HomeMy WebLinkAboutAgreement A-22-342 Supersede Agreement BBFF.pdf Agreement No. 22-342
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 9t" day of August , 2022, by
3 and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and each provider listed in Exhibit A "Provider list", attached hereto and by
5 this reference incorporated herein and made part of this Agreement, and collectively referred to
6 hereinafter as "CONTRACTORS". Reference in this Agreement to "party" or "parties" shall be
7 understood to refer to COUNTY and each individual CONTRACTORS, unless otherwise specified.
8 WITNESSETH:
9 WHEREAS, CONTRACTORS agreed to operate a Mental Health Services Act (MHSA) funded
10 Children's Full Service Partnership (FSP) program for underserved or unserved high-risk children
11 between the ages of 0-10 years with Serious Emotional Disturbance (SED) and their Families; and
12 WHEREAS, COUNTY entered into Agreement number 18-366 with Uplift Family Services,
13 Comprehensive Youth Services, Inc. and Exceptional Parents Unlimited, Inc. dated the 10th of July,
14 2018 and later amended by Agreement number 18-366-1 on the 8t" of June, 2021. Agreement
15 number 18-366 and Agreement number 18-366-1 shall hereinafter collectively be referred to as
16 Agreement number 18-366.
17 WHEREAS, Uplift Family Services notified COUNTY that the company was merging with
18 another corporation effective March 1, 2022 and would be changing its legal name to Pacific Clinics
19 as of July 1, 2022; therefore, a new Agreement is being entered into with the new legal name
20 retroactive to July 1, 2022.
21 WHEREAS, COUNTY and CONTRACTORS have agreed to terminate Agreement 18-366 and
22 supersede with the following Agreement for the final fiscal year of the contract term.
23 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
24 hereto agree as follows:
25 1. Services
26 A. CONTRACTORS shall perform all services and fulfill all responsibilities as set forth
27 in Exhibit B "Summary of Services", attached hereto and by this reference incorporated herein and made
28 part of this Agreement.
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1 B. Each CONTRACTOR shall also perform all services and fulfill all responsibilities as
2 specified in COUNTY's Request for Proposal (RFP) No. 18-037 dated March 19, 2018, Addendum No.
3 One (1) to COUNTY's RFP No. 18-037 dated April 10, 2018, collectively referred to herein as COUNTY's
4 Revised RFP, and CONTRACTORS's response to said Revised RFP dated April 20, 2018 all
5 incorporated herein by reference and made part of this Agreement. In the event of any inconsistency
6 among these documents, the inconsistency shall be resolved by giving precedence in the following order
7 of priority: 1)to this Agreement, including Exhibits and excluding the Revised RFP and
8 CONTRACTORS's Response to RFP; 2)to the Revised RFP; and 3) to CONTRACTORS's Response to
9 the Revised RFP. A copy of COUNTY's Revised RFP No. 18-037 and CONTRACTORS's response
10 thereto shall be retained and made available during the term of this Agreement by COUNTY's DBH
11 Contracts Division. CONTRACTORS agree that all references to Uplift Family Services, Inc. in the above
12 documents shall refer to Pacific Clinics as of the effective date of this agreement.
13 C. CONTRACTORS shall perform all services defined in Exhibit B in accordance with
14 Exhibit D "Guiding Principles of Care Delivery", attached hereto and by this reference incorporated herein
15 and made part of this Agreement.
16 D. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
17 services provided by CONTRACTORS, in accordance with Section Fourteen (14) of this Agreement.
18 E. CONTRACTORS shall participate in periodic workgroup meetings consisting of
19 staff from COUNTY's DBH to discuss service requirements, data reporting, outcomes measurement,
20 training, policies and procedures, overall program operations, and any problems or foreseeable problems
21 that may arise.
22 F. Changes to any CONTRACTORS corporate information as listed in Exhibit A, or
23 service sites shall be made upon 30 days advance written notification to COUNTY's DBH Director and
24 upon written approval from COUNTY's DBH Director or designee.
25 G. Each CONTRACTOR shall maintain requirements as a COUNTY MHP
26 organizational provider throughout the term of this Agreement. If, for any reason, this status is not
27 maintained, COUNTY may terminate this Agreement pursuant to Section Three (3) of this Agreement.
28 H. CONTRACTORS shall perform all FSP services as set forth in Exhibit B in
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1 accordance with the Full Service Partnership Service Delivery Model and in alignment with "Medi-Cal
2 Organization Provider Standards", as set forth in Exhibit F, attached hereto and by this reference
3 incorporated herein and made part of this Agreement.
4 I. CONTRACTORS shall provide tracking tools and measurements for effectiveness,
5 efficiency, and client satisfaction indicators as required by Commission on Accreditation of Rehabilitation
6 Facilities (CARF) standards and as further detailed in Exhibit O.
7 J. Each CONTRACTOR agrees that, prior to providing services under the terms and
8 conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
9 operations, or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
10 this Agreement as to Section Three (3) of this Agreement.
11 2. TERM
12 This Agreement shall become effective the 1st day of July, 2022 and shall terminate on
13 the 30th day of June, 2023.
14 3. TERMINATION
15 A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
16 provided thereunder, are contingent on the approval of funds by the appropriating government
17 agency. Should sufficient funds not be allocated, the services provided may be modified, or this
18 Agreement terminated at any time by giving the CONTRACTORS thirty (30) days advance written
19 notice.
20 B. Breach of Contract - COUNTY may immediately suspend or terminate this
21 Agreement in whole or in part, where in the determination of COUNTY there is:
22 1) An illegal or improper use of funds;
23 2) A failure to comply with any term of this Agreement;
24 3) A substantially incorrect or incomplete report submitted to COUNTY.
25 4) Improperly performed service.
26 In no event shall any payment by the COUNTY constitute a waiver by COUNTY of any
27 breach of this Agreement or any default which may then exist on the part of CONTRACTORS.
28 Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to
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1 breach or default. COUNTY shall have the right to demand of CONTRACTORS the repayment to
2 COUNTY of any funds disbursed to CONTRACTORS under this Agreement, which in the judgment of
3 COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTORS
4 shall promptly refund any such funds upon demand or, at COUNTY's option, such repayment shall be
5 deducted from future payments owing to CONTRACTORS under this Agreement.
6 C. Without Cause - Under circumstances other than those set forth above, this
7 Agreement may be terminated by CONTRACTORS or COUNTY or COUNTY's DBH Director, or
8 designee, upon the giving of thirty (30) days advance written notice of an intention to terminate.
9 4. COMPENSATION
10 COUNTY agrees to pay CONTRACTORS and CONTRACTORS agree to receive
11 compensation in accordance with the budget set forth in Exhibit C "Budget", attached hereto and by
12 this reference incorporated herein and made part of this Agreement.
13 The maximum amount payable to CONTRACTORS for the period of July 1, 2022
14 through June 30, 2023 shall not exceed Seven Million Four Hundred Eight Thousand Twenty-Three
15 and No/100 Dollars ($7,408,023). It is understood by CONTRACTORS and COUNTY that the
16 cumulative total of MHSA CSS funds payable under this Agreement to CONTRACTORS shall not
17 exceed Two Million Ninety-Seven Thousand Three Hundred Fifty-Three and No/100 Dollars
18 ($2,097,353.00). It is also understood by CONTRACTORS and COUNTY that CONTRACTORS
19 estimate to generate a cumulative total of Five Million Three Hundred Ten Thousand Six Hundred
20 Seventy and No/100 Dollars ($5,310,670.00) in Medi-Cal Federal FFP for SED services under this
21 Agreement to offset CONTRACTORS program costs as set forth in Exhibit C.
22 Payment shall be made upon certification or other proof satisfactory to COUNTY's
23 DBH that services have actually been performed by CONTRACTORS as specified in this Agreement.
24 A. If CONTRACTORS fail to generate the Medi-Cal revenue and/or client fee
25 reimbursement amounts set forth in Exhibit C, COUNTY shall not be obligated to pay the difference
26 between these estimated amounts and the actual amounts generated.
27 It is further understood by COUNTY and CONTRACTORS that any Medi-Cal
28 revenue and/or client fee reimbursements above the amounts stated herein will be used to directly offset
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1 the COUNTY's contribution of COUNTY funds identified in Exhibit C. The offset of funds will also be
2 clearly identified in monthly invoices received from CONTRACTORS as further described in Section Five
3 (5) of this Agreement.
4 Travel shall be reimbursed based on actual expenditures and mileage
5 reimbursement shall be at CONTRACTORS' adopted rate per mile, not to exceed the Federal Internal
6 Revenue Services (IRS) published rate.
7 B. It is understood that all expenses incidental to CONTRACTORS' performance of
8 services under this Agreement shall be borne by CONTRACTORS. If CONTRACTORS fail to comply
9 with any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
10 C. Payments shall be made by COUNTY to CONTRACTORS in arrears for services
11 provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
12 COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made after
13 receipt and verification of actual expenditures incurred by CONTRACTORS for monthly program costs, as
14 identified in Exhibit C, in the performance of this Agreement and shall be documented to COUNTY on a
15 monthly basis by the tenth (10th) of the month following the month of said expenditures. The parties
16 acknowledge that CONTRACTORS will be performing hiring, training, and credentialing of staff, and
17 COUNTY will be performing additional staff credentialing to ensure compliance with State and Federal
18 regulations.
19 D. COUNTY shall not be obligated to make any payments under this Agreement if the
20 request for payment is received by COUNTY more than sixty (60) days after this Agreement has
21 terminated or expired.
22 All final invoices shall be submitted by CONTRACTORS within sixty (60) days
23 following the final month of service for which payment is claimed. No action shall be taken by COUNTY
24 on invoices submitted beyond the sixty (60) day closeout period. Any compensation which is not
25 expended by CONTRACTORS pursuant to the terms and conditions of this Agreement shall
26 automatically revert to COUNTY.
27 E. The services provided by CONTRACTORS under this Agreement are funded in
28 whole or in part by the State of California. In the event that funding for these services is delayed by the
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1 State Controller, COUNTY may defer payments to CONTRACTORS. The amount of the deferred
2 payment shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The
3 period of time of the deferral by COUNTY shall not exceed the period of time of the State Controller's
4 delay of payment to COUNTY plus forty-five (45) days.
5 F. CONTRACTORS shall be held financially liable for any and all future
6 disallowances/audit exceptions due to CONTRACTORS deficiency discovered through the State audit
7 process and COUNTY utilization review during the course of this Agreement. At COUNTY's election, the
8 disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
9 withheld from subsequent payments to CONTRACTORS. CONTRACTORS shall not receive
10 reimbursement for any units of services rendered that are disallowed or denied by the Fresno County
11 Mental Health Plan (Mental Health Plan) utilization review process or through the State Department of
12 Health Care Services (DHCS) cost report audit settlement process for Medi-Cal eligible clients.
13 Notwithstanding the above, COUNTY must notify CONTRACTORS prior to any State audit process
14 and/or COUNTY utilization review. To the extent allowable by law, CONTRACTORS shall have the right
15 to be present during each phase of any State audit process and/or COUNTY utilization review and shall
16 be provided all documentation related to each phase of any State audit process and/or COUNTY
17 utilization review. Additionally, prior to any disallowances/audit exceptions becoming final,
18 CONTRACTORS shall be given at least 10 business days to respond to such proposed
19 disallowances/audit exceptions.
20 G. It is understood by CONTRACTORS and COUNTY that this Agreement is funded
21 with mental health funds to serve children/youth with Seriously Emotionally Disturbed (SED) disorders,
22 many of whom have co-occurring substance use disorders. It is further understood by CONTRACTORS
23 and COUNTY that funds shall be used to support appropriately integrated and documented treatment
24 services for co-occurring mental health and substance use disorders.
25 5. INVOICING
26 A. CONTRACTORS shall invoice COUNTY electronically in arrears by the
27 twentieth (20th) of each month for actual services rendered in the previous month, to:
28 dbhinvoicereview(a�fresnocountyca.gov, dbh-invoices( and Cc: the assigned
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1 DBH Mental Health Contract Analyst. After CONTRACTORS render services to referred clients,
2 CONTRACTORS will invoice COUNTY for payment, certify the expenditure, and submit electronic
3 claiming data into COUNTY's electronic information system for all clients, including those eligible for
4 Medi-Cal as well as those that are not eligible for Medi-Cal, including contracted cost per unit and actual
5 cost per unit. COUNTY must pay CONTRACTORS before submitting a claim to DHCS for Federal
6 reimbursement for Medi-Cal eligible clients.
7 B. At the discretion of COUNTY's DBH Director or designee, if an invoice is incorrect
8 or is otherwise not in proper form or substance, COUNTY's DBH Director or designee, shall have the right
9 to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days
10 prior notice to CONTRACTORS. CONTRACTORS agree to continue to provide services for a period of
11 ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90) day period,
12 the invoice(s) is still not corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director or designee,
13 may elect to terminate this Agreement, pursuant to the termination provisions stated in Section Three (3)
14 of this Agreement. In addition, for invoices received ninety (90)days after the expiration of each term of
15 this Agreement or termination of this Agreement, at the discretion of COUNTY's DBH Director or
16 designee, COUNTY's DBH shall have the right to deny payment of any additional invoices received.
17 C. Monthly invoices shall include a client roster, identifying volume reported by
18 guarantor group clients served (including third party payer of services) by month and year-to-date,
19 including percentages.
20 D. CONTRACTORS shall submit to the COUNTY by the twentieth (20th) of each
21 month a detailed general ledger(GL), itemizing costs incurred in the previous month. Failure to submit
22 GL reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
23 payments until there is compliance, as further described in Section Five (5) herein.
24 E. CONTRACTORS will remit annually within ninety(90) days from June 30, a
25 schedule to provide the required information on published charges for all authorized direct specialty
26 mental health services. The published charge listing will serve as a source document to determine the
27 CONTRACTORS' usual and customary charge prevalent in the public mental health sector that is used to
28 bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
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1 operations.
2 F. CONTRACTORS shall submit monthly staffing reports that identify all direct
3 service and support staff, applicable licensure/certifications, and full time hours worked to be used as a
4 tracking tool to determine if CONTRACTORS' program is staffed according to the services provided under
5 this Agreement.
6 G. CONTRACTORS must maintain financial records for a period of ten (10) years or
7 until any dispute, audit or inspection is resolved, whichever is later. CONTRACTORS will be responsible
8 for any disallowances related to inadequate documentation.
9 H. CONTRACTORS are responsible for collecting and managing of data in a manner
10 to be determined by DHCS and COUNTY's Mental Health Plan in accordance with applicable rules and
11 regulations. COUNTY's electronic information system is a critical source of information for purposes of
12 monitoring service volume and obtaining reimbursement.
13 I. CONTRACTORS shall submit service data into COUNTY's electronic information
14 system, in accordance with COUNTY's DBH documentation standards, to allow COUNTY to bill Medi-Cal,
15 and any other third-party source, for services and meet State and Federal reporting requirements.
16 J. CONTRACTORS must comply with all laws and regulations governing the Federal
17 Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section
18 1395 et seq; and 2)the regulations and rules promulgated by the Federal Centers for Medicare and
19 Medicaid Services as they relate to participation, coverage and claiming reimbursement.
20 CONTRACTORS will be responsible for compliance as of the effective date of each Federal, State or
21 local law or regulation specified.
22 K. If a client has dual coverage, such as other health coverage (OHC) or Federal
23 Medicare, CONTRACTORS will be responsible for billing the carrier and obtaining a payment/denial or
24 have validation of claiming with no response ninety (90) days after the claim was mailed before the
25 service can be entered into COUNTY's electronic information system. CONTRACTORS must report all
26 third party collections for Medicare, third party, client pay, or private pay in each monthly invoice and in
27 the annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500
28 form is required as documentation. CONTRACTORS must report all revenue collected from OHC, third-
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1 party, client-pay, or private-pay in each monthly invoice and in the cost report that is required to be
2 submitted. CONTRACTORS shall submit monthly invoices for reimbursement that equal the amount due
3 CONTRACTORS less any funding sources not eligible for Federal and State reimbursement.
4 CONTRACTORS must comply with all laws and regulations governing the Federal Medicare program,
5 including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and
6 2)the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as
7 they relate to participation, coverage and claiming reimbursement. CONTRACTORS will be responsible
8 for compliance as of the effective date of each Federal, State or local law or regulation specified.
9 L. Data entry shall be the responsibility of CONTRACTORS. COUNTY shall monitor
10 the volume of services and cost of services entered into COUNTY's electronic information system. Any
11 and all audit exceptions resulting from the provision and reporting of specialty mental health services by
12 CONTRACTORS shall be the sole responsibility of CONTRACTORS. CONTRACTORS will comply with
13 all applicable policies, procedures, directives and guidelines regarding the use of COUNTY's electronic
14 information system.
15 M. Medi-Cal Certification and Mental Health Plan Compliance
16 CONTRACTORS shall comply with any and all requests and directives associated
17 with COUNTY maintaining State Medi-Cal site certification. CONTRACTORS shall provide specialty
18 mental health services in accordance with COUNTY's Mental Health Plan. CONTRACTORS must
19 comply with the "Fresno County Mental Health Plan Compliance Program and Code of Conduct" set forth
20 in Exhibit G, attached hereto and incorporated herein by reference and made part of this Agreement.
21 CONTRACTORS shall comply with any and all requests associated with any State and/or Federal
22 reviews or audits.
23 CONTRACTORS may provide direct specialty mental health services using pre-
24 licensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
25 supervised by licensed staff, works within his/her scope, and only delivers allowable direct specialty
26 mental health services. It is understood that each service is subject to audit for compliance with Federal
27 and State regulations, and that COUNTY may be making payments in advance of said review. In the
28 event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set
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1 off from other payments due the amount of said disapproved services. CONTRACTORS shall be
2 responsible for audit exceptions to ineligible dates of services or incorrect application of utilization review
3 requirements.
4 6. INDEPENDENT CONTRACTORS
5 In performance of the work, duties, and obligations assumed by CONTRACTORS
6 under this Agreement, it is mutually understood and agreed that CONTRACTORS, including any and
7 all of CONTRACTORSs officers, agents, and employees will at all times be acting and performing as
8 an independent CONTRACTORS, and shall act in an independent capacity and not as an officer,
9 agent, servant, employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY
10 shall have no right to control or supervise or direct the manner or method by which CONTRACTORS
11 shall perform its work and function. However, COUNTY shall retain the right to administer this
12 Agreement so as to verify that CONTRACTORS is performing its obligations in accordance with the
13 terms and conditions thereof. CONTRACTORS and COUNTY shall comply with all applicable
14 provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction
15 over matters which are directly or indirectly the subject of this Agreement.
16 Because of its status as an independent CONTRACTORS, CONTRACTORS, including
17 any and all of CONTRACTORS's officers, agents, and employees shall have absolutely no right to
18 employment rights and benefits available to COUNTY employees. CONTRACTORS shall be solely
19 liable and responsible for providing to, or on behalf of, its employees all legally-required employee
20 benefits. In addition, CONTRACTORS shall be solely responsible and save COUNTY harmless from
21 all matters relating to payment of CONTRACTORS's employees, including compliance with Social
22 Security, withholding, and all other regulations governing such matters. It is acknowledged that
23 during the term of this Agreement, CONTRACTORS may be providing services to others unrelated to
24 COUNTY or to this Agreement.
25 7. MODIFICATION
26 Any matters of this Agreement may be modified from time to time by the written consent of
27 all the parties without, in any way, affecting the remainder.
28 Notwithstanding the above, changes to services, staffing, and responsibilities of
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1 CONTRACTORS, as needed, to accommodate changes in the laws relating to mental health treatment,
2 as set forth in Exhibit B, may be made with the signed written approval of COUNTY's DBH Director or
3 designee and CONTRACTORS through an amendment approved by COUNTY's County Counsel and
4 the COUNTY's Auditor-Controller's Office.
5 In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
6 Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the budgets, as set forth
7 in Exhibit C, that do not exceed 10% of the maximum compensation payable to CONTRACTORS may be
8 made with the written approval of COUNTY's DBH Director or designee. Changes to the expense
9 categories in the budget that exceed ten percent (10%) of the maximum compensation payable to
10 CONTRACTORS, may be made with the signed written approval of COUNTY's DBH Director or designee
11 through an amendment approved by COUNTY's Counsel and COUNTY's Auditor-Controller's Office.
12 Modifications shall not result in any change to the annual maximum compensation amount
13 payable to CONTRACTORS, as stated in this Agreement.
14 8. NON-ASSIGNMENT
15 Neither party shall assign, transfer or subcontract this Agreement nor their rights or
16 duties under this Agreement without the prior written consent of the other party.
17 9. HOLD-HARMLESS
18 CONTRACTORS agree to indemnify, save, hold harmless, and at COUNTY'S request,
19 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses
20 (including attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to
21 COUNTY in connection with the performance, or failure to perform, by CONTRACTORS, its officers,
22 agents, or employees under this Agreement, and from any and all costs and expenses (including
23 attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to any
24 person, firm, or corporation who may be injured or damaged by the performance, or failure to
25 perform, of CONTRACTORS, its officers, agents, or employees under this Agreement.
26 10. INSURANCE
27 Without limiting COUNTY's right to obtain indemnification from CONTRACTORS or any
28 third parties, CONTRACTORS, at its sole expense shall maintain in full force and affect the following
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1 insurance policies throughout the term of this Agreement:
2 A. Commercial General Liability
3 Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
4 Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations,
5 product liability, contractual liability, Explosion-Collapse-Underground (XCU),
fire legal liability, or any other liability insurance deemed necessary because of
6 the nature of the Agreement.
7
B. Automobile Liability
8
Comprehensive Automobile Liability Insurance with limits of not less than One
9 Million Dollars ($1,000,000.00) per accident for bodily injury and for property
damages. Coverage should include any auto used in connection with this
10 Agreement
11 C. Real and Property Insurance
12 CONTRACTORS shall maintain a policy of insurance for all risk personal
13 property coverage which shall be endorsed naming the County of Fresno as an
additional loss payee. The personal property coverage shall be in an amount
14 that will cover the total of COUNTY purchase and owned property, at a
minimum, as discussed in Section Twenty One (21) of this Agreement.
15
16 D. All Risk Property Insurance
17 CONTRACTORS will provide property coverage for the full replacement value of
COUNTY'S personal property in possession of CONTRACTORS and/or used in
18 the execution of this Agreement. COUNTY will be identified on an appropriate
certificate of insurance as the certificate holder and will be named as an
19 Additional Loss Payee on the Property Insurance Policy.
20 E. Professional Liability
21 Professional Liability Insurance with limits of not less than One Million Dollars
22 ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual
aggregate. CONTRACTORS agrees that it shall maintain, at its sole expense,
23 in full force and effect for a period of three (3) years following the termination of
this Agreement, one or more policies of professional liability insurance with limits
24 of coverage as specified herein.
25 F. Child Abuse/Molestation and Social Services Coverage
26 CONTRACTORS shall have either separate policies or an umbrella policy with
27 endorsements covering Child Abuse/Molestation and Social Services Liability
coverage or have a specific endorsement on their General Commercial liability
28 policy covering Child Abuse/Molestation and Social Services Liability. The
policy limits for these policies shall be One Million Dollars ($1,000,000) per
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1 occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
policies are to be on a per occurrence basis.
2
3 G. Worker's Compensation
4 A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
5
6 H. Cyber Liability
7
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
8 claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to
duties and obligations undertaken by CONTRACTORS in this agreement and
9 shall include, but not be limited to, claims involving 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, release of private information, alteration of electronic
11 information, extortion and network security. The policy shall provide coverage
for breach response costs as well as regulatory fines and penalties as well as
12 credit monitoring expenses with limits sufficient to respond to these obligations.
13
I. Additional Requirements Relating to Insurance
14
15 CONTRACTORS hereby waives its right to recover from COUNTY, its officers,
agents, and employees any amounts paid by the policy worker's compensation
16 insurance required by this Agreement. CONTRACTORS is solely responsible to
obtain any endorsement to such policy that may be necessary to accomplish
17 such waiver of subrogation, but CONTRACTORS'S waiver of subrogation under
this paragraph is effective whether or not CONTRACTORS obtains such an
18 endorsement.
19
20 CONTRACTORS shall obtain endorsements to the Commercial General Liability
21 insurance naming the County of Fresno, its officers, agents, and employees, individually and collectively,
22 as additional insured, but only insofar as the operations under this Agreement are concerned. Such
23 coverage for additional insured shall apply as primary insurance and any other insurance, or
24 self-insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
25 contributing with insurance provided under CONTRACTORS's policies herein. This insurance shall not
26 be cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY.
27 CONTRACTORS hereby waives its right to recover from COUNTY, its officers, agents,
28 and employees any amounts paid by the policy of worker's compensation insurance required by this
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1 Agreement. CONTRACTORS is solely responsible to obtain any endorsement to such policy that may
2 be necessary to accomplish such waiver of subrogation, but CONTRACTORS's waiver of subrogation
3 under this paragraph is effective whether or not CONTRACTORS obtains such an endorsement.
4 Within Thirty (30) days from the date CONTRACTORS sign this Agreement,
5 CONTRACTORS shall provide certificates of insurance and endorsement as stated above for all of the
6 foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
7 N. Millbrook Ave., Fresno, California 93703), Attention: Contracted Services Division or electronically to
8 dbhcontractedservicesdivis ion(a_fresnocountyca.gov with a copy to the assigned COUNTY's DBH Staff
9 Analyst, stating that such insurance coverage 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
11 such Commercial General Liability insurance names the County of Fresno, its officers, agents and
12 employees, individually and collectively, as additional insured, but only insofar as the operations under
13 this Agreement are concerned; that such coverage for additional insured shall apply as primary
14 insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and
15 employees, shall be excess only and not contributing with insurance provided under CONTRACTORS's
16 policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30)
17 days advance, written notice given to COUNTY.
18 In the event CONTRACTORS fails to keep in effect at all times insurance coverage as
19 herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
20 Agreement upon the occurrence of such event.
21 All policies shall be issued by admitted insurers licensed to do business in the State of
22 California, and such insurance shall be purchased from companies possessing a current A.M. Best,
23 Inc. rating of A FSC VII or better.
24 11. LICENSES/CERTIFICATES
25 Throughout each term of this Agreement, CONTRACTORS and CONTRACTORS' staff
26 shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
27 necessary for the provision of the services hereunder and required by the laws and regulations of the
28 United States of America, State of California, the County of Fresno, and any other applicable
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1 governmental agencies. CONTRACTORS shall notify COUNTY immediately in writing of its inability
2 to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
3 irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTORS and
4 CONTRACTORS's staff shall comply with all applicable laws, rules or regulations, as may now exist
5 or be hereafter changed.
6 12. RECORDS
7 CONTRACTORS shall maintain records in accordance with Exhibit H, "Documentation
8 Standards for Client Records", attached hereto and by this reference incorporated herein and made part
9 of this Agreement. COUNTY shall be allowed to review all records of services provided, including the
10 goals and objectives of the treatment plan, and how the therapy provided is achieving the goals and
11 objectives. All mental health records shall be considered the property of the COUNTY and shall be
12 retained by the COUNTY upon termination or expiration of this Agreement.
13 13. REPORTS
14 A. Outcome Reports
15 CONTRACTORS shall submit to COUNTY's DBH service outcome reports as
16 reasonably requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to
17 change at COUNTY's DBH discretion.
18 B. Additional Reports
19 CONTRACTORS shall also furnish to COUNTY such statements, records, reports,
20 data, and other information as COUNTY's DBH may reasonably request pertaining to matters covered by
21 this Agreement. In the event that CONTRACTORS fails to provide such reports or other information
22 required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until
23 there is compliance. In addition, CONTRACTORS shall provide written notification and explanation to
24 COUNTY within five (5) days of any funds received from another source to conduct the same services
25 covered by this Agreement.
26 C. Cost Report
27 CONTRACTORS shall provide financial data to identify all direct and indirect costs
28 incurred by CONTRACTORS for all services delivered under this Agreement. All Cost Reports must be
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1 prepared in accordance with Generally Accepted Accounting Principles (GAAP) and Welfare and
2 Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c). Unallowable costs such as lobbying or
3 political donations must be deducted on the cost report and monthly invoice reimbursements.
4 D. Settlements with State Department of Health Care Services (DHCS)
5 During the term of this Agreement and thereafter, COUNTY and CONTRACTORS
6 agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
7 related to the reimbursement provided under this Agreement. CONTRACTORS will participate in the
8 several phases of settlements between COUNTY/CONTRACTORS and DHCS. The phases of initial cost
9 reporting for settlement according to State reconciliation of records for paid Medi-Cal services and audit
10 settlement are: State DHCS audit 1) initial cost reporting —after an internal review by COUNTY, the
11 COUNTY files the cost report with State DHCS on behalf of CONTRACTORS's legal entity for the fiscal
12 year; 2) Settlement—State reconciliation of records for paid Medi-Cal services, approximately 18 to 36
13 months following the State close of the fiscal year, DHCS will send notice for any settlement under this
14 provision to COUNTY; and 3)Audit Settlement-State DHCS audit. After final reconciliation and
15 settlement DHCS may conduct a review of medical records, cost report along with support documents
16 submitted to COUNTY in initial submission to determine accuracy and may disallow costs and/or units of
17 services. COUNTY may choose to appeal and therefore reserves the right to defer payback settlement
18 with CONTRACTORS until resolution of the appeal. DHCS Audits will follow Federal Medicaid
19 procedures for managing overpayments. If at the end of the Audit Settlement, COUNTY determines that
20 it overpaid CONTRACTORS, it will require CONTRACTORS to repay the Medi-Cal related overpayment
21 back to COUNTY.
22 Funds owed to COUNTY will be due within forty-five (45) days of notification by COUNTY,
23 or COUNTY shall withhold future payments until all excess funds have been recouped by means of an
24 offset against any payments then or thereafter owing to COUNTY under this or any other Agreement
25 between the COUNTY and CONTRACTORS.
26 14. MONITORING
27 CONTRACTORS agree to extend to COUNTY's staff, COUNTY's DBH Director, and the
28 State Department of Health Care Services or their designees, the right to review and monitor records,
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1 services, or procedures, at any time, in regard to clients, as well as the overall operation of
2 CONTRACTORS's performance, in order to ensure compliance with the terms and conditions of this
3 Agreement.
4 15. REFERENCES TO LAWS AND RULES
5 In the event any law, regulation, or policy referred to in this Agreement is amended during
6 the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
7 such amendment.
8 16. COMPLIANCE WITH STATE REQUIREMENTS
9 CONTRACTORS recognize that COUNTY operates its mental health programs under an
10 agreement with the State of California Department Health Care Services, and that under said agreement
11 the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTORS shall
12 adhere to all State requirements, including those identified in Exhibit I, "State Mental Health
13 Requirements", attached hereto and by this reference incorporated herein and made part of this
14 Agreement. CONTRACTORS shall also file an incident report for all incidents involving clients, following
15 the Protocol and using the Worksheet identified in Exhibit J, "Incident Reporting", attached hereto and by
16 this reference incorporated herein and made part of this Agreement, or a protocol and worksheet
17 presented by CONTRACTORS that is accepted by COUNTY's DBH Director or designee.
18 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
19 CONTRACTORS shall perform all services as set forth in Exhibit B in alignment with
20 "Medi-Cal Organizational Provider Standards", as set forth in Exhibit F, attached hereto and by this
21 reference incorporated herein and made part of this Agreement.
22 CONTRACTORS shall inform every client of their rights under the COUNTY's Mental
23 Health Plan as described in Exhibit K, "Fresno County Mental Health Plan", attached hereto and by this
24 reference incorporated herein and made part of this Agreement.
25 18. CONFIDENTIALITY
26 All services performed by CONTRACTORS under this Agreement shall be in strict
27 conformance with all applicable Federal, State of California and/or local laws and regulations relating
28 to confidentiality.
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1 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
2 COUNTY and CONTRACTORS each consider and represent themselves as covered
3 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
4 104-191 (HIPAA) and agree that any use and disclosure of Protected Health Information (PHI) shall
5 be in compliance with applicable law.
6 COUNTY and CONTRACTORS acknowledge that the exchange of PHI between them
7 is only for treatment, payment, and health care operations.
8 COUNTY and CONTRACTORS intend to protect the privacy and provide for the
9 security of PHI shared pursuant to the Agreement in compliance with HIPAA, the Health Information
10 Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
11 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
12 and other applicable laws.
13 To the extent applicable, CONTRACTORS and COUNTY agree to comply with the
14 HIPAA Regulations, including those set forth in as set forth in, but not limited to, Title 45, Sections
15 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
16 20. DATA SECURITY
17 For the purpose of preventing the potential loss, misappropriation or inadvertent
18 disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
19 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
20 contractual relationship with the COUNTY for the purpose of providing services under this Agreement
21 must employ adequate data security measures to protect the confidential information provided to the
22 CONTRACTORS by the COUNTY, including but not limited to the following:
23 A. CONTRACTORS-Owned Mobile, Wireless, or Handheld Devices
24 CONTRACTORS may not connect to COUNTY networks via personally-owned
25 mobile, wireless or handheld devices, unless the following conditions are met:
26 1) CONTRACTORS has received authorization by COUNTY for
27 telecommuting purposes;
28 2) Current virus protection software is in place;
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1 3) Mobile device has the remote wipe feature enabled; and
2 A secure connection is used
3 B. CONTRACTORS-Owned Computers or Computer Peripherals
4 CONTRACTORS may not bring CONTRACTORS-owned computers or
5 computer peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief
6 Information Officer, or designee(s), including but not limited to mobile storage devices. If approved to
7 be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
8 means of a virtual private network (VPN) connection or another type of secure connection. Said data
9 must be encrypted.
10 C. COUNTY-Owned Computer Equipment
11 CONTRACTORS may not use COUNTY computers or computer peripherals on
12 non-COUNTY premises without prior authorization from COUNTY's Chief Information Officer, or
13 designee(s).
14 D. CONTRACTORS may not store COUNTY's private, confidential or sensitive
15 data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
16 E. CONTRACTORS shall be responsible to employ strict controls to ensure the
17 integrity and security of the COUNTY's confidential information and to prevent unauthorized access to
18 data maintained in computer files, program documentation, data processing systems, data files and
19 data processing equipment which stores or processes COUNTY data internally and externally.
20 F. Confidential client information transmitted to one party by the other by means of
21 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
22 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
23 G. CONTRACTORS shall be responsible to immediately notify COUNTY of any
24 breaches or potential breaches of security related to COUNTY's confidential information, data
25 maintained in computer files, program documentation, data processing systems, data files and data
26 processing equipment which stores or processes COUNTY data internally or externally.
27 H. COUNTY shall provide oversight to CONTRACTORS's response to all incidents
28 arising from an actual breach of security related to COUNTY's confidential client information provided
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1 to CONTRACTORS; however, CONTRACTORS will be responsible to issue any notification to
2 affected individuals to the extent required by law. CONTRACTORS will be responsible for all actual
3 costs incurred as a result of providing said required notification to the extent that the breach was
4 caused by CONTRACTORS's failure to adhere to the privacy, confidentiality, or data security
5 provisions set forth herein.
6 21. PROPERTY OF COUNTY
7 A. COUNTY and CONTRACTORS recognize that fixed assets are tangible and
8 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
9 capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
10 will be on a straight-line basis.
11 For COUNTY purposes, fixed assets must fulfill three qualifications:
12 1. Have life span of over one year;
13 2. Is not a repair part; and
14 3. Must be valued at or greater than the capitalization thresholds for the asset
15 type.
16
17 Asset Type Threshold
18 • Land $0
• Buildings and improvements $100,000
19 • Infrastructure $100,000
• Tangible $5,000
20 o Equipment
o Vehicles
21 • Intangible $100,000
o Internally generated software
22 o Purchased software
o Easements
23 o Patents
• Capital lease $5,000
24
25
26 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
27 approved and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset
28 Log, attached hereto as Exhibit P and by this reference incorporated herein and made part of this
Agreement, will be maintained by COUNTY's Asset Management System and annually inventoried until
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1 the asset is fully depreciated. During the terms of this Agreement, CONTRACTORS's fixed assets may
2 be inventoried in comparison to COUNTY's DBH Asset Inventory System.
3 B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
4 more than $1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
5 assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other
6 sensitive items as determined by COUNTY's DBH Director or designee. CONTRACTORS will maintain a
7 tracking system on the items and are not required to be capitalize or depreciated. The items are subject
8 to annual inventory for compliance.
9 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
10 Agreement is terminated or upon expiration of this Agreement. CONTRACTORS agrees to participate in
11 an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
12 Agreement, CONTRACTORS shall be physically present when fixed and inventoried assets are returned
13 to COUNTY possession. CONTRACTORS is responsible for returning to COUNTY all COUNTY-owned
14 undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
15 assets at the expiration or termination of this Agreement.
16 CONTRACTORS further agrees to the following:
17 1. Maintain all items of equipment in good working order and condition,
18 normal wear and tear is expected;
19 2. Label all items of equipment with COUNTY assigned program number,
20 perform periodic inventories as required by COUNTY, and maintain an inventory list showing where and
21 how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
22 shall be submitted to COUNTY within ten (10) days of any request therefore; and
23 3. Report in writing to COUNTY immediately after discovery, the loss or theft
24 of any items of equipment. For stolen items, the local law enforcement agency must be contacted and a
25 copy of the police report submitted to COUNTY.
26 D. The purchase of any equipment by CONTRACTORS with funds provided
27 hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this
28 Agreement as appropriate, and must be directly related to CONTRACTORSS services or activities under
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1 the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from
2 equipment purchased, which are incurred by CONTRACTORS, if prior written approval has not been
3 obtained from COUNTY.
4 E. CONTRACTORS must obtain prior written approval from COUNTY's DBH
5 whenever there is any modification or change in the use of any property acquired or improved, in whole or
6 in part, using funds under this Agreement. If any real or personal property acquired or improved with said
7 funds identified herein is sold and/or is utilized by CONTRACTORS for a use which does not qualify
8 under this Agreement, CONTRACTORS shall reimburse COUNTY in an amount equal to the current fair
9 market value of the property, less any portion thereof attributable to expenditures of funds not provided
10 under this Agreement. These requirements shall continue in effect for the life of the property. In the
11 event this Agreement expires, or terminates, the requirements for this Section shall remain in effect for
12 activities or property funded with said funds, unless action is taken by the State government to relieve
13 COUNTY of these obligations.
14 22. NON-DISCRIMINATION
15 During the performance of this Agreement, CONTRACTORS shall not unlawfully
16 discriminate against any employee or applicant for employment, or recipient of services, because of
17 ethnic group identification, gender, gender identity, gender expression, sexual orientation, color,
18 physical disability, mental disability, medical condition, national origin, race, ancestry, marital status,
19 religion or religious creed, pursuant to all applicable State of California and Federal statutes and
20 regulations.
21 23. CULTURAL COMPETENCY
22 As related to Cultural and Linguistic Competence, CONTRACTORS shall comply with:
23 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
24 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
25 from discriminating against persons based on race, color, national origin, sex, disability or religion.
26 This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access
27 and participation in federally funded programs through the provision of comprehensive and quality
28 bilingual services.
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1 B. Policies and procedures for ensuring access and appropriate use of trained
2 interpreters and material translation services for all LEP consumers, including, but not limited to,
3 assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
4 procedures, and monitoring its language assistance program. The CONTRACTORS's procedures
5 must include ensuring compliance of any sub-contracted providers with these requirements.
6 C. CONTRACTORS shall not use minors as interpreters.
7 D. CONTRACTORS shall provide and pay for interpreting and translation services to
8 persons participating in CONTRACTORS' services who have limited or no English language proficiency,
9 including services to persons who are deaf or blind. Interpreter and translation services shall be provided
10 as necessary to allow such participants meaningful access to the programs, services and benefits
11 provided by CONTRACTORS. Interpreter and translation services, including translation of
12 CONTRACTORS' "vital documents" (those documents that contain information that is critical for
13 accessing CONTRACTORS' services or are required by law) shall be provided to participants at no cost
14 to the participant. CONTRACTORS shall ensure that any employees, agents, subcontractors, or partners
15 who interpret or translate for a program participant, or who directly communicate with a program
16 participant in a language other than English, demonstrate proficiency in the participant's preferred
17 language and can effectively communicate any specialized terms and concepts peculiar to
18 CONTRACTORS' services.
19 E. In compliance with the State mandated Culturally and Linguistically Appropriate
20 standards as published by the Office of Minority Health, CONTRACTORS must submit to COUNTY for
21 approval, within sixty (60) days from date of execution of this Agreement, CONTRACTORS' plan to
22 address all national cultural competency standards as set forth in Exhibit E "National Standards on
23 Culturally and Linguistically Appropriate Services (CLAS)", attached hereto and incorporated herein by
24 reference and made part of this Agreement. COUNTY's annual on-site review of CONTRACTORS shall
25 include collection of documentation to ensure all national standards are implemented. As the national
26 competency standards are updated, CONTRACTORS' cultural competency plan must be updated
27 accordingly. Cultural competency training for CONTRACTORS' staff should be substantively integrated
28 into health professions education and training at all levels, both academic and functional, including core
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1 curriculum, professional licensure, and continuing professional development programs.
2 CONTRACTORS, on a monthly basis, shall provide COUNTY's DBH a monthly monitoring tool/report that
3 shows all CONTRACTORS' staff completed cultural competency trainings.
4 24. AMERICANS WITH DISABILITIES ACT
5 CONTRACTORS agree to ensure that deliverables developed and produced, pursuant to
6 this Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
7 and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
8 implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
9 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic
10 and information technology (EIT) accessible to people with disabilities. California Government Code
11 section 11135 codifies section 508 of the Act requiring accessibility of electronic and information
12 technology.
13 25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
14 To the extent necessary to prevent disallowance of reimbursement under section
15 1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four(4)
16 years after the furnishing of services under this Agreement, CONTRACTORS shall make available, upon
17 written request to the Secretary of the United States Department of Health and Human Services, or upon
18 request to the Comptroller General of the United States General Accounting Office, or any of their duly
19 authorized representatives, a copy of this Agreement and such books, documents, and records as are
20 necessary to certify the nature and extent of the costs of these services provided by CONTRACTORS
21 under this Agreement. CONTRACTORS further agree that in the event CONTRACTORS carry out any of
22 its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
23 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
24 Agreement shall contain a clause to the effect that until the expiration of four (4) years after the furnishing
25 of such services pursuant to such subcontract, the related organizations shall make available, upon
26 written request to the Secretary of the United States Department of Health and Human Services, or upon
27 request to the Comptroller General of the United States General Accounting Office, or any of their duly
28 authorized representatives, a copy of such subcontract and such books, documents, and records of such
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1 organization as are necessary to verify the nature and extent of such costs.
2 26. SINGLE AUDIT CLAUSE
3 A. If CONTRACTORS expend Seven Hundred Fifty Thousand Dollars ($750,000.00)
4 or more in Federal and Federal flow-through monies, CONTRACTORS agree to conduct an annual audit
5 in accordance with the requirements of the Single Audit Standards as set forth in Office of Management
6 and Budget (OMB) Circular A-133. CONTRACTORS shall submit said audit and management letter to
7 COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
8 there were negative findings, CONTRACTORS must include a corrective action plan signed by an
9 authorized individual. CONTRACTORS agree to take action to correct any material non-compliance or
10 weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Business
11 Office for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
12 received for the program. Failure to perform the requisite audit functions as required by this Agreement
13 may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a
14 public accountant to perform said audit, or may result in the inability of COUNTY to enter into future
15 agreements with CONTRACTORS. All audit costs related to this Agreement are the sole responsibility of
16 CONTRACTORS.
17 B. A single audit report is not applicable if CONTRACTORS' Federal contracts do not
18 exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTORS only
19 funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
20 performed and a program audit report with management letter shall be submitted by CONTRACTORS to
21 COUNTY as a minimum requirement to attest to CONTRACTORS solvency. Said audit report shall be
22 delivered to COUNTY's DBH Business Office for review no later than nine (9) months after the close of
23 the fiscal year in which the funds supplied through this Agreement are expended. Failure to comply with
24 this Act may result in COUNTY performing the necessary audit tasks or contracting with a qualified
25 accountant to perform said audit. All audit costs related to this Agreement are the sole responsibility of
26 CONTRACTORS who agrees to take corrective action to eliminate any material noncompliance or
27 weakness found as a result of such audit. Audit work performed by COUNTY under this paragraph shall
28 be billed to CONTRACTORS at COUNTY cost, as determined by COUNTY's Auditor-
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1 Controller/Treasurer-Tax Collector.
2 C. CONTRACTORS shall make available all records and accounts for inspection by
3 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
4 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
5 least three (3) years following final payment under this Agreement or the closure of all other pending
6 matters, whichever is later.
7 27. COMPLIANCE
8 CONTRACTORS agree to comply with COUNTY's Contractor Code of Conduct and
9 Ethics and the COUNTY's Compliance Program in accordance with Exhibit G. Within thirty (30) days of
10 entering into this Agreement with COUNTY, CONTRACTORS shall have all of CONTRACTORS'
11 employees, agents, and subcontractors providing services under this Agreement certify in writing, that he
12 or she has received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
13 CONTRACTORS shall ensure that within thirty (30) days of hire, all new employees, agents, and
14 subcontractors providing services under this Agreement shall certify in writing that he or she has received,
15 read, understood, and shall abide by the Contractors Code of Conduct and Ethics. CONTRACTORS
16 understand that the promotion of and adherence to the Contractors Code of Conduct is an element in
17 evaluating the performance of CONTRACTORS and its employees, agents and subcontractors.
18 Within thirty(30) days of entering into this Agreement, and annually thereafter, all
19 employees, agents, and subcontractors providing services under this Agreement shall complete general
20 compliance training and appropriate employees, agents, and subcontractors shall complete
21 documentation and billing or billing/reimbursement training. All new employees, agents, and
22 subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who is
23 required to attend training shall certify in writing that he or she has received the required training. The
24 certification shall specify the type of training received and the date received. The certification shall be
25 provided to COUNTY's Compliance Officer at 3133 N. Millbrook, Fresno, California 93703.
26 CONTRACTORS agree to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY
27 by the Federal Government as a result of CONTRACTORS' violation of the terms of this Agreement.
28 28. ASSURANCES
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1 In entering into this Agreement, CONTRACTORS certify that neither they, nor any of their
2 officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
3 Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal
4 offense related to the provision of health care items or services; nor have they, nor any of their officers,
5 been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
6 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
7 CONTRACTORS are ineligible on these grounds, COUNTY will remove CONTRACTORS from
8 responsibility for, or involvement with, COUNTY's business operations related to the Federal Health Care
9 Programs and shall remove such CONTRACTORS from any position in which CONTRACTORS'
10 compensation, or the items or services rendered, ordered or prescribed by CONTRACTORS may be paid
11 in whole or part, directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds
12 at least until such time as CONTRACTORS is reinstated into participation in the Federal Health Care
13 Programs.
14 A. If COUNTY has notice that either CONTRACTORS, or its officers, have been
15 charged with a criminal offense related to any Federal Health Care Program, or are proposed for
16 exclusion during the term of any contract, CONTRACTORS and COUNTY shall take all appropriate
17 actions to ensure the accuracy of any claims submitted to any Federal Health Care Program. At its
18 discretion, given such circumstances, COUNTY may request that CONTRACTORS cease providing
19 services until resolution of the charges or the proposed exclusion.
20 B. CONTRACTORS agree that all potential new employees of CONTRACTORS or
21 subcontractors of CONTRACTORS who, in each case, are expected to perform professional services
22 under this Agreement, will be queried as to whether(1) they are now or ever have been excluded,
23 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they
24 have been convicted of a criminal offense related to the provision of health care items or services; and (3)
25 they have been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
26 suspension, debarment, or ineligibility.
27 1. In the event the potential employee or subcontractor informs
28 CONTRACTORS that he or she is excluded, suspended, debarred, or otherwise ineligible, or has been
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1 convicted of a criminal offense relating to the provision of health care services, and CONTRACTORS
2 hires or engages such potential employee or subcontractors, CONTRACTORS will ensure that said
3 employee or subcontractors does no work, either directly or indirectly relating to services provided to
4 COUNTY.
5 2. Notwithstanding the above, COUNTY, at its discretion, may terminate this
6 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
7 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractors of
8 CONTRACTORS will perform work, either directly or indirectly, relating to services provided to COUNTY.
9 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
10 to protect the interests of COUNTY consumers.
11 C. CONTRACTORS shall verify (by asking the applicable employees and
12 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
13 perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
14 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of
15 a criminal offense related to the provision of health care items or services; and (3) have not been
16 reinstated to participate in the Federal Health Care Program after a period of exclusion, suspension,
17 debarment, or ineligibility. In the event any existing employee or subcontractor informs CONTRACTORS
18 that he or she is excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
19 Health Care Programs, or has been convicted of a criminal offense relating to the provision of health care
20 services, CONTRACTORS will ensure that said employee or subcontractor does no work, either direct or
21 indirect, relating to services provided to COUNTY.
22 1. CONTRACTORS agrees to notify COUNTY immediately during the term of
23 this Agreement whenever CONTRACTORS learns that an employee or subcontractor who, in each case,
24 is providing professional services under this Agreement is excluded, suspended, debarred, or otherwise
25 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
26 to the provision of health care services.
27 2. Notwithstanding the above, COUNTY, at its discretion, may terminate this
28 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
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1 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractors of
2 CONTRACTORS will perform work, either directly or indirectly, relating to services provided to COUNTY.
3 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
4 to protect the interests of COUNTY consumers.
5 D. CONTRACTORS agree to cooperate fully with any reasonable requests for
6 information from COUNTY which may be necessary to complete any internal or external audits relating to
7 CONTRACTORS' compliance with the provisions of this Section.
8 E. CONTRACTORS agree to reimburse COUNTY for the entire cost of any penalty
9 imposed upon COUNTY by the Federal Government as a result of CONTRACTORS' violation of
10 CONTRACTORS's obligations as described in this Section.
11 29. PUBLICITY PROHIBITION
12 None of the funds, materials, property or services provided directly or indirectly under this
13 Agreement shall be used for CONTRACTORS' advertising, fundraising, or publicity (i.e., purchasing of
14 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the
15 above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
16 necessary to raise public awareness about the availability of such specific services when approved in
17 advance by COUNTY's DBH Director or designee and at a cost to be provided in Exhibit C for such items
18 as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other related
19 expense(s).
20 30. COMPLAINTS
21 CONTRACTORS shall log complaints and the disposition of all complaints from a client or
22 a client's family. CONTRACTORS shall provide a copy of the detailed complaint log entries concerning
23 COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (loth) day of the following month,
24 in a format that is mutually agreed upon. In addition, CONTRACTORS shall provide details and attach
25 documentation of each complaint with the log. CONTRACTORS shall post signs informing clients of their
26 right to file a complaint or grievance. CONTRACTORS shall notify COUNTY of all incidents reportable to
27 State licensing bodies that affect COUNTY clients within twenty-four(24) hours of receipt of a complaint.
28 Within ten (10) days after each incident or complaint affecting COUNTY clients,
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1 CONTRACTORS shall provide COUNTY with information relevant to the complaint, investigative details
2 of the complaint, the complaint and CONTRACTORS disposition of, or corrective action taken to resolve
3 the complaint. In addition, CONTRACTORS shall inform every client of their rights as set forth in Exhibit
4 K. CONTRACTORS shall file an incident report for all incidents involving clients, following the protocol
5 and using the worksheet identified in Exhibit J.
6 31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
7 This provision is only applicable if CONTRACTORS are disclosing entities, fiscal agent,
8 or managed care entities as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101,
9 455.104, and 455.106(a)(1),(2).
10 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
11 455.106(a)(1),(2), the following information must be disclosed by CONTRACTORS by completing
12 Exhibit L, "Disclosure of Ownership and Control Interest Statement", attached hereto and by this
13 reference incorporated herein. CONTRACTORS shall submit this form to DBH within thirty (30) days
14 of the effective date of this Agreement. Additionally, CONTRACTORS shall report any changes to
15 this information within thirty-five (35) days of occurrence by completing Exhibit L, "Disclosure of
16 Ownership and Control Interest Statement." Submissions shall be scanned pdf copies and are to be
17 sent via email to DBH Contracted ServicesDivision(a)fresnocountyca.gov attention: Contracts
18 Administration:
19 A. Name and address of any person(s) whether it be an individual or corporation
20 with an ownership or controlling interest in the disclosing entity or managed care entity:
21 1) Address must include the primary business address, every business
22 location and P.O. Box address(es)
23 2) Date of birth and Social Security Number for individuals
24 3) Tax identification number for other corporations or entities with
25 ownership or controlling interest in the disclosing entity
26 B. Any subcontractors in which the disclosing entity has five (5) percent or more
27 interest
28 C. Whether the person(s) with an ownership or controlling interest of the disclosing
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1 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
2 or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity
3 is related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
4 interest in any of its subcontractors
5 D. Name of any other disclosing entity in which an owner of the disclosing entity
6 has an ownership or control interest
7 E. The ownership of any subcontractors with whom the provider has had business
8 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
9 and
10 F. Any significant business transactions between the provider and any wholly
11 owned supplier, or between the provider and any subcontractors, during the 5-year period ending on
12 the date of the request.
13 G. Any person(s) with an ownership or control interest in the provider, or agent or
14 managing employee of the provider; and
15 1) Has been convicted of a criminal offense related to that person's
16 involvement in any program under Medicare, Medicaid, or the title XX services program since the
17 inception of those programs.
18 H. The ownership of any subcontractors with whom the provider has had business
19 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
20 and
21 Any significant business transactions between the provider and any wholly owned
22 supplier, or between the provider and any subcontractors, during the 5-year period ending on the date
23 of the request.
24 32. DISCLOSURE— CRIMINAL HISTORY AND CIVIL ACTIONS
25 CONTRACTORS are required to disclose if any of the following conditions apply to them,
26 their owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section
27 as "CONTRACTORS"):
28 A. Within the three-year period preceding the Agreement award, they have been
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1 convicted of, or had a civil judgment rendered against them for:
2 1. Fraud or a criminal offense in connection with obtaining, attempting to
3 obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
4 2. Violation of a federal or state antitrust statute;
5 3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
6 records; or
7 4. False statements or receipt of stolen property.
8 B. Within a three-year period preceding their Agreement award, they have had a
9 public transaction (federal, state, or local)terminated for cause or default.
10 Disclosure of the above information will not automatically eliminate CONTRACTORS from
11 further business consideration. The information will be considered as part of the determination of whether
12 to continue and/or renew this Agreement and any additional information or explanation that
13 CONTRACTORS elect to submit with the disclosed information will be considered. If it is later determined
14 that CONTRACTORS failed to disclose required information, any contract awarded to such
15 CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
16 and conditions of the award.
17 CONTRACTORS must sign a "Certification Regarding Debarment, Suspension, and Other
18 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit M, attached hereto
19 and by this reference incorporated herein and made part of this Agreement. Additionally,
20 CONTRACTORS must immediately advise COUNTY's DBH in writing if, during the term of this
21 Agreement: (1) CONTRACTORS become suspended, debarred, excluded, or ineligible for participation
22 in Federal or State funded programs or from receiving federal funds as listed in the excluded parties' list
23 system (http://www.sam.gov); or (2) any of the above listed conditions become applicable to
24 CONTRACTORS. CONTRACTORS shall indemnify, defend, and hold COUNTY harmless for any loss or
25 damage resulting from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed
26 Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
27 33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
28 This provision is only applicable if CONTRACTORS are operating as a corporation (a for-
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1 profit or non-profit corporation) or if during the term of this Agreement, CONTRACTORS change their
2 status to operate as a corporation.
3 Members of a CONTRACTORS Board of Directors shall disclose any self-dealing
4 transactions that they are a party to while CONTRACTORS are providing goods or performing services
5 under this Agreement. A self-dealing transaction shall mean a transaction to which CONTRACTORS are
6 a party and in which one or more of its directors has a material financial interest. Members of the Board
7 of Directors shall disclose any self-dealing transactions that they are a party to by completing and signing
8 a "Self-Dealing Transaction Disclosure Form", attached hereto as Exhibit N and incorporated herein by
9 reference and made part of this Agreement, and submitting it to COUNTY prior to commencing with the
10 self-dealing transaction or immediately thereafter.
11 34. AUDITS AND INSPECTIONS
12 CONTRACTORS shall, at any time during business hours and as often as COUNTY may
13 deem necessary, make available to COUNTY for examination all of its records and data with respect to
14 the matters covered by this Agreement. CONTRACTORS shall, upon request by COUNTY, permit
15 COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTORS'
16 compliance with the terms of this Agreement.
17 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
18 CONTRACTORS shall be subject to the examination and audit of the State Auditor General for a period
19 of three (3) years after final payment under contract (California Government Code section 8546.7).
20 35. NOTICES
21 The persons having authority to give and receive notices under this Agreement and their
22 addresses include the following:
23 COUNTY CONTRACTORS
24 Director, Fresno County See Exhibit A
Department of Behavioral Health
25 1925 E. Dakota Avenue
Fresno, CA 93726
26
27 All notices between COUNTY and CONTRACTORS provided for or permitted under this
28 Agreement must be in writing and delivered either by personal service, by first-class United States mail,
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1 by an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
2 personal service is effective upon service to the recipient. A notice delivered by first-class United States
3 mail is effective three (3) COUNTY business days after deposit in the United States mail, postage
4 prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is
5 effective one (1) COUNTY business day after deposit with the overnight commercial courier service,
6 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
7 notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if
8 such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed
9 to be effective at the next beginning of a COUNTY business day), provided that the sender maintains a
10 machine record of the completed transmission. For all claims arising out of or related to this Agreement,
11 nothing in this section establishes, waives, or modifies any claims presentation requirements or
12 procedures provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1
13 of the Government Code, beginning with section 810).
14 36. GOVERNING LAW
15 Venue for any action arising out of or related to the Agreement shall only be in Fresno
16 County, California.
17 The rights and obligations of the parties and all interpretation and performance of this
18 Agreement shall be governed in all respects by the laws of the State of California.
19 37. SEVERABILITY
20 The provisions of this Agreement are severable. The invalidity or unenforceability of any
21 one provision in the Agreement shall not affect the other provisions.
22 38. CONFLICT OF INTEREST
23 No officer, agent, or employee of COUNTY who exercises any function or responsibility for
24 planning and carrying out the services provided under this Agreement shall have any direct or indirect
25 personal financial interest in this Agreement. CONTRACTORS shall comply with all Federal and State of
26 California conflict of interest laws, statutes, and regulations, which shall be applicable to all parties and
27 beneficiaries under this Agreement and any officer, agent, or employee of the COUNTY.
28 39. INTERPRETATION
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1 This Agreement is the result of arms-length negotiations between the parties and shall be
2 construed to have been drafted by all parties such that any ambiguities in this Agreement shall not be
3 construed against either party.
4 40. ELECTRONIC SIGNATURE
5 The parties agree that this Agreement may be executed by electronic signature as
6 provided in this section. An "electronic signature" means any symbol or process intended by an individual
7 signing this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a
8 faxed version of an original handwritten signature; or (3) an electronically scanned and transmitted (for
9 example by PDF document) of a handwritten signature. Each electronic signature affixed or attached to
10 this Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing
11 this Agreement for all purposes, including but not limited to evidentiary proof in any administrative or
12 judicial proceeding, and (2) has the same force and effect as the valid original handwritten signature of
13 that person. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
14 subdivision (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3, Part 2, Title 2.5,
15 beginning with section 1633.1). Each party using a digital signature represents that it has undertaken and
16 satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)through (5),
17 and agrees that each other party may rely upon that representation. This Agreement is not conditioned
18 upon the parties conducting the transactions under it by electronic means and either party may sign this
19 Agreement with an original handwritten signature.
20 41. ENTIRE AGREEMENT
21 This Agreement, including all Exhibits, constitutes the agreement between
22 CONTRACTORS and COUNTY with respect to the subject matter hereof and supersedes all previous
23 agreement negotiations, proposal, commitments, writings, advertisements, publication, and
24 understandings of any nature whatsoever unless expressly included in the Agreement. This Agreement
25 shall be retroactively effective July 1, 2022.
26
27
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1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 CONTRACTORS: '1),UNTY OF FRESNO
5 it--
rPlease see attached signatures By.
Brian Pacheco,
6 Chairman of the Board of
7 Supervisors of the County of Fresno
8 Date:
9
ATTEST:
10 Bernice E. Seidel
Clerk of the Board of Supervisors
11 County of Fresno, State of California
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By
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14 Date: R -o20a�--
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FOR ACCOUNTING PURPOSES ONLY:
19 Fund/Subclass: 0001/10000
Organization: 56304320
20 Account#: 7295/0
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1 PACIFIC CLINICS
2 DocuSigned by:
3 6DC88846F0644D0...
4 Authorized Signature
5 Kim wells, General Counsel
6 Print Name & Title
7 Mailing Address:
8 251 Llewellyn Avenue
Campbell, CA 95008
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1 COMPREHENSIVE YOUTH SERVICES OF FRESNO, INC.
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6 Print Name & Title
7 Mailing Address:
8 4545 N. West Avenue
Fresno, CA 93705
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I
1 EXCEPTIO PARENTS UNLIMITED, INC.
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4 horized Sign ture
5 �W'//T Ls �Ig0
6 Print Name &Title
7 Mailing Address:
8 4440 N. First Street
Fresno, CA 93726
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Exhibit A
Page 1 of 1
Bright Beginnings for Families
Full Service Partnership Services for Children Ages 0-10 Years
PROVIDER LIST
Pacific Clinics
251 Llewellyn Avenue
Campbell, CA 95008
Phone: (408) 379-3790
(559) 446-3054
Contact: Marilyn Bamford, Executive Director, Central Region
Comprehensive Youth Services of Fresno, Inc.
4545 N. West Avenue
Fresno, CA 93705
Phone: (559) 229-3561
Contact: Becky Kramer, Executive Director
Exceptional Parents Unlimited, Inc.
4440 N. First Street
Fresno, CA 93726
Phone: (559) 229-2000
Contact: Lowell Ens, Executive Director
Exhibit B
Page 1 of 8
Mental Health Services Act
Bright Beginnings for Families
Full Service Partnership Services for Children Ages 0-10 Years
SUMMARY OF SERVICES
PROVIDERS: Pacific Clinics
6051 N. Fresno Street Suite 201
Fresno, CA 93710
Exceptional Parents Unlimited, Inc.
4440 N. First Street
Fresno, CA 93726
Comprehensive Youth Services of Fresno, Inc.
4545 N. West Avenue
Fresno, CA 93705
CONTRACT TERM: July 1, 2022 - June 30, 2023
I. SCHEDULE OF SERVICES:
Services for the Bright Beginnings for Families (BBFF) program, a Full Service Partnership (FSP)
program, under this Agreement, will be available to clients and their families 24 hours a day, seven
days a week. The standard hours of operation will be Monday through Friday from 8:OOAM until
5:OOPM; additional services will be provided after 5:OOPM and on weekends as needed to address
client concerns and/or provide services for clients who are unavailable for services during standard
business hours.
II. TARGET POPULATION:
The target population is children, ages 0-10 years, identified as Seriously Emotionally Disturbed (SED)
who meet the criteria set forth in Welfare and Institutions Code section 5600.3(a), and their families.
Services under this Agreement shall be provided to children and their families who are unable to
maintain their school settings, families affected by substance abuse issues, children who are exhibiting
extreme behaviors at school, and at-risk children discharged from the County's Crisis Stabilization Unit.
Children and their families that are racially and ethnically diverse; typically unserved, underserved, or
hard to reach; and underinsured or uninsured that meet entry and participation criteria shall be treated
under this Agreement.
The Program will serve a minimum of 400 unduplicated identified minor clients within each 12-month
period of this Agreement. Throughout each 12-month period, Pacific Clinics (PC)will serve 184,
Exceptional Parents Unlimited, Inc. (EPU) will serve 116, and Comprehensive Youth Services, Inc.
(CYS) will serve 100 unduplicated identified minor clients. At any one time, PC will serve 150, EPU will
serve 50, and CYS will serve 50 identified minor clients.
Exhibit B
Page 2 of 8
III. PROJECT DESCRIPTION:
PC, EPU and CYS will collaboratively provide services to the target population under the Mental
Health Services Act (MHSA) FSP framework. Services to children referred to this program will be
provided within the parameters mentioned blow. Parents/caregivers and other members of the family
may be assessed for treatment needs, and provided services as needed, or may be linked to other
treatment programs or community resources to meet the individual's needs. Services may be provided
in the client's home, community, or school; other community settings; or the service provider's facilities.
Entry Criteria
The child must meet at least one of the following criteria:
A. Have a substantial impairment in at least two of the following as a result of a mental
disorder: self-care, school functioning, family relationships, and ability to function in the
community. The child must be at risk of or already removed from the home, or the mental
disorder and impairments have been present for more than six months or are likely to
continue for more than one year without treatment.
B. Displays psychotic features, is at risk of suicide, and/or is at risk of violence to a mental
disorder
C. Meets special education eligibility requirements under Chapter 26.5 of the Government
Code.
Intake and Initial Assessment
Children may be referred to this program through various sources including, but not limited to,
COUNTY's DBH, schools, individuals, or other agencies. CONTRACTORS will contact the family of
the referred child within 24 hours of receipt of the referral to determine if it is appropriate for the child
and family to receive FSP services under this Agreement. If services are appropriate, the child and
family is linked to the appropriate agency under this Agreement. A face-to-face meeting will be
scheduled within three business days to complete an assessment; an initial mental health assessment
will be completed within seven business days following the first face-to-face appointment.
Termination and Discharge
Children referred to BBFF may be denied services if the child does not meet medical necessity for a
mental health diagnosis, meets medical necessity for a mental health diagnosis that is not covered by
the County of Fresno's Mental Health Plan, and/or the child is over the age of 10 at the point of referral.
Children who are determined to be ineligible for BBFF services will be linked to other appropriate
services and resources.
Client discharge is determined on a case-by-case basis, with regard to the child's progress toward
individualized treatment goals. Reasons for discharge include the child or caregiver refuses or
terminates services; the child is transferred to another program mutually agreed upon by the child,
parent/caregiver, and BBFF; mutual agreement that the treatment goals have been met; and/or the
child is 10 years old.
Evidence-Based Practices
Evidence-based practices (EBP) utilized in BBFF include Incredible Years, Parent-Child Interaction
Therapy, Child Parent Psychotherapy, Dialectic Behavioral Therapy, Managing and Adapting Practices,
Positive Parenting Program, Trauma Focused Cognitive Behavioral Therapy, and Attachment Vitamins.
Although some EBPs are appropriate for all ages served under this contract, many are more effective
and intended for specific age sub-groups of the target population. The table below clarifies the EBP,
description, target client sub-group, and agency to provide the service.
Exhibit B
Page 3 of 8
Evidence Based Description Target PC EPU CYS
Treatment Age
Incredible Years Utilized to prevent, reduce, and treat conduct 0-8 years
(IY) problems; increase social competence; and X X X
improve school readiness.
Parent-Child Live therapist-coached sessions with 2-8 years
Interaction parent/caregiver and child to build safe,
Therapy (PCIT) positive, and nurturing relationships between
parents and their children. Decreases X X
behavior problems, improves parenting skills,
and enhances the quality of the relationship.
Child Parent Treatment for children with at least one 0-5 years
Psychotherapy traumatic event and are experiencing
(CPP) behavior, attachment, and/or mental health
problems, including PTSD. Supports and
strengthens the relationship between a child X X X
and caregiver; restores a child's sense of
safety and attachment; and improves
cognitive, behavioral, and social functioning.
Dialectic A cognitive behavioral treatment that has been Parents of
Behavioral shown to be effective in treating a wide range children
Therapy (DBT) of disorders such as depression, eating 0-18 years X X X
disorders, PTSD, and substance dependence.
Estimated service start date of July 1, 2020.
Managing and Coordinates and supplements the use of 0-18 years
Adapting Practices evidence-based programs for children's
(MAP) mental health. The system is not a single
treatment program; rather, it involves several
decision and practice support tools to assist in
the selection, review, adaptation, or
construction of empirically derived common
treatment elements to match particular child X
characteristics. The three main features of the
MAP system are:
• The PracticeWise Evidence-Based
Services Database
• The Clinical Dashboard
• The Practitioner Guides
Positive Parenting Provides education, prevention, and early 0-10 years
Program (Triple P) intervention strategies for parents. The five
core principles of Triple P are:
• Ensuring a safe and engaging
environment; X
• Creating a positive learning environment;
• Using assertive discipline;
• Having realistic expectations; and
• Taking care of oneself as a parent
Exhibit B
Page 4 of 8
Trauma Focused Treats posttraumatic stress and related 4-18 years
Cognitive emotional and behavior problems. TF-CBT
Behavioral has been adapted for use with children who
Therapy (TF-CBT) have a wide array of traumatic experiences X X
including child sexual abuse, domestic
violence, traumatic loss, and multiple
psychological traumas
Attachment Provides parents/caregivers with knowledge 0-5 years
Vitamins about childhood development and the effects
of toxic stress and trauma in order to help
them attune to their child's needs, set X X X
parenting goals, strengthen the parent-child
relationship, and understand and respond to
challenging behaviors.
IV. CONTRACTORS RESPONSIBILITIES:
CONTRACTORS shall:
A. Provide seamless FSP and intensive case management services for seriously emotionally
disturbed (SED) children and their families.
B. Develop, monitor, and adhere to FSP plan components and treatment goals; and assess
and monitor child, family, and community safety.
C. Develop, coordinate, and provide formal and informal supports and services for the client
and family, as well as develop or expand parent advocacy and support network.
D. Institute mental health treatment models other than those listed above, as needed, to meet
the mental health treatment needs of the children and families engaged in services offered
through this Agreement.
E. Provide Intensive Care Coordination (ICC) and Intensive Home-Based Services (IHBS)
when medically necessary.
F. Provide services in alignment with the Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery, as defined in Exhibit D.
G. Provide services in accordance with national standards for Culturally and Linguistically
Appropriate Services (CLAS), as defined in Exhibit E.
H. Ensure that written policies and procedures guides (PPG), as they relate to this Agreement,
are up to date, and available to be shared with COUNTY, upon request.
I. Measure and report client and system outcomes consistent with the COUNTY's MHSA Plan
requirements. UFS will serve as the lead agency and manager of outcome data.
J. Gather, report, and enter data in the State's Data Collection and Reporting (DCR) System in
accordance with MHSA FSP requirements and DCR system guidelines.
Exhibit B
Page 5 of 8
K. Maintain appropriate client to staff ratios with job classifications, responsibilities, and
licensure/certification, as recommended or required by MHSA FSP standards.
L. Provide the following staffing components, at minimum:
1. Licensed or license-eligible therapists: Provide evidenced-based clinical treatment. At
least one of the therapist positions will be occupied by a former client or family member
with comparable experience to the child and family receiving services. At least one of
the therapist positions shall be occupied by a licensed clinician with advanced training
in infant mental health in order to provide adequate oversight. These positions shall
be recruited based on linguistic and cultural needs of the targeted population (e.g.,
Latino, Southeast Asian, African American, Native American, and/or SED).
2. Licensed or license-eligible therapists: Provide linkages and therapeutic services to
enrolled children and their caregivers as identified in the individual services and
supports plan.
3. Family Partners (or equivalent): Occupied by a former client or family member with
comparable experience to the child and family receiving services.
4. Personal Service Coordinators (PSC): At least one of the PSC positions shall be
occupied by a former client or family member with comparable experience to the child
and family receiving services. These positions shall be recruited based on linguistic
and cultural needs of the targeted population (e.g., Latino, Southeast Asian, African
American, Native American, and/or SED). A Bachelors degree level is preferred for
the requirements of the PSC positions; however, 12 college units (psychology,
counseling, etc.) with mental health experience can act as a substitute for the
Bachelors degree requirement. Each PSC will maintain a caseload of 12-14 clients.
M. Ensure the following is provided in regard to PSC:
a. Assign a primary PSC to each identified client. The primary PSC will work with each
client, and family member when appropriate, to develop the client's ISSP. The ISSP is
used to identify the client's goals and describe the array of services and supports
necessary to advance these goals based on the client's needs and preferences and,
when appropriate, the needs and preferences of the client's family. ISSPs are
reviewed by COUNTY's DBH during client chart audits.
b. The PSC will act as a single point of responsibility and contact for the delivery of
personal service coordination for each client. Personal service coordination is the
assistance provided to the child, and the child's family when appropriate, to access
medical, educational, social, vocational, rehabilitative, crisis intervention, or other
community services, when needed.
c. Ensure all children and families that receive personal service coordination services
also receive mental health treatment services when a determination is made by
qualified staff using clinically proven assessment tools that a child and/or family would
benefit from mental health treatment. CONTRACTORS shall institute mental health
treatment models to meet the mental health treatment needs of the children/families
engaged in services offered in this Agreement.
N. Facilitate extensive community resource development and outreach to increase access to
and awareness of program services through participation in community resource fairs, public
presentations, distribution of informational materials, one-on-one communications with
community partners, visits to local schools and daycare centers.
Exhibit B
Page 6 of 8
O. Provide outreach and education to referring agencies to assist those agencies as they
determine appropriate resources for clients in need of services.
P. Utilize targeted outreach strategies to reach harder to engage communities, such as the
Native American population and rural communities.
V. COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Provide oversight, through its MHSA Coordinator or designee, and collaborate with
CONTACTOR and other COUNTY Departments and community agencies to help achieve
State program goals and outcomes. Oversight includes, but is not limited to, contract
monitoring and coordination with the State Department of Health Care Services in regard to
program administration and outcomes.
B. Assist CONTRACTORS in making linkages with the total mental health system of care. This
will be accomplished through regularly scheduled meetings as well as formal and informal
consultation.
C. Participate in evaluating overall program progress and efficiency, and be available to
CONTRACTORS for ongoing consultation.
D. Gather outcome information from target client groups and CONTRACTORS throughout each
term of this Agreement. COUNTY shall notify CONTRACTORS when its participation is
required. The performance outcome measurement process will not be limited to survey
instruments but will also include, as appropriate, client and staff interviews, chart reviews, and
other methods of obtaining required information.
E. Assist CONTRACTORS' efforts toward cultural and linguistic competency by providing the
following to CONTRACTORS:
1. Technical assistance and training regarding cultural competency requirements at no cost
to CONTRACTORS.
2. Mandatory cultural competency training for CONTRACTORS' personnel, on an annual
basis, at minimum.
3. Technical assistance for translating information into COUNTY's threshold languages
(Spanish and Hmong). Translation services and costs associated will be the responsibility
of CONTRACTORS.
VI. PERFORMANCE MEASUREMENT:
CONTRACTORS shall meet or exceed the outcome goals stated in the tables below:
OUTCOMES BY CARF STANDARDS
EFFECTIVENESS
Source Tool Description Goal
CANS — Total Percent of children with improved clinical 80%
condition(s) and quality of life.
Exhibit B
Page 7 of 8
CANS - CBEN Domain Percent of children with reduced emotional and 80%
behavioral problems.
CEDE 2.0 Percent of children that will maintain in-home or 80%
improve to an in-home placement. (UFS only)
CANS - CRB Domain Percent of children with reduced risk behaviors. 80%
CANS - LDF School Behavior Percent of children that will maintain or improve 80%
school behaviors.
CANS - LDF School Achievement Percent of children that will maintain or improve 80%
school achievement.
CANS - LDF School Attendance Percent of children that will maintain or improve 80%
school attendance.
PSC-35 Percent of children that will have improved 80%
psychosocial impairment functioning.
CEDE 2.0 Percent of children that will maintain non- 80%
involvement with the juvenile justice system. (UFS
only)
EFFICIENCY
Source Tool Description Goal
Contractor Finance Department Percent of productivity for Medi-Cal billing. 70%
ACCESS
Source Tool Description Goal
EHR Percent of admitted children that are seen for a 80%
face-to-face appointment within 7 business days
from receipt of service referral.
YSS — F Percent of caregivers that are satisfied with their 80%
access to services. (UFS only)
SATISFACTION
Source Tool Description Goal
YSS — F Percent of caregivers that will be satisfied with 80%
services. (Total Satisfaction mean score of 4 or
higher— UFS only)
YSS Percent of children that will increase his/her 60%
relationships/connections.
YSS Percent of children that will form sustainable 60%
relationships.
YSS Percent of children with an overall plan of 60%
permanency at Time 1, will connect and live with
connection identified in FSE services.
YSS Percent of children participating in FSE services 80%
that will improve stability of significant relationships
in his/her life.
Exhibit B
Page 8 of 8
OUTCOMES BY EVIDENCE-BASED PRACTICE
EBP Source Tool Description Goal
CPP PSI Short Form Percent of caregivers that will reduce their stress. 80%
IY PSI Short Form Percent of caregivers that will reduce their stress. 80%
PCIT ECBI Percent of children that will reduce disruptive and 80%
conduct behaviors.
PSI Short Form Percent of caregivers that will reduce their stress.
Triple P PSI Short Form Percent of caregivers that will reduce their stress. 80%
TF-CFT UCLA PTSD DSM-5 Percent of children that will reduce PTSD 80%
symptoms.
PSI Short Form Percent of caregivers that will reduce their stress. 80%
Attachment PSC-35 Percent of children that will improve psychosocial 80%
Vitamins impairment functioning.
DBT N/A Outcomes will be mutually developed prior to
estimated service start in July 2020.
VII.REPORTS:
A. CONTRACTORS shall prepare an evaluation report annually, which will be submitted to
COUNTY's DBH and made available to partnering and interested local agencies and
organizations (e.g., project collaborators, other community agencies, and mental health
treatment providers). Annual evaluation reports will include the following information:
demographics of the target population served, services provided to each participant, number of
hospitalizations, enrollment in school, results of data analysis compared to planned process,
output and outcome measures, barriers to program implementation and measures taken to
overcome those barriers, accomplishments of program participants, lessons learned, and the
final result of any and all satisfactory survey(s).
B. CONTRACTORS shall be expected to comply with all contract monitoring and compliance
protocols, procedures, data collection methods, and reporting requirements conducted by
COUNTY.
C. Additional reports and outcome information may be requested by COUNTY at a later date, as
needed.
Exhibit C
BRIGHT BEGINNINGS FOR FAMILIES
PACIFIC CLINICS
Fiscal Year(FY) 2022-2023
PROGRAM EXPENSES
1000:SALARIES&BENEFITS
Employee Salaries
Acct# Position FTE Admin Direct Total
1101 Clinician 1 5.00 $ - $ 419,803 $ 419,803
1102 Clinician II 1.00 - 93,290 93,290
1103 Facilitator 1 8.00 - 671,686 671,686
1104 Facilitator 11 2.00 - 186,580 186,580
1105 Family Partner 1 2.00 - 74,914 74,914
1106 Family Specialist 1 3.00 - 107,882 107,882
1107 Clinical Program Manager 3.20 - 342,883 342,883
1108 Support Service Coordinator 0.50 - 26,725 26,725
1109 Clinical Director 0.50 - 76,438 76,438
1110 Doctors Assistant 0.30 - 12,160 12,160
1111 Program Support Staff 2.55 188,266 - 188,266
1112 Regional Director 0.28 50,484 50,484
1113 - -
1114 - -
1115 - -
1116 - -
1117 - -
1118 - -
1119 - -
1120 - - -
Personnel Salaries Subtotal 28.33 $ 238,750 $ 2,012,361 $ 2,251,111
Employee Benefits
Acct# Description Admin Direct Total
1201 Retirement $ 6,589 $ 72,200 $ 78,789
1202 Worker's Compensation 4,424 48,477 52,901
1203 Health Insurance 43,993 482,034 526,027
1204 Other(Specify) - - -
1205 Other(Specify) - -
1206 1 Other(Specify) - -
Employee Benefits Subtotal: $ 55,006 $ 602,711 $ 657,717
Payroll Taxes&Expenses:
Acct# Description Admin Direct Total
1301 OASDI $ 11,672 $ 127,895 $ 139,567
1302 FICA/MEDICARE 2,730 29,911 32,641
1303 SUI 1,883 20,627 22,510
1304 Other(Specify) - - -
1305 Other(Specify) - -
1306 1 Other(Specify) - -
Payroll Taxes&Expenses Subtotal: $ 16,285 $ 178,433 $ 194,718
EMPLOYEE SALARIES&BENEFITS TOTAL: $ 310,041 $ 2,793,505 $ 3,103,546
Exhibit C
2000:CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support Expenditures 778
2003 Client Transportation &Support 1,252
2004 lClothing, Food,& Hygiene 4,530
2005 Education Support 192
2006 Employment Support -
2007 Household Items for Clients 1,156
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers 578
2011 Client Housing Operating Expenditures 1,155
2012 Other(Specify) -
2013 Other(Specify) -
2014 1 Other(Specify) -
2015 10ther(Specify) -
2016 Other(Specify) -
DIRECT CLIENT CARE TOTAL $ 9,641
3000:OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 40,176
3002 Printing/Postage -
3003 Office, Household& Program Supplies 10,438
3004 lAdvertising -
3005 Staff Development&Training 49,810
3006 Staff Travel/Mileage 105,818
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance -
3009 Depreciation 5,550
3010 Other(Specify) -
3011 Other(Specify) -
3012 Other(Specify) -
OPERATING EXPENSES TOTAL: $ 211,792
4000: FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 4,961
4002 Rent/Lease Building 147,095
4003 Rent/Lease Equipment 18,798
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Equipment Purchase 23,256
4008 Other(Specify) -
4009 Other(Specify) -
4010 Other(Specify) -
FACILITIES/EQUIPMENT TOTAL: $ 194,110
5000:SPECIAL EXPENSES
Exhibit C
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ 5,800
5002 HMIS(Health Management Information System) -
5003 Contract Psychiatrist 88,820
5004 ITranslation Services -
5005 Other(Specify) -
5006 Other(Specify) -
5007 Other(Specify) -
5008 Other(Specify) -
SPECIAL EXPENSES T0TAL:1 $ 94,620
6000:ADMINISTRATIVE EXPENSES
Acct# Line Item Description Amount
6001 Administrative Overhead $ 647,430
6002 Professional Liability Insurance 51,776
6003 Accounting/Bookkeeping -
6004 External Audit 3,264
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Other(Specify) -
6009 Other(Specify) -
6010 Other(Specify) -
6011 Other(Specify) -
6012 Other(Specify) -
ADMINISTRATIVE EXPENSES TOTAL $ 702,470
7000: FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture& Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(Specify) J-
TOTAL 7008 Other(Specify) FIXED ASSETS EXPENSES TOTAL $PROGRAM EXPENSES $ 4,316,179
Exhibit C
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 462,655 3.93 $ 1,820,191
8002 Case Management 339,602 3.06 1,039,690
8003 Crisis Services 11,320 5.78 65,392
8004 Medication Support 22,640 7.18 162,460
8005 Collateral 45,507 3.93 179,035
8006 Plan Development 7,584 3.93 29,837
8007 Assessment 53,091 3.93 208,872
8008 lRehabilitation 1 189,612 3.93 745,977
Estimated Specialty Mental Health Services Billing Totals: F 1,132,0111 $ 4,251,454
Estimated %of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 3,401,163
Federal Financial Participation (FFP)% 1 100% 3,401,163
MEDI-CAL FFP TOTAL $ 3,401,163
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 915,016
8302 PEI -Prevention & Early Intervention -
8303 INN -Innovations -
8304 WET-Workforce Education &Training -
8305 CFTN -Capital Facilities&Technology -
MHSA TOTAL $ 915,016
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 1 Other(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 4,316,179
NET PROGRAM COST: $ -
Exhibit C
BRIGHT BEGINNINGS FOR FAMILIES
EXCEPTIONAL PARENTS UNLIMITED, INC
Fiscal Year(FY) 2022-2023
PROGRAM EXPENSES
1000:SALARIES&BENEFITS
Employee Salaries
Acct# Position FTE Admin Direct Total
1101 Manager of Clinical Services 1.00 $ - $ 104,675 $ 104,675
1102 Senior Mental Health Clinician 1.00 - 85,935 85,935
1103 Licensed Mental Health Clinician 4.00 - 316,710 316,710
1104 Case Manager-Facilitator 5.00 - 214,240 214,240
1105 Support Services Supervisor 1.00 - 62,130 62,130
1106 Program Assistant 1.80 - 62,130 62,130
1107 Billing Specialist 1.00 44,425 - 44,425
1108 Billing Assistant 1.00 33,764 33,764
1109 Facilities Manager 0.05 3,105 3,105
1110 Program &Operations Manager-ACC 0.50 49,750 49,750
1111 - -
1112 - -
1113 - -
1114 - -
1115 - -
1116 - -
1117 - -
1118 - -
1119 - -
1120 -
Personnel Salaries Subtotal 16.35 $ 131,044 $ 845,820 $ 976,864
Employee Benefits
Acct# Description Admin Direct Total
1201 Retirement $ 5,242 $ 33,833 $ 39,075
1202 Worker's Compensation 1,835 11,841 13,676
1203 Health Insurance 16,677 90,252 106,929
1204 Other(Specify) - - -
1205 Other(Specify) - -
1206 1 Other(Specify) - -
Employee Benefits Subtotal: $ 23,754 $ 135,926 $ 159,680
Payroll Taxes&Expenses:
Acct# Description Admin Direct Total
1301 OASDI $ 8,125 $ 52,441 $ 60,566
1302 FICA/MEDICARE 1,900 12,264 14,164
1303 SUI 803 4,347 5,150
1304 Other(Specify) - - -
1305 Other(Specify) - -
1306 1 Other(Specify) - -
Payroll Taxes&Expenses Subtotal: $ 10,828 $ 69,052 $ 79,880
EMPLOYEE SALARIES&BENEFITS TOTAL: $ 165,626 $ 1,050,798 $ 1,216,424
Exhibit C
2000:CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 1,800
2003 Client Transportation &Support 1,000
2004 lClothing, Food,& Hygiene 1,000
2005 Education Support 900
2006 Employment Support 900
2007 Household Items for Clients 1,200
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers 1,200
2011 Other(Specify) -
2012 Other(Specify) -
2013 Other(Specify) -
2014 1 Other(Specify) -
2015 10ther(Specify) -
2016 Other(Specify) -
DIRECT CLIENT CARE TOTAL $ 8,000
3000:OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 7,680
3002 Printing/Postage 2,700
3003 Office Supplies& Equipment 11,200
3004 lAdvertising -
3005 Staff Development&Training 10,750
3006 Staff Mileage 1,680
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance 3,600
3009 Program Supplies-Therapeutic 7,000
3010 Food 500
3011 Other(Specify) -
3012 Other(Specify) -
OPERATING EXPENSES TOTAL: $ 45,110
4000: FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 13,200
4002 Rent/Lease Building 73,800
4003 Rent/Lease Equipment 17,800
4004 Equipment Purchase -
4005 Utilities 12,000
4006 Other(Specify) -
4007 Other(Specify) -
4008 Other(Specify) -
4009 Other(Specify) -
4010 Other(Specify) -
FACILITIES/EQUIPMENT TOTAL: $ 116,800
5000:SPECIAL EXPENSES
Exhibit C
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ 6,400
5002 HMIS(Health Management Information System) 10,800
5003 Contractual/Consulting Services (Specify) 40,000
5004 ITranslation Services 5,200
5005 Other(Specify) -
5006 Other(Specify) -
5007 Other(Specify) -
5008 Other(Specify) -
SPECIAL EXPENSES TOTAL: $ 62,400
6000:ADMINISTRATIVE EXPENSES
Acct# Line Item Description Amount
6001 Administrative Overhead $ 205,077
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 1 External Audit 3,600
6005 Insurance(Specify): 9,500
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Other(Specify) -
6009 Other(Specify) -
6010 Other(Specify) -
6011 Other(Specify) -
6012 Other(Specify) -
ADMINISTRATIVE EXPENSES TOTAL $ 218,177
7000: FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture& Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(Specify) -
7008 Other(Specify) -
FIXED ASSETS EXPENSES TOTAL $ 3,000
TOTAL PROGRAM EXPENSES $ 1,669,911
Exhibit C
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 52,000 3.78 $ 196,560
8002 Case Management 35,000 2.94 102,900
8003 Crisis Services 1,000 5.55 5,550
8004 Medication Support 0 - -
8005 Collateral 73,000 3.78 275,940
8006 Plan Development 6,525 3.78 24,665
8007 Assessment 30,500 3.78 115,290
8008 lRehabilitation 1 39,2371 3.78 1 148,316
Estimated Specialty Mental Health Services Billing Totals: 1 237,2621 $ 869,220
Estimated %of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 869,220
Federal Financial Participation (FFP)% 1 100% 869,220
MEDI-CAL FFP TOTAL $ 869,220
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 800,691
8302 PEI -Prevention & Early Intervention -
8303 INN -Innovations -
8304 WET-Workforce Education &Training -
8305 ICFTN -Capital Facilities&Technology I I -
MHSA TOTAL $ 800,691
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 1 Other(Specify) -
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,669,911
NET PROGRAM COST: $ -
Exhibit C
CHILDREN'S FULL SERVICE PARTNERSHIP PROGRAM
COMPREHENSIVE YOUTH SERVICES OF FRESNO, INC.
Fiscal Year(FY) 2022-2023
PROGRAM EXPENSES
1000:SALARIES&BENEFITS
Employee Salaries
Acct# Position FTE Admin Direct Total
1101 Program Manager 0.75 $ - $ 103,089 $ 103,089
1102 Clinical Director 0.10 - 15,044 15,044
1103 Clinical Oversight/Peer Review 0.55 - 66,261 66,261
1104 PCIT Clinicians/Lead Therapists 6.00 - 553,698 553,698
1105 Case Managers 4.00 - 168,529 168,529
1106 Finance Dir/HR Mgr/Finance&Clerical 1.25 48,808 56,108 104,916
1107 - - -
1108 - -
1109 - -
1110 - -
1111 1 - -
1112 - -
1113 - -
1114 - -
1115 - -
1116 - -
1117 - -
1118 - -
1119 - -
1120 - -
Personnel Salaries Subtotal 12.65 $ 48,808 $ 962,729 $ 1,011,537
Employee Benefits
Acct# Description Admin Direct Total
1201 Retirement $ 2,443 $ 48,148 $ 50,591
1202 Worker's Compensation 495 10,139 10,634
1203 Health Insurance 5,182 98,518 103,700
1204 Other(Specify) - - -
1205 Other(Specify) - -
1206 1 Other(Specify) - -
Employee Benefits Subtotal: $ 8,120 $ 156,805 $ 164,925
Payroll Taxes&Expenses:
Acct# Description Admin Direct Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 3,734 73,651 77,385
1303 SUI 251 6,072 6,323
1304 Other(Specify) - - -
1305 Other(Specify) - -
1306 1 Other(Specify) - -
Payroll Taxes&Expenses Subtotal: $ 3,985 $ 79,723 $ 83,708
EMPLOYEE SALARIES&BENEFITS TOTAL: $ 60,913 $ 1,199,257 $ 1,260,170
Exhibit C
2000:CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation &Support 2,000
2004 lClothing, Food,& Hygiene 2,500
2005 Education Support 300
2006 Employment Support 200
2007 Household Items for Clients -
2008 Medication Supports 250
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Specify) -
2012 Other(Specify) -
2013 Other(Specify) -
2014 1 Other(Specify) -
2015 10ther(Specify) -
2016 Other(Specify) -
DIRECT CLIENT CARE TOTAL $ 5,250
3000:OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 12,031
3002 Printing/Postage 300
3003 Office, Household& Program Supplies 10,902
3004 lAdvertising -
3005 Staff Development&Training 4,088
3006 Staff Mileage/Vehicle Maintenance 4,220
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance -
3009 Other(Specify):Transportation of Clients 4,500
3010 Other(Specify):Staff Travel (Out of County) 1,840
3011 Other(Specify): Lodging 1,200
3012 Other(Specify) -
OPERATING EXPENSES TOTAL: $ 39,081
4000: FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 5,997
4002 Rent/Lease Building 61,523
4003 Rent/Lease Equipment 11,680
4004 Rent/Lease Vehicles 7,200
4005 Security -
4006 Utilities 9,895
4007 Other(Specify) -
4008 Other(Specify) -
4009 Other(Specify) -
4010 Other(Specify) -
FACILITIES/EQUIPMENT TOTAL: $ 96,295
5000:SPECIAL EXPENSES
Exhibit C
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services(Specify): Human Resources, HIPAA, Program Oversight 2,437
5004 ITranslation Services 2,000
5005 Other(Specify) -
5006 Other(Specify) -
5007 Other(Specify) -
5008 Other(Specify) -
SPECIAL EXPENSES TOTAL: $ 4,437
6000:ADMINISTRATIVE EXPENSES
Acct# Line Item Description Amount
6001 Administrative Overhead $ 4,352
6002 Professional Liability Insurance 6,402
6003 Accounting/Bookkeeping -
6004 1 External Audit 3,525
6005 Insurance(Specify): -
6006 Payroll Services 2,421
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Other(Specify) -
6009 Other(Specify) -
6010 Other(Specify) -
6011 Other(Specify) -
6012 Other(Specify) -
ADMINISTRATIVE EXPENSES TOTAL $ 16,700
7000: FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture& Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(Specify): Leased Automobile -
7008 Other(Specify) -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,421,933
Exhibit C
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 60,421 3.78 $ 228,391
8002 Case Management 32,019 2.94 94,136
8003 Crisis Services 153 5.55 849
8004 Medication Support 0 6.89 -
8005 Collateral 132,995 3.78 502,721
8006 Plan Development 1,203 3.78 4,547
8007 Assessment 23,253 3.78 87,896
8008 lRehabilitation 1 32,2081 3.78 1 121,746
Estimated Specialty Mental Health Services Billing Totals: 1 282,2521 $ 1,040,287
Estimated %of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 1,040,287
Federal Financial Participation (FFP)% 1 100% 1,040,287
MEDI-CAL FFP TOTAL $ 1,040,287
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 381,646
8302 PEI -Prevention & Early Intervention -
8303 INN -Innovations -
8304 WET-Workforce Education &Training -
8305 CFTN -Capital Facilities&Technology -
MHSA TOTAL $ 381,646
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 1 Other(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 1,421,933
NET PROGRAM COST: $ -
Exhibit D
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
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
1
rev 01-02-2020
Exhibit D
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
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
2
rev 01-02-2020
Exhibit D
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
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
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
3
rev 01-02-2020
Exhibit D
Page 4 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
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
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
Exhibit E
National Standards for Culturally and Linguistically Page 1 of 2
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
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Exhibit E
The Case for the Enhanced National CLAS Standards Page 2 of 2
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
I THINK
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Exhibit F
Page 1 of 2
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable, and any
required certification.
2. The space owned, leased or operated by the provider and used for services or staff meets
local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any site
owned, leased, or operated by the provider and used for services or staff to ensure the safety
and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes: personnel
policies and procedures, general operating procedures, service delivery policies, and
procedures for reporting unusual occurrences relating to health and safety issues.
6. The organizational provider maintains client records in a manner that meets applicable state
and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as described in
Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F
and refrigerated drugs at 36-46 degrees F.
Exhibit F
Page 2 of 2
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation, the
provider must have a written description of the day treatment intensive and/or day treatment
rehabilitation program that complies with State Department of Health Care Service's day
treatment requirements. The COUNTY shall review the provider's written program
description for compliance with the State Department of Health Care Service's day
treatment requirements.
12. The COUNTY may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three (3) years. The COUNTY may
also conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes (example:
conversion from a non-profit status).
• The provider adds day treatment or medication support services when medications shall
be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some physical
plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for clients,
staff or members of the community.
Exhibit G
Page 1 of 3
FRESNO COUNTY MENTAL 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 mental health services.
Mental 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 and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor's employee and subcontractor must sign the
Contractor 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 mental 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, consumers, and other mental 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
Exhibit G
Page 2 of 3
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 mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
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.
Exhibit G
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature : Date
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit H
Page I of 3
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client's physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client's strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A five axis diagnosis from the most current DSM, or a diagnosis from the most current
ICD, will be documented, consistent with the presenting problems, history mental status
evaluation and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in
the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1.Client plans will:
Exhibit H
Page 2 of 3
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent)by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
➢ a physician
➢ a licensed/"waivered"psychologist
➢ a licensed/"associate" social worker
➢ a licensed/registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client's
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client's participation and agreement in the body
of the plan, client signature on the plan, or a description of the client's participation
and agreement in progress notes.
➢ client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
➢ when the client's signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2.Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1.Items that must be contained in the client record related to the client's progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person's professional degree, licensure or job title;
and the relevant identification number, if applicable
Exhibit H
Page 3 of 3
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2.Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A.Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
Exhibit I
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 of seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit I
Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990
(a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a
drug-free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and
Exhibit I
Page 3 of 6
CONTRACTOR may be ineligible for award of any future State agreements if the
department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing
to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against CONTRACTOR within the
immediately preceding two (2) year period because of CONTRACTOR's failure to
comply with an order of a Federal court, which orders CONTRACTOR to comply
with an order of the National Labor Relations Board. (Pub. Contract Code
§10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will
comply with the requirements of Section 6072 of the Business and Professions
Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number
of hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as
set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
Exhibit I
Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR's records, documents, agents or employees, or
premises if reasonably required by authorized officials of the contracting
agency, the Department of Industrial Relations, or the Department of
Justice to determine the contractor's compliance with the requirements
under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has
any questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
Exhibit I
Page 5 of 6
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against
liability for Worker's Compensation or to undertake self-insurance in accordance
with the provisions, and CONTRACTOR affirms to comply with such provisions
before commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which
prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
Exhibit I
Page 6 of 6
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air
pollution control district; (2) subject to cease and desist order not subject to
review issued pursuant to Section 13301 of the Water Code for violation of waste
discharge requirements or discharge prohibitions; or (3) finally determined to be
in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of CONTRACTOR or its subcontractors, and may, at any time,
inspect the premises, physical facilities, and equipment where Medicaid-related
activities or work is conducted. The right to audit under this section exists for ten
(10) years from the final date of the contract period or from the date of
completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's
Death Master File, the National Plan and Provider Enumeration System
(NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award
Management (SAM), and any other databases as the State or Secretary may
prescribe. These databases must be consulted upon contracting and no less
frequently than monthly thereafter. If the State finds a party that is excluded, it
must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under
this part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
Exhibit J
Page 1 of 10
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://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5O72bbl864cdee
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.
Exhibit J
Page 2 of 10
coy, Mental Health Plan (MHP) and Substance Use Disorder (SUD) services
Incident Reporting System
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 persons served, 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,the 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 additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountVca.gov if there are 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=182beOc5cdcd5O72bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Exhibit J
Page 3 of 10
F C 4 6 fresnodbh.logicmanageccomfincidents/?t=9&p=1&k=182beOc5cdcd5O72bbl864cdee4d3d6e
••
Incident Report
Please complete this form
Client Information
Name of Facility'
Name of Reporting Party'
Enter tort
Facility Address'
Facility Phone Number'
i
Mental Health or Substance Use Disorder Program?'
Client First Name'
Eiitcrteat
Client Last Name-
Client Date of Birth
Client Address
Client ID
Gender'
County of Odgin'
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'
Exhibit J
Page 4 of 10
Similar to the paper version, multiple incident categories can be selected
Incident(check all that apply)-
Medical Emergency x Death of Client -
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Violence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-inflicted or by accident)
Medication Error
<- C 4 A fmsnodbh.logicmanager.comfincidents/?t=9&p=l&k=182be0c5cdcd5072bbl864cdee4d3d6e
Date of Incident'
Time of Incident'
Enter':.:.
i
Location of Incident'
Enter-ert
Key People Directly Involved in Incident(witnesses,staff)'
Did the Injured Party seek Medical Attention?
Attach any addlUonal details
d Add File or Drop File Here
Reported By Name
En_e
Reported By Email'
Enterarf
i
Reported On
10/30/2019
Exhibit J
Page 5 of 10
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
F C Q A fresnodbh.logicmanager.com ma s1?t3&o=1&k=1826e0dcdcd50Rbb1864cdee4d3dbe
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
Please specify if other
uitu tea
Description of Action Taken'
Lntcrtcxt
Outcome'
Similar to the paper version, multiple Action Taken categories can be selected.
Follow Up
Action Taken(check all that apply)-
Law Enforcement Contacted x Called 911/EMS x -
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the
Form"to submit another incident.
Exhibit J
Page 6 of 10
'Logic . .•'
Thank you for your submission[
RELOAD THE FORM
A Notification email will be received 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 the Logic Manager login screen will show.
Wed 10/30/20191 og
SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com>
ONotification-
To O DISH Incident Reporting
01f there are problems with how this message is displayed,click here to view a in a web
Click here to download pictures.To help protect your privacy,outlook prevented autom is download of some pictures in this message.
CAUTION!!!-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
�x RyM1t-dckxhp rM M1dd M1vebtlamload pcWra.,p M1ap d>h
priory,0utlmk prna iwhneECEw.nWE dMspmrchantl�r
IMrn!
Hi Mila Arevalo,
You have received a notifimbon through LogicManager.Please see the details
below.
Type:Incident Report
Subject:102:
Notification To:Mila Arevalo
Open this incident in LlwicManaoer
If using Intemet Explorer,click here to open the notification.
This email was generated by LogicManager.If you have any technical issues,
please email suonortftooicmanacm.mm.
Exhibit J
Page 7 of 10
Enter in email address and password. First time users will be prompted to set up a password.
C Q O fresnodbh.my.logicmanager.com/login
LogicManager
Forgot your password?
Once logged in,the main screen will show reviewer 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 pro—s ".1lest SYSTEM LogicManager
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Exhibit J
Page 8 of 10
Analyst Follow Up
Task Details Cllentlnfoymatlon um y F011owup Document:
Hameof Ponllry'
Name WRepoNln[PoNy
Fuillry Aeeress•
client first Name•
Client Mitldle Initial
cask E.]135oum:1pa:
The next tab is Sum ary: No edits can be made to this section.
Analyst Follow Up
Task Details Clien[Informa[Ion S. ry Follow up Documents
Sublttt O
I—dent(-ck aIi th&apply)•
MkiM1 or 11-x
If Oth-spttify(I.e.fire,pamonin&epidemic outbreaks,atM1ercatartrepbes/events Mal(eopaNlze[M1e wend sarey&Vents,sGO antl/armembersaftM1e commumry(.
eunption of Me lncid-t•
7 7 e EP 2 9 C
r
Daeorm[d—
iop.1—
mmeo Incment•
r
I.eeadon orincltlent•
r
y ID:nv spume idn:Null <a < ' " CANCEL
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
sure to clock E w en edits are made.Then Cancel to Exi ut of the incident.
Exhibit J
Page 9 of 10
Analyst Follow Up X
Task Details Client Information Summary Follow Up Documents
Action Taken Icheck all Nat applyl'
Law Enforcement Conta-d X
Please spwfy Bother
De lifianofAction Taken'
f
o—e'
f
added information
cause of death-.near per w toner 10-31-1
Task ID:313 Source:103:null c 4 t CANCEL
The next tab is Documents: 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 x
Task Details Client Information Summary Follow Up Documents
S_3rch
Add Document �
Name Type Source Upload Date Uploaded By
fill
No documents yet.
Drop files here or click on the Add Document dropdown.
< > > » CANCEL SAVE
Task ID:313 Source:103:null
7
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHlncidentReporting@fresnocountyca.gov
Exhibit J
Page 10 of 10
To get back to the home view, click on the Lo is Manager icon at any time. Any incidents that still need review will
show on this screen, click o c incident and start the review process again.
A
Your Task List
Q
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE-
Analyst Follow Up In progress —d test SYSTEM W,—n.,e,
Exhibit K
Page 1 of 2
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit K
Page 2 of 2
Informal provider problem resolution process— the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process— the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider's claim to the MHP.
Payment authorization issues— the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider's claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints— if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
Exhibit L
Page 1 of 2
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) Telephone number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
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?......................................................................................................................... n n
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 XVIII, XIX, or XX?...................................................................................... n n
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 XVII I providers only)........... n n
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 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 ADDRESS EIN
B. Type of entity: n Sole proprietorship n Partnership n Corporation
n Unincorporated Associations n 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
ofindividuals, and provider numbers........................................................................................................... n n
NAME ADDRESS PROVIDER NUMBER
Exhibit L
Page 2 Of 2
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?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
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
Exhibit M
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit M
Page 2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) Have not within a three-year period preceding this application/proposal had
one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit N
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit N
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
Exhibit O
Page 1 of 6
C Department of Behavioral Health
Policy and Procedure Guide
O 1856 O
�RES� PPG 1.2.7
Section: Administration
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo(Sr.Staff Analyst-QA), Kannika
Toonnachat(Division Manager-Technology and Quality Management)
POLICY: It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE: To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1. Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,families and communities in Fresno County who are affected by,or ore at risk
of,mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3128116
Exhibit O
Page 2 of 6
� ti UW Department of Behavioral Health
psi Policy and Procedure Guide
p� 18s�0
�,FR� Section:Administration Effective Date:05/30/2017 PPG 1.2.7
fPolicy Title: Performance Outcome Measures
2. Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4. Objective (Goal): Intended results or the impact of learning, programs, or activities.
5. Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
III. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
Exhibit O
Page 3 of 6
ti U1y� Department of Behavioral Health
Policy and Procedure Guide
i856 0
FR$/ Section: Administration Effective Date:05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
a. Effectiveness of services — How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services —The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access — Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders— Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
Exhibit O
Page 4 Of 6
FRESNO COUNTY MENTAL HEALTH PLAN OUTCOMES REPORT- Attachment A
PROGRAM INFORMATION:
Program Title: Click here to enter text. Provider: Click here to enter text.
Program Description: Click here to enter text. MHP Work Plan: Choose an item.
Choose an item.
Choose an item.
Age Group Served 1: ADULT Dates Of Operation: Click here to enter text.
Age Group Served 2: Choose an item. Reporting Period: Choose an item.
Funding Source 1: Choose an item. Funding Source 3: Choose an item.
Funding Source 2: Choose an item. Other Funding: Click here to enter text.
FISCAL INFORMATION:
Program Budget Amount: Click here to enter text. Program Actual Amount: 0
Number of Unique Clients Served During Time Period: 0
Number of Services Rendered During Time Period: Click here to enter text.
Actual Cost Per Client: 0
CONTRACT INFORMATION:
Program Type: Type of Program:
Contract Term: Click here to enter text. For Other: Click here to enter text.
Renewal Date: Click here to enter text.
Level of Care Information Age 18&Over: Choose an item.
Level of Care Information Age 0-17: Choose an item.
TARGET POPULATION INFORMATION:
Target Population: Click here to enter text.
Revised March 2017
Exhibit O
Page 5 of 6
FRESNO COUNTY MENTAL HEALTH PLAN OUTCOMES REPORT- Attachment A
CORE CONCEPTS:
•Community collaboration: individuals,families, agencies, and businesses work together to accomplish a shared vision.
•Cultural competence: adopting behaviors,attitudes and policies that enable providers to work effectively in cross-cultural situations.
•Individual/Family-Driven,Wellness/Recovery/Resiliency-Focused Services: adult clients and families of children and youth identify needs and preferences that result in
the most effective services and supports.
•Access to underserved communities: Historically unserved and underserved communities are those groups that either have documented low levels of access and/or use of
mental health services,face barriers to participation in the policy making process in public mental health, have low rates of insurance coverage for mental health care, and/or
have been identified as priorities for mental health services.
-integrated service experiences: services for clients and families are seamless. Clients and families do not have to negotiate with multiple agencies and funding sources to
meet their needs.
Please select core concepts embedded in services/ program:
(May select more than one) Please describe how the selected concept(s)embedded
Choose an item. Click here to enter text.
Choose an item.
Choose an item.
Choose an item.
PROGRAM OUTCOME &GOALS
- Must include each of these areas/domains: (1)Effectiveness, (2)Efficiency, (3)Access, (4)Satisfaction&Feedback Of Persons Served &Stakeholder
-Include the following components for documenting each goal: (1) Indicator, (2)Who Applied, (3)Time of Measure, (4)Data Source, (5)Target Goal Expectancy
Click here to enter text.
DEPARTMENT RECOMMENDATION(S):
Click here to enter text.
Revised March 2017
Exhibit O
FRESNO COUNTY MENTAL HEALTH PLAN Page 6 of 6
Outcomes Analysis Attachment C
Name of Program: Click here to enter text.
What is the Program/Contract Goals? Click here to enter text.
Program Type: Type of Program: Other, please specify below
Other: Click here to enter text.
CLINICAL INFORMATION:
Does the Program Utilize Any of the Following? (May select more than one)
Evidence Informed Practice Best Practice Evidence Based Practice
Other: Click here to enter text.
Please Describe: Click here to enter text.
OUTCOMES
What Outcome Measures Are Being Used? Click here to enter text.
What Outcome Measures/Functional Variables Could Be Added to Better Explain the Program's
Effectiveness? Click here to enter text.
Describe the Program's E (i.e. have the program/contract goals been met? Number served,
waiting list,wait times, budget to volume,etc.): Click here to enter text.
What Barriers Prevent the Program from Achieving Better Outcomes? Click here to enter text.
What Changes to the Program Would You Recommend to Improve the outcomes? Click here to
enter text.
For Committee Use Only:
Recommendations:do include a conclusion and a to-do list with action items
Click here to enter text.
Exhibit P
Page 1 of 2
Vendor: Contract# Contact Person Contact#
1
d
Serial# ate ate resno
w £ Requested Approved( Purcha Cost
se I County
Item Make/Brand Mod x �' y m Condition
(If Fixed If Fixed Date Inventory
Asss t) I Number
E Copier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00
x
w
m
Q
E DVD Player Sony DV2230 PXC4356A x n/a n/a 4/1/2008 Heritage N $450.00
x
w
Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Date Received:
EXHIBIT P
Page 2 of 2
FI XED ASSET AND SENSI TI VE I TEM TRAM NG
Fi el d Nurrber Fi el d I nst r uct i on or ConT ent s Required or
Descr i pt i on Condi t i onal
Header Vendor I ndi cat e t he I egal name of t he agency cont r act ed t o Requi red
provide servi ces.
Header Pr ogr am I ndi cat e t he title of the project as described in the Required
cont r act wi t h t he Count y.
Header Cont r act # I ndi cat e t he assi gned Count y cont r act number. I f not Required
known, County st of f can pr ovi de.
Header Contact Person I ndi cat e the first and last name of the primary agency Required
cont act f or t he cont r act.
Header Cont act # I ndi cat e t he most appr opr i at e t el ephone number of t he Requi red
pr i mar y agency cont act f or t he cont r act.
Header Date Prepared I ndi cat e t he Trost cur rent dat e t hat t he t r acki ng form Requi red
was conpl et ed by t he vendor.
a Item I dent i f y t he i t em by pr ovi di ng a comrronl y recognized Requi red
descr i pt i on of t he i t em
b Nbke/Brand I dent i f y the corrpany t hat manuf act ur ed t he i t em Requi red
c K/bdel I dent i f y t he model number f or t he i t ern i f appl i cabl e. Condi t i onal
d Seri al # I dent i f y t he ser i al number f or t he i t em if Condit i onal
appl i cabl e.
Wr k t he box wi t h an "X" i f t he cost of t he i t em i s
e Fi xed Asset $5,000 or more to i ndi cat e that the item is a f i xed Condi t i onal
asset.
f Sensi t i ve I t em Nfir k t he box with an "X' if the item meets t he Condi t i onal
cr i t er i a of a sensitive item as defined by t he Count y.
g Dat a Request ed I ndi cat e t he dat e t hat t he agency submi t t ed a request Required
t o the County to purchase the item
h Date Approved I ndi cat e t he dat e t hat t he Count y approved t he request Requi red
t o purchase t he i t em
i Purchase Date I ndi cat e t he dat e t he agency ur chased t he i t em Requi red
Locat i on I ndi cat e t he physi cal I ocat i on of t he i t em Requi red
k Condi t i on I ndi cat e t he general condition of t he i t em (New, Good, Requi red
V,br n, Bad).
Fresno County
I I nvent or y I ndi cat e t he FIR # pr ovi ded by t he County for the item Condi t i onal
Number
m Cost I ndi cat e t he t of al purchase pr i ce of t he i t em Requi red
i ncl udi ng sal es t ax and of her cost s, such as shi ppi ng.