HomeMy WebLinkAboutAgreement A-22-358 Certificate of Compliance Medi-Cal.pdf Agreement No. 22-358
STATE OF CALIFORNIA GAVIN NEWSOM,Governor
DEPARTMENT OF VETERANS AFFAIRS
1227 O Street
SACRAMENTO,CALIFORNIA 95814 a
Telephone: (800)952-5626 r
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Annual Medi-Cal Cost Avoidance Certificate of Compliance
Fiscal Year 2022/2023
I certify that Fresno County has appointed a County Veterans Service
Officer(CVSO) in compliance with California Code of Regulations, Title 12, Subchapter 4.
Please consider this as our application to participate in the Medi-cal Cost Avoidance Program
authorized by Military and Veterans Code Section 972.5
I understand and will comply with the following:
1. All activities of the CVSO for which payment is made by the Ca1Vet under this
agreement will reasonably benefit the Department of Health Care Services (DHCS) or
realize cost avoidance to the Medi-Cal program. All State and County Medi-Cal
Eligibility Workers who generate a Form MC 05 (Military Verification and Referral
form)will be instructed to indicate the applicant's Aid Code on the face of the form.
2. All monies received under this agreement shall be allocated to and spent on the
salaries and expenses of the CVSO.
3. This agreement is binding only if federal funds are available to Ca1Vet from the
DHCS.
4. The CVSO is responsible for administering this program in accordance with California
Code of Regulations, Title 12, Subchapter 4 and the Cal Vet Procedure Manual for
Subvention and Medi-Cal Cost Avoidance for the current state fiscal year.
8-9-2022
Chairman, County Board of Supervisors Date
(or other County Official authorized by
the Board to act on their behalf)
SCAN AND UPLOAD THIS COMPLETED FORM VIA THE AGENCY ATTACHMENTS IN VETPRO
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
Rev(6/22) County o esno,State of California
By
Deputy
Agreement California Department of Veterans Affairs: Medi-Cal Certificate of
Compliance (FY 2022-23), and Subvention Certificate of Compliance (FY 2022-23)
County of Fresno
Fund/Subclass: 0001/10000
Organization: 7110
Account/Program: 3560/0