HomeMy WebLinkAboutAgreement A-22-178.pdf Agreement No. 22-178
1 AGREEMENT
2
3 THIS AGREEMENT is made and entered into this 3rd 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, "Non-DMC Residential Treatment and Withdrawal
6 Management Services Vendor List," attached hereto and by this reference incorporated herein, collectively
7 herein after referred to as "CONTRACTOR", and such additional CONTRACTOR as may, from time to time
8 during the term of this Agreement, be added by COUNTY. Reference in this Agreement to "party" or
9 "parties" shall be understood to refer to COUNTY and each CONTRACTOR, unless otherwise specified.
10 WITNESSETH:
11 WHEREAS, COUNTY is authorized through its Substance Abuse Block Grant (SABG)Application
12 with the California Department of Health Care Services, hereinafter referred to as State or DHCS, to
13 subcontract for Substance Use Disorder (SUD)treatment services 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 provide all services and fulfill all responsibilities for the
24 provision of adult perinatal and non-perinatal residential SUD treatment services, as described in Exhibit B,
25 Modality of Service Descriptions, attached hereto and incorporated by this reference, at State certified
26 locations to eligible persons served of Fresno County, as identified in this Agreement, including all Exhibits
27 incorporated herein by reference and made part of this Agreement.
28 B. CONTRACTOR shall comply with requirements stated within the SABG Application
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1 as listed in Exhibit C, SABG Specific Requirements, attached hereto and by this reference incorporated
2 herein; and with all other provisions set forth in the SABG Application, made available by the Department of
3 Behavioral Health (DBH) at the following web address and by this reference incorporated herein:
4 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
5 providers/substance-use-disorder-providers. CONTRACTOR is referred to therein as "Subcontractor" and
6 COUNTY is referred to therein as "Contractor."
7 C. CONTRACTOR shall comply with the Fresno County Substance Use Disorder
8 (FCSUD) Provider Manual, herein after referred to as the "Provider Manual" and by this reference
9 incorporated herein, available at the DBH website at:
10 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
11 providers/substance-use-disorder-providers. No formal amendment of this agreement is required for
12 changes to the Provider Manual to apply.
13 D. CONTRACTOR shall align program, services, and practices with the vision and
14 mission within Exhibit D, DBH Guiding Principles of Care Delivery, attached hereto and by this reference
15 incorporated herein. Contractor may be required to utilize and integrate clinical tools such as Reaching
16 Recovery at DBH's discretion. Employees involved in a crisis incident should be offered appropriate
17 Employee Assistance Program (EAP) or similar related wellness and recovery assistance. In
18 conjunction with the County DBH's Guiding Principles of Care Delivery and wellness of the workforce,
19 Contractors shall align their practices around this vision and ensure needed debriefing services are
20 offered to all employees involved in a crisis incident. Employees shall be afforded all services to
21 strengthen their recovery and wellness related to the crisis incident. Appropriate follow-up with the
22 employee shall be carried out and a plan for workforce wellness shall be submitted to the County's DBH.
23 E. CONTRACTORs must complete intake for all persons served (including persons
24 served referred by Drug Court or Probation) within timeframes specified below from initial contact:
25 1) Residential services within ten (10) business days.
26 2) Contractors shall comply with reporting requirements of Court or Probation
27 relating to person served status change and treatment progress if an appropriate Release of Information
28 (ROI) is in place;
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1 F. CONTRACTOR shall maintain, at CONTRACTOR's cost, a computer system
2 compatible with COUNTY's current billing and electronic health record (EHR) system for the provision of
3 submitting information required under the terms and conditions of this Agreement. CONTRACTOR shall
4 complete billing and EHR data entry as follows: initial contact, when applicable; admissions; California
5 Outcomes Measurement System (CalOMS) reporting, American Society of Addiction Medicine (ASAM)
6 level of care reporting; Wait List reporting, discharge; and no show/missed appointments and referrals.
7 G. CONTRACTOR's staff will be required to attend regularly occurring meetings such
8 as Diversity, Equity and Inclusion Committee and All Provider Meetings, and trainings on an as-needed
9 basis, which includes but is not limited to, trainings related to SUD treatment, fiscal processes, cultural
10 competency, compliance and reporting requirements. Refer to the Annual Provider Training Plan available
11 on the provider webpage at: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
12 providers/contract-providers/substance-use-disorder-providers.
13 2. ADDITIONS/DELETIONS OF CONTRACTOR(S)
14 COUNTY's DBH Director, or his or her designee, reserves the right at any time during the
15 term of this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A, "Non-DMC Residential
16 Treatment and Withdrawal Management Services Vendor List." It is understood any such additions will not
17 affect compensation paid to the other CONTRACTOR(S), and therefore such additions may be made by
18 COUNTY without notice to or approval from other CONTRACTOR(S) under this Agreement. These same
19 provisions shall apply to the deletion of any CONTRACTOR listed in Exhibit A, "Non-DMC Residential
20 Treatment and Withdrawal Management Services Vendor List," except that deletions shall be made by
21 written mutual agreement between the COUNTY and the particular CONTRACTOR to be deleted, or shall
22 be in accordance with the provisions of Section Four (4), TERMINATION, of this Agreement.
23 3. TERM
24 The term of this Agreement shall be for a period of three (3) years, commencing on July 1,
25 2022 through and including June 30, 2025. This Agreement may be extended for two (2) additional
26 consecutive twelve (12) month periods upon written approval of both parties no later than thirty (30) days
27 prior to the first day of the next twelve (12) month extension period. The DBH Director, or his or her
28 designee, is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR's
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1 satisfactory performance.
2 4. TERMINATION
3 A. Non-Allocation of Funds- The terms of this Agreement, and the services to be
4 provided hereunder, are contingent on the approval of funds by the appropriating government agency.
5 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
6 terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
7 B. Breach of Contract- The COUNTY may immediately suspend or terminate this
8 Agreement in whole or in part, wherein the determination of the COUNTY there is:
9 1) An illegal or improper use of funds;
10 2) A failure to comply with any term of this Agreement;
11 3) A substantially incorrect or incomplete report submitted to the COUNTY; or
12 4) Improperly performed service.
13 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
14 breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
15 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
16 default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
17 COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
18 the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
19 shall promptly refund any such funds upon demand.
20 C. Without Cause - Under circumstances other than those set forth above, this
21 Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an
22 intention to terminate to CONTRACTOR.
23 D. Voluntary Termination of Intergovernmental Agreement - The COUNTY may
24 terminate its Agreement with DHCS at any time, for any reason, by giving sixty (60) days written notice
25 to DHCS. In the event the Intergovernmental Agreement is terminated, COUNTY may terminate this
26 contractor agreement. CONTRACTOR shall be paid for services provided to person served up to the
27 date of termination.
28
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1 5. COMPENSATION
2 A. COMPENSATION - For claims submitted for services rendered under this
3 Agreement, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive the negotiated
4 contractor-specific rates as approved by DHCS "Non-DMC Residential and Withdrawal Management
5 Reimbursement Rates," attached hereto as Exhibit E and by this reference incorporated herein, and
6 updated annually, for each term of this Agreement, not to exceed the contractor-specific maximum
7 compensation. The maximum compensation for the period of July 1, 2022 through June 30, 2023 shall not
8 exceed Two Million Six Hundred Forty-Six Thousand Three Hundred Thirteen and No/100 Dollars
9 ($2,646,313.00). The maximum compensation for each twelve (12) month period from July 1, 2023 through
10 June 30, 2027 shall not be in excess of Two Million Six Hundred Forty-Six Thousand Three Hundred
11 Thirteen and No/100 Dollars ($2,646,313.00). CONTRACTOR shall be reimbursed to the extent that funds
12 are available.
13 The total maximum compensation to be paid by COUNTY to CONTRACTOR(S) through
14 June 30, 2027 shall not exceed Thirteen Million Two Hundred Thirty-One Thousand Five Hundred Sixty-
15 Five ($13,231,565.00).
16 1) The contract maximum amount as identified in this Agreement may be
17 reduced based upon State, Federal, and local funding availability. In the event of such action, the
18 COUNTY's DBH Director, or his or her designee, shall notify the CONTRACTOR in writing of the
19 reduction in the maximum amount within thirty (30) days.
20 In the event that funding for these services is delayed by the State Controller,
21 COUNTY may defer payment to CONTRACTOR. The amount of the deferred payment shall not exceed
22 the amount of funding delayed by the State Controller to the COUNTY. The deferral by COUNTY shall
23 not exceed the period of time of the State Controller's delay of payment to COUNTY plus forty-five (45)
24 days.ln addition, if the State of California does not allocate funding for services described in the terms
25 and conditions of this Agreement, COUNTY shall not be obligated to reimburse CONTRACTOR for
26 services performed.
27 B. PAYMENTS— Regardless of the contract maximum, CONTRACTOR will be
28 reimbursed only for costs up to the negotiated rates herein and stated on Exhibit E. Within forty-five (45)
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1 days of the year-end cost settlement reconciliation by COUNTY, CONTRACTOR shall make payment to
2 COUNTY or COUNTY shall reimburse CONTRACTOR as appropriate.
3 It is understood that all expenses incidental to CONTRACTOR'S performance of services
4 under this Agreement shall be borne by CONTRACTOR.
5 1) Payments by COUNTY shall be in arrears, based on CONTRACTOR's
6 monthly invoices submitted for services provided during the preceding month, within forty-five (45) days
7 after receipt, verification and approval of CONTRACTOR's monthly invoices by COUNTY's DBH. If
8 CONTRACTOR is not in compliance with periodic reporting requirements as described in Exhibit F,
9 Provider Reporting Requirements, then payments may be held until compliance is achieved.
10 2) CONTRACTOR must accept, as payment in full, the amounts paid by
11 COUNTY in accordance with Exhibit E, Non-DMC Residential and Withdrawal Management
12 Reimbursement Rates. CONTRACTOR may not demand any additional payments from persons served
13 and shall only request payments according to subsection H, FUNDING SOURCES, below.
14 CONTRACTOR shall comply with 45 CFR 162.410(a)(1) for any subpart that would be a covered health
15 care provider if it were a separate legal entity. For purposes of this paragraph, a covered health care
16 provider shall have the same definition as set forth in 45 CFR 160.103. DHCS shall make payments for
17 covered services only if CONTRACTOR is in compliance with federal regulations.
18 C. COMPLIANCE — If CONTRACTOR should fail to comply with any provision of this
19 Agreement, COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR's and
20 COUNTY's obligations under this section shall survive the termination of this Agreement with respect to
21 services provided during the term of this Agreement without regard to the cause of termination of this
22 Agreement.
23 D. QUALITY ASSURANCE — For services rendered herein, CONTRACTOR shall
24 assure that an on-going quality assurance component is in place and is occurring. CONTRACTOR shall
25 assure that clinical records for each participant are of such detail and length that a review of said record
26 will verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates
27 that appropriate services were not provided, COUNTY reserves the right to withhold payment for the
28 applicable unit(s) of service.
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1 E. PUBLIC INFORMATION — CONTRACTOR shall disclose its funding source in all
2 public information. Communication products must follow DBH graphic standards, including typefaces
3 and colors, to communicate our authority and project a unified brand. This includes all media types and
4 channels and all materials on and offline that are created as part of DBH's efforts to provide information
5 to the public. Communication products must include a funding acknowledgement determined by the
6 level of funding provided by DBH as follows:
7 1) A Program of Fresno County Department of Behavioral Health (100%
8 funded);
9 2) Funding provided by Fresno County Department of Behavioral Health
10 (50% or more funded);
11 3) Funded, in part, by County of Fresno Department of Behavioral Health
12 (less than 50% funded); and
13 4) A partnership, with funding by Fresno County department of Behavioral
14 Health (any funding amount)
15 F. LOBBYING ACTIVITY—CONTRACTOR shall not directly or indirectly use any of
16 the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
17 support or defeat legislation pending before the Congress of the United States or the Legislature of the
18 State of California.
19 G. POLITICAL ACTIVITY—CONTRACTOR shall not directly or indirectly use any of
20 the funds under this Agreement for any political activity or to further the election or defeat of any
21 candidate for public office.
22 H. FUNDING SOURCES — It shall be the obligation of CONTRACTOR to determine
23 and claim all revenue possible from private pay sources and third-party payers. CONTRACTOR shall
24 not use any funds under this Agreement for services covered by Drug Medi-Cal or other health
25 insurance for eligible persons served. CONTRACTOR shall claim all Drug Medi-Cal covered services for
26 eligible persons served through the Drug Medi-Cal claiming process. COUNTY will only reimburse
27 CONTRACTOR for services rendered that are not covered by Drug Medi-Cal, other insurance or other
28 revenue sources.
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1 CONTRACTOR shall not use any funds under this Agreement to the extent that a
2 participant is eligible for Medi-Cal, insurance or other revenue reimbursement for services rendered.
3 Any revenues generated by CONTRACTOR in excess of costs may be utilized to
4 expand/enhance the services during COUNTY's fiscal years in which revenues are collected. Additional
5 revenues will be considered separate and distinct from COUNTY's payment to CONTRACTOR. The
6 manner and means of service expansion/enhancement shall be subject to the prior written approval of
7 COUNTY's DBH Director, or his or her designee. CONTRACTOR shall disclose all sources of revenue
8 to COUNTY. Under no circumstances will COUNTY funded staff time be used for fund-raising purposes.
9 6. INVOICING
10 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
11 compensation at negotiated rates. CONTRACTOR shall enter billing information into the COUNTY's
12 designated information system by the twentieth (20t") of every month for actual services rendered in the
13 previous month. Billing shall be in accordance with the established rates in Exhibit E, Non-DMC Residential
14 and Withdrawal Management Reimbursement Rates, for the current fiscal year. If an invoice is incorrect or
15 is otherwise not in proper form or substance, COUNTY's DBH Director, or his or her designee, shall have
16 the right to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5)
17 days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of
18 ninety (90) days after notification of an incorrect or improper invoice. If after said ninety (90) day period said
19 invoice(s) is still not corrected to COUNTY's DBH Director's, or his or her designee's, satisfaction,
20 COUNTY's DBH Director, or his or her designee, may elect to terminate this Agreement, pursuant to the
21 termination provisions stated in Section Four(4), TERMINATION, of this Agreement. In addition,
22 CONTRACTOR shall submit all invoices to COUNTY's DBH Director, or his or her designee, for services
23 provided no later than thirty (30) days after the close of each twelve (12) month fiscal period or from the
24 termination date of this Agreement. If invoices are not submitted within thirty (30) days after the close of
25 each twelve (12) month fiscal period or from the termination date of this Agreement, COUNTY's DBH
26 Director, or his or her designee, shall have the right to deny payment on such invoices.
27 A. In addition to billing, CONTRACTOR(s) shall submit on a monthly basis by the
28 twenty-fifth (25t"), an Operational Expense Report, per modality of service, along with a general ledger,
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1 payroll register and supporting documentation for any line items selected. For the purposes of verifying
2 that costs are allowable and equitable, CONTRACTOR shall submit any additional documentation as
3 deemed necessary by DBH.
4 B. CONTRACTORs that elect to use the COUNTY's electronic health records
5 system (EHR) shall be invoiced in arrears by the fifth (5'h) day of the month for the prior month's hosting
6 fee for access to COUNTY's EHR in accordance with the fee schedule set forth in Exhibit G, "Electronic
7 Health Records Software Charges," attached hereto and incorporated herein by this reference and
8 made part of this Agreement. COUNTY shall invoice CONTRACTOR(S) annually for the annual
9 maintenance and licensing fee for access to COUNTY's electronic information system in accordance
10 with the fee schedule as set forth in Exhibit G. CONTRACTOR shall provide payment for these
11 expenditures to COUNTY's Department of Behavioral Health, Accounts Receivable, P.O. Box 712,
12 Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of receipt
13 by CONTRACTOR of the invoicing provided by COUNTY.
14 C. COUNTY's DBH shall invoice CONTRACTOR on an annual basis the amount of
15 $75 per clinical position to access The Change Companies ASAM training modules which are required
16 to be completed upon hire and prior to delivering clinical services then annually thereafter.
17 7. LICENSING-CERTIFICATES
18 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall
19 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
20 provision of the services hereunder and required by the laws and regulations of the United States of
21 America, State of California, the County of Fresno, and any other applicable governmental agencies.
22 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
23 licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
24 appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
25 applicable laws, rules or regulations, as may now exist or be hereafter changed.
26 8. RESIDENTIAL AOD CERTIFICATION
27 A. The COUNTY requires CONTRACTOR(S) of residential Alcohol and Other
28 Substance Use Disorder treatment services to obtain the California Department of Health Care Services
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1 (DHCS)Alcohol and Other Drug Program (AOD) Certification, including the program's American Society of
2 Addiction Medicine (ASAM) level of care designation or certification.
3 B. Residential CONTRACTOR(S) shall maintain a current AOD Certification during the
4 term of this Agreement.
5 C. COUNTY shall terminate this Agreement immediately in the event any of the
6 following occurs:
7 1) CONTRACTOR fails to submit to the COUNTY a copy of the AOD
8 Certification within thirty (30) days after being approved by the DHCS, or
9 2) Certification is not maintained throughout the contract term.
10 9. PERINATAL SERVICES
11 CONTRACTOR shall comply with the requirements of the "Perinatal Practice Guidelines,"
12 available at the DHCS web address at: https://www.dhcs.ca.gov/individuals/Pages/Perinatal-
13 Services.aspx and by this reference incorporated herein, until such time new Perinatal Practice
14 Guidelines are updated and adopted. No formal amendment of this contract is required for new
15 guidelines to apply. Additionally, CONTRACTOR shall comply with the perinatal requirements stated in
16 Exhibit C, "SABG Specific Requirements" and the FC SUD Provider Manual. No formal amendment of
17 this contract is required for new guidelines or amendments to Exhibit C or the FC SUD Provider Manual
18 to apply.
19 CONTRACTOR shall comply with federal and state mandates to provide alcohol and
20 other drug treatment services deemed medically necessary for Medi-Cal eligible: (1) pregnant and
21 postpartum women, and (2) youth under age 21 who are eligible under the Early and Periodic
22 Screening, Diagnostic, and Treatment (EPSDT) Program.
23 CONTRACTOR shall require that counselors of perinatal services are properly certified to
24 provide these services and comply with the requirements contained in Title 22, § 51341.1, Services for
25 Pregnant and Postpartum Women and Title 9 commencing with section 10360.
26 10. PROHIBITION ON PUBLICITY
27 None of the funds, materials, property or services provided directly or indirectly under this
28 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
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1 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the above,
2 publicity of the services described in Section One (1), SERVICES, of this Agreement shall be allowed as
3 necessary to raise public awareness about the availability of such specific services when approved in
4 advance by the DBH Director, or his or her designee, and at a cost to be provided for such items as
5 written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
6 expense(s). Communication products must follow DBH graphic standards, including typefaces and colors,
7 to communicate our authority and project a unified brand. This includes all media types and channels and
8 all materials on and offline that are created as part of DBH's efforts to provide information to the public.
9 11. NO THIRD-PARTY BENEFICIARIES
10 It is understood and agreed by and between the parties that the services provided by
11 CONTRACTOR for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
12 Agreement is intended to confer on any person other than the parties hereto any right under or by reason of
13 this Agreement.
14 12. INDEPENDENT CONTRACTOR
15 In performance of the work, duties and obligations assumed by CONTRACTOR under this
16 Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
17 CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
18 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
19 employee,joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
20 to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
21 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
22 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
23 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
24 rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
25 thereof.
26 Because of its status as an independent contractor, CONTRACTOR shall have absolutely
27 no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
28 solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
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1 benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
2 matters relating to payment of CONTRACTOR'S employees, including compliance with Social Security
3 withholding and all other regulations governing such matters. It is acknowledged that during the term of this
4 Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or to this
5 Agreement.
6 13. NON-ASSIGNMENT/SUBCONTRACTS
7 Neither party shall assign, transfer or sub-contract this Agreement nor their rights or duties
8 under this Agreement without the prior written consent of the other party.
9 CONTRACTOR shall be required to assume full responsibility for all services and activities
10 covered by this Agreement, whether or not CONTRACTOR is providing services directly. Further,
11 CONTRACTOR shall be the sole point of contact with regard to contractual matters, including payment of
12 any and all charges resulting from this Agreement.
13 If CONTRACTOR should propose to subcontract with one or more third parties to carry out
14 a portion of services covered by this Agreement, any such subcontract shall be in writing and approved as
15 to form and content by COUNTY's DBH Director, or his or her designee, prior to execution and
16 implementation. COUNTY's DBH Director, or his or her designee, shall have the right to reject any such
17 proposed subcontract. Any such subcontract together with all activities by or caused by CONTRACTOR
18 shall not require compensation greater than the total budget contained herein. An executed copy of any
19 such subcontract shall be received by COUNTY before any implementation and shall be retained by
20 COUNTY. CONTRACTOR shall be responsible to COUNTY for the proper performance of any
21 subcontract. Any subcontractor shall be subject to the same terms and conditions that CONTRACTOR is
22 subject to under this Agreement.
23 It is expressly recognized that CONTRACTOR cannot engage in the practice of physical
24 health medicine. If any medical services outside of the scope of the CONTRACTOR's medical director are
25 provided in connection with the services under this Agreement, such medical services shall be performed
26 by an independent contract physician. In this instance, the requirements of the Confidential Medical
27 Information Act (Civil Code 56 et seq.) shall be met.
28 If CONTRACTOR hires an independent contract physician, CONTRACTOR shall require
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1 and ensure that such independent contract physician carries at least the following insurance coverages:
2 A. Professional Liability
3 Professional Liability (Medical Malpractice) Insurance, with limits of not less than One Million
4 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
5 B. Cyber Liability
6 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim,
7 $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is
8 undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to, claims involving
9 infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade
10 dress, invasion of privacy violations, information theft, damage to or destruction of electronic information,
11 release of private information, alteration of electronic information, extortion and network security. The policy
12 shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit
13 monitoring expenses with limits sufficient to respond to these obligations.
14 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
15 Breaches, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii) breach
16 of any of the Contractor's obligations under Section#of this Agreement; (iii) infringement of intellectual
17 property, including but not limited to infringement of copyright, trademark, and trade dress; (iv) invasion of
18 privacy, including release of private information; (v) information theft; (vi) damage to or destruction or
19 alteration of electronic information; (vii) extortion related to the Contractor's obligations under this
20 Agreement regarding electronic information, including Personal Information; (viii) network security; (ix)data
21 breach response costs, including Security Breach response costs; (x) regulatory fines and penalties related
22 to the Contractor's obligations under this Agreement regarding electronic information, including Personal
23 Information; and (xi) credit monitoring expenses.
24 C. Molestation
25 Sexual abuse/molestation liability insurance with limits of not less than One Million Dollars
26 ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy shall be
27 issued on a per occurrence basis.
28 CONTRACTOR will also ensure that the independent contract physician shall maintain, at
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1 their sole expense, in full force and effect for a period of three (3) years following the termination of this
2 Agreement, one or more policies of professional liability insurance with limits of coverage as specified
3 herein.
4 14. CONFLICT OF INTEREST
5 No officer, agent, or employee of COUNTY who exercises any function or responsibility for
6 planning and carrying out the services provided under this Agreement shall have any direct or indirect
7 personal financial interest in this Agreement. CONTRACTOR shall comply with all Federal, State of
8 California, and local conflict of interest laws, statutes, and regulations, which shall be applicable to all
9 parties and persons served under this Agreement and any officer, agent, or employee of COUNTY.
10 15. DISCLOSURE OF SELF-DEALING TRANSACTIONS
11 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
12 for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes
13 its status to operate as a corporation.
14 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
15 transactions that they are a party to while CONTRACTOR is providing goods or performing services
16 under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
17 is a party and in which one or more of its directors has a material financial interest. Members of the
18 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
19 signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit H and incorporated
20 herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
21 transaction or immediately thereafter.
22 16. ASSURANCES
23 In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
24 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; that it has
25 not been convicted of a criminal offense related to the provision of health care items or services; nor has it
26 been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
27 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
28 CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
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1 for, or involvement with, COUNTY's business operations related to the Federal Health Care Programs and
2 shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or the
3 items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly
4 or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time as
5 CONTRACTOR is reinstated into participation in the Federal Health Care Programs. Further the
6 CONTRACTOR agrees to the Disclosure of Criminal History and Civil Actions and Certification regarding
7 debarment suspension and other responsibility matters primary covered transactions; CONTRACTOR
8 must sign an appropriate Certification regarding debarment, suspension, and other responsibility matters,
9 attached hereto as Exhibit I, incorporated herein by reference and made part of this Agreement.
10 A. If COUNTY has notice that CONTRACTOR has been charged with a criminal
11 offense related to any Federal Health Care Program or is proposed for exclusion during the term on any
12 contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
13 claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
14 COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or the
15 proposed exclusion.
16 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
17 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
18 this Agreement, will be queried as to whether(1)they are now or ever have been excluded, suspended,
19 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
20 convicted of a criminal offense related to the provision of health care items or services; and or(3)they have
21 been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
22 suspension, debarment, or ineligibility.
23 1) In the event the potential employee or subcontractor informs
24 CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
25 convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
26 or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
27 subcontractor does not work, either directly or indirectly relating to services provided to COUNTY.
28 2) Notwithstanding the above, COUNTY at its discretion may terminate this
Non-DMC Residential Master Agreement -15-
1 Agreement in accordance with Section Four(4), TERMINATION, of this Agreement, or require adequate
2 assurance (as defined by COUNTY)that no excluded, suspended or otherwise ineligible employee or
3 subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to services provided
4 to COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
5 by COUNTY to protect the interests of COUNTY persons served.
6 C. CONTRACTOR shall verify (by asking the applicable employees and
7 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
8 perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
9 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
10 criminal offense related to the provision of health care items or services; and (3) have not been reinstated to
11 participation in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
12 ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
13 excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs,
14 or has been convicted of a criminal offense relating to the provision of health care services,
15 CONTRACTOR will ensure that said employee or subcontractor does not work, either direct or indirect,
16 relating to services provided to COUNTY.
17 1) CONTRACTOR agrees to notify COUNTY immediately during the term of
18 this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
19 providing professional services under this Agreement is excluded, suspended, debarred or otherwise
20 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating to
21 the provision of health care services.
22 2) Notwithstanding the above, COUNTY at its discretion may terminate this
23 Agreement in accordance with the Section Four (4), TERMINATION, of this Agreement, or require
24 adequate assurance (as defined by COUNTY)that no excluded, suspended or otherwise ineligible
25 employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
26 services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time frame
27 to be determined by COUNTY to protect the interests of COUNTY persons served.
28 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
Non-DMC Residential Master Agreement -16-
1 information from COUNTY which may be necessary to complete any internal or external audits relating to
2 this Agreement.
3 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
4 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of the terms
5 of this Agreement.
6 17. MODIFICATION
7 Any matters of this Agreement may be modified from time to time by the written consent of
8 all the parties without, in any way, affecting the remainder.
9 Notwithstanding the above, changes to Section One (1), SERVICES, as needed to
10 accommodate changes in State and Federal Law relating to SUD treatment may be made with the signed
11 written approval of COUNTY's DBH Director, or his or her designee, and respective CONTRACTOR(S)
12 through an amendment approved by County Counsel and Auditor.
13 18. INSURANCE
14 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
15 third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
16 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
17 arrangement or Joint Powers Agreement (JPA)throughout the term of the Agreement:
18 A. Commercial General Liability
19 Commercial General Liability Insurance with limits of not less than Two Million
20 Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00).
21 This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
22 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
23 liability or any other liability insurance deemed necessary because of the nature of this contract.
24 B. Automobile Liability
25 Comprehensive Automobile Liability Insurance with limits of not less than One
26 Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
27 include any auto used in connection with this Agreement.
28
Non-DMC Residential Master Agreement -17
1 C. Professional Liability
2 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
3 M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
4 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
5 D. Worker's Compensation
6 A policy of Worker's Compensation insurance as may be required by the California
7 Labor Code.
8 E. Molestation
9 Sexual abuse/molestation liability insurance with limits of not less than One Million
10 Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy
11 shall be issued on a per occurrence basis.
12 F. Cyber Liability
13 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
14 claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations
15 as is undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to, claims
16 involving infringement of intellectual property, including but not limited to infringement of copyright,
17 trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
18 electronic information, release of private information, alteration of electronic information, extortion and
19 network security. The policy shall provide coverage for breach response costs as well as regulatory fines
20 and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
21 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
22 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional
23 insured, but only insofar as the operations under this Agreement are concerned. Such coverage for
24 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained
25 by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance
26 provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without
27 a minimum of thirty(30)days advance written notice given to COUNTY.
28 CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
Non-DMC Residential Master Agreement -18
1 employees any amounts paid by the policy of worker's compensation insurance required by this
2 Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
3 necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under
4 this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
5 Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
6 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
7 foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of
8 Behavioral Health, Contracts Division —SUD Services at 3133 N Millbrook Avenue, Fresno, California,
9 93703, stating that such insurance coverages have been obtained and are in full force; that the County of
10 Fresno, its officers, agents and employees will not be responsible for any premiums on the policies; that for
11 such worker's compensation insurance the CONTRACTOR has waived its right to recover from the
12 COUNTY, its officers, agents, and employees any amounts paid under the insurance policy and that waiver
13 does not invalidate the insurance policy; that such Commercial General Liability insurance names the
14 County of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but
15 only insofar as the operations under this Agreement are concerned; that such coverage for additional
16 insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by
17 COUNTY, its officers, agents and employees, shall be excess only and not contributing with insurance
18 provided under CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed
19 without a minimum of thirty (30) days advance, written notice given to COUNTY.
20 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
21 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
22 Agreement upon the occurrence of such event.
23 All policies shall be issued by admitted insurers licensed to do business in the State of
24 California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
25 rating of A FSC VI or better.
26 19. HOLD HARMLESS
27 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request,
28 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
Non-DMC Residential Master Agreement -19
1 attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in
2 connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
3 employees under this Agreement, and from any and all costs and expenses (including attorney's fees and
4 costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who
5 may be injured or damaged by the performance, or failure to perform, of CONTRACTOR, its officers,
6 agents, or employees under this Agreement.
7 CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit
8 exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
9 The provisions of this Section Nineteen (19), HOLD HARMLESS, shall survive
10 termination of this Agreement.
11 20. SINGLE AUDIT
12 A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or
13 more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit in
14 accordance with the requirements of the Single Audit Standards as set forth in 2 Code of Federal
15 Regulations (CFR) Part 200. CONTRACTOR shall submit said audit and management letter to COUNTY.
16 The audit must include a statement of findings or a statement that there were no findings. If there were
17 negative findings, CONTRACTOR must include a corrective action plan signed by an authorized individual.
18 CONTRACTOR agrees to take action to correct any material non-compliance or weakness found as a
19 result of such audit. Such audit shall be delivered to COUNTY's Department of Behavioral Health, Business
20 Office for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
21 received for the program. Failure to perform the requisite audit functions as required by this Agreement may
22 result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a public
23 accountant to perform said audit, or may result in the inability of COUNTY to enter into future agreements
24 with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
25 CONTRACTOR.
26 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
27 exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR's only
28 funding is through Drug Medi-Cal. If a single audit is not applicable, a program audit must be performed and
Non-DMC Residential Master Agreement -20
1 a program audit report with management letter shall be submitted by CONTRACTOR to COUNTY as a
2 minimum requirement to attest to CONTRACTOR's solvency. Said audit report shall be delivered to
3 COUNTY's Department of Behavioral Health, Business Office for review, no later than nine (9) months after
4 the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
5 comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
6 qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
7 responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
8 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
9 section shall be billed to the CONTRACTOR at COUNTY's cost, as determined by COUNTY's Auditor-
10 Controller/Treasurer-Tax Collector.
11 C. CONTRACTOR shall make available all records and accounts for inspection by
12 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
13 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a minimum of
14 ten (10)years, in accordance with 42 CFR Part 438.3(h), from the finalized cost settlement process or, if an
15 audit by the Federal government or DHCS has been started before the expiration of the ten (10) year
16 period, records shall be maintained until completion of the audit and final resolution of all findings.
17 21. AUDITS AND INSPECTIONS
18 The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
19 may deem necessary, make available to the COUNTY for examination all of its records and data with
20 respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
21 COUNTY, permit the COUNTY to audit and inspect all of electronic or print books and records as well as
22 inspection of the premises, physical facilities and equipment where Medicaid-related activities are
23 conducted to ensure CONTRACTOR'S compliance with the terms of this Agreement.
24 The refusal of CONTRACTOR to permit access to, and inspection of, electronic or print
25 books and records, physical facilities, and/or refusal to permit interviews with employees, as described in
26 this part, constitutes an express and immediate material breach of this Agreement and will be sufficient
27 basis to terminate the Agreement for cause or default.
28 The right to audit under this section exists for ten (10) years from the final date of the
Non-DMC Residential Master Agreement -21
1 agreement period or from the date of completion of any audit, whichever is later.
2 Notwithstanding the provisions stated in Section Three (3), TERM, of this Agreement, it is
3 acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all audit
4 procedures and requirements as stated in this Agreement have been completed to the review and
5 satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or resulting from any audit
6 and/or inspections including, but not limited to, actual costs incurred and the payment of any expenditures
7 disallowed by either COUNTY, State, or Federal governmental entities, including any assessed interest and
8 penalties.
9 If CONTRACTOR, through an audit by the STATE or COUNTY, is found to be in violation of
10 this contract which results in the recoupment of funds paid to CONTRACTOR, COUNTY may, upon mutual
11 consent between CONTRACTOR and COUNTY, enter into a repayment agreement with the
12 CONTRACTOR, with total monthly payments not to exceed twelve (12) months from the date of the
13 repayment agreement, to recover the amount of funds to be recouped. The monthly repayment amounts
14 shall be netted against the CONTRACTOR's monthly billing for services rendered during the month.
15 COUNTY reserves the right to forgo a repayment agreement and recoup all funds immediately.
16 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be
17 subject to the examination and audit of the California State Auditor for a period of three (3) years after final
18 payment under contract (Government Code Section 8546.7).
19 22. EVALUATION — MONITORING
20 CONTRACTOR shall participate in a review of the program at least yearly or more
21 frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
22 information requested by the COUNTY, DHCS, and/or the subcontractor during the program evaluation,
23 monitoring, and/or review.
24 COUNTY's DBH Director, or his or her designee, and DHCS or their designees shall
25 monitor and evaluate the performance of CONTRACTOR under this Agreement to determine to the best
26 possible degree the success or failure of the services provided under this Agreement. At the discretion of
27 the COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
28 performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of the program as
Non-DMC Residential Master Agreement -22
1 needed, at the discretion of COUNTY.
2 COUNTY shall recapture from CONTRACTOR the value of any services or other
3 expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
4 discretion of the COUNTY, CONTRACTOR shall enter into a repayment agreement with the COUNTY, with
5 total monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to
6 recover the amount of funds to be recouped. The monthly repayment amounts shall be netted against the
7 CONTRACTOR's monthly billing for services rendered during the month. COUNTY reserves the right to
8 forgo a repayment agreement and recoup all funds immediately.
9 23. REPORTS—SUBSTANCE USE DISORDER SERVICES
10 CONTRACTOR(S) shall submit all information and data required by County and State in
11 accordance with Exhibit F — Provider Reporting Requirements, incorporated in this Agreement and also
12 available on the DBH website at: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
13 providers/contract-providers/substance-use-disorder-providers. Reporting requirements may be revised
14 periodically to reflect changes to State mandated reporting. CONTRACTOR(S) that are not in
15 compliance with reporting deadlines are subject to payment withholding until reporting compliance is
16 achieved. Reporting requirements include, but are not limited to the following:
17 A. Drug and Alcohol Treatment Access Report (DATAR) in an electronic format
18 provided by the State and due no later than five (5) days after the preceding month;
19 B. CalOMS Treatment— Submit CalOMS treatment admission, discharge, annual
20 update, and "provider activity report" record in an electronic format through COUNTY's information
21 system, and on a schedule as determined by the COUNTY which complies with State requirements for
22 data content, data quality, reporting frequency, reporting deadlines, and report method and due no later
23 than five (5) days after the preceding month. All CalOMS admissions, discharges, and annual updates
24 must be entered into the COUNTY's CalOMS system within twenty-four (24) hours of occurrence; and
25 C. ASAM Level of Care (LOC) — Submit ASAM LOC data in a format determined by
26 DBH, no less than once per month;
27 D. Access Form — CONTRACTOR shall enter access information into COUNTY's
28 EHR at time of first contact with person served;
Non-DMC Residential Master Agreement -23
1 E. Ineligible Person Screening Report—format provided by COUNTY DBH and due
2 by the fifteenth (15th) day of each month to comply with State requirements;
3 F. Logic Manager Incident Reporting —as needed, when incidents occur and as
4 instructed in Exhibit J, Protocol for Completion of Incident Report.
5 G. Monthly Status Report—format provided by COUNTY DBH and due by the fifteen
6 (15th) day of each month;
7 H. Wait list— required by residential providers only and due by the fifteen (15th) day
8 of each month;
9 I. Grievance Log - due by the fifteen (15th) day of each month;
10 J. Missed appointments — CONTRACTOR shall enter all missed appointments into
11 COUNTY's EHR by the fifteenth (15th) of the following month;
12 K. Cultural Competency Survey— completed annually in a format to be determined
13 by DBH;
14 L. Americans with Disabilities (ADA) —Annually, upon request by COUNTY DBH,
15 CONTRACTOR(S) shall complete a system-wide accessibility survey in a format determined by DBH for
16 each service location and modality and shall submit an ADA Accessibility Certification and Self-
17 Assessment, including an Implementation Plan, for each service location;
18 M. Culturally and Linguistically Appropriate Services (CLAS) -Annually, upon request
19 by COUNTY DBH, CONTRACTOR(S) shall complete an agency CLAS survey in a format determined
20 by COUNTY DBH and shall submit a CLAS Self-Assessment, including an Implementation Plan;
21 N. Risk Assessment—Annually, upon request by COUNTY DBH, CONTRACTOR
22 shall submit a Risk Assessment on a form and in a format to be provided by DBH. The Assessment
23 must be submitted to the COUNTY in hard copy as well as electronically by the due date set by
24 COUNTY;
25 O. Network Adequacy Certification Tool (NACT)—Annually, upon request,
26 CONTRACTOR shall submit NACT data as requested by COUNTY DBH;
27
28
Non-DMC Residential Master Agreement -24
1 P. Operating Expense Report— CONTRACTOR shall submit expenses by the 25th
2 of each month on a form provided by COUNTY DBH, including a general ledger, payroll register and
3 other supporting documentation as request; and
4 Q. Cost Reports— On an annual basis for each fiscal year ending June 30th non-
5 NTP CONTRACTOR(S) shall submit a complete and accurate detailed cost report(s). Refer to Section
6 Twenty-four (24), COST REPORTING, for cost reporting requirements.
7 24. COST REPORTING
8 Cost reports must be submitted to the COUNTY as a hard copy with a signed cover letter and an
9 electronic copy by the due date. Submittal must also include any requested support documents such as
10 general ledgers and detailed electronic (e.g., Excel) schedules demonstrating how costs were allocated
11 both within programs, if provider has multiple funding sources (e.g., DMC and SABG), and between
12 programs, if CONTRACTOR provides multiple SUD treatment modalities. Provider shall maintain
13 general ledgers that reflect the original transaction amounts where each entry in their accounting
14 records represents one-hundred percent (100%) of the total transaction cost and can be supported with
15 the original source documentation (i.e., receipts, bills, invoices, payroll registers, etc.). Bank statements
16 reflecting purchases are not original source documents and will not be accepted as such. All costs found
17 to not be supported by original source documentation will be disallowed. Total unallowable costs shall
18 be allocated their percentage share of the indirect Costs along with the Contractor's direct costs. All
19 reports submitted by CONTRACTOR(S) to COUNTY must be typewritten. COUNTY will issue
20 instructions for completion and submittal of the annual cost report, including the relevant cost report
21 template(s) and due dates within forty-five (45) days of each fiscal year end. All cost reports must be
22 prepared in accordance with Generally Accepted Accounting Principles. Unallowable costs such as
23 those denoted in 2 CFR 200 Subpart E, Cost Principles, 41 U.S.C. 4304, and the Center for Medicare
24 and Medicaid Services (CMS) Provider Reimbursement Manual (PRM) 15-1, must not be included as an
25 allowable cost on the cost report and all invoices. Unallowable costs must be kept in the provider's
26 General Ledger in accounts entitled Unallowable followed by name of the account (e.g., Unallowable —
27 Food) or in some other appropriate form of segregation in the provider's accounting records. For further
28 information on unallowable costs refer to regulations provided above. If the CONTRACTOR(S) does not
Non-DMC Residential Master Agreement -25
1 submit the cost report by the due date, including any extension period granted by the COUNTY, the
2 COUNTY may withhold payment of pending invoices until the cost report(s) has been submitted and
3 clears COUNTY desk audit for completeness and accuracy. Once the cost reports have been approved
4 by the County, originally executed signed certification pages attesting to the accuracy of the information
5 contained in cost reports shall be submitted to the County.
6 A. DMC —A DMC cost report must be submitted in a format prescribed by the DHCS
7 for the purposes of Short Doyle Medi-Cal reimbursement of total costs for all programs.
8 CONTRACTOR(S) shall report costs under their approved legal entity number established during the
9 DMC certification process. Total units of service reported on the cost report will be compared to the units
10 of services entered by CONTRACTOR(S) into COUNTY's data system. CONTRACTOR(S) will be
11 required to correct discrepancies and resubmit to COUNTY prior to COUNTY's final acceptance of the
12 cost report.
13 B. OTHER FUNDING SOURCES — CONTRACTOR(S) will be required to submit a
14 cost report on a form approved and provided by the COUNTY to reflect actual costs and reimbursement
15 for services provided through funding sources other than DMC. Contracts that include a negotiated rate
16 per unit of service will be reimbursed for actual costs incurred (the sum of both direct costs as defined in
17 2 CFR 200.413, and allocated indirect costs as defined in 2 CFR 200.414) not to exceed the contract
18 maximum. If the cost report indicates an amount due to COUNTY, CONTRACTOR(S) shall submit
19 payment with the report. If an amount is due to CONTRACTOR(S) COUNTY shall reimburse
20 CONTRACTOR within forty-five (45) days of receiving and accepting the year-end cost report.
21 C. MULTIPLE FUNDING SOURCES — CONTRACTOR(S) with multiple agreements
22 for the same services (e.g., Outpatient, Residential) provided at the same location where at least one of
23 the Agreements is funded through DMC and the other funding is other federal or county realignment
24 funding will be required to complete DMC cost reports and COUNTY approved cost reports. Such
25 Agreements will be settled for actual allowable costs in accordance with Medicaid reimbursement
26 requirements as specified in Title XIX or Title XXI of the Social Security Act; Title 22, and the State's
27 Medicaid Plan. Within forty-five (45) days of the reconciliation by COUNTY, CONTRACTOR shall make
28 payment to COUNTY or COUNTY shall reimburse CONTRACTOR as appropriate.
Non-DMC Residential Master Agreement -26
1 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR(S)
2 agree to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit
3 settlement findings. DHCS audit process is approximately eighteen (18) to thirty-six (36) months
4 following the close of the State fiscal year. COUNTY may choose to appeal DHCS settlement results
5 and therefore reserves the right to defer payback settlement with CONTRACTOR(S) until resolution of
6 the appeal.
7 CONTRACTOR shall furnish to COUNTY such statements, records, reports, data, and
8 information as COUNTY may request pertaining to matters covered by this Agreement. All reports
9 submitted to the COUNTY must be typewritten.
10 In the event that CONTRACTOR(S) fails to provide such reports or other information
11 required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments
12 until there is compliance. In addition, the CONTRACTOR shall provide written notification and
13 explanation to the COUNTY within fifteen (15) days of any funds received from another source to
14 conduct the same services covered by this Agreement.
15 25. PROPERTY OF COUNTY
16 A. CONTRACTOR shall submit purchase invoices for the purchase of any fixed assets
17 with their monthly invoices. All purchases over Five Thousand and No/100 Dollars ($5,000.00), and certain
18 purchases under Five Thousand and No/100 Dollars ($5,000.00) such as fans, calculators, cameras,
19 VCRs, DVDs and other sensitive items as determined by COUNTY's DBH Director, or his or her designee,
20 made during the life of this Agreement shall be identified as assets that can be inventoried and maintained
21 in COUNTY's DBH Asset Inventory System. These assets shall be retained by COUNTY, as COUNTY
22 property, in the event this Agreement is terminated or upon expiration of this Agreement. CONTRACTOR
23 agrees to participate in an annual inventory of all COUNTY fixed assets and shall be physically present
24 when fixed assets are returned to COUNTY's possession at the termination or expiration of this Agreement.
25 CONTRACTOR is responsible for returning to COUNTY all COUNTY owned fixed assets, or the monetary
26 value of said fixed assets if unable to produce the fixed assets at the expiration or termination of this
27 Agreement.
28
Non-DMC Residential Master Agreement -27
1 B. The purchase of any equipment by CONTRACTOR with funds provided
2 hereunder shall require the prior written approval of COUNTY's DBH Director, or his or her designee,
3 shall fulfill the provisions of this Agreement as appropriate, and must be directly related to
4 CONTRACTOR's services or activity under the terms of this Agreement. COUNTY's DBH Director, or
5 his or her designee, may refuse reimbursement for any costs resulting from equipment purchased,
6 which are incurred by CONTRACTOR, if prior written approval has not been obtained from COUNTY.
7 C. The terms and conditions described in this Section are not applicable to the
8 leasing of vehicles by CONTRACTOR with the funds provided under this Agreement.
9 26. RECORDS
10 A. RECORD ESTABLISHMENT AND MAINTENANCE —CONTRACTOR shall
11 establish and maintain records in accordance with State and Federal rules and regulations in addition to
12 those requirements prescribed by COUNTY with respect to all matters covered by this Agreement.
13 Except as otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period
14 of ten (10) years from the finalized cost settlement process, or from the date of completion of any audit,
15 whichever is later.
16 B. DOCUMENTATION — CONTRACTOR shall maintain adequate records in
17 sufficient detail to make possible an evaluation of services and contain all the data necessary in
18 reporting to the State of California and/or Federal agency. All persons served records shall be
19 maintained pursuant to applicable State of California and Federal requirements concerning
20 confidentiality. In the event of contract termination or expiration, all original copies of clinical records,
21 including clinical charts, group sign-in sheets, and fiscal records, including original receipts, for a period
22 of ten (10) years shall be delivered to COUNTY.
23 C. REPORTS — CONTRACTOR shall submit to COUNTY periodic fiscal and all
24 program reports as further described in Section Twenty-Three (23), REPORTS — Substance Use
25 Disorder Services. CONTRACTOR shall submit a complete and accurate year-end cost report for each
26 fiscal year affected by this Agreement, following the end of each fiscal year affected by this Agreement.
27 CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and information
28 as COUNTY may request pertaining to matters covered by this Agreement. All reports submitted by
Non-DMC Residential Master Agreement -28
1 CONTRACTOR to COUNTY must be typewritten.
2 D. SUSPENSION OF COMPENSATION — In the event that CONTRACTOR fails to
3 provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
4 payments until there is compliance.
5 E. PERSON SERVED CONFIDENTIALITY— CONTRACTOR shall conform to and
6 COUNTY shall monitor compliance with all State and Federal statutes and regulations regarding
7 confidentiality, including but not limited to confidentiality of information requirements of 42 CFR § 2.1 et
8 seq., Welfare and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety Code §§ 11977
9 and 11812, Civil Code, Division 1, Part 2.6, and CCR Title 22 § 51009.
10 27. DATA SECURITY
11 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
12 viewing, use or disclosure of COUNTY data including sensitive or personal person served information;
13 abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
14 enter into a contractual relationship with the COUNTY for the purpose of providing services under this
15 Agreement must employ adequate data security measures to protect the confidential information provided
16 to CONTRACTOR by the COUNTY, including but not limited to the following:
17 A. CONTRACTOR-OWNED MOBILE, WIRELESS, OR HANDHELD DEVICES
18 CONTRACTOR may not connect to COUNTY networks via personally owned
19 mobile, wireless or handheld devices, unless the following conditions are met:
20 1) CONTRACTOR has received authorization by COUNTY for telecommuting
21 purposes;
22 2) Current virus protection software is in place;
23 3) Mobile device has the remote wipe feature enabled; and
24 4) A secure connection is used.
25 B. CONTRACTOR-OWNED COMPUTERS OR COMPUTER PERIPHERALS
26 CONTRACTOR may not bring CONTRACTOR-owned computers or computer
27 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief Information
28 Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
Non-DMC Residential Master Agreement -29
1 transferred, data must be stored on a secure server approved by the COUNTY and transferred by means of
2 a Virtual Private Network (VPN) connection, or another type of secure connection. Said data must be
3 encrypted.
4 C. COUNTY-OWNED COMPUTER EQUIPMENT
5 CONTRACTOR or anyone having an employment relationship with the COUNTY
6 may not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
7 authorization from the COUNTY's Chief Information Officer, and/or designee(s).
8 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on
9 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
10 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
11 and security of COUNTY's confidential information and to prevent unauthorized access, viewing, use or
12 disclosure of data maintained in computer files, program documentation, data processing systems, data
13 files and data processing equipment which stores or processes COUNTY data internally and externally.
14 F. Confidential person served information transmitted to one party by the other by
15 means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
16 of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
17 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
18 breaches or potential breaches of security related to COUNTY's confidential information, data maintained in
19 computer files, program documentation, data processing systems, data files and data processing
20 equipment which stores or processes COUNTY data internally or externally.
21 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
22 arising from a possible breach of security related to COUNTY's confidential person served information
23 provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
24 individuals as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR
25 will be responsible for all costs incurred as a result of providing the required notification.
26 28. EHR CERTIFICATION
27 CONTRACTOR shall obtain certification from the Certification Commission for Healthcare
28 Information Technology (CCHIT)for Security Access Control, Audit, and Authentication if using a non-
Non-DMC Residential Master Agreement -30-
1 Avatar electronic health record (EHR) and shall provide a copy of the certification to COUNTY. Additionally,
2 CONTRACTOR shall recertify their EHR annually and provide a copy of the recertification to COUNTY.
3 CONTRACTOR shall ensure all employees who use an EHR other than Avatar sign an Electronic
4 Signature Agreement (See example, Exhibit K ) and maintain a copy in the employee's personnel file.
5 29. COMPLIANCE WITH LAWS, POLICIES AND RULES
6 CONTRACTOR shall comply with all applicable rules and regulations set forth in CCR Titles
7 9 and 22, and California Health and Safety Code § 11750 et seq., with the exception of regulations waived
8 by the Centers for Medicare and Medicaid Services and DHCS, as stated within the DMC-Organized
9 Delivery System (ODS) Special Terms and Conditions (STCs) and the SABG Application. CONTRACTOR
10 shall comply with any other Federal and State laws or guidelines applicable to CONTRACTOR's
11 performance under this Agreement or any local ordinances, regulations, or policies applicable. Such
12 provisions include, but are not restricted to:
13 A. CONTRACTOR shall comply with 42 CFR Part 438.
14 B. CONTRACTOR shall comply with Early and Periodic Screening, Diagnostic and
15 Treatment (EPSDT) statutes and regulations.
16 C. CONTRACTOR shall ensure that each person served's ability to pay for services is
17 determined by the use of the method approved by COUNTY.
18 D. CONTRACTOR shall establish and use COUNTY's approved method of
19 determining and collecting fees from persons served.
20 E. CONTRACTOR shall furnish person served records in accordance with the
21 applicable Federal, State and local regulations and requirements, including in such records a treatment
22 plan for each person served, and evidence of each service rendered.
23 F. CONTRACTOR shall submit accurate, complete and timely claims and cost reports,
24 reporting only allowable costs.
25 G. CONTRACTOR shall comply with statistical reporting and program evaluation
26 systems as provided in State of California regulations and in this Agreement.
27 H. CONTRACTOR shall comply with requirements contained in the SABG Application
28 with DHCS by this reference incorporated herein, until such time that a new SABG Application is approved.
Non-DMC Residential Master Agreement -31-
1 Upon amendment of the SABG Application, the terms of such amendment shall automatically be
2 incorporated into this Agreement.
3 I. CONTRACTOR shall inform every person served of their rights regarding Grievance
4 and Appeals as described in the Provider Manual, attached hereto and by this reference incorporated.
5 J. CONTRACTOR shall file an incident report for all incidents involving persons served
6 and CONTRACTOR staff, using COUNTY'S Incident Reporting System, following the Protocol for
7 Completion of Incident Report described in Exhibit J, Protocol for Completion of Incident Report, attached
8 hereto and by this reference incorporated.
9 K. In the event any law, regulation, or policy referred to in this Agreement is amended
10 during the term thereof, the parties hereto agree to comply with the amended provision as of the effective
11 date of such amendment. Exhibits will be updated as needed and no formal amendment of this contract is
12 required for new rules to apply.
13 30. NON-DISCRIMINATION PROVISION
14 ELIGIBILITY FOR SERVICES — CONTRACTOR shall prepare, prominently post in its
15 facility, and make available to the DBH Director, or his or her designee, and to the public all eligibility
16 requirements to participate in the program funded under this Agreement. CONTRACTOR shall not
17 unlawfully discriminate in the provision of services because of sex, race, religion, color, national origin,
18 ancestry, ethnic group identification, physical disability, mental disability, medical condition, genetic
19 information, sexual orientation, marital status, age, gender, gender identity, gender expression, or
20 military or veteran status as provided by State of California and Federal law in accordance with Title VI
21 of the Civil Rights Act of 1964 (42 USC § 2000(d)); Age Discrimination Act of 1975 (42 USC § 1681);
22 Rehabilitation Act of 1973 (29 USC § 794); Education Amendments of 1972 (20 USC § 1681);
23 Americans with Disabilities Act of 1990 (42 USC § 12132); 45 CFR, Part 84; provisions of the Fair
24 Employment and Housing Act (California Government Code § 12900); and regulations promulgated
25 thereunder (CCR Title 2, § 7285.0); Title 2, Division 3, Article 9.5 of the California Government Code
26 commencing with section 11135; and CCR Title 9, Division 4, Chapter 6 commencing with section
27 10800.
28
Non-DMC Residential Master Agreement -32
1 A. EQUAL OPPORTUNITY— CONTRACTOR shall comply with California Government
2 Code, § 2990 and CCR Title 2, Division 4, Chapter 5, in matters related to the development,
3 implementation, and maintenance of a nondiscrimination program. CONTRACTOR shall not discriminate
4 against any employee or applicant for employment because sex, race, religion, color, national origin,
5 ancestry, ethnic group identification, physical disability, mental disability, medical condition, genetic
6 information, sexual orientation, marital status, age, gender, gender identity, gender expression, or military
7 or veteran status. Such practices include retirement, recruitment, advertising, hiring, layoff, termination,
8 upgrading, demotion, transfer, rates of pay or other forms of compensation, use of facilities, and other terms
9 and conditions of employment. CONTRACTOR agrees to post in conspicuous places, notices available to
10 all employees and applicants for employment setting forth the provisions of the Equal Opportunity Act (42
11 USC § 2000(e)) in conformance with Federal Executive Order No. 11246. CONTRACTOR agrees to
12 comply with the provisions of the Rehabilitation Act of 1973 (29 USC § 794).
13 B. SUSPENSION OF COMPENSATION — If an allegation of discrimination occurs,
14 DBH may withhold all further funds, until CONTRACTOR can show by clear and convincing evidence to the
15 satisfaction of DBH that funds provided under this Agreement were not used in connection with the alleged
16 discrimination.
17 C. NEPOTISM — Except by consent of the DBH Director, or his or her designee, no
18 person shall be employed by CONTRACTOR who is related by blood or marriage to or who is a member of
19 the Board of Directors or an officer of CONTRACTOR.
20 D. NEW FACILITIES AND DISABILITY ACCESS— New facilities shall be wheelchair
21 accessible and provide access to the disabled, consistent with CCR Title 9, § 10820. If a new facility will be
22 utilized, a plan ensuring accessibility to the disabled must be developed. DBH shall assess, monitor, and
23 document CONTRACTOR's compliance with the Rehabilitation Act of 1973 and Americans with Disabilities
24 Act of 1990 to ensure that recipients/persons served and intended recipients/persons served of services
25 are provided services without regard to physical or mental disability and that CONTRACTOR has provided
26 a facility accessible to the physically disabled.
27
28
Non-DMC Residential Master Agreement -33-
1 31. COMPLIANCE
2 CONTRACTOR(S) shall comply with all requirements of the "Fresno County Behavioral
3 Health Compliance Program Contractor Code of Conduct and Ethics" as set forth in Exhibit L. Within
4 thirty (30) days of entering into this Agreement with the COUNTY, new CONTRACTOR(S) shall have all
5 of CONTRACTOR(S) employees, agents and subcontractors providing services under this Agreement
6 complete General Compliance training and certify in writing, that they have received, read, understood,
7 and shall abide by the requirements set forth in Exhibit L. CONTRACTOR(S) shall ensure that within
8 thirty (30) days of hire, all new employees, agents and subcontractors providing services under this
9 Agreement complete General Compliance training and certify in writing that they have received, read,
10 understood, and shall abide by the requirements set forth in Exhibit L.
11 CONTRACTOR(S) will require all employees, agents and subcontractors providing
12 services under this Agreement to complete General Compliance training annually thereafter and
13 appropriate employees, agents and subcontractors shall complete Substance Use Disorder
14 Documentation Billing or billing/reimbursement training. CONTRACTOR(S) understands that the
15 promotion of and adherence to such requirements is an element in evaluating the performance of
16 CONTRACTOR(S) and its employees, agents and subcontractors.
17 CONTRACTOR(S) employees, agents and subcontractors will submit written
18 certifications upon completion of General Compliance training to the COUNTY's Compliance Officer.
19 CONTRACTOR(S) and its employees, agents and subcontractors will promptly report
20 any suspected violation(s) of the Code of Conduct and Ethics or report any activity that they believe may
21 violate the standards of the Compliance Program through the DBH Compliance Hotline: (888) 262-4174.
22 CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty
23 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S) violation of the
24 terms of this Agreement.
25 32. COMPLAINTS
26 CONTRACTOR shall log complaints and the disposition of all complaints from a person
27 served or a person served's family. CONTRACTOR shall provide a summary of the complaint log entries
28 concerning COUNTY-sponsored persons served to COUNTY at monthly intervals by the fifteenth (15th)
Non-DMC Residential Master Agreement -34-
1 day of the following month, in a format that is mutually agreed upon. CONTRACTOR shall post signs
2 informing person served of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY
3 of all incidents reportable to state licensing bodies that affect COUNTY persons served within twenty-four
4 (24) hours of receipt of a complaint.
5 Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
6 persons served, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
7 investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or corrective
8 action taken to resolve the complaint.
9 33. CULTURAL COMPETENCY
10 As related to Cultural and Linguistic Competence:
11 A. Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d, and 45
12 CFR Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
13 from discriminating against persons based on race, color, national origin, sex, disability or religion. This is
14 interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
15 participation in federally funded programs through the provision of comprehensive and quality bilingual
16 services.
17 B. Policies and procedures for ensuring access and appropriate use of trained
18 interpreters and material translation services for all LEP persons served, including, but not limited to,
19 assessing the cultural and linguistic needs of its persons served, training of staff on the policies and
20 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
21 include ensuring compliance of any sub-contracted providers with these requirements.
22 C. CONTRACTOR assurance that minors shall not be used as interpreters.
23 D. CONTRACTOR shall provide and pay for interpreting and translation services to
24 persons participating in CONTRACTOR's services who have limited or no English language proficiency,
25 including services to persons who are deaf or blind. Interpreter and translation services shall be provided as
26 necessary to allow such participants meaningful access to the programs, services and benefits provided by
27 CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR's "vital
28 documents" (those documents that contain information that is critical for accessing CONTRACTOR's
Non-DMC Residential Master Agreement -35-
1 services or are required by law) shall be provided to participants at no cost to the participant.
2 CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
3 translate for a program participant, or who directly communicate with a program participant in a language
4 other than English, demonstrate proficiency in the participant's language and can effectively communicate
5 any specialized terms and concepts peculiar to CONTRACTOR's services.
6 E. In compliance with the State-mandated Culturally and Linguistically Appropriate
7 Services standards as published by the Office of Minority Health, new CONTRACTOR must submit to
8 COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR's plan to address
9 all fifteen national cultural competency standards as set forth in the "National Standards on Culturally and
10 Linguistically Appropriate Services" (CLAS), attached hereto as Exhibit M , and incorporated herein by this
11 reference. County's annual on-site review of CONTRACTOR shall include collection of documentation to
12 ensure all national standards are implemented. As the national competency standards are updated,
13 CONTRACTOR's plan must be updated accordingly.
14 F. CONTRACTOR shall complete and submit county-issued CLAS self-assessment
15 annually. CONTRACTOR shall update CLAS plan as necessary.
16 34. CLEAN AIR AND WATER
17 In the event funding under this Agreement exceeds One Hundred Thousand Dollars
18 ($100,000.00), the CONTRACTOR must comply with all applicable standards, orders, or requirements
19 issued under section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), section 506 of the Clean Water Act (33
20 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR part 32).
21 35. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
22 COUNTY and CONTRACTOR each consider and represent themselves as covered
23 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
24 104-191(HIPAA) and agree to use and disclose protected health information as required by law.
25 COUNTY and CONTRACTOR acknowledge that the exchange of protected health
26 information between them is only for treatment, payment, and health care operations.
27 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
28 Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
Non-DMC Residential Master Agreement -36-
1 Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
2 regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
3 Regulations) and other applicable laws.
4 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
5 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
6 as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code
7 of Federal Regulations (CFR).
8 Additionally, CONTRACTOR shall comply with the HIPAA requirements stated in Exhibit
9 C, "SABG Specific Requirements."
10 36. CHILD ABUSE REPORTING
11 CONTRACTOR shall utilize a procedure acceptable to the COUNTY to ensure that all of
12 CONTRACTOR's employees, volunteers, consultants, subcontractors or agents performing services under
13 this Agreement shall report all known or suspected child abuse or neglect to one or more of the agencies
14 set forth in Penal Code § 11165.9. This procedure shall include having all of CONTRACTOR's employees,
15 volunteers, consultants, subcontractors or agents performing services under this Agreement sign a
16 statement that he or she knows of and will comply with the reporting requirements set forth in Penal Code §
17 11166. The statement to be utilized by CONTRACTOR for reporting is set forth in Exhibit N, "Notice of
18 Child Abuse Reporting," attached hereto and by this reference incorporated herein.
19 37. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
20 CONTRACTOR shall adhere to the requirement that no funds shall be used to carry out any
21 program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug unless the
22 DHCS chooses to implement a demonstration syringe services program for intravenous drug users.
23 38. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
24 INFORMATION
25 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
26 managed care entity as defined in 42 CFR § 455.101, 455.104, and 455.106(a)(1),(2).
27 In accordance with 42 CFR §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2), the
28 following information must be disclosed by CONTRACTOR by completing Exhibit O, "Disclosure of
Non-DMC Residential Master Agreement -37
1 Ownership and Control Interest Statement," attached hereto and by this reference incorporated herein.
2 CONTRACTOR shall submit this form to COUNTY DBH within thirty (30) days of the effective date of
3 this Agreement and at any time in which the status changes. Submissions shall be scanned pdf copies
4 and are to be sent via email to SAS(a_fresnocountyca.gov and the assigned analyst at the County of
5 Fresno, Department of Behavioral Health, Contracts Division.
6 A. Name and address of any person(s) whether it be an individual or corporation with
7 an ownership or controlling interest in the disclosing entity or managed care entity.
8 1) Address must include the primary business address, every business
9 location and P.O. Box address(es).
10 2) Date of birth and Social Security Number for individuals.
11 3) Tax identification number for other corporations or entities with ownership
12 or controlling interest in the disclosing entity.
13 B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
14 interest.
15 C. Whether the person(s) with an ownership or controlling interest of the disclosing
16 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling or
17 child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
18 related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
19 interest in any of its subcontractors.
20 D. Name of any other disclosing entity in which an owner of the disclosing entity has
21 an ownership or control interest.
22 E. The ownership of any subcontractor with whom CONTRACTOR has had business
23 transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month period
24 ending on the date of the request; and
25 F. Any significant business transactions between CONTRACTOR and any wholly
26 owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
27 ending on the date of the request.
28 G. Any person(s) with an ownership or control interest in CONTRACTOR, or agent or
Non-DMC Residential Master Agreement -38
1 managing employee of CONTRACTOR; and
2 1) Has been convicted of a criminal offense related to that person's
3 involvement in any program under Medicare, Medicaid, or the Title XX services program since the
4 inception of those programs.
5 H. The ownership of any subcontractor with whom CONTRACTOR has had
6 business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
7 period ending on the date of the request; and
8 I. Any significant business transactions between CONTRACTOR and any wholly
9 owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
10 ending on the date of the request.
11 39. CHANGE OF LEADERSHIP/MANAGEMENT
12 Any and all notices between COUNTY and CONTRACTOR(S) provided for or permitted
13 under this Agreement or by law, shall be in writing and shall be deemed duly served when personally
14 delivered to one of the parties, or in lieu of such personal service, when deposited in the United States Mail,
15 postage prepaid, addressed to such party.
16 In the event of any change in the status of CONTRACTOR's leadership or management,
17 CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of change.
18 Such notification shall include any new leader or manager's name, address and qualifications. "Leadership
19 or management" shall include any employee, member, or owner of CONTRACTOR who either a) directs
20 individuals providing services pursuant to this Agreement; b) exercises control over the manner in which
21 services are provided; or c) has authority over CONTRACTOR's finances.
22 40. NOTICES
23 The persons and their addresses having authority to give and receive notices under this
24 Agreement include the following:
25 COUNTY CONTRACTOR
Director, Fresno County See Exhibit A
26 Department of Behavioral Health
27 1925 E Dakota Ave
Fresno, CA 93726
28 All notices between the COUNTY and CONTRACTOR provided for or permitted under this
Non-DMC Residential Master Agreement -39
1 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
2 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
3 personal service is effective upon service to the recipient. A notice delivered by first-class United States
4 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
5 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
6 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
7 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
8 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
9 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
10 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
11 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
12 establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
13 including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
14 beginning with section 810).
15 41. SEPARATE AGREEMENT
16 It is mutually understood by the parties that this Agreement does not, in any way, create
17 a joint venture among CONTRACTOR(S). By execution of this Agreement, CONTRACTOR(S)
18 understands that a separate Agreement is formed between each individual CONTRACTOR and
19 COUNTY.
20 42. GOVERNING LAW
21 Venue for any action arising out of or related to this Agreement shall only be in Fresno
22 County, California.
23 The rights and obligations of the parties and all interpretation and performance of this
24 Agreement shall be governed in all respects by the laws of the State of California.
25 43. SEVERABILITY
26 The provisions of this Agreement are severable. The invalidity or unenforceability of any
27 one provision in the Agreement shall not affect the other provisions
28 H
Non-DMC Residential Master Agreement -40-
1 44. ELECTRONIC SIGNATURE
2 The parties agree that this Agreement may be executed by electronic signature as provided
3 in this section. An "electronic signature" means any symbol or process intended by an individual signing this
4 Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a faxed
5 version of an original handwritten signature; or(3) an electronically scanned and transmitted (for example
6 by PDF document) of a handwritten signature. Each electronic signature affixed or attached to this
7 Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing this
8 Agreement for all purposes, including but not limited to evidentiary proof in any administrative or judicial
9 proceeding, and (2) has the same force and effect as the valid original handwritten signature of that person.
10 The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in the
11 Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1).
12 Each party using a digital signature represents that it has undertaken and satisfied the requirements of
13 Government Code section 16.5, subdivision (a), paragraphs (1)through (5), and agrees that each other
14 party may rely upon that representation. This Agreement is not conditioned upon the parties conducting the
15 transactions under it by electronic means and either party may sign this Agreement with an original
16 handwritten signature.
17 45. ENTIRE AGREEMENT
18 This Agreement, including all Exhibits, constitutes the entire agreement between the
19 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
20 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
21 understanding of any nature whatsoever unless expressly included in this Agreement.
22 H
23 H
24 H
25 H
26 H
27 H
28 H
Non-DMC Residential Master Agreement -41-
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
3
4 CONTRACTOR CO N OF FRESNO
5
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:
Deputy
22
23
24
25
26
27
28
Non-DMC Residential Master Agreement -42
1 Provider: BAKERSFIELD RECOVERY SERVICE, INC.
2
3 By
4
5 Print Name: C(�n�
6
7 Title: �(9
Chairman of the Board, President, or Vice President
8
9 Date: - 2-2-
10
11
12 By
13
14 Print Name: �� —kA I tj
15
16 Title: -r►_.,.
Secretary (of Corporation), Assistant Secretary,
17 Chief Financial Officer, or Assistant Treasurer
18
19 Date: 3 I ' 2 Z
20
21
22
23
24
25
26
27
28
Non-DMC Residential Master Agreement -43-
1 Provider: FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL AND DRUG
2 ABUSE SERVICES, INC.
3
4 BY
5
6 Print Name:A .C, e
7
8 Title:
Chairman of the Board, President, or Vice President
9
10 Date: 2022-
11
12
13 By
14
15 Print Name:
16
17 Title: �)C Pee 1,,ye b(frGljv i/
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20 Date: 9` 4- z,?-
21
22
23
24
25
26
27
28
Non-DMC Residential Master Agreement 44
1 Provider: MENTAL HEALTH SYSTEMS, INC.
2
3 B �✓z
4
5 James C.Print Name: Callaghan, Jr
6
7 �idemt&CEO
Title;
8 Chairman of the Board, President, or Vice President
9
10 Date: �a�/ 2,02— —
11
12
13
By
14
15 Print Name: 7)rw ly ( k�0cfw
16 Title: QN0
17 Secretary (of Corporation), Assistant Secretary,
18 Chief Financial Officer, or Assistant Treasurer
Date: 2)1AO)z`L
20 -
21
22
23
24
25
26
27
28
Non-DMC Residential Master Agreement -45
1 Provider: TURNING POINT OF CENTRAL CALIFORNIA, INC.
2
3
4 By ie2,q,~9,a/, A
5
Print Name: Raymond R. Banks
6
7
Title: Chief Executive Officer
8 Chairman of the Board, President, or Vice President
9
10
Date: 4/22/2022
11
12
13 BY WJ 9040
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
Non-DMC Residential Master Agreement -46-
t
i
1
i
�I
I
I Provider: WESTCARE CALIFORNIA, INC.
2
3
By ` `:, )
4
Print Name:2SyjDu�,o�
6 I
7 Title: CSJ(Z-':)
8 Chairman of the Board, President, or Vice President
9
10 Date:
1
12 wc_r--rA
13 By --�`�_,
14
Print-Nam . t- aka h
15
t
16
Title:
17 Secretarr(of Corporation), Assistant G)jcretary,
i
Chief Financial Officer, or Assistant Treasurer
18
p i
19 Date: C244f t -Q 2,-Z
20
21
22
23
24
25
26
27
i
j 28
i
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Non-DMC Residential Master Agreement -51-
Fresno County Department of Behavioral Health Exhibit A
Provider Maximum Annual Allocations
Non-DMC Residential Treatment Services Vendor List
VENDOR CONTACT PHONE NUMBER TYPE OF BUSINESS Contract Max Contract Max Contract Max Contract Max Contract Max
FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26 FY 2026-27
Bakersfield Recovery Services,Inc.(Jason's
Retreat) Executive Director
Remit to: Eric Sanders (661)325-1817 501(c)3 Non-Profit Corporation $15,500 $15,500 $15,500 $15,500 $15,500
PO Box 3218
Bakersfield,CA 93385
Fresno County Hispanic Commission on Alcohol
and Drug Abuse Services,Inc. Executive Director
Remit to: Domingo Zapata (559)268-6480 501(c)3 Non-profit Corporation $225,000 $225,000 $225,000 $225,000 $225,000
1414 W Kearney Blvd
Fresno,Ca 93706
Mental Health Systems,Inc. CEO
Remit to: James Callaghan (858)573-2600 501(c)3 Non-profit Corporation $135,000 $135,000 $135,000 $135,000 $135,000
9465 Farnham St. CFO
San Diego,CA 92123 Joelle Verbestel
Turning Point of Central California,Inc. Chief Executive Officer
Remit to: (559)732-8086 501(c)3 Non-profit Corporation $110,000 $110,000 $110,000 $110,000 $110,000
P.O.Box 7447
Visalia,Ca 93290
WestCare California,Inc. Chief Operating Officer
Remit to: Shawn A.Jenkins (559)251-4800 501(c)3 Non-profit Corporation $440,000 $440,000 $440,000 $440,000 $440,000
1900 N.Gateway Blvd,100
Fresno,CA 93727
Non-DMC Withdrawal Management Services Vendor List
VENDOR PHONE NUMBER TYPE OF BUSINESS Contract Max Contract Max Contract Max Contract Max Contract Max
FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26 FY 2026-27
Bakersfield Recovery Services(Jason's Retreat) Executive Director
Remit to: Eric Sanders (661)325-1817 501(c)3 Non-Profit Corporation See Above See Above See Above See Above See Above
PO Box 3218
Bakersfield,CA 93385
Mental Health Systems,Inc. CEO
Remit to: James Callaghan (858)573-2600 501(c)3 Non-profit Corporation See Above See Above See Above See Above See Above
9465 Farnham St. CFO
San Diego,CA 92123 Joelle Verbestel
WestCare California,Inc. Chief Operating Officer
Remit to: Shawn A.Jenkins (559)251-4800 501(c)3 Non-profit Corporation See Above See Above See Above See Above See Above
1900 N.Gateway Blvd,100
Fresno,CA 93727
$ 925,500 $ 925,500 $ 925,500 $ 925,500 $ 925,500
**A list of current provider sites can be found at:
https://www.co.fresno.ca.us/d eoa rtme nts/behavi ora I-health/substance-use-disorder-services
Revised 07/01/2022 Non-DMC Residential Master Agreement
Exhibit B
Fresno County,Department of Behavioral Health
Non-DMC Substance Use Disorder Residential Treatment Services
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.
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:
• Residential treatment
• Withdrawal Management Level 3.2-WM
• Additional Medication Assisted Treatment
• 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.
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
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Non-DMC Residential Master Agreement
Exhibit B
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.
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 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
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Non-DMC Residential Master Agreement
Exhibit B
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
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
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Non-DMC Residential Master Agreement
Exhibit B
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.
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.
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Non-DMC Residential Master Agreement
Exhibit B
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.
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.
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Non-DMC Residential Master Agreement
Exhibit B
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.
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Non-DMC Residential Master Agreement
Exhibit C
SUBSTANCE ABUSE PREVENTION AND TREATMENT (SABG)
SPECIFIC REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes Substance Use Disorder
(SUD)treatment services available throughout the county to eligible persons served through funds
provided under an Substance Abuse Block Grant (SABG)with the California Department of Health
Care Services. The County, and all contracted providers, must comply with the terms of the SABG
application, and any amendments thereto, including but not limited to the following:
1. RESTRICTIONS ON USE OF SUBSTANCE ABUSE BLOCK GRANT (SABG)
FUNDS TO PAY FOR SERVICES REIMBURSABLE BY MEDI-CAL
CONTRACTOR shall ensure that billing SABG funds only occurs for services that are
not reimbursable by Medi-Cal. If CONTRACTOR utilizes SABG funds to pay for a service included
in the DMC-ODS, CONTRACTOR shall maintain documentation sufficient to demonstrate that
Medi-Cal reimbursement was not available. This documentation shall be provided to COUNTY at
the time of billing and retained in the person served's file for review.
2. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless the
State, its officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, materialmen, laborers and any other person, firm or
corporation furnishing or supplying work, services, materials or supplies in connection with the
performance of this Agreement and from any and all claims and losses accruing or resulting to any
person, firm or corporation who may be injured or damaged by the CONTRACTOR in the
performance of this Agreement.
B. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of CONTRACTOR, in
the performance of this Agreement, shall act in an independent capacity and not as officers or
employees or agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws,
regulations and standards. CONTRACTOR(S) shall establish written procedures consistent with
State-County Contract requirements. The provisions of this Agreement are not intended to
abrogate any provisions of law or regulation existing or enacted during the term of this Agreement.
D. CONFIDENTIALITY
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.
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Non-DMC Residential Master Agreement
Exhibit C
E. REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures regarding
revenue collection issued by the State under the provisions of the Health and Safety Code, Division
10.5.
F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be used
exclusively for providing alcohol and/or drug program services, administrative costs, and allowable
overhead.
G. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H. REPORTS
CONTRACTOR agrees to participate in surveys related to the performance
of this Agreement and expenditure of funds and agrees to provide any such information in a
mutually agreed upon format.
I. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S) pursuant to
this Agreement along with related patient fees, third party payments, or other related revenues and
funds commingled with the foregoing funds are subject to audit by the State. The State may audit
all alcohol and drug program revenue and expenditures contained in this Agreement for the
purpose of establishing the basis for the subsequent year's negotiation.
J. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents, and other
evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal records
relating to individuals served under the terms of this Agreement, as required, to meet the needs of
the State in monitoring quality, quantity, fiscal accountability, and accessibility of services.
Information on each individual shall include, but not be limited to, admission records, patient and
participant interviews and progress notes, and records of service provided by various service
locations, in sufficient detail to make possible an evaluation of services provided and compliance
with this Agreement.
3) CONTRACTOR shall include in any contract with an audit firm a
clause to permit access by DHCS to the working papers of the external independent auditor and
require that copies of the working papers shall be made for DHCS at its request.
3. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds will be
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Non-DMC Residential Master Agreement
Exhibit C
used under the terms of this Agreement. For purposes of this section, DBH will be referred to as
the "prospective recipient".
B. This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants'
responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal
Register (pages 19160-19211).
1) The prospective recipient of Federal assistance funds certifies by
entering this Agreement, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this
covered transaction, unless authorized by the Federal department or agency with which this
transaction originated.
3) Where the prospective recipient of Federal assistance funds is
unable to certify to any of the statements in this certification, such prospective participant shall
attach an explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to DBH
if at any time CONTRACTOR learns that its certification in this clause of this Agreement was
erroneous when submitted or has become erroneous by reason of changed circumstances.
5) The prospective recipient further agrees that by entering into this
Agreement, it will include a clause identical to this clause of this Agreement, and titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions", in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction was
entered into.
C. CONTRACTOR shall not employ or subcontract with any party listed in the
government wide exclusions in the System for Award Management (SAM) in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986
Comp. p. 189) and 12689 (3 CFR part 1989., p. 235), "Debarment and Suspension." SAM
exclusions contain the names of parties debarred, suspended, or otherwise excluded by
agencies, as well as parties declared ineligible under statutory or regulatory authority other than
Executive Order 12549. If CONTRACTOR employs or subcontracts an excluded party, DHCS
has the right to withhold payments, disallow costs, or issue a CAP, as appropriate, pursuant to
HSC Code 11817.8(h).
D. If CONTRACTOR subcontracts or employs an excluded party, COUNTY
and DHCS have the right to withhold payments, disallow costs, or issue a CAP, as appropriate,
pursuant to HSC Code 11817.8(h).
1) By signing this Agreement, the Contractor/Grantee agrees to
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Non-DMC Residential Master Agreement
Exhibit C
comply with applicable federal suspension and debarment regulations including, but not limited
to 2 CFR 180, 2 CFR 376
2) By signing this Agreement, the Contractor certifies to the best of its
knowledge and belief, that it and its principals:
(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
application/proposal/agreement 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) violation of Federal or State antitrust statutes; or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, tax evasion, receiving stolen property, making false claims, obstruction
of justice, or the commission of any other offense indicating a lack of business integrity or
business honesty that seriously affects its business honesty;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with commission of any of the
offenses enumerated in Paragraph b(2) herein; and
(d) Have not within a three-year period preceding this
application/proposal/agreement had one or more public transactions (Federal, State or local)
terminated for cause or default.
(e) Have not, within a three-year period preceding this
application/proposal/agreement, engaged in any of the violations listed under 2 CFR Part 180,
Subpart C as supplemented by 2 CFR Part 376.
(f) Shall not knowingly enter into any lower tier covered
transaction with a person who is proposed for debarment under federal regulations (i.e., 48 CFR
part 9, subpart 9.4), debarred, suspended, declared ineligible, or voluntarily excluded from
participation in such transaction, unless authorized by the State.
(g) Will include a clause entitled, "Debarment and Suspension
Certification" that essentially sets forth the provisions herein, in all lower tier covered
transactions and in all solicitations for lower tier covered transactions.
E. If the Contractor is unable to certify to any of the statements in this
certification, the Contractor shall submit an explanation to the DBH Program Contract Manager.
F. The terms and definitions herein have the meanings set out in 2 CFR Part
180 as supplemented by 2 CFR Part 376.
G. If the Contractor knowingly violates this certification, in addition to other
remedies available to the Federal Government, the DBH may terminate this Agreement for
cause or default.
4. SMOKING-FREE WORKPLACE CERTIFICATION
(Applicable to federally funded agreements and subcontracts, that provide health,
day care, early childhood development services, education or library services to children under
4
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Non-DMC Residential Master Agreement
Exhibit C
18 directly or through local governments.)
A. Public Law 103-227, also known as the Pro-Children Act of 1994 (Act),
requires that smoking not be permitted in any portion of any indoor facility owned or leased or
contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of
18, if the services are funded by federal programs either directly or through state or local
governments, by federal grant, contract, loan, or loan guarantee. The law also applies to
children's services that are provided in indoor facilities that are constructed, operated, or
maintained with such federal funds. The law does not apply to children's services provided in
private residences; portions of facilities used for inpatient drug or alcohol treatment; service
providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities
where WIC coupons are redeemed.
B. Failure to comply with the provisions of the law may result in the imposition
of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an
administrative compliance order on the responsible party.
C. By signing this Agreement, Contractor certifies that it will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used
for the provision of services for children as defined by the Act. The prohibitions herein are
effective December 26, 1994.
D. Contractor further agrees that it will insert this certification into any
subawards entered into that provide for children's services as described in the Act.
5. CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written confidentiality
oath, attached hereto as Attachment A, before they begin employment with CONTRACTOR and
shall renew said document annually thereafter. CONTRACTOR shall retain each employee's
written confidentiality oath for COUNTY and DHCS inspection for a period of six (6) years
following the termination of this agreement.
6. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall ensure equal access to quality care by diverse populations,
each service provider receiving funds from this agreement shall adopt the Federal Office of
Minority Health Culturally and Linguistically Appropriate Service (CLAS) national standards as
outlined at: Think Cultural Health - The Office of Minority Health (hhs.gov) and complying with 42
CFR 438.206(c)(2). 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. CONTRACTOR shall provide effective, equitable, understandable
and respectful quality of care and services that are responsive to diverse cultural health beliefs
and practices, preferred languages, health literacy and other communication needs.
7. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable accommodations,
and accessible equipment for persons served with physical or mental disabilities are provided to
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Non-DMC Residential Master Agreement
Exhibit C
all persons served in accordance with CFR Title 45, Part 84 and the American with Disabilities
Act.
8. ADDITIONAL CONTRACT RESTRICTIONS
This Contract is subject to any additional restrictions, limitations, or conditions
enacted by the Congress, or any statute enacted or amended by the Congress, as well as the
federal or state governments which may affect the provisions, terms, or funding of this Contract in
any manner.
Noncompliance with the requirements of nondiscrimination in services shall
constitute grounds for COUNTY to withhold payments under this Contract or terminate all, or any
type, of funding provided hereunder.
9. HATCH ACT
CONTRACTOR shall comply with the provisions of the Hatch Act (USC, Title 5,
Part III, Subpart F., Chapter 73, Subchapter III), which limit the political activities of employees
whose principal employment activities are funded in whole or in part with federal funds.
10. UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds, and
which pertains 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) Division 10.7, Chapter 1429, Sections 11999-11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol Certification,
attached hereto as Attachment B, incorporated herein by reference and made part of this
Agreement agreeing to uphold the obligations of HSC 11999— 11999.3.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR or
a subcontractor that is a private entity is determined to have violated a prohibition of the Unlawful
Use of Drugs and Alcohol message or has an employee who is determined by the DBH Director or
her designee to have violated a prohibition of the Unlawful Use of Drugs and Alcohol message.
11. LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION OF
CONTROLLED SUBSTANCES
CONTRACTOR 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).
12. NONDISCRIMINATION AND INSTITUTIONAL SAFEGUARDS FOR RELIGIOUS
CONTRACTORS
CONTRACTOR shall establish such processes and procedures as necessary to
comply with the provisions of USC, Title 42, Section 300x-65 and Title 42, CFR, Part 54. to
prohibit discrimination against nongovernmental organizations and certain individuals on the
basis of religion in the distribution of government funds to provide substance abuse services and
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Non-DMC Residential Master Agreement
Exhibit C
to allow the organizations to accept the funds to provide the services to the individuals without
impairing the religious character of the organizations or the religious freedom of the individuals.
13. COUNSELOR CERTIFICATION
CONTRACTOR shall ensure that any counselor or registrant providing intake,
assessment of need for services, treatment or recovery planning, individual or group counseling
to participants, patients, or residents in a DHCS licensed or certified program is required to be
registered or certified as defined in CCR, Title 9, Division 4, Chapter 8.
14. INTRAVENOUS DRUG USE (IVDU) TREATMENT
CONTRACTOR shall ensure that individuals in need of IVDU treatment shall be
encouraged to undergo AOD treatment adhering to provisions in 42 USC 300x-23 and 45 CFR
96.126(e). DHCS shall monitor programs for compliance with this requirement.
15. TUBERCULOSIS TREATMENT
CONTRACTOR shall ensure the following related to Tuberculosis (TB):
A. Routinely make available TB services to each individual receiving
treatment for AOD use and/or abuse.
B. Reduce barriers to patients' accepting TB treatment.
C. Develop strategies to improve follow-up monitoring, particularly after
patients leave treatment, by disseminating information through educational
bulletins and technical assistance.
16. TRAFFICKING IN PERSONS PROVISIONS— PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations prohibiting
trafficking in persons, as well as trafficking-related activities, including, but not limited to the
trafficking of persons provisions in Section 106(g) of the Trafficking Victims Protection Act of
2000 (TVPA) as amended by Section 1702 of Pub. L. 112-239.
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 02/03/22
Non-DMC Residential 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
C, incorporated herein by reference and made part of this Agreement and must require all
employees to complete annual TVPA training.
17. BYRD ANTI-LOBBYING AMENDMENT
CONTRACTOR certifies that it will not and has not used Federal appropriated
funds to pay any person or organization for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, officer or employee of Congress, or an
employee of a member of Congress in connection with obtaining any Federal contract, grant or
any other award covered by 31 USC 1352. CONTRACTOR shall also disclose to DHCS any
lobbying with non-Federal funds that takes place in connection with obtaining any Federal
award.
18. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
CONTRACTOR certifies that under the laws of the United States and the State of
California, CONTRACTOR shall not unlawfully discriminate against any person.
19. FEDERAL LAW REQUIREMENTS
CONTRACTORS shall comply with the following Federal law requirements:
A. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in
federally funded programs.
B. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.) prohibiting
discrimination on the basis of race, color, religion, sex, handicap, familial
status or national origin in the sale or rental of housing.
C. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42 USC
Sections 6101 — 6107), which prohibits discrimination on the basis of age.
D. Age Discrimination in Employment Act (29 CFR Part 1625).
E. Title I of the Americans with Disabilities Act (29 CFR Part 1630) prohibiting
discrimination against the disabled in employment.
F. Title II of the Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities.
G. Title III of the Americans with Disabilities Act (28 CFR Part 36) regarding
access.
Revised 02/03/22
Non-DMC Residential Master Agreement
Exhibit C
H. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC
Section 794), prohibiting discrimination on the basis of individuals with
disabilities.
I. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part 60)
regarding nondiscrimination in employment under federal contracts and
construction contracts greater than $10,000 funded by federal financial
assistance.
J. Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
K. The Drug Abuse Office and Treatment Act of 1972, as amended, relating to
nondiscrimination on the basis of drug abuse.
L. Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part 2,
Subparts A— E).
20. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A. Fair Employment and Housing Act (Government Code Section 12900 et
seq.) and the applicable regulations promulgated thereunder (2 CCR
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 of the CCR, commencing with Section 13000.
D. No State or Federal funds shall be used by COUNTY, or CONTRACTOR,
for sectarian worship, instruction, and/or prose lytization. No State or
Federal funds shall be used by CONTRACTOR to provide direct,
immediate, or substantial support to any religious activity.
21. INFORMATION ACCESS FOR INDIVIDUALS WITH LIMITED ENGLISH
PROFICIENCY
CONTRACTOR shall comply with all applicable provisions of the Dymally-Alatorre
Bilingual Services Act (Government Code sections 7290-7299.8) regarding access to materials
that explain services available to the public as well as providing language interpretation services.
CONTRACTOR shall comply with the applicable provisions of Section 1557 of the
Affordable Care Act (45 CFR Part 92), including, but not limited to, 45 CFR 92.201, when
providing access to:
A. Materials explaining services available to the public,
B. Language assistance,
C. Language interpreter and translation services, and
D. Video remote language interpreting services.
Revised 02/03/22
Non-DMC Residential Master Agreement
Exhibit C
22. INTERIM SERVICES
CONTRACTOR must adhere to the State-County Contract requirement to provide
Interim Services in the event that an individual must wait to be placed in treatment.
Interim Substance Abuse Services means services that are provided until an
individual is admitted to a substance abuse treatment program. The purposes of the services are to
reduce the adverse health effects of such abuse, promote the health of the individual, and reduce
the risk of transmission of disease. At a minimum, interim services include counseling and
education about HIV and tuberculosis (TB), about the risks of needle-sharing, the risks of
transmission to sexual partners and infants, and about steps that can be taken to ensure the HIV
and TB transmission does not occur, as well as referral for HIV or TB treatment services if
necessary. For pregnant women, interim services also include counseling on the effects of alcohol
and drug use on the fetus, as well as referral for prenatal care.
Records must indicate evidence that Interim Services have been provided and
documentation will be reviewed for compliance.
23. CHARITABLE CHOICE
CONTRACTOR shall document the total number of referrals necessitated by
religious objection to other alternative SUD providers.-66j;CONTRACTOR may not discriminate in
its program delivery against a client or potential client on the basis of religion or religious belief, a
refusal to hold a religious belief, or a refusal to actively participate in a religious practice. Any
specifically religious activity or service made available to individuals by the CONTRACTOR must
be voluntary as well as separate in time and location from County funded activities and services.
CONTRACTOR shall inform County as to whether it is faith-based. If CONTRACTOR identifies
as faith-based it must submit to DBH Contracts Division—Substance Use Disorder(SUD) Services
a copy of its policy on referring individuals to alternate treatment CONTRACTOR and include a
copy of this policy in its client admission forms. The policy must inform individuals that they may
be referred to an alternative provider if they object to the religious nature of the program and
include a notice to SUD Services. Adherence to this policy will be monitored during annual site
reviews, and a review of client files. If CONTRACTOR identifies as faith-based, by July 1 of
each year CONTRACTOR will be required to report to SUD Services the number of individuals
who requested referrals to alternate providers based on religious objection. In addition,
CONTRACTOR
24. MINIMUM QUALITY DRUG TREATMENT STANDARDS
CONTRACTOR shall comply with the Minimum Quality Drug Treatment Standards
for SABG for all SUD treatment programs. The Minimum Quality Drug Treatment Standards are
attached hereto and by this reference incorporated herein as Attachment D.
25. RISK ASSESSMENT
CONTRACTOR shall comply with the sub-recipient pre-award risk assessment
requirements contained in 45 CFR 72.205. COUNTY shall review the merit and risk associated
with each potential CONTRACTOR annually prior to making an award. COUNTY shall perform
and document annual sub-recipient pre-award risk assessments for each CONTRACTOR and
retain documentation for audit purposes.
Revised 02/03/22
Non-DMC Residential Master Agreement
Exhibit C
26. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State
laws, regulations and standards. In accepting the State drug and alcohol combined program
allocation pursuant to California Health and Safety Code (HSC) Sections 11814(a) and (b),
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, Part 2 commencing with Section 11760, State
Government's Role to Alleviate Problems Related to the Inappropriate Use of Alcoholic
Beverages and Other Drug Use.
B. California Code of Regulations (CCR), Title 9, Division 4, commencing with
Chapter 1(herein referred to as Title 9).
C. Government Code (GC), Title 2, Division 4, Part 2, Chapter 2, Article 1.7,
Federal Block Grant Funds.
D. GC, Title 5, Division 2, Part 1, Chapter 1, Article 7, Federally Mandated
Audits of Block Grant Funds Allocated to Local Agencies, commencing with Section 53130.
E. United State Code (USC), Title 42, Chapter 6A, Subchapter XVII, Part B,
Subpart ii, commencing with Section 300x-21, Block Grants for Prevention and Treatment of
Substance Abuse.
F. Code of Federal Regulations (CFR), Title 45, Part 75, Uniform
Administration Requirements, Cost Principles, and Audit Requirements for Federal Awards.
G. CFR, Title 45, Part 96, Block Grants.
H. CFR, Title 42, Part 2, Confidentiality of Substance Use Disorder Patient
Records.
I. Title 42, CFR, Part 8, Medication Assisted Treatment for Opioid Use
Disorders.
J. CFR, Title 21, Chapter II, Drug Enforcement Administration, Department of
Justice.
K. State Administrative Manual (SAM), Chapter 7200, General Outline of
Procedures.
27. DRUG FREE WORKPLACE
CONTRACTOR shall comply with the requirements of the Drug-Free Work Place Act
of 1990 (California Government Code section 8350).
28. YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the "Youth Treatment Guidelines," available at the
DHCS web address at: http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and
Revised 02/03/22
Non-DMC Residential Master Agreement
Exhibit C
by this reference incorporated herein, in developing and implementing youth treatment programs
funded under this Agreement until such time new Youth Treatment Guidelines are established
and adopted. No formal amendment of this contract is required for new guidelines to apply.
29. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
OF 1996
If any of the work performed under this Agreement is subject to the HIPAA,
CONTRACTOR shall perform the work in compliance with all applicable provisions of HIPAA.
As identified in Exhibit F of the State County Intergovernmental Agreement, DHCS, COUNTY
and CONTRACTOR shall cooperate to assure mutual agreement as to those transactions
between them, to which this Provision applies. Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the personal
health information (PHI), it shall not change any definition, data condition or use of a data
element or segment as proscribed in the federal Health and Human Services Transaction
Standard Regulation [45 CFR 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 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 HHS Transactions
Implementation specification or are not in the HHS Transaction Standard's implementation
specification [45CFR 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 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
Revised 02/03/22
Non-DMC Residential Master Agreement
Exhibit C
pertinent information regarding electronic transactions to enrolled CONTRACTORS for which
they provide clearinghouse services.
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.
30. CAPACITY REPORTING
CONTRACTOR shall ensure that if their program reaches or exceeds 90 percent
of dedicated capacity CONTRACTOR shall report this information to COUNTY and
DHCSOWPS@dhcs.ca.gov within four days of reaching capacity.
31. SALARY RESTRICTION
CONTRACTOR agrees that no part of any federal funds provided under this
Contract shall be used by CONTRACTOR to pay the salary and wages of an individual at a rate
in excess of Level II of the Executive Schedule as found online at:
https://grants.nih.gov/qrants/policy/salcap summary.htm.
Executive salaries shall be provided to COUNTY in the annual Provider Risk
Assessment and/or upon request.
SABG funds used to pay a salary in excess of the rate of basic pay for Level I of
the Executive Schedule shall be subject to disallowance. The amount disallowed shall be
determined by subtracting the individual's actual salary from the Level I rate of basic pay and
multiplying the result by the percentage of the individual's salary that was paid with SABG funds
(Reference: Terms and Conditions of the SABG award).
Note that indirect costs can only be allocated to SABG contracted services using
any of the following cost allocation methodologies; percentage of direct cost, percentage of
direct salary cost, or federally-approved indirect cost rate.
Revised 02/03/22
Non-DMC Residential 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:
Non-DMC Residential 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:
Non-DMC Residential 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
Non-DMC Residential 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
Non-DMC Residential 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
Non-DMC Residential 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
rev 01-02-2020
Non-DMC Residential 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
4
rev 01-02-2020
Non-DMC Residential Master Agreement
Exhibit E
Fresno County Department of Behavioral Health
Non-DMC Residential/Withdrawal Management Treatment Services
Approved Rates by Provider
Fiscal Year 2022-23
15-Minute Unit Day Rate
Care Clinician Withdrawal Residential Residential
Coordination Consultation MAT Management 3.1 3.5
APPROVED MAXIMUM UOS RATE 51.45 153.60 153.60 164.24 185.13 188.52
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc. -Jason's Retreat 153.60 164.24
Bakersfield Recovery, Inc. -Capistrano 153.60 164.24
Fresno County Hispanic Commission 43.07 153.60 153.60 111.05
Mental Health Systems - Fresno First (Womens) 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
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 Bakersfield Residential 40.50 153.60 153.60 163.41 120.63
WestCare Fresno Residential
Mens 32.25 153.60 153.60 164.24 156.84 163.66
Perinatal 32.25 153.60 153.60 164.24 170.78 175.84
Womens 32.25 153.60 153.60 164.24 158.83 173.87
Revised 07/01/2022
Non-DMC Residential Master Agreement 1 Of 5
Exhibit E
Fresno County Department of Behavioral Health
Non-DMC Residential/Withdrawal Management Treatment Services
Approved Rates by Provider
Fiscal Year 2023-24
15-Minute Unit Day Rate
Case Physician MAT Withdrawal Residential Residential
Management Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc. -Jason's Retreat
Bakersfield Recovery, Inc. -Capistrano
Fresno County Hispanic Commission
Mental Health Systems - Fresno First (Womens)
Mental Health Systems - Fresno First (Perinatal)
Turning Point- Quest House
Turning Point-Visalia
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
Revised 07/01/2022
Non-DMC Residential Master Agreement 2 of 5
Exhibit E
Fresno County Department of Behavioral Health
Non-DMC Residential/Withdrawal Management Treatment Services
Approved Rates by Provider
Fiscal Year 2024-25
15-Minute Unit Day Rate
Case Physician MAT Withdrawal Residential Residential
Management Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc. -Jason's Retreat
Bakersfield Recovery, Inc. -Capistrano
Fresno County Hispanic Commission
Mental Health Systems - Fresno First (Womens)
Mental Health Systems - Fresno First (Perinatal)
Turning Point- Quest House
Turning Point-Visalia
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
Revised 07/01/2022
Non-DMC Residential Master Agreement 3 of 5
Exhibit E
Fresno County Department of Behavioral Health
Non-DMC Residential/Withdrawal Management Treatment Services
Approved Rates by Provider
Fiscal Year 2025-26
15-Minute Unit Day Rate
Case Physician MAT Withdrawal Residential Residential
Management Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc. -Jason's Retreat
Bakersfield Recovery, Inc. -Capistrano
Fresno County Hispanic Commission
Mental Health Systems - Fresno First (Womens)
Mental Health Systems - Fresno First (Perinatal)
Turning Point- Quest House
Turning Point-Visalia
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
Revised 07/01/2022
Non-DMC Residential Master Agreement 4 of 5
Exhibit E
Fresno County Department of Behavioral Health
Non-DMC Residential/Withdrawal Management Treatment Services
Approved Rates by Provider
Fiscal Year 2026-27
15-Minute Unit Day Rate
Case Physician MAT Withdrawal Residential Residential
Management Consultation Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc. -Jason's Retreat
Bakersfield Recovery, Inc. -Capistrano
Fresno County Hispanic Commission
Mental Health Systems - Fresno First (Womens)
Mental Health Systems - Fresno First (Perinatal)
Turning Point- Quest House
Turning Point-Visalia
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
Revised 07/01/2022
Non-DMC Residential Master Agreement S of S
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 Non-DMC Residential 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 Non-DMC Residential 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 Non-DMC Residential 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 ME)Rth A R additiGRal fee of$0.20 peF faxed page will apply theFeafteF.
Non-DMC Residential 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).
Non-DMC Residential 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:
Non-DMC Residential 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.
Non-DMC Residential 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.
Non-DMC Residential 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)
Non-DMC Residential 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.
Non-DMC Residential Master Agreement
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Co Incident Reporting System Exhibit 1
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:
Non-DMC Residential Master Agreement
Exhibit J
E C 4 Y fresnodbh.logicmanagecmmincidents/?t=9&p=18ik=182beOc5cdcd5072bbl864cdee4d3d6e
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
Client Date of Birth
Client Address
i
ClientlD
Gender'
County of origin'
Summary
Subject O
Incident(check all that apply)'
If 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):
Description of the Incident'
Non-DMC Residential 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
Non-DMC Residential 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% Called 911/EM5
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)
RELOAD THE FORM
Non-DMC Residential 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
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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?
Non-DMC Residential 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 Ea<iliry•
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 Sour<e:103:null « < 3 > CANCEL
Non-DMC Residential 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.
Non-DMC Residential 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
Non-DMC Residential 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
Non-DMC Residential Master Agreement 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
Non-DMC Residential 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.
Non-DMC Residential 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.
Non-DMC Residential 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
Non-DMC Residential 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
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Non-DMC Residential 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
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Non-DMC Residentialaster 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.
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Non-DMC Residential Master Agreement