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AMENDMENT I TO AGREEMENT
THIS AMENDMENT is made and entered into this 29th
Agreement No . 18-692-1
day of January, 2019,
3 by and between the COUNTY OF FRESNO, a political subdivision of the State of California,
4 hereinafter referred to as "COUNTY", and each Contractor listed in Exhibit A, "Non-DMC
5 Residential Treatment Services Vendor List " attached hereto and by this reference
6 incorporated herein, collectively hereinafter referred to as "CONTRACTORS", and such
7 additional CONTRACTORS as may, from time to time during the term of this Agreement, be
8 added by COUNTY. Reference in this Agreement to "party" or "parties" shall be understood to
9 refer to COUNTY and each CONTRACTOR, unless otherwise specified.
10 WHEREAS , the parties entered into that certain Agreement, identified as COUNTY
11 Agreement No . 18-692 effective January 1st, 2019, hereafter referred to as the Agreement;
12 and
13 WHEREAS the parties desire to amend the Agreement, regarding changes as stated
14 below and restate the Agreement in its entirety.
15 NOW, THEREFORE, in consideration of their mutual promises, covenants and
16 conditions , hereinafter set forth, the sufficiency of which is acknowledged , the parties agree as
1 7 follows:
18 1. That the following text in the Agreement, Page One (1), beginning with Paragraph
19 One (1), Line Twenty-Two (22) and ending on Page Three (3), Line Sixteen (16) with the word
2 o "trainings" be deleted and the following inserted in its place :
"1. SERVICES 21
22 A. CONTRACTOR shall perform all services and fulfill all responsibilities for
2 3 the provision of adult perinatal and non-perinatal residential SUD treatment services, as
2 4 identified in this Agreement, including all Exhibits, COUNTY's Request for Statement of
2 5 Qualifications (RFSQ) #18-064 dated July 3, 2018 ; Addendum No. One (1) dated July 26 ,
26 2018; and Addendum No . Two (2) dated August 10, 2018, hereinafter collectively referred to
2 7 as COUNTY Revised RFSQ #18-064 , and CONTRACTOR's response to said RFSQ #18-064,
2 8 dated August 15, 2018, all incorporated herein by reference and made part of this Agreement.
-1 -CO UNTY OF FRESNO
Fresno , CA
COUNTY OF FRESNO
Fresno, CA
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B. In the event of any inconsistency among these documents, the
inconsistency shall be resolved by giving precedence in the following order of priority: 1) to
this Agreement, including any Exhibits and amendments attached hereto but excluding RFSQ
#18-064 and the Response to the Revised RFSQ; 2) to the Revised RFSQ #18-064, and; 3) to
the Response to the Revised RFSQ. A copy of COUNTY’s Revised RFSQ #18-064, and
CONTRACTOR’s response shall be retained and made available during the term of this
Agreement by COUNTY’s Purchasing Division.
C. COUNTY shall waive DMC Certification requirements for Residential
treatment CONTRACTORS for a period of no longer than twelve (12) months for
CONTRACTOR to pursue DMC certification. CONTRACTOR shall be required to submit proof
of application for DMC certification. Residential CONTRACTORS that are not certified can
serve only the non-DMC population under this Agreement.
D. COUNTY shall waive DMC Certification requirements for Withdrawal
Management CONTRACTORS for a period of no longer than twelve (12) months for
CONTRACTOR to pursue DMC Certification. CONTRACTOR shall be required to submit proof
of application for DMC certification. Withdrawal Management CONTRACTORS that are not
DMC certified can serve both DMC and non-DMC populations under this Agreement until DMC
certification is obtained.
E. CONTRACTOR shall provide services as described in Exhibit B, Modality
of Service Descriptions, attached hereto and incorporated by this reference.
F. CONTRACTOR shall comply with requirements stated within the
Intergovernmental Agreement as listed in Exhibit C, SAPT Specific Requirements, attached
hereto and by this reference incorporated herein; and with all other provisions set forth in the
Intergovernmental Agreement, made available by the Department of Behavioral Hea lth (DBH),
Contracts Division - Substance Use Disorder (SUD) Services at the following web address and
by this reference incorporated herein: https://www.co.fresno.ca.us/departments/behavioral-
health/substance-use-disorder-services/provider-page. CONTRACTOR is referred to therein
COUNTY OF FRESNO
Fresno, CA
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as “Subcontractor” and COUNTY is referred to therein as “Contractor.”
G. CONTRACTOR shall comply with the Fresno County Substance Use
Disorder (FCSUD) Provider Manual, herein after referred to as the “Provider Manual” and by
this reference incorporated herein, available at the DBH website at
https://www.co.fresno.ca.us/departments/behavioral-health/substance-use-disorder-
services/provider-page. No formal amendment of this agreement is required for changes to the
Provider Manual to apply.
H. CONTRACTOR shall align program, services, and practices with the
vision and mission within Exhibit D, DBH Guiding Principles of Care Delivery, attached hereto
and by this reference incorporated herein. Contractor may be required to utilize and integrate
clinical tools such as Reaching Recovery at DBH’s discretion.
I. CONTRACTORs serving beneficiaries referred by Drug Court or Probation
shall carry out the following:
1) Comply with reporting requirements of Court or Probation relating to
beneficiary status change and treatment progress if an appropriate Release of Information
(ROI) is in place; and
2) Conduct beneficiary intake within timeframes specified below from
referral or initial contact:
a) Within one (1) business day for urgent conditions; and
b) Within ten (10) business days for all residential settings,
including withdrawal management.
J. CONTRACTOR shall maintain, at CONTRACTOR’s cost, a computer
system compatible with COUNTY’s current billing and electronic health record (EHR) system
for the provision of submitting information required under the terms and conditions of this
Agreement. CONTRACTOR shall complete billing and EHR data entry as follows: initial
contact, when applicable; appointments; admissions; ASAM level of care; discharge; and
referrals.
K. CONTRACTOR’s staff will be required to attend meetings and trainings on an
COUNTY OF FRESNO
Fresno, CA
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as-needed basis, which may include but are not limited to, SUD treatment and fiscal trainings
provided by the State of California. Refer to the Provider Manual for a listing of required trainings.”
2. That Exhibit A “Non-DMC Residential Treatment Services Vendor List” be deleted
and replaced with Revised Exhibit A “Non-DMC Residential Treatment Services Vendor List”.
3. That Exhibit E “Fresno County Drug Medi-Cal Rates for Fiscal Year 2018-19” be
deleted and replaced with Revised Exhibit E “Fresno County Drug Medi -Cal Rates for Fiscal
Year 2018-19”.
4. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend
Agreement No. 18-692 and Amendment I together with the Agreement shall be considered the
Agreement.
5. The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions, and promises contained in the Agreement and not amended herein
shall remain in full force and effect. This Amendment I shall be effective January 1, 2019.
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EXECUTED AND EFFECTIVE as of the date first above set forth .
CONTRACTOR
5 SEE EXHIBIT A
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FOR ACCOUNTING USE ONLY:
ORG No .: 56302081
Account No .: 7295/0
Fund/Subclass : 0001/10000
Requisition No.: 5631810050
COUNTY OF FRESNO
Nathan Magsig , Chairman of the Board
of Supervisors of the County of Fresno
ATTEST :
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
-5 -COUN TY OF FRESNO
F resno , CA
John Giarmarco
President
12/27/18
Chief Financial Officer
12/29/18
Jeff Ward
COUNTY OF FRESNO
Fresno, CA
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THIS PAGE INTENTIONALLY LEFT BLANK
Revised Exhibit A
VENDOR PHONE NUMBER TYPE OF BUSINESS
Contract Max
Jan 1, 2019 to June
30, 2019
Contract Max
FY 2019-20
Contract Max
FY 2020-21
Contract Max
FY 2021-22
Comprehensive Addiction Program, Inc.
Remit to:(559)264-5096 501(c)3 Non-profit Corporation $ 401,242 $ 802,485 $ 802,485 $ 802,485
2445 W. Whitesbridge Road
Fresno, Ca 93706
Fresno County Hispanic Commission
Remit to:(559) 268-6480 501(c)3 Non-profit Corporation $ 27,500 $ 55,001 $ 55,001 $ 55,001
1414 W Kearney Blvd
Fresno, Ca 93706
Mental Health Systems, Inc.
Remit to:(858) 573-2600 501(c)3 Non-profit Corporation 91,273$ 182,547$ 182,547$ 182,547$
9465 Farnham St.
San Diego, CA 92123
Spirit of Woman of California, Inc.
Remit to:(559) 233-4353 501(c)3 Non-profit Corporation 85,304$ 170,608$ 170,608$ 170,608$
327 W. Belmont Ave.
Fresno, Ca 93728
WestCare California, Inc.
Remit to:(559) 251-4800 501(c)3 Non-profit Corporation 917,072$ 1,834,143$ 1,834,143$ 1,834,143$
1900 N. Gateway Blvd, 100
Fresno, CA 93727
** A list of current provider sites can be found at:
https://www.co.fresno.ca.us/departments/behavioral-health/substance-use-disorder-services
Non-DMC Residential Services Vendor List
Revised 11/01/18 1 of 1
Exhibit B
Revised 11/5/18 1
Fresno County, Department of Behavioral Health
Non-Drug Medi-Cal Adult Residential Treatment Services
Description of Service Modalities
Residential/Withdrawal Management services available in Fresno County will be provided
parallel to the Drug Medi-Cal Organized Delivery System (DMC-ODS) to beneficiaries who are
not DMC eligible. Non-DMC eligible beneficiaries will have access to the same services as
DMC beneficiaries with costs reimbursed through other sources. These services, available to all
perinatal and non-perinatal adults, include residential treatment and residential withdrawal
management. Case management, additional medication assisted treatment and physician
consultation are also available to non-DMC eligible beneficiaries as a component of residential
treatment modalities.
Covered services under the Drug Medi-Cal Organized Delivery System (DMC-ODS) shall be
furnished in an amount, duration, and scope that is no less than the amount, duration, and scope
for the same services furnished to beneficiaries under fee-for-service Medicaid, as set forth in 42
CFR 440.230. Contractors shall ensure that the services are sufficient in amount, duration, or
scope to reasonably be expected to achieve the purpose for which the services are furnished.
Contractors may not arbitrarily deny or reduce the amount duration, or scope of a required
service solely because of diagnosis, type of illness, or condition of the beneficiary (IA III.C,
Covered Services).
Contractors are required to ensure services are provided timely. Timeliness is defined as no more
than 48 hours from initial contact for non-emergency residential services and no more than 24
hours from initial contact for urgent services.
Placement in an appropriate level of care must be determined through an assessment based on
the American Society of Addiction Medicine (ASAM) criteria and prescribed by the contractor’s
medical director.
PERINATAL/NON-PERINATAL RESIDENTIAL SUBSTANCE USE DISORDER
TREATMENT SERVICES (EXCLUDING ROOM AND BOARD) (ASAM LEVELS 3.1,
3.3 and 3.5)
Residential services are provided in California Department of Health Care Services (DHCS)
(Department of Social Services for adolescents) licensed residential facilities that also have
DMC certification and an ASAM designation by DHCS as capable of delivering care consistent
with ASAM treatment criteria. The treatment portion of residential services is reimbursable
through Drug Medi-Cal.
There is no bed capacity limit for residential services.
Adults (21 and over): may receive up to two (2) non-continuous short-term residential regimens
per 365-day period. A short-term residential regimen is defined as one (1) residential stay in a
DHCS licensed facility for a maximum of ninety (90) days.
Exhibit B
Revised 11/5/18 2
An adult beneficiary may receive one thirty (30) day extension per 365-day period, if that
extension is determined to be medically necessary.
Adolescents (under the age of 21): may receive up to two (2) non-continuous residential
regimens per 365-day period for a maximum of thirty (30) days. Adolescent beneficiaries may
receive one thirty (30) day extension per 365-day period, if that extension is determined to be
medically necessary. Adolescent beneficiaries receiving residential treatment shall be stabilized
as soon as possible and moved down to a less intensive level of treatment. Nothing in the DMC-
ODS or in this paragraph overrides any EPSDT requirements.
Perinatal beneficiaries: If determined to be medically necessary, perinatal beneficiaries may
receive a longer length of stay than those described above. Perinatal beneficiaries may receive
lengths of stay up to the length of the pregnancy and postpartum period (60 days after the
pregnancy ends).
Residential contractor(s) must seek prior authorization for residential services following the
established Substance Use Treatment and Authorization Request (STAR) timeframes, found in
the Provider Manual.
RESIDENTIAL WITHDRAWAL MANAGEMENT (WM 3.2)
The treatment portion of withdrawal management service is reimbursable through Drug Medi-
Cal.
Withdrawal management (WM) services are prescribed based on an individual assessment using
the ASAM criteria. Contractor(s) shall ensure beneficiaries receiving residential WM services
are monitored during the detoxification process.
The components of withdrawal management services are:
Intake: The process of admitting a beneficiary into a substance use disorder treatment
program. Intake includes the evaluation or analysis of substance use disorders; the
diagnosis of substance use disorders; and the assessment of treatment needs to provide
medically necessary services. Intake may include a physical examination and laboratory
testing necessary for substance use disorder treatment.
Observation: The process of monitoring the beneficiary’s course of withdrawal. To be
conducted as frequently as deemed appropriate for the beneficiary and the level of care
the beneficiary is receiving. This may include but is not limited to observation of the
beneficiary’s health status.
Medication Services: The prescription or administration related to substance use disorder
treatment services, or the assessment of the side effects or results of that medication,
conducted by staff lawfully authorized to provide such services within their scope of
practice or license.
Discharge Services: The process to prepare the beneficiary for referral into another level
of care, post treatment return or reentry into the community, and/or the linkage of the
individual to essential community treatment, housing and human services
Exhibit B
Revised 11/5/18 3
Contractor(s) shall provide medically necessary habilitative and rehabilitative services in
accordance with an individualized treatment plan prescribed by a licensed physician or licensed
prescriber.
ASAM 3.7-WM and 4-WM services are part of the DMC-ODS continuum of care but are offered
through with the Medi-Cal fee-for-service Managed Care Plans, Anthem Blue Cross and
CalViva Health. If a beneficiary is determined to be in need of this level of care, the provider
should coordinate the transition to a provider under one of the above-mentioned Managed Care
Plans for treatment.
ADDITIONAL MEDICATION ASSISTED TREATMENT (MAT)
Additional MAT involves the ordering, prescribing, administering, and monitoring of
medications for substance use disorders. Medically necessary services are provided in
accordance with an individualized treatment plan determined by a licensed physician or licensed
prescriber.
The program providing MAT is responsible for the prescribing, ordering, and monitoring of
medications to beneficiaries receiving SUD treatment. Allowable medications include:
buprenorphine; naltrexone; disulfiram; acamprosate; and naloxone.
CASE MANAGEMENT SERVICE
Case management services are defined as a service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational, rehabilitative, or other community
services.
Case management services shall focus on coordination of SUD care, integration around primary
care especially for beneficiaries with a chronic SUD, and interaction with the criminal justice
system, if needed.
Case management services will be provided by contractors once the beneficiary is enrolled in an
SUD program. Case management services will be monitored by County during the annual site
review.
Case management services may be provided by a Licensed Practitioner of the Healing Arts or
certified counselor.
Contractors shall use case management services to coordinate with physical and/or mental health
systems of care.
Case management services may be provided in person, by telephone, or by telehealth with the
beneficiary and may be provided anywhere in the community.
Exhibit B
Revised 11/5/18 4
Case management shall be consistent with and shall not violate confidentiality of alcohol or drug
beneficiaries as set forth in 42 CFR Part 2, and California law.
PHYSICIAN CONSULTATION
Physician Consultation services include DMC physicians’ consulting with addiction medicine
physicians, addiction psychiatrists or clinical pharmacists. Physician consultation services are
designed to assist DMC physicians by allowing them to seek expert advice with regards to
designing treatment plans for specific DMC-ODS beneficiaries. Physician consultation services
may address medication selection, dosing, side effect management, adherence, drug-drug
interactions, or level of care considerations.
County will provide DMC certified contractors with access to one or more American Board of
Addiction Medicine-certified physicians or pharmacists in order to facilitate consultations.
Access to physician consultation will only be available to DMC contracted treatment providers.
Fresno County DMC-ODS Approved Rates by Provider OPT IOT
Case
Management
Recovery
Services
Physician
Consultation
Withdrawal
Management
WM
Room/Board
Residential
3.1
Residential
3.1
Room/Board
Residential
3.5
Residential 3.5
Room/Board MAT
APPROVED MAXIMUM UOS RATE 36.79 22.71 35.00 33.30 153.60 129.36 - 180.44 - 178.62 - 153.60
COUNTY APPROVED PROVIDER RATES:
Central California Recovery 31.69 22.18 27.42 31.96
Fresno New Connections 28.14 22.18 21.50 23.99
Kings View 29.45 27.03 30.02
Mental Health Systems 36.79 22.18 33.67 32.74 157.11 68.51 157.11 68.51
Panacea 30.24 22.18 27.28 16.83
Promesa 33.68 28.73 23.86
Spirit of Woman 30.24 22.18 26.08 18.58 65.07 111.42 65.07
Turning Point 31.15 29.73 16.42 111.05 72.35 111.05 78.61
Prodigy 30.65 30.23 30.67
Comprehensive Addiction Program 30.80 33.17 84.33 32.07 136.55 32.07
Fresno County Hispanic Commission 28.13 44.48 63.34 44.48
Transitions Children's Services 36.23 26.38
WestCare 32.13 22.18 35.00 32.13 153.60 100.00 37.74 180.44 153.60
WestCare - Perinatal 37.74 178.62 37.03
WestCare - Mens 35.35 133.51 35.15
WestCare - Womens 36.81 150.92 36.81
Revised Exhibit E
12/12/2018
Revised Exhibit E
Department of Health Care Services
Substance Use Disorders - Program, Prevention and Fiscal
Division Drug Medi-Cal (DMC) Rates for Fiscal Year 2018-19
Non-Perinatal DMC
Description Unit of Service (UOS) FY 2018-19 UOS
Rate**
Narcotic Treatment Program (NTP) -
Methadone Daily $13.54
NTP - Individual Counseling One 10-minute Increment $15.88
NTP - Group Counseling One 10-minute Increment $3.43
Intensive Outpatient Treatment Face-to-Face Visit $58.53
Naltrexone (*) Face-to-Face Visit $19.06
Residential - for EPSDT Beneficiaries Daily $90.14
Outpatient Drug Free (ODF) Individual
Counseling
Face-to-Face Visit (Per
Person) $79.44
ODF Group Counseling Face-to-Face Visit (Per
Person) $30.89
Perinatal DMC
Description Unit of Service (UOS) FY 2018-19 UOS
Rate**
NTP - Methadone Daily $14.58
NTP - Individual Counseling One 10-minute Increment $16.39
NTP - Group Counseling One 10-minute Increment $4.28
Intensive Outpatient Treatment Face-to-Face Visit $87.21
Perinatal Residential Daily $90.14
ODF Individual Counseling Face-to-Face Visit (Per
Person) $81.93
ODF Group Counseling Face-to-Face Visit (Per
Person) $38.56
* From FY 2002-03 through FY 2008-09, Naltrexone was frozen at the $21.19 (FY 1999 -2000)
approved rate. Counties and service providers have not provided, submitted claims, nor reported
cost for this service since FY 1997-98. For FY 2009-10, the $21.19 frozen rate was reduced by
10 percent to $19.07. Excluding county administration from the cost data used to produce the
$21.19 frozen approved rate decreased it to $19.06. Drug Medi-Cal used $19.06 as the FY 2018-
19 developed rate.
Revised Exhibit E
** FY 2009-2010 rates were adjusted by a 19.4 percent cumulative growth in the Implicit Price
Deflator (IDP), in accordance with Welfare & Institutions Code Section 14021.9(b). The change
from year to year are as follows: 0% for FY 2009-10, 3.2% for
FY 2010-11, 2.5% for FY 2011-12, 1.9% for FY 2012-13, 2.1% for FY 2013-14, 1.2% for FY
2014-15, 0.4% for FY 2015-16, 1.9% for FY 2016-17, 2.4% for FY 2017-18 and 2.3% for FY
2018-19.
Revised Exhibit E
Department of Health Care Services
Substance Use Disorders - Program, Policy and Fiscal Division
Drug Medi-Cal Rates for Fiscal Year 2018-19
Additional Medication Assisted Treatments Available in Waiver Opt-In
Counties, Narcotic Treatment Programs
FY 2018-19 FY 2018-19
Description Unit of Service (UOS) UOS Rate UOS Rate
Regular DMC Perinatal DMC
Narcotic Treatment Program (NTP)
Buprenorphine - Mono 1 Daily $16.91 $20.15
NTP - Buprenorphine-Naloxone
Combination Product 2 Daily $20.10 $23.34
NTP – Disulfiram 3 Daily $7.36 $7.59
NTP - Naloxone: 2-pack Nasal Spray4 Dispensed according to need $144.60 $144.60
1 Buprenorphine-Mono: Average daily dose of 16 milligrams, sublingual tablets
2 Buprenorphine-Naloxone Combination
3 Disulfiram: Average daily dose between 250 and 500 milligrams
4 Naloxone: One dose equal to 4 milligrams per 0.1 milliliter