HomeMy WebLinkAboutAgreement A-18-329 with each Contractor listed in Exhibit A.pdf Agreement No. 18-329
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 12th day of June 2018, by
3 and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and each Contractor listed in Exhibit A, attached hereto by this reference and
5 incorporated herein, collectively hereinafter referred to as "CONTRACTOR(S)", and such additional
6 CONTRACTOR(S), as may, from time to time during the term of this Agreement, be added by the
7 COUNTY, reference in this Agreement to "party" or "parties" shall be understood to refer to COUNTY
8 and each CONTRACTOR, unless otherwise specified.
9 WITNESSETH:
10 WHEREAS, COUNTY, through its Department of Behavioral Health Substance Use Disorder
11 (DBH-SUD) Services and Mental Health Services Act (MHSA) divisions, have determined there is a
12 need for certain Fresno County residents to receive family-focused drug and alcohol abuse/misuse
13 prevention and educational services; and
14 WHEREAS, COUNTY is authorized to contract with privately operated agencies for the
15 provision of Non-Drug Medi-Cal and SUD Services to Fresno County residents, pursuant to Title 9,
16 Division 4 of the California Code of Regulations and Division 10.5 (commencing with section 11750) of
17 the California Health and Safety Code; and
18 WHEREAS, CONTRACTOR(S) is willing and able to provide these services required by
19 COUNTY, pursuant to the terms and conditions of this Agreement.
20 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
21 hereto agree as follows:
22 1. OBLIGATIONS OF CONTRACTOR
23 A. CONTRACTOR(S) shall provide Drug and Alcohol Abuse/Misuse Prevention
24 Education services to minor children (ages 17 and younger) whose parent is enrolled and participating
25 in a COUNTY funded SUD program.
26 B. CONTRACTOR(S) shall adhere to an Evidence-Based intervention that is
27 appropriate for the population being served and approved by the County's DBH Director or designee.
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1 C. COUNTY encourages CONTRACTOR(S) to adopt and maintain Electronic
2 Health Records (EHR) that meet the requirements of the Health Information Technology for Economic
3 and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act (ARRA) of
4 2009. CONTRACTOR(S) shall bear all costs associated with penalties and/or fines for any non-
5 compliance with such regulations.
6 D. CONTRACTOR shall comply with all reporting requirements identified in Section
7 12 below.
8 E. For services rendered herein, CONTRACTOR(S) shall assure that ongoing
9 quality assurance component is in place and is occurring. CONTRACTOR(S) shall assure that clinical
10 records for each participant are of such detail and length that a review of said record will verify that
11 appropriate services were provided. If the record is unclear, incomplete, and/or indicates that
12 appropriate services were not provided, COUNTY reserves the right to withhold payment for the
13 applicable unit(s) of service. If CONTRACTOR(S) should fail to comply with any provision of this
14 Agreement, COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR(S)'s
15 and COUNTY's obligations under this Section shall survive the termination or expiration of this
16 Agreement.
17 2. TERM
18 The term of this Agreement shall be for a period of three (3) years, commencing on July 1, 2018
19 through and including June 30, 2021. This Agreement may be extended for two (2) additional
20 consecutive twelve (12) month periods upon written approval of both parties no later than thirty (30)
21 days prior to the first day of the next twelve (12) month extension period. The DBH Director or his or
22 her designee is authorized to execute such written approval on behalf of COUNTY based on
23 CONTRACTOR(S)'s satisfactory performance.
24 3. TERMINATION
25 A. Non-Allocation of Funds —The terms of this Agreement, and the services to be
26 provided thereunder, are contingent on the approval of funds by the appropriating government agency.
27 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
28 terminated at any time by giving CONTRACTOR(S) thirty (30) days advance written notice.
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1 B. Breach of Contract— COUNTY may immediately suspend or terminate this
2 Agreement in whole or in part, where in the determination of COUNTY there is:
3 1) An illegal or improper use of funds;
4 2) A failure to comply with any term of this Agreement;
5 3) A substantially incorrect or incomplete report submitted to COUNTY;
6 4) Improperly performed service.
7 In no event shall any payment by COUNTY constitute a waiver by COUNTY of any
8 breach of this Agreement or any default which may then exist on the part of CONTRACTOR(S).
9 Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
10 breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
11 COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
12 COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR(S) shall
13 promptly refund any such funds upon demand, or at COUNTY's option, such repayment shall be
14 deducted from future payments owing to CONTRACTOR under this Agreement.
15 C. Without Cause— Under circumstances other than those set forth above, this
16 Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director or
17 designee upon the giving of sixty (60) days advance written notice of an intention to terminate.
18 4. COMPENSATION
19 A. COMPENSATION — COUNTY agrees to pay CONTRACTOR(S) and
20 CONTRACTOR(S) agrees to receive compensation in accordance with the budget attached hereto and
21 referenced herein as Exhibit B, "Budget". The maximum amount for the period of July 1, 2018 through
22 June 30, 2019 shall not exceed One Hundred Twenty Thousand and No/100 Dollars ($120,000.00).
23 The maximum amount for the period of July 1, 2019 through June 30, 2020 shall not exceed One
24 Hundred Twenty Thousand and No/100 Dollars ($120,000.00). The maximum amount for the period of
25 July 1, 2020 through June 30, 2021 shall not exceed One Hundred Twenty Thousand and No/100
26 Dollars ($120,000.00). The maximum amount for the period of July 1, 2021 through June 30, 2022
27 shall not exceed One Hundred Twenty Thousand and No/100 Dollars ($120,000.00). The maximum
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1 amount for the period of July 1, 2022 through June 30, 2023 shall not exceed One Hundred Twenty
2 Thousand and No/100 Dollars ($120,000.00).
3 B. BUDGET— Prior to March 1st of each twelve (12) month period of this
4 Agreement, CONTRACTOR(S) shall provide to COUNTY's DBH an updated budget in the format
5 identified in Exhibit B, for the upcoming twelve (12) month period. Each such budget shall require the
6 approval of COUNTY's DBH Director or his/her designee prior to April 1st for the upcoming twelve (12)
7 month period covered by said budget. If said budget is not received by the March 1 st due date, the
8 budget for the upcoming twelve (12) month period will remain at the prior year's funding level. The
9 maximum amount of said approved budget shall not exceed the maximum compensation for the current
10 Agreement period.
11 C. The contract maximum amounts as identified in this Agreement may be reduced
12 based upon State, Federal, and local funding availability. In the event of such action, COUNTY's DBH
13 Director or designee shall notify the CONTRACTOR(S) in writing of the reduction in the maximum
14 amount within 30 days of notification of same from the funding source.
15 In the event funding for these services is delayed by the State Controller, COUNTY may
16 defer payment to CONTRACTOR(S). The amount of the deferred payment shall not exceed the
17 amount of funding delayed by the State Controller to the COUNTY. The period of time of the deferral
18 by COUNTY shall not exceed the period of time of the State Controller's delay of payment to COUNTY
19 plus forty-five (45) days.
20 D. Payment by COUNTY shall be arrears, based on CONTRACTOR(S)'s monthly
21 invoices submitted for services provided during the preceding month, within forty-five (45) days after
22 receipt and verification of CONTRACTOR(S)'s monthly invoices by COUNTY'S DBH-SUD Services.
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24 E. PUBLIC INFORMATION — CONTRACTOR(S) shall disclose its funding source in
25 all public information, however, this requirement of disclosure of funding source shall not be required in
26 spot radio or television advertising.
27 F. LOBBYING ACTIVITY— CONTRACTOR(S) shall not directly or indirectly use
28 any of the funds provided under this Agreement for publicity, lobbying, or propaganda purposes
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1 designed to support or defeat legislation pending before the Congress of the United States or the
2 Legislature of the State of California.
3 G. POLITICAL ACTIVITY— CONTRACTOR(S) shall not directly or indirectly use
4 any of the funds under this Agreement for any political activity or to further the election or defeat any
5 candidate for public office.
6 H. FUNDING SOURCES — It shall be the obligation of CONTRACTOR(S) to
7 determine and claim all revenue possible from private pay sources and third party payers.
8 CONTRACTOR(S) shall not use any funds under this Agreement for services covered by Drug Medi-
9 Cal or other health insurance for eligible beneficiaries. CONTRACTOR(S) shall claim all Drug Medi-Cal
10 covered services for eligible beneficiaries through the Drug Medi-Cal claiming process. The COUNTY
11 will only reimburse CONTRACTOR(S) for services that are not covered by Drug Medi-Cal, other
12 insurance or other revenue sources.
13 CONTRACTOR(S) shall not use any funds under this Agreement to the extent that a
14 participant is eligible for Medi-Cal, insurance or other revenue reimbursement for services rendered.
15 Any revenues generated by CONTRACTOR(S) in excess of the amounts budgeted in
16 this Agreement, may be utilized to expand/enhance the services during the COUNTY's fiscal year in
17 which revenues are collected or in the following COUNTY fiscal year. Additional revenues will be
18 considered separate and distinct from COUNTY's payment to CONTRACTOR(S). The manner and
19 means of service expansion/enhancement shall be subject to the prior written approval of COUNTY's
20 DBH Director or designee. CONTRACTOR(S) shall disclose all sources of revenue to COUNTY.
21 Under no circumstances will COUNTY funded staff time be used for fund-raising purposes.
22 I. COST OF LIVING ADJUSTMENT— CONTRACTOR(S) shall not utilize any funds
23 provided under this Agreement to provide cost of living adjustment to CONTRACTOR(S)'s employee
24 compensation.
25 5. INVOICING
26 CONTRACTOR(S) shall invoice COUNTY in arrears by the twentieth (20th) day of each
27 month for actual services rendered in the previous month. Invoices shall be submitted via email to
28 SAS(a)co.fresno.ca.us, Subject: Attn: Staff Analyst, and accompanied by a monthly participant roster
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1 and other documentation and reports as indicated in Section 12, herein below. All such reports and
2 other required documentation shall be in a form and in such detail as acceptable to COUNTY's DBH-
3 SUD Services. No reimbursement for services shall be made until the invoice is received, reviewed
4 and approved by COUNTY's DBH-SUD Services.
5 If an invoice is incorrect or is otherwise not in proper form or substance, COUNTY's DBH
6 Director or designee, shall have the right to withhold payment as to only that portion of the invoice that
7 is incorrect or improper after five (5) days prior to notice to CONTRACTOR(S). CONTRACTOR(S)
8 agrees to continue to provide services for a period of ninety (90) days after notification of an incorrect or
9 improper invoice. If after said ninety (90) day period said invoice(s) is still not corrected to COUNTY's
10 satisfaction, COUNTY may elect to terminate this Agreement, pursuant to Section 3 hereinabove. In
11 addition, CONTRACTOR(S) shall submit all invoices to COUNTY's DBH, for services provided within
12 ninety (90) days after each twelve (12) month period of the Agreement expires or this Agreement is
13 terminated. COUNTY DBH shall have to right to deny payment for any invoices that are not submitted
14 within ninety (90) days after the end of each fiscal year or the date this Agreement is terminated.
15 General ledgers shall be submitted for services provided corresponding to the period
16 being billed. Invoices will not be processed without the general ledger that corresponds to the period
17 being billed. Line-item costs reported on invoices must match the corresponding costs as recorded in
18 the general ledger. General ledger entries shall have corresponding source documentation (e.g.
19 invoices, bills, etc.) that verifies the expense. Source documentation shall be submitted with the invoice
20 and general ledger. For general ledgers and/or corresponding source documentation that verifies each
21 expense reported on invoice not submitted within sixty (60) days after each billing period, COUNTY's
22 DBH shall have the right to deny payment for services covered by such general ledgers.
23 6. INDEPENDENT CONTRACTOR
24 In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
25 under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any and
26 all of CONTRACTOR(S)'s officers, agents, and employees will at all times be acting and performing as
27 an independent contractor, and shall act in an independent capacity and not as an officer, agent,
28 servant, employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have
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1 no right to control or supervise or direct the manner or method by which CONTRACTOR(S) shall
2 perform its work and function. However, COUNTY shall retain the right to administer this Agreement so
3 as to verify that CONTRACTOR(S) is performing its obligations in accordance with the terms and
4 conditions thereof.
5 CONTRACTOR(S) and COUNTY shall comply with all applicable provisions of law and
6 the rules and regulations, if any, of governmental authorities having jurisdiction over matters which are
7 directly or indirectly the subject of this Agreement.
8 Because of its status as an independent contractor, CONTRACTOR(S) shall have
9 absolutely no right to employment rights and benefits available to COUNTY employees.
10 CONTRACTOR(S) shall be solely liable and responsible for providing to, or on behalf of, its employees
11 all legally-required employee benefits. In addition, CONTRACTOR(S) shall be solely responsible and
12 save COUNTY harmless from all matters relating to payment of CONTRACTOR(S)'s employees,
13 including compliance with Social Security, withholding, and all other regulations governing such
14 matters. It is acknowledged that during the term of this Agreement, CONTRACTOR(S) may be
15 providing services to others unrelated to COUNTY or to this Agreement.
16 7. MODIFICATION
17 Notwithstanding the above, changes to Section One (1) SERVICES and Section Four (4)
18 COMPENSATION as needed to accommodate changes in State and Federal Law relating to mental
19 health and substance use disorder treatment services may be made with the signed written approval of
20 COUNTY' s DBH Director or designee and CONTRACTOR through an amendment approved by
21 County Counsel and Auditor. Changes to line items in the budget that do not exceed 10% of the
22 maximum compensation payable to CONTRACTOR, may be made with the written approval of
23 COUNTY's DBH Director or designee, and CONTRACTOR. Changes in the line items in the budget
24 that exceed 10% of the maximum compensation payable to the CONTRACTOR, may be made with
25 signed written approval of the COUNTY' s DBH Director or designee and CONTRACTOR through an
26 amendment approved by County Counsel and Auditor. Said budget line item changes shall not result
27 in any change to the annual maximum compensation amount payable to CONTRACTOR, as stated in
28 the agreement.
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1 CONTRACTOR further understands that this Agreement is subject to any restrictions,
2 limitations, or enactments of all legislative bodies which affect the provisions, term or funding of this
3 Agreement in any manner.
4 8. NON-ASSIGNMENT
5 No party shall assign, transfer or subcontract this Agreement nor their rights or duties
6 under this Agreement without the prior written consent of COUNTY.
7 9. HOLD HARMLESS
8 CONTRACTOR(S) agrees to indemnify, save, hold harmless, and at COUNTY's request,
9 defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
10 attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
11 in connection with the performance, or failure to perform, by CONTRACTOR(S), its officers, agents or
12 employees under this Agreement, and from any and all costs and expenses, including attorney fees
13 and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
14 corporation who may be injured or damaged by the performance, or failure to perform, of
15 CONTRACTOR(S), its officers, agents or employees under this Agreement. CONTRACTOR(S) agrees
16 to indemnify COUNTY for Federal, State of California and/or local audit exceptions resulting from
17 noncompliance herein on the part of CONTRACTOR(S).
18 10. INSURANCE
19 Without limiting COUNTY's right to obtain indemnification from CONTRACTOR(S) or any
20 third parties, CONTRACTOR(S), at its sole expense, shall maintain in full force and effect the following
21 insurance policies throughout the term of this Agreement:
22 A. Commercial General Liability
23 Commercial General Liability Insurance with limits of not less than Two Million
24 Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars
25 ($4,000,000.00). This policy shall be issued on a per occurrence basis. COUNTY may require specific
26 coverage including completed operations, product liability, contractual liability, Explosion, Collapse, and
27 Underground (XCU), fire legal liability or any other liability insurance deemed necessary because of the
28 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
3 Dollars ($1,000.000) per accident and for property damages. Coverage should include owned and non-
4 owned vehicles used in connection with this Agreement.
5 C. Real and Personal Property
6 CONTRACTOR(S) shall maintain a policy of insurance for all risk personal property
7 coverage which shall be endorsed naming the County of Fresno as an additional loss payee. The
8 personal property coverage shall be in an amount that will cover the total of the County purchased and
9 owned property, at a minimum, as discussed in Section Twenty-One (21), PROPERTY OF COUNTY,
10 of this Agreement.
11 D. All Risk Property Insurance
12 CONTRACTOR(S) will provide property coverage for the full replacement value of
13 the County's Personal Property in the possession of CONTRACTOR(S) and/or used in the execution of
14 this Agreement. COUNTY will be identified on an appropriate certificate of insurance as the certificate
15 holder and will be named as an Additional Loss Payee on the Property Insurance Policy.
16 E. Professional/Medical Malpractice Liability
17 If CONTRACTOR(S) employ licensed professional staff (e.g. Ph.D., R.N., L.C.S.W.,
18 L.M.F.T.) in providing services, Professional Liability Insurance with limits of not less than One Million
19 Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual aggregate.
20 CONTRACTOR(S) agrees that it shall maintain, at its sole expense, in full force and effect for a period
21 of three (3) years following the termination of this Agreement, one or more policies of professional
22 liability insurance with limits of coverage as specified herein.
23 F. Worker's Compensation
24 A policy of Worker's Compensation Insurance as may be required by the
25 California Labor Code.
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1 G. Molestation
2 Sexual Abuse/molestation liability insurance with limits not less than One Million
3 Dollars ($1,000.000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This
4 policy shall be issued on a per occurrence basis.
5 H. Additional Requirements Relating to Insurance
6 CONTRACTOR(S) shall obtain endorsements to the Commercial General
7 Liability insurance naming the County of Fresno, its officers, agents, and employees, individually and
8 collectively, as additional insured, but only insofar as the operations under this Agreement are
9 concerned. Such coverage for additional insured shall apply as primary insurance and any other
10 insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees shall be
11 excess only and not contributing with insurance provided under the CONTRACTOR(S)'s policies
12 herein. This insurance shall not be cancelled or changed without a minimum of thirty (30) days
13 advance written notice given to COUNTY.
14 Within thirty (30) days from the date CONTRACTOR(S) signs this Agreement,
15 CONTRACTOR(S) shall provide certificates of insurance and endorsements as stated above for all of
16 the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
17 3133 N. Millbrook Avenue, Fresno, California, 93703, Attention: Contracts Division, stating that such
18 insurance coverages have been obtained and are in full force; that the County of Fresno, its officers,
19 agents and employees will not be responsible for any premiums on the policies; that such Commercial
20 General Liability insurance names the County of Fresno, its officers, agents and employees, individually
21 and collectively, as additional insured, but only insofar as the operations under this Agreement are
22 concerned; that such coverage for additional insured shall apply as primary insurance and any other
23 insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be
24 excess only and not contributing with insurance provided under CONTRACTOR(S)'s policies herein;
25 and that this insurance shall not be cancelled or changed without a minimum of thirty (30) days
26 advance, written notice given to COUNTY.
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1 In the event CONTRACTOR(S) fails to keep in effect at all times insurance
2 coverage as herein provided, COUNTY may, in addition to other remedies it may have, suspend or
3 terminate this Agreement upon the occurrence of such event.
4 All policies shall be with admitted insurers licensed to do business in the State of
5 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
6 A FSC VIII or better.
7 11. LICENSES/CERTIFICATES
8 Throughout each term of this Agreement, CONTRACTOR(S) and CONTRACTOR(S)'s
9 staff shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
10 necessary for the provision of the services hereunder and required by the laws and regulations of the
11 United States of America, State of California, the County of Fresno, and any other applicable
12 governmental agencies. CONTRACTOR(S) shall notify COUNTY immediately in writing of its inability
13 to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
14 irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTOR(S) and
15 CONTRACTOR(S)'s staff shall comply with all applicable laws, rules or regulations, as may now exist
16 or be hereafter changed.
17 12. REPORTS
18 Mental Health Services
19 A. Outcome Reports
20 CONTRACTOR(S) shall submit to COUNTY's DBH service outcome reports as
21 requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at
22 COUNTY's DBH discretion.
23 B. Additional Reports
24 CONTRACTOR(S) shall also furnish to COUNTY such statements, records,
25 reports, data, and other information as COUNTY's DBH may request pertaining to matters covered by
26 this Agreement. In the event that CONTRACTOR(S) fails to provide such reports or other information
27 required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
28 until there is compliance. In addition, CONTRACTOR(S) shall provide written notification and
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1 explanation to COUNTY within five (5) days of any funds received from another source to conduct the
2 same services covered by this Agreement.
3 Each fiscal year ending June 30, CONTRACTOR(S) shall remit a hard copy of their
4 annual cost report with a signed cover letter and requested support documents to County of Fresno,
5 Attention: Fiscal Analyst, 3133 N. Millbrook Ave., Fresno, CA 93703. In addition, CONTRACTOR(S)
6 shall remit an electronic copy of any inquiries to sas(a)co.fresno.ca.us. COUNTY shall provide
7 instructions of the cost report, cost report training, State DHCS cost report template worksheets, and
8 deadlines to submit the cost reports as determined by the State each fiscal year. All cost reports must
9 be prepared in accordance with General Accepted Accounting Principles (GAAP) and Welfare and
10 Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 14705. Unallowable costs such as lobby or
11 political donations must be shown but deducted on the cost report and invoice reimbursements.
12 If the CONTRACTOR(S) does not submit the cost report by the deadline,
13 including any extension period granted by the COUNTY, the COUNTY may withhold payments of
14 pending invoicing under compensation until the cost report has been submitted and clears COUNTY
15 desk audit for completeness.
16 C. Substance Use Disorder Services
17 CONTRACTOR(S) shall submit all information and data required by State, including,
18 but not limited to the following:
19 1. CONTRACTOR(S) shall submit to COUNTY monthly fiscal and all program
20 reports within twenty (20) days of the end of each month.
21 2. Americans with Disabilities (ADA)—Annually, upon request by DBH,
22 CONTRACTOR(S) shall complete a system-wide accessibility survey in a format determined by DBH
23 for each service location and modality and shall submit an ADA Accessibility Certification and Self-
24 Assessment, including an Implementation Plan, for each service location.
25 3. Cost Reports— On an annual basis for each fiscal year ending June 30tn
26 CONTRACTOR(S) shall submit a complete and accurate detailed cost report(s). Cost reports must be
27 submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the due
28 date. Submittal must also include any requested support documents such as general ledgers. All
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1 reports submitted by CONTRACTOR(S) to COUNTY must be typewritten. COUNTY will issue
2 instructions for completion and submittal of the annual cost report, including the relevant cost report
3 template(s) and due dates within forty-five (45) days of each fiscal year end. All cost reports must be
4 prepared in accordance with Generally Accepted Accounting Principles. Unallowable costs such as
5 lobbying or political donations must be deducted from the cost report and all invoices. If the
6 CONTRACTOR(S) does not submit the cost report by the due date, including any extension period
7 granted by the COUNTY, the COUNTY may withhold payment of pending invoices until the cost
8 report(s) has been submitted and clears COUNTY desk audit for completeness and accuracy. Total
9 costs as reported on cost reports shall match those costs as reported on final billing invoice for the
10 fiscal year.
11 4. OTHER FUNDING SOURCES — CONTRACTOR(S) will be required to submit a
12 cost report on a form(s) approved and provided by the COUNTY to reflect actual costs and
13 reimbursement for services provided through funding sources other than DMC.
14 5. MULTIPLE FUNDING SOURCES — CONTRACTOR(S) who have multiple
15 agreements for the same services provided at the same location where at least one of the Agreements
16 is funded through DMC and the other funding is other federal or county realignment funding will be
17 required to complete DMC cost reports and COUNTY approved cost reports. Such Agreements will be
18 settled for actual costs in accordance with Medicaid reimbursement requirements as specified in Title
19 XIX or Title XXI of the Social Security Act; Title 22, and the State's Medicaid Plan.
20 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR(S)
21 agree to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit
22 settlement findings related to the DMC and realignment reimbursements. DHCS audit process is
23 approximately eighteen (18) to thirty-six (36) months following the close of the State fiscal year.
24 COUNTY may choose to appeal DHCS settlement results and therefore reserves the right to defer
25 payback settlement with CONTRACTOR(S) until resolution of the appeal.
26 In the event that CONTRACTOR(S) fails to provide such reports or other information
27 required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments
28 until there is compliance. In addition, the CONTRACTOR(S) shall provide written notification and
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1 explanation to the COUNTY within fifteen (15) days of any funds received from another source to
2 conduct the same services covered by this Agreement.
3 13. MONITORING
4 CONTRACTOR(S) agrees to extend to COUNTY's staff, COUNTY's DBH Director and
5 DHCS, or their designees, the right to review and monitor records, programs or procedures, at any
6 time, in regard to clients, as well as the overall operation of CONTRACTOR(S)'s programs, in order to
7 ensure compliance with the terms and conditions of this Agreement.
8 Outcomes — COUNTY's DBH Director, or her designee, and the California Department
9 of Health Care Services (DHCS), or their designees shall monitor and evaluate the performance of
10 CONTRACTOR(S) under this Agreement to determine to the best possible degree the success or
11 failure of the services provided under this Agreement. At the discretion of the COUNTY, a
12 subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
13 performance of the CONTRACTOR(S). CONTRACTOR(S) shall participate in the evaluation of the
14 program as needed, at the discretion of COUNTY.
15 CONTRACTOR shall participate in a program review of the program at least yearly or
16 more frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
17 information requested by the COUNTY, DHCS and/or the subcontractor during the program evaluation,
18 monitoring, and/or review.
19 14. REFERENCES TO LAWS AND RULES
20 In the event any law, regulation, or policy referred to in this Agreement is amended
21 during the term thereof, the parties hereto agree to comply with the amended provision as of the
22 effective date of such amendment.
23 15. COMPLIANCE WITH STATE REQUIREMENTS
24 CONTRACTOR(S) recognizes that COUNTY operates its mental health programs under
25 an agreement with DHCS, and that under said agreement the State imposes certain requirements on
26 COUNTY and its subcontractors. CONTRACTOR(S) shall adhere to all State requirements, including
27 those identified in Exhibit C "State Mental Health Requirements", attached hereto and by this reference
28 incorporated herein and made part of this Agreement.
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1 16. CONFIDENTIALITY
2 All services performed by CONTRACTOR(S) under this Agreement shall be in strict
3 conformance with all applicable Federal, State of California and /or local laws and regulations relating
4 to confidentiality.
5 17. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
6 COUNTY and CONTRACTOR(S) each consider and represent themselves as covered
7 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
8 104-191(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
9 COUNTY and CONTRACTOR(S) acknowledge that the exchange of PHI between them
10 is only for treatment, payment, and health care operations.
11 COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
12 security of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information
13 Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
14 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
15 and other applicable laws.
16 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
17 CONTRACTOR(S) to enter into a contract containing specific requirements prior to the disclosure of
18 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
19 Code of Federal Regulations (CFR).
20 18. DATA SECURITY
21 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
22 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
23 COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
24 into a contractual relationship with the COUNTY for the purpose of providing services under this
25 Agreement must employ adequate data security measures to protect the confidential information
26 provided to CONTRACTOR(S) by the COUNTY, including but not limited to the following:
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1 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices CONTRACTOR
2 may not connect to COUNTY networks via personally-owned mobile, wireless or handheld devices,
3 unless the following conditions are met:
4 1. CONTRACTOR has received authorization by COUNTY for
5 telecommuting purposes;
6 2. Current virus protection software is in place;
7 3. Mobile device has the remote wipe feature enabled; and
8 4. A secure connection is used.
9 B. CONTRACTOR-Owned Computers or Computer Peripherals CONTRACTOR
10 may not bring CONTRACTOR-owned computers or computer peripherals into the COUNTY for use
11 without prior authorization from the COUNTY's Chief Information Officer, and/or designee(s), including
12 but not limited to mobile storage devices. If data is approved to be transferred, data must be stored on
13 a secure server approved by the COUNTY and transferred by means of a Virtual Private Network
14 (VPN) connection, or another type of secure connection. Said data must be encrypted.
15 C. COUNTY-Owned Computer Equipment CONTRACTOR, including its
16 subcontractors and employees, may not use COUNTY computers or computer peripherals on non-
17 COUNTY premises without prior authorization from the COUNTY's Chief Information Officer, and/or
18 designee(s).
19 D. CONTRACTOR(S) may not store COUNTY's private, confidential or sensitive
20 data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
21 E. CONTRACTOR(S) shall be responsible to employ strict controls to ensure the
22 integrity and security of COUNTY's confidential information and to prevent unauthorized access,
23 viewing, use or disclosure of data maintained in computer files, program documentation, data
24 processing systems, data files and data processing equipment which stores or processes COUNTY
25 data internally and externally.
26 F. Confidential client information transmitted to one party by the other by means of
27 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
28 BIT or higher. Additionally, a password or pass phrase must be utilized.
16
1 G. CONTRACTOR(S) is responsible to immediately notify COUNTY of any
2 violations, breaches or potential breaches of security related to COUNTY's confidential information,
3 data maintained in computer files, program documentation, data processing systems, data files and
4 data processing equipment which stores or processes COUNTY data internally or externally.
5 H. COUNTY shall provide oversight to CONTRACTOR(S)'s response to all incidents
6 arising from a possible breach of security related to COUNTY's confidential client information provided
7 to CONTRACTOR(S). CONTRACTOR(S)will be responsible to issue any notification to affected
8 individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
9 CONTRACTOR(S) will be responsible for all costs incurred as a result of providing the required
10 notification.
11 19. PROPERTY OF COUNTY
12 A. COUNTY and CONTRACTOR(S) recognize that fixed assets are tangible and
13 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
14 capacity and will benefit COUNTY for a period more than one (1) year. Depreciation of the qualified
15 items will be on a straight-line basis.
16 For COUNTY purposes, fixed assets must fulfill three qualifications:
17 1. Asset must have life span of over one year;
18 2. The asset is not a repair part; and
19 3. The asset must be valued at or greater than the capitalization
20 thresholds for the asset type:
21 Asset type Threshold
22 • Land $0
23 • Buildings and improvements $100,000
24 • Infrastructure $100,000
25 • Tangible $5,000
26 o equipment
27 o vehicles
28 • Intangible $100,000
17
1 o Internally generated software
2 o Purchased software
3 o Easements
4 o Patents
5 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
6 approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed Asset
7 Log will be maintained by COUNTY's Asset Management System and inventoried annually until the
8 asset is fully depreciated. During the terms of this Agreement, CONTRACTOR(S)'s fixed assets may
9 be inventoried in comparison to COUNTY's DBH Asset Inventory System.
10 B. Certain purchases under Five Thousand and No/100 Dollars ($5,000.00) with
11 over one (1) year life span, and are mobile and high risk of theft or loss are sensitive assets. Such
12 sensitive items include, but are not limited to computers, copiers, televisions, cameras and other
13 sensitive items as determined by COUNTY's DBH Director or designee. CONTRACTOR(S) maintains
14 a tracking system on the items and the items are not required to be capitalized or depreciated. The
15 items are subject to annual inventory for compliance.
16 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
17 Agreement is terminated or upon expiration of this Agreement. CONTRACTOR(S) agrees to
18 participate in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination of this
19 Agreement, CONTRACTOR(S) shall be physically present when fixed and inventoried assets are
20 returned to COUNTY possession. CONTRACTOR(S) is responsible for returning to COUNTY all
21 COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
22 unable to produce the assets at the expiration or termination of this Agreement.
23 CONTRACTOR(S)further agrees to the following:
24 1. To maintain all items of equipment in good working order and
25 condition, normal wear and tear excepted;
26 2. To label all items of equipment with COUNTY assigned program
27 number, to perform periodic inventories as required by COUNTY and
28 to maintain an inventory list showing where and how the equipment is
18
1 being used in accordance with procedures developed by COUNTY.
2 All such lists shall be submitted to COUNTY within ten (10) days of
3 any request therefore;
4 3. To report in writing to COUNTY immediately after discovery, the loss
5 or theft of any items of equipment. For stolen items, the local law
6 enforcement agency must be contacted and a copy of the police
7 report submitted to COUNTY.
8 D. The purchase of any equipment by CONTRACTOR(S) with funds provided
9 hereunder shall require the prior written approval of COUNTY's DBH Director or designee, shall fulfill
10 the provisions of this Agreement as appropriate, and must be directly related to CONTRACTOR(S)'s
11 services or activity under the terms of this Agreement. COUNTY's DBH may refuse reimbursement for
12 any costs resulting from equipment purchased, which are incurred by CONTRACTOR(S), if prior written
13 approval has not been obtained from COUNTY's DBH Director or designee.
14 E. CONTRACTOR(S) must obtain prior written approval form COUNTY's DBH
15 whenever there is any modification or change in the use of any property acquired or improved, in whole
16 or in part, using funds under this Agreement. If any real or personal property acquired or improved with
17 said funds identified herein is sold and/or is utilized by CONTRACTOR(S)for a use which does not
18 qualify under this program, CONTRACTOR(S) shall reimburse COUNTY in an amount equal to the
19 current fair market value of the property, less any portion thereof attributable to expenditures of
20 nonprogram funds. These requirements shall continue in effect for the life of the property. In the event
21 the program is closed out, the requirements for this Section shall remain in effect for activities or
22 property funded with said funds, unless action is taken by the State government to relieve COUNTY of
23 these obligations.
24 20. NON-DISCRIMINATION
25 During the performance of this Agreement, CONTRACTOR(S) shall not unlawfully
26 discriminate against any employee or applicant for employment, or recipient of services, because of
27 race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
28 condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
19
1 sexual orientation, or military or veteran status pursuant to all applicable State and Federal statutes and
2 regulations.
3 A. Eligibility for Services - CONTRACTOR(S) shall prepare, prominently post in its
4 facility, and make available to the DBH Director or designee and to the public all eligibility requirements
5 to participate in the program funded under this Agreement. CONTRATOR(S) shall not unlawfully
6 discriminate in the provision of services because of race, religious creed, color, national origin,
7 ancestry, physical disability, mental disability, medical condition, genetic information, marital status,
8 sex, gender, gender identity, gender expression, age, sexual orientation, or military or veteran status as
9 provided by State of California and Federal law in accordance with Title VI of the Civil Rights Act of
10 1964 (42 USC section 2000(d)); Age Discrimination Act of 1975 (42 USC section 1681); Rehabilitation
11 Act of 1973 (29 USC section 794); Education Amendments of 1972 (20 USC section 1681); Americans
12 with Disabilities Act of 1990 (42 USC section 12132); Title 45, Code of Federal Regulations, Part 84;
13 provisions of the Fair Employment and Housing Act (California Government Code section 12900); and
14 regulations promulgated thereunder (Title 2, CCR, section 7285.0); Title 2, Division 3, Article 9.5 of the
15 California Government Code commencing with section 11135; and Title 9, Division 4, Chapter 6 of the
16 California Code of Regulations commencing with section 10800.
17 B. Equal Opportunity- CONTRACTOR(S) shall comply with California Government
18 Code, section 12990 and California Code of Regulations, Title II, Division 4, Chapter 5, in matters
19 related to the development, implementation, and maintenance of a nondiscrimination program.
20 CONTRACTOR(S) shall not discriminate against any employee or applicant for employment because of
21 race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
22 condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
23 sexual orientation, or military or veteran status. Such practices include retirement, recruitment,
24 advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates of pay or other forms of
25 compensation, use of facilities, and other terms and conditions of employment. CONTRACTOR(S)
26 agrees to post in conspicuous places, notices available to all employees and applicants for employment
27 setting forth the provisions of the Equal Opportunity Act (42 USC section 2000(e)) in conformance with
28
20
1 Federal Executive Order No. 11246. CONTRACTOR(S) agrees to comply with the provisions of the
2 Rehabilitation Act of 1973 (29 USC section 794).
3 C. Suspension of Compensation - If an allegation of discrimination occurs, DBH
4 may withhold all further funds, until CONTRACTOR(S) can show by clear and convincing evidence to
5 the satisfaction of DBH that funds provided under this Agreement were not used in connection with the
6 alleged discrimination.
7 D. Nepotism - Except by consent of the DBH Director or designee, no person shall
8 be employed by CONTRACTOR(S) who is related by blood or marriage to or who is a member of the
9 Board of Directors or an officer of CONTRACTOR.
10 E. New Facilities and Disability Access - New facilities shall be wheelchair
11 accessible and provide access to the disabled, consistent with Title 9, California Code of Regulations,
12 section 10820. If a new facility will be utilized, a plan ensuring accessibility to the disabled must be
13 developed. DBH shall assess, monitor, and document CONTRACTOR(S)' compliance with the
14 Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
15 recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without
16 regard to physical or mental disability and that CONTRACTOR(S) has provided a facility accessible to
17 the physically disabled.
18 21. CULTURAL COMPETENCY
19 A. As related to Cultural and Linguistic Competence, CONTRACTOR(S) shall
20 comply with: A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R. Part 80)
21 and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance from
22 discriminating against persons based on race, color, national origin, sex, disability or religion. This is
23 interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
24 participation in federally funded programs through the provision of comprehensive and quality bilingual
25 services.
26 B. Policies and procedures for ensuring access and appropriate use of trained
27 interpreters and material translation services for all LEP clients, including, but not limited to, assessing
28 the cultural and linguistic needs of its clients, training of staff on the policies and procedures, and
21
1 monitoring its language assistance program. The CONTRACTOR(S)'s procedures must include
2 ensuring compliance of any sub-contracted contractors with these requirements.
3 C. CONTRACTOR(S) shall not use minors as interpreters.
4 D. CONTRACTOR(S) shall provide and pay for interpreting and translation services
5 to persons participating in CONTRACTOR(S)'s services who have limited or no English language
6 proficiency, including services to persons who are deaf or blind. Interpreter and translation services
7 shall be provided as necessary to allow such participants meaningful access to the programs, services
8 and benefits provided by CONTRACTOR(S). Interpreter and translation services, including translation
9 of CONTRACTOR(S)'s "vital documents" (those documents that contain information that is critical for
10 accessing CONTRACTOR(S)'s services or are required by law) shall be provided to participants at no
11 cost to the participant. CONTRACTOR(S) shall ensure that any employees, agents, subcontractors, or
12 partners who interpret or translate for a program participant, or who directly communicate with a
13 program participant in a language other than English, demonstrate proficiency in the participant's
14 language and can effectively communicate any specialized terms and concepts peculiar to
15 CONTRACTOR(S)'s services.
16 E. In compliance with the State mandated Culturally and Linguistically Appropriate
17 Services standards as published by the Office of Minority Health, CONTRACTOR(S) must submit to
18 COUNTY for approval, within sixty (60) days from date of contract execution, CONTRACTOR(S)'s plan
19 to address all fifteen national cultural competency standards as set forth in Exhibit D, "National
20 Standards for Culturally and Linguistically Appropriate Services in Health and Heath Care," attached
21 hereto and incorporated by this reference. COUNTY's annual on-site review of CONTRACTOR(S) shall
22 include collection of documentation to ensure all national standards are implemented. As the national
23 competency standards are updated, CONTRACTOR(S)'s plan must be updated accordingly.
24 22. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
25 To the extent necessary to prevent disallowance of reimbursement under section
26 1861(v) (1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four
27 (4) years after the furnishing of services under this Agreement, CONTRACTOR(S) shall make
28 available, upon written request of the Secretary of the United States Department of Health and Human
22
1 Services, or upon request of the Comptroller General of the United States General Accounting Office,
2 or any of their duly authorized representatives, a copy of this Agreement and such books, documents,
3 and records as are necessary to certify the nature and extent of the costs of these services provided by
4 CONTRACTOR(S) under this Agreement. CONTRACTOR(S) further agrees that in the event
5 CONTRACTOR(S) carries out any of its duties under this Agreement through a subcontract, with a
6 value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month
7 period, with a related organization, such Agreement shall contain a clause to the effect that until the
8 expiration of four (4) years after the furnishing of such services pursuant to such subcontract, the
9 related organizations shall make available, upon written request of the Secretary of the United States
10 Department of Health and Human Services, or upon request of the Comptroller General of the United
11 States General Accounting Office, or any of their duly authorized representatives, a copy of such
12 subcontract and such books, documents, and records of such organization as are necessary to verify
13 the nature and extent of such costs.
14 23. SINGLE AUDIT CLAUSE
15 A. If any CONTRACTOR(S) expends Seven Hundred Fifty Thousand Dollars
16 ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR(S) agrees to
17 conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth
18 in Office of Management and Budget (OMB) Circular A-133. CONTRACTOR(S) shall submit said audit
19 and management letter to COUNTY. The audit must include a statement of findings or a statement that
20 there were no findings. If there were negative findings, CONTRACTOR(S) shall include a corrective
21 action plan signed by an authorized individual. CONTRACTOR(S) agrees to take action to correct any
22 material non-compliance or weakness found as a result of such audit. Such audits shall be delivered to
23 COUNTY's DBH Business Office for review within nine (9) months of the end of any fiscal year in which
24 funds were expended and/or received for the program. Failure to perform the requisite audit functions
25 as required by this Agreement may result in COUNTY performing the necessary audit tasks, or at
26 COUNTY's option, contracting with a public accountant to perform said audit, or may result in the
27 inability of COUNTY to enter into future agreements with CONTRACTOR(S). All audit costs related to
28 this Agreement are the sole responsibility of CONTRACTOR(S).
23
1 B. A single audit report is not applicable if CONTRACTOR(S)'s Federal contracts do
2 not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or
3 CONTRACTOR(S)'s only funding is through Medi-Cal. If a single audit is not applicable, a program
4 audit must be performed and a program audit report with management letter shall be submitted by
5 CONTRACTOR(S) to COUNTY as a minimum requirement to attest to CONTRACTOR(S)'s solvency.
6 Said audit reports shall be delivered to COUNTY's DBH Business Office for review no later than nine
7 (9) months after the close of the fiscal year in which the funds supplied through this Agreement are
8 expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks
9 or contracting with a qualified accountant to perform said audit. All audit costs related to this
10 Agreement are the sole responsibility of CONTRACTOR(S) who agrees to take corrective action to
11 eliminate any material noncompliance or weakness found as a result of such audit. Audit work
12 performed by COUNTY under this Section shall be billed to the CONTRACTOR(S) at COUNTY's cost,
13 as determined by COUNTY's Auditor-Controller/Treasurer-Tax Collector.
14 C. CONTRACTOR(S) shall make available all records and accounts for inspection
15 by COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
16 Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
17 period of at least three (3) years following final payment under this Agreement or the closure of all other
18 pending matters, whichever is later.
19 24. COMPLIANCE
20 CONTRACTOR(S) agrees to comply with COUNTY's Contractor Code of Conduct and
21 Ethics and the COUNTY's Compliance Program in accordance with Exhibit E, "Fresno County Mental
22 Health Plan Compliance Program." Within thirty (30) days of entering into this Agreement with the
23 COUNTY, CONTRACTOR(S) shall have all of CONTRACTOR(S)'s employees, agents and
24 subcontractors providing services under this Agreement certify in writing, that he or she has received,
25 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S)
26 shall ensure that within thirty (30) days of hire, all new employees, agents and subcontractors providing
27 services under this Agreement shall certify in writing that he or she has received, read, understood, and
28 shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S) understand that the
24
1 promotion of and adherence to the code of Conduct and Ethics is an element in evaluating the
2 performance of CONTRACTOR(S) and its employees, agents and subcontractors.
3 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
4 employees, agent and subcontractors providing services under this Agreement shall complete general
5 compliance training and appropriate employees, agents and subcontractors shall complete
6 documentation and billing or billing/reimbursement training. All new employees, agents and
7 subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual
8 required to attend training shall certify in writing that he or she has received the required training. The
9 certification shall specify the type of training received and the date received. The certification shall be
10 provided to the COUNTY's Compliance Officer at 3133 N. Millbrook, Fresno, California 93703.
11 CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
12 COUNTY by the Federal Government as a result of CONTRACTOR(S)'s violation of the terms of this
13 Agreement.
14 25. ASSURANCES
15 In entering into this Agreement, CONTRACTOR(S) certifies that it nor any of its officers are not
16 currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health
17 Care Programs: that it or any of its officers have not been convicted of a criminal offense related to the
18 provision of health care items or services; nor have they been reinstated to participate in the Federal
19 Health Care Programs after a period of exclusion, suspension, debarment, or ineligibility. If COUNTY
20 learns, subsequent to entering into this Agreement, that CONTRACTOR(S) is ineligible on these
21 grounds, COUNTY will remove CONTRACTOR(S) from responsibility for, or involvement with,
22 COUNTY's business operations related to the Federal Health Care Programs and shall remove such
23 CONTRACTOR(S) from any position in which CONTRACTOR(S)'s compensation, or the items or
24 services rendered, ordered or prescribed by CONTRACTOR(S) may be paid in whole or part, directly or
25 indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time as
26 CONTRACTOR(S) is reinstated into participation in the Federal Health Care Programs.
27 A. If COUNTY has notice that CONTRACTOR(S) has been charged with a criminal
28 offense related to any Federal Health Care Programs, or proposed for exclusion during the term on any
25
1 contract, CONTRACTOR(S) and COUNTY shall take all appropriate actions to ensure the accuracy of
2 any claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
3 COUNTY may request that CONTRACTOR(S) cease providing services until resolution of the charges
4 or the proposed exclusion.
5 B. CONTRACTOR(S) agrees that all potential new employees of CONTRACTOR or
6 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
7 under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
8 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
9 they have been convicted of criminal offense related to the provision of health care items or services;
10 and or (3) they have been reinstated to participate in the Federal Health Care Programs after a period
11 of exclusion, suspension, debarment, or ineligibility.
12 1. In the event the potential employee or subcontractor informs
13 CONTRACTOR(S) that he or she is excluded, suspended, debarred or
14 otherwise ineligible, or has been convicted of a criminal offense relating to the
15 provision of health care services, and CONTRACTOR hires or engages such
16 potential employee or subcontractor, the CONTRACTOR will ensure that said
17 employee or subcontractor does no work, either directly or indirectly relating to
18 services provided to COUNTY.
19 2. Notwithstanding the above, COUNTY at its discretion may terminate this
20 Agreement in accordance with Section Three (3) —TERMINATION - of this
21 Agreement, or require adequate assurance (as defined by COUNTY) that no
22 excluded, suspended or otherwise ineligible employee of CONTRACTOR(S)
23 will perform work, either directly or indirectly, relating to services provided to
24 COUNTY. Such demand for adequate assurance shall be effective upon a
25 time frame to be determined by COUNTY to protect the interests of COUNTY
26 clients.
27 C. CONTRACTOR(S) shall verify (by asking the applicable employees and
28 subcontractors) that all current employees and existing subcontractors who, in each case, are expected
26
1 to perform professional services under this Agreement: (1) are not currently excluded, suspended,
2 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
3 convicted of a criminal offense related to the provision of health care items or services; and (3) have not
4 been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
5 suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs a
6 CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligible to
7 participate in the Federal Health Care Programs, or has been convicted of a criminal offense relating to
8 the provision of heath care services, CONTRACTOR(S) will ensure that said employee or
9 subcontractor does no work, either direct or indirect, relating to services provided to COUNTY.
10 1. CONTRACTOR(S) agrees to notify COUNTY immediately during the term of
11 this Agreement whenever CONTRACTOR learns that an employee or
12 subcontractor who, in each case, is providing professional services under
13 Section One (1)— SERVICES - of this Agreement is excluded, suspended,
14 debarred or otherwise ineligible to participate in the Federal Health Care
15 Programs, or is convicted of a criminal offense relating to the provision of
16 health care services.
17 2. Notwithstanding the above, COUNTY at its discretion may terminate this
18 Agreement in accordance with Section Three (3) - TERMINATION - of this
19 Agreement, or require adequate assurance (as defined by COUNTY) that no
20 excluded, suspended or otherwise ineligible employee or subcontractor of
21 CONTRACTOR(S) will perform work, either directly or indirectly, relating to
22 services provided to COUNTY. Such demand for adequate assurance shall
23 be effective upon a time frame to be determined by COUNTY to protect the
24 interests of COUNTY clients.
25 D. CONTRACTOR(S) agrees to cooperate fully with any reasonable requests for
26 information from COUNTY which may be necessary to complete any internal or external audits relating
27 to CONTRACTOR(S)'s compliance with the provisions of this Section.
28
27
1 E. CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any
2 penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S)'s
3 violation of CONTRACTOR(S)'s obligations as described in this Section.
4 26. PROHIBITION ON PUBLICITY
5 None of the funds, materials, property or services provided directly or indirectly under
6 this Agreement shall be used for CONTRACTOR(S)'s advertising, fundraising, or publicity (i.e.,
7 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
8 Notwithstanding the above, publicity of the services described in Section One (1)— SERVICES —of this
9 Agreement shall be allowed as necessary to raise public awareness about the availability of such
10 specific services when approved in advance by COUNTY's DBH Director or designee and at a cost to
11 be provided in Section Four (4)— COMPENSATION - of this Agreement for such items as
12 written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
13 expense(s).
14 27. SUBCONTRACTS
15 CONTRACTOR(S) shall be required to assume full responsibility for all services and
16 activities covered by this Agreement, whether or not the CONTRACTOR is providing services directly.
17 Further, CONTRACTOR(S) shall be the sole point of contact with regard to contractual matters,
18 including payment of any and all charges resulting from this Agreement.
19 If CONTRACTOR(S) should propose to subcontract with one or more third parties to
20 carry out a portion of services covered by this Agreement, any such subcontract shall be in writing and
21 approved as to form and context by COUNTY's DBH Director, or designee prior to execution and
22 implementation. COUNTY's DBH Director, or designee, shall have the right to reject any such
23 proposed subcontract. Any such subcontract together with all activities by or caused by
24 CONTRACTOR(S) shall not require compensation greater than the total budget contained herein. An
25 executed copy of any such subcontract shall be received by COUNTY before any implementation and
26 shall be retained by COUNTY. CONTRACTOR(S) shall be responsible to COUNTY for the proper
27 performance of any subcontract. Any subcontractor shall be subject to the same terms and conditions
28 that CONTRACTOR is subject to under this Agreement.
28
1 It is expressly recognized that CONTRACTOR(S) cannot engage in the practice of
2 medicine. If any medical services are to be provided in connection with the services under this
3 Agreement, such medical services shall be performed by an independent contracted physician. In this
4 instance, the requirements of the Confidential Medical Information Act (Civil Code 56 et. seq.) shall be
5 met.
6 If CONTRACTOR(S) hires an independent contracted physician, CONTRACTOR(S)
7 shall require and ensure that such independent contracted physician carries Professional Liability
8 (Medical Malpractice) Insurance, with limits of not less than One Million Dollars ($1,000,000.00) per
9 occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
10 28. CONTROL REQUIREMENTS
11 Performance under this Agreement is subject to all applicable Federal and State laws,
12 regulations and standards. In accepting the State drug and alcohol combined program allocation,
13 CONTRACTOR(S) shall establish written accounting procedures consistent with applicable Federal and
14 State laws, regulations and standards, and shall be held accountable for audit exceptions taken by the
15 State or COUNTY for failure to comply with these requirements. These requirements include, but may
16 not be limited to, those set forth in this Agreement, and:
17 A. Division 10.5 of the California Health and Safety Code;
18 B. California Government Code sections 16366.1 through 16367.8 and 53130
19 through 53138;
20 C. Title 9, Division 4 of the California Code of Regulations;
21 D. 42 United States Code (U.S.C.) section 300x-5;
22 E. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single
23 Audit Act Amendments of 1996);
24 D. Office of Management and Budget (OMB) Circular A-133 (Audits of States, Local
25 Governments and Non-Profit Organizations); and G. Title 45, Part 96, Subparts B, C
26 and L of the Code of Federal Regulations (Block Grants).
27 1H
28 1H
29
1 29. CHANGE OF LEADERSHIP / MANAGEMENT
2 Any and all notices between COUNTY and CONTRACTOR(S) provided for or permitted
3 under this Agreement or by law, shall be in writing and shall be deemed duly served when personally
4 delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
5 Mail, postage prepaid, addressed to such party.
6 In the event of any change in the status of CONTRACTOR(S)' leadership or
7 management, CONTRACTOR(S) shall provide written notice to COUNTY within thirty (30) days from
8 the date of change. Such notification shall include any new leader or manager's name, address and
9 qualifications. "Leadership or management" shall include any employee, member, or owner of
10 CONTRACTOR(S) who either:
11 A. Directs individuals providing services pursuant to this Agreement,
12 B. Exercises control over the manner in which services are provided,
13 C. Has authority over CONTRACTOR(S)'s finances.
14 30. CHILD ABUSE REPORTING
15 CONTRACTOR(S) shall utilize a procedure acceptable to the COUNTY to ensure that all
16 of CONTRACTOR(S)' employees, volunteers, consultants, subcontractors or agents performing
17 services under this Agreement shall report all known or suspected child abuse or neglect to one or
18 more of the agencies set forth in Penal Code section 11165.9. This procedure shall include having all
19 of CONTRACTOR(S)'s employees, volunteers, consultants, subcontractors or agents performing
20 services under this Agreement sign a statement that he or she knows of and will comply with the
21 reporting requirements set forth in Penal Code section 11166. The statement to be utilized by
22 CONTRACTOR(S) for reporting is set forth in Exhibit F, "Notice of Child Abuse Reporting Law,"
23 attached hereto and by this reference incorporated herein.
24 31. CONFLICT OF INTEREST
25 No officer, agent, or employee of COUNTY who exercises any function or responsibility
26 for planning and carrying out the services provided under this Agreement shall have any direct or
27 indirect personal financial interest in this Agreement. CONTRACTOR(S) shall comply with all Federal,
28 State of California, and local conflict of interest laws, statutes, and regulations, which shall be
30
1 applicable to all parties and beneficiaries under this Agreement and any officer, agent, or employee of
2 COUNTY.
3 32. DRUG-FREE WORKPLACE
4 CONTRACTOR(S) shall comply with the requirements of the Drug-Free Work Place Act
5 of 1990 (California Government Code section 8350).
6 33. CHARITABLE CHOICE
7 CONTRACTOR(S) may not discriminate in its program delivery against a client or
8 potential client on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal
9 to actively participate in a religious practice. Any specifically religious activity or service made available
10 to individuals by the CONTRACTOR(S) must be voluntary as well as separate in time and location from
11 County funded activities and services. CONTRACTOR(S) shall inform County as to whether it is faith-
12 based. If CONTRACTOR(S) identifies as faith-based it must submit to DBH Contracts Division - SUD
13 Services a copy of its policy on referring individuals to alternate treatment CONTRACTOR, and include
14 a copy of this policy in its client admission forms. The policy must inform individuals that they may be
15 referred to an alternative contractor if they object to the religious nature of the program, and include a
16 notice to DBH Contracts Division - SUD Services. Adherence to this policy will be monitored during
17 annual site reviews, and a review of client files. If CONTRACTOR(S) identifies as faith-based, by July
18 1 of each year CONTRACTOR(S) will be required to report to DBH-Contracts the number of individuals
19 who requested referrals to alternate contractors based on religious objection.
20 34. AOD CERTIFICATION
21 A. The COUNTY requires all COUNTY contracted contractors of Alcohol and Other
22 Substance Use Disorder treatment services to obtain the California Department of Health Care
23 Services (DHCS) Alcohol and Other Drug Program (AOD) Certification. The AOD Certification
24 Standards will apply to all residential and outpatient treatment modalities. The purpose of the AOD
25 Certification Standards is to ensure an acceptable level of service quality is provided to program
26 participants.
27 B. CONTRACTOR(S) shall provide proof of a completed application for AOD
28 Certification to the County within Thirty (30) days from the execution date of this Amendment to the
31
1 current Agreement with the COUNTY. A copy of the AOD Certification shall be submitted to the
2 COUNTY when approved by the DHCS.
3 C. This AOD Certification requirement applies to every primary treatment facility
4 operated by the CONTRACTOR(S). CONTRACTOR(S) is not required to obtain a separate AOD
5 Certification for satellite sites associated with CONTRACTOR(S)'s primary treatment facility. Satellite
6 sites are expected to operate within the same AOD Certification guidelines and maintain the same
7 standards as the CONTRACTOR(S)'s related primary site. CONTRACTOR(S)'s whose agencies are
8 nationally accredited with the Joint Commission on Accreditation of Health Care Organizations
9 (JCAHO) or the Commission on Accreditation of Rehabilitative Facilities (CARF) are exempt from this
10 requirement of AOD Certification. CONTRACTOR(S) shall submit a copy of their JCAHO or CARF
11 accreditation to the COUNTY within Thirty (30) days from the date this Amendment is executed.
12 CONTRACTOR(S) shall notify COUNTY if at any time their JCAHO or CARF accreditation lapses or
13 becomes invalid due to any reason during the term of this Agreement. CONTRACTOR(S) shall apply
14 with DHCS for AOD Certification if their JCAHO or CARF accreditation lapses or becomes invalid and
15 shall submit a copy of the completed application for AOD Certification to the COUNTY within Thirty (30)
16 days from the date the JCAHO or CARF accreditation lapses or becomes invalid.
17 D. COUNTY shall terminate this Agreement immediately in the event any of the
18 following occurs:
19 1. CONTRACTOR(S)fails to submit a copy of the completed application
20 for AOD Certification, or a copy of either their JCAHO or CARF
21 accreditation within Thirty (30) days from the execution date of this
22 Amendment to the current Agreement with the COUNTY.
23 2. CONTRACTOR(S)'s application for AOD Certification is denied by the
24 DHCS.
25 3. CONTRACTOR(S)fails to submit to the COUNTY a copy of the AOD
26 Certification within Thirty (30) days after being approved by the DHCS, or
27 certification is not maintained throughout the contract period.
28 4. CONTRACTOR(S) fails to apply for AOD Certification with DHCS or
32
1 fails to submit to the COUNTY a copy of the completed application for
2 AOD Certification within Thirty (30) days after the JCAHO or CARF
3 accreditation lapses or becomes invalid.
4 35. NO THIRD PARTY BENEFICIARIES
5 It is understood and agreed by and between the parties that the services provided by
6 CONTRACTOR(S)for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in
7 this Agreement is intended to confer on any person other than the parties hereto any right under or by
8 reason of this Agreement.
9 36. SMOKING PROHIBITION REQUIREMENTS
10 CONTRACTOR(S) shall comply with Public Law 103-227, also known as the Pro-
11 Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5,
12 the California Smoke-Free Workplace Law.
13 37. COMPLAINTS
14 CONTRACTOR(S) shall log complaints and the disposition of all complaints from a client
15 or a client's family. CONTRACTOR(S) shall provide a copy of the detailed complaint log entries
16 concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of the
17 following month, in a format that is mutually agreed upon. In addition, CONTRACTOR(S) shall provide
18 details and attach documentation of each complaint with the log. CONTRACTOR(S) shall post signs
19 informing clients of their right to file a complaint or grievance. CONTRACTOR(S) shall notify COUNTY
20 of all incidents reportable to State licensing bodies that affect COUNTY clients within twenty-four (24)
21 hours of receipt of a complaint.
22 Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
23 clients, CONTRACTOR(S) shall provide COUNTY with information relevant to the complaint,
24 investigative details of the complaint, the complaint and CONTRACTOR(S)'s disposition of, or
25 corrective action taken to resolve the complaint. In addition, CONTRACTOR(S) shall inform every
26 client of their rights as set forth in Exhibit G, "Fresno County Mental Health Plan."
27
28
33
1 38. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
2 This provision is only applicable if CONTRACTOR(S) is a disclosing entity, fiscal agent,
3 or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
4 and 455.106(a)(1),(2).
5 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
6 the following information must be disclosed by CONTRACTOR(S) by completing Exhibit H, "Disclosure
7 of Ownership and Control Interest Statement," attached hereto and by this reference incorporated
8 herein and made part of this Agreement. CONTRACTOR(S) shall submit this form to COUNTY's DBH
9 within thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR(S) shall
10 report any changes to this information within thirty-five (35) days of occurrence by completing a new
11 Exhibit H, "Disclosure of Ownership and Control Interest Statement." Submissions shall be scanned
12 pdf copies and are to be sent via email to SAS@co.fresno.ca.us attention: Contracts Administration.
13 A. Name and address of any person(s) whether it be an individual or corporation
14 with an ownership or controlling interest in the disclosing entity or managed care entity.
15 1) Address must include the primary business address, every business location
16 and P.O. Box address(es).
17 2) Date of birth and Social Security Number for individuals.
18 3) Tax identification number for other corporations or entities with ownership or
19 controlling interest in the disclosing entity.
20 B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more.
21 interest.
22 C. Whether the person(s)with an ownership or controlling interest of the disclosing
23 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
24 or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
25 related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
26 interest in any of its subcontractors.
27 D. Name of any other disclosing entity in which an owner of the disclosing entity
28 has an ownership or control interest.
34
1 E. The ownership of any subcontractor with whom the contractor has had business
2 transactions totaling more than $25,000 during the 12-month period ending on the date of the request.
3 F. Any significant business transactions between the contractor and any wholly
4 owned supplier, or between the contractor and any subcontractor, during the 5-year period ending on
5 the date of the request.
6 G. Any person(s) with an ownership or control interest in the contractor, or agent or
7 managing employee of the contractor; and
8 1) Has been convicted of a criminal offense related to that person's involvement
9 in any program under Medicare, Medicaid, or the title XX services program
10 since the inception of those programs.
11 H. The ownership of any subcontractor with whom the contractor has had business
12 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
13 and
14 I. Any significant business transactions between the contractor and any wholly
15 owned supplier, or between the contractor and any subcontractor, during the 5-year period ending on
16 the date of the request.
17 39. DISCLOSURE OF CRIMINAL HISTORY & CIVIL ACTIONS
18 CONTRACTOR(S) is required to disclose if any of the following conditions apply to
19 them, their owners, officers, corporate managers or partners (hereinafter collectively referred to as
20 "CONTRACTOR"):
21 A. Within the three-year period preceding the Agreement award, CONTRACTOR(S)
22 has been convicted of, or had a civil judgment tendered against it for:
23 1. Fraud or criminal offense in connection with obtaining, attempting to
24 obtain, or performing a public (federal, state, or local) transaction or contract
25 under a public transaction;
26 2. Violation of a federal or state antitrust statute;
27 3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
28 records; or
35
1 4. False statements or receipt of stolen property.
2 B. Within a three-year period preceding their Agreement award, CONTRACTOR(S)
3 has had a public transaction (federal, state, or local) terminated for cause or default.
4 Disclosure of the above information will not automatically eliminate CONTRACTOR(S) from further
5 business consideration. The information will be considered as part of the determination of whether to
6 continue and/or renew the Contract and any additional information or explanation that a
7 CONTRACTOR(S) elects to submit with the disclosed information will be considered. If it is later
8 determined that the CONTRACTOR(S) failed to disclose required information, any contract awarded to
9 such CONTRACTOR(S) may be immediately voided and terminated for material failure to comply with
10 the terms and conditions of the award.
11 CONTRACTOR(S) must sign a "Certification Regarding Debarment, Suspension, and Other
12 Responsibility Matters — Primary Covered Transactions" in the form set forth in Exhibit I attached hereto
13 and by this reference incorporated herein. Additionally CONTRACTOR(S) must immediately advise the
14 COUNTY in writing if, during the term of the Agreement: (1) CONTRACTOR becomes suspended,
15 debarred, excluded or ineligible for participation in federal or state funded programs or from receiving
16 federal funds as listed in the excluded parties list system (http://www.sam.gov); or (2) any of the above
17 listed conditions become applicable to CONTRACTOR. CONTRACTOR(S) shall indemnify, defend
18 and hold the COUNTY harmless for any loss or damage resulting from a conviction, debarment,
19 exclusion, ineligibility or other matter listed in the signed "Certification Regarding Debarment,
20 Suspension, and other Responsible Matters".
21 40. DISCLOSURE OF SELF DEALING TRANSACTIONS
22 This provision is only applicable if the CONTRACTOR(S) is operating as a corporation (a
23 for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR(S)
24 changes its status to operate as a corporation.
25 Members of the CONTRACTOR(S)'s Board of Directors shall disclose any self-dealing
26 transactions that they are a party to while CONTRACTOR(S) is providing goods or performing services
27 under this agreement. A self-dealing transaction shall mean a transaction to which the
28 CONTRACTOR(S) is a party and in which one or more of its directors has a material financial interest.
36
1 Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
2 by completing and signing a "Self-Dealing Transaction Disclosure Form," attached hereto as Exhibit J
3 and by this reference incorporated herein and made part of this Agreement, and submitting it to the
4 COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
5 41. AUDITS AND INSPECTIONS
6 The CONTRACTOR(S) shall at any time during business hours, and as often as the
7 COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
8 data with respect to the matters covered by this Agreement. The CONTRACTOR(S) shall, upon
9 request by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary
10 to ensure CONTRACTOR(S)'s compliance with the terms of this Agreement.
11 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
12 CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor for a period of
13 three (3) years after final payment under contract (Government Code section 8546.7).
14 42. NOTICES
15 The persons having authority to give and receive notices under this Agreement and their
16 addresses include the following:
17 COUNTY CONTRACTOR
18 Director, Fresno County See Exhibit A
19 Department of Behavioral Health
20 3133 N. Millbrook Ave.
21 Fresno, CA 93703
22 Any and all notices between the COUNTY and the CONTRACTOR(S) provided for or
23 permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
24 personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
25 United States Mail, postage prepaid, addressed to such party.
26 43. STATE ALCOHOL AND DRUG REQUIREMENTS
27 A. INDEMNIFICATION
28
37
1 The CONTRACTOR(S) agrees to indemnify, defend and save harmless the
2 State, its officers, agents and employees from any and all claims and losses accruing or resulting to
3 any and all contractors, subcontractors, materialmen, laborers and any other person, firm or corporation
4 furnishing or supplying work, services, materials or supplies in connection with the performance of this
5 Agreement and from any and all claims and losses accruing or resulting to any person, firm or
6 corporation who may be injured or damaged by the CONTRACTOR(S) in the performance of this
7 Agreement.
8 B. INDEPENDENT CONTRACTOR
9 The CONTRACTOR(S) and the agents and employees of CONTRACTOR(S), in
10 the performance of this Agreement, shall act in an independent capacity and not as officers or
11 employees or agents of State of California.
12 C. CONTROL REQUIREMENTS
13 This Agreement is subject to all applicable Federal and State laws, regulations
14 and standards. CONTRACTOR(S) shall establish written procedures consistent with State-County
15 Contract requirements. The provisions of this Agreement are not intended to abrogate any provisions
16 of law or regulation existing or enacted during the term of this Agreement.
17 D. CONFIDENTIALITY
18 CONTRACTOR(S) shall conform to and COUNTY shall monitor compliance with
19 all State of California and Federal statutes and regulations regarding confidentiality, including but not
20 limited to confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations;
21 California Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6
22 of the California Health and Safety Code; Title 22, California Code of Regulations, section 51009; and
23 Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
24 E. REVENUE COLLECTION POLICY
25 CONTRACTOR(S) shall conform to all policies and procedures regarding
26 revenue collection issued by the State under the provisions of the Health and Safety Code, Division
27 10.5.
28
38
1 F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
2 CONTRACTOR(S) agrees that all funds paid out by the State shall be used
3 exclusively for providing alcohol and/or drug program services, administrative costs, and allowable
4 overhead.
5 G. ACCESS TO SERVICES
6 CONTRACTOR(S) shall provide accessible and appropriate services in
7 accordance with Federal and State statutes and regulations to all eligible persons.
8 H. REPORTS
9 CONTRACTOR(S) agrees to participate in surveys related to the performance of
10 this Agreement and expenditure of funds and agrees to provide any such information in a mutually
11 agreed upon format.
12 I. AUDITS
13 All State and Federal funds furnished to the CONTRACTOR(S) pursuant to this
14 Agreement along with related patient fees, third party payments, or other related revenues and funds
15 commingled with the foregoing funds are subject to audit by the State. The State may audit all alcohol
16 and drug program revenue and expenditures contained in this Agreement for the purpose of
17 establishing the basis for the subsequent year's negotiation.
18 J. RECORDS MAINTENANCE
19 1. CONTRACTOR(S) shall maintain books, records, documents, and other
20 evidence necessary to monitor and audit this Agreement.
21 2. CONTRACTOR(S) shall maintain adequate program and fiscal records
22 relating to individuals served under the terms of this Agreement, as required,
23 to meet the needs of the State in monitoring quality, quantity, fiscal
24 accountability, and accessibility of services. Information on each individual
25 shall include, but not be limited to, admission records, patient and participant
26 interviews and progress notes, and records of service provided by various
27 service locations, in sufficient detail to make possible an evaluation of
28 services provided and compliance with this Agreement.
39
1 44. COMPLIANCE WITH LAWS AND POLICIES
2 CONTRACTOR(S) shall comply with all applicable rules and regulations set forth in
3 Titles 9 and 22 of the California Code of Regulations, and California Health and Safety Code section
4 11750 et seq. CONTRACTOR(S) shall comply with any other Federal and State laws or guidelines
5 applicable to CONTRACTOR(S)'s performance under this Agreement or any local ordinances,
6 regulations, or policies applicable. Such provisions include, but are not restricted to:
7 A. CONTRACTOR(S) shall provide that each client's ability to pay for services is
8 determined by the use of the method approved by COUNTY.
9 B. CONTRACTOR(S) shall establish and use COUNTY's approved method of
10 determining and collecting fees from clients.
11 C. CONTRACTOR(S) shall furnish client records in accordance with the applicable
12 Federal and State regulations, and with the Standards for Alcohol and Drug Treatment Programs set
13 forth by the State Department of Alcohol and Drug Programs, including in such records a treatment
14 plan for each client, and evidence of each service rendered.
15 D. CONTRACTOR(S) shall submit accurate, complete and timely claims and cost
16 reports, reporting only allowable costs.
17 E. CONTRACTOR(S) shall comply with statistical reporting and program evaluation
18 systems as provided in State of California regulations and in this Agreement.
19 F. CONTRACTOR(S) shall comply with requirements contained in the State-County
20 Contract with DHCS by this reference incorporated herein, until such time that a new State-County
21 Contract is established. Upon amendment of the State-County Contract, the terms of the amended
22 Contract shall automatically be incorporated into this Agreement.
23 45. FEDERAL CERTIFICATIONS
24 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
25 VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS
26 A. DBH and CONTRACTOR(S) recognize that Federal assistance funds will be
27 used under the terms of this Agreement. For purposes of this section, DBH will be referred to as the
28 "prospective recipient".
40
1 B. This certification is required by the regulations implementing Executive Order
2 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants' responsibilities. The
3 regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).
4 1. The prospective recipient of Federal assistance funds certifies by entering
5 this Agreement, that neither it nor its principals are presently debarred,
6 suspended, proposed for debarment, declared ineligible, or voluntarily
7 excluded from participation in this transaction by any Federal department or
8 agency.
9 2. The prospective recipient of funds agrees by entering into this
10 Agreement, that it shall not knowingly enter into any lower tier covered
11 transaction with a person who is debarred, suspended, declared ineligible, or
12 voluntarily excluded from participation in this covered transaction, unless
13 authorized by the Federal department or agency with which this transaction
14 originated.
15 3. Where the prospective recipient of Federal assistance funds is unable to
16 certify to any of the statements in this certification, such prospective
17 participant shall attach an explanation to this Agreement.
18 4. The prospective recipient shall provide immediate written notice to DBH
19 if at any time prospective recipient learns that its certification in this clause of
20 this Agreement was erroneous when submitted or has become erroneous by
21 reason of changed circumstances.
22 5. The prospective recipient further agrees that by entering into this
23 Agreement, it will include a clause identical to this clause of this Agreement,
24 and titled "Certification Regarding Debarment, Suspension, Ineligibility and
25 Voluntary Exclusion Lower Tier Covered Transactions", in all lower tier
26 covered transactions and in all solicitations for lower tier covered
27 transactions.
28
41
1 6. The certification in this clause of this Agreement is a material representation
2 of fact upon which reliance was placed by COUNTY when this transaction
3 was entered into.
4 46. ADDITIONS OF CONTRACTORS
5 COUNTY's DBH Director, or designee, reserves the right at any time during the term of
6 this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A. It is understood any such
7 additions will not affect compensation paid to any other CONTRACTOR, and therefore such additions
8 may be made by COUNTY without notice to or approval of the other CONTRACTOR(S) under this
9 Agreement.
10 47. UNLAWFUL USE OF DRUGS AND ALCOHOL
11 CONTRACTOR(S) shall ensure that information provided to clients contains a clearly
12 written statement that there shall be no unlawful use of drugs or alcohol associated with
13 CONTRACTOR(S). Additionally CONTRACTOR(S) shall ensure that no aspect of the program
14 includes any message in materials, curricula, teachings, or promotion of the responsible use, if the use
15 is unlawful, of drugs or alcohol pursuant to Health and Safety Code sections 11999-11999.3.
16 CONTRACTOR(S) shall maintain that any unlawful use of drugs and alcohol is illegal and dangerous.
17 CONTRACTOR(S) must sign the "Unlawful Use of Drugs and Alcohol Certification", attached hereto as
18 Exhibit K, incorporated herein by reference and made part of the Agreement agreeing to uphold the
19 obligations of Health and Safety Code sections 11999-11999.3.
20 COUNTY shall enforce the requirement of"No Unlawful Use" set forth by DHCS and
21 requires CONTRACTOR(S) to enforce the requirement as well.
22 This agreement may be unilaterally terminated, without penalty, if CONTRACTOR(S) or
23 a subcontractor that is a private entity is determined to have violated a prohibition of the Unlawful Use
24 of Drugs and Alcohol message or has an employee who is determined by the DBH Director or designee
25 to have violated a prohibition of the Unlawful Use of Drugs and Alcohol message.
26 48. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
27 CONTRACTOR(S) shall adhere to the State-County Contract requirement that no funds
28 shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic
42
1 injection of any illegal drug unless the DHCS chooses to implement a demonstration syringe services
2 program for intravenous drug users with Substance Abuse Prevention and Treatment (SAPT) Block
3 Grant funds.
4 49. CONFIDENTIALITY OATH
5 CONTRACTOR(S) shall ensure that all of its employees sign a written confidentiality
6 oath, attached hereto as Exhibit L, before they begin employment with CONTRACTOR(S) and shall
7 renew said document annually thereafter. CONTRACTOR(S) shall retain each employee's written
8 confidentiality oath for COUNTY and DHCS inspection for a period of six (6) years following the
9 termination of this agreement.
10 50. SEPARATE AGREEMENT
11 It is mutually understood by the parties that this Agreement does not, in any way, create
12 a joint venture among CONTRACTOR(S). By execution of this Agreement, CONTRACTOR(S)
13 understands that a separate Agreement is formed between each individual CONTRACTOR(S) and
14 COUNTY.
15 51. GOVERNING LAW
16 Venue for any action arising out of or related to this Agreement shall only be in Fresno
17 County, California. The rights and obligations of the parties and all interpretation and performance of
18 this Agreement shall be governed in all respects by the laws of the State of California.
19 52. ENTIRE AGREEMENT
20 This Agreement, including all Exhibits between CONTRACTOR(S) and COUNTY, RFA
21 released on February 14, 2018, and response to RFA with respect to the subject matter hereof and
22 supersedes all previous agreement negotiations, proposals, commitments, writings, advertisements,
23 publications, and understandings of any nature whatsoever unless expressly included in this
24 Agreement.
25
26
27
28
43
1
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
2
3 first hereinabove written.
4 CONTRACTOR(S) COUNTY OF FRESNO
5 SEE EXHIBIT A
Q1 IA;t�
S Q inUro, hairperson of the Board
7 o eof the County of Fresno
8
9
10
11 ATTEST:
Bernice E. Seidel
12 Clerk of the Board of Supervisors
County of Fresno, State of California
13
14
15
16
17 By
Deputy
18 FOR ACCOUNTING USE ONLY:
19 ORG No. 56302081
Account No.: 7295
20 Requisition No.:
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Exhibit A
Page 1 of 1
Vendor Phone Site Location Contract Max
Central California Recovery, Inc. (559) 273-2942 1100 W. Shaw Ave. #130
Remit to: Fresno CA 93711 $29,520
1204 W. Shaw Ave.,#102
Fresno, CA 93711
Delta Care, Inc.
Remit to: (559) 276-7558 4705 N. Sonora Ave.
4705 N. Sonora Ave., Suite 101 Fresno, CA 93722 $38,949
Fresno, CA 93722
Fresno New Connections, Inc. (559) 248-1548 4411 N. Cedar Ave.
4411 N. Cedar Ave. #118 Fresno, CA 93726 $12,000
Fresno, CA 93726
Total: $80,469
Exhibit B
Page 1 of 10
FAMILY FOCUSED PREVENTION SERVICES
Substance Use Disorder(SUD)
Projected Budget-Fiscal Year 2018-19
Provider Name: Delta Care Inc Mailing Address: 4705 N. Sonora Avenue, Suite 101
Program Name: Total Family SUD unifdication System Fresno CA 93722
Approved by: Street Address: 4705 N. Sonora Avenue, Suite 101
Fresno,CA 93722
No.of Budgeted FTEs-Admin: 3 Phone Number: (559)276-7558
No.of Budgeted FTEs-Direct: 6 Fax Number: (559)276-7568
E-mail Address: deltacareinc@yahoo.com
Budget Categories %of FTE %Time dedicated Proposed Program Budget
Line Item Description Annual dedicated to to services Total Proposed
(Must be Itemized) Salary this program Admin. Direct Admin. Direct Budget
PERSONNEL/SALARIES
0101 Dr. Felix Enunwa-Business Administrator/Counselor $ 47,000 25% 20% 80% $ 2,350.00 $ 9,400.00 $ 11,750.00
0102 Joy Troyn-Administrative Assistant/Counselor $ 36,000 15% 90% 10% $ 4,860.00 $ 540.00 $ 5,400.00
0103 George Tapia-Counselor $ 36,000 10% 100% $ - $ 3,600.00 $ 3,600.00
0104 Denise Campos-Counselor $ 36,000 10% 100% $ - $ 3,600.00 $ 3,600.00
0105 Rita Enunwa-Executive Director $ 47,000 5% 100% $ 2,350.00 $ - $ 2,350.00
0106 Yolanda Garcia-BookKeeper $ 4,800 5% 100% $ - $ 240.00 $ 240.00
0107 $ $ - $ -
0108 $ $ $
0109 $ $ $
0110 $ $ $
0111 $ $ $
0112 $ $ $ -
SALARIES TOTAL $ 9,560 $ 17,380 $ 26,940
PAYROLL TAXES Rate 35% 65% 100%
0151 F.I.C.A.Social Security and Medicare SS 6.2%rate applied to$127.2k of gross earnings per employee 6.20% $ 593 $ 1,078 $ 1,670.28
0152 Federal Unemployment(FUTA) Rate applied to only first$7k of gross earnings per employee 0.00% $ - $ -
0153 State Employment Training Tax(ETT) Rate applied to only first$7k of gross earnings per employee 0.00% $ $
0154 State Unemployment Insurance(UI) Rate applied to only first$7k of gross earnings per employee 0.00% $ $ -
0155 Workers'Compensation Insurance 1.20% $ 115 $ 209 $ 323.28
PAYROLL TAXES TOTAL $ 708 $ 1,287 $ 19994
EMPLOYEE BENEFITS Rate 35.49% 64.51% 100%
0201 Health Insurance 0.00% $ - $ -
0202 Life Insurance 0.00% $ $
0203 Retirement 0.00% $ $
Exhibit B
Page 2 of 10
0204 Benefits Other-Specify 0.00% $ $
EMPLOYEE BENEFITS TOTAL $ $ $ -
TAXES&BENEFITS TOTAL $ 1,994
TOTAL PERCENT OF BENEFITS TO SALARIES 7.40%
Services and Supplies
INSURANCE
0252 Liability Insurance $ 75.00
0253 Insurance Other-Specify $ 75.00
INSURANCE TOTAL $ 150.00
COMMUNICATIONS
0301 Telecommunications/data lines $ 150.00
0302 Answering Service
COMMUNICATIONS TOTAL $ 150.00
OFFICE EXPENSE
0351 Office Supplies $ 375.00
0352 Soc Rec.,Workbooks $ 125.00
0353 Printing/Reproduction $ 350.00
0354 Publications
0355 Legal Notices/Advertising
OFFICE EXPENSE TOTAL $ 850.00
EQUIPMENT
0401 Purchase of Equipment(Computers/Furniture) $ 150.00
0402 Equipment Rent/Lease(Copy Machines)
0403 Equipment Maintenance
EQUIPMENT TOTAL $ 150.00
FACILITIES
0451 Rent/Lease Building $ 1,050.00
0452 Facilities Maintenance $ 150.00
0453 Utilities
FACILITIES TOTAL $ 1,275.00
TRAVEL COSTS
0501 Staff Mileage $ 450.00
0502 Staff Travel(Out of County)
0503 Staff Training/Registration $ 250.00
0504 Transportation $ 450.00
TRAVEL COSTS TOTAL $ 1,150.00
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives $ 2,750.00
0552 Program Supplies-Curriculum $ 550.00
0553 Program Supplies-Food $ 2,750.00
Exhibit B
Page 3of10
PROGRAM SUPPLIES TOTAL $ 6,050.00
CONSULTANCY
0601 Consultant Services(Interpretive Services)
0602 Contracted Services(Recruitment)
CONSULTANCY TOTAL $
FISCAL AND AUDITS
0651 Accounting/Bookkeeping(IT Support) $ 240.00
0652 External Audit
FISCAL AND AUDITS TOTAL $ 240.00
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
OTHER COSTS TOTAL $
ONE TIME ADVANCE-Start Up Costs
TOTAL PROGRAM EXPENDITURES $ 38,948.56
REVENUE/MATCH
3120 Drug Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees
3160 Insurance
REVENUE/MATCH TOTAL $NET PROGRAM BUDGET $ 3s,949
Exhibit B
Page 4 of 10
FAMILY FOCUSED PREVENTION SERVICES
Substance Use Disorder(SUD)
Projected Budget
Provider Name: DELTA CARE INC
PERSONNEL/SALARIES Annual Salary and FTE Equivalence as in Budget.
Budget Categories-Line Item Description Positions Annual Salary for %of FTE dedicated to this
Descriptions this Program program
Dr.Felix Enunwa-Business Administrator&Counselor $ 47,000 25%
Joy Troyn-Administrative Assitant/Assistant $ 36,000 15%
George Tapia-Counselor $ 36,000 10%
Denise Campos-Counselor $ 36,000 5%
Rita Enunwa,Executive Director $ 47,000 5%
Yolanda Garcia,Bookkeeper $ 4,800 5%
Amount:FY 18-19
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS TOTAL $ 1,620.28
INSURANCE List the provider and expiration date for the following insurance categories, if applicable:
:1 0251 -Workers Compensation Insurance: $ 323.28
0252-Liability Insurance: $ 75.00
:1 0253-Insurance Other: $ 75.00
COMMUNICATIONS Provide a brief description for each category, if applicable:
:1 0301 -Telecommunications/data lines: $ 150.00
:1 0302-Answering Service:
OFFICE EXPENSE Provide a brief description for each category, if applicable:
:1 0351-Office Supplies: $ 375.00
:1 0352-Social/Rec,Workbooks: $ 125.00
:1 0353-Printing/Reproduction: $ 350.00
:1 0354-Publications:
:1 0355-Legal Notices/Advertising:
EQUIPMENT Provide a brief description for each category, if applicable:
:1 0401 -Purchase of Equipment: $ 150.00
:1 0402-Equipment Rent/Lease:
:1 0403-Equipment Maintenance:
FACILITIES Provide a brief description for each category, if applicable:
:1 0451 -Rent/Lease Building: $ 1,050.00
0452-Facilities Maintenance: $ 150.00
:1 0453-Utilities: $ 75.00
TRAVEL Provide a brief description for each category, if applicable:
:1 0501 -Staff Mileage: $ 450.00
:1 0502-Staff Travel (Out of County):
:1 0503-Staff Training/Registration: $ 350.00
:1 0504-Transportation: $ 450.00
PROGRAM SUPPLIES Provide a brief description for each category, if applicable:
:1 0551 -Program Supplies-Client Incentives: $ 2,750.00
:1 0552-Program Supplies-Curriculum: $ 550.00
:1 0553-Program Supplies-Food: $ 2,750.00
CONSULTANCY Provide a brief description for each category, if applicable:
:1 0601 -Consultant Services
:1 0602-Contracted Services:
FISCAL AND AUDITS Provide a brief description for each category, if applicable:
:1 0651 -Accounting/Bookkeeping: $ 240.00
:1 0652-External Audit:
OTHER COSTS Provide a brief description for each category, if applicable:
:1 0701 -Indirect Costs:
1 0702-Licenses/Taxes:
Exhibit B
Page 5 of 10
:1 0703-County Administration Fee:
:1 0749-Other Costs:
REVENUE/MATCH Identify all anticipated funding sources and distinguish whether the revenue offsets expenditures
for the existing/proposed program:
3120-Drug Medi-Cal:
Mental Health Medi-Cal:
:1 3130-State Grant:
:1 3140-Private Donations:
3150-Client Fees:
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount N/A
cannot exceed 1/12th of the total cost proposal for this section.
Exhibit B
Page 6 of 10
FAMILY FOCUSED PREVENTION SERVICES
Substance Use Disorder(SUD)
Projected Budget-Fiscal Year 2018-19
Provider Name: Fresno New Connections, Inc. Mailing Address: 4411 N.Cedar#108 Fresno, CA 93726
Program Name: Family Focused Prevention Services
Approved by: Rob Martin Street Address: 4411 N.Cedar#108 Fresno, CA 93726
No.of Budgeted FTEs-Admin: 0 Phone Number: (559)248-1548
No.of Budgeted FTEs-Direct: 0.21 Fax Number: (559)248-1530
E-mail Address: ncaodl@sbcglobal.net
Budget Categories %of FTE %Time dedicated Proposed Program Budget
Line Item Description Annual dedicated to to services Total Proposed
(Must be Itemized) Salary this program Admin. Direct Admin. Direct Budget
PERSONNEL/SALARIES
0101 Counselor $ 24,960 4% 0% 100% $ $ 998.40 $ 998.40
0102 Counselor $ 24,960 4% 0% 100% $ $ 998.40 $ 998.40
0103 $ $ $
0104 $ $ $
0105 $ $ $
0106 $ $ $
0107 $ $ $
0108 $ $ $
0109 $ $ $
0110 $ $ $
0111 $ $ $
0112 $ $ $
SALARIES TOTAL $ - $ 1,997 $ 1,997
PAYROLL TAXES Rate 0% 100% 100%
0151 F.I.C.A. Social Security and Medicare SS 6.2%rate applied to$127.2k of gross earnings per employee 7.65% $ $ 153 $ 152.76
0152 Federal Unemployment(FUTA) Rate applied to only first$7k of gross earnings per employee 0.00% $ $ -
0153 State Employment Training Tax(ETT) Rate applied to only first$7k of gross earnings per employee 1.00% $ $ 20 $ 19.97
0154 State Unemployment Insurance(UI) Rate applied to only first$7k of gross earnings per employee 3.40% $ $ 68 $ 67.89
0155 Workers'Compensation Insurance 8.00% $ $ 160 $ 159.74
PAYROLL TAXES TOTAL $ - $ 401 $ 400
EMPLOYEE BENEFITS Rate 0.00% 100.00% 100%
0201 Health Insurance 0.00% $ $ -
0202 Life Insurance 0.00% $ $ -
0203 Retirement 0.00% $ $ -
0204 Benefits Other-Specify 0.00% $ $ -
Exhibit B
Page 7 of 10
EMPLOYEE BENEFITS TOTAL $ $ $
TAXES&BENEFITS TOTAL $ 400
TOTAL PERCENT OF BENEFITS TO SALARIES 20.05%
Services and Supplies
INSURANCE
0252 Liability Insurance $ 250.00
0253 Insurance Other-Specify
INSURANCE TOTAL $ 250.00
COMMUNICATIONS
0301 Telecommunications/data lines
0302 Answering Service
COMMUNICATIONS TOTAL $ -
OFFICE EXPENSE
0351 Office Supplies $ 120.00
0352 Soc Rec.,Workbooks $ 500.00
0353 Printing/Reproduction
0354 Publications
0355 Legal Notices/Advertising
OFFICE EXPENSE TOTAL $ 620.00
EQUIPMENT
0401 Purchase of Equipment(Computers/Furniture)
0402 Equipment Rent/Lease(Copy Machines)
0403 Equipment Maintenance
EQUIPMENT TOTAL $ -
FACILITIES
0451 Rent/Lease Building $ 4,800.00
0452 Facilities Maintenance $ 300.00
0453 Utilities $ 900.00
FACILITIES TOTAL $ 6,000.00
TRAVEL COSTS
0501 Staff Mileage
0502 Staff Travel(Out of County)
0503 Staff Training/Registration
0504 Transportation
TRAVEL COSTS TOTAL $ -
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives $ 333.00
0552 Program Supplies-Curriculum
0553 Program Supplies-Food $ 1,200.00
PROGRAM SUPPLIES TOTAL $ 1,533.00
Exhibit B
Page 8 of 10
CONSULTANCY
0601 Consultant Services(Interpretive Services)
0602 Contracted Services(Recruitment)
CONSULTANCY TOTAL $
FISCAL AND AUDITS
0651 Accounting/Bookkeeping(IT Support) $ 1,200.00
0652 External Audit
FISCAL AND AUDITS TOTAL $ 1,200.00
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
OTHER COSTS TOTAL $
ONE TIME ADVANCE-Start Up Costs
TOTAL PROGRAM EXPENDITURES $ 12,000.16
REVENUE/MATCH
3120 Drug Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees
3160 Insurance
REVENUE/MATCH TOTAL $
NET PROGRAM BUDGET 12,000
Exhibit B
Page 9 of 10
FAMILY FOCUSED PREVENTION SERVICES
Substance Use Disorder(SUD)
Projected Budget
Provider Name: Fresno New Connections,Inc.
PERSONNEL/SALARIES Annual Salary and FTE Equivalence as in Budget.
Budget Categories-Line Item Description Positions Annual Salary for %of FTE dedicated to this
Descriptions this Program program
2 Counselors to facilitate meetings and take charge of
essential elements of program delivery. $ 1,997
Amount:FY 18-19
PAYROLL TAXES TOTAL $ 240.62
EMPLOYEE BENEFITS TOTAL
INSURANCE List the provider and expiration date for the following insurance categories, if applicable:
I 0251 -Workers Compensation Insurance: $ 159.74
I 0252-Liability Insurance: $ 250.00
0253-Insurance Other:
COMMUNICATIONS Provide a brief description for each category, if applicable:
:1 0301 -Telecommunications/data lines:
0302-Answering Service:
OFFICE EXPENSE Provide a brief description for each category, if applicable:
:1 0351-Office Supplies: Office Supplies: Purchase of paper, pens,stapplers,and other $ 120.00
I 0352-Social/Rec,Workbooks: Purchase of curriculum,Training kit, Program DVD and $ 500.00
0353-Printing/Reproduction:
:1 0354-Publications:
:1 0355-Legal Notices/Advertising:
EQUIPMENT Provide a brief description for each category, if applicable:
0401 -Purchase of Equipment:
I 0402-Equipment Rent/Lease:
I 0403-Equipment Maintenance:
FACILITIES Provide a brief description for each category, if applicable:
1 0451 -Rent/Lease Building: $ 4,800.00
I 0452-Facilities Maintenance: $ 300.00
0453-Utilities: $ 900.00
TRAVEL Provide a brief description for each category, if applicable:
:1 0501 -Staff Mileage:
:1 0502-Staff Travel (Out of County):
:1 0503-Staff Training/Registration:
:1 0504-Transportation:
PROGRAM SUPPLIES Provide a brief description for each category, if applicable:
:1 0551 -Program Supplies-Client Incentives: Purchase of gift cards,trinkets,certificates, etc. $ 333.00
:1 0552-Program Supplies-Curriculum:
:1 0553-Program Supplies-Food: Purchase of food to augment pot lucks,graduations, and $ 1,200.00
CONSULTANCY Provide a brief description for each category, if applicable:
:1 0601 -Consultant Services
:1 0602-Contracted Services:
FISCAL AND AUDITS Provide a brief description for each category, if applicable:
:1 0651 -Accounting/Bookkeeping: $ 1,200.00
:1 0652-External Audit:
OTHER COSTS Provide a brief description for each category, if applicable:
0701 -Indirect Costs:
Exhibit B
Page 10 of 10
0702-Licenses/Taxes:
J 0703-County Administration Fee:
:1 0749-Other Costs:
REVENUE/MATCH Identify all anticipated funding sources and distinguish whether the revenue offsets expenditures
for the existing/proposed program:
3120-Drug Medi-Cal:
Mental Health Medi-Cal:
:1 3130-State Grant:
:1 3140-Private Donations:
3150-Client Fees:
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount N/A
cannot exceed 1/12th of the total cost proposal for this section.
Exhibit
Page 1of3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CO&0UCTAND ETHICS
Fresno County ie firmly committed 1ofull compliance with all applicable |avvo, regu|ationo, 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 tnaining, each oontnaobzr, 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 |avvu, regu|oUunm, 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, coneumera, 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 |avv, regu|a1ion, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately,timely
and are consistent with all applicable |avve, ragu|at|ono, 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
Exhibit C
Page 2 of 3
codes that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other 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 C
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 hereby 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 P'roviders
Name (print):
Discipline: ❑ Psychiatr' t ❑ Psychologist ❑ LCSW ❑ LMFT
Signature: Date:
For Group or Organizational Providers
Group/Org. Name (print):
GA, � CI
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
c
ther:
Job Title (if different from Discipline): ��—
Signature: Date: / /
Exhibit C
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
Exhibit C
Page 2 of 3
codes that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other 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 C
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 hereby 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) C-�4
Employee Name (print): F C r�3�-A t`J'UA
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
[ ther: �-A'Ib
Job Title (if differ)C=,
Signature: Date: Q-5/3%/
Exhibit C
Page I 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
Exhibit C
Page 2 of 3
codes that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other 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 C
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 hereby 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): Fresno New Connections, Inc.
Employee Name (print): Rob Martin
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
0 Other: Executive Director
Job Title (if different from Discipline):
Signature: Date: S IA / (�
Exhibit D
Page 1 of 2
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES
CONTRACTOR shall adhere to and develop written procedures in accordance with the below standards
adapted from the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in
Health Care:
Culturally Competent Care:
1. Organizations must ensure that consumers receive from all staff members effective,
understandable, and respectful care that is provided in a manner compatible with
their cultural health beliefs and practices and preferred language.
2. Organizations must implement strategies to recruit, retain, and promote at all levels
of the organization a diverse staff and leadership that are representative of the
demographic characteristics of the service area.
3. Organizations must ensure that staff at all levels and across all disciplines receive
ongoing education and training in culturally and linguistically appropriate service
delivery.
Language Access Services:
4. Organizations must offer and provide language assistance services, including bilingual
staff and interpreter services, at no cost to consumers with limited English proficiency
at all points of contact, in a timely manner during all hours of operation.
5. Organizations must provide to consumers in their preferred language both verbal
offers and written notices informing them of their right to receive language assistance
services.
6. Organizations must assure the competence of language assistance provided to limited
English proficient consumers by interpreters and bilingual staff. Family and friends
should not be used to provide interpretation services (except on the request of the
consumer).
7. Organizations must make available easily understood patient-related materials and
post signage in the languages of the commonly encountered groups and/or groups
represented in the service area.
Organizational Supports:
8. Organizations must develop, implement, and promote a written strategic plan that
outlines clear goals, policies, operational plans, and management
accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
Exhibit D
Page 2 of 2
9. Organizations must conduct initial and ongoing organizational self-assessments of
CLAS related activities and are encouraged to integrate cultural and linguistic
competence-related measures into their internal audits, performance improvement
programs, consumer satisfaction Assessments, and Outcomes-Based Evaluations.
10. Organizations must ensure that data on the individual consumer's race, ethnicity, and
spoken and written language are collected in program records, integrated into the
organizations management information systems, and periodically updated.
11. Organizations must maintain a current demographic, cultural, and epidemiological
profile of the community as well as a needs assessment to accurately plan for and
implement services that respond to the cultural and linguistic characteristics of the
service area.
12. Organizations must develop participatory, collaborative partnerships with
communities and utilize a variety of formal and informal mechanisms to facilitate
community and consumer involvement in designing and implementing CLAS-related
activities.
13. Organizations must ensure that conflict and grievance resolution processes are
culturally and linguistically sensitive and capable of identifying, preventing, and
resolving cross-cultural conflicts or complaints by consumers.
14. Organizations must regularly make available to the public information about their
progress and successful innovations in implementing these standards and to provide
public notice in their communities about the availability of this information.
15. Organizations must ensure communication regarding the organization's progress in
implementing and sustaining CLAS to all stakeholders, constituents, and general
public.
CONTRACTOR shall develop written procedures in accordance with the above standards. The
provisions of this Agreement are not intended to abrogate any provisions of law or regulation existing
or enacted during the term of this Agreement.
Exhibit E
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 et 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 E
Page 2of6
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.
Exhibit E
Page 3of6
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and 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 E
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 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)
Exhibit E
Page 5of6
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.
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.
Exhibit E
Page 6of6
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 F
Page 1 of 1
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code(P.C.) section (§) 11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect" includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any
police department or sheriff's department(not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a"reasonable suspicion"means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing,when appropriate, on his or her
training and experience,to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§I 1166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
URE AT
0980fadx
Exhibit F
Page 1 of 1
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section(§) 11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect"includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any
police department or sheriff's department(not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a"reasonable suspicion"means that it is
objectively reasonable for a person to entertain a suspicion,based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
6chiladar-tingg,requirements.
S1 NATURE DATE
0980fadx
Exhibit F
Page 1 of 1
NOTICE OF CHILI)A13USE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY)and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents,require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code(P.C.)section(§) 11165.9.
For purposes of the undersigned's child abuse reporting requirements,"child
abuse or neglect"includes physical injury inflicted by other than accidental means upon a
child by another person,sexual abuse as defined in P.C. §I 1165.1,neglect as defined in
P.C. §11165.2,willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment,has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any
police department or sheriffs department(not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting,a"reasonable suspicion"means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position,drawing,when appropriate,on his or her
training and experience,to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself,constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§i 1166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained fronn the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
SIGNATURE DA I E
0980fadx
Exhibit G
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 G
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 H
Pagel of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity WIL D/B/A
Address(number, �� Cit State ZIP co ?,.7
CLIA number T ,payer ID number(EIN) Telephone num er
�- ?,- l--
A. List the names,addresses,date of birth,SSN,and EIN if a plicable for any person(s)whether it bean individual or corporation with
an ownership or controlling interest in the disclosing entity or managed care entity. If a person(s)with an ownership or controlling
interest of the disclosing entity is related to another person having ownership or controlling interest as a parent,spouse,sibling or
child .Including whether the person(s)with ownership or controlling interest of the disclosing entity is related to a person(parent,
spouse,sibling or child)with ownership or has five(5)percent or more interest in any of its subcontractors please list under
Remarks section.
NAM151, ADDRESS EIN SSN DOB
B. List the names,addresses,and EIN if applicable for any subcontractor(s)in which the disclosing entity has five(5)percent or more
interest.
NAME ADDRESS EIN
C. List the names,addresses,and EIN of any other disclosing entity in which an owner of the disclosing entity has an ownership or
control interest.
NAME A ADDRESS EIN
D. List the names,addresses,date of birth,SSN of Any person(s)with an ownership or control interest in the provider,or agent or
managing employee of the provider;and has been convicted of a criminal offense related to that person's involvement in any
program under Medicare,Medicaid,or the title XX services program since the inception of those programs.
NAME ADDRESS EIN/SSN DOB
E. List any significant business transactions between the provider and any wholly owned supplier,or between the provider and any
subcontractor,during the 5-year period ending on the date of the request.If additional space is needed,attach additional sheets of
paper and indicate the questioning answered.
e'
Name of Sup lier:
Explain:
F. List each pers ,including corporate officers and directors for corporations and all partners in partnerships,with an ownership or
control interest in any subcontractor with whom the applicant or provider has had business transactions totaling more than
$25,000 during the 12-month period preceding the date of the request.
NAME ADDRESS EIN/SSN DOB
Exhibit H
Page 2 of 2
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 repre entative(typed) Title
Signature Date
Remarks
Exhibit H
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity F/B/A�k
Address(number,street) citv St to ZIP code
\\
CILIA number Taxpayer ID number(EIN) Telephone number
A. List the names,addresses,date of birth,SSN,and EIN if applicable for any person(s)whether it be an individual or corporation with
an ownership or controlling interest in the disclosing entity or managed care entity. If a person(s)with an ownership or controlling
interest of the disclosing entity is related to another person having ownership or controlling interest as a parent,spouse,sibling or
child . Including whether the person(s)with ownership or controlling interest of the disclosing entity is related to a person(parent,
spouse,sibling or child)with ownership or has five(5)percent or more interest in any of its subcontractors please list under
Remarks section.
NAME ADDRESS EIN/SSN DOB
6— %*—\cis -- 5—\\b T ::> 2..1 I9
VI,V�tom— r4t.x(! 11.1
B. List the names,addresses,and EIN if applicable for any subcontractor(s)in which the disclosing entity has five(5)percent or more
interest.
AME ADDRESS EIN
C. List the names,addresses,and EIN of any other disclosing entity in which an owner of the disclosing entity has an ownership or
control interest.
_NAME ADDRESS EIN
svk
D. List the names,addresses,date of birth,SSN of Any person(s)with an ownership or control interest in the provider,or agent or
managing employee of the provider;and has been convicted of a criminal offense related to that person's involvement in any
h g program under Medicare, Medicaid,or the title XX services program since the inception of those programs.
`� NAME ADDRESS EIN/SSN DOB
E. List any significant business transactions between the provider and any wholly owned supplier,or between the provider and any
subcontractor,during the 5-year period ending on the date of the request. If additional space is needed,attach additional sheets of
1 — paper and indicate the question being answered.
Name of Supplier:
Explain:
F. List each person,including corporate officers and directors for corporations and all partners in partnerships,with an ownership or
control interest in any subcontractor with whom the applicant or provider has had business transactions totaling more than
� - $25,000 during the 12-month period preceding the date of the request.
NAME ADDRESS EIN/SSN DOB
Exhibit H
Page 2 of 2
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. /n 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) �y ( Title
Signature � � � Date
Remarks
Exhibit H
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I, identifying Information
Name of entity D/B/A
Fresno New Connections, Inc.
Address(number,street) City State ZIP code
4411 N. Cedar#108 Fresno CA 93726
CLIA number Taxpayer ID number(EIN) Telephone number
77 053 4019 1 559 A 248-1548
A. List the names,addresses,date of birth,SSN,and E[N if applicable for any person(s)whether it be an individual or corporation with
an ownership or controlling interest in the disclosing entity or managed care entity. If a person(s)with an ownership or controlling
interest of the disclosing entity is related to another person having ownership or controlling interest as a parent,spouse,sibling or
child . Including whether the person(s)with ownership or controlling interest of the disclosing entity is related to a person(parent,
spouse,sibling or child)with ownership or has five(5)percent or more interest in any of its subcontractors please list under
Remarks section.
NAME ADDRESS EIN/SSN DOB
Suzanne Kotkin-Jaszi 3267 Greenfield Ave. Clovis CA 93611 151-42-2388 7113152
Joanna Tilghman 4449 N.Tamara Ave.Fresno,CA 93722 553-73-9217 10/6/82
B, List the names,addresses,and EIN if applicable for any subcontractor(s)in which the disclosing entity has five(5) percent or more
interest.
NAME ADDRESS EIN
C. List the names,addresses,and EIN of any other disclosing entity in which an owner of the disclosing entity has an ownership or
control interest.
NAME ADDRESS EIN
- D. List the names,addresses,date of birth,SSN of Any person(s)with an ownership or control interest in the provider,or agent or
managing employee of the provider;and has been convicted of a criminal offense related to that person's involvement in any
program under Medicare, Medicaid,or the title XX services program since the inception of those programs.
NAME ADDRESS EIN/SSN DOB
E. List any significant business transactions between the provider and any wholly owned supplier,or between the provider and any
subcontractor,during the 5-year period ending on the date of the request. If additional space is needed,attach additional sheets of
paper and indicate the question being answered.
Name of Su lien:
Explain:
F. List each person,including corporate officers and directors for corporations and all partners in partnerships,with an ownership or
control interest in any subcontractor with whom the applicant or provider has had business transactions totaling more than
$25,000 during the 12-month period preceding the date of the request.
NAME ADDRESS EIN/SSN DOB
Exhibit H
Page 2 of 2
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
Rob Martin Executive Director
Signature �`� � � � � � � Date
Remarks
Ehibit H:A Board Members continued
Donald Lyle 2237 E. Everglade Ave. Fresno, CA 93720 SS#: 570-82-3138 DOB: 7/5/54
Terry Littleton 6675 N. Woodson Ave. Fresno, CA 93711 SS#: 546-64-9226 DOB: 9/13/41
Jerry Martin 415 N. Highland Ave. Sanger, CA 93657 SS#: 554-83-0370 DOB: 3/9/84
Exhibit I
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.
CiMH Agreement
Exhibit I
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:
o 44g�- , A c .
(Printed Name &Title) (Name of Agency or Company
CiMH Agreement
Exhibit I
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.
CiMH Agreement
Exhibit I
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: 1
�V rV a rt W } ?5 -- a
(Printed Name &Title) 1 (Name of Agency or Company)
CiMH Agreement
Exhibit I
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.
CiMH Agreement
Exhibit I
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:
Rob Martin Executive Director Fresno New Connections, Inc.
(Printed Name & Title) (Name of Agency or Company)
CiMH Agreement
Exhibit J
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 J
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):
t4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):.
(5)Aut!I'Lkrized Signature
Signature: je:
Exhibit J
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.
(S) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit J
Page 2 of 2
(1)Company Board Member Information'-
Name: Date:
Job Title:
( )Compan /A er►cy,Name and ct6ass.
Disclosure Please describe the nature of the self-dealing transemon you are e part}t to
(4)explain why this self dealing ra sactior i c6nslst ni i "6 the re i it an16 Of Corporations Code 5233(a):
(5)Authoriz ature .
Signatur Date:
Exhibit J
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.
(S) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
E
Exhibit J
Page 2 of 2
(1),C6inpany BoardMember Information:.: -
Name: bate;
Job Title:
(2)Company/Agency.Name and.Address
(3)'D'iisclosure(Please'describe the nature.of the self=dealing;transaction you area party to): :�-.
(g}Liiplain:why tliis.se[f-dealing`#ansactoq:)sc¢iis sten#.ui►ith the:requirements of Corporatiops'Code
{5}Authorized Sfgna_t_ure
Signature; Date:
Exhibit K
Page 1 of 1
UNLAWFUL USE OF DRUGS AND ALCOHOL
CERTIFICATION
as an authorized agent of
CA_LPioltel
e. U , acknowledge the requirement to
rganization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
• The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
• All aspects of a drug- or alcohol-related program are consistent with the "no
unlawful use" message, including, but not limited to, program standards,
curricula, materials, and teachings; and
• The "no unlawful use" of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. If this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminated.
Signatur _ Date:
Title: e > ti Ac3az=
Exhibit K
Page 1 of 1
UNLAWFUL USE OF DRUGS AND ALCOHOL
CERTIFICATION
I, C--&�oi_ IE3 "�-A 1,4 UEIPI-_,. , as an authorized agent of
(Print Name)
t-- f'�, \0 (— , acknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
• The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
• All aspects of a drug- or alcohol-related program are consistent with the "no
unlawful use" message, including, but not limited to, program standards,
curricula, materials, and teachings; and
• The "no unlawful use" of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. If this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminate
Signature: Date: �� '� o�
Title: 5 �A ass )t*,.Y\1
Exhibit K
Page 1 of 1
UNLAWFUL USE OF ®RUGS AND ALCOHOL
CERTIFICATION
1, Rob Martin , as an authorized agent of
(Print Name)
Fresno New Connections, Inc. , acknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
• The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
• All aspects of a drug- or alcohol-related program are consistent with the "no
unlawful use" message, including, but not limited to, program standards,
curricula, materials, and teachings; and
• The "no unlawful use" of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. If this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminate .
Signature: 4,L,V Date:
Title: Executive Director
I
Exhibit L
Page 1 of 1
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH(DBH)EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining acc to any r cal Health Information(PHI)that is necessary to carry
out my function with DBH, I ,agree to not divulge any PHI to
unauthorized persons.Furthermore, I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel,subcontractors,and
subcontractors' personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath,I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH,surveillance and safeguarding announcements
issued by DHCS,and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
I. Exercise due care to preserve data integrity and confidentiality.
2. Treat passwords and user accounts as confidential information.
3. Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4. Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a"Privacy Incident Report"at:
littp://www.dhes.ca.aov/formsandpubs/laws/priv/Pages/DHCSBusiiiessAssociatesOniv.aspx and
return the completed form to: privacyofficerndhes.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq.and the Health Insurance Portability and
Accountability Act of 1996(HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any offic of employment oi~contract.
Agency Name: i G{l
'SiLrnature- Date:
3133 N Millbrook,Fresno,California 93703
FAX(559)600-7673 www.co.fresno.cams
The County of Fresno is an Equal Employment Opportunity Employer
Exhibit L
Page 1 of 1
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH(DBH)EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information(PHI)that is necessary to carry
out my function with DBH, I t]€- Fmk.--t:c. G rI�(AvW agree to not divulge any PHI to
unauthorized persons. Furthermore,I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel,subcontractors, and
subcontractors' personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath, I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH, surveillance and safeguarding announcements
issued by DHCS, and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
1. Exercise due care to preserve data integrity and confidentiality.
2. Treat passwords and user accounts as confidential information.
3. Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4. Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a"Privacy Incident Report"at:
http:iiwww.dhcs.ca.gov/formsandpubs/laws/priv/Pages/DHCS Bus inessAssociatesOnlv.aspx and
return the completed form to: privacyofficert(i,dhcs.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq. and the Health Insurance Portability and
Accountability Act of 1996(HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name. X Wit—i t �_ —� ( ►*� C�
Si n Date:
c
3133 N Millbrook,Fresno,California 93703
FAX(559)600-7673 www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer
Exhibit L
Page 1 of 1
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFOR RATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH(DBH)EMPLOYEES AND/OR NON-DBH SUD SERVICES .
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information(PHI)that is necessary to carry
out my function with DBH, I Rob Martin ,agree to not divulge any PHI to
unauthorized persons.Furthermore,I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel,subcontractors,and
subcontractors' personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath,I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH, surveillance and safeguarding announcements
issued by DHCS,and other applicable terms and stipulations provided by the HI.PAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
1. Exercise due care to preserve data integrity and confidentiality.
2. Treat passwords and user accounts as confidential information.
3. Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4. Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a"Privacy Incident Report"at:
http:/hv«,Nv.dhes.ca.gov/fonnsandpubs/laws/priv/Pages/DHCSBtisitiessAssociates0tily.aspx and
return the completed form to: privagyofficer@dhcs.ca.gov.
a,dhcs.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq.and the Health Insurance Portability and
Accountability Act of 1996(HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name: Fresno New Connections, Inc.
Signature: Date:
3133 v Nfillbrook,Fresno,California 93703
FAX(559)600-7673 -,"vw.co.fresnoxams
The County of Fresno is an Equal Employment Opportunity Employer