HomeMy WebLinkAboutAgreement A-22-341 Supersede Agreement ACT.pdf Agreement No. 22-341
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 Pacific Clinics, a California Non-profit, 501 (c)(3), Corporation, whose
5 address is 251 Llewellyn Ave, Campbell, CA 95008 (hereinafter"CONTRACTOR").
6 WITNESSETH:
7 WHEREAS, CONTRACTOR, formerly referred to as Uplift Family Services, agreed to operate
8 a Mental Health Services Act (MHSA) funded Children/Youth Assertive Community Treatment
9 Program and provide integrated mental health and community support services to youth ages 10-18
10 with serious emotional disturbance (SED) and at least one diagnosis from the current Diagnostic and
11 Statistical Manual of Mental Disorder (DSM) to COUNTY; and
12 WHEREAS, COUNTY entered into Agreement number 18-689 with Uplift Family Services,
13 dated the 11th of December, 2018 and later amended by Agreement number 18-689-1 on the 8t" of
14 June, 2021. Agreement number 18-689 and Agreement number 18-689-1 shall hereinafter
15 collectively be referred to as Agreement number 18-689.
16 WHEREAS, Uplift Family Services notified COUNTY that the company was merging with
17 another corporation effective March 1, 2022 and would be changing its legal name to Pacific Clinics
18 as of July 1, 2022; therefore, a new Agreement is being entered into with the new legal name
19 retroactive to July 1, 2022.
20 WHEREAS, COUNTY and CONTRACTOR have agreed to terminate Agreement 18-689 and
21 supersede with the following Agreement for the final fiscal year of the contract term.
22 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
23 hereto agree as follows:
24 1. Services
25 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
26 in Exhibit A"Summary of Services", attached hereto and by this reference incorporated herein and made
27 part of this Agreement.
28 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as
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1 specified in COUNTY's Request for Proposal (RFP) No. 18-044 dated April 10, 2018, Addendum No. One
2 (1)to COUNTY's RFP No. 18-044 dated May 3, 2018, collectively referred to herein as COUNTY's
3 Revised RFP, and CONTRACTOR's response to said Revised RFP dated May 17, 2018 all incorporated
4 herein by reference and made part of this Agreement. In the event of any inconsistency among these
5 documents, the inconsistency shall be resolved by giving precedence in the following order of priority: 1)
6 to this Agreement, including Exhibits and excluding the Revised RFP and CONTRACTOR's Response to
7 RFP; 2)to the Revised RFP; and 3)to CONTRACTOR's Response to the Revised RFP. A copy of
8 COUNTY's Revised RFP No. 18-044 and CONTRACTOR's response thereto shall be retained and made
9 available during the term of this Agreement by COUNTY's DBH Contracts Division. CONTRACTOR
10 agrees that all references to Uplift Family Services, Inc. in the above documents shall refer to
11 CONTRACTOR as of the effective date of this agreement.
12 C. CONTRACTOR shall perform all services defined in Exhibit A in accordance with
13 Exhibit C "Guiding Principles of Care Delivery", attached hereto and by this reference incorporated herein
14 and made part of this Agreement.
15 D. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
16 services provided by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
17 E. CONTRACTOR shall participate in periodic workgroup meetings consisting of staff
18 from COUNTY's DBH to discuss service requirements, data reporting, outcomes measurement, training,
19 policies and procedures, overall program operations, and any problems or foreseeable problems that may
20 arise.
21 F. Changes to any CONTRACTOR corporate information or service sites shall be
22 made upon 30 days advance written notification to COUNTY's DBH Director and upon written approval
23 from COUNTY's DBH Director or designee.
24 G. CONTRACTOR shall maintain requirements as a COUNTY MHP organizational
25 provider throughout the term of this Agreement. If, for any reason, this status is not maintained, COUNTY
26 may terminate this Agreement pursuant to Section Three (3) of this Agreement.
27 H. CONTRACTORS shall provide tracking tools and measurements for effectiveness,
28 efficiency, and client satisfaction indicators as required by Commission on Accreditation of Rehabilitation
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1 Facilities (CARF) standards and as further detailed in Exhibit N.
2 I. CONTRACTOR agrees that, prior to providing services under the terms and
3 conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
4 operations, or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
5 this Agreement as to Section Three (3) of this Agreement.
6 2. TERM
7 This Agreement shall become effective the 1st day of July, 2022 and shall terminate on
8 the 30th day of June, 2023.
9 3. TERMINATION
10 A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
11 provided thereunder, are contingent on the approval of funds by the appropriating government
12 agency. Should sufficient funds not be allocated, the services provided may be modified, or this
13 Agreement terminated at any time by giving the CONTRACTOR thirty (30) days advance written
14 notice.
15 B. Breach of Contract - COUNTY may immediately suspend or terminate this
16 Agreement in whole or in part, where in the determination of COUNTY there is:
17 1) An illegal or improper use of funds;
18 2) A failure to comply with any term of this Agreement;
19 3) A substantially incorrect or incomplete report submitted to COUNTY.
20 4) Improperly performed service.
21 In no event shall any payment by the COUNTY constitute a waiver by COUNTY of any
22 breach of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither
23 shall such payment impair or prejudice any remedy available to COUNTY with respect to breach or
24 default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of
25 any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY
26 were not expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly
27 refund any such funds upon demand or, at COUNTY's option, such repayment shall be deducted
28 from future payments owing to CONTRACTOR under this Agreement.
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1 C. Without Cause - Under circumstances other than those set forth above, this
2 Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director, or
3 designee, upon the giving of thirty (30) days advance written notice of an intention to terminate.
4 4. COMPENSATION
5 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
6 compensation in accordance with the budget set forth in Exhibit B "Budget", attached hereto and by
7 this reference incorporated herein and made part of this Agreement.
8 The maximum amount payable to CONTRACTOR for the period of July 1, 2022 through
9 June 30, 2023 shall not exceed Three Million, Seven Hundred Forty-One Thousand, Two Hundred
10 Seventy-Eight and No/100 Dollars ($3,741,278.00). It is understood by CONTRACTOR and COUNTY
11 that the total of MHSA funds payable under this Agreement to CONTRACTOR shall not exceed Nine
12 Hundred Eighty-One Thousand Nine Hundred Twenty-One and No/100 Dollars ($981,921.00). It is
13 also understood by CONTRACTOR and COUNTY that CONTRACTOR estimated generating a total
14 of Two Million Seven Hundred Fifty-Nine Thousand Three Hundred Fifty Six and No /100 Dollars
15 ($2,759,356.00) in Medi-Cal Federal FFP under this Agreement to offset CONTRACTOR program
16 costs as set forth in Exhibit B.
17 Payment shall be made upon certification or other proof satisfactory to COUNTY's
18 DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
19 A. If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
20 reimbursement amounts set forth in Exhibit B, COUNTY shall not be obligated to pay the difference
21 between these estimated amounts and the actual amounts generated.
22 It is further understood by COUNTY and CONTRACTOR that any Medi-Cal
23 revenue and/or client fee reimbursements above the amounts stated herein will be used to directly offset
24 the COUNTY's contribution of COUNTY funds identified in Exhibit B. The offset of funds will also be
25 clearly identified in monthly invoices received from CONTRACTOR as further described in Section Five
26 (5) of this Agreement.
27 Travel shall be reimbursed based on actual expenditures and mileage
28 reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal
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1 Revenue Services (IRS) published rate.
2 B. It is understood that all expenses incidental to CONTRACTOR's performance of
3 services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with
4 any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
5 C. Payments shall be made by COUNTY to CONTRACTOR in arrears for services
6 provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
7 COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made after
8 receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program costs, as
9 identified in Exhibit B, in the performance of this Agreement and shall be documented to COUNTY on a
10 monthly basis by the tenth (10th) of the month following the month of said expenditures. The parties
11 acknowledge that CONTRACTOR will be performing hiring, training, and credentialing of staff, and
12 COUNTY will be performing additional staff credentialing to ensure compliance with State and Federal
13 regulations.
14 D. COUNTY shall not be obligated to make any payments under this Agreement if the
15 request for payment is received by COUNTY more than sixty (60) days after this Agreement has
16 terminated or expired.
17 All final invoices shall be submitted by CONTRACTOR within sixty (60) days
18 following the final month of service for which payment is claimed. No action shall be taken by COUNTY
19 on invoices submitted beyond the sixty (60) day closeout period. Any compensation which is not
20 expended by CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically
21 revert to COUNTY.
22 E. The services provided by CONTRACTOR under this Agreement are funded in
23 whole or in part by the State of California. In the event that funding for these services is delayed by the
24 State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment
25 shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of
26 time of the deferral by COUNTY shall not exceed the period of time of the State Controller's delay of
27 payment to COUNTY plus forty-five (45) days.
28 F. CONTRACTOR shall be held financially liable for any and all future
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1 disallowances/audit exceptions due to CONTRACTOR deficiency discovered through the State audit
2 process and COUNTY utilization review during the course of this Agreement. At COUNTY's election, the
3 disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
4 withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive
5 reimbursement for any units of services rendered that are disallowed or denied by the Fresno County
6 Mental Health Plan (Mental Health Plan) utilization review process or through the State Department of
7 Health Care Services (DHCS) cost report audit settlement process for Medi-Cal eligible clients.
8 Notwithstanding the above, COUNTY must notify CONTRACTOR prior to any State audit process and/or
9 COUNTY utilization review. To the extent allowable by law, CONTRACTOR shall have the right to be
10 present during each phase of any State audit process and/or COUNTY utilization review and shall be
11 provided all documentation related to each phase of any State audit process and/or COUNTY utilization
12 review. Additionally, prior to any disallowances/audit exceptions becoming final, CONTRACTOR shall be
13 given at least 10 business days to respond to such proposed disallowances/audit exceptions.
14 G. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
15 with mental health funds to serve children/youth with Seriously Emotionally Disturbed (SED) disorders,
16 many of whom have co-occurring substance use disorders. It is further understood by CONTRACTOR
17 and COUNTY that funds shall be used to support appropriately integrated and documented treatment
18 services for co-occurring mental health and substance use disorders.
19 5. INVOICING
20 A. CONTRACTOR shall invoice COUNTY electronically in arrears by the twentieth
21 (20th) of each month for actual services rendered in the previous month, to:
22 dbhinvoicereview()fresnocountyca.gov, dbh-invoices()fresnocountyca.gov, and Cc: the assigned
23 DBH Mental Health Contract Analyst. After CONTRACTOR renders service to referred clients,
24 CONTRACTOR will invoice COUNTY for payment, certify the expenditure, and submit electronic claiming
25 data into COUNTY's electronic information system for all clients, including those eligible for Medi-Cal as
26 well as those that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per unit.
27 COUNTY must pay CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for
28 Medi-Cal eligible clients.
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1 B. At the discretion of COUNTY's DBH Director or designee, if an invoice is incorrect
2 or is otherwise not in proper form or substance, COUNTY's DBH Director or designee, shall have the right
3 to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days
4 prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of
5 ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90) day period,
6 the invoice(s) is still not corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director or designee,
7 may elect to terminate this Agreement, pursuant to the termination provisions stated in Section Three (3)
8 of this Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of
9 this Agreement or termination of this Agreement, at the discretion of COUNTY's DBH Director or
10 designee, COUNTY's DBH shall have the right to deny payment of any additional invoices received.
11 C. Monthly invoices shall include a client roster, identifying volume reported by
12 guarantor group clients served (including third party payer of services) by month and year-to-date,
13 including percentages.
14 D. CONTRACTOR shall submit to the COUNTY by the twentieth (20th) of each
15 month a detailed general ledger(GL), itemizing costs incurred in the previous month. Failure to submit
16 GL reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
17 payments until there is compliance, as further described in Section Five (5) herein.
18 E. CONTRACTOR will remit annually within ninety (90) days from June 30, a
19 schedule to provide the required information on published charges for all authorized direct specialty
20 mental health services. The published charge listing will serve as a source document to determine the
21 CONTRACTOR's usual and customary charge prevalent in the public mental health sector that is used to
22 bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
23 operations.
24 F. CONTRACTOR shall submit monthly staffing reports that identify all direct service
25 and support staff, applicable licensure/certifications, and full time hours worked to be used as a tracking
26 tool to determine if CONTRACTOR's program is staffed according to the services provided under this
27 Agreement.
28 G. CONTRACTOR must maintain financial records for a period of ten (10)years or
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1 until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible
2 for any disallowances related to inadequate documentation.
3 H. CONTRACTOR is responsible for collecting and managing of data in a manner to
4 be determined by DHCS and COUNTY's Mental Health Plan in accordance with applicable rules and
5 regulations. COUNTY's electronic information system is a critical source of information for purposes of
6 monitoring service volume and obtaining reimbursement.
7 I. CONTRACTOR shall submit service data into COUNTY's electronic information
8 system, in accordance with COUNTY's DBH documentation standards, to allow COUNTY to bill Medi-Cal,
9 and any other third-party source, for services and meet State and Federal reporting requirements.
10 J. CONTRACTOR must comply with all laws and regulations governing the Federal
11 Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section
12 1395 et seq; and 2) the regulations and rules promulgated by the Federal Centers for Medicare and
13 Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
14 will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
15 specified.
16 K. If a client has dual coverage, such as other health coverage (OHC) or Federal
17 Medicare, CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial or
18 have validation of claiming with no response ninety (90) days after the claim was mailed before the
19 service can be entered into COUNTY's electronic information system. CONTRACTOR must report all
20 third party collections for Medicare, third party, client pay, or private pay in each monthly invoice and in
21 the annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500
22 form is required as documentation. CONTRACTOR must report all revenue collected from OHC, third-
23 party, client-pay, or private-pay in each monthly invoice and in the cost report that is required to be
24 submitted. CONTRACTOR shall submit monthly invoices for reimbursement that equal the amount due
25 CONTRACTOR less any funding sources not eligible for Federal and State reimbursement.
26 CONTRACTOR must comply with all laws and regulations governing the Federal Medicare program,
27 including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and
28 2)the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as
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1 they relate to participation, coverage and claiming reimbursement. CONTRACTOR will be responsible for
2 compliance as of the effective date of each Federal, State or local law or regulation specified.
3 L. Data entry shall be the responsibility of CONTRACTOR. COUNTY shall monitor
4 the volume of services and cost of services entered into COUNTY's electronic information system. Any
5 and all audit exceptions resulting from the provision and reporting of specialty mental health services by
6 CONTRACTOR shall be the sole responsibility of CONTRACTOR. CONTRACTOR will comply with all
7 applicable policies, procedures, directives and guidelines regarding the use of COUNTY's electronic
8 information system.
9 M. Medi-Cal Certification and Mental Health Plan Compliance
10 CONTRACTOR shall comply with any and all requests and directives associated
11 with COUNTY maintaining State Medi-Cal site certification. CONTRACTOR shall provide specialty
12 mental health services in accordance with COUNTY's Mental Health Plan. CONTRACTOR must comply
13 with the "Fresno County Mental Health Plan Compliance Program and Code of Conduct" set forth in
14 Exhibit D, attached hereto and incorporated herein by reference and made part of this Agreement.
15 CONTRACTOR shall comply with any and all requests associated with any State and/or Federal reviews
16 or audits.
17 CONTRACTOR may provide direct specialty mental health services using pre-
18 licensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
19 supervised by licensed staff, works within his/her scope, and only delivers allowable direct specialty
20 mental health services. It is understood that each service is subject to audit for compliance with Federal
21 and State regulations, and that COUNTY may be making payments in advance of said review. In the
22 event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set
23 off from other payments due the amount of said disapproved services. CONTRACTOR shall be
24 responsible for audit exceptions to ineligible dates of services or incorrect application of utilization review
25 requirements.
26 6. INDEPENDENT CONTRACTOR
27 In performance of the work, duties, and obligations assumed by CONTRACTOR under
28 this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
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1 CONTRACTORs officers, agents, and employees will at all times be acting and performing as an
2 independent contractor, and shall act in an independent capacity and not as an officer, agent,
3 servant, employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall
4 have no right to control or supervise or direct the manner or method by which CONTRACTOR shall
5 perform its work and function. However, COUNTY shall retain the right to administer this Agreement
6 so as to verify that CONTRACTOR is performing its obligations in accordance with the terms and
7 conditions thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law
8 and the rules and regulations, if any, of governmental authorities having jurisdiction over matters
9 which are directly or indirectly the subject of this Agreement.
10 Because of its status as an independent contractor, CONTRACTOR, including any and
11 all of CONTRACTOR's officers, agents, and employees shall have absolutely no right to employment
12 rights and benefits available to COUNTY employees. CONTRACTOR shall be solely liable and
13 responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
14 addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all matters
15 relating to payment of CONTRACTOR's employees, including compliance with Social Security,
16 withholding, and all other regulations governing such matters. It is acknowledged that during the term
17 of this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to
18 this Agreement.
19 7. MODIFICATION
20 Any matters of this Agreement may be modified from time to time by the written consent of
21 all the parties without, in any way, affecting the remainder.
22 Notwithstanding the above, changes to services, staffing, and responsibilities of
23 CONTRACTOR, as needed, to accommodate changes in the laws relating to mental health treatment, as
24 set forth in Exhibit A, may be made with the signed written approval of COUNTY's DBH Director or
25 designee and CONTRACTOR through an amendment approved by COUNTY's County Counsel and the
26 COUNTY's Auditor-Controller's Office.
27 In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
28 Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the budgets, as set forth
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1 in Exhibit B, that do not exceed 10% of the maximum compensation payable to CONTRACTOR may be
2 made with the written approval of COUNTY's DBH Director or designee. Changes to the expense
3 categories in the budget that exceed ten percent (10%) of the maximum compensation payable to
4 CONTRACTOR, may be made with the signed written approval of COUNTY's DBH Director or designee
5 through an amendment approved by COUNTY's Counsel and COUNTY's Auditor-Controller's Office.
6 Modifications shall not result in any change to the annual maximum compensation amount
7 payable to CONTRACTOR, as stated in this Agreement.
8 8. NON-ASSIGNMENT
9 Neither party shall assign, transfer or subcontract this Agreement nor their rights or
10 duties under this Agreement without the prior written consent of the other party.
11 9. HOLD-HARMLESS
12 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request,
13 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses
14 (including attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to
15 COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
16 agents, or employees under this Agreement, and from any and all costs and expenses (including
17 attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to any
18 person, firm, or corporation who may be injured or damaged by the performance, or failure to
19 perform, of CONTRACTOR, its officers, agents, or employees under this Agreement.
20 10. INSURANCE
21 Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any
22 third parties, CONTRACTOR, at its sole expense shall maintain in full force and affect the following
23 insurance policies throughout the term of this Agreement:
24 A. Commercial General Liability
25 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
26 Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations,
27 product liability, contractual liability, Explosion-Collapse-Underground (XCU),
fire legal liability, or any other liability insurance deemed necessary because of
28 the nature of the Agreement.
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1 B. Automobile Liability
2 Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property
3 damages. Coverage should include any auto used in connection with this
4 Agreement
5 C. Real and Property Insurance
6 CONTRACTOR shall maintain a policy of insurance for all risk personal property
coverage which shall be endorsed naming the County of Fresno as an additional
7 loss payee. The personal property coverage shall be in an amount that will
cover the total of COUNTY purchase and owned property, at a minimum, as
8 discussed in Section Twenty One (21) of this Agreement.
9 D. All Risk Property Insurance
10 CONTRACTOR will provide property coverage for the full replacement value of
11 COUNTY'S personal property in possession of CONTRACTOR and/or used in
the execution of this Agreement. COUNTY will be identified on an appropriate
12 certificate of insurance as the certificate holder and will be named as an
Additional Loss Payee on the Property Insurance Policy.
13
14 E. Professional Liability
15 Professional Liability Insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual
16 aggregate. CONTRACTOR agrees that it shall maintain, at its sole expense, in
full force and effect for a period of three (3) years following the termination of
17 this Agreement, one or more policies of professional liability insurance with limits
of coverage as specified herein.
18
19 F. Child Abuse/Molestation and Social Services Coverage
20 CONTRACTOR shall have either separate policies or an umbrella policy with
endorsements covering Child Abuse/Molestation and Social Services Liability
21 coverage or have a specific endorsement on their General Commercial liability
policy covering Child Abuse/Molestation and Social Services Liability. The
22 policy limits for these policies shall be One Million Dollars ($1,000,000) per
occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
23 policies are to be on a per occurrence basis.
24 G. Worker's Compensation
25 A policy of Worker's Compensation Insurance as may be required by the
26 California Labor Code.
27 H. Cyber Liability
28
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1 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to
2 duties and obligations undertaken by CONTRACTOR in this agreement and
shall include, but not be limited to, claims involving infringement of intellectual
3 property, including but not limited to infringement of copyright, trademark, trade
dress, invasion of privacy violations, information theft, damage to or destruction
4 of electronic information, release of private information, alteration of electronic
information, extortion and network security. The policy shall provide coverage
5 for breach response costs as well as regulatory fines and penalties as well as
credit monitoring expenses with limits sufficient to respond to these obligations.
6
7 I. Additional Requirements Relating to Insurance
8
CONTRACTOR hereby waives its right to recover from COUNTY, its officers,
9 agents, and employees any amounts paid by the policy worker's compensation
insurance required by this Agreement. CONTRACTOR is solely responsible to
10 obtain any endorsement to such policy that may be necessary to accomplish
such waiver of subrogation, but CONTRACTOR'S waiver of subrogation under
11 this paragraph is effective whether or not CONTRACTOR obtains such an
endorsement.
12
13
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
14
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
15
additional insured, but only insofar as the operations under this Agreement are concerned. Such
16
coverage for additional insured shall apply as primary insurance and any other insurance, or
17
self-insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
18
contributing with insurance provided under CONTRACTOR's policies herein. This insurance shall not be
19
cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY.
20
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
21
employees any amounts paid by the policy of worker's compensation insurance required by this
22
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
23
necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under
24
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
25
Within Thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
26
CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
27
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
28
N. Millbrook Ave., Fresno, California 93703), Attention: Contracted Services Division or electronically to
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1 dbhcontractedservicesdivis ion(5-�fresnocountyca.gov with a copy to the assigned COUNTY's DBH Staff
2 Analyst, stating that such insurance coverage have been obtained and are in full force; that the County of
3 Fresno, its officers, agents and employees will not be responsible for any premiums on the policies; that
4 such Commercial General Liability insurance names the County of Fresno, its officers, agents and
5 employees, individually and collectively, as additional insured, but only insofar as the operations under
6 this Agreement are concerned; that such coverage for additional insured shall apply as primary
7 insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and
8 employees, shall be excess only and not contributing with insurance provided under CONTRACTOR's
9 policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30)
10 days advance, written notice given to COUNTY.
11 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
12 herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
13 Agreement upon the occurrence of such event.
14 All policies shall be issued by admitted insurers licensed to do business in the State of
15 California, and such insurance shall be purchased from companies possessing a current A.M. Best,
16 Inc. rating of A FSC VII or better.
17 11. LICENSES/CERTIFICATES
18 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR shall
19 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
20 for the provision of the services hereunder and required by the laws and regulations of the United
21 States of America, State of California, the County of Fresno, and any other applicable governmental
22 agencies. CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or
23 maintain such licenses, permits, approvals, certificates, waivers and exemptions irrespective of the
24 pendency of any appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff
25 shall comply with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
26 12. RECORDS
27 CONTRACTOR shall maintain records in accordance with Exhibit E, "Documentation
28 Standards for Client Records", attached hereto and by this reference incorporated herein and made part
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1 of this Agreement. COUNTY shall be allowed to review all records of services provided, including the
2 goals and objectives of the treatment plan, and how the therapy provided is achieving the goals and
3 objectives. All mental health records shall be considered the property of the COUNTY and shall be
4 retained by the COUNTY upon termination or expiration of this Agreement.
5 13. REPORTS
6 A. Outcome Reports
7 CONTRACTOR shall submit to COUNTY's DBH service outcome reports as
8 reasonably requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to
9 change at COUNTY's DBH discretion.
10 B. Additional Reports
11 CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
12 data, and other information as COUNTY's DBH may reasonably request pertaining to matters covered by
13 this Agreement. In the event that CONTRACTOR fails to provide such reports or other information
14 required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until
15 there is compliance. In addition, CONTRACTOR shall provide written notification and explanation to
16 COUNTY within five (5) days of any funds received from another source to conduct the same services
17 covered by this Agreement.
18 C. Cost Report
19 CONTRACTOR shall provide financial data to identify all direct and indirect costs
20 incurred by CONTRACTOR for all services delivered under this Agreement. All Cost Reports must be
21 prepared in accordance with Generally Accepted Accounting Principles (GAAP) and Welfare and
22 Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c). Unallowable costs such as lobbying or
23 political donations must be deducted on the cost report and monthly invoice reimbursements.
24 D. Settlements with State Department of Health Care Services (DHCS)
25 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
26 agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
27 related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the
28 several phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost
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1 reporting for settlement according to State reconciliation of records for paid Medi-Cal services and audit
2 settlement are: State DHCS audit 1) initial cost reporting —after an internal review by COUNTY, the
3 COUNTY files the cost report with State DHCS on behalf of CONTRACTOR's legal entity for the fiscal
4 year; 2) Settlement—State reconciliation of records for paid Medi-Cal services, approximately 18 to 36
5 months following the State close of the fiscal year, DHCS will send notice for any settlement under this
6 provision to COUNTY; and 3)Audit Settlement-State DHCS audit. After final reconciliation and
7 settlement DHCS may conduct a review of medical records, cost report along with support documents
8 submitted to COUNTY in initial submission to determine accuracy and may disallow costs and/or units of
9 services. COUNTY may choose to appeal and therefore reserves the right to defer payback settlement
10 with CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures
11 for managing overpayments. If at the end of the Audit Settlement, COUNTY determines that it overpaid
12 CONTRACTOR, it will require CONTRACTOR to repay the Medi-Cal related overpayment back to
13 COUNTY.
14 Funds owed to COUNTY will be due within forty-five (45) days of notification by COUNTY,
15 or COUNTY shall withhold future payments until all excess funds have been recouped by means of an
16 offset against any payments then or thereafter owing to COUNTY under this or any other Agreement
17 between the COUNTY and CONTRACTOR.
18 14. MONITORING
19 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director, and the
20 State Department of Health Care Services or their designees, the right to review and monitor records,
21 services, or procedures, at any time, in regard to clients, as well as the overall operation of
22 CONTRACTOR's performance, in order to ensure compliance with the terms and conditions of this
23 Agreement.
24 15. REFERENCES TO LAWS AND RULES
25 In the event any law, regulation, or policy referred to in this Agreement is amended during
26 the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
27 such amendment.
28 16. COMPLIANCE WITH STATE REQUIREMENTS
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1 CONTRACTOR recognizes that COUNTY operates its mental health programs under an
2 agreement with the State of California Department Health Care Services, and that under said agreement
3 the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall
4 adhere to all State requirements, including those identified in Exhibit F, "State Mental Health
5 Requirements", attached hereto and by this reference incorporated herein and made part of this
6 Agreement. CONTRACTOR shall also file an incident report for all incidents involving clients, following
7 the Protocol and using the Worksheet identified in Exhibit G, "Incident Reporting", attached hereto and by
8 this reference incorporated herein and made part of this Agreement, or a protocol and worksheet
9 presented by CONTRACTOR that is accepted by COUNTY's DBH Director or designee.
10 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
11 CONTRACTOR shall perform all services as set forth in Exhibit A in accordance with the
12 Assertive Community Treatment Model and in alignment with "Medi-Cal Organizational Provider
13 Standards", as set forth in Exhibit H, attached hereto and by this reference incorporated herein and made
14 part of this Agreement.
15 CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health
16 Plan as described in Exhibit I, "Fresno County Mental Health Plan", attached hereto and by this reference
17 incorporated herein and made part of this Agreement.
18 18. CONFIDENTIALITY
19 All services performed by CONTRACTOR under this Agreement shall be in strict
20 conformance with all applicable Federal, State of California and/or local laws and regulations relating
21 to confidentiality.
22 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
23 COUNTY and CONTRACTOR each consider and represent themselves as covered
24 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
25 104-191 (HIPAA) and agree that any use and disclosure of Protected Health Information (PHI) shall
26 be in compliance with applicable law.
27 COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
28 only for treatment, payment, and health care operations.
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1 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security
2 of PHI shared pursuant to the Agreement in compliance with HIPAA, the Health Information
3 Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
4 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
5 and other applicable laws.
6 To the extent applicable, CONTRACTOR and COUNTY agree to comply with the
7 HIPAA Regulations, including those set forth in as set forth in, but not limited to, Title 45, Sections
8 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
9 20. DATA SECURITY
10 For the purpose of preventing the potential loss, misappropriation or inadvertent
11 disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
12 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
13 contractual relationship with the COUNTY for the purpose of providing services under this Agreement
14 must employ adequate data security measures to protect the confidential information provided to the
15 CONTRACTOR by the COUNTY, including but not limited to the following:
16 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
17 CONTRACTOR may not connect to COUNTY networks via personally-owned
18 mobile, wireless or handheld devices, unless the following conditions are met:
19 1) CONTRACTOR has received authorization by COUNTY for telecommuting
20 purposes;
21 2) Current virus protection software is in place;
22 3) Mobile device has the remote wipe feature enabled; and
23 A secure connection is used
24 B. CONTRACTOR-Owned Computers or Computer Peripherals
25 CONTRACTOR may not bring CONTRACTOR-owned computers or computer
26 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief
27 Information Officer, or designee(s), including but not limited to mobile storage devices. If approved to
28 be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
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1 means of a virtual private network (VPN) connection or another type of secure connection. Said data
2 must be encrypted.
3 C. COUNTY-Owned Computer Equipment
4 CONTRACTOR may not use COUNTY computers or computer peripherals on
5 non-COUNTY premises without prior authorization from COUNTY's Chief Information Officer, or
6 designee(s).
7 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data
8 on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
9 E. CONTRACTOR shall be responsible to employ strict controls to ensure the
10 integrity and security of the COUNTY's confidential information and to prevent unauthorized access to
11 data maintained in computer files, program documentation, data processing systems, data files and
12 data processing equipment which stores or processes COUNTY data internally and externally.
13 F. Confidential client information transmitted to one party by the other by means of
14 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
15 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
16 G. CONTRACTOR shall be responsible to immediately notify COUNTY of any
17 breaches or potential breaches of security related to COUNTY's confidential information, data
18 maintained in computer files, program documentation, data processing systems, data files and data
19 processing equipment which stores or processes COUNTY data internally or externally.
20 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
21 arising from an actual breach of security related to COUNTY's confidential client information provided
22 to CONTRACTOR; however, CONTRACTOR will be responsible to issue any notification to affected
23 individuals to the extent required by law. CONTRACTOR will be responsible for all actual costs
24 incurred as a result of providing said required notification to the extent that the breach was caused by
25 CONTRACTOR's failure to adhere to the privacy, confidentiality, or data security provisions set forth
26 herein.
27 21. PROPERTY OF COUNTY
28 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
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1 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
2 capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
3 will be on a straight-line basis.
4 For COUNTY purposes, fixed assets must fulfill three qualifications:
5 1. Have life span of over one year;
6 2. Is not a repair part; and
7 3. Must be valued at or greater than the capitalization thresholds for the asset
8 type.
9
10 Asset Type Threshold
11 • Land $0
• Buildings and improvements $100,000
12 • Infrastructure $100,000
• Tangible $5,000
13 o Equipment
o Vehicles
14 • Intangible $100,000
o Internally generated software
15 o Purchased software
o Easements
16 o Patents
• Capital lease $5,000
17
18
19 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
20 approved and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset
21 Log, attached hereto as Exhibit O and by this reference incorporated herein and made part of this
22 Agreement, will be maintained by COUNTY's Asset Management System and annually inventoried until
23 the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets may be
24 inventoried in comparison to COUNTY's DBH Asset Inventory System.
25 B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
26 more than $1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
27 assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other
28 sensitive items as determined by COUNTY's DBH Director or designee. CONTRACTOR will maintain a
tracking system on the items and are not required to be capitalize or depreciated. The items are subject
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1 to annual inventory for compliance.
2 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
3 Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in
4 an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
5 Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are returned to
6 COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY-owned
7 undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
8 assets at the expiration or termination of this Agreement.
9 CONTRACTOR further agrees to the following:
10 1. Maintain all items of equipment in good working order and condition,
11 normal wear and tear is expected;
12 2. Label all items of equipment with COUNTY assigned program number,
13 perform periodic inventories as required by COUNTY, and maintain an inventory list showing where and
14 how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
15 shall be submitted to COUNTY within ten (10) days of any request therefore; and
16 3. Report in writing to COUNTY immediately after discovery, the loss or theft
17 of any items of equipment. For stolen items, the local law enforcement agency must be contacted and a
18 copy of the police report submitted to COUNTY.
19 D. The purchase of any equipment by CONTRACTOR with funds provided hereunder
20 shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement as
21 appropriate, and must be directly related to CONTRACTORS services or activities under the terms of this
22 Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from equipment
23 purchased, which are incurred by CONTRACTOR, if prior written approval has not been obtained from
24 COUNTY.
25 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH
26 whenever there is any modification or change in the use of any property acquired or improved, in whole or
27 in part, using funds under this Agreement. If any real or personal property acquired or improved with said
28 funds identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under
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1 this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair market
2 value of the property, less any portion thereof attributable to expenditures of funds not provided under this
3 Agreement. These requirements shall continue in effect for the life of the property. In the event this
4 Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
5 property funded with said funds, unless action is taken by the State government to relieve COUNTY of
6 these obligations.
7 22. NON-DISCRIMINATION
8 During the performance of this Agreement, CONTRACTOR shall not unlawfully
9 discriminate against any employee or applicant for employment, or recipient of services, because of
10 ethnic group identification, gender, gender identity, gender expression, sexual orientation, color,
11 physical disability, mental disability, medical condition, national origin, race, ancestry, marital status,
12 religion or religious creed, pursuant to all applicable State of California and Federal statutes and
13 regulations.
14 23. CULTURAL COMPETENCY
15 As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
16 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
17 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
18 from discriminating against persons based on race, color, national origin, sex, disability or religion.
19 This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access
20 and participation in federally funded programs through the provision of comprehensive and quality
21 bilingual services.
22 B. Policies and procedures for ensuring access and appropriate use of trained
23 interpreters and material translation services for all LEP consumers, including, but not limited to,
24 assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
25 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
26 include ensuring compliance of any sub-contracted providers with these requirements.
27 C. CONTRACTOR shall not use minors as interpreters.
28 D. CONTRACTOR shall provide and pay for interpreting and translation services to
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1 persons participating in CONTRACTOR's services who have limited or no English language proficiency,
2 including services to persons who are deaf or blind. Interpreter and translation services shall be provided
3 as necessary to allow such participants meaningful access to the programs, services and benefits
4 provided by CONTRACTOR. Interpreter and translation services, including translation of
5 CONTRACTOR's "vital documents" (those documents that contain information that is critical for accessing
6 CONTRACTOR's services or are required by law) shall be provided to participants at no cost to the
7 participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who
8 interpret or translate for a program participant, or who directly communicate with a program participant in
9 a language other than English, demonstrate proficiency in the participant's preferred language and can
10 effectively communicate any specialized terms and concepts peculiar to CONTRACTOR's services.
11 E. In compliance with the State mandated Culturally and Linguistically Appropriate
12 standards as published by the Office of Minority Health, CONTRACTOR must submit to COUNTY for
13 approval, within sixty (60) days from date of execution of this Agreement, CONTRACTOR's plan to
14 address all national cultural competency standards as set forth in Exhibit J "National Standards on
15 Culturally and Linguistically Appropriate Services (CLAS)", attached hereto and incorporated herein by
16 reference and made part of this Agreement. COUNTY's annual on-site review of CONTRACTOR shall
17 include collection of documentation to ensure all national standards are implemented. As the national
18 competency standards are updated, CONTRACTOR's cultural competency plan must be updated
19 accordingly. Cultural competency training for CONTRACTOR's staff should be substantively integrated
20 into health professions education and training at all levels, both academic and functional, including core
21 curriculum, professional Iicensure, and continuing professional development programs. CONTRACTOR,
22 on a monthly basis, shall provide COUNTY's DBH a monthly monitoring tool/report that shows all
23 CONTRACTOR's staff completed cultural competency trainings.
24 24. AMERICANS WITH DISABILITIES ACT
25 CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to
26 this Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
27 and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
28 implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
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1 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic
2 and information technology (EIT) accessible to people with disabilities. California Government Code
3 section 11135 codifies section 508 of the Act requiring accessibility of electronic and information
4 technology.
5 25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
6 To the extent necessary to prevent disallowance of reimbursement under section
7 1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[1]), until the expiration of four(4)
8 years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
9 written request to the Secretary of the United States Department of Health and Human Services, or upon
10 request to the Comptroller General of the United States General Accounting Office, or any of their duly
11 authorized representatives, a copy of this Agreement and such books, documents, and records as are
12 necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR
13 under this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of
14 its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
15 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
16 Agreement shall contain a clause to the effect that until the expiration of four (4) years after the furnishing
17 of such services pursuant to such subcontract, the related organizations shall make available, upon
18 written request to the Secretary of the United States Department of Health and Human Services, or upon
19 request to the Comptroller General of the United States General Accounting Office, or any of their duly
20 authorized representatives, a copy of such subcontract and such books, documents, and records of such
21 organization as are necessary to verify the nature and extent of such costs.
22 26. SINGLE AUDIT CLAUSE
23 A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
24 or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit
25 in accordance with the requirements of the Single Audit Standards as set forth in Office of Management
26 and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to
27 COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
28 there were negative findings, CONTRACTOR must include a corrective action plan signed by an
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1 authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
2 weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Business
3 Office for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
4 received for the program. Failure to perform the requisite audit functions as required by this Agreement
5 may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a
6 public accountant to perform said audit, or may result in the inability of COUNTY to enter into future
7 agreements with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
8 CONTRACTOR.
9 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
10 exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR's only
11 funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
12 performed and a program audit report with management letter shall be submitted by CONTRACTOR to
13 COUNTY as a minimum requirement to attest to CONTRACTOR solvency. Said audit report shall be
14 delivered to COUNTY's DBH Business Office for review no later than nine (9) months after the close of
15 the fiscal year in which the funds supplied through this Agreement are expended. Failure to comply with
16 this Act may result in COUNTY performing the necessary audit tasks or contracting with a qualified
17 accountant to perform said audit. All audit costs related to this Agreement are the sole responsibility of
18 CONTRACTOR who agrees to take corrective action to eliminate any material noncompliance or
19 weakness found as a result of such audit. Audit work performed by COUNTY under this paragraph shall
20 be billed to CONTRACTOR at COUNTY cost, as determined by COUNTY's Auditor-Controller/Treasurer-
21 Tax Collector.
22 C. CONTRACTOR shall make available all records and accounts for inspection by
23 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
24 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
25 least three (3) years following final payment under this Agreement or the closure of all other pending
26 matters, whichever is later.
27 27. COMPLIANCE
28 CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and Ethics
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1 and the COUNTY's Compliance Program in accordance with Exhibit D. Within thirty (30) days of entering
2 into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees,
3 agents, and subcontractors providing services under this Agreement certify in writing, that he or she has
4 received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
5 CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents, and
6 subcontractors providing services under this Agreement shall certify in writing that he or she has received,
7 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
8 understands that the promotion of and adherence to the Contractor Code of Conduct is an element in
9 evaluating the performance of CONTRACTOR and its employees, agents and subcontractors.
10 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
11 employees, agents, and subcontractors providing services under this Agreement shall complete general
12 compliance training and appropriate employees, agents, and subcontractors shall complete
13 documentation and billing or billing/reimbursement training. All new employees, agents, and
14 subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who is
15 required to attend training shall certify in writing that he or she has received the required training. The
16 certification shall specify the type of training received and the date received. The certification shall be
17 provided to COUNTY's Compliance Officer at 3133 N. Millbrook, Fresno, California 93703.
18 CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY
19 by the Federal Government as a result of CONTRACTOR's violation of the terms of this Agreement.
20 28. ASSURANCES
21 In entering into this Agreement, CONTRACTOR certifies that neither they, nor any of their
22 officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
23 Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal
24 offense related to the provision of health care items or services; nor have they, nor any of their officers,
25 been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
26 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
27 CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
28 for, or involvement with, COUNTY's business operations related to the Federal Health Care Programs
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1 and shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or
2 the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
3 directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such
4 time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
5 A. If COUNTY has notice that either CONTRACTOR, or its officers, have been
6 charged with a criminal offense related to any Federal Health Care Program, or are proposed for
7 exclusion during the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions
8 to ensure the accuracy of any claims submitted to any Federal Health Care Program. At its discretion,
9 given such circumstances, COUNTY may request that CONTRACTOR cease providing services until
10 resolution of the charges or the proposed exclusion.
11 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
12 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
13 under this Agreement, will be queried as to whether(1)they are now or ever have been excluded,
14 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they
15 have been convicted of a criminal offense related to the provision of health care items or services; and (3)
16 they have been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
17 suspension, debarment, or ineligibility.
18 1. In the event the potential employee or subcontractor informs
19 CONTRACTOR that he or she is excluded, suspended, debarred, or otherwise ineligible, or has been
20 convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
21 or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
22 subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
23 2. Notwithstanding the above, COUNTY, at its discretion, may terminate this
24 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
25 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
26 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
27 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
28 to protect the interests of COUNTY consumers.
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1 C. CONTRACTOR shall verify (by asking the applicable employees and
2 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
3 perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
4 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of
5 a criminal offense related to the provision of health care items or services; and (3) have not been
6 reinstated to participate in the Federal Health Care Program after a period of exclusion, suspension,
7 debarment, or ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR
8 that he or she is excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
9 Health Care Programs, or has been convicted of a criminal offense relating to the provision of health care
10 services, CONTRACTOR will ensure that said employee or subcontractor does no work, either direct or
11 indirect, relating to services provided to COUNTY.
12 1. CONTRACTOR agrees to notify COUNTY immediately during the term of
13 this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
14 providing professional services under this Agreement is excluded, suspended, debarred, or otherwise
15 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
16 to the provision of health care services.
17 2. Notwithstanding the above, COUNTY, at its discretion, may terminate this
18 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
19 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
20 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
21 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
22 to protect the interests of COUNTY consumers.
23 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
24 information from COUNTY which may be necessary to complete any internal or external audits relating to
25 CONTRACTOR's compliance with the provisions of this Section.
26 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
27 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
28 CONTRACTOR's obligations as described in this Section.
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1 29. PUBLICITY PROHIBITION
2 None of the funds, materials, property or services provided directly or indirectly under this
3 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
4 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the
5 above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
6 necessary to raise public awareness about the availability of such specific services when approved in
7 advance by COUNTY's DBH Director or designee and at a cost to be provided in Exhibit B for such items
8 as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other related
9 expense(s).
10 30. COMPLAINTS
11 CONTRACTOR shall log complaints and the disposition of all complaints from a client or a
12 client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
13 COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (loth) day of the following month,
14 in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and attach
15 documentation of each complaint with the log. CONTRACTOR shall post signs informing clients of their
16 right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents reportable to
17 State licensing bodies that affect COUNTY clients within twenty-four(24) hours of receipt of a complaint.
18 Within ten (10) days after each incident or complaint affecting COUNTY clients,
19 CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
20 the complaint, the complaint and CONTRACTORS disposition of, or corrective action taken to resolve the
21 complaint. In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit I.
22 CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and
23 using the worksheet identified in Exhibit G.
24 31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
25 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
26 managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101, 455.104,
27 and 455.106(a)(1),(2).
28 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
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1 455.106(a)(1),(2), the following information must be disclosed by CONTRACTOR by completing
2 Exhibit K, "Disclosure of Ownership and Control Interest Statement", attached hereto and by this
3 reference incorporated herein. CONTRACTOR shall submit this form to DBH within thirty (30) days of
4 the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to this
5 information within thirty-five (35) days of occurrence by completing Exhibit K, "Disclosure of
6 Ownership and Control Interest Statement." Submissions shall be scanned pdf copies and are to be
7 sent via email to DBH Contracted ServicesDivision(a)-fresnocountyca.gov attention: Contracts
8 Administration:
9 A. Name and address of any person(s) whether it be an individual or corporation
10 with an ownership or controlling interest in the disclosing entity or managed care entity:
11 1) Address must include the primary business address, every business
12 location and P.O. Box address(es)
13 2) Date of birth and Social Security Number for individuals
14 3) Tax identification number for other corporations or entities with
15 ownership or controlling interest in the disclosing entity
16 B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
17 interest
18 C. Whether the person(s) with an ownership or controlling interest of the disclosing
19 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
20 or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity
21 is related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
22 interest in any of its subcontractors
23 D. Name of any other disclosing entity in which an owner of the disclosing entity
24 has an ownership or control interest
25 E. The ownership of any subcontractors with whom the provider has had business
26 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
27 and
28 F. Any significant business transactions between the provider and any wholly
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1 owned supplier, or between the provider and any subcontractor, during the 5-year period ending on
2 the date of the request.
3 G. Any person(s) with an ownership or control interest in the provider, or agent or
4 managing employee of the provider; and
5 1) Has been convicted of a criminal offense related to that person's
6 involvement in any program under Medicare, Medicaid, or the title XX services program since the
7 inception of those programs.
8 H. The ownership of any subcontractor with whom the provider has had business
9 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
10 and
11 Any significant business transactions between the provider and any wholly owned
12 supplier, or between the provider and any subcontractor, during the 5-year period ending on the date
13 of the request.
14 32. DISCLOSURE— CRIMINAL HISTORY AND CIVIL ACTIONS
15 CONTRACTOR is required to disclose if any of the following conditions apply to them,
16 their owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section
17 as "CONTRACTOR"):
18 A. Within the three-year period preceding the Agreement award, they have been
19 convicted of, or had a civil judgment rendered against them for:
20 1. Fraud or a criminal offense in connection with obtaining, attempting to
21 obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
22 2. Violation of a federal or state antitrust statute;
23 3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
24 records; or
25 4. False statements or receipt of stolen property.
26 B. Within a three-year period preceding their Agreement award, they have had a
27 public transaction (federal, state, or local)terminated for cause or default.
28 Disclosure of the above information will not automatically eliminate CONTRACTOR from
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1 further business consideration. The information will be considered as part of the determination of whether
2 to continue and/or renew this Agreement and any additional information or explanation that
3 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
4 that CONTRACTOR failed to disclose required information, any contract awarded to such
5 CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
6 and conditions of the award.
7 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other
8 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit L, attached hereto
9 and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
10 must immediately advise COUNTY's DBH in writing if, during the term of this Agreement: (1)
11 CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation in Federal or
12 State funded programs or from receiving federal funds as listed in the excluded parties' list system
13 (http://www.sam.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
14 CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or damage resulting
15 from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed Certification
16 Regarding Debarment, Suspension, and Other Responsibility Matters.
17 33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
18 This provision is only applicable if a CONTRACTOR is operating as a corporation (a for-
19 profit or non-profit corporation) or if during the term of this Agreement, CONTRACTOR changes its status
20 to operate as a corporation.
21 Members of a CONTRACTORS Board of Directors shall disclose any self-dealing
22 transactions that they are a party to while CONTRACTOR is providing goods or performing services
23 under this Agreement. A self-dealing transaction shall mean a transaction to which CONTRACTOR is a
24 party and in which one or more of its directors has a material financial interest. Members of the Board of
25 Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
26 "Self-Dealing Transaction Disclosure Form", attached hereto as Exhibit M and incorporated herein by
27 reference and made part of this Agreement, and submitting it to COUNTY prior to commencing with the
28 self-dealing transaction or immediately thereafter.
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1 34. AUDITS AND INSPECTIONS
2 CONTRACTOR shall, at any time during business hours and as often as COUNTY may
3 deem necessary, make available to COUNTY for examination all of its records and data with respect to
4 the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit
5 COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTOR's
6 compliance with the terms of this Agreement.
7 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
8 CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a period of
9 three (3) years after final payment under contract (California Government Code section 8546.7).
10 35. NOTICES
11 The persons having authority to give and receive notices under this Agreement and their
12 addresses include the following:
13 COUNTY CONTRACTOR
14 Director, Fresno County Marilyn Bamford
Department of Behavioral Health Pacific Clinics
15 1925 E. Dakota Avenue 251 Llewelyn Ave
Fresno, CA 93726 Campbell, CA 95008
16
17 All notices between COUNTY and CONTRACTOR provided for or permitted under this
18 Agreement must be in writing and delivered either by personal service, by first-class United States mail,
19 by an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
20 personal service is effective upon service to the recipient. A notice delivered by first-class United States
21 mail is effective three (3) COUNTY business days after deposit in the United States mail, postage
22 prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is
23 effective one (1) COUNTY business day after deposit with the overnight commercial courier service,
24 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
25 notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if
26 such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed
27 to be effective at the next beginning of a COUNTY business day), provided that the sender maintains a
28 machine record of the completed transmission. For all claims arising out of or related to this Agreement,
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1 nothing in this section establishes, waives, or modifies any claims presentation requirements or
2 procedures provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1
3 of the Government Code, beginning with section 810).
4 36. GOVERNING LAW
5 Venue for any action arising out of or related to the Agreement shall only be in Fresno
6 County, California.
7 The rights and obligations of the parties and all interpretation and performance of this
8 Agreement shall be governed in all respects by the laws of the State of California.
9 37. SEVERABILITY
10 The provisions of this Agreement are severable. The invalidity or unenforceability of any
11 one provision in the Agreement shall not affect the other provisions.
12 38. CONFLICT OF INTEREST
13 No officer, agent, or employee of COUNTY who exercises any function or responsibility for
14 planning and carrying out the services provided under this Agreement shall have any direct or indirect
15 personal financial interest in this Agreement. CONTRACTOR shall comply with all Federal and State of
16 California conflict of interest laws, statutes, and regulations, which shall be applicable to all parties and
17 beneficiaries under this Agreement and any officer, agent, or employee of the COUNTY.
18 39. INTERPRETATION
19 This Agreement is the result of arms-length negotiations between the parties and shall be
20 construed to have been drafted by all parties such that any ambiguities in this Agreement shall not be
21 construed against either party.
22 40. ELECTRONIC SIGNATURE
23 The parties agree that this Agreement may be executed by electronic signature as
24 provided in this section. An "electronic signature" means any symbol or process intended by an individual
25 signing this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a
26 faxed version of an original handwritten signature; or (3) an electronically scanned and transmitted (for
27 example by PDF document) of a handwritten signature. Each electronic signature affixed or attached to
28 this Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing
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1 this Agreement for all purposes, including but not limited to evidentiary proof in any administrative or
2 judicial proceeding, and (2) has the same force and effect as the valid original handwritten signature of
3 that person. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
4 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5,
5 beginning with section 1633.1). Each party using a digital signature represents that it has undertaken and
6 satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)through (5),
7 and agrees that each other party may rely upon that representation. This Agreement is not conditioned
8 upon the parties conducting the transactions under it by electronic means and either party may sign this
9 Agreement with an original handwritten signature.
10 41. ENTIRE AGREEMENT
11 This Agreement, including all Exhibits, constitutes the agreement between
12 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
13 agreement negotiations, proposal, commitments, writings, advertisements, publication, and
14 understandings of any nature whatsoever unless expressly included in the Agreement. This Agreement
15 shall be retroactively effective July 1, 2022.
16
17
18
19
20
21
22
23
24
25
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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 CONTRACTOR: COUNTY OF FRESNO
Pacific Clinics
DocuSipned by:L (�
5V/
6 By °°°"°��°"`UO By.Brian Pacheco,
7 Chairman of the Board of
Supervisors of the County of Fresno
8 Print Name: Ki m wel Is
9 Title: General counsel Date: g -q ra 6aa
10
Date: 6/9/2022 ATTEST:
11 Bernice E. Seidel
12 Clerk of the Board of Supervisors
County of Fresno, State of California
13
By r �u
14
15 Date: �g o2Cb2d2_
16
17 Mailing Address:
18 251 Llewellyn Avenue
Campbell, CA 95008
19
20
FOR ACCOUNTING PURPOSES ONLY:
21 Fund/Subclass: 0001/10000
22 Organization: 56304323
Account#: 7295/0
23
24
25
26
27
28
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Exhibit A
Page 1 of 25
Department of Behavioral Health
Assertive Community Treatment Program to Children/Youth
SUMMARY OF SERVICES
PROVIDER: Pacific Clinics
251 Llewellyn Ave
Campbell, CA 95008
CONTRACT TERM: 2-year, 6-month base term, with two optional 12-month periods
January 1, 2019 -June 30, 2019
July 1, 2019 -June 30, 2020
July 1, 2020 -June 30, 2021
July 1, 2021 -June 30, 2022
July 1, 2022 -June 30, 2023
I. SCHEDULE OF SERVICES:
Services for Assertive Community Treatment program, under this Agreement, will be available
to clients and their families during the hours of 8:00am-8:00pm Monday - Friday. Additional
services will be provided after the standard hours of operation and on weekends as needed to
address client concerns and/or provide services to client who are unavailable for services
during standard business hours.
II. TARGET POPULATION:
The target population is youth, ages 10-18 years with serious emotional disturbance (SED) and
at least one diagnosis from the current Diagnostic and Statistical Manual of Mental Disorders
(DSM). Additionally, services shall be provided to clients/families as necessary, to optimize the
youth's ability to reach wellness and recovery.
The program will serve a minimum of 160 unduplicated identified clients within each 12-month
period of this Agreement. In addition, identified clients' siblings, other relatives, caregivers, and
other significant support person may participate and receive specialty mental health services
from this program.
III. PROJECT DESCRIPTION:
Pacific Clinics (PC) will provide services to the target population under the Mental Health
Services ACT (MHSA) CSS framework. Services to youth referred to this program will be
provided within the parameters mentioned below. Parents/caregivers and other members of
the family may be assessed for treatment needs, and provided services as needed, or may be
Exhibit A
Page 2 of 25
linked to other treatment programs or community resources to meet the individuals needs.
Services are conducted in the home, community, and educational locations, whichever is most
comfortable for the youth and family.
Intake and Initial Assessment
Youth may be referred to this program through various sources including, but not limited to,
Fresno County Superior Court, Department of Behavioral Health (DBH) Children's Mental
Health, Department of Social Services (DSS) Child Welfare Services, and schools. DBH Children's
Mental Health referrals will take priority over Behavioral Health Court and other referrals,
depending on client acuity. Contractor will be responsible for contacting County DBH first
whenever an opening becomes available. CONTRACTOR will contact the family of the referred
youth within three business days of receipt of the referral for the youth and family to receive
ACT services under this Agreement. An initial intake, orientation, and initial assessment
appointment with the team leaders, the child/youth, and the family should take place within
the first seven business days of initial contact.
CONTRACTOR may also utilize the existing assessment provided by the referring agency to
develop a treatment plan to guide the delivery of services.
Termination and Discharge
Client discharge is determined on a case-by-case basis. Reasons for discharge include youth has
successfully reached individually established goals for discharge, youth has demonstrated the
ability to function in all major role areas without ongoing assistance, Youth has moved outside
the geographic area of ACT's responsibility in which ACT will assist with case transfer, and youth
refuses or declines further services and requests discharge.
Evidence-Based Practices
Evidence-based practices (EBP) utilized in Assertive Community Treatment program include
Dialectic Behavioral Therapy (DBT), Managing and Adapting Practices (MAP), Motivational
Interviewing, and Trauma Focused Cognitive Behavioral Therapy (TF CBT).
IV. CONTRACTOR RESPONSIBILITIES:
CONTRACTOR shall:
A. CONTRACTOR shall carefully adhere to the principles of ACT evidence-based practice
model and procedures, as well as the competent delivery of the model.
B. CONTRACTOR shall participate in continuing training and technical assistance with a
certified agency that can provide clinical oversight of the delivery of the ACT model and
Evidence-Based Practices.
Exhibit A
Page 3 of 25
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 C.
G. Provide services in accordance with national standards for Culturally and Linguistically
Appropriate Services (CLAS), as defined in Exhibit J.
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.
J. Provide community supports to achieve the goals identified in individual treatment plans,
such as the need for transportation, housing, food, medication, education support and
employment services.
K. Maintain appropriate client to staff ratios with job classifications, responsibilities, and
licensure/certification, as recommended or required by MHSA FSP standards.
L. Provide appropriate staffing including appropriate job classifications and numbers of
staff.
M. Provide outreach and education to referring agencies to assist those agencies as they
determine appropriate resources for clients in need of services.
N. Utilize targeted outreach strategies to reach harder to engage communities, such as the
Native American population and rural communities.
0. Secure the services of trained translators/interpreters as may be necessary.
P. Develop a plan to continually engage targeted populations.
Exhibit A
Page 4 of 25
Q. Distribute literature/informational brochures in appropriate languages and request
feedback as to how access to care could be improved for these culturally diverse
communities.
V. PROGRAM SPECIFICATIONS:
1. Service Intensity and Capacity:
a. Staff to client ratio: At full capacity, the ACT Program has three teams; each team
is responsible for 40 children and youth. Each team is staffed with 5 FTE, with a
standard one-to-eight staff-to-child/youth ratio set to ensure that capacity and
workload do not jeopardize child/youth services.
b. Frequency and type of client contacts: Access to treatment, rehabilitation, and
support services is available 24 hours a day, seven days per week. Service
contacts vary in intensity and frequency to meet the child/youth's changing
needs for support in community settings. Service levels are modified as needed
to maintain an effective level of child/youth contacts. The service plan may
require multiple contacts each week with children and youth experiencing
severe symptoms, trying a new medication, experiencing a health problem or
serious life event, trying to go back to school or starting a new job, making
changes in living situation or employment, or having significant ongoing
problems in daily living. Multiple contacts may occur as frequently as two to
three times per day, seven days per week, dependent upon child/youth need
and a mutually agreed upon plan between child/youth and program staff. Each
child/youth receives at least the minimum number of visits needed to ensure
stability and safety, and to support continued progress toward treatment goals.
Team members share responsibility for addressing the needs of all
children/youth requiring frequent contact, ensuring that the child/youth always
has access to someone familiar with his/her needs and situations.
Child and youth contact locations vary, dependent upon service needs. Some
activities may occur at the CONTRACTOR site. Examples might include group
therapy, peer support meetings, psychiatric appointments, or personal and
interpersonal skills classes. Other direct contacts more commonly occur at the
child or youth's home, school, or preferred neighborhood location such as a park
or local restaurant, depending upon the child and youth's comfort and
convenience and the purpose of the contact. Where appropriate, contacts may
also be made by phone.
2. Staff Requirements: Pacific Clinics maintains stringent background and
professional references research to assure that each employee hired meets or
exceeds the standards expected for the job classification. COUNTY must approve
Exhibit A
Page 5 of 25
the combination of education and experience. The requirements for key ACT
clinical positions are summarized below.
a. Clinical Program Manager
i. Education: Master's degree in a related field.
ii. License: Appropriate license to practice as a Licensed Clinical Social Worker
(LCSW) or Marriage Family Therapist (LMFT) in the State of California.
iii. Experience: two to four years in related work.
iv. Must meet the California Board of Behavioral Science (BBS) requirements
to provide clinical oversight and supervision.
b. Mental Health Clinician 11: Serves as Team Leader
i. Education: Master of Arts or Science degree in a Social Science such as
Psychology or a Health Science related field.
ii. May require two or more years of experience working with children, youth,
young adults and families in a therapeutic environment (must meet specific
county requirements.)
iii. License: Appropriate license to practice as a Licensed Clinical Social Worker
or Marriage Family Therapist in the State of California preferred.
iv. Experience: Community-based with Medi-Cal population preferred.
c. Mental Health Clinician I
i. Education: Master's Degree.
ii. License: If unlicensed must be a registered intern with the Board of
Behavioral Sciences and receiving appropriate clinical supervision.
iii. Experience: At least two years of experience working with youth, young
adults, and families in a therapeutic environment.
d. Addiction/Prevention Counselor
i. Education: Bachelor's degree or higher in Psychology, Counseling, or Social
Work.
ii. License/Certification: certified drug and alcohol counselor preferred.
iii. Experience: Two to four years of related experience, or an equivalent
combination of education and experience working with youth or young
adults with co-occurring disorders.
e. Education/Vocation Specialist
i. Education: Bachelor of Arts or Science degree.
ii. Experience: Two years in an education or vocational setting with children
and youth.
f. Family Specialist
i. Education: Bachelor of Arts or Science degree.
Exhibit A
Page 6 of 25
ii. Experience: Six months, one year, or two years of experience working with
SED children required, dependent upon contract, or an equivalent
combination of education and experience.
g. Psychiatrist (subcontracted)
i. Education: Doctoral degree.
ii. License: California medical license as a physician in the State of California.
Board certified in adolescent and child psychiatry preferred.
iii. Experience: Treatment strategies, behavioral management approaches, and
medication management.
In addition to clinical positions, each team is supported by appropriate management
and executive oversight, and administrative support for clerical and outcome and
evaluation reporting. Psychiatrist time will also be utilized to provide medication
management and support.
3. Staffing Pattern: CONTRACTOR is experienced with the complexities of ensuring
child and youth access to services 24 hours per day, 7 days per week, including
holidays. Through its Fresno ACT and other community based mental health
programs, CONTRACTOR has established effective policies, practices, and personnel
guidelines that support appropriate levels of response for children, youth, and
families at all times.
4. Job Classifications and Responsibilities: The ACT teams have written policies and
procedures guiding supervision of all staff providing treatment, rehabilitation, and
support services. The Clinical Program Manager assumes administrative and clinical
responsibility for supervising and directing all staff on the teams. Supervision and
direction consists of individual supervision during child/youth contacts and
performance review, participation in staff meetings to review and assess staff
performance, and provide direction regarding individual cases, and assessment of
clinical performance. Each team member has a specific role and assigned
responsibilities within the team structure. The ACT team approach is based on the
concept that many, if not all, team members share responsibility for addressing the
needs of all children and youth requiring ACT services.
VI. PROGRAM ORGANIZATION AND COMMUNICATION:
1. Planned hours of operation and staff coverage: ACT teams are available to provide
treatment, rehabilitation, and support activities seven days per week, which entails:
• Staggered staff starting times to provide direct services at least 12 hours per
day on weekdays.
Exhibit A
Page 7 of 25
• Regularly scheduling mental health professionals for on-call duty to provide
crisis and other services during the hours when staff are not scheduled.
• Team members with experience in the program and skilled in crisis
intervention procedures are on call and available to respond to children and
youth by telephone or in person.
• Regularly arranging for and providing psychiatric backup during all hours the
psychiatrist is not regularly scheduled to work. If availability of the ACT
psychiatrist during all hours is not feasible, alternative psychiatric backup is
arranged.
2. Staff communication and planning activities: The ACT teams conduct daily
organizational staff meetings at regularly scheduled times, maintain written daily
logs of child and youth identification, and provide brief documentation of each
child/youth's status for the prior 24 hours. Detailed logs provide a continuous roster
of children/youth in the program, service contacts, and concise behavioral
description of each child/youth's needs on any given day. The teams maintain
weekly child and youth schedules for all treatment and service contacts to fulfill the
goals and objectives in the child/youth's treatment plan. The teams develop daily
staff assignment schedules from the weekly child and youth schedules. During the
daily organizational and treatment planning meetings, the teams assess the day-to-
day progress of all children and youth, revise treatment plans as needed, plan for
emergency and crisis situations, and add service contacts to the daily staff
assignment schedule per the revised treatment plans.
3. Assertive engagement mechanisms: The ACT teams deliver services in community
locations most comfortable for the child/youth and family. The majority of all
services are provided outside program offices, in the child/youth's most natural
environment. Home and community based services encourage child/youth
engagement and participation, and can address day-to-day issues the child/youth
normally encounters in his/her own living and educational settings. These settings
may include leisure and recreational sites such as parks, shopping malls, and
churches.The intent is to actively provide psychosocial services where the
child/youth need to use those services, rather than in an institutional setting with
little relevance to the child/youth's normal environment.
CONTRACTOR uses several other mechanisms to engage and retain children and
youth in the ACT program:
• The "no eject, no reject" policy has been implemented for ACT to assure that
children and youth continue to participate regardless of the complexity and
frequency of high-intensity service needs.
• Frequency of contact maintains close connections and strengthens the
relationship between the ACT team and the children and youth.
Exhibit A
Page 8 of 25
The ACT team approach and 24/7 availability ensure that children and youth can
reach someone with whom they are familiar at any time a need arises, keeping them
engaged at times when crisis situations may put them at risk of dropping out of the
program.
4. Staff education and training: CONTRACTOR has a strong agency-wide staff training
program that includes topics such as child and youth assessment and engagement
skills, co-occurring disorders, gender awareness and sensitivity, and culture-specific
topics such as sexual orientation and identity issues. Specialized training in
evidence-based practices such as Managing and Adapting Practices, and Trauma
Focused Cognitive Behavioral Therapy is provided to program staff as needed for
each of CONTRACTOR's programs.
Cultural competency is a core component of all CONTRACTOR training programs. In
addition to specific training modules, an agency-wide commitment to culturally
competent services is infused throughout all programs at every level. CONTRACTOR
has established a Cultural Competence Plan that ensures ongoing fidelity to cultural
competence values and practices.
The ACT team members receive focused training on such topics as the Assertive
Community Treatment model, co-occurring mental health and substance abuse
disorders, medication monitoring, social development and functioning, family and
social relationship building, and dealing with high-risk behaviors. Team members
also receive training related to Mental Health Services Act (MHSA), Full Service
Partnerships (FSP), and interacting with Behavioral Health Court and other child
welfare and criminal justice systems.
To ensure model fidelity, CONTRACTOR uses the National Standards and ACT
implementation materials developed by SAMHSA. "Implementing Evidence-Based
Practices Project Assertive Community Treatment Workbook"1, to develop a step-by-
step training plan, implementing the program as an effective evidence-based
practice. The outline below illustrates basic ACT training modules. CONTRACTOR
will review and update a detailed training plan and submit it to Fresno County for
review, if requested. The schedule will be modified as needed to include all team
members.
Annually, and as staff are hired, the following trainings are provided:
• Emphasis on the ACT model and vision, organizational tools,
1 Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and Robert
Wood Johnson Foundation,2003
Exhibit A
Page 9 of 25
team/organizational psychology, philosophy of child and youth based
services, integration of roles/team dynamics, assessment and individualized
treatment planning.
• General services, organizing admissions, individualized treatment planning,
daily teamwork, medication set-up, pharmacy issues, education, vocational
and employment issues.
• Individualized treatment planning and education, vocational and
employment issues.
• Evaluation, troubleshooting, and quality improvement.
• Mentoring to provide support and reinforce team attitudes, knowledge and
skills related to ACT development.
• Full implementing and use of ACT organizational tools, treatment,
rehabilitation, and support. Emphasis continues on organization of services,
integration of roles, team building, individualized treatment planning, and
education and employment services.
• Emphasis on evaluation, troubleshooting, and quality improvement.
VII. CLIENT-CENTERED ASSESSMENT AND INDIVIDUALIZED TREATMENT PLANNING:
1. Initial assessment and comprehensive assessment: The ACT intake and assessment
process is based on existing agency standards for comprehensive assessment,
incorporating psychiatric and treatment information provided by BHC. All written
information provided by the BHC becomes part of the child/youth's permanent
CONTRACTOR record, available to all team members for service planning.
CONTRACTOR uses a full-scope intake and assessment process to identify the
specific needs of every child and youth referred. Children and youth, as appropriate
to age, are full partners in determining preferences, service modalities, and desired
goals, as are their family members. Planning includes accommodations for culture,
language, gender, and age. CONTRACTOR's child and youth assessment processes
evaluate the needs and strengths of each child/youth and his/her family members
when appropriate. Every step of engagement, planning, and implementation is
based on the individual needs and goals identified by the child/youth and family
members during the self-assessment and planning process. Using the Client Data
Sheet, the Fresno County Mental Health Plan assessment, and a Safety Plan, the ACT
team members develop and record the clinical and social functioning information
needed to support the comprehensive individualized Intensive Care Coordination
Plan (ICC).
During the initial assessment, the BHC evaluations and treatment plans are reviewed
with the family. If there are indications that the plan may need to be modified, the
team leader meets with the BHC team to review and discuss options. CONTRACTOR
Exhibit A
Page 10 of 25
minimizes duplicative interviewing by entering the demographic and clinical data
provided by BHC into the online TIER client record as an integral part of
comprehensive treatment planning.
As soon as possible after intake, the ACT team leaders and designated team
members complete a multi-layered assessment that addresses the full scope of
youth and family needs and issues, including psychiatric history, physical health,
substance and alcohol abuse history, education and employment, social
development and functioning, activities of daily living, and family structure and
relationships. The assessment forms the basis for the individualized service plan.
Research-proven and state-approved outcome measurement tools track and
evaluate the outcomes of treatment and support services, including the Child
Adolescent Needs and Strengths (CANS) survey. In addition, CONTRACTOR
implements the Clinical Condition and Quality of Life measurement through the
collection of core date elements. Results from each child/youth's completed forms
are entered into the electronic health care system.
2. Individualized treatment plans: All treatment planning with children and youth and
their families is based on the client-centered, recovery-oriented mental health
service delivery characteristics established by the National Program Standards for
ACT teams:
• Serve children and youth with severe and persistent mental illnesses that are
complex, have devastating effects on functioning, and, because of the
limitations of traditional mental health services, may have gone without
appropriate services.
• Deliver services through teams of multidisciplinary mental health staff who
provide the majority of the treatment, rehabilitation, and support services
children and youth need to achieve their goals.
• Individually tailor services to address the preferences and identified goals of
each child/youth.
• Provide mobile services in community locations to enable each child/youth
to feel comfortable in his/her home, neighborhood, and school; and to allow
each child/youth, as appropriate to his/her age, to find and live in his/her
own residence, and find and maintain educational or employment efforts in
their chosen communities.
• Deliver services in an ongoing, rather than time-limited, framework to aid the
child/youth's process of recovery and stabilization in the community. The
service plan includes child/youth-driven goals and milestones to support
progress toward discharge and connection with community resources.
Timeframes for progressive achievement of increasingly independent skill
levels are determined by the child/youth's needs, desires, and abilities.
Exhibit A
Page 11 of 25
The ACT ICC plan begins with information provided by the BHC and/or the results of
CONTRACTOR's comprehensive intake and assessment process. Each child/youth
and family has input into the services and supports desired and how such care is
delivered, which enables them some control over service decisions. Treatment
plans are tailored to child/youth and family strengths, desired treatment outcomes,
and cultural and linguistic preferences.
Treatment plans are specific, with service types, intensities and frequencies
designed to achieve the desired outcomes. The ICC plan identifies issues/problems;
sets measurable short- and long-term goals; and establishes specific approaches and
interventions for the child/youth to meet goals, improve capacity to function in the
community, and achieve the maximum level of recovery possible. Planning for
integration into and reliance on home, neighborhood and community resources is
developed with respect for the child/youth's desires, skills, interests, and abilities.
Flexible plans include crisis and safety awareness and resources; clear delineation of
roles and responsibilities; and definition of mechanisms for rapid response to
changing service needs.
Each treatment plan is detailed and tailored to accomplishing specific tasks, focused
on keeping the child/youth out of incarceration, out of hospitals, and maintaining
maximum function in their schools,jobs, and communities. All ACT team members,
regardless of their specific discipline or expertise, become familiar with the
child/youth, the family, and with each other to share knowledge, provide continuity
in service delivery, and ensure that all service delivery occurs within the context of
the treatment plan goals. CONTRACTOR values support doing whatever it takes,
wherever and whenever it's needed to ensure that children/youth and families
receive the most effective services at the times and in the places that will meet their
specific needs. An intensive, comprehensive ACT program delivers treatment and
rehabilitation services and case management. ACT services differ significantly from
traditional case management models, and provide the following features:
ACT Service Delivery Model
• Staff to child/youth ratio of 1 to 8;
• All services provided directly by team members;
• Team members share responsibility for all individuals;
• Type and intensity of services can be modified easily;
• Team members provide ANY service an individual needs, that would support
the treatment goal;
• Team is responsible for ensuring individuals receive services they need even
if they are difficult to engage, get arrested, or are hospitalized;
• If a team member goes on vacation or quits, service plans are continued by
Exhibit A
Page 12 of 25
other team members who are known to the individual; and
• Team discusses changes to an individual's status daily and adjusts treatment
as needed.
3. Intake timeline and procedure: CONTRACTOR makes initial contact with child/youth
within three business days of receiving initial referrals. Referrals are distributed
between the ACT teams on a rotating basis, unless available information indicates
that the child/youth and family could benefit from specific expertise available on
one team or another. Every effort is made to schedule an intake, orientation
appointment with the team leader, the child/youth, and the family so it occurs
within the first seven days of initial contact. During intake, a time and location is
scheduled for the child/youth and family to meet the rest of the team to develop a
comprehensive assessment and service plan (the first service must occur within ten
business days from the family/child's first request for services). Information
provided to the child/youth explains the ACT program, describes the team concept,
clarifies team and child/youth roles and expectations, and provides emergency
contact information to the child/youth and family.
4. Timely provision of services: Initial contact, assessment and development of service
plans occur within the first seven business days after referral, dependent upon the
family's availability. In urgent situations, children and youth are connected to a team
member for intervention and support even before a service plan is developed, using
information from the referral as the basis for a temporary service plan. Service
contact frequency and timing are driven by the child and youth's needs, goals, and
desires, with no less than three contacts per week.
5. Managing crisis or other participant emergencies: The ACT program model uses
multiple resources to respond to crisis and emergency issues. On-call team
members are available by phone at all times to respond if the primary team contact
is not available. Emergency contacts are made via telephone or face-to-face visits,
as deemed appropriate by the responding team member.
Team members are familiar with all local emergency physical health and psychiatric
emergency services, including urgent care clinics, hospitals, and the County-
operated Youth's Crisis, Assessment, Intervention, and Resolution facility.
CONTRACTOR maintains a budgeted flexible child and youth services fund to
respond quickly to basic need emergencies such as temporary housing,
transportation, food, clothing, school supplies, etc. Each team member has access
to the fund to quickly respond to crisis situations.
6. Transition and community reintegration: Discharge planning includes planning for
future stability in the community with decreased hospitalization, increased school
Exhibit A
Page 13 of 25
attendance and academic achievement, and/or juvenile justice recidivism; and
occurs during intake, assessment and service development. Each team, with the
child/youth and family as fully participating partners, defines transition and
reintegration goals, develops measurable milestones and strategies for
achievement, and identifies resources and services likely to support the
child/youth's progress toward recovery and stability.
The service delivery process includes education about available community
resources, assisting and mentoring the child/youth and family in learning how to
access those resources, and establishing community-based relationships that will
continue to serve and support the child/youth and family after reintegration.
Planning includes long-term follow-up to monitor and assure sustained
improvement, with the frequency and intensity of contacts decreasing as the
child/youth's ability to function independently increases. The team ensures that the
youth and family are connected to adequate sources of assistance and support
before terminating formal contacts.
VIII. EXPLICIT ADMISSION AND DISCHARGE CRITERIA:
1. Admission Criteria: CONTRACTOR accepts and will continue to accept two referral
categories, which may have varied admission criteria dependent upon the referral
source.
a. BHC Team Referrals: Referrals from the team will have been evaluated for
compliance with ACT admission criteria prior to referral to the program. Each
referral includes the BHC mental health assessment, treatment plan, and signed
consent forms. Based on the BHC team's assurance that youth referred to the
program meet the national ACT standards, CONTRACTOR's ACT Clinical Program
Manager (CPM) reviews the referral information for appropriateness for the
particular child/youth. If necessary, the CPM confers with the BHC team to
address any questions or concerns.
b. Alternative Referral Sources: For referrals received from other sources, such as
County of Fresno Child Welfare Services, Children's Mental Health, schools, and
the District Attorney's office, the CPM ensures compliance with National Act
Standards defining admission criteria, adapted to serve children and youth:
Children and youth with severe and persistent mental illness listed in the DSM IV
that seriously impair their functioning in community living. Priority is given to
children/youth experiencing their first psychotic breaks, as well as those with
schizophrenia, other psychotic disorders (e.g., schizoaffective disorder), and
Exhibit A
Page 14 of 25
bipolar disorder as these illnesses more often cause long-term psychiatric
disability. Eligibility of children and youth with other psychiatric illnesses is
dependent on the level of potential long-term disability. Individuals diagnosed
with co-occurring substance abuse disorders will be accepted into the ACT
program if they meet the mental health criteria described above.
c. Children and youth with significant functional impairments as demonstrated by
at least one of the following conditions:
i. Significant difficulty consistently performing the range of practical daily living
tasks required for basic functioning in school, work, or the community.
ii. Significant difficulty maintaining consistent school attendance, employment
and/or self-care (including child-care tasks and responsibilities for parenting
youth) at a self-sustaining level.
iii. Significant difficulty maintaining personal safety.
d. Children and youth with one or more of the following problems, which are
indicators of continuous high service needs:
i. High use of acute psychiatric hospitals or psychiatric emergency services.
ii. Intractable severe major symptoms associated with mental health issues.
iii. Coexisting substance abuse disorder of significant duration.
iv. High risk or recent history of criminal justice involvement (e.g., arrest,
incarceration).
v. Significant difficulty meeting basic survival needs, homelessness, or
imminent risk of becoming homeless.
vi. Residing in an inpatient or supervised community residence, but clinically
assessed as being able to maintain functioning in a more independent living
situation if intensive services are provided, or requiring a residential or
institutional placement if more intensive services are not available.
vii. Difficulty effectively utilizing traditional office-based outpatient services.
2. Discharge Criteria: The Youth ACT model is based on development of child/youth-
driven treatment goals and services to help the child/youth and family move
progressively toward decreased dependence on ACT team support. Due to the
individual needs of each participant involved with the ACT program, the progress of
a child/youth cannot be projected on a preset timeline, but rather must occur based
on each individual's progress and achievement of specific treatment goals. When
the participant's acuity of mental health symptoms have stabilized over a significant
period of time and the family can obtain needed services in the community, the
team will work with the child/youth and family to develop a plan for transitioning to
case closure.
Exhibit A
Page 15 of 25
a. BHC Team Case Closures: Discharge occurs when the BHC team, the ACT team,
and the child/youth and family mutually agree that community-based services
will be sufficient to maintain safety and stability because the child/youth exhibits
the indicators of discharge (see item 2 below).
b. Alternative Referral Source Case Closures: The ACT teams follow clinical
standards of care governing quality and continuity to assess readiness for
discharge. A plan for transitioning to discharge is developed when the
child/youth:
i. Successfully reached individually established goals for discharge.
ii. Successfully demonstrated an ability to function in all major role areas (e.g.,
work, social, self-care) without ongoing assistance, with supportive
community services if needed.
iii. Moves outside the geographic area of ACT's responsibility. In such cases, the
ACT team, to the extent possible, assists with the transfer of mental health
service responsibility to an ACT program or another provider within the
service area where the child/youth is relocating. The ACT team makes every
effort to maintain contact with the child/youth until this service transfer is
implemented. .
iv. Declines or refuses further services and requests discharge, despite the
team's best efforts to develop an acceptable treatment plan with the
child/youth.
IX. REQUIRED SERVICES:
1. Service Coordination: Policies and procedures are in place to ensure consistent
communication and service coordination between team members to integrate a full
range of services for each child/youth into an individualized service plan. Team
meetings are held regularly and as needed to address changes to the child/youth's
circumstances. The ACT team members will coordinate service delivery with other
community-based providers that may provide services to ACT enrollees to minimize
duplicative services, ensure compliance with service delivery standards, and avoid
imposing conflicting service or time demands on the child/youth. Additionally,
CONTRACTOR will implement information sharing guidelines to ensure consistency
with County, State, and Federal rules regarding individuals' rights to privacy.
2. On-Call Crisis Assessment and Intervention: CONTRACTOR has an existing On-Call
system to provide crisis intervention services to children/youth and their families
after regular work hours and on weekends. The system has been enhanced to
include a range of accessibility, ranging from telephone "warm line" support to face-
to-face contact and home visits, to assess and de-escalate crises with appropriate
interventions and ensure child/youth and family safety. All children/youth and
Exhibit A
Page 16 of 25
families in the program are given the access number to reach On-Call staff, 24 hours
a day, seven days a week. The On-Call system uses On-Call treatment team staff
and/or the Clinical Program Manager to provide clinical support.
3. Symptom Assessment and Management: The services described above are among
the core components of CONTRACTOR programming for all children and youth
served. All team members share responsibility and accountability for each
child/youth on their caseload, and are given the same training regarding mental
illness and medications. Team members learn to observe, understand, and record
signs and symptoms of the child/youth's mental illness and provide information to
clinical staff to assist with assessment of response to treatment. CONTRACTOR staff
will routinely monitor the effects of medication in every contact between a
treatment team member and the child/youth, and provide psychological support is
one of the underlying foundations of treatment in an ACT model, infused into every
aspect of the treatment teams' roles and responsibilities.
4. Psychiatric services (i.e. medication, medication management): The ACT program
will provide for Psychiatrist services to treat children and youth in the program who
are receiving psychotropic medications, as well as those in need of medication
evaluations and/or monitoring. The Psychiatrist provides medication education and
management, including observed administration if needed, to children/youth and
families, as well as training to ACT team members regarding medication side effects
and symptoms.
5. Dual Diagnosis (mental health and substance abuse services): The ACT program
provides an integrated approach to co-occurring disorders, recognizing that the
treatment must be inclusive, focused on harm reduction and supportive of sobriety.
One of the ACT Addiction Counselors will be certified by the CA Association of
Alcoholism and Drug Abuse Counselors, utilizes the Addiction Severity Index
screening to assess the client's level of addiction, and makes recommendations to
the assigned Mental Health Clinician. The Addiction Counselor provides therapeutic
addiction treatment as indicated by the Clinician's Plan of Care, including group
therapy. The Addiction Counselor also provides prevention classes for clients and
families and trains team members to understand, model, and reinforce the coping
skills needed to achieve periods of abstinence. Children/youth and their families are
encouraged to plan for and participate in sober recreational activities during leisure
time to build new diversion skills and form healthy social relationships.
6. Individual and Group Therapy: Therapeutic treatment services may be provided in a
group process or on an individual face-to-face basis. Individual therapy is provided
as the need is indicated. Specific interventions are determined through the use of
evidence-based and best practices, including Trauma Focused Cognitive Behavioral
Therapy, Managing Adaptive Practices, and the ACT model.
Exhibit A
Page 17 of 25
7. Case Management: The typical goals of case management (e.g., preventing
hospitalization, improving quality of life, and improving client functioning), as well as
some typical case management activities (e.g., service planning, assessment, and
advocacy) overlap with those for ACT programs. However, the methods and
resources to achieve these ends differ significantly. Unlike traditional case
management, in which clients are linked to other service providers rather than
directly intervening, ACT team members provide direct case management as part of
the treatment and supportive services delivery process. Case management services
help the child/youth and family locate and link with services in the community that
promote ongoing mental health.
8. Rehabilitation and family support: Each ACT team includes a Family Specialist who is
familiar with public service programs. Through coaching, mentoring, and role
modeling, the Family Specialist assists the child/youth and family members in
building or rebuilding the skills needed for effective day-to-day functioning. The
Family Specialist builds familial alignment and utilizes the strengths of
children/youth and others to assist in the implementation and achievement of goals
and outcomes.
CONTRACTOR's network and knowledge of available resources throughout the
county helps to develop a support network, as well as the self-confidence and self-
sufficiency of the child/youth and family, preparing them to function successfully in
their community upon discharge. CONTRACTOR tracks information on the use of
referral services during treatment.
9. Social/Interpersonal Relationship and Leisure-Time Skill Training: CONTRACTOR fully
understands the importance of normative social relationships and recreational
activities and ensures that each enrolled child/youth has appropriate opportunities
to engage in community based activities that foster peer to peer skill building
activities. Using relationship building techniques and establishment of an open and
trusting environment, enrolled children/youth are encouraged to participate in
healthy group dynamics within various settings including family homes, schools,
parks, and recreation centers. Team members assist, coach, and support
children/youth and their families as they participate in activities, and use modeling
and role playing to practice possible interactions with others, including examples of
conflict resolution and activities to develop and strengthen family relationships, self-
expression, and self-esteem. As with other aspects of personal and social learning,
team members assist participants to first understand, then practice, and finally
perform the planned activity.
Daily and weekly schedules of activities include ample opportunities for child/youth-
driven free time and development of planning for participation in activities of
Exhibit A
Page 18 of 25
interest. The child/youth's and family's spiritual and religious preferences, identified
in the initial assessment, are respected and valued, and the child/youth and families
will choose to participate in related activities. CONTRACTOR's collaboration with
other agencies expands opportunities for program participants to experience
educational, social, and recreational activities beyond the scope of funded services.
10. Peer Support Services: The Family Specialist works directly with each child/youth,
and their parents or other significant persons, at a peer level to outline alternatives
and predict consequences while supporting good decision-making; fostering
participation in healthy group dynamics within various settings, including family
homes, schools, parks and recreation centers, and treatment facilities; and providing
an open forum to express feelings and ideas when appropriate. The Family
Specialist builds familial alignment while working with the child/youth and family by
utilizing their strengths to assist in the implementation and achievement of goals
and outcomes.
11. Support Services: CONTRACTOR understands the importance of ensuring that
children/youth and families have access to a full and comprehensive range of
support services as they move toward wellness and sustainable recovery. Each
individualized care plan for enrolled ACT children and youth includes a combination
of services available by both the ACT team and other community providers, as
appropriate. For example, the ACT teams provide transportation to appointments
and scheduled activities as necessary, as well as emergency short-term housing
through rental assistance, housing vouchers, or accommodations in local hotels if
needed. Support services include, but are not limited to the following:
• Medical and dental services
• Safe, clean, affordable housing
• Financial support and/or benefits counseling
• Social services
• Transportation
• Legal advocacy
Other services available through collaboration with other professionals include
schools,juvenile and adult probation, health providers, cultural and community
organizations, and individuals who provide specific services to meet individual
needs. CONTRACTOR will have an established a collaborative network that includes
other non-profit organizations, faith-based groups, and grass-roots organizations
serving children, youth, transition age youth, adults, and families. These
relationships encompass the full range of services most likely to be needed by
Exhibit A
Page 19 of 25
participating children and youth and families. Collaborative partners may include,
but are not limited to, the following:
• County Health and Human Services Departments
• Court Appointed Special Advocates
• Boys and Girls Club
• Employment and vocational training resources
• Workforce Investment Departments and One-Stop Centers
• County Independent Living Programs
• County Mental Health Services,
• City Police Departments
• Local schools, community colleges, and universities
• Drug and Behavioral Health Courts
• Substance abuse prevention and treatment services
• Health services providers
• Community food banks, emergency shelters, and transportation services
CONTRACTOR is already familiar with the full range of community services available
in Fresno County. In addition to maintaining its own directory of service resources,
CONTRACTOR ensures that all staff are familiar with the use of resource directories
maintained by the County library and Fresno Metro Ministry, and the internet-based
Network of Care website for Fresno County.
The ACT model of service delivery is based on staged development of independent
function, encouraging increasingly responsible behavior as developmental stages
allow.
Program staff are trained to build trusting relationships in an environment where
change is recognized as part of the journey to personal growth and development to
encourage children, youth and families in the program to accept and benefit from
available services. Client and family participants are active members of the team
process, and help identify their own strengths, needs, and life skills objectives.
Program staff engage children/youth, assess their readiness for change, and assist
them in working through the stages of change. As service needs are identified and
incorporated into the individualized service, children/youth and families are guided
to make their own decisions about what services they need and where to access
those services. Team members serve as coaches in every aspect of service-seeking
behavior to increase the child/youth's knowledge, security, and self-confidence; and
henceforth assure that the child/youth learns to take independent action.
Exhibit A
Page 20 of 25
12. Education: CONTRACTOR is fully familiar with meeting the school-related needs of
enrolled children and youth. Through the County of Fresno ACT CONTRACTOR will
maintain relationships with the major school districts in the County, as well as with
Fresno City College and California State University, Fresno. During each initial intake
and assessment, the child/youth's academic level and specialized needs are included
as integral components of the service planning process. The Education/Vocation
Counselor assigned to each ACT team provides direct supportive services where
appropriate, consults with academic and vocational institution representatives, and
connects children and youth with any resources needed to support the maximum
level of educational achievement, including but not limited to the following:
• Individualized Education Plan, special education, and alternative education
support
• GED preparation and referral
• Secondary and post-secondary support including tutoring, career
exploration, and financial aid
13. Support and Consultation: Family involvement is often critical to the success of
treatment; therefore, collateral services which include family therapy, parent
education, and coaching on appropriate behavior, are provided. As part of intensive
case management, children/youth and families are referred or linked to community
resources for peer support, self-help services, and information resources.
Pregnant and parenting youth enrolled in the program are connected with health
and social support services, including private medical practitioners; public clinics;
and local, public, and private social service agencies to ensure adequate prenatal
and delivery care, as well as child development and parenting education. Team
members offer assistance, counseling, and psychological support as needed to serve
the child/youth and family. They also serve as mentors and supportive advocates, as
appropriate, to work with parents in their efforts to establish or restore
relationships with their children, both those in their custody and those for whom
they do not have custody.
14. Court Participation: CONTRACTOR is familiar with both juvenile and adult courts,
including juvenile dependency and delinquency courts, Behavioral Health Court, and
Drug Court. ACT staff will have working relationships with representatives in the
previously mentioned courts, as well as with law enforcement staff at Juvenile
Probation. CONTRACTOR will participate in judicial proceedings, including testimony
when necessary, and meet all requirements for court appearances and written
reporting. For the purpose of serving ACT clients, one member of each ACT team
will be designated as liaison to law enforcement departments and all courts.
Treatment schedules will include mandated justice-related activities, transportation,
and support.
Exhibit A
Page 21 of 25
X. COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Provide oversight and collaborate with CONTRACTOR 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 CONTRACTOR 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
CONTRACTOR for ongoing consultation.
D. Gather outcome information from target client groups and CONTRACTOR throughout
each term of this Agreement. COUNTY shall notify CONTRACTOR 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.
XI. PERFORMANCE MEASUREMENT:
CONTRACTOR will gather, collect, and submit Mental Health Services Act (MHSA) Full
Service Partnership data as required by the State Data Collection Reporting system and
other data reports as requested by COUNTY, such as the Annual Mental Health Advisory
Board Data Report. These data will be submitted as required and entered into a local
database for internal reporting purposes.
Service satisfaction data will be collected for all cross-sectional mental health programs, as
required by the California Department of Health Care Services, at two time periods across
the agency for each twelve (12) month period of the Agreement term. Additionally, the
Youth Satisfaction Survey (YSS) is collected for each child/youth six months post-entry to
provide more detailed and relevant information regarding service satisfaction over time.
CONTRACTOR will also participate in the Performance Outcomes and Quality Improvement
(POQI) satisfaction survey.
CONTRACTOR will have a unit dedicated to providing outcome and evaluation information
pertaining to the services provided and clients served. CONTRACTOR will implement a core
set of outcome measures, permitting comparative and other analyses that add depth and
value to the outcomes obtained by specific programs. Measurement tools used will include
Exhibit A
Page 22 of 25
the Child and Adolescent Needs and Strengths (CANS) and indicators of system performance
and child outcomes designed to assess whether children youth are in home, in school, or at
work and out of trouble. Such indicators will be used to track and report each enrolled
child/youth's progress. In addition, these measurement tools allow CONTRACTOR and
COUNTY to assess effectiveness at child/youth and systemic levels.
CONTRACTOR's electronic health record will be used to collect basic system level indicators,
upon program entry and discharge, of whether children/youth are in home, in school, or at
work and out of trouble. Outcome indicators allow the following factors to be assessed in
12 month time spans: frequency of incarceration (probation involvement), frequency of
hospitalizations, frequency of contacts with the COUNTY's Children's Crisis Stabilization
Center; school attendance, school grades and performance, employment, and living
situations. Data will be routinely reported to program staff and agency leadership as a part
of ongoing continuous quality improvement, and to COUNTY on a fixed or variable schedule
according to COUNTY requirements.
The tables below summarize outcome measures used by CONTRACTOR. System Level
Measures are somewhat dependent on cross systems collaboration; whereas, Practice Level
Measures capture data that are often most directly linked to the work of the practitioner.
A. System Level Measures and Outcomes:
URCE N
1. Living Situation: Recorded by Upon entry, at three
a. Restrictiveness Clinician/Case Manager month intervals, and upon
b. Stability discharge.
c. Permanence
2. Educational Performance: Recorded by Upon entry, at three
a. School Attendance Clinician/Case Manager month intervals, and upon
2. School Performance discharge.
3. Employment (when relevant): Recorded by Upon entry, at three
a. Hours Worked Clinician/Case Manager month intervals, and upon
b. Length of Employment discharge.
4. Juvenile Justice: Recorded by Upon entry, at three
a. Recidivism: arrests and Clinician/Case Manager month intervals, and upon
citations by type of offense discharge.
B. Practice Level Measures and Outcomes:
Iff CE
1. Functioning, competence, and Caregiver Upon entry, at three
impairment from caregiver, Child/youth month intervals, and upon
child/youth, and clinician Clinician discharge.
perspectives; Child and
Adolescent Needs and Strengths At six month cross-
Exhibit A
Page 23 of 25
(CANS) � sections and six months
post intake.
2. Satisfaction with Services (YSS) Child/youth Bi-annual sample, at six
month intervals, and upon
discharge.
C. Program Outcomes
At minimum, one performance indicator will be identified for each of the four CARF
domains listed below.
a. Access to care: The ability of clients to receive the right service at the right time. Examples
include:
1. Timeliness of bridging prescriptions
2. Timeliness of identifying clients with a serious mental illness
3. Timeliness between client referral for assessment and completion of assessment;
assessment to first treatment service; and, first treatment service to next follow-up
4. Timeliness of subsequent follow-up visits
5. Timeliness of response to sick call/health service requests
b. Effectiveness: Objective results achieved through health care services. Examples include:
1. Effectiveness of crisis interventions
2. Effectiveness of treatment interventions (medical and behavioral health indicators)
3. Effectiveness of discharge planning (such as percentage of clients successfully linked to
County programs, community providers, and/or other community resources after
release)
4. Timely continuity of verified community prescriptions for medication(s), upon client's
release
5. Effectiveness of transportation coordination, upon release
c. Efficiency: The demonstration of the relationship between results and the resources used
to achieve them.
Examples include:
1. Cost per client
2. Number of units of services per FTE by discipline
3. Number of clients served per general population
4. Comparison of numbers served against industry standards
d. Satisfaction and Compliance: The degree to which clients, County, and other stakeholders
are satisfied with the services.
Examples include:
1. Audits and other performance and utilization reviews of health care services and
compliance with agreement terms and conditions
2. Surveys of persons served, family members, other health care providers, and other
stakeholders
XII. REPORTS:
Exhibit A
Page 24 of 25
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.
XIII. ADDITIONAL CONTRACTOR REQUIREMENTS:
CONTRACTOR shall:
A. Maintain facilities and equipment, and operate continuously with the number and
classification of staff required described under this Agreement. If CONTRACTOR does not
have the positions filled for these services, CONTRACTOR shall notify COUNTY in writing
within fifteen (15) days of the vacancy and provide a plan of action to continue the current
level of services.
B. Provide Plans of Care that include all safety, emergency, and crisis procedures in the field
and in CONTRACTOR's offices.
C. Assume responsibility for client medication costs.
D. Maintain client treatment records according to all Federal, State, MHSA FSP regulations as
it relates to Health Insurance Portability and Accountability Act (HIPAA).
E. Ensure facility location is approved by COUNTY. COUNTY must be informed of new site
locations in writing and provide approval prior to use of the new site prior to use for
services provided through this Agreement.
F. Maintain site certification in accordance with Medi-Cal Organization provider status, and
ensure Medi-Cal billing is conducted in accordance with the Fresno County Mental Health
Plan.
G. Provide housing and employment support services as stated in CONTRACTOR's response to
Revised RFP No. 18-044.
Exhibit A
Page 25 of 25
H. Log all complaints and grievances, and produce such logs upon COUNTY's request.
Exhibit B
CHILDREN/YOUTH ASSERTIVE COMMUNITY TREATMENT(ACT)
PACIFIC CLINICS
Fiscal Year(FY) 2022-2023
PROGRAM EXPENSES
1000:SALARIES&BENEFITS
Employee Salaries
Acct# Position FTE Admin Direct Total
1101 Clinician 1 6.00 $ - $ 503,764 $ 503,764
1102 Clinician 11 3.00 - 279,871 279,871
1103 Family Specialist 1 4.00 - 141,620 141,620
1104 Family Partner 1 1.00 - 39,297 39,297
1105 Education/Vocation Specialist 3.00 - 132,576 132,576
1106 Addiction Prevention Counselor 11 2.00 - 88,373 88,373
1107 Addiction Prevention Counselor 111 1.00 - 62,407 62,407
1108 Clinical Program Manager 2.33 - 249,930 249,930
1109 lSupport Services Coordinator 0.50 - 26,725 26,725
1110 Clinical Director 0.50 - 76,438 76,438
1111 Program Supervisor 1.00 - 83,960 83,960
1112 Doctors Assistant 0.30 - 12,160 12,160
1113 Program Support Staff 2.17 153,065 - 153,065
1114 1 Regional Director 0.24 43,272 - 43,272
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotall 27.04 1 $ 196,337 1 $ 1,697,121 1 $ 1,893,458
Employee Benefits
Acct# Description Admin Direct Total
1201 Retirement $ 5,326 $ 60,556 $ 65,882
1202 Worker's Compensation 3,576 40,658 44,234
1203 Health Insurance 35,757 406,565 442,322
1204 Other(Specify) - I - I -
1205 10ther(Specify) - - -
1206 10ther(Specify) - - -
Employee Benefits Subtotal: $ 44,659 $ 507,779 $ 552,438
Payroll Taxes&Expenses:
Acct# Description Admin Direct Total
1301 OASDI $ 9,434 $ 107,265 $ 116,699
1302 FICA/MEDICARE 2,206 25,087 27,293
1303 SUI 1,522 17,301 18,823
1304 10ther(Specify) - - -
1305 10ther(Specify) - -
1306 10ther(Specify) - -
Payroll Taxes&Expenses Subtotal: $ 13,162 $ 149,653 $ 162,815
EMPLOYEE SALARIES&BENEFITS TOTAL: $ 254,158 $ 2,354,553 $ 2,608,711
2000:CLIENT SUPPORT
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support Expenditures 1,065
2003 Client Transportation &Support 3,714
2004 lClothing, Food,& Hygiene 3,003
2005 Education Support 263
2006 Employment Support -
2007 Household Items for Clients 1,583
2008 Medication Supports -
2009 1 Program Supplies-Medical -
2010 Utility Vouchers 791
2011 Client Housing Operating Expenditures 1,581
2012 Other(Specify) -
2013 Other(Specify) -
2014 10ther(Specify) -
2015 10ther(Specify) -
2016 10ther(Specify) -
DIRECT CLIENT CARE TOTAL $ 12,000
3000:OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 39,337
3002 Printing/Postage -
3003 General Office Expenditures 15,383
3004 lAdvertising -
3005 Staff Development&Training 51,068
3006 Staff Travel/Mileage 119,873
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance -
3009 1 Depreciation 4,990
3010 Other(Specify) -
3011 Other(Specify) -
3012 Other(Specify) -
OPERATING EXPENSES TOTAL:1 $ 230,651
4000: FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 3,145
4002 Rent/Lease Building 132,550
4003 Rent/Lease Equipment 5,845
4004 1 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Equipment Purchase 26,519
4008 Other(Specify) -
4009 10ther(Specify) -
4010 10ther(Specify) -
FACILITIES/EQUIPMENT TOTAL: $ 168,059
5000:SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 5,800
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B
5002 HMIS(Health Management Information System) -
5003 Contract Psychiatrist 108,268
5004 Translation Services -
5005 Other(Specify) -
5006 Other(Specify) -
5007 10ther(Specify) -
5008 Other(Specify) -
SPECIAL EXPENSES TOTAL: $ 114,068
6000:ADMINISTRATIVE EXPENSES
Acct# Line Item Description Amount
6001 Administrative Overhead $ 561,200
6002 Professional Liability Insurance 43,550
6003 Accounting/Bookkeeping -
6004 1 External Audit 3,039
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) I -
6012 Other(Specify) -
ADMINISTRATIVE EXPENSES TOTAL $ 607,789
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) -
7008 Other(Specify) -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES 1 $ 3,741,278
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 518,853 3.83 $ 1,986,353
8002 Case Management 84,673 2.98 252,250
8003 Crisis Services 9,052 5.62 50,883
8004 Medication Support 14,270 6.98 99,643
8005 Collateral 45,394 3.83 173,784
8006 Plan Development 13,617 3.83 52,131
8007 Assessment 54,472 3.83 208,538
8008 Rehabilitation 1 163,4161 3.83 625,614
Estimated Specialty Mental Health Services Billing Totals: 1 903,7471 $ 3,449,196
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries F 2,759,357
Federal Financial Participation (FFP)% 100%1 2,759,357
MEDI-CAL FFP TOTAL $ 2,759,357
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 $ 981,921
8302 PEI -Prevention & Early Intervention -
8303 INN -Innovations -
8304 IWET-Workforce Education &Training I -
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 981,921
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 10ther(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: 1 $ 3,741,278
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
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 C
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 C
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 C
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 D
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 D
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 D
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 E
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 E
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 E
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 F
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 F
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 F
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 F
Page 4of6
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 F
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 F
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 G
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 G
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 G
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'
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 G
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 G
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 G
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 G
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 G
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 G
Page 9 of 10
Analyst Follow Up
Task Details Client Information Summary Follow Up Documents
Ilm Taken(check all th—pplyl-
LawEnforrementContaoun!X
Please spwfy Bother
Descnphan ofAction Taken'
f
—all.
f
added information
cause of death-.near per.tuner L -1
Task ID:313 Source:103:null [ 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 G
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 H
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 H
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 I
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 I
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 J
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.
THINK
us*
Department of www.ThinkCulturalHealth.hhs.gov CULTURAL -
HeaOh and Hunwn SeMces 1*M H 01Nae at MlnoMy Heolth HEALTH
Exhibit J
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 K
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 K
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 L
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 L
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 M
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 M
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 N
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 N
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 N
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 N
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 N
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 N
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 O
Page 1 of 2
Vendor: Contract# Contact Person Contact#
1
d a e Date Fresno
a « £ Requested Approved( Purchase I County
Item Make/Brand Mod Serial# x �' y m Condition Cost
(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 O
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 Con rent 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, Count y 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 Nbdel I dent i f y t he rrodel number for 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 with an "X" i f the cost oft 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 rreet s 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.