations of the parties and all interpretation and performance of this
20 Agreement shall be governed in all respects by the laws of the State of California.
21 43. SEVERABILITY
22 The provisions of this Agreement are severable. The invalidity or unenforceability of
23 any one provision in the Agreement shall not affect the other provisions.
24 44. ELECTRONIC SIGNATURE
25 The parties agree that this Agreement may be executed by electronic signature as
26 provided in this section. An "electronic signature" means any symbol or process intended by an
27 individual signing this Agreement to represent their signature, including but not limited to (1) a
28 digital signature; (2) a faxed version of an original handwritten signature; or (3) an electronically
DMC Master Agreement -39
1 scanned and transmitted (for example by PDF document) of a handwritten signature. Each
2 electronic signature affixed or attached to this Agreement (1) is deemed equivalent to a valid
3 original handwritten signature of the person signing this Agreement for all purposes, including but
4 not limited to evidentiary proof in any administrative or judicial proceeding, and (2) has the same
5 force and effect as the valid original handwritten signature of that person. The provisions of this
6 section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in the Uniform
7 Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1).
8 Each party using a digital signature represents that it has undertaken and satisfied the
9 requirements of Government Code section 16.5, subdivision (a), paragraphs (1) through (5), and
10 agrees that each other party may rely upon that representation. This Agreement is not conditioned
11 upon the parties conducting the transactions under it by electronic means and either party may
12 sign this Agreement with an original handwritten signature.
13 45. ENTIRE AGREEMENT
14 This Agreement, including all Exhibits, constitutes the entire agreement between the
15 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
16 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
17 understanding of any nature whatsoever unless expressly included in this Agreement.
18 //
19 //
20
21
22 //
23 //
24
25
26
27 //
28 //
DMC Master Agreement -40-
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day
2 and year first hereinabove written.
3
4 CONTRACTOR COYNT,Y OF FRESNO
5 _ L VQ -
6 SEE EXHIBIT A Brian Pacheco
Chairman of the Board of Supervisors of the
7 County of Fresno
8
9
10 ATTEST:
11 Bernice E. Seidel
12 Clerk of the Board of Supervisors
County of Fresno, State of California
13
14
15
16
FOR ACCOUNTING USE ONLY:
17
18
ORG No.: 56302081
19 Account No.: 7295/0
20 Fund/Subclass: 0001/10000
Requisition No.: N/A
21 By: �d
Deputy
22
23
24
25
26
27
28
-41-
DMC Master Agreement
1 Provider: AEGIS TREATMENT CENTERS, LLC.
2
3 By
4
5
Print Name: Susan D. Hoeflich
6
Title: Vice President, Managed Care
7 Chairman of the Board, President, or Vice President
8
9 Date: 4/6/2022
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
DMC Master Agreement -42
1 Provider: BAKERSFIELD RECOVERY SERVICE, INC.
2
3 By
4
5 Print Na
6
7 Title: _ N
Chairman of the Board, President, or Vice President
8
9 Date: 3 —31
10
11
12 By
13
14 Print Name: K lM q zt) Cva�s
15
16 Title: _ j-c j k r-t r`
Secretary (of Corporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
19
Date:
20
21
22
23
24
25
26
27
28
DMC Master Agreement -43-
1 Provider: BAYMARK HEALTH SERVICES, INC.
2 ADDICTION RESEARCH AND TREATMENT, INC.
3 MEDMARK TREATMENT CENTERS — FRESNO WEST, INC.
4
5 By
6
7 Print Name: Frank Baumann
8
Vice President
9 Title:
Chairman of the Board, President, or Vice President
10
11 Date:
12
13
14 By O
15
16 Print Name: Gilbert D'Andria
17
18 Title: VP Treasurer
Secretary (of Corporation), Assistant Secretary,
19 Chief Financial Officer, or Assistant Treasurer
20
21 Date: y/ 8/2 o Z Z
22
23
24
25
26
27
28
DMC Master Agreement -44-
1 Provider: CENTRAL CALIFORNIA RECOVERY, INC.
2
3 By 1
4
5 Print Name:
6
Title:
7
dairman oft1be Board, President, or Vice President
8
9 Date-
10
c.
11
12 ByQ6at&�� 6 6d�etzz
13
14 Print Name:
15
16 Title: 64,<-e-l?-
Secretary (of Corporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
Date: Z/4//--�0
19 V
20
21
22 K'
23
24
25
26
27
28
-45-
DMC Master Agreement
1 Provider: DELTA CARE, INC.
2
3 By
4
5 Print Name: G -
6
7 Title:
Chairman of the Board, President, or Vice President
8
9 Date:
10
r
11
12 By
13
14 Print Name:�'r .
15
16
Title:
Secretary (o orporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
-46-
DMC Master Agreement
1 Provider: FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL AND DRUG
2 ABUSE SERVICES, INC.
3
4 BY _
5
6 Print Name: C
7
8 Title: d-fkXt A-AAAN
Chairman of the Board, President, or Vice President
9
10
Date: •2d��
11
12
13 By At
14
15 Print Name: L o&1r,Q,. � �,,
16
17 Title: �cP[ u Au.e _hrvieG�ny-
Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
19
20 Date: 4I 4 /Z2.
21
22
23
24
25
26
27
28
DMC Master Agreement -47
1 Provider: FRESNO NEW CONNECTIONS, INC.
2
3 By
4
5 Print Name: ( h SLf)
6
J 11++
7 Title: �-� C .�U I��{' 1�1(-e t-)C'
Chairman of the Board, President, or Vice President
8
9 Date:
10
11
12 By
13 I I
14 Print Name: 1 )L"CkAA C
15 `
16 Title: &L y \
Secretary (of Corporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
19 Date: Z
20
21
22
23
24
25
26
27
28
DMC Master Agreement -48
ii
DocuSign Envelope ID:54020EB0-58E3-4D2F-99D2-9A5009164C53
1 Provider: KINGS VIEW
2
DocuSigned by:
4 By A04F817F73914D5...
5
Print Name: Amanda Nugent Divine, PhD
6
7 Title: Chief Executive Officer
8 Chairman of the Board, President, or Vice President
9
10
Date: 3/29/2022
11
12 DocuSigned by:
13 By — 79925D1G4D6C40B .
14
Print Name: Michael Kosareff
15
16
Title: Chief Financial Officer
17 Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
19 Date: 3/29/2022
20
21
22
23
24
25
26
27
28
DMC Master Agreement -49
1 Provider: MENTAL HEALTH SYSTEMS, INC.
2
3
4
�i
5 James C.Cafla h
Print Name: g an, fr•
6
7 Title: P*Sidear&CEO
8 Chairman of the Board, President, or Vice President
9 /
10 Date: 13U/�D .
11
12 r\
13 By
14 � yC�Oca�.
Print Name:
15
16
Title:
0
17 Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
19
Date:
20
21
22
23
24
25
26
27
28
DMC Master Agreement _50-
1 Provider: PRODIGY HEALTHCARE, INC.
2
By
3 `
4
Prin ame:
5
6 Title:
7 Chairman of the Board, President, or Vice President
9 Date: l
10
11
12 B _
Y
13
14 Print Name: \cwf,)p
15
16 Title: FO
Secretary (of Corporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
19 Date: Z�-
20
21
22
23
24
25
26
27
28
-51-
DMC Master Agreement
1 Provider: PROMESA BEHAVIORAL HEALTH, INC.
2
3
By
4
5 Print Name:/'l�Cf1R(?� '� /�/i9NOKG-L,
6
7 Title: Ar
8 C airman of the Board, President, or Vice President
9 10
Date: y A-A Z
11
12
13 By
14
15 Print Name: Z UN I',A
16
17 Title: C F-0
Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
19
20 Date: +J`— 1 L
21
22
23
24
25
' 26
27
28
-52-
DMC Master Agreement
1 Provider: TURNING POINT OF CENTRAL CALIFORNIA, INC.
2
3 �le U'a��
By
4 61
5
Print Name: Raymond R. Banks
6
7
Title: Chief Executive Officer
8 Chairman of the Board, President, or Vice President
9
10
Date: 4/20/2022
11
12 13 B wl 40aa
y
14
15 Print Name: William Goodall
16
17 Title: Chief Financial Officer
Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
19
20 Date: 4/19/2022
21
22
23
24
25
26
27
28
DMC Master Agreement -53-
I
i
i
I Provider: WESTCARE CALIFORNIA, INC.
2
By
5 I
Print Name:
6
7 Title: C C:>Q3 i
i
8 Chairman of the Board, President, or Vice President
9
10 Date:
11 ��i-�.a-a'►..iV.� -btu o�,�t-�,z 3�,. � C.c.S rJ -}ta i
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17 Secretary (of Corporation), Assista Secretary,
Chief Financial Officer, or Assistant Treasurer
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DMC Master Agreement -58
Fresno County Department of Behavioral Health Exhibit A
Drug Medi-Cal Services Vendor List
VENDOR CONTACT PHONE NUMBER TYPE OF BUSINESS
BayMark Health Services,Inc.
Addiction Research and Treatment,Inc. Regional Vice President (707)290-0670 For Profit Corporation
MedMark Treatment Centers—Fresno West,Inc. Dawn Groendyke
Remit to:
1720 Lakepointe Drive#117
Lewisville,Tx 75057
Aegis Treatment Centers,I.I.C. Regional Director (818)206-0360 Limited Liability Company
Remit to: Sarah Khawaja-Laljiani
7246 Remmet Ave.
Canoga Park,Ca 91303
Bakersfield Recovery Services Inc. Executive Director (661)325-1817 501(c)3 Non-Profit Corporation
Remit to: Eric Sanders
PO Box 3218
Bakersfield,CA 93385
Central California Recovery,Inc. President (559)273-2942 501(c)3 Non-Profit Corporation
Remit to: Dale White (559)681-1947
1204 W.Shaw Ave.#102
Fresno,CA 93711
Delta Care,Inc. Executive Director (559)276-7558 501(c)3 Non-Profit Corporation
Remit to:
4705 N.Sonora Ave#113
Fresno,Ca 93722
Fresno County Hispanic Commission on Alcohol and
Drug Abuse Services,Inc. Executive Director (559)268-6480 501(c)3 Non-Profit Corporation
Remit to: Domingo Zapata
1803 Broadway St.
Fresno,Ca 93721
Fresno New Connections,Inc. Executive Director (559)248-1548 501(c)3 Non-profit Corporation
Remit to: Carrie Christensen
4411 N.Cedar Ave.#108
Fresno,CA 93726
Kings View Chief Financial Officer (559)251-0100 x3011 501(c)3 Non-profit Corporation
Remit to:
7170 N.Financial Drive,#110
Fresno,CA 93720
Mental Health Systems,Inc. CEO (858)573-2600 501(c)3 Non-profit Corporation
Remit to: James Callaghan
9465 Farnham St. CFO
San Diego,CA 92123 Joelle Verbestel
Prodigy Healthcare,Inc. President (559)892-9452 For Profit Corporation
Remit to: J.D.Dhanda
P.O.Box 820
Fowler,Ca 93625
Promesa Behavioral Health CEO (559)439-5437 501(c)3 Non-profit Corporation
Remit to: Lisa Weigant
7120 N.Marks Ave,#110
Fresno,Ca 93711
Turning Point of Central California,Inc. Chief Executive Officer (559)732-8086 501(c)3 Non-profit Corporation
Remit to:
PO Box 7447
Visalia,CA 93290
WestCare California,Inc. Chief Operating Officer (559)251-4800 501(c)3 Non-profit Corporation
Remit to: Shawn A.Jenkins
1900 N.Gateway Blvd,100
Fresno,CA 93727
**A list of current provider sites can be found at:
httos://www.co.fresno.ca.us/departments/behaviora I-health/substance-use-d isorder-service:
DMC Master Agreement
Revised 7/01/2022 1 of 1
Exhibit B
Fresno County,Department of Behavioral Health
Drug Medi-Cal Organized Delivery System
Modality of Service Descriptions
Covered services under the Drug Medi-Cal Organized Delivery System(DMC-ODS) shall be
furnished in an amount, duration, and scope that is no less than the amount, duration, and scope
for the same services furnished to persons served under fee-for-service Medicaid, as set forth in
42 CFR 440.230. Contractors shall ensure that the services are sufficient in amount, duration, or
scope to reasonably be expected to achieve the purpose for which the services are furnished.
Contractors may not arbitrarily deny or reduce the amount duration, or scope of a required
service solely because of diagnosis, type of illness, or condition of the person served.
Contractors are required to ensure services are provided timely as further described in the Fresno
County Substance Use Disorder Provider Manual.
In all levels of care, contractors are required to either offer medications for addiction treatment
(MAT) directly or demonstrate effective referral mechanisms in place to the most clinically
appropriate MAT services. Providing a person served the contact information for a MAT
program is insufficient.
Placement in an appropriate level of care must be determined through an assessment based on
the American Society of Addiction Medicine (ASAM) criteria and prescribed by the contractor's
medical director.
DRUG MEDI-CAL SERVICES:
EARLY INTERVENTION SERVICES (ASAM LEVEL 0.5)
Early intervention services (EIS) are available to persons served under 21 who are screened and
determined to be at risk of developing an SUD. At risk persons served may receive any service
component covered under the outpatient level of care (ASAM 1.0) as early intervention services.
An SUD diagnosis is not required for early intervention services.
A full assessment utilizing the ASAM criteria is not required for a person served under the age of
21 to receive EIS.
EIS services may be delivered in a wide variety of settings and can be provided in person, by
telehealth, or by telephone.
EIS services do not limit or modify the Early Periodic Screening, Diagnostic and Treatment
(EPSDT)mandate.
OUTPATIENT SERVICES (ASAM LEVEL 1.0)
Outpatient services consist of up to nine (9)hours per week of medically necessary services for
adults and up to six (6) hours per week of services for adolescents. Services may exceed the
maximum hours based on individual medical necessity.
Revised 07/01/2022 1
DMC Master Agreement
Exhibit B
Services can be provided by an LPHA or registered/certified counselor in-person, by telephone,
or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42
CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons
served.
Outpatient services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDs
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
INTENSIVE OUTPATIENT SERVICES (ASAM LEVEL 2.1)
Intensive outpatient involves structured programming provided to persons served as medically
necessary for a minimum of nine (9)hours and a maximum of nineteen(19) hours for adults and
a minimum of six(6)hours and a maximum of nineteen(19) for adolescents. Providers may
exceed maximum treatment hours when determined to be medically necessary.
Intensive outpatient treatment services include the same service components listed under
Outpatient 1.0.
Services can be provided by an LPHA or registered/certified counselor in-person, by telephone,
or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42
CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons
served.
OPIOID (NARCOTIC) TREATMENT PROGRAMS (ASAM LEVEL 1.0)
Narcotic treatment program services shall be provided in accordance with Title 9, Chapter 4,
Division 4 and CFR 42.
Narcotic Treatment Programs (NTP), also known as Opioid Treatment Programs (OTP), are
outpatient programs that provide Food and Drug Administration (FDA)-approved medications
and biological products to treat SUDs when ordered by a physician as medically necessary.
NTPs are required to administer, dispense, or prescribe medications to persons served covered
under the DMC-ODS formulary including methadone,buprenorphine (transmucosal and long-
acting injectable), naltrexone (oral and long-acting injectable), disulfiram, and naloxone. NTPs
may also prescribe the medication for dispensing at a pharmacy. The medical evaluation for
methadone treatment must be conducted in-person.
Revised 07/01/2022 2
DMC Master Agreement
Exhibit B
Persons served in OTP/NTP settings shall receive no less than fifty(50)minutes of treatment
services per calendar month although additional services may be provided based on medical
necessity. Counseling services provided in the NTP modality can be provided in person, by
telehealth or by telephone.
NTP services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medical Psychotherapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDs
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
PERINATAL/NON-PERINATAL RESIDENTIAL SUBSTANCE USE DISORDER
TREATMENT SERVICES (EXCLUDING ROOM AND BOARD) (ASAM LEVELS 3.1,
3.3 and 3.5)
Residential treatment services are provided in facilities licensed by the California Department of
Health Care Services (DHCS) or the California Department of Social Services for adolescents
that also have DMC certification and a DHCS Level of Care Designation or an ASAM LOC
Certification demonstrating ability to delivery care consistent with ASAM treatment criteria.
There is no bed capacity limit for residential facilities.The Contactor must provide 24-hour care
with trained personnel, including awake staff on the overnight shift to address persons served
needs.
Adults (21 and over): The length of stay in a short-term residential setting shall be determined
by individualized clinical need. Services must include preparation for a step down to a less
intensive level of care, when clinically appropriate. The statewide goal for the average length of
stay for residential treatment services is 30 days.
Adolescents (under the age of 21): The length of stay in a short-term residential setting shall be
determined by individualized clinical need. Services must include preparation for step down to a
less intensive level of care as soon as clinically appropriate. Adolescent beneficiaries receiving
residential treatment shall be stabilized as soon as possible and moved down to a less intensive
level of treatment. Nothing in the DMC-ODS or in this paragraph overrides any EPSDT
requirements.
Revised 07/01/2022 3
DMC Master Agreement
Exhibit B
Residential contractor(s) must seek prior authorization for residential treatment services upon
admission and prior to the expiration of each authorized treatment period. Treatment
authorization request processes can be found in the Fresno County SUD Provider Manual.
Residential services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDs
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
WITHDRAWAL MANAGEMENT (Level 1-WM,Level 2-WM and Level 3.2-WM)
Withdrawal management (WM) services are prescribed based on an individual assessment using
the ASAM criteria. Contractor(s) shall ensure persons served receiving both residential and
outpatient WM services are monitored during the detoxification process. Withdrawal
Management Services may be provided in an outpatient or residential setting.
Withdrawal management services are urgent and provided on a short-term basis. When provided
as part of withdrawal management services, service activities such as the assessment, focus on
the stabilization and management of psychological and physiological symptoms associated with
withdrawal, engagement in care and effective transitions to a level of care where comprehensive
treatment services are provided.
A full ASAM assessment shall not be required as a condition of admission to a withdrawal
management program.
ASAM 3.7-WM and 4-WM services are part of the DMC-ODS continuum of care but are offered
through the Medi-Cal Managed Care Plans, Anthem Blue Cross and CalViva Health. If a person
served is determined to be in need of this level of care, the provider should provide care
coordination to the Managed Care Plans for treatment.
Withdrawal Management services include the following service components:
• Assessment
• Care Coordination
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDs
• Observation
• Recovery Services
Revised 07/01/2022 4
DMC Master Agreement
Exhibit B
ADDITIONAL MEDICATION ASSISTED TREATMENT (MAT)
Medication for addiction treatment include all FDA-approved medications and biological
products to treat Alcohol Use Disorders (AUD), Opioid Use Disorders (OUD) and any SUD.
MAT may be provided in clinical or non-clinical settings and can be delivered as a standalone
service or as a service delivered as part of another level of care. Persons served who decline
counseling services shall not be denied access to MAT or administratively discharged.
Additional MAT involves the ordering, prescribing, administering, and monitoring of
medications for substance use disorders.
All DMC-ODS providers, at all levels of care, must demonstrate that they either directly offer or
have an effective referral mechanism/process to MAT for persons served with SUD diagnoses.
MAT services may be provided in conjunction with the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
• Withdrawal Management Services
CARE COORDINATION SERVICE (formerly Case Management)
Care Coordination services are defined as a service that assists persons served to access needed
medical, educational, social, prevocational, vocational, rehabilitative, or other community
services.
Care coordination consists of activities to provide coordination of SUD care, mental health care,
and medical care, and to support the person served with linkages to services and supports
designed to restore the person served to their best possible functional level.
Care Coordination services are provided to a person served in conjunction with all levels of
treatment and may also be claimed as a standalone service.
Care Coordination services may be provided by an LPHA or certified counselor. Contractors
shall use care coordination services to coordinate with physical and/or mental health systems of
care.
Care coordination can be provided in clinical or nonclinical settings (including the community)
and can be provided face-to-face,by telehealth, or by telephone.
Revised 07/01/2022 5
DMC Master Agreement
Exhibit B
Care Coordination shall include one or more of the following components:
• Coordination with medical and mental health providers to monitor and support comorbid
health conditions.
• Discharge planning, including coordinating with SUD treatment providers to support
transitions between levels of care and to recovery resources, referrals to mental health
providers, and referrals to primary or specialty medical providers.
• Coordinating with ancillary services, including individualized connection, referral, and
linkages to community-based services and supports including but not limited to
educational, social, prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage education, cultural sources,
and mutual aid support groups.
Care Coordination shall be consistent with and shall not violate confidentiality of persons served
as set forth in 42 CFR Part 2, and California law.
PEER SUPPORT SERVICES (Available following completion of Fresno County opt-in)
Peer support services promote recovery, resiliency, engagement, socialization, self-sufficiency,
self-advocacy, development of natural supports, and identification of strengths through
structured activities such as group and individual coaching to set recovery goals and identify
steps to reach the goals.
Peer support services may be provided with the person served or significant support person(s)
and may be provided in a clinical or non-clinical setting. Peer support services can include
contact with family members or other people (collaterals) supporting the person served if the
purpose of the collateral's participation is to focus on the treatment needs of the person served.
Peer support services are delivered and claimed as a standalone service. Peer support services
can be provided concurrently with other levels of care and are based on a plan of care approved
by a Behavioral Health Professional.
Peer support services consist of Education Skill Building Groups, Engagement services and
Therapeutic Activity services.
Peer Support Specialists are individuals in recovery with a current State-approved Medi-Cal Peer
Support Specialist Certification Program certification and working under the direction of a
Behavioral Health Professional. Behavioral Health Professionals must be licensed, waivered, or
registered in accordance with applicable State of California licensure requirements and listed in
the California Medicaid State Plan as a qualified DMC provider.
RECOVERY SERVICES
Recovery Services are designed to support recovery and prevent relapse with the objective of
restoring the person served to their best possible functional level.
Revised 07/01/2022 6
DMC Master Agreement
Exhibit B
Recovery services can be utilized when the person served is triggered, when the person served
has relapsed or simply as a measure to prevent relapse.
Persons served do not need to be diagnosed as being in remission to access Recovery Services.
Persons served may receive Recovery Services while receiving MAT services, including NTP
services. Persons served may receive Recovery Services immediately after incarceration with a
prior diagnosis of SUD. Services may be provided in person, by telehealth, or by telephone.
Recovery Services can be delivered and claimed as a standalone service, concurrently with the
other levels of care or as a service delivered as part of other levels of care.
Contractors that do not opt to make recovery services available must refer persons served to a
contractor that provides recovery services.
Recovery Services shall include the following service components:
• Assessment
• Care Coordination
• Counseling (individual and group)
• Family Therapy
Recovery Monitoring, which includes recovery coaching and monitoring designed for the
maximum reduction of the person served's SUD
• Relapse Prevention which includes interventions designed to teach persons served with
SUD how to anticipate and cope with the potential for relapse for the maximum reduction
of the person served's SUD.
CLINICIAN CONSULTATION (formerly Physician Consultation)
Clinician Consultation consists of LPHAs consulting with LPHAs, such as addiction medicine
physicians, addiction psychiatrists, licensed clinicians, or clinical pharmacists, to support the
provision of care.
Clinician Consultation is designed to support licensed clinicians with complex cases and may
address medication selection, dosing, side effect management, adherence, drug-drug interactions,
or level of care considerations. It includes consultations between clinicians designed to assist
clinicians with seeking expert advice on treatment needs for specific persons served. These
consultations can occur in person,by telehealth,by telephone, or by asynchronous
telecommunication systems.
NON-DMC FUNDED SERVICES:
Non-DMC eligible persons served will have access to the same services as DMC-eligible
persons served with costs reimbursed through other sources. These services, available to all
perinatal and non-perinatal adults and adolescents, include:
• Early Intervention Services
• Outpatient
• Intensive Outpatient
• Additional Medication Assisted Treatment
• Residential treatment, including Withdrawal Management
Revised 07/01/2022 7
DMC Master Agreement
Exhibit B
• Care Coordination
• Peer Support Services
• Recovery Services
• Clinician Consultation
Room and Board for Residential Treatment and Withdrawal Management services is not eligible
for reimbursement through DMC. These costs will be covered with other non-DMC funding
sources.
Revised 07/01/2022 8
DMC Master Agreement
Exhibit C
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 persons served 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
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.
Revised 01/31/2022
DMC Master Agreement
Exhibit C
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 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
Revised 01/31/2022
DMC Master Agreement
Exhibit C
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 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.
Revised 01/31/2022
DMC Master Agreement
Exhibit C
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.
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. 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. HSC, Division 10.5, commencing with Section 11760;
B. California Code of Regulations (CCR), Title 9, Division 4, Chapter 8,
commencing with Section 13000;
C. Government Code Section 16367.8
Revised 01/31/2022
DMC Master Agreement
Exhibit C
D. 42, CFR, Sections 8.1 through 8.6.
E. Title 21, CFR, Sections 1301.01 through 1301.93, Department of Justice,
Controlled Substances.
F. State Administrative Manual (SAM), Chapter 7200 (General Outline of
Procedures).
G. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
Amendments of 1996);
H. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards); and
CONTRACTOR shall be familiar with the above requirements and must incorporate
these requirements into written policies and procedures, as applicable.
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 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 persons served,
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 persons served with physical or mental
disabilities in accordance with CFR Title 45, Part 84 and the Americans with Disabilities Act.
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 person served 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.
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Exhibit C
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 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.
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Exhibit C
M. 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.
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 group counseling to
participants, patients, or residents in a DHCS licensed or certified program is required to be
certified as defined in CCR 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 follow all Federal and
State civil rights laws. CONTRACTOR shall not unlawfully discriminate, exclude people, or treat
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DMC Master Agreement
Exhibit C
them differently, on any ground protected under Federal or State law, including sex, race, color,
religion, ancestry, national origin, ethnic group identification, age, mental disability, physical
disability, medical condition, genetic information, marital status„ gender, gender identity, or sexual
orientation and will not use any policy or practice that has the effect of discriminating on the basis
of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental
disability, physical disability, medical condition, genetic information, marital status, gender, gender
identity, or sexual orientation. CONTRACTOR shall ensure that persons served that meet
medical necessity for Medication Assisted Treatment (MAT) receive the same access to care as
non-MAT persons served.
CONTRACTOR shall provide information on how to file a Discrimination Grievance
with COUNTY or DHCS if there is a concern of discrimination based on sex, race, color, religion,
ancestry, national origin, ethnic group identification, age, mental disability, physical disability,
medical condition, genetic information, marital status, gender, gender identity, or sexual
orientation. CONTRACTOR shall also provide information on how to file a Discrimination
Grievance 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, sex, age, or disability.
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 persons served 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 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 Member Handbook.
CONTRACTOR shall make the following grievance information available to all
persons served:
A. Perons Served's right to a State Fair Hearing and how to obtain a hearing as
well as representation rules.
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Exhibit C
B. Person Served's right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Person Served's right to give written consent to allow CONTRACTOR or
legal representative, acting on behalf of the person served, to file an appeal.
D. Person Served 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. Person Served's right to request continuation of benefits during an appeal or
state fair hearing filing although the person served 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 person served grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Person served
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. PERSON SERVED INFORMING AND TRANSLATION SERVICES
CONTRACTOR shall make written and verbal information available to persons
served in their language of choice.
Written material: CONTRACTOR shall use COUNTY's written/translated materials
that are critical to obtaining services, including the provider directory, member 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 use easily
understood language and format, use a font size no smaller than 12-point, and are made available
in alternative formats upon request of the potential person served or person served at no cost.
Written materials shall include taglines in the prevalent non-English languages in the state, as well
as large print, explaining the availability of written translation or oral interpretation to understand
the information provided and the toll-free and TTY/TDY telephone number of COUNTY's
member/customer service unit. Written materials for potential and current persons served shall
include language taglines in at least the top sixteen (16) non-English languages spoken by
individuals with limited English proficiency of the State, as well as large print, explaining the
availability of written translation or oral interpretation to understand the information provided.
Large print means in a font size no smaller than 18 point.
Auxiliary aids: CONTRACTOR shall ensure auxiliary aids and services in an
appropriate manner that takes into consideration the special needs of persons served or potential
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Exhibit C
persons served with disabilities or limited English proficiency shall be made available upon
request of the potential person served or person served at no cost.
Interpretation services: CONTRACTOR shall make interpretation services available
free of charge and in a timely manner to each person served. 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 the following qualifications:
A. Demonstrated proficiency in speaking and understanding both spoken
English and the language spoken by the limited-English-proficient person served;
B. The ability to interpret effectively, accurately, and impartially, both receptively
and expressly, to and from the language spoken by the limited-English-proficient person served
and English, using any necessary specialized vocabulary, terminology, and phraseology; and
C. Adherence to generally accepted interpreter ethics principles, including client
confidentiality.
CONTRACTOR shall notify its persons served and prospective persons served that
oral interpretation is available for any language and written translation is available in prevalent
languages to individuals whose primary language is not English free of cost and how to access
those materials. This may include, but is not limited to qualified interpreters and information
written in other languages. CONTRACTOR shall notify persons served that auxiliary aids and
services are available upon request, at no cost and in a timely manner for non-English
speaking/reading/writing persons served and persons served with disabilities. Free aides and
services to people with disabilities to help them communicate better may include, but are not
limited to, qualified sign language interpreters and written information in other formats (e.g. large
print, audio, accessible electronic formats, and other formats). CONTRACTOR shall notify
persons served how to access these services.
Pursuant to 14029.91(a)(1)(C), CONTRACTOR shall not require a person served
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 person served 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.
Pursuant to 45 CFR 92.201, CONTRACTOR shall not require a person served with
limited English proficiency to accept language assistance services.
CONTRACTOR shall post a DHCS-approved nondiscrimination notice and
language taglines in at least the top sixteen (16) non-English languages in the State (as
determined by DHCS) as well as large print, explaining the availability of free language assistance
services, including written translation and oral interpretation to understand the information
provided, and the toll-free and TTY/TDY telephone number of CONTRACTOR's
member/customer service unit, as follows:
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Exhibit C
A. In all conspicuous physical locations where CONTRACTOR interacts with
the public;
B. In a conspicuous location on CONTRACTOR's website that is accessible on
CONTRACTOR's home page, and in a manner that allows persons served and prospective
persons served to easily locate the information; and
C. In all significant communications and significant publications targeted to
persons served, enrollees, applicants, and members of the public, except for significant
publications and significant communications that are small-sized, such as postcards and tri-fold
brochures.
CONTRACTOR shall post a DHCS-approved nondiscrimination statement and
language taglines in a least the top two non-English languages in the State (as determined by
DHCS), explaining the availability of free language assistance services, and the toll-free and
TTY/TDY telephone number of CONTRACTOR's member/customer service unit, as follows:
A. In all significant publications and significant communications that are small-
sized, such as postcards and tri-fold brochures; and
B. CONTRACTOR's nondiscrimination notice, nondiscrimination statement,
and language taglines must be in a conspicuously visible font size no smaller than 12-point. Any
large print tagline required must be in a font size no smaller than 18-point and must include
information on how to request auxiliary aides and services, including the provision of the materials
in alternative formats.
25. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and issue to
persons served at intake. Member handbooks can also be made available by mailing a printed
copy of the information to the person served's mailing address, emailing after obtaining the person
served'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
person served 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 persons
served or comparable to Medicaid FFS, if CONTRACTOR services only Medicaid persons served.
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.
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DMC Master Agreement
Exhibit C
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 person served 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 person served.
The person served shall be provided information on how to contact their case manager.
CONTRACTOR shall coordinate services between levels of care, with services the person served
receives from any other managed care organization and the services the person served receives
from community and social support providers. Care coordination efforts shall be accurately
documented in person served'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
person served's ancillary needs, within thirty (30) calendar days of the effective date of admission
for all new persons served, including subsequent attempts if the initial attempt to contact the
person served is unsuccessful.
CONTRACTOR shall ensure that it maintains and shares, as appropriate, a person
served health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each person
served'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 persons served 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
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DMC Master Agreement
Exhibit C
person served. 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 person served 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.
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 person served encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years.
CONTRACTOR shall ensure sites keep a record of persons served being treated at
that location.
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.
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DMC Master Agreement
Exhibit C
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.
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 SLID 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 person served'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", "From Assessment to Service Planning and Level of Care" and "Introduction to the
ASAM Criteria". CONTRACTOR shall maintain records of ASAM trainings in personnel files and
will make these records available to COUNTY upon request.
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Exhibit C
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. If a person served's assessment and intake information are
completed by a counselor through a face-to-face review or telehealth, the Medical Director or
LPHA shall evaluate each person served's assessment and intake information with the counselor
to establish whether that person served meets medical necessity criteria. The ASAM Criteria shall
be applied to determine placement into the level of assessed services.
CONTRACTOR shall ensure that all ADULT persons served receive at least one
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.
OTP/NTP CONTRACTOR shall periodically as directed by COUNTY, and at a
minimum within two (2) years from admission and annually thereafter, reassess for continued
medical necessity of an ongoing treatment and determine that those services are still clinically
appropriate for that individual.
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, perons served 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:
1) Substance use does NOT meet the minimum diagnosis criteria per
the DSM 5; and
2) 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.
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DMC Master Agreement
Exhibit C
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
person served 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 person served are described in the DHCS DMC Provider Billing Manual at the following web
address and by this reference incorporated herein.
https://www.dhcs.ca.gov/services/Documents/SUD%20-
%20DMC%20Billinq%20Manual/DMC Billing Manual 2019%20Final.pdf
38. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a person served 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. NTP CONTRACTOR shall submit cost reports
to DHCS.
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 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
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DMC Master Agreement
Exhibit C
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 person served's pregnancy
and the last day of pregnancy shall be maintained in the person served 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 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.
Revised 01/31/2022
DMC Master Agreement
Exhibit C
44. MEDICATION ASSISTED TREATMENT
CONTRACTORs that do not provide medication assisted treatment shall have
procedures for linkage/integration for persons served requiring medication assisted treatment.
CONTRACTOR staff will regularly communicate with physicians of person served who are
prescribed these medications unless the person served 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
CaIVIVA 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 person served 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 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 person served'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,
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DMC Master Agreement
Exhibit C
assessment, person served 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)].
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.
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DMC Master Agreement
Exhibit C
E. Code Set Retention
Both COUNTY and CONTRACTOR 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 COUNTY and CONTRACTOR 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.
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 person
served (whether or not the benefits are furnished by the CONTRACTOR). (42 CFR 438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to person
served 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))
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DMC Master Agreement
Exhibit C
52. 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)).
53. ACCESSIBILITY CONSIDERATIONS
CONTRACTOR shall ensure that their health programs or activities provided
through electronic and information technology are accessible to person served 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 person served 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).
54. STATE PLAN COUNTIES OTP/NTP PERSONS SERVED
OTP CONTRACTORs shall ensure that a person served that resides in a county
that does not participate in DMC-ODS does not experience a disruption of OTP/NTP services. OTP
CONTRACTORs shall provide any medically necessary NTP services covered by the California
Medi-Cal State Plan to persons served that reside in a county that does not participate in DMC-
ODS. OTP CONTRACTORs who provide services to an out-of-county person served shall submit
claims for those services to the county in which the person served resides (according to MEDS).
PERSON SERVED RIGHTS
CONTRACTOR shall comply with any applicable Federal and state laws that pertain
to person served rights and shall ensure that its employees observe and protect those rights.
CONTRACTOR shall have written policies guaranteeing the person served's rights specified in 42
CFR 438.100.
RECORD RETENTION
CONTRACTORS shall maintain records for each service rendered, to whom it was
rendered, and the date of service, pursuant to WIC 14124.1 and 42 CFR 438.3(h) and 438.3(u).
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DMC Master Agreement
Exhibit C, 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:
DMC Master Agreement
Exhibit C, 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:
DMC Master Agreement
Exhibit C,Attachment C
Page 1 of 1
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:
hllp://www.dhcs.ca.gov/fortnsandpubs/laws/priv/Pages/DHCSBusinessAssociates0nly.aspx and
return the completed form to: privacyofficerndhcs.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:
3133 N Millbrook,Fresno,California 93703
FAX(559)600-7673 www.co.fresno.ca.us
DMC Master Agreement
The County of Fresno is an Equal Employment Opportunity Employer
Exhibit D
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
2. Principle Two - Strengths-based
1
rev 01-02-2020
DMC Master Agreement
Exhibit D
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
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
2
rev 01-02-2020
DMC Master Agreement
Exhibit D
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
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
3
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DMC Master Agreement
Exhibit D
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
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DMC Master Agreement
Exhibit E
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2022-23
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Withdrawal Residential Residential
Coordination Services Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE 51.00 53.85 51.45 52.05 153.60 153.60 164.24 185.13 188.52
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat 164.24
Bakersfield Recovery, Inc.-Capistrano 164.24
Central California Recovery 45.00 46.35 153.60 153.60
Delta Care 40.50 51.45 33.00 153.60 153.60
Fresno County Hispanic Commission 1 43.07 1 153.60 153.60 111.05
Fresno New Connections 32.70 53.85 51.45 27.00 153.60 153.60
Kings View-Fresno 44.55 44.55 153.60 153.60
Mental Health Systems- FYA 39.00 38.55 37.20 153.60 153.60
Mental Health Systems- IMPACT 40.95 42.90 39.75 39.75 153.60 153.60
Mental Health Systems- Fresno First(Womens) 1 43.07 153.60 153.60 127.27 172.38 172.38
Mental Health Systems- Fresno First(Perinatal) 43.07 153.60 153.60 127.27 172.38 172.38
Prodigy 50.55 50.10 52.05 153.60 153.60
Promesa 48.90 46.80 49.50 153.60 153.60
Turning Point-First Street Center 36.60 35.55 153.60 153.60
Turning Point-Quest House 43.07 153.60 153.60 177.92 188.52
Turning Point-Visalia 43.07 153.60 153.60 106.00
WestCare Outpatient-Belmont 51.00 50.70 49.65 42.75 153.60 153.60
WestCare Bakersfield Residential 40.50 153.60 153.60 163.41 120.63
WestCare Fresno Residential
Mens 35.25 153.60 153.60 164.24 156.84 163.66
Perinatal 35.251 153.601 153.60 164.241 170.781 175.84
Womens 35.251 153.601 153.601 164.241 158.831 173.87
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Exhibit E
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Exhibit E
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2023-24
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Withdrawal Residential Residential
Coordination Services Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems- FYA
Mental Health Systems- IMPACT
Mental Health Systems- Fresno First(Womens)
Mental Health Systems- Fresno First(Perinatal)
Prodigy
Promesa
Turning Point-First Street Center
Turning Point-Quest House
Turning Point-Visalia
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
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Exhibit E
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Exhibit E
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Exhibit E
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2024-25
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Withdrawal Residential Residential
Coordination Services Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems- FYA
Mental Health Systems- IMPACT
Mental Health Systems- Fresno First(Womens)
Mental Health Systems- Fresno First(Perinatal)
Prodigy
Promesa
Turning Point-First Street Center
Turning Point-Quest House
Turning Point-Visalia
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
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Exhibit E
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Exhibit E
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Exhibit E
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2025-26
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Withdrawal Residential Residential
Coordination Services Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems- FYA
Mental Health Systems- IMPACT
Mental Health Systems- Fresno First(Womens)
Mental Health Systems- Fresno First(Perinatal)
Prodigy
Promesa
Turning Point-First Street Center
Turning Point-Quest House
Turning Point-Visalia
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
07/01/2022 DMC Master Agreement 10 of 15
Exhibit E
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07/01/2022 DMC Master Agreement 11 of 15
Exhibit E
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07/01/2022 DMC Master Agreement 12 of 15
Exhibit E
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2026-27
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Withdrawal Residential Residential
Coordination Services Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems- FYA
Mental Health Systems- IMPACT
Mental Health Systems- Fresno First(Womens)
Mental Health Systems- Fresno First(Perinatal)
Prodigy
Promesa
Turning Point-First Street Center
Turning Point-Quest House
Turning Point-Visalia
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
07/01/2022 DMC Master Agreement 13 of 15
Exhibit E
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07/01/2022 DMC Master Agreement 14 of 15
Exhibit E
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07/01/2022 DMC Master Agreement 15 of 15
PROVIDER REPORTS Fresno County Substance Use Disorder Services
Department of Behavioral Health Exhibit F
Report Purpose Submit to Notes weekly Monthly Annual As
Needed
ASAM Level of Care Tracks level of care determined at sas@ Submit reports by Monday for the
(LOC) screening,assessment,and reassessment fresnocountyca.gov previous week; ensure that reports are Monday
and actual LOC referred to. password protected or encrypted.
Provides capacity and utilization 5th of
DATAR information on publicly funded SUD DHCS Webpage following
programs. month
Template provided by DBH.
• Provider shall enter information per
modality. If provider offers multiple
Managed care requirement. Used to levelsof care within a modality,
provider is to use the program ID with 15th of
Monthly Status Report monitor network adequacy standards. sas@ followin
(MSR) Provides status on DMC programs and is fresnocountyca.gov the lowest LOC(e.g.,for residential, monthg
used to update provider directory. enter info under 3.1 instead of 3.5).
• Providers are asked to report
departing counselors via MSR as
soon asthey become aware of the
upcoming change.
Provides information on length of waittime 15th of
Wait List* for admission into a residential sas@ Applicable to residential providers only following
program. fresnocountyca.gov month
Checks for clinicians'eligibility to provide 15th of
Ineligible Persons services based on sanctions or exclusion sas@ Template provided by DBH current
Screening status. fresnocountyca.gov month
15t"of
Missed Appointments Collects missed appointment data. Avatar following
month
15th of
Grievance Log DHCS requirement.Collects grievances at mcare@ Template provided by DBH following
SUD programs. fresnocountyca.gov month
25th of
Operational Expense Tracks provider expenses and monitors sas@ Template provided by DBH following
Review(OER)* whether reported costs are allowable. fresnocountyca.gov month
12/27/2021 DMC Master Agreement Page 1
PROVIDER REPORTS Fresno County Substance Use Disorder Services
Department of Behavioral Health Exhibit F
Report Purpose Submit to Notes weekly Monthly Annual As
Needed
Network Adequacy sas@
Certification Tool Used to monitor network adequacy Template provided by DBH Feb 1
(NACT) standards. fresnocountyca.gov
Culturally and Used to monitor adherence to the
Linguistically National CLAS Standards which are sas@
Appropriate Services intended to advance health equity, Template provided b DBH TBD
fresnocountyca.gov p p Y
(CLAS)self-assessment improve quality,and help eliminate
and CLAS plan health care disparities.
Americans with Used to monitor compliance with sas@
Disabilities Act(ADA) legislation that prohibits discrimination fresnocountyca.gov Template provided by DBH TBD
self-assessment against people with disabilities.
Identifies costs and charges related to sas@
Cost Report* program. fresnocountyca.gov Due annually; date set by DHCS and DBH TBD
Electronic copy:
sas@
fresnocountyca.gov
Hard copy:
Mandated questionnaire used to determine Department of
Risk Assessment a provider's risk categoryclassification. Behavioral Health Due annually; date set by DBH TBD
Substance Use
Disorder Services
Attn: Fiscal Analyst
3133 N Millbrook
Ave
Fresno, CA 93703
12/27/2021 DMC Master Agreement Page 2
PROVIDER REPORTS Fresno County Substance Use Disorder Services
Department of Behavioral Health Exhibit F
Additional Reports
Report Purpose Submit to Notes weekly Monthly Annual As
Needed
• Providers are required to complete
an online report of any incidents
that compromise the health and
Logic Manager Incident reporting system Logic Manager safety of clients, employees or X
community members.
• Reports must be submitted within
48 hours of an incident
• Complete form at the time
that an individual requests
Access Form Collects timeliness data. Avatar SUD treatment X
• Instructions are posted at our SUD
Services Provider Page
• Timeframes vary. Refer to
MHSUDS IN #18-010E:
https://www.dhcs.ca.gov/forms
andpubs/Pages/Behavioral Heal
Managed care requirement. NOABD letters th Information Notice.aspx
Notice of Adverse Benefit provide information to Medi-Cal persons mcare@ • Templates provided by DBH,
Determination (NOABD) served about their appeal rights and other fresnocountyca.gov available at the Provider page: X
rights under the Medi-Cal program. https://www.co.fresno.ca.us/depar
tments/behavioral-
health/home/for-
providers/contract-
providers/substance-use-disorder-
providers
*Excluding NTP-only Providers
12/27/2021 DMC Master Agreement Page 3
Exhibit G
Page 1 of 1
ELECTRONIC HEALTH RECORD SOFTWARE CHARGES
CONTRACTOR(S) understand that COUNTY utilizes NetSmart's Avatar for its Electronic Health Records Management.
CONTRACTOR(S) agree to reimburse COUNTY for all user license fees for accessing NetSmart's Avatar, as set forth below.
Description FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22 FY 2022-23
General Users
Avatar Named User Hosting
(per active user per month; every Avatar"active" log on $37.00 $37.00 $37.00 $37.00 $37.00
ID is a named user)
Avatar Named User Maintenance* $14.00 $14.00 $14.00 $14.00
(per active user per month) $14.00
Cloud Hosting- Perceptive Disaster Recovery
(per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66
eRx Users
Full Suite Prescriber $104.00 $104.00 $104.00 $104.00
(per active user per month; applicable to an active $104.00
Prescriber user
ePrescribing Controlled Substances Tokens $8.00 $8.00 $8.00 $8.00
(per active user per month; applicable to an active $8.00
Prescriber user of Controlled Substances
Non-Prescribing User $13.00 $13.00 $13.00 $13.00
(per active user per month; applicable to an active Non- $13.00
Prescriber user
Reaching Recovery Users
Reaching Recovery
(per adult client/person served per year; applicable to $10.00 $10.00 $10.00 $10.00 $10.00
adult treatment programs except contracted triage/CI,
CSU or PHF
ProviderConnect Users
Individual Subscription'
(per user per month; applicable to provider-user whose $41.25 $41.25 $41.25 $41.25 $41.25
claims are reviewed and posted by Managed Care)
Should CONTRACTOR(S) choose not to utilize NetSmart's Avatar for its Electronic Health Records management, CONTRACTOR(S)
will be responsible for obtaining its own system for Electronic Health Records management.
*Annual Maintenance increases by 3%each FY on July 111
aI AA faxed pages peF MORth A R additiGRal fee of$0.20 peF faxed page will apply theFeafteF.
DMC Master Agreement
Exhibit H
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).
DMC Master Agreement
Exhibit H
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:
DMC Master Agreement
Exhibit I
Pagel of 3
DISCLOSURE - CRIMINAL HISTORY & CIVIL ACTIONS:
In their proposal, the bidder is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively
referred to as "Bidder"):
• Within the three-year period preceding the proposal, they have been convicted of, or
had a civil judgment rendered against them for:
o 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;
o violation of a federal or state antitrust statute;
o embezzlement, theft, forgery, bribery, falsification, or destruction of records; or
o false statements or receipt of stolen property
• Within a three-year period preceding their proposal, they have had a public transaction
(federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate a Bidder from
consideration. The information will be considered as part of the determination of whether to
award the contract and any additional information or explanation that a Bidder elects to submit
with the disclosed information will be considered. If it is later determined that the Bidder failed
to disclose required information, any contract awarded to such Bidder may be immediately
voided and terminated for material failure to comply with the terms and conditions of the
award.
Any Bidder who is awarded a contract must sign an appropriate Certification Regarding
Debarment, Suspension, and Other Responsibility Matters, pages 2 and 3 of this Exhibit,
Additionally, the Bidder awarded the contract must immediately advise the County in writing if,
during the term of the agreement: (1) Bidder becomes suspended, debarred, excluded or
ineligible for participation in federal or state funded programs or from receiving federal funds
as listed in the excluded parties list system (http://sam.gov); or (2) any of the above listed
conditions become applicable to Bidder. The Bidder 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.
DMC Master Agreement
Exhibit I
Page 2 of 3
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.
DMC Master Agreement
Exhibit I
Page 3 of 3
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)
DMC Master Agreement
Exhibit J
Page 1 of 1
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
• The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, CONTRACTOR shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
DMC Master Agreement
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Co Incident Reporting System Exhibit J
t,
1
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of clients, employees, or community
members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
• Do away with submitting a paper version with a signature.
• This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, your responsibility is to:
• Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
• Review incident for clarity, missing information and add in additional information deemed
appropriate.
• Notify DBHlncidentReporting@fresnocountyca.gov if there is addition information you need to
report that you are unable to add in Logic Manager.
• Contact.DBHlncidentReporting@fresnocountVca.gov if you have any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take you to reporting screen and you may begin your incident submission:
DMC Master Agreement
Exhibit J
E C 4 Y fresnodbh.logicmanagecmmlncidents/?t=9&p=18ik=182be0c5cdcd5072bbl864cdee4d3d6e
LogicManager
Incident Report
Please complete this form
Client Information
Name of Facility'
Name of Reporting Party'
Facility Address'
Enter to r
Facility Phone Number'
Mental Health or Substance Use Disorder Program?'
Client First Name`
Client Last Name
E 4 C 4 ... .. t . . I .. :.. ..... ..
i
Client Date of Birth
Client Address
i
ClientlD
i
Gender'
County of origin'
Summary
Subject O
Incident(check all that apply)'
It Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
i
Description of the incident'
DMC Master Agreement
Exhibit J
Similar to the paper version, you can select multiple incident categories.
I nci dent(check all that apply)'
Medical Emergency X Death of Client X
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
V olence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-inflicted or by accident)
Medication Error
E 4 C 4 A fresnodbh.logicmamgeccom/incidents/?t-9&p=1&k-182be0c5cdcd5072bbl864cdee4d3d6e
Date of Incident*
Time of Incident*
Fner:cxi
i
Location of Incident'
Key People Directly Involved in Incident(witnesses,staff)'
Did the Injured Party seek Medical Attention?
S�k-.t::oti-
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Fnter.as
Reported By Email'
Geer:z
i
Reported On
10/30/2019
DMC Master Agreement
Exhibit J
As another bonus feature,you can either drag files (such as a copy of a UOR, additional statements/document) or
click on Add File to upload a file.
E C 0 i fresnodbh.logicmanagecco mcl tsRt_4&o=1&k=182beOc5cdcd5072bbl864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
I rater re a
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
Please specify if other
Description of Action Taken'
,rater te;;i
Outcome'
Similar to the paper version, you can select multiple Action Taken categories.
- Follow Up
Action Taken(check all that apply)'
Law Enforcement Contacted X Called 911/EMS%
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
When you are done entering all information simply click submit.
Any fields that have a red asterisk require information and will prevent you from submitting the form.
A "Thank you for your submission" statement will pop up if an incident is successfully submitted. You can click
"Reload the F " to submit another incident.
LogicManager
Thank you for your submission)
RELOADe•
DMC Master Agreement
Exhibit J
You will receive a Notification email when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and this will take you to the Logic Manager login screen.
Wed'!G,3G/21,�9.u.40 AM
SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com>
O Notification-
To DBH Incident Reporting
OI If there are problems with how this message is displayed,click here to view it in a web
Click here to download pictures.To help protect your privacy,Outlook prevented autom oc�download of some pictures in this message.
CAUTION!!!-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
x�NOFPcPk ��liaeba daw�i .,Wvrelan—Meaur
�KH y�.rrc.
Hi Mila Arevalo,
You have received a notification through LogicManager.Please see the details
below_
Type:Incident Report
Subject:102:
Notification To:Mila Arevalo
Ocen this inciderd in LogicManager
If using Internet Brplorer,click here to open the notification.
This email was generated by LogicManager.If you have any technical issues,
please email suDmrt(@Il icmanamr.com_
Enter in your email address and password. First time users will be prompted to set up a password.
Q 6 fresnodbh.my.logicmanager.comjlogin
LogicManager
Forgot your password?
DMC Master Agreement
Exhibit J
Once you log in,the main screen will show your task(incidents to review). Click on analyst/supervisor follow up to
view the incident.
Your Task List
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE.
Analyrt Follow Up In Progi 11d cell SYSTEM L.,c nager
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show you the client
and facility information. No edits can be made to this section.
Analyst Follow Up
Tasty Delalls CllentlnfarmMlon
xameof facility•
xamenmpodinewxy
F 111y Redress•
sapliry Pnone xumber
xemal xeakh or mbaun«u:e pl:omer proeomr
alenuaxwmr
The next tab is Sum ary: This section can be edited. You can add on to the areas below or make corrections to
these fields. Be sur to click SAVE when you made edits.Then Cancel to exit out of the incident.
Analyst Follow Up
Task Detalls Cllentlnform ,,,, 5ummary r.)low Up Documents
—j-0
Incleenl(<heckall that apply)'
0-h of Cllent st -
If Otherzpecify(1,(re,p.—I,S,epidemic outbreaks,ether<ataxmphes/events that leopaMUA the welh«and safety of clients,slax and/--b—f the cpmmpmry)
Descrlpt—dthein<ident'
f
Daepf m<m.nr
to/3onm9
rime pnn<leenr
f
LRahon..—d.-
f
Tssk ID:311 Source:103:null « < 3 > CANCEL
DMC Master Agreement
Exhibit J
The next tab is Follow up: This section can be edited. You can a d on to the areas below or make corrections to
these fields. Be sure to click SAVE when you made edits.Th Cancel to Exit out of the incident.
Analyst Follow Up
Task Details Clientlnform ahon Summary Follow Up Documents
Action Taken(check all thatapply)'
Law Enforcement Co—d N
Pleases fyifother
Descnphon mAction Taken'
f
Outcome'
f
added information
cause of death-renter per corona 10-31-0
Task ID:313 Sourte:303:null �� �� CANCEL
The next tab is Documents: You can view and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up
Task Details Client Information Summary Follow Up Documents
Add Document "
Name Type Source Upload Date Uploaded By
,j
No Documents yet.
Drop files here or click on the Add Document dropch-n.
« < 5 1 » CANCEL SAVE
Task ID:313 Source:103:null
If all tasks are followed up with and the incident no longer needs further review/information,you will click SUBMIT.
Once you click Submit the incident will be removed from your task list and no further edits can be made. Notice the
SUBMIT button is on every tab.
DMC Master Agreement
Exhibit K
ELECTRONIC SIGNATURE AGREEMENT
This Agreement governs the rights, duties, and responsibilities of
County in the use of an electronic signature in County.
The undersigned understands that this Agreement describes my obligations to protect
my electronic signature, and to notify appropriate authorities if it is stolen, lost,
compromised, unaccounted for, or destroyed. I agree to the following terms and
conditions:
1 agree that my electronic signature will be valid for one year from date of
issuance or earlier if it is revoked or terminated per the terms of this agreement.
• I will be notified and given the opportunity to renew my electronic signature each
year prior to its expiration. The terms of this Agreement shall apply to each such
renewal.
I will use my electronic signature to establish my identity and sign electronic
documents and forms.
• I am solely responsible for protecting my electronic signature.
• If I suspect or discover that my electronic signature has been stolen, lost, used
by an unauthorized party, or otherwise compromised, then I will immediately
notify the County Alcohol and Drug Administrator or his/her designee and request
that my electronic signature be revoked.
• I will then immediately cease all use of my electronic signature.
• I agree to keep my electronic signature secret and secure by taking reasonable
security measures to prevent it from being lost, modified or otherwise
compromised, and to prevent unauthorized disclosure of, access to, or use of it
or of any media on which information about it is stored.
• I will immediately request that my electronic signature be revoked if I discover or
suspect that it has been or is in danger of being lost, disclosed, compromised or
subjected to unauthorized use in any way.
1 understand that I may also request revocation at any time for any other reason.
• If I have requested that my electronic signature be revoked, or I am notified that
someone has requested that my electronic signature be suspended or revoked,
and I suspect or discover that it has been or may be compromised or subjected
to unauthorized use in any way, I will immediately cease using my electronic
signature. I will also immediately cease using my electronic signature upon
termination of employment or termination of this Agreement.
• 1 further agree that, for the purposes of authorizing and authenticating electronic
health records, my electronic signature has the full force and effect of a signature
affixed by hand to a paper document.
Requestor
Signature Date
Requestor
Printed Name
Approver
Signature Date
Title
DMC Master Agreement
Exhibit L
FRESNO COUNTY BEHAVIORAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations, rules
and guidelines that apply to the provision and payment of behavioral health services. Behavioral health
contractors and the manner in which they conduct themselves are a vital part of this commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor, contractor's employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno County
DBH. After completion of this training, each contractor, contractor's employee and subcontractor must
sign the Behavioral Health Compliance Training Acknowledgment and Agreement form and return this
form to the Compliance officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing for
behavioral health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, beneficiaries, and other behavioral health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor engage in any
other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement of
any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other behavioral health contractors, or report any activity
that they believe may violate the standards of the Compliance Program, or any other applicable
Revised 09/20/18
DMC MasterAgreement 1
Exhibit L
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person making
a report. Any person engaging in any form of retaliation will be subject to disciplinary or other
appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
12. Immediately contact the DBH Business Office inbox using the
DBHADPBusinessOfficegfresnocountyca.gov and your assigned DBH analyst and report any
overpayment.
Revised 09/20/18
DMC Master Agreement 2
Exhibit M
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.
DMC Master Agreement
Exhibit M
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.
DMC Master Agreement
Exhibit N
Page 1 of 1
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section(§) 11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect" includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any
police department or sheriff's department (not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a"reasonable suspicion"means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
SIGNATURE DATE
0980fadx
DMC Master Agreement
Exhibit O
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address(number,street) City State ZIP Code
CLIA Number Taxpayer ID Number(EIN)/Social Security Number /Telephone Number
)
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list all names
and addresses (primary, every business location, and P.O. Box address)of individuals or corporations under"Remarks" on
page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest YES No
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
byTitles XVIII, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVI II, XIX, or XX? ...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses (primary, every business location, and P.O. Box address) under "Remarks" on page 2. If more than
one individual is reported and any of these persons are related to each other, this must be reported under"Remarks."
NAME DOB ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership n Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers...........................................................................................................
NAME DOB ADDRESS PROVIDER
Page 1 of 3
DMC Master Agreement
Exhibit O
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... n n
VII. A. Is this facility chain affiliated? ...................................................................................................................... n n
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Page 2 of 3
DMC Master Agreement
Exhibit O
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date.If the yes block for any item is checked,list requested additional information under
the Remarks Section on page 2,referencing the item number to be continued.If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form.Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION
BE CURRENT.
Item I-Under"Identifying Information"specify in what capacity the entity is doing business as(DBA)(e.g.name of trade or
corporation).
Item II-Self-explanatory
Item III-List the names of all individuals and organizations having direct or indirect ownership interests,or controlling interest
separately or in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest-is defined as the possession of stock,equity in capital or any interest in the profits of the disclosing entity.
A disclosing entity is defined as a Medicare provider or supplier,or other entity that furnishes services or arranges for furnishing
services under Medicaid or the Maternal and Child Health program,or health related services under the social services program.
Indirect ownership interest-is defined as ownership interest in an entity that has direct or hospital-based home health agencies,are not
indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any other
entity is determined by multiplying the percentage of ownership interest at each level.An indirect ownership interest must beds in the
facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing entity.Example:
if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8
percent indirect ownership and must be reported.
Controlling interest-is defined as the operational direction or management of disclosing entity which may be maintained by any or all
of the following devices:the ability or authority,expressed or reserved,to amend or change the corporate identity(i.e.,joint venture
agreement,unincorporated business status)of the disclosing entity;the ability or authority to nominate or name members of the Board
of Directors or Trustees of the disclosing entity;the ability or authority,expressed or reserved,to amend or change the by-laws,
constitution,or other operating or management direction of the disclosing entity;the right to control any or all of the assets or other
property of the disclosing entity upon the sale or dissolution of that entity;the ability or authority,expressed or reserved,to control the
sale of any or all of the assets,to encumber such assets by way of mortgage or other indebtedness,to dissolve the entity or to arrange
for the sale or transfer of the disclosing entity to new ownership or control.
Item IV-VII-(Changes in Provider Status)For Items IV-VII,if the yes box is checked,list additional information requested under
Remarks. Clearly identify which item is being continued.
Change in provider status-is defined as any change in management control.Examples of such changes would include;a change in
Medical or Nursing Director,a new Administrator,contracting the operation of the facility to a management corporation,a change in
the composition of the owning partnership which under applicable State law is not considered a change in ownership,or the hiring or
dismissing of any employees with 5 percent or more financial interest in the facility or in an owning corporation,or any change of
ownership.
Item IV-(A&B)If there has been a change in ownership within the last year or if you anticipate a change,indicate the date in the
appropriate space.
Item V-If the answer is yes,list name of the management firm and employer identification number(EIN),or the name of the leasing
organization.A management company is defined as any organization that operates and manages a business on behalf of the owner of
that business,with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI-If the answer is yes,identify which has changed(Administrator,Medical Director,or Director of Nursing)and the date the
change was made.Be sure to include name of the new Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is either owned,controlled,or operated under lease or contract
by an organization consisting of two or more free-standing health care facilities organized within or across State lines which is under
the ownership or through any other device,control and direction of a common party. Chain affiliates include such facilities whether
public,private,charitable or proprietary.They also include subsidiary organizations and holding corporations.Provider-based
facilities,such as hospital-based home health agencies,are not considered to be chain affiliates.
Page 3 of 3
DMC Master Agreement