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HomeMy WebLinkAboutAgreement A 22-026 Atencion Plena and Platicas.pdf Agreement No. 22-026 1 AGREEMENT 2 This Agreement is made and entered into this 18th day of January 2022, by and between 3 the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as 4 "COUNTY", and Integral Community Solutions Institute, a California non-profit corporation, whose 5 address is 255 N. Fulton St. Suite 105, Fresno, CA 93701, hereinafter referred to as "CONTRACTOR," 6 (collectively the "parties"). 7 WITNESSETH: 8 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a qualified 9 agency, or agencies, to operate a Mental Health Services Act(MHSA) Innovation-funded culturally 10 responsive, community-defined, and innovative program, which will utilize community-defined mental 11 health strategies to help reduce disparities that exist among underserved populations; and 12 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the 13 California Code of Regulations, section 1810.226; and 14 WHEREAS, CONTRACTOR, is qualified, have the staffing, facilities, support services, and is 15 willing and able to provide services required by the COUNTY, pursuant to the terms and conditions of this 16 Agreement. 17 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto 18 agree as follows: 19 1. SERVICES 20 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in 21 Exhibit A"Summary of Services" attached hereto and by this reference incorporated herein and made 22 part of this Agreement. 23 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as 24 specified in the MHSA Innovation Plan approved by the COUNTY Board of Supervisors on July 7, 2020 25 and submitted to the Mental Health Services Oversight and Accountability Commission's (MHSOAC), 26 which is incorporated herein by reference and, to the extent this Agreement differs from the MHSA 27 Innovation Plan, is revised by this Agreement. 28 C. CONTRACTOR shall align services and practices with the vision, mission, and 1 1 guiding principles of the DBH, as further described in Exhibit B, "Fresno County Department 2 of Behavioral Health Guiding Principles of Care Delivery", attached hereto and by this reference 3 incorporated herein and made part of this Agreement. 4 D. CONTRACTOR shall participate in meetings consisting of staff from COUNTY's 5 DBH and evaluator to discuss service requirements, data reporting, outcomes measurement, program 6 evaluation, training, policies and procedures, over program operations, and any problems or foreseeable 7 problems that may arise. 8 2. TERM 9 This Agreement is effective November 1, 2021 and shall terminate on the 30th of June, 10 2024. 11 3. TERMINATION 12 A. Non Allocation of Funds - The terms of this Agreement, and the services to be 13 provided thereunder, are contingent on the approval of funds by the appropriating government agency. 14 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement 15 terminated at any time by giving CONTRACTOR thirty (30) days advance written notice. 16 B. Breach of Contract - COUNTY may immediately suspend or terminate this 17 Agreement in whole or in part, where in the determination of COUNTY there is: 18 1) An illegal or improper use of funds; 19 2) A failure to comply with any term of this Agreement; 20 3) A substantially incorrect or incomplete report submitted to COUNTY; 21 4) Improperly performed service. 22 In no event shall any payment by COUNTY constitute a waiver by COUNTY of any 23 breach of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither 24 shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach or 25 default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of any 26 funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not 27 expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly refund any 28 such funds upon demand or, at COUNTY's option, such repayment shall be deducted from future 2 1 payments owing to CONTRACTOR under this Agreement. 2 C. Without Cause - Under circumstances other than those set forth above, this 3 Agreement may be terminated by CONTRACTOR or COUNTY upon thirty(30) days advance written 4 notice of an intention to terminate the Agreement. COUNTY's DBH Director, or designee, is authorized to 5 execute such written notice on behalf of COUNTY. 6 4. COMPENSATION 7 For actual services provided as identified in the terms and conditions of this Agreement, 8 including Exhibit A, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive 9 compensation in accordance with Exhibit C, "Budget Summary," attached hereto and by this reference 10 incorporated herein. Payment shall be made upon certification or other proof satisfactory to COUNTY's 11 DBH that services have actually been performed by CONTRACTOR as specified in this Agreement. 12 The maximum amount payable to CONTRACTOR for the period November 1, 2021 13 through June 30, 2022 shall not exceed One Hundred Sixty Thousand Eight Hundred Twenty-Two and 14 No/100 Dollars ($160,822.00). 15 The maximum amount payable to CONTRACTOR for the period effective July 1, 2022 16 through June 30, 2023 shall not exceed Two Hundred Seventy-Six Thousand Six Hundred Twelve and 17 No/100 Dollars ($276,612.00). 18 The maximum amount payable to CONTRACTOR for the period effective July 1, 2023 19 through June 30, 2024 shall not exceed Two Hundred Seventy-Six Thousand Four Hundred Fifty-Five 20 and No/100 Dollars ($276,455.00). 21 In no event shall services performed under this Agreement be in excess of Seven Hundred 22 Thirteen Thousand Eight Hundred Eighty-Nine and No/100 Dollars ($713,889.00). It is understood that all 23 expenses incidental to CONTRACTOR's performance of services under this Agreement shall be borne by 24 CONTRACTOR. 25 Except as provided below regarding State payment delays, payments shall be made by 26 COUNTY to CONTRACTOR in arrears, for services provided during the preceding month, within forty-five 27 (45) days after the date of receipt, verification, and approval of CONTRACTOR's invoices by COUNTY's 28 DBH. 3 1 If CONTRACTOR should fail to comply with any provision of this Agreement, COUNTY 2 shall be relieved of its obligation for further compensation. All final invoices shall be submitted by 3 CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed. 4 No action shall be taken by COUNTY on claims submitted beyond the sixty (60) day closeout period. Any 5 compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this 6 Agreement shall automatically revert to COUNTY. 7 The services provided by CONTRACTOR under this Agreement are funded in whole or in 8 part by the State of California. In the event that funding for these services is delayed by the State 9 Controller, COUNTY may defer payment to CONTRACTOR. The amount of the deferred payment shall 10 not exceed the amount of funding delayed by the State Controller to COUNTY. The period of time of the 11 deferral by COUNTY shall not exceed the period of time of the State Controller's delay of payment to 12 COUNTY plus forty-five (45) days. 13 5. INVOICING 14 CONTRACTOR shall invoice COUNTY in arrears by the tenth (10t") day of each month for 15 actual expenses incurred and services rendered in the previous month electronically to 16 dbh-invoices(a)fresnocountyca.gov, with a carbon copy email to the assigned COUNTY's DBH Staff 17 Analyst. 18 CONTRACTOR shall submit to the COUNTY by the tenth (10t") of each month a detailed 19 general ledger(GL), itemizing costs incurred in the previous month. Failure to submit GL reports and 20 supporting documentation shall be deemed sufficient cause for COUNTY to withhold payments until there 21 is compliance, as further described in Section Five (5) herein. Supporting documentation shall include but 22 is not limited to receipts, invoices received, and documented administrative/overhead costs. No 23 reimbursement for services shall be made until invoices, reports and outcomes are received, reviewed 24 and approved by COUNTY's DBH. Support documents will be made available upon request. 25 At the discretion of COUNTY's DBH Director or designee, if an invoice is incorrect or is 26 otherwise not in proper form or substance, COUNTY's DBH Director or designee shall have the right to 27 withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days prior 28 notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of ninety 4 1 (90) days after notification of an incorrect or improper invoice. If after the ninety (90) day period, the 2 invoice(s) is still not corrected to COUNTY's DBH satisfaction, COUNTY's DBH Director or designee may 3 elect to terminate this Agreement, pursuant to the termination provisions stated in Section Three (3) of 4 this Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of this 5 Agreement or termination of this Agreement, at the discretion of COUNTY's DBH Director or designee, 6 COUNTY's DBH shall have the right to deny payment of any additional invoices received. 7 CONTRACTOR must maintain such financial records for a period of three (3) years or until 8 any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for 9 any disallowances related to inadequate documentation. 10 Each monthly invoice will be in the format as identified in Exhibit C, showing each budget 11 line item, expenses incurred, and the balance remaining for each budget line item for all services and 12 items as identified in Exhibit C. 13 CONTRACTOR shall submit monthly staff reports that identify all direct services and 14 support staff, applicable licensure/certifications, and full-time hours worked to be used as a tracking tool to 15 determine if CONTRACTOR's program is staffed according to the services provided under this 16 Agreement. 17 6. INDEPENDENT CONTRACTOR 18 In performance of the work, duties, and obligations assumed by CONTRACTOR under this 19 Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of 20 CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an 21 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant, 22 employee,joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to 23 control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and 24 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that 25 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof. 26 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and 27 regulations, if any, of governmental authorities having jurisdiction over matters which are directly or 28 indirectly the subject of this Agreement. 5 1 Because of its status as an independent contractor, CONTRACTOR shall have absolutely 2 no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be 3 solely liable and responsible for providing to, or on behalf of, its employees all legally required employee 4 benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all 5 matters relating to payment of CONTRACTOR's employees, including compliance with Social Security, 6 withholding, and all other regulations governing such matters. It is acknowledged that during the term of 7 this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this 8 Agreement. 9 7. MODIFICATION 10 Any matters of this Agreement may be modified from time to time by the written consent of 11 all the parties without, in any way, affecting the remainder. 12 Changes to expense category (i.e., Salary& Benefits, Client Support, Facilities/Equipment, 13 Operating Expenses, Administrative Expenses, Special Expenses, Fixed Assets, etc.)subtotals in the 14 budgets, as set forth in Exhibit C that do not exceed ten percent (10%) of the maximum compensation 15 payable to the CONTRACTOR, may be made with the written approval of DBH's Director, or designee, 16 and CONTRACTOR. Modifications shall not result in any change to the maximum compensation amounts 17 payable to CONTRACTOR, as stated in this Agreement. 18 8. NON-ASSIGNMENT 19 Neither party shall assign, transfer or subcontract this Agreement nor their rights or duties 20 under this Agreement without the prior written consent of the other party. 21 9. HOLD HARMLESS 22 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request, 23 defend COUNTY, its officers, agents and employees from any and all costs and expenses, including 24 attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY in 25 connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or 26 employees of covenants and duties under this Agreement, and from any and all costs and expenses, 27 including attorney fees and court costs damages, liabilities, claims and losses occurring or resulting to 28 any person, firm or corporation who may be injured or damaged by the performance, or failure to perform, 6 1 of CONTRACTOR, their officers, agents or employees of covenants and duties under this Agreement. 2 CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit 3 exceptions resulting from noncompliance herein on the part of the CONTRACTOR. 4 The provisions of this Section 9 shall survive termination of this Agreement. 5 10. INSURANCE 6 Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any third 7 parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the following insurance 8 policies throughout the term of this Agreement: 9 A. Commercial General Liability 10 Commercial General Liability Insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million 11 Dollars ($4,000,000). This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including completed operations, product 12 liability, contractual liability, Explosion-Collapse-Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of this 13 contract. 14 B. Automobile Liability 15 Comprehensive Automobile Liability Insurance with limits no less than One Million Dollars ($1,000,000) per accident for bodily injury and property damage. Coverage 16 should include any automobile used in connection with this Agreement. 17 C. Professional Liability If CONTRACTOR employs licensed professional staff(e.g. Ph.D., R.N., L.C.S.W., 18 L.M.F.T., etc.) in providing services, Professional Liability Insurance with limits of not less than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars 19 ($3,000,000) annual aggregate. CONTRACTOR agrees that it shall maintain, at its 20 sole expense, in full force and effect for a period of three (3)years following the termination of this Agreement, one or more policies of professional liability 21 insurance with limits of coverage as specified herein. 22 D. Property Insurance CONTRACTOR shall maintain a policy of insurance for all risk personal property 23 coverage which shall be endorsed naming the County of Fresno as an additional loss payee. The personal property coverage shall be in an amount that will cover 24 the total COUNTY purchase and owned property, at a minimum, as discussed in 25 Section Twenty (20) of this Agreement. 26 All Risk Property Insurance CONTRACTOR will provide property coverage for the full replacement value of the 27 COUNTY's personal property in possession of CONTRACTOR and/or used in the execution of this Agreement. COUNTY will be identified on an appropriate 28 certificate of insurance as the certificate holder and will be named as an Additional 7 1 Loss Payee on the Property Insurance Policy. 2 E. Worker's Compensation 3 A policy of Worker's Compensation Insurance as may be required by the California 4 Labor Code. 5 G. Molestation 6 CONTRACTOR shall have either separate policy or an umbrella policy with endorsements covering sexual abuse/molestation coverage or have a specific 7 endorsement on their General Commercial liability policy covering sexual abuse/molestation. The policy limits for this policy shall be One Million Dollars 8 ($1,000,000) per occurrence with a Two Million Dollars ($2,000,000) annual 9 aggregate. The policy shall be on a per occurrence basis. 10 H. Cyber Liability 11 Cyber Liability Insurance, with limits not less than Two Million Dollars ($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000) aggregate. Coverage 12 shall be sufficiently broad to respond to duties and obligations undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims 13 involving infringement of intellectual property, including but not limited to 14 infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of 15 private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as 16 regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. 17 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security 18 Breaches, which may include Disclosure of Personal Information to an 19 Unauthorized Third Party; (ii) breach of any of the Contractor's obligations under Section #of this Agreement; (iii) infringement of intellectual property, including but 20 not limited to infringement of copyright, trademark, and trade dress; (iv) invasion of privacy, including release of private information; (v) information theft; (vi) damage to 21 or destruction or alteration of electronic information; (vii) extortion related to the Contractor's obligations under this Agreement regarding electronic information, 22 including Personal Information; (viii) network security; (ix) data breach response costs, including Security Breach response costs; (x) regulatory fines and penalties 23 related to the Contractor's obligations under this Agreement regarding electronic 24 information, including Personal Information; and (xi) credit monitoring expenses. 25 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance 26 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as 27 additional insured, but only insofar as the operations under this Agreement are concerned. Such 28 coverage for additional insured shall apply as primary insurance and any other insurance, or self- 8 1 insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not 2 contributing with insurance provided under CONTRACTOR's policies herein. This insurance shall not be 3 cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY. 4 CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and 5 employees any amounts paid by the policy of worker's compensation insurance required by this 6 Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be 7 necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under 8 this paragraph is effective whether or not CONTRACTOR obtains such an endorsement. 9 Within thirty (30) days from the date each CONTRACTOR signs this Agreement, said 10 CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the 11 foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 1925 E. 12 Dakota Ave, Fresno, California, 93726, Attention: Public Behavioral Health Division or electronically to the 13 assigned COUNTY's DBH Staff Analyst, stating that such insurance coverages have been obtained and 14 are in full force; that the County of Fresno, its officers, agents and employees will not be responsible for 15 any premiums on the policies; that for such worker's compensation insurance the CONTRACTOR has 16 waived its right to recover from the COUNTY, its officers, agents, and employees any amounts paid under 17 the insurance policy and that waiver does not invalidate the insurance policy; that such Commercial 18 General Liability insurance names the County of Fresno, its officers, agents and employees, individually 19 and collectively, as additional insured, but only insofar as the operations under this Agreement are 20 concerned; that such coverage for additional insured shall apply as primary insurance and any other 21 insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be excess 22 only and not contributing with insurance provided under CONTRACTOR policies herein; and that this 23 insurance shall not be cancelled or changed without a minimum of thirty (30) days advance, written notice 24 given to COUNTY. 25 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein 26 provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement 27 upon the occurrence of such event. 28 All policies shall be with admitted insurers licensed to do business in the State of California. 9 1 Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or 2 better. 3 11. LICENSES/CERTIFICATES 4 Throughout the term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall 5 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for 6 the provision of the services hereunder and required by the laws and regulations of the United States of 7 America, State of California, County of Fresno, and any other applicable governmental agencies. 8 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such 9 licenses, permits, approvals, certificates, waivers and exemptions irrespective of pendency of any appeal 10 related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all applicable 11 laws, rules or regulations, as may now exist or be hereafter changed. 12 12. RECORDS 13 Financial, statistical and demographic data shall be kept and reports made as required by 14 the County's Department of Behavioral Health Director and State. COUNTY shall be allowed to review all 15 records of services provided, including the goals and objectives of services, and how the services 16 provided is achieving the goals and objectives. All such records shall be available for inspection by the 17 designated Auditors of COUNTY or State at reasonable times during normal business hours. All such 18 records shall be maintained through the end of this Agreement. All records shall be considered property 19 of COUNTY and shall be retained by COUNTY at the termination or expiration of this Agreement. 20 13. REPORTS 21 A. Outcome Reports 22 CONTRACTOR shall submit to COUNTY's DBH service outcome reports as 23 requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at 24 COUNTY's DBH discretion. 25 B. Staffing Reports 26 CONTRACTOR shall submit monthly staff reports that identify all direct services 27 and support staff, applicable licensure/certifications, and full-time hours worked to be used as a tracking 28 tool to determine if CONTRACTOR's program is staffed according to the services provided under this 10 1 Agreement. 2 C. MHSA Innovation Reporting 3 It is understood that COUNTY and CONTRACTOR are responsible for providing 4 reports and contributing to the evaluation of this pilot project to the MHSOAC as outlined in the approved 5 MHSA Innovation Plan submitted and approved by COUNTY's Board of Supervisors on July 7, 2020. 6 Outcomes data and report requirements may be changed in consultation with and written agreement by 7 all Parties. 8 D. Additional Reports 9 In addition, CONTRACTOR shall submit to DBH by the tenth (10th) of each month 10 all monthly activity and budget reports for the preceding month. CONTRACTORS shall also furnish to 11 COUNTY such statements, records, reports, data, and other information as DBH may request pertaining 12 to matters covered by this Agreement as required by MHSOAC. In the event that CONTRACTORS fails 13 to provide such reports or other information required hereunder, it shall be deemed sufficient cause for 14 COUNTY to withhold monthly payments until there is compliance. In addition, CONTRACTOR shall 15 provide written notification and explanation to COUNTY within five (5) days of any funds received from 16 another source to conduct the same services covered by this Agreement. 17 14. MONITORING 18 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director and the 19 State Department of Mental Health, or their designees, the right to review and monitor records, program 20 or procedures, at any time, in regard to clients, as well as the overall operation of CONTRACTOR's 21 program, in order to ensure compliance with the terms and conditions of this Agreement. 22 15. COMPLIANCE WITH APPLICABLE LAW AND GRANT 23 Each Party shall comply with all laws and related regulations applicable to its performance 24 of this Agreement, and all laws and related regulations for which it agrees to comply under this 25 Agreement (collectively and separately referred to as "Applicable Law" and shall include any amendment 26 thereto and laws and related regulations that are effective as of the Effective Date or that become 27 effective during the Agreement Term). Each Applicable Law is deemed inserted herein; however, if any 28 conflict or inconsistency exists between a provision in this Agreement and a provision in an Applicable 11 1 Law, the provision in this Agreement shall govern except where the provision in this Agreement is 2 specifically prohibited or void by the Applicable Law in which case the provision in the Applicable Law 3 shall govern to the extent provided in the Applicable Law. Each Party shall comply with the terms and 4 conditions of each grant (if any)that provides funding for this Agreement and all applicable laws, 5 regulations, and requirements. 6 16. COMPLIANCE WITH STATE MENTAL HEALTH REQUIREMENTS 7 CONTRACTOR recognizes that COUNTY operates its mental health programs under an 8 agreement with the State of California Department Health Care Services, and that under said agreement 9 the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTORS shall 10 adhere to all State requirements, including those identified in Exhibit D, "State Mental Health 11 Requirements", attached hereto and by this reference incorporated herein and made part of this 12 Agreement. 13 17. CONFIDENTIALITY 14 All services performed by CONTRACTOR under this Agreement shall be in strict 15 conformance with all applicable Federal, State of California and/or local laws and regulations relating to 16 confidentiality. 17 18. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT 18 COUNTY and CONTRACTOR each consider and represent themselves as covered 19 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 20 104-191(HI PAA) and agree to use and disclose protected health information as required by law. 21 COUNTY and CONTRACTOR acknowledge that the exchange of protected health 22 information between them is only for treatment, payment, and health care operations. 23 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of 24 Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health 25 Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and 26 regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA 27 Regulations) and other applicable laws. 28 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require 12 1 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI, 2 as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of 3 Federal Regulations (CFR). 4 19. DATA SECURITY 5 For the purpose of preventing the potential loss, misappropriation or inadvertent access, 6 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of 7 COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into 8 a contractual relationship with the COUNTY for the purpose of providing services under this Agreement 9 must employ adequate data security measures to protect the confidential information provided to 10 CONTRACTOR by the COUNTY, including but not limited to the following: 11 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices 12 CONTRACTOR may not connect to COUNTY networks via personally-owned 13 mobile, wireless or handheld devices, unless the following conditions are met: 14 1) CONTRACTOR has received authorization by COUNTY for 15 telecommuting purposes; 16 2) Current virus protection software is in place; 17 3) Mobile device has the remote wipe feature enabled; and 18 4) A secure connection is used. 19 B. CONTRACTOR-Owned Computers or Computer Peripherals 20 CONTRACTOR may not bring CONTRACTOR-owned computers or computer 21 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief Information 22 Officer, and/or his or her designee(s), including but not limited to mobile storage devices. If data is 23 approved to be transferred, data must be stored on a secure server approved by the COUNTY and 24 transferred by means of a Virtual Private Network (VPN) connection, or another type of secure 25 connection. Said data must be encrypted. 26 C. COUNTY-Owned Computer Equipment 27 CONTRACTOR may not use COUNTY computers or computer peripherals on non- 28 COUNTY premises without prior authorization from the COUNTY's Chief Information Officer, and/or his or 13 1 her designee(s). 2 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on 3 any hard-disk drive, portable storage device, or remote storage installation unless encrypted. 4 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity 5 and security of COUNTY's confidential information and to prevent unauthorized access, viewing, use or 6 disclosure of data maintained in computer files, program documentation, data processing systems, data 7 files and data processing equipment which stores or processes COUNTY data internally and externally. 8 F. Confidential client information transmitted to one party by the other by means of 9 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128 10 BIT or higher. Additionally, a password or pass phrase must be utilized. 11 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations, 12 breaches or potential breaches of security related to COUNTY's confidential information, data maintained 13 in computer files, program documentation, data processing systems, data files and data processing 14 equipment which stores or processes COUNTY data internally or externally. 15 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents 16 arising from a possible breach of security related to COUNTY's confidential client information provided to 17 CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals as 18 required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be 19 responsible for all costs incurred as a result of providing the required notification. 20 20. PROPERTY OF COUNTY 21 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and 22 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational 23 capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items 24 will be on a straight-line basis. 25 For COUNTY purposes, fixed assets must fulfill three qualifications: 26 1) Asset must have life span of over one year; 27 2) The asset is not a repair part; and 28 3) The asset must be valued at or greater than the capitalization thresholds for the 14 1 asset type. 2 Asset type Threshold 3 . land $0 • buildings and improvements $100,000 4 • infrastructure $100,000 5 • be tangible $5,000 o equipment 6 o vehicles • or intangible asset $100,000 7 o Internally generated software o Purchased software$ o Easements 9 o Patents • capital lease equipment $5,000 10 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is 11 approved and identified as an asset it will be tagged with a COUNTY program number. A "Fixed Asset 12 Log", attached hereto as Exhibit E and by this reference incorporated herein, will be maintained by 13 COUNTY's Asset Management System and inventoried annually until the asset is fully depreciated. 14 During the terms of this Agreement, CONTRACTOR's fixed assets may be inventoried in comparison 15 to COUNTY's DBH Asset Inventory System. 16 B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) with 17 over one-year life span and are mobile and high risk of theft or loss are sensitive assets. Such 18 sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive items as 19 determined by COUNTY's DBH Director or designee. CONTRACTOR maintains a tracking system on 20 the items that are not required to be capitalized or depreciated. The items are subject to annual 21 inventory for compliance. 22 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this 23 Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in 24 an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this 25 Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are returned 26 to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY owned 27 undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce 28 the assets at the expiration or termination of this Agreement. 15 1 CONTRACTOR further agrees to the following: 2 1) To maintain all items of equipment in good working order and condition, 3 normal wear and tear is expected; 4 2) To label all items of equipment with COUNTY assigned program number, 5 to perform periodic inventories as required by COUNTY and to maintain an inventory list showing 6 where and how the equipment is being used, in accordance with procedures developed by COUNTY. 7 All such lists shall be submitted to COUNTY within ten (10) days of any request; therefore, and 8 3) To report in writing to COUNTY immediately after discovery, the lost or 9 theft of any items of equipment. For stolen items, the local law enforcement agency must be 10 contacted, and a copy of the police report submitted to COUNTY. 11 D. The purchase of any equipment by CONTRACTOR with funds provided 12 hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this 13 Agreement as appropriate, and must be directly related to CONTRACTOR's services or activity under 14 the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from 15 equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been 16 obtained from COUNTY. 17 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH 18 whenever there is any modification or change in the use of any property acquired or improved, in 19 whole or in part, using funds under this Agreement. If any real or personal property acquired or 20 improved with said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which 21 does not qualify under this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal 22 to the current fair market value of the property, less any portion thereof attributable to expenditures of 23 funds not provided under this Agreement. These requirements shall continue in effect for the life of the 24 property. In the event this Agreement expires, or terminates, the requirements for this Section shall 25 remain in effect for activities or property funded with said funds, unless action is taken by the State 26 government to relieve COUNTY of these obligations. 27 21. NON-DISCRIMINATION 28 During the performance of this Agreement, CONTRACTOR and its subcontractors shall not 16 1 deny the contract's benefits to any person on the basis of race, religious creed, color, national origin, 2 ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, 3 gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor 4 shall they discriminate unlawfully against any employee or applicant for employment because of race, 5 religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, 6 genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual 7 orientation, or military or veteran status. CONTRACTOR shall insure that the evaluation and treatment of 8 employees and applicants for employment are free of such discrimination. 9 CONTRACTOR and its subcontractors shall comply with the provisions of the Fair 10 Employment and Housing Act (Gov. Code §12800 et seq.), the regulations promulgated thereunder(Cal. 11 Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of 12 the Government Code (Gov. Code §11135-11139.5), and the regulations or standards adopted by the 13 awarding state agency to implement such article. CONTRACTOR shall permit access by representatives 14 of the Department of Fair Employment and Housing and the awarding state agency upon reasonable 15 notice at any time during the normal business hours, but in no case less than twenty-four (24) hours 16 notice, to such of its books, records, accounts, and all other sources of information and its facilities as 17 said Department or Agency shall require to ascertain compliance with this clause. CONTRACTOR and 18 its subcontractors shall give written notice of their obligations under this clause to labor organizations with 19 which they have a collective bargaining or other agreement. (See Cal. Code Regs., tit. 2, §11105). 20 CONTRACTOR shall include the Non-Discrimination and compliance provisions of this clause in all 21 subcontracts to perform work under this Agreement. 22 22. CULTURAL COMPETENCY 23 As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with: 24 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. 25 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance 26 from discriminating against persons based on race, color, national origin, sex, disability or religion. 27 This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access 28 and participation in federally funded programs through the provision of comprehensive and quality 17 1 bilingual services. 2 B. Policies and procedures for ensuring access and appropriate use of trained 3 interpreters and material translation services for all LEP consumers, including, but not limited to, 4 assessing the cultural and linguistic needs of its consumers, training of staff on the policies and 5 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must 6 include ensuring compliance of any sub-contracted providers with these requirements. 7 C. CONTRACTOR shall not use minors as interpreters. 8 D. CONTRACTOR shall provide and pay for interpreting and translation services to 9 persons participating in CONTRACTOR's services who have limited or no English language 10 proficiency, including services to persons who are deaf or blind. Interpreter and translation services 11 shall be provided as necessary to allow such participants meaningful access to the programs, services 12 and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of 13 CONTRACTOR's "vital documents" (those documents that contain information that is critical for 14 accessing CONTRACTOR's services or are required by law) shall be provided to participants at no 15 cost to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or 16 partners who interpret or translate for a program participant, or who directly communicate with a 17 program participant in a language other than English, demonstrate proficiency in the participant's 18 language and can effectively communicate any specialized terms and concepts peculiar to 19 CONTRACTOR's services. 20 E. CONTRACTOR shall ensure that employees, agents, subcontractors, and/or 21 partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a 22 language other than English (1) have completed annual training provided by COUNTY at no cost to 23 CONTRACTOR; (2) have demonstrated proficiency in the beneficiary's language; (3) can effectively 24 communicate any specialized terms and concepts specific to CONTRACTOR's services; and (4) 25 adheres to generally accepted interpreter ethic principles. As requested by COUNTY, CONTRACTOR 26 shall identify all who interpret for or provide direct communication to any program beneficiary in a 27 language other than English and identify when the CONTRACTOR last monitored the interpreter for 28 language competence. 18 1 F. CONTRACTORS shall submit to COUNTY for approval, within ninety (90) days 2 from date of contract execution, CONTRACTORS's plan to address all fifteen (15) National Standards 3 for Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of Minority 4 Health and as set forth in Exhibit F "National Standards on Culturally and Linguistically Appropriate 5 Services", attached hereto and incorporated herein by reference and made part of this Agreement. As 6 the CLAS standards are updated, CONTRACTORS's plan must be updated accordingly. As requested 7 by COUNTY, CONTRACTORS shall be responsible for conducting an annual CLAS self-assessment 8 and providing the results of the self-assessment to the COUNTY. The annual CLAS self-assessment 9 instruments shall be reviewed by the COUNTY and revised as necessary to meet the approval of the 10 COUNTY. 11 G. Cultural competency training for CONTRACTOR staff should be substantively 12 integrated into health professions education and training at all levels, both academically and 13 functionally, including core curriculum, professional licensure, and continuing professional 14 development programs. As requested by COUNTY, CONTRACTOR shall report on the completion of 15 cultural competency trainings to ensure direct service providers are completing a minimum of one (1) 16 cultural competency training annually. 17 H. CONTRACTOR shall create and sustain a forum that includes staff at all agency 18 levels to discuss cultural competence. COUNTY encourages a representative from CONTRACTOR's 19 forum to attend COUNTY's Cultural Humility Committee. 20 23. AMERICANS WITH DISABILITIES ACT 21 CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to 22 this Agreement, shall comply with the accessibility requirements of section 508 of the Rehabilitation 23 Act and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations 24 implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998, 25 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic 26 and information technology (EIT) accessible to people with disabilities. California Government Code 27 section 11135 codifies section 508 of the Act requiring accessibility of electronic and information 28 technology. 19 1 24. CONFLICT OF INTEREST 2 No officer, agent, or employee of COUNTY who exercises any function or responsibility for 3 planning and carrying out the services provided under this Agreement shall have any direct or indirect 4 personal financial interest in this Agreement. In addition, no employee of COUNTY shall be employed by 5 CONTRACTOR to fulfill any contractual obligations with COUNTY. 6 CONTRACTOR shall also comply with all Federal, State of California, and local conflict of 7 interest laws, statutes, and regulations, which shall be applicable to all parties and beneficiaries under this 8 Agreement and any officer, agent, or employee of COUNTY. 9 25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT 10 To the extent necessary to prevent disallowance of reimbursement under section 11 1861(v)(1) (1) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[11), until the expiration of four(4) 12 years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon 13 written request to the Secretary of the United States Department of Health and Human Services, or upon 14 request to the Comptroller General of the United States General Accounting Office, or any of their duly 15 authorized representatives, a copy of this Agreement and such books, documents, and records as are 16 necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR 17 under this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of 18 its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100 19 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such 20 Agreement shall contain a clause to the effect that until the expiration of four(4)years after the furnishing 21 of such services pursuant to such subcontract, the related organizations shall make available, upon 22 written request to the Secretary of the United States Department of Health and Human Services, or upon 23 request to the Comptroller General of the United States General Accounting Office, or any of their duly 24 authorized representatives, a copy of such subcontract and such books, documents, and records of such 25 organization as are necessary to verify the nature and extent of such costs. 26 26. SINGLE AUDIT CLAUSE 27 A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars and No/100 28 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to 20 1 conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth in 2 Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and 3 management letter to COUNTY. The audit must include a statement of findings or a statement that there 4 were no findings. If there were negative findings, CONTRACTOR must include a corrective action plan 5 signed by an authorized individual. CONTRACTOR agrees to take action to correct any material non- 6 compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY's 7 DBH Business Office for review within nine (9) months of the end of any fiscal year in which funds were 8 expended and/or received for the program. Failure to perform the requisite audit functions as required by 9 this Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, 10 contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to 11 enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole 12 responsibility of CONTRACTOR. 13 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not 14 exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or 15 CONTRACTOR's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a 16 program audit must be performed and a program audit report with management letter shall be submitted 17 by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR's solvency. Said 18 audit report shall be delivered to COUNTY's DBH Business Office for review, no later than nine (9) 19 months after the close of the fiscal year in which the funds supplied through this Agreement are 20 expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks or 21 contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement are 22 the sole responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material 23 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under 24 this Section shall be billed to the CONTRACTOR at COUNTY's cost, as determined by COUNTY's 25 Auditor-Controller/Treasurer-Tax Collector. 26 C. CONTRACTOR shall make available all records and accounts for inspection by 27 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal 28 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at 21 1 least three (3) years following final payment under this Agreement or the closure of all other pending 2 matters, whichever is later. 3 27. ASSURANCES 4 In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded, 5 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs: that it 6 has not been convicted of a criminal offense related to the provision of health care items or services; nor 7 has it been reinstated to participation in the Federal Health Care Programs after a period of exclusion, 8 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that 9 CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility 10 for, or involvement with, COUNTY's business operations related to the Federal Health Care Programs 11 and shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or 12 the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, 13 directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such 14 time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs. 15 A. If COUNTY has notice that CONTRACTOR has been charged with a criminal 16 offense related to any Federal Health Care Program, or is proposed for exclusion during the term of any 17 contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any 18 claims submitted to any Federal Health Care Program. At its discretion given such circumstances, 19 COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or the 20 proposed exclusion. 21 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or 22 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services 23 under this Agreement, will be queried as to whether: (1)they are now or ever have been excluded, 24 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they 25 have been convicted of a criminal offense related to the provision of health care items or services; and or 26 (3) they have been reinstated to participation in the Federal Health Care Programs after a period of 27 exclusion, suspension, debarment, or ineligibility. 28 C. In the event the potential employee or subcontractor informs a CONTRACTOR that 22 1 he or she is excluded, suspended, debarred, or otherwise ineligible, or has been convicted of a criminal 2 offense relating to the provision of health care services, and that CONTRACTOR hires or engages such 3 potential employee or subcontractor, that potential employee or subcontractor may not be hired or 4 engaged to do work under this Agreement. 5 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for 6 information from COUNTY, which may be necessary to complete any internal or external audits relating to 7 CONTRACTOR's compliance with the provisions of this Section. 8 28. PUBLIC PROHIBITION 9 None of the funds, materials, property or services provided directly or indirectly under this 10 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of 11 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the 12 above, publicity of the services described in Section One (1) of this Agreement shall be allowed as 13 necessary to raise public awareness about the availability of such specific services when approved in 14 advance by COUNTY's DBH Director, or his or her designee, and at a cost to be provided in Exhibit C for 15 such items as written/printed materials, the use of media (i.e., radio, television, newspapers) and any 16 other related expense(s). 17 29. COMPLAINTS 18 CONTRACTOR shall log complaints and the disposition of all complaints from a client or a 19 client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning 20 COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of the following 21 month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and 22 attach documentation of each complaint with the log. CONTRACTOR shall post signs informing clients of 23 their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents reportable 24 to State licensing bodies that affect COUNTY clients within twenty-four(24) hours of receipt of a 25 complaint. 26 Within ten (10) days after each incident or complaint affecting COUNTY clients, 27 CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of 28 the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the 23 1 complaint. In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit G. 2 CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and 3 using the worksheet identified in Exhibit H. 4 30. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION 5 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or 6 managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 §455.101 455.104, and 7 455.106(a)(1),(2). 8 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2), 9 the following information must be disclosed by CONTRACTOR by completing Exhibit I, "Disclosure of 10 Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein 11 and made part of this Agreement. CONTRACTOR shall submit this form to COUNTY's DBH within thirty 12 (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes 13 to this information within thirty-five (35) days of occurrence by completing Exhibit I. CONTRACTOR is 14 required to submit a set of fingerprints for any person with a five (5) percent or greater direct or indirect 15 ownership interest in CONTRACTOR. COUNTY may terminate this Agreement where any person with a 16 five (5) percent or greater direct or indirect ownership interest in the CONTRACTOR did not submit timely 17 and accurate information and cooperate with any screening method required in CFR, Title 42, Section 18 455.416. Submissions shall be scanned portable document format (pdf) copies and are to be sent via 19 email to DBHContractedServicesDivision(a_fresnocountyca.gov. COUNTY may deny enrollment or 20 terminate this Agreement where any person with a five (5) percent or greater direct or indirect ownership 21 interest in CONTRACTOR has been convicted of a criminal offense related to that person's involvement 22 with the Medicare, Medicaid, or Title XXI program in the last ten (10)years. 23 31. DISCLOSURE— CRIMINAL HISTORY AND CIVIL ACTIONS 24 CONTRACTOR is required to disclose if any of the following conditions apply to them, their 25 owners, officers, corporate managers and partners (hereinafter collectively referred to as 26 "CONTRACTOR"): 27 A. Within the three (3)year period preceding the Agreement award, they have been 28 convicted of, or had a civil judgment rendered against them for: 24 1 1) Fraud or a criminal offense in connection with obtaining, attempting to 2 obtain, or performing a public (federal, state, or local)transaction or contract under a public transaction; 3 2) Violation of a federal or state antitrust statute; 4 3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records; 5 or 6 4) False statements or receipt of stolen property. 7 B. Within a three (3) year period preceding their Agreement award, they have had a 8 public transaction (federal, state, or local)terminated for cause or default. 9 Disclosure of the above information will not automatically eliminate CONTRACTOR from 10 further business consideration. The information will be considered as part of the determination of whether 11 to continue and/or renew the Agreement and any additional information or explanation that a 12 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined 13 that the CONTRACTOR failed to disclose required information, any contract awarded to such 14 CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms 15 and conditions of the award. 16 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other 17 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit J, attached hereto 18 and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR 19 must immediately advise the COUNTY in writing if, during the term of this Agreement: (1) 20 CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or state 21 funded programs or from receiving Federal funds as listed in the excluded parties' list system 22 (https://www.sam.gov/SAM); or(2) any of the above listed conditions become applicable to 23 CONTRACTOR. The applicable CONTRACTOR shall indemnify, defend, and hold COUNTY harmless 24 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other matter 25 listed in the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters. 26 32. DISCLOSURE OF SELF-DEALING TRANSACTIONS 27 This provision is only applicable if the CONTRACTOR is operating as a corporation (a for- 28 profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes its 25 1 status to operate as a corporation. 2 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing 3 transactions that they are a party to while CONTRACTOR is providing goods or performing services 4 under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is 5 a party and in which one or more of its directors has a material financial interest. Members of the Board 6 of Directors shall disclose any self-dealing transactions that they are a party to by completing and signing 7 a "Self-Dealing Transaction Disclosure Form", attached hereto as Exhibit K and incorporated herein by 8 reference and made part of this Agreement, and submitting it to the COUNTY prior to commencing with 9 the self-dealing transaction or immediately thereafter. 10 33. COMPLIANCE 11 CONTRACTOR agrees to comply with the COUNTY's Contractor Code of Conduct and 12 Ethics and the COUNTY's Compliance Program in accordance with Exhibit L, attached hereto and 13 incorporated herein by reference and made part of this Agreement. Within thirty (30) days of entering into 14 this Agreement with the COUNTY, CONTRACTOR shall have all of the CONTRACTOR's employees, 15 agents and subcontractors providing services under this Agreement certify in writing, that he or she has 16 received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics. 17 CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents, and 18 subcontractors providing services under this Agreement shall certify in writing that he or she has received, 19 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR 20 understands that the promotion of and adherence to the Code of Conduct is an element in evaluation the 21 performance of CONTRACTOR and its employees, agents and subcontractors. 22 Within thirty (30) days of entering into this Agreement, and annually thereafter, all 23 employees, agents, and subcontractors providing services under this Agreement shall complete general 24 compliance training and appropriate employees, agents and subcontractors shall complete 25 documentation and billing or billing/reimbursement training. All new employees, agents and 26 subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is required 27 to attend training shall certify in writing that he or she has received the required training. The certification 28 shall specify the type of training received and the date received. The certification shall be provided to the 26 1 COUNTY's Compliance Officer at 1925 E. Dakota Avenue, Fresno, California 93726. CONTRACTOR 2 agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY by the Federal 3 Government as a result of CONTRACTOR's violation of the terms of this Agreement. 4 34. SUBCONTRACTS 5 CONTRACTOR shall obtain written approval from COUNTY's DBH Director, or designee, 6 before subcontracting any of the services delivered under this Agreement, unless previously budgeted at 7 time of award. COUNTY's DBH Director, or designee, retains the right to approve or reject any request for 8 subcontracting services. Any transferee, assignee, or subcontractor will be subject to all applicable 9 provisions of this Agreement, and all applicable State and Federal regulations. CONTRACTOR shall be 10 held primarily responsible by COUNTY for the performance of any transferee, assignee, or subcontractor 11 unless otherwise expressly agreed to in writing by COUNTY's DBH Director, or designee. The use of 12 subcontractors by CONTRACTOR shall not entitle CONTRACTOR to any additional compensation that is 13 provided for under this Agreement. 14 35. CHILD ABUSE REPORTING 15 CONTRACTOR shall utilize a procedure acceptable to COUNTY to ensure that all of 16 CONTRACTORS' employees, volunteers, consultants, subcontractors or agents performing services 17 under this Agreement shall report all known or suspected child abuse or neglect to one or more of the 18 agencies set forth in Penal Code Section 11165.9. This procedure shall include having all of 19 CONTRACTORS' employees, volunteers, consultants, subcontractors or agents performing services 20 under this Agreement sign a statement that he or she knows of and will comply with the reporting 21 requirements set forth in Penal Code Section 11166. The statement to be utilized by CONTRACTOR is 22 set forth in Exhibit M, attached hereto and by this reference incorporated herein. 23 36. AUDITS AND INSPECTIONS 24 CONTRACTOR shall at any time during business hours, and as often as COUNTY may 25 deem necessary, make available to COUNTY for examination all of its records and data with respect to 26 the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit 27 COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTOR's 28 compliance with the terms of this Agreement. 27 1 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00), 2 CONTRACTOR shall be subject to the examination and audit of the State of California Auditor General 3 for a period of three (3) years after final payment under contract (California Government Code section 4 8546.7). 5 37. NOTICES 6 The persons having authority to give and receive notices under this Agreement and their 7 addresses include the following: 8 COUNTY CONTRACTOR Director, County of Fresno Integral Community Solutions Institute 9 Department of Behavioral Health Cc to: Dr. Juan Garcia 10 1925 E. Dakota Ave 255 N. Fulton St. Suite 105 Fresno, CA 93726 Fresno, CA 93701 11 12 All notices between the COUNTY and CONTRACTOR provided for or permitted under this 13 Agreement must be in writing and delivered either by personal service, by first-class United States mail, 14 by an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by 15 personal service is effective upon service to the recipient. A notice delivered by first-class United States 16 mail is effective three (3) COUNTY business days after deposit in the United States mail, postage 17 prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is 18 effective one (1) COUNTY business day after deposit with the overnight commercial courier service, 19 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A 20 notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if 21 such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed 22 to be effective at the next beginning of a COUNTY business day), provided that the sender maintains a 23 machine record of the completed transmission. For all claims arising out of or related to this Agreement, 24 nothing in this Section establishes, waives, or modifies any claims presentation requirements or 25 procedures provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 26 of the Government Code, beginning with Section 810). 27 38. ELECTRONIC SIGNATURE 28 The parties agree that this Agreement may be executed by electronic signature as provided 28 1 in this section. An "electronic signature" means any symbol or process intended by an individual signing 2 this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a faxed 3 version of an original handwritten signature; or(3) an electronically scanned and transmitted (for example 4 by PDF document) of a handwritten signature. Each electronic signature affixed or attached to this 5 Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing this 6 Agreement for all purposes, including but not limited to evidentiary proof in any administrative or judicial 7 proceeding, and (2) has the same force and effect as the valid original handwritten signature of that 8 person. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision 9 (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3, Part 2, Title 2.5, beginning with 10 section 1633.1). Each party using a digital signature represents that it has undertaken and satisfied the 11 requirements of Government Code section 16.5, subdivision (a), paragraphs (1)through (5), and agrees 12 that each other party may rely upon that representation. This Agreement is not conditioned upon the 13 parties conducting the transactions under it by electronic means and either party may sign this Agreement 14 with an original handwritten signature. 15 39. SEVERABILITY 16 If any non-material term, provision, covenant, or condition of this Agreement is held by a 17 court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions shall 18 remain in full force and effect, and shall in no way be affected, impaired or invalidated. 19 40. GOVERNING LAW 20 Venue for any action arising out of or related to the Agreement shall only be in Fresno 21 County, California. 22 The rights and obligations of the parties and all interpretation and performance of this 23 Agreement shall be governed in all respects by the laws of the State of California. 24 41. ENTIRE AGREEMENT 25 This Agreement, including all Exhibits, constitutes the entire Agreement between 26 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous 27 agreement negotiations, proposals, commitments, writings, advertisements, publications, and 28 understandings of any nature whatsoever unless expressly included in this Agreement. 29 4 � 1 !; IN WITNESS WHEREOF the parties herein have executed this Agreement as of the day and year ; ii 2 first hereinabove written. 3 4 INTEGRAL COMMUNITY SOLUTIONS COUNTY OF FRESNO INSTITUTE: 6 uthorized Signature) Brian Pacheco. Chairman of the Board of 7 T Supervisors of the County of Fresno ' 8 ! Pent Name&Title !i 10 + 11 �5 fL'' �L.//7n Mailing Address ATTEST: 12 � Bernice E.Seidel 13 Clerk of the Board of Supervisors County of Fresno.State of California 14 15 By- w(Authorized Si re i Deputy 16 oe - - 17 Print Name -v i{ 18 19 ?t Title: Secretary(of Corporation).or ! any Assistant Secretary.or 20 Chief Financial Officer,or any Assistant Treasurer l 21 ,� 1 f� 22 23 24 i FOR ACCOUNTING USF. ONLY: 25i Fund: 0001 Subdass: 10000 i 26 ORG. 56304797 Account 729510 27 i I 26 30 ;e I � i Exhibit A- Page 1 of 5 SUMMARY OF SERVICES ORGANIZATION: Integral Community Solutions Institute PROGRAM NAME: Atencion Plena and Platicas OFFICE ADDRESS: 255 North Fulton St. Suite 105, Fresno, CA 93701 OFFICE TELEPHONE: (559) 497- 5056 CONTACT(S): Dr. Juan Garcia, LMFT, Executive Director Fausto Novelo, MA, APPC, Operations Manager CONTRACT PERIOD: November 1, 2021 — June 30, 2024 AMOUNT: November 1, 2021 — June 30, 2022: $160,822 FY 22-23: $276,612 FY 23-24: $276,455 Total: $713,889 A. SUMMARY OF SERVICE "Atencion Plena" means the practice of mindfulness or one's mental capacity to accomplish self-awareness, inner-peace, and being attentive to one's surroundings. "Platicas" means of transmitting knowledge about wellbeing through songs, stories, and poetry. Integral Community Solutions Institute ("CONTRACTOR") will provide services known as the Atencion Plena and Platicas Program ("Program"). Atencion Plena and Platicas are interventions focused on prevention and early intervention. The Program supports community health and engagement through advocacy and systems change that promotes whole person wellness for Latino/x youth. The Program adapts things such as expression activities, talking circles, and mindfulness practices that are rendered in a youth-centric Latino/x focused manner for behavioral health engagement and early non-clinical prevention and engagement activities. B. TARGET POPULATION The Program will serve Latino/x youth in Fresno County. Exhibit A- Page 2 of 5 C. CONTRACTOR's RESPONSIBILITIES CONTRACTOR shall perform the activities below: 1. Provide culturally responsive, community-defined, and community-derived mental health strategies (Atencion Plena and Platicas) to reduce disparities that exist. Strategies in Atencion Plena include progressive relaxation technique and guided meditation in periods of 5, 10, or 15 minutes in order to prepare participants to practice centering meditation (meditacion centrante) and related mindfulness activities that impact positive outlook on living. Strategies in Platicas include canciones (songs), dichos (sayings), cuentos (stories), and poesia (poetry) to create meaningful life guidance based on cultural foundations. 2. Activities in the program may include, but are not limited to: a. Providing Placticas and Atencion Plena to unaccompanied minors who reside in Fresno and are assisted by Kids In Need of Defense (KIND). b. Operating School Based Mindfulness Club (Atencion Plena) driven by students where through campus club they are able to develop their own wellness management and leadership skills. c. Providing campus-based prevention through a local charter school (Placticas and Atencion Plena) and its afterschool services. d. Collaboration with a local advocacy community based organization ("CBO") who will provide services for local Latino/x and rural afterschool services and (both) will provide the behavioral health engagement component. 3. Provide services to 670 unique individuals throughout the term of this Agreement. 4. Recruit and maintain staffing in accordance with Exhibit C, Budget Summary. Staff should have experience working with Fresno's diverse communities and reflect the targeted underserved and inappropriately served population. 5. Supervisory and/or Management staff shall participate in meetings with the County of Fresno ("COUNTY"), Department of Behavioral Health ("DBH") to discuss program and/or contractual issues. DBH shall coordinate the meetings. 6. Comply with all contract monitoring and compliance protocols, procedures, data collection methods, and reporting requirements conducted by the COUNTY. Exhibit A- Page 3 of 5 7. Actively participate with DBH and any outside consultants for performance monitoring and reporting requirements. 8. Comply with request for additional reports/outcomes by the COUNTY's DBH, based on among other things, identification of client/family specific needs as well as State required reports/outcomes as needed. 9. Participate in performance outcome measurements throughout the term of this Agreement, if needed. DBH will notify CONTRACTOR when its participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, individual and staff interviews, chart reviews, and other methods of obtaining needed information. 10.Work with and assist DBH with communicating and presenting program and findings to stakeholders, public and social media. D. LOCATION OF SERVICES Services will be primarily provided in school settings or at local community-based organizations. E. IMPLEMENTATION TIMELINE Implementation timeline below is considered preliminary and may be modified, by written mutual consent, by DBH Director, or designee, and by CONTRACTOR during the contract term. Timeframe Activities • Secure space and plan for community planning process. Months 1-4 . Develop flyer and messaging community feedback. • Hire staff, if needed. • Analyze and implement of strategies from planning process into program • Assist evaluator with the evaluation process, including Months 5-8 participation in meetings, services, data collection and evaluation coordination. • Hire staff, if needed. • Provide staff training, if needed. Exhibit A- Page 4 of 5 • Begin Program Month 9+ . Continue to work with the Department and program evaluator for data collection. F. COUNTY RESPONSIBILITIES County shall: 1. Participate in monthly meetings with CONTRACTOR to discuss program and/or contractual issues. Meeting frequency may be changed after the first year of implementation. DBH will be responsible for coordination of these meetings. 2. Participate in evaluating the progress of the overall program and the efficiency of collaboration with CONTRACTOR's staff and will be available to the CONTRACTOR for ongoing consultation. 3. Gather outcome information from CONTRACTOR throughout the term of this Agreement, as needed. 4. Participate with the CONTRACTOR and any outside consultants for performance monitoring and reporting requirements. 5. DBH shall include CONTRACTOR's staff in DBH trainings that are relevant to the services as described in this Agreement, if there is sufficient space available, at no cost. G. REPORTS / PERFORMANCE OUTCOME MEASURES This collaboration is a Mental Health Services Act (MHSA) Innovations funded project and throughout the process of services, CONTRACTOR will provide regular updates to DBH and/or the Innovation Project evaluator summarizing how the goals and objectives are being met through the provision of services. During the term of this Agreement, additional data collection opportunities may be identified and implemented to support the MHSA Innovation research aspects of the Hmong Helping Hands program. DBH and CONTRACTOR will review additional outcomes, MHSA INN requirements and CARF standards to establish further agreed upon outcomes to be tracked. CONTRACTOR will actively collaborate with DBH and a third-party consultant to develop and refine data collection and reporting processes to ensure compliance with MHSA Innovation Plan requirements. Exhibit A- Page 5 of 5 Data Collection 1. Data collection and evaluation methods may include, but are not limited to, staff, participant, and family interviews, focus groups, surveys, participation observations, and case file reviews. 2. CONTRACTOR shall also conduct consumer satisfaction surveys to see if there is a strong correlation of the efficacy of the evidence-based program with specific ethnicities and languages as well as to identify gaps in meeting cultural needs of clients/families, if any. 3. CONTRACTOR shall ensure all program clients/families participate in the semiannual State Consumer Perception Survey (CPS). CPS surveys will be distributed to all clients/families to fill out and return to CONTRACTOR. 4. CONTRACTOR shall collect data required by MHSA INN and/or PEI regulations. PEI Regulations - http://mhsoac.ca.gov/sites/default/files/documents/2018- 08/PEI%20Regulations As Of July%202018.pdf INN Regulations - https://www.m hsoac.ca.gov/sites/default/files/documents/2018- 08/INN%20Regulations As Of July%202018.pdf a. Demographics i. Age group ii. Race iii. Ethnicity iv. Primary language v. Sexual orientation vi. Disability vii. Veteran status viii. Gender assigned at birth ix. Current gender identity 5. CONTRACTOR shall maintain all client data in permanent electronic case records. CONTRACTOR shall have established policies and procedures for data collection and client confidentiality. Performance Goals 1. Upon implementation of the Program adaptation, CONTRACTOR shall work with the project evaluator to determine applicable outcomes data to be collected for the remainder of the contract term. 2. Performance goals, once established, will be incorporated into this agreement via a written amendment to this Agreement approved by the COUNTY and the CONTRACTOR. Exhibit B Page 1 of 4 Fresno County Department of Behavioral Health Guiding Principles of Care Delivery DBH VISION: Health and well-being for our community. DBH MISSION: DBH, in partnership with our diverse community, is dedicated to providing quality, culturally responsive, behavioral health services to promote wellness, recovery, and resiliency for individuals and families in our community. DBH GOALS: Quadruple Aim • Deliver quality care • Maximize resources while focusing on efficiency • Provide an excellent care experience • Promote workforce well-being GUIDING PRINCIPLES OF CARE DELIVERY: The DBH 11 principles of care delivery define and guide a system that strives for excellence in the provision of behavioral health services where the values of wellness, resiliency, and recovery are central to the development of programs, services, and workforce. The principles provide the clinical framework that influences decision-making on all aspects of care delivery including program design and implementation, service delivery, training of the workforce, allocation of resources, and measurement of outcomes. 1. Principle One -Timely Access & Integrated Services o Individuals and families are connected with services in a manner that is streamlined, effective, and seamless o Collaborative care coordination occurs across agencies, plans for care are integrated, and whole person care considers all life domains such as health, education, employment, housing, and spirituality o Barriers to access and treatment are identified and addressed o Excellent customer service ensures individuals and families are transitioned from one point of care to another without disruption of care 1 rev 01-02-2020 Exhibit B Page 2 of 4 Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 2. Principle Two - Strengths-based o Positive change occurs within the context of genuine trusting relationships o Individuals, families, and communities are resourceful and resilient in the way they solve problems o Hope and optimism is created through identification of, and focus on, the unique abilities of individuals and families 3. Principle Three - Person-driven and Family-driven o Self-determination and self-direction are the foundations for recovery o Individuals and families optimize their autonomy and independence by leading the process, including the identification of strengths, needs, and preferences o Providers contribute clinical expertise, provide options, and support individuals and families in informed decision making, developing goals and objectives, and identifying pathways to recovery o Individuals and families partner with their provider in determining the services and supports that would be most effective and helpful and they exercise choice in the services and supports they receive 4. Principle Four- Inclusive of Natural Supports o The person served identifies and defines family and other natural supports to be included in care o Individuals and families speak for themselves o Natural support systems are vital to successful recovery and the maintaining of ongoing wellness; these supports include personal associations and relationships typically developed in the community that enhance a person's quality of life o Providers assist individuals and families in developing and utilizing natural supports. 5. Principle Five - Clinical Significance and Evidence Based Practices (EBP) o Services are effective, resulting in a noticeable change in daily life that is measurable. o Clinical practice is informed by best available research evidence, best clinical expertise, and values and preferences of those we serve o Other clinically significant interventions such as innovative, promising, and emerging practices are embraced 2 rev 01-02-2020 Exhibit B Page 3 of 4 Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 6. Principle Six- Culturally Responsive o Values, traditions, and beliefs specific to an individual's or family's culture(s) are valued and referenced in the path of wellness, resilience, and recovery o Services are culturally grounded, congruent, and personalized to reflect the unique cultural experience of each individual and family o Providers exhibit the highest level of cultural humility and sensitivity to the self- identified culture(s) of the person or family served in striving to achieve the greatest competency in care delivery 7. Principle Seven -Trauma-informed and Trauma-responsive o The widespread impacts of all types of trauma are recognized and the various potential paths for recovery from trauma are understood o Signs and symptoms of trauma in individuals, families, staff, and others are recognized and persons receive trauma-informed responses o Physical, psychological and emotional safety for individuals, families, and providers is emphasized 8. Principle Eight - Co-occurring Capable o Services are reflective of whole-person care; providers understand the influence of bio-psycho-social factors and the interactions between physical health, mental health, and substance use disorders o Treatment of substance use disorders and mental health disorders are integrated; a provider or team may deliver treatment for mental health and substance use disorders at the same time 9. Principle Nine - Stages of Change, Motivation, and Harm Reduction o Interventions are motivation-based and adapted to the person's stage of change o Progression though stages of change are supported through positive working relationships and alliances that are motivating o Providers support individuals and families to develop strategies aimed at reducing negative outcomes of substance misuse though a harm reduction approach o Each individual defines their own recovery and recovers at their own pace when provided with sufficient time and support 3 rev 01-02-2020 Exhibit B Page 4 of 4 Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven o Individual and program outcomes are collected and evaluated for quality and efficacy o Strategies are implemented to achieve a system of continuous quality improvement and improved performance outcomes o Providers participate in ongoing professional development activities needed for proficiency in practice and implementation of treatment models 11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma Reduction o The rights of all people are respected o Behavioral health is recognized as integral to individual and community well-being o Promotion of health and wellness is interwoven throughout all aspects of DBH services o Specific strategies to prevent illness and harm are implemented at the individual, family, program, and community levels o Stigma is actively reduced by promoting awareness, accountability, and positive change in attitudes, beliefs, practices, and policies within all systems o The vision of health and well-being for our community is continually addressed through collaborations between providers, individuals, families, and community members 4 rev 01-02-2020 Exhibit C-Page 1 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY) 2021-22 PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 Program Manager/Executive Director 0.375 $ - $ 30,000 $ 30,000 1102 Operations Manager 0.25 - 9,167 9,167 1103 Clinician 1/Mental Health Prevention 0.50 - 14,325 14,325 1104 Clinician 2/Mental Health Prevention 0.35 - 12,133 12,133 1105 Mindfulness Specialist 0.20 - 9,707 9,707 1106 Youth Activities Coordinator 0.70 - 21,000 21,000 1107 Data Coordinator 0.35 - 8,979 8,979 1108 Data Evaluator/Development 0.10 - 8,000 8,000 Personnel Salaries Subtotal 2.825 $ - $ 113,311 $ 113,311 Employee Benefits Acct# Description I Admin Direct Total 1202 Worker's Compensation 1,246 1,246 1203 Health Insurance 4,928 4,928 Employee Benefits Subtotal: $ $ 6,174 $ 6,174 Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI $ $ 7,025 $ 7,025 1302 FICA/MEDICARE 1,643 1,643 1303 SUI 848 848 Payroll Taxes&Expenses Subtotal: $ - $ 9,517 $ 9,517 EMPLOYEE SALARIES&BENEFITS TOTAL: $ - $ 129,002 $ 129,002 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3006 Staff Mileage 750 3007 Subscriptions& Memberships 1,680 OPERATING EXPENSES TOTAL: $ 2,430 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4002 Rent/Lease Building 6,503 4006 Utilities 1,080 4007 Other(Leaseholdlnsurance) 270 4008 Other(Property Taxes) 360 FACILITIES/EQUIPMENT TOTAL: $ 8,213 5000:SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network& Data Management) $ 400 5002 HMIS(Health Management Information System) 600 SPECIAL EXPENSES TOTAL: $ 1,000 Exhibit C-Page 2 of 12 6000:ADMINISTRATIVE EXPENSES Acct# Line Item Description Amount 6001 lAdministrative Overhead $ 20,177 ADMINISTRATIVE EXPENSES TOTAL $ 20,177 TOTAL PROGRAM EXPENSES $ 160,822 PROGRAM FUNDING SOURCES 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name I Amount 8301 CSS-Community Services&Supports $ 8302 PEI -Prevention & Early Intervention - 8303 INN -Innovations CRDP Evolutions 160,822 8304 WET-Workforce Education &Training 8305 ICFTN -Capital Facilities&Technology I I - MHSA TOTAL $ 160,822 TOTAL PROGRAM FUNDING SOURCES: $ 160,822 NET PROGRAM COST: $ - Exhibit C-Page 3 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY)2021-22 Budget Narrative PROGRAM EXPENSE ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:SALARIES&BENEFITS 129,002 Employee Salaries 113,311 1101 Program Manager/Executive Director 30,000 Program Manager/Executive Director will identify and negotiate sites for increasing mental health awareness and wellness for implementation of innovative Community Defined Evidence Program Practices. (37.5%of$120,000)/12*8 Mos=$30,000 1102 Operations Manager 9,167 Operations Manager will assist in recruiting,training,and assigning roles and tasks for overall project implementation. (25%of$55,000)/12*8 Mos=$9,167 1103 Clinician 1/Mental Health Prevention 14,325 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,,as well as develop resources for needs identified. (50%of$57,300)/12*6 Mos=$14,325 1104 Clinician 2/Mental Health Prevention 12,133 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,,as well as develop resources for needs identified. (35%of$52,000)/12*8 Mos=$12,133 1105 Mindfulness Specialist 9,707 Mindful Specialist will develop training activities and shape and implement introduction and sustain mindfulness orientation for student,staff,and administrators. (20%of$72,800 FTE)12*8 Mos=$9,707 1106 Youth Activities Coordinator 21,000 Coordinator will assist with recruitment,engage youth,introduce Community Defined Evidence Program Practice and create wellness groups and activities. (70%of$45,000)/12*8 Mos=$21,000 1107 Data Coordinator 8,979 Data coordinator will set-up data gathering procedures,systematize for easy access, and assist with evaluation purposes (35%of$38,480)/12*8 Mos=$8,979 1108 Data Evaluator/Development 8,000 Data Evaluator/Development will collect data produced and evaluate for impact and effectiveness,and assist with analyzing and summarizing data for evaluation. (10%of$120,000)/12 x 8 Mos=$8,000 Employee Benefits 6,174 1202 Worker's Compensation 1,246 1.1%of Gross Wages $113,311*.011=$1,246 1203 Health Insurance 4,928 Estimated 1.6 FTE for$550/Mo each at 70%ICSI's Share for Health and Dental Insurance 1.6 x$550/mo*8 Mos*.7 ICSI Share=$4,928 Payroll Taxes&Expenses: 9,517 1301 OASDI 7,025 6.2%of Gross Program Wages .062*$113,311=$7,025 1302 FICA/MEDICARE 1,643 1.45%of Gross Program Wages .0145*$113,311=$1,643 1303 SUI 848 2.9%for Program FTEs factored at 1.6 for variations 2.58 FTE*$7000*.029*1.6=$848 Exhibit C-Page 4 of 12 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 3000:OPERATING EXPENSES 2,430 3006 Staff Mileage 750 Professional trainings in Mental Health topics to stay current with interventions and understandings of target population 3007 Subscriptions&Memberships 1,680 Estimated at 100 Mls/Wk to be reimbursed at$.56 per MI.for 30 Wks 100 miles*.56*30 weeks=$1,680 4000:FACILITIES&EQUIPMENT 8,213 4002 Rent/Lease Building 6,503 30%of ICSI's Rent Exp.(2600 sf x$1.18/sf x 6 Mos x 30%)for 6 Mos plus 30%of $1,633.50 for 2 months 4006 Utilities 1,080 30%of$600/Mo for 6 Mos 4007 Other(Leasehold Insurance) 270 30%of$150/Mo for 6Mos 4008 Other(Property Taxes) 360 30%of$200/Mo for 6Mos 5000:SPECIAL EXPENSES 1,000 5001 Consultant(Network&Data Management) 400 Data Back-up and security,and website maintenance 5002 HMIS(Health Management Information 600 HIPPA compliant software for case records and quality control System) 6000:ADMINISTRATIVE EXPENSES 20,177 6001 Administrative Overhead 20,177 Indirect costs are those costs of general management that are agency-wide.General management costs consist of expenditures for administrative activities necessary for the general operation. TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 160,822 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 160,822 BUDGET CHECK: - Exhibit C-Page 5 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY) 2022-23 PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 Program Manager 0.375 $ - $ 45,000 $ 45,000 1102 Operations Manager 0.25 - 13,750 13,750 1103 Administration Assistant 0.20 7,696 - 7,696 1104 Clinician 1/Mental Health Prevention 0.65 - 37,245 37,245 1105 Clinician 2/Mental Health Prevention 0.35 - 18,200 18,200 1106 Clinician 3/Mental Health Prevention 0.08 - 4,800 4,800 1107 Mindfulness Specialist 0.20 - 14,560 14,560 1108 Youth Activities Coordinator 0.70 - 31,500 31,500 1109 Data Coordinator 0.35 - 13,468 13,468 1110 Data Evaluator/Development 0.10 - 12,000 12,000 Personnel Salaries Subtotal 3.255 $ 7,696 $ 190,523 $ 198,219 Employee Benefits Acct# Description Admin Direct Total 1202 Worker's Compensation 85 2,096 2,180 1203 Health Insurance - 9,240 9,240 Employee Benefits Subtotal: $ 85 $ 11,336 $ 11,420 Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI $ 477 $ 12,290 $ 12,767 1302 FICA/MEDICARE 112 2,874 2,986 1303 SUI 63 898 961 Payroll Taxes&Expenses Subtotal: $ 652 $ 16,062 $ 16,714 EMPLOYEE SALARIES&BENEFITS TOTAL: $ 8,432 $ 217,921 $ 226,353 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3005 Staff Development&Training 1,500 3006 Staff Mileage 4,659 OPERATING EXPENSES TOTAL: $ 6,159 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4002 Rent/Lease Building 11,045 4006 Utilities 2,250 4007 Other(Leaseholdlnsurance) 540 4008 Other(Property Taxes) 720 FACILITIES/EQUIPMENT TOTAL: $ 14,555 Exhibit C-Page 6 of 12 5000:SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant (Network& Data Management) $ 1,200 5002 HMIS(Health Management Information System) 2,400 SPECIAL EXPENSES TOTAL: $ 3,600 6000:ADMINISTRATIVE EXPENSES Acct# Line Item Description Amount 6001 lAdministrative Overhead $ 25,945 ADMINISTRATIVE EXPENSES TOTAL $ 25,945 TOTAL PROGRAM EXPENSES $ 276,612 PROGRAM FUNDING SOURCES 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ 8302 PEI -Prevention & Early Intervention - 8303 INN - Innovations CRDP Evolutions 276,612 8304 WET-Workforce Education &Training 8305 ICFTN -Capital Facilities&Technology I I - MHSA TOTAL $ 276,612 TOTAL PROGRAM FUNDING SOURCES: $ 276,612 NET PROGRAM COST: $ - Exhibit C-Page 7 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY)2022-23 Budget Narrative PROGRAM EXPENSE ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:SALARIES&BENEFITS 226,353 Employee Salaries 198,219 1101 Program Manager 45,000 Program Manager/Executive Director will identify and negotiate sites for increasing mental health awareness and wellness for implementation of innovative Community Defined Evidence Program Practices. 37.5%*$120,000=$45,000 1102 Operations Manager 13,750 Operations Manager will assist in recruiting,training,and assigning roles and tasks for overall project implementation. 25%*$55,000=$13,750 1103 Administration Assistant 7,696 Administration Assistant will track personnel activities and tasks related to the Innovations Community Defined Evidence Program implementation for impact. 20%*$38,480=$7,696 1104 Clinician 1/Mental Health Prevention 37,245 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,,as well as develop resources for needs identified. 65%*$57,300=$37,245 1105 Clinician 2/Mental Health Prevention 18,200 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,as well as develop resources for needs identified. 35%*$52,000=$18,200 1106 Clinician 3/Mental Health Prevention 4,800 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,as well as develop resources for needs identified. 1601-Irs*$30/Hr.=$4,800 1107 Mindfulness Specialist 14,560 Mindful Specialist will develop training activities and shape and implement introduction and sustain mindfulness orientation for student,staff,and administrators. 20%*$72,800 FTE=$14,560 1108 Youth Activities Coordinator 31,500 Coordinator will assist with recruitment,engage youth,introduce Community Defined Evidence Program Practice and create wellness groups and activities. 70%*$45,000=$31,500 1109 Data Coordinator 13,468 Data coordinator will set-up data gathering procedures,systematize for easy access,and assist with evaluation purposes 35%*$38,480=$13,468 1110 Data Evaluator/Development 12,000 Data Evaluator/Development will collect data produced and evaluate for impact and effectiveness,and assist with analyzing and summarizing data for evaluation. 10%*$120,000=$12,000 Employee Benefits 11,420 1202 Worker's Compensation 2,180 1.1%of Gross Wages $198,219*.011=$2,180 1203 Health Insurance 9,240 Estimated 2 FTE for$550/Mo each at 70%ICSI's Share for Health and Dental Insurance 2FTE x$550/mo*12 Mos*.7 ICSI Share=$9,240 Exhibit C-Page 8 of 12 PROGRAM EXPENSE ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE Payroll Taxes&Expenses: 16,714 1301 OASDI 12,767 6.2%of Gross Program Wages .062*$198,219=$12,767 1302 FICA/MEDICARE 2,986 1.45%of Gross Program Wages .0145*$198,219=$2,986 1303 SUI 961 2.9%for Program FTEs factored at 1.45 for variations 3.26 FTE*$7000*.029*1.45=$961 3000:OPERATING EXPENSES 6,159 3005 Staff Development&Training 1,500 Professional trainings in Mental Health topics to stay current with interventions and understandings of target population 3006 Staff Mileage 4,659 Estimated at 100 Mls/Wk to be reimbursed at$.56 per MI.for 52 Wks 100 miles*.56*52 weeks=$4,659 4000:FACILITIES&EQUIPMENT 14,555 4002 Rent/Lease Building 11,045 30%of ICSI's Rent Exp.(2600 sf x$1.18/sf x12 Mos x 30%) 4006 Utilities 2,250 30%of$600/Mo for 12 Mos 4007 Other(Leasehold Insurance) 540 30%of$150/Mo for 12 Mos 4008 Other(Property Taxes) 720 30%of$200/Mo for 12 Mos 5000:SPECIAL EXPENSES 3,600 5001 Consultant(Network&Data Management) 1,200 Data Back-up and security,and website maintenance 5002 HMIS(Health Management Information 2,400 HIPPA compliant software for case records and quality control System) 6000:ADMINISTRATIVE EXPENSES 25,945 6001 Administrative Overhead 25,945 Indirect costs are those costs of general management that are agency-wide.General management costs consist of expenditures for administrative activities necessary for the general operation. TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 276,612 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 276,612 BUDGET CHECK: - Exhibit C-Page 9 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY) 2023-24 PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 Program Manager 0.375 $ - $ 45,000 $ 45,000 1102 Operations Manager 0.25 - 13,750 13,750 1103 Administration Assistant 0.20 7,696 7,696 1104 Clinician 1/Mental Health Prevention 0.65 - 37,245 37,245 1105 Clinician 2/Mental Health Prevention 0.35 - 18,200 18,200 1106 Clinician 3/Mental Health Prevention 0.08 - 4,800 4,800 1107 Mindfulness Clinician 0.20 - 14,560 14,560 1108 Youth Activities Coordinator 0.70 - 31,500 31,500 1109 Data Coordinator 0.35 - 13,468 13,468 1110 IData Evaluator/Development 1 0.10 - 12,000 12,000 Personnel Salaries Subtotal 3.255 $ 7,696 $ 190,523 $ 198,219 Employee Benefits Acct# Description Admin Direct Total 1202 Worker's Compensation 85 2,096 2,180 1203 Health Insurance - 9,240 9,240 Employee Benefits Subtotal: $ 85 $ 11,336 $ 11,420 Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI $ 477 $ 12,290 $ 12,767 1302 FICA/MEDICARE 112 2,874 2,986 1303 SUI 63 898 961 Payroll Taxes&Expenses Subtotal: $ 652 $ 16,062 $ 16,714 EMPLOYEE SALARIES&BENEFITS TOTAL: $ 8,432 $ 217,921 $ 226,353 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3005 Staff Development&Training 1,500 3006 Travel/Staff Mileage 4,659 OPERATING EXPENSES TOTAL: $ 6,159 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4002 Rent/Lease Building 11,045 4006 Utilities 2,250 4007 Other(Leasehold insurance) 540 4008 Other(Property Taxes) 720 FACILITIES/EQUIPMENT TOTAL: $ 14,555 Exhibit C-Page 10 of 12 5000:SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant (Network& Data Management) $ 1,200 5002 HMIS(Health Management Information System) 2,400 SPECIAL EXPENSES TOTAL: $ 3,600 6000:ADMINISTRATIVE EXPENSES Acct# Line Item Description Amount 6001 lAdministrative Overhead $ 25,788 ADMINISTRATIVE EXPENSES TOTAL $ 25,788 TOTAL PROGRAM EXPENSES $ 276,455 PROGRAM FUNDING SOURCES 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ 8302 PEI -Prevention & Early Intervention - 8303 INN - Innovations CRDP Evolutions 276,455 8304 WET-Workforce Education &Training 8305 ICFTN -Capital Facilities&Technology I I - MHSA TOTAL $ 276,455 TOTAL PROGRAM FUNDING SOURCES: $ 276,455 NET PROGRAM COST: $ - Exhibit C-Page 11 of 12 ATENCION PLENA AND PLATICAS Integral Community Solutions Institute Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:SALARIES&BENEFITS 226,353 Employee Salaries 198,219 1101 Program Manager 45,000 Program Manager/Executive Director will identify and negotiate sites for increasing mental health awareness and wellness for implementation of innovative Community Defined Evidence Program Practices. 37.5%*$120,000=$45,000 1102 Operations Manager 13,750 Operations Manager will assist in recruiting,training,and assigning roles and tasks for overall project implementation. 25%*$55,000=$13,750 1103 Administration Assistant 7,696 Administration Assistant will track personnel activities and tasks related to the Innovations Community Defined Evidence Program implementation for impact. 20%*$38,480=$7,696 1104 Clinician 1/Mental Health Prevention 37,245 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,,as well as develop resources for needs identified. 65%*$57,300=$37,245 1105 Clinician 2/Mental Health Prevention 18,200 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,as well as develop resources for needs identified. 35%*$52,000=$18,200 1106 Clinician 3/Mental Health Prevention 4,800 Clinician will implement Prevention and Early Intervention and Community Defined Evidence Program Practice activities in appropriate sites,as well as develop resources for needs identified. 1601-Irs*$30/Hr.=$4,800 1107 Mindfulness Clinician 14,560 Mindful Specialist will develop training activities and shape and implement introduction and sustain mindfulness orientation for student,staff,and administrators. 20%*$72,800 FTE=$14,560 1108 Youth Activities Coordinator 31,500 Coordinator will assist with recruitment,engage youth,introduce Community Defined Evidence Program Practice and create wellness groups and activities. 70%*$45,000=$31,500 1109 Data Coordinator 13,468 Data coordinator will set-up data gathering procedures,systematize for easy access,and assist with evaluation purposes 35%*$38,480=$13,468 1110 Data Evaluator/Development 12,000 Data Evaluator/Development will collect data produced and evaluate for impact and effectiveness,and assist with analyzing and summarizing data for evaluation. 10%*$120,000=$12,000 Employee Benefits 11,420 1202 Worker's Compensation 2,180 1.1%of Gross Wages $198,219*.011=$2,180 1203 Health Insurance 9,240 Estimated 2 FTE for$550/Mo each at 70%ICSI's Share for Health and Dental Insurance 2FTE x$550/mo*12 Mos*.7 ICSI Share=$9,240 Exhibit C-Page 12 of 12 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE Payroll Taxes&Expenses: 16,714 1301 OASDI 12,767 6.2%of Gross Program Wages .062*$198,219=$12,767 1302 FICA/MEDICARE 2,986 1.45%of Gross Program Wages .0145*$198,219=$2,986 1303 SUI 961 2.9%for Program FTEs factored at 1.45 for variations 3.26 FTE*$7000*.029*1.45=$961 3000:OPERATING EXPENSES 6,159 3005 Staff Development&Training 1,500 Professional trainings in Mental Health topics to stay current with interventions and understandings of target population 3006 Travel/Staff Mileage 4,659 Estimated at 100 Mls/Wk to be reimbursed at$.56 per MI.for 52 Wks 100 miles*.56*52 weeks=$4,659 4000:FACILITIES&EQUIPMENT 14,555 4002 Rent/Lease Building 11,045 30%of ICSI's Rent Exp.(2600 sf x$1.18/sf x12 Mos x 30%) 4006 lUtilities 2,250 30%of$600/Mo for 12 Mos 4007 1 Other(Leasehold Insurance) 540 30%of$150/Mo for 12 Mos 4008 Other(Property Taxes) 720 30%of$200/Mo for 12 Mos 5000:SPECIAL EXPENSES 3,600 5001 Consultant(Network&Data Management) 1,200 Data Back-up and security,and website maintenance 5002 HMIS(Health Management Information 2,400 HIPPA compliant software for case records and quality control System) 6000:ADMINISTRATIVE EXPENSES 25,788 6001 Administrative Overhead 25,788 Indirect costs are those costs of general management that are agency-wide.General management costs consist of expenditures for administrative activities necessary for the general operation. TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 276,455 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 276,455 BUDGET CHECK: - Exhibit D Page 1 of 6 STATE MENTAL HEALTH REQUIREMENTS 1. CONTROL REQUIREMENTS The COUNTY and its subcontractors shall provide services in accordance with all applicable Federal and State statutes and regulations. 2. PROFESSIONAL LICENSURE All (professional level) persons employed by the COUNTY Mental Health Program (directly or through contract) providing Short-Doyle/Medi-Cal services have met applicable professional licensure requirements pursuant to Business and Professions and Welfare and Institutions Codes. 3. CONFIDENTIALITY CONTRACTOR shall conform to and COUNTY shall monitor compliance with all State of California and Federal statutes and regulations regarding confidentiality, including but not limited to confidentiality of information requirements at 42, Code of Federal Regulations sections 2.1 of seq; California Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code. 4. NON-DISCRIMINATION A. Eligibility for Services CONTRACTOR shall prepare and make available to COUNTY and to the public all eligibility requirements to participate in the program plan set forth in the Agreement. No person shall, because of ethnic group identification, age, gender, color, disability, medical condition, national origin, race, ancestry, marital status, religion, religious creed, political belief or sexual preference be excluded from participation, be denied benefits of, or be subject to discrimination under any program or activity receiving Federal or State of California assistance. B. Employment Opportunity CONTRACTOR shall comply with COUNTY policy, and the Equal Employment Opportunity Commission guidelines, which forbids discrimination against any person on the grounds of race, color, national origin, sex, religion, age, disability status, or sexual preference in employment practices. Such practices include retirement, recruitment advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates of pay or other forms of compensation, use of facilities, and other terms and conditions of employment. Exhibit D Page 2 of 6 C. Suspension of Compensation If an allegation of discrimination occurs, COUNTY may withhold all further funds, until CONTRACTOR can show clear and convincing evidence to the satisfaction of COUNTY that funds provided under this Agreement were not used in connection with the alleged discrimination. D. Nepotism Except by consent of COUNTY's Department of Behavioral Health Director, or designee, no person shall be employed by CONTRACTOR who is related by blood or marriage to, or who is a member of the Board of Directors or an officer of CONTRACTOR. 5. PATIENTS' RIGHTS CONTRACTOR shall comply with applicable laws and regulations, including but not limited to, laws, regulations, and State policies relating to patients' rights. STATE CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted, complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. C. Every employee who works on this Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, 2) agree to abide by the terms of the company's statement as a condition of employment on this Agreement. Failure to comply with these requirements may result in suspension of payments under this Agreement or termination of this Agreement or both and Exhibit D Page 3 of 6 CONTRACTOR may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the CONTRACTOR has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against CONTRACTOR within the immediately preceding two (2) year period because of CONTRACTOR's failure to comply with an order of a Federal court, which orders CONTRACTOR to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. CONTRACTOR agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm's offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All CONTRACTORS contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. CONTRACTOR further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. Exhibit D Page 4 of 6 b. CONTRACTOR agrees to cooperate fully in providing reasonable access to the CONTRACTOR's records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor's compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR certifies that CONTRACTOR is in compliance with Public Contract Code Section 10295.3. 8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR certifies that CONTRACTOR is in compliance with Public Contract Code Section 10295.35. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following provisions regarding current or former state employees. If CONTRACTOR has any questions on the status of any person rendering services or involved with this Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code §10410): a). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. b). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411): a). For the two (2) year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. b). For the twelve (12) month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as Exhibit D Page 5 of 6 the proposed contract within the twelve (12) month period prior to his or her leaving state service. If CONTRACTOR violates any provisions of above paragraphs, such action by CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and CONTRACTOR affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the CONTRACTOR's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the CONTRACTOR is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. C. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body, which by law has authority to enter into an agreement, authorizing execution of the agreement. Exhibit D Page 6 of 6 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. 9. INSPECTION and Audit of Records and access to Facilities. The State, CMS, the Office of the Inspector General, the Comptroller General, and their designees may, at any time, inspect and audit any records or documents of CONTRACTOR or its subcontractors, and may, at any time, inspect the premises, physical facilities, and equipment where Medicaid-related activities or work is conducted. The right to audit under this section exists for ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later. Federal database checks. Consistent with the requirements at § 455.436 of this chapter, the State must confirm the identity and determine the exclusion status of CONTRACTOR, any subcontractor, as well as any person with an ownership or control interest, or who is an agent or managing employee of CONTRACTOR through routine checks of Federal databases. This includes the Social Security Administration's Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and any other databases as the State or Secretary may prescribe. These databases must be consulted upon contracting and no less frequently than monthly thereafter. If the State finds a party that is excluded, it must promptly notify the CONTRACTOR and take action consistent with § 438.610(c). The State must ensure that CONTRACTOR with which the State contracts under this part is not located outside of the United States and that no claims paid by a CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial institution located outside of the U.S. are considered in the development of actuarially sound capitation rates. Exhibit E Page 1 of 2 Vendor: Contract# Contact Person Contact# ` ZIi Date Date I Fresno y Q £ Requested Approved( Purchase County Item Make/Brand Model Serial# n d Location Condition Cost (If Fixed If Fixed Date Inventory K Asset) Assset) Number LL I I n F Copier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00 m w A Q m DVD Player Sony DV2230 PXC4356A _�Ej /a 4/1/2008 Heritage $450.00 x IL w IM Date Prepared: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Date Received: EXHIBIT E Page 2 of 2 FI XED ASSET AND SENSI TI VE I TEM TRACM NG Fi el d Number Fi el d I nst r uct i on or Comment s Requi red or Descr i pt i on Condi t i onal Header Vendor I ndi cat e t he I egal name of t he agency cont r act ed t o Requi red provide services. Header Pr ogr am I ndi cat e t he title of the project as described in the Required cont r act wi t h t he Count y. Header Cont r act # I ndi cat e t he assi gned Count y cont r act number. I f not Required known, Count y st of f can pr ovi de. Header Cont act Person I ndi cat e the first and last nacre of the pr i mar y agency Required cont act f or t he cont r act. Header Cont act # I ndi cat e t he rrost appr opr i at e t el ephone number of t he Requi red pr i mar y agency cont act f or t he cont r act. Header Date Prepared I ndi cat e t he rrost cur rent dat e t hat t he t r acki ng form Requi red was corrpl et ed by the vendor. a I t em I dent i f y t he i t em by pr ovi di ng a comrronl y recognized Requi red descr i pt i on of t he i t em b Nbke/Brand I dent i f y t he corrpany t hat manuf act ur ed t he i t em Requi red c IVbdel I dent i f y t he model number f or t he i t ern i f appl i cabl e. Condit i onal d Ser i al # I dent i f y t he ser i al number f or t he i t ems if Condit i onal appl i cabl e. IVbr k t he box wi t h an "X" i f t he cost of t he i t em i s e Fi xed Asset $5,000 or more to i ndi cat e that the item i s a f i xed Condit i onal asset. f Sensi t i ve I t em fvbr k t he box with an "X" if the item meets t he Condit i onal cr i t er i a of a sensitive item as defined by t he Count y. g Dat a Request ed I ndi cat e t he dat e t hat t he agency submi t t ed a request Requi red t o the County to purchase the item h Date Approved I ndi cat e t he dat e t hat t he Count y approved t he request Requi red to purchase t he i t em i Purchase Date I ndi cat e t he date t he agency purchased t he i tern Requi red j Locat i on I ndi cat e t he physi cal I ocat i on of t he i t em Requi red k Condi t i on I ndi cat e t he general condition of t he i t em (New, Good, Requi red V)br n, Bad). Fresno County I I nvent or y I ndi cat e t he FIR # pr ovi ded by t he County for the item Condit i onal Nurrber m Cost I ndi cat e t he t of al purchase pr i ce of t he i t em Requi red i ncl udi ng sal es t ax and of her cost s, such as shi ppi ng. Exhibit F Page 1 of 2 1 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principal Standard: 1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and practices,preferred languages,health literacy,and other communication needs. Governance,Leadership,and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and allocated resources. 3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in the service area. 4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate timely access to all health care and services. 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing. 7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement,Continuous Improvement,and Accountability: 9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's planning and operations. 10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. 13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts or complaints. 15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public. ��� 1 Think Cultural Health F S(_ U.S.Deporfinentof https://www.thinkculturalhealth.hhs.gov/ �O M H Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov o�� Exhibit F Page 2 of 2 2 The Case for the National CLAS Standards Health equity is the attainment of the highest level of health for all people.'Currently,individuals across the United States from various cultural backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3 Though health inequities are directly related to the existence of historical and current discrimination and social injustice,one of the most modifiable factors is the lack of culturally and linguistically appropriate services,broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. Of all the forms of Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in the issue not only an individual concern but also a public health concern. In the United States,it health care is the most has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane. inadequate and/or inequitable care is$1.24 trillion.4 Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr. the quality of care and services.5,6 By providing a structure to implement culturally and linguistically appropriate services,the National CLAS Standards will improve an organization's ability to address health care disparities. The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of these Standards will help advance better health and health care in the United States. Bibliography 1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa 2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/ 3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www. hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?topicid=39 4. LaVeist,T A.,Gaskin,D.J.,&Richard,P(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www. jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.pdf 5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.pdf 6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf 7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http:// minorityhealth.hhs.gov/npa/f les/Plans/HHS/H HS_Plan_complete.pdf 8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286 ��� 1 Think Cultural Health F S(_ U.S.Deporfinentof https://www.thinkculturalhealth.hhs.gov/ 1O M H Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov o�� 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 the individuals served 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. Informal provider problem resolution process—the provider may first speak to a Provider Relations Specialist (PRS) regarding his or her complaint or concern. Exhibit G Page 2 of 2 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 Page 1 of 9 INCIDENT REPORTING PROTOCOL FOR COMPLETION OF INCIDENT REPORT The Incident Report must be completed for all incidents involving individuals served through DBH's current incident reporting portal, Logic Manager, at https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee 4d3d6e • The reporting portal is available 24 hours a day, every day. • Any employee of the CONTRACTOR can submit an incident using the reporting portal at any time. No login is required. • The designated administrator of the CONTRACTOR can add information to the follow up section of the report after submission. • When an employee submits an incident within 24 hours from the time of the incident or first knowledge of the incident, the CONTRACTOR's designated administrator, the assigned contract analyst and the Incident Reporting email inbox will be notified immediately via email from the Logic Manager system that there is a new incident to review. • Meeting the 24 hour incident reporting requirements will be easier as there are no signatures to collect. • The user guide attached identifies the reporting process and the reviewer process, and is subject to updates based on DBH's selected incident reporting portal system. Questions about incident reporting, how to use the incident reporting portal, or designating/changing the name of the administrator who will review incidents for the CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract analyst. Mental Health Plan (MHP) and Substance Use Disorder SUD ga service Exhibit H ge 2 of 9 Co�,� Incident Reporting System 19 INCIDENT REVIEWER ROLE — User Guide Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete a written report of any incidents compromising the health and safety of persons served, employees, or community members. Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's an easier way for any employee to report an incident at any time. A few highlights: • No supervisor signature is immediately required. • Additional information can be added to the report by the program supervisor/manager without having to resubmit the incident. • When an incident is submitted, the assigned contract analyst, program supervisor/manager, clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email notification of a new incident and can log in any time to review the incident. Everything that was on the original paper/electronic form matches the online form. • Do away with submitting a paper version with a signature. • This online submission allows for timely action for the health and safety of the persons-served, as well as compliance with state reporting timelines when necessary. As an Incident Reviewer,the responsibility is to: • Log in to Logic Manager and review incident submitted within 48 hours of notification of incident. • Review incident for clarity, missing information and add in additional information deemed appropriate. • Notify DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report after initial submission • Contact.DBHlncidentReporting@fresnocountVca.gov if there are any concerns, questions or comments with Logic Manager or incident reporting. Below is the link to report incidents https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e The link will take employees to the reporting screen to begin incident submission: Exhibit H Page 3 of 9 E C O Y Iresrtotfohlragicnunagcr.com, _ - - ... - - . LogicManager Incident Report Please complete this form • client information Nam.of facility' Name of Reporting Party Faclllty Address' Facility Phone Numher- M-1 Nwlth or Subztanc.Us.Disorder Program?' Client First Name' Cllont last Nam. F C O r client Data.181rth [Gent Address cLmuD tsender county of origin' • Summary Subject u Incident icheck all that apply) If olh.-p-fy ll...fire,poisomng.epidemic outbreaks,other catastropin—ents that jeopardise the walfam and safety of chants,staff and for members of the commumtyj: D—Opllon of the Incident' Exhibit H Page 4 of 9 Similar to the paper version, multiple incident categories can be selected incident)check MIIhaI apply Medr,MEmmgency , D.AA.Client Homicide/Homicide Attempt AWOL;Elopement from locked facility Vlol....lAbuselAssault Doward lb—,client and'or prop.ny Attempted Sulcule(resulting In serious injury) injury(seV-lnflkted w by accident) Medlcau—Error E C d a besnodbbJopkmenagercaNrk4Mnts(11-qft:t&k-182DedScdcd$072bb7064cdeeAd]d6e Dal.of Incldonl' Time of Iricident- Location of Inciderit- Bay Poopl.Dlr.cfly Indeed in Incident Iwltresses.st.M Did the Injured Parry seek Medical Attention? Allach any additional details ®P�tl Eilc or Drop Rio H.- Reported by Name' Reported By Email' Reported On 10/30120/9 Exhibit H Page 5 of 9 As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on Add File to r ur ptre sdmlie.ig. . 4 rr,rom Reported By Name' Reported By Email Ruponod On 10/30/2019 • follow Up kini.Taken(check all that apply) Please sp—fy it other Dvw 1ptlon of Action Takon- Outcome' Similar to the paper version, multiple Action Taken categories can be selected. . T•ttnw U, action Taken(check all that apply, Law Entercement Contacted• Called 9ll/EMS Conwlted with Physician fir:)Aid;C PR Ad--stered Chant n—M hem bund�ng Parentr'Legal Goacdlan Contacted Other When done entering all the information, simply click submit. Any fields that have a red asterisk, require information an will prevent submission of the form if left blank. A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the Form"to submit another incident. LogicManager Thank you for your submission) RELOAD THE FORM Exhibit H Page 6 of 9 A Notification email will be received when a new incident is reported, or a new comment has been made regarding an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show. Wed 10/30/2019 10:40 AM SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com> Notification- To DBH Incident Reporting ©f there are problems with haw this message is displayed,click here to view it in a web Click here to download pictures.To help protect your privacy,Outlook prevented autom ocdownload of some pictures in this message. CAUTION!!I-EXTERNAL EMAIL-THINK BEFORE YOU CLICK 0"hlchhd W re hdd hve m dwnkm pn,res.TP h*W,,te car Wtlmk Prrmdd wmnvEc dwmbd dMu PCWre Fontlx lv,rNan9r,IM. th Mila Arevalo, You have received a notficafion through LogicManager.Please see the details below. Type:Incident Report Subject:102 Notification To:Mila Arevalo 01xn this incident in LogicManager If using Internet Explorer,click here to open the notification. This email was generated by LogicManager If you have any technical issues. please email supportC@Iogicmanager.com. Enter in email address and password. First time users will be prompted to set up a password. C Q Q fresnodbh.my.logicmanager.com/login LogicManager F61 dI FuasI,"ICJ Exhibit H Page 7 of 9 Once logged in,the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up to view the incident. Your Task List TASK NAM[ SV�((l! ,1:.1�iY .�,.,.1�., �..,,I. P• _i_..t. This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and facility information. No edits can be made to this section. Analyst Follow Up -.uMarm. The next tab is Sum ary: No edits can be made to this section. Analyst Follow Up wr�.�ra.r r .an u+.�r..nn.w��..w�i..a.....e�.�«w...a..r.«u.w.+.-�e.wi«va.m.r•....e..rreo..�.,ue,.•e m.....b...erw.<.mW��nr B I V S 11 bmwrma«n• w,nrw. I r Exhibit H Page 8 of 9 The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be E w en edits are made.Then Cancel to Exi ut of the incident. Analyst Follow Up Actwn r,ken to«a.0 tM+OMri' uw FA,.e.m.nt[wr.u.e r - «.aysp.ce.•r:r. p�,.phond,ncr:»en ,edn M«m.ao. gut.ordwm.,nt«p«toton«ta nab r.fkia nx lnwnr tot nm • ., O The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding documents.Then Cancel to Exit out of the incident. Analyst Follow Up in;k Uctal: fli.M iMnrmttlnn ;ur^.r•nv tol•,w t'c bocumrnr• ® Add Darament v !lame Tra Source piead p,te upt.—dnv �i !b OocumrnF yel Drop fi z here or tuck—he Add livcum«A drop.— « < ! [AN[rl - ra.k to:n3 sou.<r:tox Holt IrD If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT button is on every tab. If further information needs to be included, email DBHlncidentReportine@fresnocountyca.gov Exhibit H Page 9 of 9 To get back to the home view, cli�thheis Manager icon at any time. Any incidents that still need review will show on this screen, click o and start the review process again. Your Task List TASK NAMf SOU— fi:l�.s .��li�ti r.Ci�.� ,..S�I'._`:r:b'• _�_;>. Exhibit I Page 1 of 2 DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT I. Identifying Information Name of entity D/B/A Address(number,street) City State ZIP code CLIA number Taxpayer ID number(EIN) Telephone number ( ) II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued. YES NO A. Are there any individuals or organizations having a direct or indirect ownership or control interest of five percent or more in the institution, organizations, or agency that have been convicted of a criminal offense related to the involvement of such persons or organizations in any of the programs established by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0 B. Are there any directors, officers, agents, or managing employees of the institution, agency, or organization who have ever been convicted of a criminal offense related to their involvement in such programs established by Titles XVI Il, XIX, or XX?...................................................................................... o 71 C. Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organization's, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 71 III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are related to each other, this must be reported under"Remarks." NAME ADDRESS EIN B. Type of entity: o Sole proprietorship o Partnership o Corporation n Unincorporated Associations o Other(specify) C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations under"Remarks." D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses ofindividuals, and provider numbers........................................................................................................... 71 o NAME ADDRESS PROVIDER NUMBER Exhibit I Page 2 of 2 YES NO IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0 If yes, give date. B. Do you anticipate any change of ownership or control within the year?....................................................... o 0 If yes, when? C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0 If yes, when? V. Is the facility operated by a management company or leased in whole or part by another organization?.......... n n If yes, give date of change in operations. VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... n n VII. A. Is this facility chain affiliated? ...................................................................................................................... n n If yes, list name, address of corporation, and EIN. Name EIN Address(number,name) City State ZIP code B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain? (If yes, list name, address of corporation, and EIN.) Name EIN Address(number,name) City State ZIP code Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the information requested may result in denial of a request to participate or where the entity already participates, a termination of its agreement or contract with the agency, as appropriate. Name of authorized representative(typed) Title Signature Date Remarks Exhibit J 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. 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; Exhibit J Page 2 of 2 (c) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date: (Printed Name & Title) (Name of Agency or Company) Exhibit K 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 K Page 2 of 2 (1)Company Board Member Information: Name: Date: Job Title: (2)Company/Agency Name and Address: (3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to): (4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a): (5)Authorized Signature Signature: Date: Exhibit L 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(S) shall require its employees and subcontractors to attend a compliance training that will be provided by Fresno County. After completion of this training, CONTRACTOR(S), CONTRACTOR(S)' employees and subcontractors 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. Exhibit L Page 2of3 7. Bill only for eligible services actually rendered and fully documented. Use billing codes that accurately describe the services provided. 8. Act promptly to investigate and correct problems if errors in claims or billing are discovered. 9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct and Ethics by COUNTY employees or other 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(S) 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 L Page 3 of 3 Fresno County Mental Health Compliance Program Contractor Acknowledgment and Agreement I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental Health Compliance Program and understand the contents thereof. I further agree to abide by the Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my responsibilities as a mental health contractor for Fresno County. I understand and accept my responsibilities under this Agreement. I further understand that any violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program may result in termination of my agreement with Fresno County. I further understand that Fresno County will report me to the appropriate Federal or State agency. For Individual Providers Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT Signature: Date: For Group or Organizational Providers Group/Org. Name (print): Employee Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT ❑ Other: Job Title (if different from Discipline): Signature: Date: / / Exhibit M — 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 THE FRESNO CENTER(CONTRACTOR), 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 County of Fresno Department head or designee. I have read and understand the above statement and agree to comply with the child abuse reporting requirements. SIGNATURE DATE