HomeMy WebLinkAboutAgreement A-23-158 Amendment II to DMC Master Agreement 22-016.pdf Agreement No. 23-158
1 AMENDMENT II TO AGREEMENT
2 THIS AMENDMENT II (hereinafter"Amendment") is dated April 11, 2023 , by and between
3 the COUNTY OF FRESNO, a Political Subdivision of the State of California, Fresno, California
4 (hereinafter "COUNTY'), and each Contractor listed in Exhibit A-I, "Drug Medi-Cal Services Vendor
5 List," attached hereto and by this reference incorporated herein (hereinafter collectively referred to as
6 "CONTRACTOR"), and such additional CONTRACTORS as may, from time to time during the term of
7 this Agreement, be added by COUNTY. Reference in this Agreement to "party" or"parties" shall be
8 understood to refer to COUNTY and each CONTRACTOR, unless otherwise specified.
9 WITNESSETH:
10 WHEREAS, COUNTY and CONTRACTOR entered into Agreement number 22-176, effective
11 July 1, 2022 and COUNTY Amendment No. 23-016, effective January 3, 2023 (hereinafter collectively
12 referred to as "Agreement") wherein CONTRACTOR agreed to provide Drug Medi-Cal (DMC)
13 Substance Use Disorder (SUD) treatment services; and
14 WHEREAS, the California Department of Health Care Services (DHCS) has issued new State-
15 mandated requirements; and
16 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement, regarding
17 changes as stated below.
18 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
19 is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
20 1. That Section One (1) of the Agreement, beginning on Page One (1), Lines Twenty-Two
21 (22) through Page Three (3), Line Eighteen (18), is deleted in its entirety and replaced with the
22 following:
23 11
1. SERVICES
24 A. CONTRACTOR shall fulfill all the responsibilities of providing Drug Medi-Cal
25 substance use disorder treatment services at State certified locations to eligible persons served of
26 Fresno County, as identified in this Agreement, including all Exhibits, incorporated herein by reference
27 and made part of this Agreement.
28 B. CONTRACTOR shall provide services as described in Exhibit B, Modality of
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1 Service Descriptions, attached hereto and incorporated by this reference.
2 C. CONTRACTOR shall comply with requirements stated within the
3 Intergovernmental Agreement as listed in Revised Exhibit C, Drug Medi-Cal Specific Requirements,
4 attached hereto and by this reference incorporated herein; and with all other provisions set forth in the
5 Intergovernmental Agreement, made available by the Department of Behavioral Health (DBH) at the
6 following web address and by this reference incorporated herein:
7 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
8 providers/substance-use-disorder-providers. CONTRACTOR is referred to therein as "Subcontractor"
9 and COUNTY is referred to therein as "Contractor."
10 D. CONTRACTOR shall comply with the Fresno County Substance Use Disorder
11 (FCSUD) Provider Manual, herein after referred to as the "Provider Manual" and by this reference
12 incorporated herein, available at the DBH website at:
13 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
14 providers/substance-use-disorder-providers. No formal amendment of this agreement is required for
15 changes to the Provider Manual to apply.
16 E. CONTRACTOR shall align program, services, and practices with the vision and
17 mission within Exhibit D, DBH Guiding Principles of Care Delivery, attached hereto and by this
18 reference incorporated herein. Contractor may be required to utilize and integrate clinical tools such as
19 Reaching Recovery at DBH's discretion. Employees involved in a crisis incident should be offered
20 appropriate Employee Assistance Program (EAP) or similar related wellness and recovery assistance.
21 In conjunction with the County DBH's Principles of Care delivery and wellness of the workforce,
22 Contractors shall align their practices around this vision and ensure needed debriefing services are
23 offered to all employees involved in a crisis incident. Employees shall be afforded all services to
24 strengthen their recovery and wellness related to the crisis incident. Appropriate follow-up with the
25 employee shall be carried out and a plan for workforce wellness shall be submitted to the County's
26 DBH.
27 F. CONTRACTORs must complete intake for all persons served (including persons
28 served referred by Drug Court or Probation) within timeframes specified below from initial contact:
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1 1) Outpatient and Intensive Outpatient within ten (10) business days;
2 2) Opioid Treatment Programs (OTP) within three (3) business days; and
3 3) Residential services within ten (10) business days.
4 4) Contractors shall comply with reporting requirements of Court or Probation
5 relating to beneficiary status change and treatment progress if an appropriate
6 Release of Information (ROI) is in place.
7 G. CONTRACTOR shall maintain, at CONTRACTOR's cost, a computer system
8 compatible with COUNTY's current billing and electronic health record (EHR) system for the provision
9 of submitting information required under the terms and conditions of this Agreement. CONTRACTOR
10 shall complete billing and EHR data entry as follows: initial contact, when applicable; admissions;
11 California Outcomes Measurement System (CaIOMS) reporting; American Society of Addiction
12 Medicine (ASAM) level of care reporting; discharge; and no show/missed appointments and referrals.
13 H. CONTRACTOR's staff will be required to attend regularly occurring meetings
14 such as Cultural Humility Committee and All-Provider Meetings and trainings on an as-needed basis,
15 which includes but is not limited to, trainings related to SUD treatment, fiscal processes, cultural
16 competency, compliance, quality improvement and reporting requirements. Refer to the Annual
17 Provider Training Plan available on the provider webpage at:
18 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
19 providers/substance-use-disorder-providers.
20 I. CONTRACTOR shall ensure staff, including all subcontracted staff providing or
21 administering the SUD services are trained on the compliance requirements of applicable statues,
22 regulations and relevant Behavioral Health Information Notices (BHINs) prior to the delivery of
23 services. CONTRACTOR shall ensure all staff administering services meet California State education,
24 training and work experience requirements set forth in the Counselor Certification Regulations, Cal
25 Code Regs, tit. 9, div. 4, chapter 8 and have completed American Society of Addiction Medicine
26 (ASAM) foundational training. Ongoing training on requirements shall be complete per the Fresno
27 County SUD Annual Training Plan available on the provider webpage at:
28 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
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1 providers/substance-use-disorder-providers.
2 J. CONTRACTOR shall ensure that all personnel who provide Withdrawal
3 Management (WM) services or who monitor or supervise the provision of such services shall meet
4 additional state-mandated training requirements:
5 1.) Six (6) hours of orientation training that covers the needs of residents who
6 receive WM services.
7 2.) Repeating the orientation training fourteen (14) calendar days of return if
8 staff is returning to work after a break in employment of more than 180
9 consecutive calendar days;
10 3.) On an annual basis, completing eight (8) hours of training that covers the
11 needs of residents who receive WM services."
12 2. That Section Four (4) on Page Five (5) of the Amended Agreement 23-016 is deleted in
13 its entirety and replaced with the following:
14 "6. INVOICING
15 A. DMC SERVICES - COUNTY agrees to pay CONTRACTOR and
16 CONTRACTOR agrees to receive compensation at negotiated DMC rates for DMC covered services
17 described in Amended Exhibit B, Modality of Service Descriptions. CONTRACTOR shall enter billing
18 information into the COUNTY's designated information system by the fifteenth (15th) of every month.
19 Billing process shall be in accordance with the DHCS DMC Billing Manual, and by this reference
20 incorporated herein, available at the DBH website at
21 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
22 providers/substance-use-disorder-providers.
23 In addition to billing, non-NTP CONTRACTOR(S) shall submit on a monthly basis by
24 the twenty-fifth (25th), an Operational Expense Report, per modality of service, along with a general
25 ledger, payroll register and supporting documentation for any line items selected. For the purposes of
26 verifying that costs are allowable and equitable, CONTRACTOR shall submit any additional
27 documentation as deemed necessary by DBH. Non-NTP CONTRACTORs are all CONTRACTORs
28 that are not DEA licensed Narcotic Treatment Programs.
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1 CONTRACTOR shall use the accrual method of accounting in preparation of all
2 financial documents, forms, and reports. Accounting must be in accordance with Generally Accepted
3 Accounting Principles.
4 B. CONTINGENCY MANAGEMENT STARTUP FUNDS - COUNTY agrees to pay
5 CONTRACTOR(S) and CONTRACTOR(S) agrees to accept reimbursement for expenses approved
6 under the Contingency Management Startup Funds Request for Applications (RFA) in amounts not to
7 exceed provider budgets in Exhibit E2 for costs incurred between November 1, 2022 through March
8 31, 2023. The County will make the Contingency Management Pilot Program Startup Funds RFA
9 available upon request for the term of the Agreement. Costs not approved through the RFA will be
10 withheld from CONTRACTOR reimbursement.
11 C. CONTRACTORs that elect to use the COUNTY's electronic health records
12 system (EHR) shall be invoiced in arrears by the fifth (5th) day of the month for the prior month's
13 hosting fee for access to COUNTY's EHR in accordance with the fee schedule set forth in Exhibit G,
14 "Electronic Health Records Software Charges," attached hereto and incorporated herein by this
15 reference and made part of this Agreement. COUNTY shall invoice CONTRACTOR(S) annually for the
16 annual maintenance and licensing fee for access to COUNTY's electronic information system in
17 accordance with the fee schedule as set forth in Exhibit G. CONTRACTOR shall provide payment for
18 these expenditures to COUNTY's Department of Behavioral Health, Accounts Receivable, P.O. Box
19 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of
20 receipt by CONTRACTOR of the invoicing provided by COUNTY.
21 D. COUNTY's DBH shall invoice CONTRACTOR on an annual basis the amount of
22 $75 per clinical position to access The Change Companies ASAM training modules which are required
23 to be completed upon hire and prior to delivering clinical services then annually thereafter."
24 3. That Section Ten (10) of the Agreement, beginning on Page Nine (9), Line Twenty-one
25 (21) through Page Ten (10), Line Four (4), is deleted in its entirety and replaced with the following:
26 10. PROHIBITION ON PUBLICITY
27 None of the funds, materials, property or services provided directly or indirectly under
28 this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e.,
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1 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
2 Notwithstanding the above, publicity of the services described in Section One (1), SERVICES, of this
3 Agreement shall be allowed as necessary to raise public awareness about the availability of such
4 specific services when approved in advance by the DBH Director, or his or her designee, and at a cost
5 to be provided for such items as written/printed materials, the use of media (i.e., radio, television,
6 newspapers) and any other related expense(s). Communication products must follow DBH graphic
7 standards, including typefaces and colors, to communicate our authority and project a unified brand.
8 This includes all media types and channels and all materials on and offline that are created as part of
9 DBH's efforts to provide information to the public.
10 CONTRACTOR shall notify COUNTY of any community event of which CONTRACTOR
11 is the primary organizer at least thirty (30) days in advance of said event. CONTRACTOR shall
12 disclose and supply COUNTY with all written/printed/digital materials and media used in the marketing
13 and operation of this event. CONTRACTOR shall provide all materials to COUNTY at least two weeks
14 prior to the date of the event. COUNTY reserves the right to review and approve all CONTRACTOR
15 submitted materials."
16 4. That Section Four (4) on Page 6 of the Amended Agreement 23-016 be deleted in its
17 entirety and replaced with the following:
18 18. INSURANCE
19 CONTRACTOR shall comply with all the insurance requirements in Exhibit P to this
20 Agreement. Exhibit P is attached and incorporated by this reference."
21 5. That Section Nineteen (19), of the Agreement beginning on Page Eighteen (18), Line
22 Twenty-two (22) through Page Nineteen (19), Line Six (6), is deleted in its entirety and replaced with
23 the following:
24 19. HOLD HARMLESS
25 The Contractor shall indemnify and hold harmless and defend the County (including its
26 officers, agents, employees, and volunteers) against all claims, demands, injuries, damages, costs,
27 expenses (including attorney fees and costs), fines, penalties, and liabilities of any kind to the County,
28 the Contractor, or any third party that arise from or relate to the performance or failure to perform by
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1 the Contractor (or any of its officers, agents, subcontractors, or employees) under this Agreement. The
2 County may conduct or participate in its own defense without affecting the Contractor's obligation to
3 indemnify and hold harmless or defend the County. This clause survives the termination of this
4 Agreement."
5 6. That Section Twenty-Two (22) of the Agreement beginning on Page Twenty-One (21),
6 Line Fifteen (15) and ending on Page Twenty-Two (22), Line Four (4) be deleted in its entirety and
7 replaced with the following:
8 "22. EVALUATION - MONITORING
9 "CONTRACTOR shall participate in a review of the program at least yearly or more
10 frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
11 information requested by the COUNTY, DHCS, and/or the subcontractor during the program
12 evaluation, monitoring, and/or review.
13 COUNTY's DBH Director, or his or her designee, and DHCS or their designees shall
14 monitor and evaluate the performance of CONTRACTOR under this Agreement to determine to the
15 best possible degree the success or failure of the services provided under this Agreement. At the
16 discretion of the COUNTY, a subcontractor may be obtained by the COUNTY to independently
17 evaluate and monitor the performance of the CONTRACTOR. CONTRACTOR shall participate in the
18 evaluation of the program as needed, at the discretion of COUNTY.
19 COUNTY shall recapture from CONTRACTOR the value of any services or other
20 expenditures determined to be ineligible based on the COUNTY or State monitoring results. The
21 COUNTY reserves the right to enter into a repayment agreement with CONTRACTOR, with total
22 monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to
23 recover the amount of funds to be recouped. The COUNTY has the discretion to extend the repayment
24 plan up to a total of twenty- four (24) months from the date of the repayment agreement. The
25 repayment agreement may be made with the signed written approval of COUNTY's DBH Director, or
26 his or her designee, and respective CONTRACTOR through a repayment agreement. The monthly
27 repayment amounts may be netted against the CONTRACTOR's monthly billing for services rendered
28 during the month, or the COUNTY may, in its sole discretion, forego a repayment agreement and
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1 recoup all funds immediately. This remedy is not exclusive, and COUNTY may seek requital from any
2 other means, including, but not limited to, a separate contract or agreement with CONTRACTOR.
3 A. QUALITY IMPROVEMENT
4 CONTRACTORS shall participate in ongoing quality assessment and performance
5 improvement programs (PIPs) consistent with requirements contained within the DMC
6 Intergovernmental Agreement that focus on both clinical and nonclinical areas. Each performance
7 improvement project shall be designed to achieve significant improvement, sustained over time, in
8 health outcomes and satisfaction of persons served. All performance improvement projects shall
9 contain the following elements:
10 1) Measurement of performance using objective quality indicators.
11 2) Implementation of interventions to achieve improvement in the access to and
12 quality of care.
13 3) Evaluation of the effectiveness of the interventions based on the
14 performance measures.
15 4) Planning and initiation of activities for increasing or sustaining improvement.
16 CONTRACTOR shall report the status and result of each PIP to COUNTY as
17 requested, within the timeframe specified by COUNTY.
18 COUNTY shall establish a QI Committee to review the quality of SUD treatment
19 services provided to persons served. The QI Committee shall recommend policy decisions; review and
20 evaluate the results of QI activities, including performance improvement projects; institute needed QI
21 actions; ensure follow-up of QI processes; and document QI Committee meeting minutes regarding
22 decisions and actions taken. CONTRACTORS shall actively participate in quality improvement
23 trainings, meetings, and committees on an as needed basis. "
24 7. That Section Twenty-Seven (27) of the Agreement beginning on Page Twenty-Eight
25 (28), Line Six (6) and ending on Page Twenty-Nine (29), Line Twenty-Two (22) be deleted in its
26 entirety and replaced with the following:
27 "27. DATA SECURITY
28 CONTRACTOR shall comply with all the data security requirements in Exhibit Q to this
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1 Agreement. Exhibit Q is attached and incorporated by this reference."
2 8. That all references in the Agreement to "Exhibit A" and "Revised Exhibit A" shall be
3 deemed references to "Exhibit A-I", attached and incorporated by this reference.
4 9. That all references in the Agreement to "Exhibit B" and "Amended Exhibit B" shall be
5 deemed references to "Exhibit B-I", attached and incorporated by this reference.
6 10. That all references in the Agreement to "Exhibit C" shall be deemed references to
7 "Exhibit C-I", attached and incorporated by this reference.
8 11. That all references in the Agreement to "Exhibit E" and "Amended Exhibit E1" shall be
9 changed to read "Exhibit El-I", attached and incorporated by this reference.
10 12. The parties agree that this Amendment may be executed by electronic signature as
11 provided in this section. An "electronic signature" means any symbol or process intended by an
12 individual signing this Amendment to represent their signature, including but not limited to (1) a digital
13 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and
14 transmitted (for example by PDF document) of a handwritten signature. Each electronic signature
15 affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten
16 signature of the person signing this Amendment for all purposes, including but not limited to
17 evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as
18 the valid original handwritten signature of that person. The provisions of this section satisfy the
19 requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act
20 (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital
21 signature represents that it has undertaken and satisfied the requirements of Government Code
22 section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely
23 upon that representation. This Amendment is not conditioned upon the parties conducting the
24 transactions under it by electronic means and either party may sign this Amendment with an original
25 handwritten signature.
26 13. COUNTY and CONTRACTOR agree that this Amendment 11 is sufficient to amend the
27 Agreement and, that upon execution of this Amendment, the Agreement, Amendment I and this
28 Amendment II together shall be considered the Agreement.
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1 14. The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
2 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
3 in full force and effect.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II as of the day and
2 year first hereinabove written.
3
CONTRACTOR COUNTY OF FRESNO
4
5
6 SEE FOLLOWING SIGNATURE PAGES S91 Q ' ter , Chairman of the Board of
4
Suptfryisors of the County of Fresno
7
8
9
10 ATTEST:
Bernice E. Seidel
11 Clerk of the Board of Supervisors
12 County of Fresno, State of California
13
14
15
16 By:
17 —� Deputy
18 FOR ACCOUNTING USE ONLY:
19
20
Fund: 0001
21
Subclass: 10000
22
ORG: 56302081
23
Account: 7295/0
24
25
26
27
28
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The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: AEGIS TREATMENT CENTERS, LLC.
By
Print Name: Susan D. Hoeflich
Title: VP, Managed Care
Chairman of the Board, President, or Vice President
Date: 3/17/2023
DMC Master Agreement-Amendment II
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The parties are signing this Amendment 11 to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: BAKERSFIELD RECOVERY SERVICE, INC.
B
Print Name:
Title: I �t t'e o'CC
Chairman of the' Board, President, or Vice President
Date: zl f3/a t),q
t
By
Print Na e:
Title: T&�40r n!(
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
a
Date: Zj
DMC Master Agreement-Amendment 11
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DocuSign Envelope ID: 1D78E945-8993-478B-938E-16347F94909F
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: BAYMARK HEALTH SERVICES, INC.
dba ADDICTION RESEARCH AND TREATMENT, INC.
dba MEDMARK TREATMENT CENTERS —WEST SHAW, INC.
E�ocuSigned by:
r.gy 412B5B62D7484..
Print Name: Frank Baumann
Title: Vice President
Chairman of the Board, President, or Vice President
3/15/2023
Date:
,v EDocuSigned by:
Uf P-l"aw 'iaBy 9849B4BD4E0...
Print Name: Genco Gilberto D'Andria
Title: VP Treasurer
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
3/16/2023
Date:
DMC Master Agreement-Amendment II
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The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: CENTRAL CALIFORNIA RECOVERY, INC.
By
Print Name: CJr�
Title:
Chairman of the Board, President, or Vice President
Date: `X/ ?
By a,t 14 a'
Print Name-2i4,z L/VA l/l�//► �e,
Title:
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: o�
DMC Master Agreement-Amendment II
- 15 -
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The parties are signing this Amendment 11 to Agreement No. 22-176 on the date stated in the h
introductory clause.
Provider: COMPREHENSIVE D ACTION PROGRAMS INC.
By
Print Name:
i
Title: 14�
Chairman of the Board, President, or Vice President
Date:
F
By IQ
Print Name:
-- I
/Pre
Title: -�Cll
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
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Date: J t0 i
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DMC Master Agreement-Amendment rr - 16 -
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5
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: DELTA CARE, INC.
By
Print Name: r t u tJ w
Title: ` )5,C—C' iZ�G-rbV-
Chairman of the Board, President, or Vice President
Date: �-21-2023
1
By
Print Name: t--( X `LA N U,
Title: Q--'�= C)
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3-21-2023
DMC Master Agreement-Amendment II
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The parties are signing this Amendment it to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
SERVICES, INC.
By .
Print Name: t- c'> G'.
Title: ( -t Q
Chairman of the Board, President, or Vice President
Date:
By
Print Name: 1 V
Title: G�t;
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 343 12-3
DMC Master Agreement-Amendment 11
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The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: FRESNO NEW CONNECTIONS, INC.
By �LW�
Print Name:
Title:
Chairman of the Board, President, or Vice President
Date: h4l 7�i z D
By
Print Name: D(;��1 Lt-� 1�
Title: gc�� I v �c nr� 4��
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 31 L�1 20 Z 3
DMC Master Agreement-Amendment II
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DocuSign Envelope ID:4C7B45CE-295F-45AE-8DOD-AA1335E55EDA
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: KINGS VIEW
DocuSigned by:
By Dzv-4 t
Print Name: Amanda Nugent Divine
Title: CEO
Chairman of the Board, President, or Vice President
Date: 3/23/2023
DocuSigned by:
mclzauLooaa r
By
Print Name: Michael Kosareff
Title: CFO
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3/23/2023
DMC Master Agreement-Amendment 11
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: MENTAL HEALTH SYSTEMS, INC.
dba TURN Behavioral Health Services
,Awe[ C Callaghan,�
By Jones C Eallnoiman 1,ibta L.�A2307 t PDT!
Print Name: James C Callaghan Jr
Title: CEO
Chairman of the Board, President, or Vice President
Date:
Mar 19,2023
By trac n c' I molt(Mix 20,2023 13:54 PDT)
Print Name: tracey mcdermott
Title: CFO
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: Mar 20, 2023
DMC Master Agreement-Amendment II
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The parties are signing this Amendment I] to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: PRODIGY HEALTHCARE, INC.
By
Pri ame: �tacclt� _7h�n��
Title: rrC)
Chairman of the Board, President, or Vice President
Date: Z7--j o2-3
By
_ A '0—
Print Name: Nuv��Q �a..�1 Lr
Title: �{'U
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3 /ZI, ZG23
DMC Master Agreement-Amendment II
- 22 -
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: PROMESA BEHAVIORAL HEALTH, INC.
By �� .
Print Name: f,1i(.NAEL DF4Z MANOUEL-
Title:
Chairman of the Board, President, or Vice President
Date: 3 -1 ) Z3
By
Print Name: "rrZc� 0 i,M S T EAP
Title: S ECAZF�TNizj/-j- A u -
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3/2-11 Z3
DMC Master Agreement-Amendment II
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The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: TURNING POINT OF CENTRAL CALIFORNIA, INC.
By
Print Name: Ray Banks
Title: CEO
Chairman of the Board, President, or Vice President
Date: 3/21/2023
By J) 040
Print Name: Will Goodall
Title: CFO
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3/21/2023
DMC Master Agreement-Amendment II
- 24 -
The parties are signing this Amendment II to Agreement No. 22-176 on the date stated in the
introductory clause.
Provider: WESTCARE CALIFORNIA, INC.
By
Print Name:,.,
Title: CCU
Chairman of the Board, President, or Vice President
Date: 03/17/2023
W�L C-1)2.
By
Print a
Title:�(C)611(1— a
Secretary (of Corporation), Assist Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: I y Jag Z2
DMC Master Agreement-Amendment II
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Fresno County Department of Behavioral Health ExhibitA-1
Drug Medi-Cal Services Vendor List
VENDOR CONTACT PHONE NUMBER TYPE OF BUSINESS
BayMark Health Services,Inc.
Addiction Research and Treatment,Inc. Regional Vice President (707)290-0670 For Profit Corporation
Med Mark Treatment Centers—Fresno West,Inc. Dawn Groendyke
Remit to:
1720 Lakepointe Drive#117
Lewisville,Tx 75057
Aegis Treatment Centers,LLC. Regional Director (818)206-0360 Limited Liability Company
Remit to:
7246 Remmet Ave.
Canoga Park,Ca 91303
Bakersfield Recovery Services Inc. Executive Director (661)325-1817 501(c)3 Non-Profit Corporation
Remit to: Eric Sanders
PO Box 3218
Bakersfield,CA 93385
Central California Recovery,Inc. President (559)273-2942 501(c)3 Non-Profit Corporation
Remit to: Dale White (559)681-1947
1204 W.Shaw Ave.#102
Fresno,CA 93711
Comprehensive Addiction Programs,Inc. Executive Director (559)492-1373 501(c)3 Non-Profit Corporation
Remit to:
2445 W.Whitesbridge Ave.
Fresno,CA 93706
Delta Care,Inc. Executive Director (559)276-7558 501(c)3 Non-Profit Corporation
Remit to:
4705 N.Sonora Ave#113
Fresno,Ca 93722
Fresno County Hispanic Commission on Alcohol and
Drug Abuse Services,Inc. Executive Director (559)268-6480 501(c)3 Non-Profit Corporation
Remit to: Domingo Zapata
1803 Broadway St.
Fresno,Ca 93721
Fresno New Connections,Inc. Executive Director (559)248-1548 501(c)3 Non-profit Corporation
Remit to: Carrie Christensen
4411 N.Cedar Ave.#108
Fresno,CA 93726
Kings View Chief Financial Officer (559)251-0100 x3011 501(c)3 Non-profit Corporation
Remit to:
7170 N.Financial Drive,#110
Fresno,CA 93720
Mental Health Systems,Inc. CEO (858)573-2600 501(c)3 Non-profit Corporation
Remit to: James Callaghan
9465 Farnham St. CFO
San Diego,CA 92123 Joelle Verbestel
Prodigy Healthcare,Inc. President (559)892-9452 For Profit Corporation
Remit to: J.D.Dhanda
P.O.Box 820
Fowler,Ca 93625
Promesa Behavioral Health CEO (559)439-5437 501(c)3 Non-profit Corporation
Remit to: Lisa Weigant
7120 N.Marks Ave,#110
Fresno,Ca 93711
Turning Point of Central California,Inc. Chief Executive Officer (559)732-8086 501(c)3 Non-profit Corporation
Remit to:
PO Box 7447
Visalia,CA 93290
WestCare California,Inc. Chief Operating Officer (559)251-4800 501(c)3 Non-profit Corporation
Remit to: Shawn A.Jenkins
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/behaviora I-health/substance-use-disorder-services
DMC Master Agreement-Amendment II
Revised 4/11/2023 1 of 1
Fresno County,Department of Behavioral Health
Drug Medi-Cal Organized Delivery System
Modality of Service Descriptions
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 persons served 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 person served.
Contractors are required to ensure services are provided timely as further described in the Fresno
County Substance Use Disorder Provider Manual.
In all levels of care, contractors are required to either offer medications for addiction
treatment(MAT) directly or demonstrate effective referral mechanisms in place to the
most clinically appropriate MAT services. Providing a person served the contact
information for a MAT program is insufficient.
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.
DRUG MEDI-CAL SERVICES:
EARLY INTERVENTION SERVICES (ASAM LEVEL 0.5)
Early intervention services (EIS) are available to persons served under 21 who are screened and
determined to be at risk of developing an SUD. At risk persons served may receive any service
component covered under the outpatient level of care (ASAM 1.0) as early intervention services.
An SUD diagnosis is not required for early intervention services.
A full assessment utilizing the ASAM criteria is not required for a person served under the age of
21 to receive EIS. An abbreviated ASAM screening tool may be used. If the person served under
21 meets diagnostic criteria for SUD, a full ASAM assessment shall be performed and the person
served shall receive a referral to the appropriate level of care indicated by the assessment.
EIS services may be delivered in a wide variety of settings and can be provided in person, by
telehealth, or by telephone.
EIS services do not limit or modify the Early Periodic Screening, Diagnostic and Treatment
(EPSDT)mandate.
DMC Master Agreement-Amendment II
1
OUTPATIENT SERVICES (ASAM LEVEL 1.0)
Outpatient services consist of up to nine (9) hours per week of medically necessary services for
adults and up to six (6) hours per week of services for adolescents. Services may exceed the
maximum hours based on individual medical necessity.
Services can be provided by an LPHA or registered/certified counselor in-person, by telephone,
or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42
CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons
served. Outpatient services may be provided in person,by telehealth or by telephone.
Outpatient services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDs
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
INTENSIVE OUTPATIENT SERVICES (ASAM LEVEL 2.1)
Intensive outpatient involves structured programming provided to persons served as medically
necessary for a minimum of nine (9) hours and a maximum of nineteen (19) hours for adults and
a minimum of six(6) hours and a maximum of nineteen(19) for adolescents. Providers may
exceed maximum treatment hours when determined to be medically necessary.
Intensive outpatient treatment services include the same service components listed under
Outpatient 1.0.
Services can be provided by an LPHA or registered/certified counselor in-person, by telephone,
or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42
CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons
served.
OPIOID (NARCOTIC) TREATMENT PROGRAMS (ASAM LEVEL 1.0)
Narcotic treatment program services shall be provided in accordance with Title 9, Division 4,
Chapter 4 and CFR 42.
Narcotic Treatment Programs (NTP), also known as Opioid Treatment Programs (OTP), are
outpatient programs that provide Food and Drug Administration(FDA)-approved medications
and biological products to treat SUDS when ordered by a physician as medically necessary.
DMC Master Agreement-Amendment II
2
NTPs are required to administer, dispense, or prescribe medications to persons served covered
under the DMC-ODS formulary including methadone,buprenorphine (transmucosal and long-
acting injectable), naltrexone (oral and long-acting injectable), disulfiram, and naloxone.NTPs
may also prescribe the medication for dispensing at a pharmacy. The medical evaluation for
methadone treatment must be conducted in-person.
Persons served in OTP/NTP settings shall be offered no less than fifty(50) minutes of
counseling services per calendar month although additional services may be provided based on
medical necessity. Counseling services provided in the NTP modality can be provided in person,
by telehealth or by telephone.
NTP services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medical Psychotherapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDS
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
PERINATAL/NON-PERINATAL RESIDENTIAL SUBSTANCE USE DISORDER
TREATMENT SERVICES (EXCLUDING ROOM AND BOARD) (ASAM LEVELS 3.1,
3.3 and 3.5)
Residential treatment services are delivered to persons served when medically necessary in a
short-term residential program corresponding to at least one of the following levels:
• Level 3.1 - Clinically Managed Low-Intensity residential Services.
• Level 3.3 - Clinically Managed Population-Specific High Intensity Residential Services.
• Level 3.5 - Clinically Managed High Intensity Residential Services.
Residential treatment services are provided in facilities licensed by the California Department of
Health Care Services (DHCS) or the California Department of Social Services for adolescents
that also have DMC certification and a DHCS Level of Care Designation or an ASAM LOC
Certification demonstrating ability to delivery care consistent with ASAM treatment criteria.
Residential providers are required to maintain a ASAM LOC certification for each level of care
provided by the facility.
The Contactor must provide 24-hour care with trained personnel, including awake staff on the
overnight shift to address persons served needs.
The length of stay in a short-term residential setting shall be determined by individualized
clinical need. The statewide goal for the average length of stay for residential treatment services
DMC Master Agreement-Amendment II
3
is 30 days. Services must include preparation for a step down to a less intensive level of care,
when clinically appropriate. 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.
Residential contractor(s)must seek prior authorization for residential treatment services upon
admission and prior to the expiration of each authorized treatment period. Treatment
authorization request processes can be found in the Fresno County SUD Provider Manual.
Residential services include the following service components:
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDS
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
All residential treatment services may be provided in person,by telehealth, or telephone.
Telehealth and telephone services, when provided, shall supplement, not replace, the in-person
services and the in-person treatment milieu; most services in a residential facility must be in-
person.
WITHDRAWAL MANAGEMENT (Level 1-WM, Level 2-WM and Level 3.2-WM)
Withdrawal management services are provided to persons served experiencing withdrawal in the
following outpatient, residential, or inpatient settings:
• Level 1 -WM: Ambulatory withdrawal management without extended on-site monitoring
(Mild withdrawal with daily or less than daily outpatient supervision).
• Level 2-WM: Ambulatory withdrawal management with extended on-site monitoring
(Moderate withdrawal with daytime withdrawal management and support and
supervision in a non-residential setting).
• Level 3.2-WM: Clinically managed residential withdrawal management (24-hour support
for moderate withdrawal symptoms that are not manageable in outpatient setting).
• Level 3.7-WM: Medically Managed Inpatient Withdrawal Management(24-hour care for
severe withdrawal symptoms requiring 24-hour nursing care and physician visits).
• Level 4-WM: Medically managed intensive inpatient withdrawal management(Severe,
unstable withdrawal requiring 24-hour nursing care and daily physician visits to modify
withdrawal management regimen and manage medical instability).
Withdrawal management(WM) services are prescribed based the ASAM criteria. Contractor(s)
shall ensure persons served receiving both residential and outpatient WM services are monitored
DMC Master Agreement-Amendment II
4
during the detoxification process. Withdrawal Management Services may be provided in an
outpatient or residential setting.
Withdrawal management services are urgent and provided on a short-term basis. When provided
as part of withdrawal management services, service activities such as the assessment shall focus
on the stabilization and management of psychological and physiological symptoms associated
with withdrawal, engagement in care and effective transitions to a level of care where
comprehensive treatment services are provided.
A full ASAM assessment shall not be required as a condition of admission to a withdrawal
management program.
ASAM 3.7-WM and 4-WM services are part of the DMC-ODS continuum of care but are offered
through the Medi-Cal Managed Care Plans, Anthem Blue Cross and CalViva Health. If a person
served is determined to be in need of this level of care,the provider should provide care
coordination to the Managed Care Plans for treatment.
Withdrawal Management services include the following service components:
• Assessment
• Care Coordination
• Medication Services
• MAT for opioid use disorders
• MAT for alcohol use disorders and non-opioid SUDS
• Observation
• Recovery Services
MEDICATION ASSISTED TREATMENT (MAT)
Medication for addiction treatment includes all FDA-approved medications and biological
products to treat Alcohol Use Disorders (AUD), Opioid Use Disorders (OUD) and any SUD.
MAT may be provided in clinical or non-clinical settings and can be delivered as a standalone
service or as a service delivered as part of another level of care.
Additional MAT involves the ordering,prescribing, administering, and monitoring of
medications for substance use disorders.
All DMC-ODS providers, at all levels of care, must demonstrate that they either directly offer or
have an effective referral mechanism/process to MAT for persons served with SUD diagnoses.
Providers shall monitor the referral process or the provision of MAT services.
Persons served needing or utilizing MAT shall be served and cannot be denied treatment services
or be required to decrease dosage or be tapered off medications as a condition of entering or
remaining in the program. Persons served who decline counseling services shall not be denied
access to MAT or administratively discharged.
MAT services may be provided in conjunction with the following service components:
DMC Master Agreement-Amendment II
5
• Assessment
• Care Coordination
• Counseling (individual/group)
• Family Therapy
• Medication Services
• Prescribing, administering, dispensing, ordering, monitoring and/or managing the
medications for MAT for opioid use disorders, alcohol use disorders and non-opioid
SUDS
• Patient Education
• Recovery Services
• SUD Crisis Intervention Services
• Withdrawal Management Services
CONTINGENCY MANAGEMENT (RECOVERY INCENTIVES)
Contingency Management(CM) is an evidence-based behavioral treatment that provides
motivational incentive to reduce the use of stimulants. CM is the only treatment that has
demonstrated robust outcomes for persons served with stimulant use disorder, including
reduction or cessation of drug use and longer retention in treatment.
CM is a structured 24-week program, followed by six or more months of additional recovery
support services. Persons served will be able to earn motivational incentives in the form of low-
denomination gift cards, with a total retail value determined per treatment episode.
In the Fall of 2022, CM will be piloted in select DMC-ODS counties, including Fresno County,
as an optional DMC benefit. CM will initially be available through DMC certified outpatient
providers that opted into participation during the pilot. Following the conclusion of the CM pilot
on March 31, 2024, opting in will become available to all outpatient programs so long as DHCS
adds CM as a permanent Medi-Cal benefit.
CARE COORDINATION SERVICE (formerly Case Management)
Care Coordination services are defined as a service that assists persons served to access needed
medical, educational, social,prevocational, vocational, rehabilitative, or other community
services.
Care coordination consists of activities to provide coordination of SUD care, mental health care,
and medical care, and to support the person served with linkages to services and supports
designed to restore the person served to their best possible functional level.
Care Coordination services are provided to a person served in conjunction with all levels of
treatment and may also be claimed as a standalone service.
Care Coordination services may be provided by an LPHA, certified counselor or registered
counselor. Contractors shall use care coordination services to coordinate with physical and/or
mental health systems of care.
DMC Master Agreement-Amendment II
6
Care coordination can be provided in clinical or nonclinical settings (including the community)
and can be provided face-to-face, by telehealth, or by telephone.
Care Coordination shall include one or more of the following components:
• Coordination with medical and mental health providers to monitor and support comorbid
health conditions.
• Discharge planning, including coordinating with SUD treatment providers to support
transitions between levels of care and to recovery resources, referrals to mental health
providers, and referrals to primary or specialty medical providers.
• Coordinating with ancillary services, including individualized connection, referral, and
linkages to community-based services and supports including but not limited to
educational, social,prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage education, cultural sources,
and mutual aid support groups.
Care Coordination shall be consistent with and shall not violate confidentiality of persons served
as set forth in 42 CFR Part 2, and California law.
PEER SUPPORT SERVICES (Available following completion of Fresno County opt-in)
Peer support services promote recovery, resiliency, engagement, socialization, self-sufficiency,
self-advocacy, development of natural supports, and identification of strengths through
structured activities such as group and individual coaching to set recovery goals and identify
steps to reach the goals.
Peer support services may be provided with the person served or significant support person(s)
and may be provided in a clinical or non-clinical setting. Peer support services can include
contact with family members or other people (collaterals) supporting the person served if the
purpose of the collateral's participation is to focus on the treatment needs of the person served.
Peer support services are delivered and claimed as a standalone service. Peer support services
can be provided in conjunction with other services or levels of care, including inpatient and
residential services,but shall be billed separately. There may be times when, based on clinical
judgment, the person served is not present during the delivery of the service,but remains the
focus of the service.
Peer Support Services are based on a plan of care that includes specific individualized goals and
is approved by a Behavioral Health Specialist or a Peer Support Supervisor.
Peer support services consist of Education Skill Building Groups, Engagement services and
Therapeutic Activity services.
Peer Support Specialists are individuals in recovery with a current State-approved Medi-Cal Peer
Support Specialist Certification Program certification and working under the direction of a
Behavioral Health Professional. Behavioral Health Professionals must be licensed, waivered, or
DMC Master Agreement-Amendment II
7
registered in accordance with applicable State of California licensure requirements and listed in
the California Medicaid State Plan as a qualified DMC provider.
RECOVERY SERVICES
Recovery Services are designed to support recovery and prevent relapse with the objective of
restoring the person served to their best possible functional level.
Recovery services can be utilized when the person served is triggered, when the person served
has relapsed or simply as a measure to prevent relapse.
Persons served do not need to be diagnosed as being in remission to access Recovery Services.
Persons served may receive Recovery Services while receiving MAT services, including NTP
services. Persons served may receive Recovery Services immediately after incarceration with a
prior diagnosis of SUD. Services may be provided in person,by telehealth, or by telephone.
Recovery Services can be delivered and claimed as a standalone service, concurrently with the
other levels of care or as a service delivered as part of other levels of care.
Contractors that do not opt to make recovery services available must refer persons served to a
contractor that provides recovery services.
Recovery Services shall include the following service components:
• Assessment
• Care Coordination
• Counseling (individual and group)
• Family Therapy
Recovery Monitoring, which includes recovery coaching and monitoring designed for the
maximum reduction of the person served's SUD
• Relapse Prevention which includes interventions designed to teach persons served with
SUD how to anticipate and cope with the potential for relapse for the maximum reduction
of the person served's SUD.
CLINICIAN CONSULTATION (formerly Physician Consultation)
Clinician Consultation consists of LPHAs consulting with LPHAs, such as addiction medicine
physicians, addiction psychiatrists, licensed clinicians, or clinical pharmacists, to support the
provision of care.
Clinician Consultation is not a direct service provided to persons served. Clinician Consultation
is designed to support licensed clinicians with complex cases and may address medication
selection, dosing, side effect management, adherence, drug-drug interactions, or level of care
considerations. It includes consultations between clinicians designed to assist clinicians with
seeking expert advice on treatment needs for specific persons served. These consultations can
occur in person, by telehealth, by telephone, or by asynchronous telecommunication systems.
DMC Master Agreement-Amendment II
8
NON-DMC FUNDED SERVICES:
Non-DMC eligible persons served will have access to the same services as DMC-eligible
persons served with costs reimbursed through other sources. These services, available to all
perinatal and non-perinatal adults and adolescents, include:
• Early Intervention Services
• Outpatient
• Intensive Outpatient
• Medication Assisted Treatment
• Residential treatment, including Withdrawal Management
• Care Coordination
• Peer Support Services
• Recovery Services
• Clinician Consultation
Room and Board for Residential Treatment and Withdrawal Management services is not eligible
for reimbursement through DMC. These costs will be covered with other non-DMC funding
sources.
DMC Master Agreement-Amendment II
9
DRUG MEDI-CAL INTERGOVERNMENTAL AGREEMENT REQUIREMENTS
Fresno County, through the Department of Behavioral Health (DBH), makes substance use
disorder treatment services available throughout the county to Medi-Cal eligible persons served
through funds provided under an Intergovernmental Agreement with the California Department of
Health Care Services. The County, and all contracted providers, must comply with the terms of the
Intergovernmental Agreement, DHCS Behavioral Health Information Notices (BHINs), and any
amendments thereto, including but not limited to the following:
1. ADMISSION DISCRIMINATION
CONTRACTOR shall accept individuals eligible for admission in the order in
which they apply without restriction, up to the limits set under the State-County
Intergovernmental Agreement. CONTRACTOR shall not, based on health status or need for
health care services, discriminate against individuals eligible for admission. CONTRACTOR
shall follow all Federal and State civil rights laws. CONTRACTOR shall not unlawfully
discriminate, exclude people, or treat them differently, on any ground protected under Federal
or State law, including sex, race, color, religion, ancestry, national origin, ethnic group
identification, age, mental disability, physical disability, medical condition, genetic information,
marital status, gender, gender identity, or sexual orientation and will not use any policy or
practice that has the effect of discriminating on the basis of sex, race, color, religion, ancestry,
national origin, ethnic group identification, age, mental disability, physical disability, medical
condition, genetic information, marital status, gender, gender identity, or sexual orientation.
CONTRACTOR shall provide information on how to file a Discrimination
Grievance with COUNTY or DHCS if there is a concern of discrimination based on sex, race,
color, religion, ancestry, national origin, ethnic group identification, age, mental disability,
physical disability, medical condition, genetic information, marital status, gender, gender
identity, or sexual orientation. CONTRACTOR shall also provide information on how to file a
Discrimination Grievance with the United States Department of Health and Human Services
Office of Civil Rights if there is a concern of discrimination based on race, color, national origin,
sex, age, or disability.
2. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES
CONTRACTOR agrees that COUNTY, DHCS, CMS, the Office of the Inspector
General, the Comptroller General, or their designees have the right to audit, evaluate, and
inspect any books, records, contracts, computer or other electronic systems of
CONTRACTOR, or of the CONTRACTOR's sub-contractor, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid related activities are conducted. If
COUNTY, DHCS, or HHS Inspector General determines there is a reasonable possibility of
fraud risk, the COUNTY, DHCS, or the HHS Inspector General may inspect, evaluate, and
audit' CONTRACTOR at any time. The right to audit will exist through 10 years from the final
date of the contract period or from the date of completion of any audit, whichever is later.
3. SUBCONTRACTUAL REQUIREMENTS
CONTRACTOR shall fulfill contractual requirements of delegated services or
activities in accordance with 42 CFR §438.230 and shall perform the delegated activities and
reporting responsibilities in compliance with COUNTYs State-County Intergovernmental
DMC Master Agreement-Amendment II 1
Agreement obligations. CONTRACTOR shall comply with all applicable Medicaid laws and
regulations, including applicable sub-regulatory guidance and contract provisions.
CONTRACTOR shall not bill persons served for covered services under this agreement in
excess of the amount that would be owed by the individual if the COUNTY had directly provided
the services (42 U.S.C. 1396u-2(b)(6)(C)).
4. STATE ALCOHOL AND DRUG REQUIREMENTS
A. RECORDKEEPING REQUIREMENTS
1) CONTRACTOR shall maintain books, records, documents, and
other evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal records
relating to individuals served under the terms of this Agreement, as required, to meet the needs of
the State in monitoring quality, quantity, fiscal accountability, and accessibility of services.
Information on each individual shall include, but not be limited to, admission records, person served
interviews and progress notes, and records of service provided by various service locations, in
sufficient detail to make possible an evaluation of services provided and compliance with this
Agreement.
3) CONTRACTOR shall retain all person served grievance and
appeals records in 42 CFR §438.416, and the data, information, and documentation specified in 42
CFR §§438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years.
C. ACCESS AND CULTURAL CONSIDERATIONS
CONTRACTOR shall participate in the Department's efforts to promote the
delivery of services in a culturally competent manner and provide physical access, reasonable
accommodations, and accessible equipment for Medicaid persons served with physical or mental
disabilities.
D. CONFIDENTIALITY
CONTRACTOR shall use and disclose medical records and any other
health and enrollment information that identifies a particular person served's identifiable health
information in accordance with the privacy requirements in 45 CFR parts 160 and 164, subparts A
and E and 42 CFR Part 2, to the extent that these requirements are applicable
E. REPORTS
CONTRACTOR agrees to participate in surveys related to the performance
of this Agreement and expenditure of funds and agrees to provide any such information in a
mutually agreed upon format.
5. GRIEVANCE AND APPEALS RECORDKEEPING REQUIREMENTS
CONTRACTOR shall retain person served grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Person served
grievance and appeal data shall include a general description of the reason for the grievance or
appeal, the date the grievance or appeal was received, the date of each review or, if applicable,
review meeting, the resolution and date of resolution at each level of the grievance or appeal
DMC Master Agreement-Amendment 11 2
and the name of the covered person for whom the grievance or appeal was filed. The record
must be accurately maintained in a manner accessible to DHCS and available upon request to
CMS
6. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and issue to
persons served at intake either in paper or in electronic format. Member handbooks can also
be made available by mailing a printed copy of the information to the person served's mailing
address, emailing after obtaining the person served's agreement to receive information by
email, providing direction in paper or electronic form to the COUNTY website where the
handbook is available, or any other method that can reasonably be expected to result in the
person served receiving that information.
7. TIMELY ACCESS COVERAGE AND REQUIREMENTS
CONTRACTOR shall meet DHCS and COUNTY standards for timely access to
care and services, taking into account the urgency of the need for services. CONTRACTORs
must offer hours of operation that are no less than the hours of operation offered to commercial
persons served or comparable to Medicaid FFS, if CONTRACTOR serves only Medicaid
persons served. Timeliness standards include, but are not limited to:
A. Initial contact to first face-to-face appointment— 10 business days
B. Initial contact to first dose of NTP — 3 business days
C. Timeliness of services for Urgent Conditions — 1 business day
CONTRACTOR shall ensure services included in this agreement are available 24
hours a day, 7 days a week when medically necessary.
Initial Assessment and Services Provided During the Assessment Process:
A. Covered and clinically appropriate DMC-ODS services (except for
residential) shall be reimbursable for up to 30 days following the first visit with a Licensed
Practitioner of the Healing Arts (LPHA) or AOD counselor, whether or not a Diagnostic and
Statistical Manual (DSM) diagnosis for Substance-Related and Addictive Disorders is
established, or up to 60 days if the person served is under age 21, or if a provider documents
that the person served is experiencing homelessness and therefore requires additional time to
complete the assessment. If a person served withdraws from treatment prior to establishing a
DSM diagnosis for Substance-Related and Addictive Disorders, and later returns, the 30-day
time period starts over. The initial assessment shall be performed face-to-face or, by telehealth
(synchronous audio and video), or by telephone (synchronous audio-only) by an LPHA or AOD
counselor and may be done in the community or the home. If the assessment of the person
served is completed by an AOD counselor, then the LPHA shall evaluate that assessment with
the counselor and the LPHA shall make the initial diagnosis. The consultation between the
LPHA and the AOD counselor may be conducted in person, by videoconferencing, or by
telephone.
DMC Master Agreement-Amendment 11 3
DMC-ODS Access for Persons Served After Assessment:
A. For persons served 21 years and older, to qualify for DMC-ODS services
after the initial assessment process, persons served 21 years of age and older shall meet one of
the following criteria:
1) Have at least one diagnosis from the Diagnostic and Statistical
Manual of Mental Disorders (DSM) for Substance-Related and
Addictive Disorders, with the exception of Tobacco-Related
Disorders and Non-Substance-Related Disorders, or
2) Have had at least one diagnosis from the DSM for Substance-
Related and Addictive Disorders, with the exception of Tobacco-
Related Disorders and Non-Substance-Related Disorders, prior to
being incarcerated or during incarceration, determined by
substance use history.
B. Persons served under age 21 qualify to receive all medically necessary
DMC-ODS services as required pursuant to section 1 396d(r) of Title 42 of the United States
Code. Federal EPSDT statutes and regulations require States to furnish all Medicaid-coverable,
appropriate, and medically necessary services needed to correct and ameliorate health
conditions, regardless of whether those services are covered in the state's Medicaid State Plan.
Consistent with federal guidance, services need not be curative or completely restorative to
ameliorate a mental health condition, including substance misuse and SUDs. Services that
sustain, support, improve, or make more tolerable substance misuse or an SUD are considered
to ameliorate the condition and are thus covered as EPSDT service
C. Consistent with W&I Code section 14184.402(f), covered SUD
prevention, screening, assessment, and treatment services are Medi-Cal reimbursable when:
1) Services are provided prior to determination of a diagnosis or prior to
determination of whether DMC-ODS criteria are met.
i. Clinically appropriate and covered DMC-ODS services
provided to persons served over 21 shall be reimbursable
during the assessment process as described above. In
addition, the Contractor shall not disallow reimbursement
for clinically appropriate and covered DMC-ODS services
provided during the assessment process if the assessment
determines that the person served does not meet the
DMC-ODS access criteria after assessment.
ii. This does not eliminate the requirement that all Medi-Cal
claims, including DMCODS claims, include a CMS
approved International Classification of Diseases, Tenth
Revision (ICD-10) diagnosis code as described in
applicable DHCS guidance. In cases where services are
provided due to a suspected SUD that has not yet been
diagnosed or due to trauma as noted above, options are
available in the CMS approved ICD-10 diagnosis code list,
for example, codes for"Other specified" and "Unspecified"
disorders," or"Factors influencing health status and
contact with health services".
2) Prevention, screening, assessment, treatment, or recovery services
were not included in an individual treatment plan;
DMC Master Agreement-Amendment 11 4
3) The person served has a co-occurring mental health condition.
8. NETWORK ADEQUACY REQUIREMENTS
Pursuant to W&I Code section 14197(d)(1)(A), under Health and Safety Code
(H&S Code) section 1367.03, commencing on January 1, 2022 unless otherwise specified,
CONTRACTOR shall:
A. Provide or arrange for the provision of covered substance use disorder
services in a timely manner appropriate for the nature of the person served condition consistent
with good professional practice (H&S Code section 1367.03(a)(1)).
B. Establish and maintain provider networks, policies, procedures, and
quality assurance monitoring systems and processes sufficient to ensure compliance with this
clinical appropriateness standard (H&S Code section 1367.03(a)(1)).
C. Ensure that all processes necessary to obtain covered substance use
disorder services, including, but not limited to, prior authorization processes, are completed in a
manner that assures the provision of covered substance use disorder services to a person
served in a timely manner appropriate for the individual's condition and in compliance with H&S
Code section 1367.03 (H&S Code section 1367.03(a)(2)).
D. Ensure that, if it is necessary for CONTRACTOR or a person served to
reschedule an appointment, the appointment is promptly rescheduled in a manner that is
appropriate for the persons served's health care needs, and ensures continuity of care
consistent with good professional practice, and consistent with H&S Code section 1\367.03 and
the regulations adopted thereunder (H&S Code section 1367.03(a)(3)).
E. Ensure that interpreter services required by H&S Code section 1 367.04
of and Cal. Code Regs., tit. 28, §1300.67.0428 are coordinated with scheduled appointments for
covered substance use disorder services in a manner that ensures the provision of interpreter
services at the time of the appointment without imposing delay on the scheduling of the
appointment (H&S Code section 1367.03(a)(4)).
F. Ensure a non-urgent appointment with a non-physician substance use
disorder provider within ten business days of the request for the appointment (H&S Code
section 1367.03(a)(5)(E)), except under the following circumstances:
1) The applicable waiting time for a particular appointment may be
extended if the referring or treating licensed health care provider,
or the health professional providing triage or screening services,
as applicable, acting within the scope of their practice and
consistent with professionally recognized standards of practice,
has determined and noted in the relevant record that a longer
waiting time will not have a detrimental impact on the individual's
health (H&S Code section 1367.03(a)(5)(H)).
2) Preventive care services and periodic follow-up care, including
standing referrals to specialists for chronic conditions, periodic
office visits to monitor and treat pregnancy, cardiac, mental health,
or substance use disorder conditions, and laboratory and
radiological monitoring for recurrence of disease, may be
DMC Master Agreement-Amendment 11 5
scheduled in advance consistent with professionally recognized
standards of practice as determined by the treating licensed
health care provider acting within the scope of their practice (H&S
Code section 1367.03(a)(5)(1)).
G. Ensure that, commencing July 1, 2022, non-urgent follow up
appointments with a non-physician substance use disorder provider: within ten business days of
the prior appointment for those undergoing a course of treatment for an ongoing substance use
disorder condition (H&S Code section 1367.03(a)(5)(F)), except under the following
circumstance:
1) The applicable waiting time for a particular appointment may be
extended if the referring or treating licensed health care provider,
or the health professional providing triage or screening services,
as applicable, acting within the scope of their practice and
consistent with professionally recognized standards of practice,
has determined and noted in the relevant record that a longer
waiting time will not have a detrimental impact on the individual's
health (H&S Code section 1367.03(a)(5)(H)).
H. Arrange for the coverage through the Managed Care Plans in accordance
with subdivision H&S Code section 1 374.72(d) to ensure timely access to medically necessary
covered substance use disorder services that are not available in network within the geographic
and timely access standards set by law or regulation (H&S Code section 1367.03(a)(7)(B)).
9. PERSON SERVED RIGHTS AND PROTECTIONS
CONTRACTOR shall comply with any applicable Federal and state laws that
pertain to person served rights and shall ensure that its employees observe and protect those
rights. CONTRACTOR shall have written policies guaranteeing the person served's rights
specified in 42 CFR 438.100.
10. PROVIDER-PERSON SERVED COMMUNICATIONS
CONTRACTOR is not restricted from acting within the lawful scope of practice,
from advising or advocating on behalf of a person served who is their patient, for the following
the person served's health status, medical care, or treatment options, including any alternative
treatment that may be self-administred, any information the person served needs to decide
among all relevant treatment options, the risks, benefits, and consequences of treatment or non-
treatment, or the person served's right to participate in decisions regarding their health care,
including the right to refuse treatment, and to express preferences about future treatment
decisions.
11. LIABILITY FOR PAYMENT
CONTRACTOR shall ensure that persons served are not held liable for any of
the following:
A. CONTRACTOR's debts, in the event of the CONTRACTOR's insolvency.
DMC Master Agreement-Amendment 11 6
B. Covered services provided to the person served for which the state does
not pay the CONTRACTOR or the CONTRACTOR or the COUNTY does not pay the individual
or health care provider that furnished the service under a contractual referral or other obligation.
C. Payments for covered services furnished under a contract, referral, or
other arrangement, to the extent that those payments are in excess of the amount the person
served would owe if the CONTRACTOR covered the services directly.
12. CARE COORDINATION
CONTRACTOR and COUNTY shall comply with the care and coordination
requirements of the State-County Intergovernmental Agreement, Exhibit A, Attachment I, II.E.3.
CONTRACTOR shall ensure that each person served has an ongoing source of care
appropriate to his or her needs and shall ensure a person or entity within their organization is
formally designated as primarily responsible for coordinating the services accessed by the
person served. The person served shall be provided information on how to contact their case
manager. CONTRACTOR shall coordinate services between levels of care, with services the
person served receives from any other managed care organization and the services the person
served receives from community and social support providers. Care coordination efforts shall
be accurately documented in person served's chart to be verified during COUNTY chart audits
conducted at least annually.
CONTRACTOR shall make a best effort to conduct an initial screening of each
person served's ancillary needs, within thirty (30) calendar days of the effective date of
admission for all new persons served, including subsequent attempts if the initial attempt to
contact the person served is unsuccessful.
CONTRACTOR shall ensure that it maintains and shares, as appropriate, a
person served health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each
person served's privacy is protected in accordance with the privacy requirements in 45 CFR
parts 160 and 164 subparts A and E and 42 CFR Part 2, to the extent that they are applicable.
CONTRACTOR shall ensure that persons served are aware of and are referred
to, when appropriate, recovery supports and services immediately after discharge or upon
completion of an acute care stay.
In addition to the requirements outlined in Article III.G of Exhibit A, Attachment I,
CONTRACTOR shall comply with the following requirements for transitioning persons served
to other levels of care:
A. CONTRACTOR's care coordinators shall ensure the transition of the
person served to an appropriate LOC. This may include step-up or step-down in covered DMC-
ODS services. Care coordinators shall provide warm hand-offs and transportation to the new
LOC when medically necessary.
B. CONTRACTOR's care coordinators shall ensure transitions to other
LOCs occur no later 10 days from the time of assessment or reassessment with no interruption
of current treatment services.
DMC Master Agreement-Amendment 11 7
C. The initial treating provider shall be responsible for arranging care
coordination services and communicating with the next provider to ensure smooth transitions
between LOCs.
13. AUTHORIZATION OF SERVICES
CONTRACTOR shall adhere to COUNTY's written policies and procedures,
outlined in the Provider Manual, for authorization of services.
14. CREDENTIALING/RECREDENTIALING
CONTRACTOR shall follow the COUNTY's established credentialing and re-
credentialing process for all licensed and/or certified staff. Initial credentialing must be
completed prior to providing treatment services. Re-credentialing must be completed every
three (3) years.
15. PERFORMACE IMPROVING PROJECTS
CONTRACTOR shall PARTICIPATE, when requested by COUNTY, in annual
Performance Improvement Projects including but not limited to identifying a clinical and a non-
clinical problem, brainstorming causes and barriers, implementation of interventions for the
identified problems, and analysis of interventions. CONTRACTOR shall assist in planning and
initiation of activities for increasing or sustaining improvement.
16. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the State-
County Intergovernmental Agreement, the Provider Manual and the Member Handbook.
CONTRACTOR shall make the following grievance information available to all
persons served:
A. Perons Served's right to a State Fair Hearing and how to obtain a hearing
as well as representation rules.
B. Person Served's right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Person Served's right to give written consent to allow CONTRACTOR or
legal representative, acting on behalf of the person served, to file an appeal.
D. Person Served may file a grievance orally or in writing to DHCS or
COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
G. Person Served's right to request continuation of benefits during an appeal
or state fair hearing filing although the person served may be liable for the cost of any
continued benefits if the action is upheld.
H. Any state determined contractor's appeal rights to challenge the failure of
the COUNTY to cover a service.
DMC Master Agreement-Amendment 11 8
17. PROGRAM INTEGRITY REQUIREMENTS
CONTRACTOR shall implement and maintain arrangements or procedures that
are designed to detect and prevent fraud, waste, and abuse. CONTRACTOR shall maintain
written policies, procedures, and standards of conduct that articulate CONTRACTOR's
commitment to comply with all applicable requirements and standards under the State-County
Intergovernmental Agreement, and all applicable Federal and State requirements.
CONTRACTOR shall establish and implement procedures and a system with dedicated staff
for routine internal monitoring and auditing of compliance risks, prompt response to compliance
issues as they are raised, investigation of potential compliance problems as identified in the
course of self-evaluation and audits, correction of such problems promptly and thoroughly (or
coordination of suspected criminal acts with law enforcement agencies) to reduce the potential
for recurrence, and ongoing compliance.
CONTRACTOR shall provide reports to COUNTY within 60 calendar days when
it has identified an overpayment. COUNTY shall provide a mechanism for reporting and
collecting overpayment.
CONTRACTOR shall retain information regarding data, information, and
documentation for person served encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years.
CONTRACTOR shall ensure sites keep a record of persons served being treated
at that location.
CONTRACTOR shall not knowingly have a relationship with a director, officer or
partner of CONTRACTOR, a subcontractor of CONTRACTOR, a person with beneficial
ownership of five (5) percent or more of CONTRACTOR's equity or a network provider or
person with an employment, consulting or other arrangement with the CONTRACTOR for the
provision of items and services that are significant and material to the CONTRACTOR's
obligations under this Agreement with the following:
A. An individual or entity that is debarred, suspended, or otherwise excluded
from participating in procurement activities under the Federal Acquisition Regulation or from
participating in non-procurement activities under regulations issued under Executive Order No.
12549 or under guidelines implementing Executive Order No. 12549.
B. An individual or entity who is an affiliate, as defined in the Federal
Acquisition Regulation at 48 CFR 2, Section 101, of a person described above.
CONTRACTOR shall not have a relationship with an individual or entity that is
excluded from participation in any Federal Health Care Program under section 1128 or 1128A
of the Act.
18. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDDER
BENEFITS
A. General Parity Requirement
CONTRACTOR shall not impose any financial requirements, Quantitative
Treatment Limitations, or Non-Quantitative Treatment Limitations in any classification of benefit
(inpatient, outpatient, emergency care, or prescription drugs) other than those limitations
permitted and outlined in the State-County Contract.
DMC Master Agreement-Amendment 11 9
CONTRACTOR shall not apply any financial requirement or treatment
limitation to substance use disorder services in any classification of benefit that is more
restrictive than the predominant financial requirement or treatment limitation of that type applied
to substantially all medical/surgical benefits in the same classification of benefit furnished to
person served (whether or not the benefits are furnished by the CONTRACTOR). (42 CFR
438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to person
served in every classification in which medical/surgical benefits are provided. (42 CFR
438.910(b)(2))
B. Quantitative Limitations
CONTRACTOR shall not apply any cumulative financial requirement for
substance use disorder services in a classification that accumulates separately from any
established for medical/surgical services in the same classification. (42 CFR 438.910(c)(3))
C. Non-Quantitative Limitations
CONTRACTOR shall not impose a non-quantitative treatment limitation
for substance use disorder benefits in any classification unless, under the policies and
procedures of CONTRACTOR as written and in operation, any processes, strategies,
evidentiary standards, or other factors used in applying the non-quantitative treatment limitation
to substance use disorder benefits in the classification are comparable to, and are applied no
more stringently than, the processes, strategies, evidentiary standards, or other factors used in
applying the limitation for medical/surgical benefits in the classification. (42 CFR §438.910(d))
19. PERSON SERVED INFORMING AND TRANSLATION SERVICES
CONTRACTOR shall comply with all applicable state and federal requirements
regarding nondiscrimination, language assistance, information access, including but not limited
to, the Dymally-Alatorre Bilingual Services Act, section 1 557 of the Patient Protection and
Affordable Care Act, the Americans with Disabilities Act, and Section 504 of the Rehabilitation
Act.
Nondiscrimination Notice:
A. CONTRACTOR shall post a DHCS-approved nondiscrimination notice
that informs persons served, potential persons served, and the public about nondiscrimination,
protected characteristics, and accessibility requirements and conveys the CONTRACTOR'S
compliance with the requirements.
B. The nondiscrimination notice shall be posted in at least a 12-point font
and be included in any documents that are vital or critical to obtaining services and/or benefits,
and all other informational notices targeted to persons served, potential persons served, and the
public. Informational notices include not only documents intended for the public, such as
outreach, education, and marketing materials, but also written notices requiring a response from
an individual and written notices to an individual such as those pertaining to rights or benefits.
C. The nondiscrimination notice shall also be posted in at least a 12-point
font in conspicuous physical locations where the CONTRACTOR interacts with the public, and
on the CONTRACTOR's website in a location that allows any visitor to the website to easily
locate the information.
DMC Master Agreement-Amendment II 10
D. The nondiscrimination notice shall include all legally required elements
under the applicable subsections of W&I Code section 14029.91 and Gov. Code section 11135.
E. The nondiscrimination notice shall include information on how to file a
discrimination grievance directly with the DHCS Office of Civil Rights, in addition to information
about how to file a discrimination grievance with the County and the U.S. Health and Human
Services Office for Civil Rights.
F. CONTRACTOR is not prohibited from posting the nondiscrimination
notice in additional publications and communications
Language Assistance Taglines
A. CONTRACTOR shall post taglines in a conspicuously visible size (no less
than 12-point font), in English and at least the top 18 non-English languages in the State (as
determined by DHCS), persons served, potential persons served, and the public of the
availability of no-cost language assistance services, including assistance in non-English
languages and the provision of free auxiliary aids and services for people with disabilities.
B. Taglines shall be posted in any documents that are vital or critical to
obtaining services and/or benefits, conspicuous physical locations where the CONTRACTOR
interacts with the public, on the CONTRACTOR'S website in a location that allows any visitor to
the website to easily locate the information, and in all person served's information and other
information notice, in accordance with federal and state requirements.
Language Assistance Services
CONTRACTOR shall make interpretation services available free of charge and in
a timely manner to each person served. This includes two primary types of language assistance
services: oral and written. Limited English proficiency (LEP) individuals are not required to
accept language services, although a qualified interpreter may be used to assist in
communicating with an LEP individual who has refused language assistance services.
CONTRACTOR shall comply with the following oral interpretation requirements:
A. CONTRACTOR shall provide oral interpretation services from a qualified
interpreter, on a 24-hour basis, at all key points of contact, at no cost to persons served. Key
points of contact may include medical care settings and non-medical care settings.
B. Font shall be provided in all languages and is not limited to threshold or
concentration standard languages.
C. Interpretation can take place in-person, through a telephonic interpreter,
or internet or video remote interpreting (VRI) services. However, the CONTRACTOR is
prohibited from using remote audio or VRI services that do not comply with federal quality
standards, or relying on unqualified bilingual/multilingual staff, interpreters, or translators. The
CONTRACTOR should not solely rely on telephone language lines for interpreter services.
Rather, telephonic interpreter services should supplement face-to-face interpreter services,
which are a more effective means of communication.
D. An interpreter is a person who renders a message spoken in one
language into one or more languages. An interpreter shall be qualified and have knowledge in
both languages of the relevant terms or concepts particular to the program or activity and the
DMC Master Agreement-Amendment II 11
dialect spoken by the LEP individual. In order to be considered a qualified interpreter for an
LEP individual, the interpreter must:
1) have demonstrated proficiency in speaking and understanding
both English and the language spoken by the LEP individual;
2) be able to interpret effectively, accurately, and impartially, both
receptively and expressly, to and from the language spoken by the
LEP individual and English, using any necessary specialized
vocabulary, terminology, and phraseology; and
3) adhere to generally accepted interpreter ethics principles,
including person served confidentiality.
E. If the CONTRACTOR provides a qualified interpreter for an individual with
LEP through remote audio interpreting services, the CONTRACTOR shall provide real-time
audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection
that delivers high-quality audio without lags or irregular pauses in communication; a clear,
audible transmission of voices; and adequate training to users of the technology and other
involved individuals so that they may quickly and efficiently set up and operate the remote
interpreting services.
F. CONTRACTOR is prohibited from requiring LEP individuals to provide
their own interpreters, or from relying on bilingual/multilingual staff members who do not meet
the qualifications of a qualified interpreter. Some bilingual/multilingual staff may be able to
communicate effectively in a non-English language when communicating information directly in
that language but may not be competent to interpret in and out of English. Bilingual/multilingual
staff may be used to communicate directly with LEP individuals only when they have
demonstrated that they meet all the qualifications of a qualified interpreter listed above.
G. The CONTRACTOR is prohibited from relying on an adult or minor child
accompanying an LEP individual to interpret or facilitate communication except when there is
an emergency involving an imminent threat to the safety or welfare of the individual or the
public and a qualified interpreter is not immediately available or the LEP individual specifically
requests that an accompanying adult interpret or facilitate communication, the accompanying
adult agrees to provide that assistance, and reliance on that accompanying adult for that
assistance is appropriate under the circumstances. Prior to using a family member, friend or, in
an emergency only, a minor child as an interpreter for an LEP individual, the CONTRACTOR
shall first inform the individual that they have the right to free interpreter services and second,
ensure that the use of such an interpreter will not compromise the effectiveness of services or
violate the LEP individual's confidentiality.
CONTRACTOR shall use COUNTY's written/translated materials that are critical
to obtaining services, including the provider directory, member handbook, appeal and
grievance notices, and denial and termination notices, available in the prevalent non—English
languages. All other CONTRACTOR specific written materials must be made available in the
prevalent non-English languages. CONTRACTOR shall ensure that written materials use easily
understood language and format, use a font size no smaller than 12-point, and are made
available in alternative formats upon request of the potential person served or person served at
no cost. Written materials shall include taglines in the prevalent non-English languages in the
state, as well as large print, explaining the availability of written translation or oral interpretation
DMC Master Agreement-Amendment 11 12
to understand the information provided and the toll-free and TTY/TIDY telephone number of
COUNTY's member/customer service unit.
CONTRACTOR shall use a qualified translator when translating written content in
paper or electronic form. A qualified translator is a translator who:
A. Adheres to generally accepted translator ethics principles, including
person served confidentiality;
B. Has demonstrated proficiency in writing and understanding both written
English and the written non-English language(s) in need of translation; and
C. Is able to translate effectively, accurately, and impartially to and from
such language(s) and English, using any necessary specialized vocabulary, terminology, and
phraseology.
At a minimum, CONTRACTOR shall provide written translations of the person
served's information in the threshold and concentration languages.
20. EFFECTIVE COMMUNICATION WITH INDIVIDUALS WITH DISABILITIES
CONTRACTOR shall comply with all applicable requirements of federal and state
disability law and take appropriate steps to ensure effective communication with individuals with
disabilities. CONTRACTOR shall provide appropriate auxiliary aids and services to persons with
impaired sensory, manual, or speaking skills, including the provision of qualified interpreters and
written materials in alternative formats, free of charge and in a timely manner, when such aids
and services are necessary to ensure that individuals with disabilities have an equal opportunity
to participate in, or enjoy the benefits of, the CONTRACTOR'S covered services, programs, and
activities. CONTRACTOR shall provide interpretive services and make member information
available in the following alternative formats: Braille, audio format, large print (no less than 20-
point font), and accessible electronic format (such as a data CD). In determining what types of
auxiliary aids and services are necessary, CONTRACTOR shall give "primary consideration" to
the individual's request of a particular auxiliary aid or service.
Auxiliary aids and services include the following:
A. Qualified interpreters on-site or through VRI services; note takers; real-
time computer-aided transcription services; written materials; exchange of written notes;
telephone handset amplifiers; assistive listening devices; assistive listening systems; telephones
compatible with hearing aids; closed caption decoders; open and closed captioning, including
realtime captioning; voice, text, and video-based telecommunication products and systems, text
telephones (TTYs), videophones, captioned telephones, or equally effective telecommunications
devices; videotext displays; accessible information and communication technology; or other
effective telecommunications devices, videotext displays, accessible information and
communication technology; or other effective methods of making aurally delivered information
available to individuals who are dead or hard of hearing.
B. Qualified readers; taped texts; audio recordings; Braille materials and
displays; screen reader software; magnification software; optical readers; secondary auditory
programs; large print materials (no less than 20-point font); accessible information and
DMC Master Agreement-Amendment 11 13
communication technology; or other effective methods of making visually delivered materials
available to individuals who are blind or have low vision.
When providing interpretive services, CONTRACTOR shall use qualified
interpreters to interpret for an individual with a disability, whether through a remote interpreting
service or an on-site appearance. A qualified interpreter for an individual with a disability is an
interpreter who:
1) adheres to generally accepted interpreter ethics principals,
including person served confidentiality; and
2) is able to interpret effectively, accurately, and impartially, both
receptively and expressively, using any necessary specialized
vocabulary, terminology, and phraseology.
For an individual with a disability, qualified interpreters can include, for example,
sign language interpreters, oral transliterators (individuals who represent or spell in the
characters of another alphabet), and cued language transliterators (individuals who represent
or spell by using a small number of handshapes).
If a CONTRACTOR provides a qualified interpreter for an individual with a
disability through VRI services, the Contractor shall provide real-time, full-motion video and
audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection
that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy
images, or irregular pauses in communication; a sharply delineated image that is large enough
to display the interpreter's face, arms, hands, and fingers, and the participating individual's face,
arms, hands, and fingers, regardless of body position; a clear, audible transmission of voices;
and adequate training to users of the technology and other involved individuals so that they may
quickly and efficiently set up and operate the VRI.
CONTRACTOR shall not require an individual with a disability to provide their
own interpreter. CONTRACTOR is also prohibited from relying on an adult or minor child
accompanying an individual with a disability to interpret or facilitate communication except
when:
1) there is an emergency involving an imminent threat to the safety
or welfare of the individual or the public and a qualified interpreter
is not immediately available; or,
2) the individual with a disability specifically requests that an
accompanying adult interpret or facilitate communication, the
accompanying adult agrees to provide that assistance, and
reliance on that accompanying adult for that assistance is
appropriate under the circumstances. Prior to using a family
member, friend, or, in an emergency only, a minor child as an
interpreter for an individual with a disability, CONTRACTOR shall
first inform the individual that they have the right to free interpreter
services and second, ensure that the use of such an interpreter
will not compromise the effectiveness of services or violate the
individual's confidentiality. CONTRACTOR shall ensure that the
refusal of free interpreter services and the individual's request to
DMC Master Agreement-Amendment 11 14
use a family member, friend, or a minor child as an interpreter is
documented.
CONTRACTOR shall make reasonable modifications to policies, practices, or
procedures when such modifications are necessary to avoid discrimination based on disability.
21. CONTRACTOR SPECIFICATIONS
CONTRACTOR shall ensure that professional staff are licensed, registered,
enrolled, and/or approved in accordance with all applicable state and federal laws and
regulations. Professional staff shall abide by the definitions, rules, and requirements for
stabilization and rehabilitation services established by the Department of Health Care Services.
CONTRACTOR shall ensure that Physicians receive a minimum of five (5) hours of continuing
medical education related to addiction medicine each year and professional staff(LPHAs)
receive a minimum of five (5) hours of continuing education related to addiction medicine each
year. Copies of these certifications and licenses shall be maintained in staff's personnel files
and records shall be made available to COUNTY upon request.
Profession staff is defined as any of the following:
A. Licensed Practitioners of the Healing Arts (LPHA), including:
1) Physicians
2) Nurse Practitioners
3) Physician Assistants
4) Registered Nurses
5) Registered Pharmacists
6) Licensed Clinical Psychologists
7) Licensed Professional Clinical Counselors
8) Licensed Marriage and Family Therapists
9) Licensed-eligible practitioners registered with the Board of
Psychology or Behavioral Science Board working under the
supervision of a licensed clinician
B. An Alcohol or other drug (AOD) counselor that is either certified or
registered by an organization that is recognized by the Department of
Health Care Services and accredited with the National Commission for
Certifying Agencies (NCCA), and meets all California State education,
training, and work experience requirements set forth in the Counselor
Certification Regulations, Cal. Code Regs., tit. 9, Div. 4, chapter 8.
C. Medical Director of a Narcotic Treatment Program who is a licensed
physician in the State of California.
D. A Peer Support Specialist with a current State approved Medi-Cal Peer
Support Specialist Certification Program certification and who meet all
other applicable California state requirements, including ongoing
education requirements
CONTRACTOR shall ensure that non-professional staff receive appropriate
onsite orientation and training prior to performing assigned duties. A professional and/or
administrative staff shall supervise non-professional staff. Professional and non-professional
staff are required to have appropriate experience and any necessary training at the time of
DMC Master Agreement-Amendment 11 15
hiring. Documentation of trainings, certifications and licensure shall be contained in personnel
files.
22. MEDICAL NECESSITY
CONTRACTOR shall use ASAM criteria to determine medical necessity. Level of
Care determinations are separate and distinct from determining medical necessity.
CONTRACTOR shall ensure that all ADULT persons served receive at least one
diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition
for Substance-Related and Addictive Disorders. After establishing a diagnosis and
documenting the basis for diagnosis, the American Society of Addiction Medicine (ASAM)
Placement Criteria shall be applied by the diagnosing individual to for placement into the
correct level of care.
Non-NTP CONTRACTORS shall periodically as directed by COUNTY, and at a
minimum of every six (6) months, reassess for continued medical necessity of an ongoing
treatment. The reassessment determination must be documented by the Medical Director,
licensed physician or LPHA as clinically appropriate.
OTP/NTP CONTRACTORS shall periodically as directed by COUNTY, and at a
minimum within two (2) years from admission and annually thereafter, reassess for continued
medical necessity of an ongoing treatment and determine that those services are still clinically
appropriate for that individual.
For Medical Necessity definition and Assessment and Reassessment timeframes
CONTRACTOR shall refer to the Provider Manual.
A. For individuals under 21 years of age, a service is "medically necessary"
or a "medical necessity" if the service is necessary to correct or ameliorate screened health
conditions. Consistent with federal guidance, services need not be curative or completely
restorative to ameliorate a health condition, including substance misuse and SUDs. Services
that sustain, support, improve, or make more tolerable substance misuse or an SUD are
considered to ameliorate the condition and are thus covered as EPSDT services. (Section
1396d(r)(5) of Title 42 of the United States Code; W&I Code section 14059.5(b)(1)).
B. Individuals over 21 must receive DMC-ODS services that are medically
necessary. Pursuant to W&I Code section 14059.5(a), a service is "medically necessary" or a
"medical necessity" when it is reasonable and necessary to protect life, to prevent significant
illness or significant disability, or to alleviate severe pain.
23. ASAM REQUIREMENTS
CONTRACTOR shall use COUNTY's American Society of Addiction Medicine
(ASAM) criteria assessment tools to determine placement into the appropriate level of care for
all persons served. CONTRACTOR shall ensure that assessment of services for adolescents
will follow the ASAM adolescent treatment criteria.
CONTRACTOR and CONTRACTOR's staff shall comply with obtaining ASAM
Criteria training prior to providing services. CONTRACTOR shall ensure that, at minimum, staff
conducting assessments complete ASAM trainings as described in the Staff Training Plan
DMC Master Agreement-Amendment 11 16
available on the Provider website. CONTRACTOR shall maintain records of ASAM trainings in
personnel files and will make these records available to COUNTY upon request.
For persons served 21 and over, a full assessment using the ASAM Criteria shall
be completed within 30 days of the person served's first visit with an LPHA or
registered/certified counselor.
For persons served under 21, or for adults experiencing homelessness, a full
assessment using the ASAM Criteria shall be completed within 60 days of the person served's
first visit with an LPHA or registered/certified counselor.
A full ASAM Criteria assessment is not required to deliver prevention and early
intervention services for persons served under 21; a brief screening ASAM Criteria tool is
sufficient for these services (see below regarding details about ASAM level of care.
If a person served withdraws from treatment prior to completing the ASAM
Criteria assessment and later returns, the time period starts over.
A full ASAM Criteria assessment, or initial provisional referral tool for preliminary
level of care recommendations, shall not be required to begin receiving DMC-ODS services. A
full ASAM assessment does not need to be repeated unless the person served condition
changes.
A person served's placement and level of care determinations shall ensure that
individuals are able to receive care in the least restrictive level of care that is clinically
appropriate to treat their condition.
24. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a person served has Other Health Coverage (OHC),
CONTRACTOR shall bill the OHC prior to billing DMC to receive either payment from the OHC,
or a notice of denial from the OHC indicating that either the recipient's OHC coverage has been
exhausted or that the specific service is not a benefit of the OHC.
25. DMC REIMBURSEMENT RATE SETTING
CONTRACTOR shall submit financial and service data to COUNTY on an annual
basis in a format provide by, and by a deadline set by, COUNTY for reimbursement rate setting
purposes. COUNTY shall approve contractor-specific reimbursement rates for each modality
except NTPs. CONTRACTORs that do not comply with the requirements of the rate setting
process will be considered out of compliance with contractual requirements and will not receive
annual reimbursement rates CONTRACTORs that are non-compliant are subject to contract
termination.
Annual reimbursement rates for NTP services shall be set by DHCS pursuant to the
process set forth in W&I Code, Section 14021.51. NTP CONTRACTOR shall submit cost
reports to DHCS.
DMC Master Agreement-Amendment 11 17
26. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable accommodations,
and accessible equipment are available for Medicaid persons served with physical or mental
disabilities in accordance with CFR Title 45, Part 84 and the Americans with Disabilities Act.
27. STATE PLAN COUNTIES NTP PERSONS SERVED
OTP CONTRACTORs shall ensure that a person served that resides in a county
that does not participate in DMC-ODS does not experience a disruption of NTP services. NTP
CONTRACTORs shall provide any medically necessary NTP services covered by the California
Medi-Cal State Plan to persons served that reside in a county that does not participate in DMC-
ODS. NTP CONTRACTORs who provide services to an out-of-county person served shall
submit claims for those services to the county in which the person served resides (according to
MEDS).
28. MEDICAL DIRECTOR REQUIREMENTS
CONTRACTOR's Medical Director must, prior to the delivery of services under
this Contract, be enrolled with DHCS under applicable state regulations, screened in
accordance with 42 CFR 455.450(a) as a "limited" categorical risk within a year prior to serving
as a Medical Director under this Agreement, and have a signed Medicaid provider agreement
with DHCS as required by 42 CFR 431.107.
Medical Directors shall receive a minimum of five (5) hours of continuing medical
education related to addiction medicine annually.
SUD Medical Director's responsibilities shall, at a minimum, include all of the
following:
A. Ensure that medical care provided by physicians, registered nurse
practitioners, and physician assistants meets the applicable standard of care.
B. Ensure that physicians do not delegate their duties to non-physician
personnel.
C. Develop and implement written medical policies and standards for the
provider.
D. Ensure that physicians, registered nurse practitioners, and physician
assistants follow the provider's medical policies and standards.
E. Ensure that the medical decisions made by physicians are not influenced
by fiscal considerations.
F. Ensure that provider's physicians and LPHAs are adequately trained to
perform diagnosis of substance use disorders for persons served, and determine services are
medically necessary.
G. Ensure that provider's physicians are adequately trained to perform other
physician duties, as outlined in this section.
The Medical Director Medical Director may delegate their responsibilities to a
physician consistent with the provider's medical policies and standards; however, the Medical
Director shall remain responsible for ensuring all delegated duties are properly performed.
DMC Master Agreement-Amendment 11 18
29. DMC CERTIFICATION AND ENROLLMENT
Prior to delivering SUD services CONTRACTOR shall obtain any licenses,
registrations, DMC certifications or approval to operate a SUD program or provide a covered
service in accordance with applicable laws and regulations. CONTRACTOR shall continuously
maintain any licenses, registrations, DMC certifications or approval to operate a SUD program
or provide a covered service in accordance with applicable laws and regulations for the
duration of this Contract. CONTRACTOR and any subcontractors shall comply with the
following regulations and guidelines:
A. Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
B. Cal. Code Regs., tit. 22, Sections 51490.1(a);
C. Exhibit A, Attachment I, Article II I.XX— Requirements for Services;
D. Cal. Code Regs., Title 9, Division 4, Chapter 4, Subchapter 1, Sections
10000, et seq.;
E. Cal. Code Regs., tit. 22, Div. 3, chapter 3, §§ 51000 et. Seq; and
F. W&I Code section 1 41 84.100 et seq.
30. PERINATAL CERTIFICATION REQUIREMENTS
CONTRACTORs of perinatal DMC services shall be properly certified to provide these services
and comply with the applicable requirements below:
A. Perinatal services shall address treatment and recovery issues specific to
pregnant and postpartum women, such as relationships, sexual and physical abuse, and
development of parenting skills.
B. Perinatal services shall include:
1) Parent/child habilitative and rehabilitative services (i.e., development
of parenting skills, training in child development, which may include
the provision of cooperative child care pursuant to Health and Safety
Code Section 1596.792);
2) Service access (i.e., provision of or arrangement for transportation to
and from medically necessary treatment);
3) Education to reduce harmful effects of alcohol and drugs on the
parent and fetus or the parent and infant; and
4) Coordination of ancillary services (i.e., assistance in accessing and
completing dental services, social services, community services,
educational/vocational training and other services which are medically
necessary to prevent risk to fetus or infant).
C. Medical documentation that substantiates the person served's pregnancy
and the last day of pregnancy shall be maintained in the person served file.
DMC Master Agreement-Amendment 11 19
31. CONTRACTOR CHANGE IN SERVICE OR LOCATION
CONTRACTOR shall ensure that any reduction of covered services or
relocations are not implemented until approval is issued by DHCS. CONTRACTOR must submit
a new DMC certification application to the DHCS Provider Enrollment Division (PED). The DMC
certification application shall be submitted to PED 60 days prior to the desired effective date of
the reduction of covered services or relocation.
CONTRACTOR shall notify COUNTY when its license, registration, certification, or approval to
operate a SUD program or provide a covered service is revoked, suspended, modified, or not
renewed by entities other than DHCS.
32. CONTRACTOR DMC CERTIFICATION
DMC certified CONTRACTORs shall be subject to continuing certification
requirements at least once every five years. DHCS may allow the CONTRACTOR to continue
delivering covered services to person served at a site subject to on-site review by DHCS as part
of the recertification process prior to the date of the on-site review, provided the site is
operational, the certification remains valid, and has all required fire clearances. DHCS shall
conduct unannounced certification and recertification site visits at clinics pursuant to W&I Code,
Section 14043.7.
33. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall promote the delivery of services in a culturally competent
manner to all persons served, including those with limited English proficiency and diverse
cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or
gender identity. CONTRACTOR shall develop a cultural competency plan and subsequent plan
updates.
CONTRACTOR is responsible to provide culturally competent services.
CONTRACTOR's policies, procedures, and practices must be consistent with the principles
outlined and are embedded in the organizational structure, as well as being upheld in day-to-
day operations. Translation services shall be available for persons served, as needed.
34. ADDITIONAL AGREEMENT RESTRICTIONS
This Agreement is subject to any additional restrictions, limitations, conditions, or
statutes enacted or amended by the federal or state governments, which may affect the
provisions, terms, or funding of this Agreement in any manner.
35. VOLUNTARY TERMINATION OF DMC-ODS SERVICE
CONTRACTOR may terminate this Agreement at any time, for any reason, by
giving 60 days written notice to DHCS. CONTRACTOR shall be paid for DMC-ODS services
provided to persons served up to the date of termination. Upon termination, the Contractor shall
immediately begin providing DMC services to persons served in accordance with the State Plan.
36. NULLIFICATION OF DMC-ODS SERVICES
The parties agree that failure of COUNTY, or CONTRACTOR, to comply with
W&I Code section 14124.24, 14184.100 et seq., BHIN 21-075, as superseded by BHIN 23-001,
DMC Master Agreement-Amendment 11 20
the Intergovernmental Agreement, and any other applicable statutes, regulations or guidance
issued by DHCS, shall be deemed a breach that results in the termination of the State-County
Intergovernmental Agreement for cause. In the event of a breach, the DMC-ODS services shall
terminate. The COUNTY shall immediately begin providing DMC services to the person served
in accordance with the State Plan.
37. HATCH ACT
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5 USC,
Sections 1501-1508), which limit the political activities of employees whose principal
employment activities are funded in whole or in part with federal funds.
38. NO UNLAWFUL USE OR UNLAWFUL USE MESSAGES REGARDING
DRUGS
CONTRACTOR agrees that information produced through these funds, and
which pertains to drug and alcohol related programs, shall contain a clearly written statement
that there shall be no unlawful use of drugs or alcohol associated with the program. Additionally,
no aspect of a drug or alcohol related program shall include any message on the responsible
use, if the use is unlawful, of drugs or alcohol (H&S Code section 11999-11999.3). By signing
this Agreement, CONTRACTOR agrees that it shall enforce these requirements.
39. NONCOMPLIANCE WITH REPORTING REQUIREMENTS
CONTRACTOR agrees that COUNTY and DHCS have the right to withhold
payment until CONTRACTOR has submitted any required data and reports to DHCS, as
identified in the Intergovernmental Agreement, Exhibit A, Attachment I or as identified in
Document 1 F(a), Reporting Requirement Matrix for Counties.
40. LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION OF
CONTROLLED SUBSTANCES
None of the funds made available through this Agreement may be used for any
activity that promotes the legalization of any drug or other substance included in Schedule I of
Section 202 of the Controlled Substances Act (21 USC 812).
41. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
OF 1996
If any of the work performed under this Agreement is subject to the HIPAA,
CONTRACTOR shall perform the work in compliance with all applicable provisions of HIPAA.
As identified in Exhibit F of the State County Intergovernmental Agreement, DHCS, COUNTY
and CONTRACTOR shall cooperate to ensure mutual agreement as to those transactions
between them, to which this Provision applies. Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the personal
health information (PHI), it shall not change any definition, data condition or use of a data
element or segment as proscribed in the federal Health and Human Services Transaction
Standard Regulation [45 CFR Part 162915(a)].
DMC Master Agreement-Amendment 11 21
2) No Additions: CONTRACTOR hereby agrees that for PHI, it shall
not add any data elements or segments to the maximum data set as proscribed in the HHS
Transaction Standard Regulation [45CFR Part 162.915 (b)].
3) No Unauthorized Uses: CONTRACTOR hereby agrees that for
PHI, it shall not use any code or data elements that are marked `not used" in the in the HHS
Transactions Implementation specification or are not in the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (c)].
4) No Changes to Meaning or Intent: CONTRACTOR hereby agrees
that for PHI, it shall not change the meaning or intent of the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (d)].
B. Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility that
DHCS or others may request an extension from the uses of a standard in the HHS Transaction
Standards. If this occurs, CONTRACTOR agrees that it shall participate in such test
modifications.
C. Adequate Testing
CONTRACTOR is responsible to adequately test all business rules appropriate
to their types and specialties. If the CONTRACTOR is acting as a clearinghouse for enrolled
providers, CONTRACTOR has obligations to adequately test all business rules appropriate to
each and every provider type and specialty for which they provide clearinghouse services.
D. Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies identified
by DHCS, and transactions errors or deficiencies identified by an enrolled CONTRACTOR if
the COUNTY is acting as a clearinghouse for that CONTRACTOR. If the CONTRACTOR is a
clearinghouse, the CONTRACTOR agrees to properly communicate deficiencies and other
pertinent information regarding electronic transactions to enrolled CONTRACTORS for which
they provide clearinghouse services.
E. Code Set Retention
Both COUNTY and CONTRACTOR understand and agree to keep open code
sets being processed or used in this Agreement for a least the current billing period or any
appeal period, whichever is longer.
F. Data Transmission Log
Both COUNTY and CONTRACTOR shall establish and maintain a Data
Transmission Log, which shall record any and all data transmissions taking place between the
Parties during the term of this Agreement. Each Party shall take necessary and reasonable
steps to ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be retained
by each Party for no less than twenty-four (24) months following the date of the Data
Transmission. The Data Transmission Log may be maintained on computer media or other
suitable means provided that, if necessary to do so, the information contained in the Data
Transmission Log may be retrieved in a timely manner and presented in readable form.
DMC Master Agreement-Amendment 11 22
42. COUNSELOR CERTIFICATION
Any counselor or registrant providing intake, assessment of need for services,
treatment or recovery planning, individual or group counseling to persons served in a DHCS
licensed or certified program is required to comply with the requirements in Cal. Code Regs., tit.
9, div. 4, chapter 8. (Document 3H).
43. CULTURAL AND LINGUISTIC PROFICIENCY
CONTRACTOR shall ensure equal access to quality care by diverse populations
by adopting the federal Office of Minority Health Culturally and Linguistically Appropriate Service
(CLAS) national standards (Document 3V) and complying with 42 CFR 438.206(c)(2).
44. TRAFFICKING VICTIMS PROTECTION ACT OF 2000
CONTRACTOR shall comply with section 106(g) of the Trafficking Victims
Protection Act of 2000 (22 U.S.C. 7104(g)) as amended by section 1702. For full text of the
award term, go to: htti)://uscode.house.gov/view.xhtmI?reg=granuleid:USCr)relim-title22-
section7104d&num=0&edition=prelim.
CONTRACTOR, CONTRACTOR's employees, subrecipients, and subrecipients'
employees may not:
A) Engage in severe forms of trafficking in persons during the period of time
that the award is in effect;
B) Procure a commercial sex act during the period of time that the award is
in effect; or
C) Use forced labor in the performance of the award or subawards under the
award.
This agreement may be unilaterally terminated, without penalty, if
CONTRACTOR or a subrecipient that is a private entity is determined to have violated a
prohibition of the TVPA or has an employee who is determined by the DBH Director or her
designee to have violated a prohibition of the TVPA through conduct that is either associated
with performance under the award or imputed to the CONTRACTOR or their subrecipient using
the standards and due process for imputing the conduct of an individual to an organization that
are provided in 2 C.F.R. Part 180, "OMB Guidelines to Agencies on Government-wide
Debarment and Suspension (Non-procurement).
CONTRACTOR must inform the DBH Director or her designee immediately of
any information received from any source alleging a violation of a prohibition of the TVPA.
CONTRACTOR must sign a certification annually acknowledging the Trafficking
Victims Protection Act of 2000 requirements (TVPA Certification), attached hereto as
Attachment A, incorporated herein by reference and made part of this Agreement and must
require all employees to complete annual TVPA training.
DMC Master Agreement-Amendment 11 23
45. PARTICIPATION IN THE COUNTY BEHAVIORAL HEALTH DIRECTOR'S
ASSOCIATION OF CALIFORNIA
CONTRACTOR'S administrator or designee shall participate and represent the
CONTRACTOR in meetings of the County Behavioral Health Director's Association of California
for the purposes of representing the CONTRACTOR in their relationship with DHCS and the
COUNTY with respect to policies, standards, and administration for SUD services. The
CONTRACTOR'S administrator or designee shall attend any special meetings called by the
Director of DHCS.
46. ADOLESCENT BEST PRACTICES GUIDELINES
CONTRACTOR shall follow the guidelines in Document 1V, incorporated by this
reference, "Adolescent Best Practices Guidelines," in developing and implementing adolescent
treatment programs funded under this Exhibit, until such time new Adolescent Best Practices
Guidelines are established and adopted. No formal amendment of this Agreement is required
for new guidelines to be incorporated into this Agreement.
47. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
By signing this Agreement, CONTRACTOR certifies that under the laws of the
United States and the State of California, incorporated into this Agreement by reference and
made a part hereof as if set forth in full, CONTRACTOR shall not unlawfully discriminate against
any person.
48. FEDERAL LAW REQUIREMENTS
CONTRACTOR shall comply with the following Federal law requirements:
A. Title VI of the Civil Rights Act of 1964, section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in federally funded programs.
B. Title IX of the Education Amendments of 1972 (regarding education and
programs and activities), if applicable.
C. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.) prohibiting
discrimination on the basis of race, color, religion, sex, handicap, familial status or national
origin in the sale or rental of housing.
D. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42 USC
sections 6101 — 6107), which prohibits discrimination on the basis of age.
E. Age Discrimination in Employment Act (29 CFR Part 1625).
F. Title I of the Americans with Disabilities Act (29 CFR Part 1630)
prohibiting discrimination against the disabled in employment.
G. Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities.
H. Title III of the Americans with Disabilities Act (28 CFR Part 36) regarding
access.
I. Rehabilitation Act of 1973, as amended (29 USC section 794), prohibiting
discrimination on the basis of individuals with disabilities.
J. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part 60)
regarding nondiscrimination in employment under federal contracts and construction contracts
greater than $10,000 funded by federal financial assistance.
DMC Master Agreement-Amendment 11 24
K. Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
L. The Drug Abuse Office and Treatment Act of 1972, as amended, relating
to nondiscrimination on the basis of drug abuse.
M. The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L.91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism.
49. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A. Fair Employment and Housing Act (Gov. Code section 12900 et seq.) and
the applicable regulations promulgated thereunder (Cal. Code Regs., tit. 2, Div. 4 § 7285.0 et
seq.).
B. Title 2, Division 3, Article 9.5 of the Gov. Code, commencing with Section
11135.
C. Cal. Code Regs., tit. 9, div. 4, chapter 8, commencing with §10800.
D. No state or Federal funds shall be used by the Contractor, or its
subcontractors, for sectarian worship, instruction, and/or prose lytization. No state funds shall be
used by CONTRACTOR, to provide direct, immediate, or substantial support to any religious
activity.
E. Noncompliance with the requirements of nondiscrimination in services
shall constitute grounds for state to withhold payments under this Agreement or terminate all, or
any type, of funding provided hereunder.
50. INVESTIGATIONS AND CONFIDENTIALITY OF ADMINISTRATIVE ACTIONS
If a DMC provider is under investigation by DHCS or any other state, local or
federal law enforcement agency for fraud or abuse, DHCS may temporarily suspend
CONTRACTOR from the DMC program, pursuant to W&I Code, Section 14043.36(a).
Information about CONTRACTOR's administrative sanction status is confidential until such time
as the action is either completed or resolved. The DHCS may also issue a Payment
Suspension to a provider pursuant to W&I Code, Section 14107.11 and Code of Federal
Regulations, Title 42, section 455.23. The COUNTY is to withhold payments from a DMC
provider during the time a Payment Suspension is in effect. COUNTY has executed a
Confidentiality Agreement that permits DHCS to communicate with COUNTY concerning
CONTRACTOR(S) that are subject to administrative sanctions.
51. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the State-
County Intergovernmental Agreement, the Provider Manual and the Member Handbook.
CONTRACTOR shall make the following grievance information available to all
persons served:
A. Perons Served's right to a State Fair Hearing and how to obtain a hearing
as well as representation rules.
DMC Master Agreement-Amendment 11 25
B. Person Served's right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Person Served's right to give written consent to allow CONTRACTOR or
legal representative, acting on behalf of the person served, to file an appeal.
D. Person Served may file a grievance orally or in writing to DHCS or
COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
G. Person Served's right to request continuation of benefits during an appeal
or state fair hearing filing although the person served may be liable for the cost of any continued
benefits if the action is upheld.
H. Any state determined contractor's appeal rights to challenge the failure of
the COUNTY to cover a service.
52. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall promote the delivery of services in a culturally competent
manner to all persons served, including those with limited English proficiency and diverse
cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or
gender identity. CONTRACTOR shall develop a cultural competency plan and subsequent plan
updates.
CONTRACTOR is responsible to provide culturally competent services.
CONTRACTOR's policies, procedures, and practices must be consistent with the principles
outlined and are embedded in the organizational structure, as well as being upheld in day-to-
day operations. Translation services shall be available for persons served, as needed
53. MEDICATION ASSISTED TREATMENT
DMC-ODS providers, at all levels of care, shall demonstrate that they either
directly offer or have an effective referral mechanism to the most clinically appropriate MAT
services for persons served with SUD diagnoses that are treatable with medications or
biological products (defined as facilitating access to MAT off-site for persons served if not
provided on-site. Providing individuals with the contact information for a treatment program is
insufficient). An appropriate facilitated referral to any Medi-Cal provider rendering MAT to the
person served is compliant whether or not that provider seeks reimbursement.
54. EVIDENCE BASED PRACTICES (EBP)
CONTRACTOR shall implement Motivational Interviewing and at least two EBPs
prescribed by DHCS based on the timeline established by COUNTY as outlined in the Provider
Manual, and are delivering these practices to fidelity. The two additional required EBPs may be
selected from the following: Cognitive-Behavioral Therapy, Relapse Prevention, Trauma-
Informed Treatment and Psycho-Education. Three EBPs shall be utilized per service modality.
COUNTY and DHCS will monitor the implementation and regular training of EBPs to staff during
DMC Master Agreement-Amendment 11 26
reviews. CONTRACTOR shall ensure that staff are internally monitored for training, quality of
delivery and fidelity of Evidence Based Practices.
55. MEDI-CAL ELIGIBILITY VERIFICATION
CONTRACTOR shall be responsible for verifying the Medi-Cal eligibility of each
person served for each month of service prior to billing for DMC services for that month. Medi-
Cal eligibility verification should be performed prior to rendering service, in accordance with and
as described in the DHCS DMC Provider Billing Manual. Options for verifying the eligibility of a
Medi-Cal person served are described in the DHCS DMC Provider Billing Manual available on
the Provider webpage at: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
providers/contract-providers/substance-use-disorder-providers
56. POSTSERVICE POSTPAYMENT AND POSTSERVICE PREPAYMENT (PSPP)
DHCS shall conduct Postservice Postpayment and Postservice Prepayment
(PSPP) Utilization Reviews of contracted DMC providers to determine whether the DMC
services were provided in compliance with all regulations and requirements contained in the
Intergovernmental Agreement. DHCS shall issue the PSPP report to the COUNTY with a copy
to CONTRACTOR. CONTRACTOR shall ensure any deficiencies are remediated and COUNTY
shall attest the deficiencies have been remediated. CONTRACTOR payments are subject to
recoupment when a PSPP review identifies non-compliant services.
All CONTRACTOR shall submit a COUNTY-approved corrective action plan (CAP) to DHCS
within 60 days of the date of the PSPP report. CONTRACTOR(S) that do not comply with the
CAP submittal requirements or fail to implement the approved CAP provisions within the
designated timeline are subject to payment withholding until compliance is determined.
57. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State
laws, regulations and standards. CONTRACTOR shall establish written policies and
procedures consistent with applicable Federal and State laws, regulations and standards, and
shall be held accountable for audit exceptions taken by the State or COUNTY for failure to
comply with these requirements.
These requirements include, but may not be limited to, those set forth in this
Agreement, and:
A. HSC, Division 10.5, Part 2, commencing with Section 11760;
B. California Code of Regulations (CCR), Title 9, Division 4, Chapter 8,
commencing with Section 13000;
C. Government Code Section 16367.8
D. 42, CFR, Sections 8.1 through 8.6.
E. Title 21, CFR, Sections 1301.01 through 1301.93, Department of Justice,
Controlled Substances.
F. State Administrative Manual (SAM), Chapter 7200 (General Outline of
Procedures).
DMC Master Agreement-Amendment 11 27
G. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
Amendments of 1996);
H. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards); and
CONTRACTOR shall be familiar with the above requirements and must
incorporate these requirements into written policies and procedures, as applicable.
58. PERFORMANCE REQUIREMENTS
CONTRACTOR shall ensure that in planning for the provision of services, the
following barriers to services are considered and addressed:
A. Lack of educational materials or other resources for the provision of
services.
B. Geographic isolation and transportation needs of persons seeking
services or remoteness of services.
C. Institutional, cultural, and/or ethnicity barriers.
D. Language differences.
E. Lack of service advocates.
F. Failure to survey or otherwise identify the barriers to service accessibility.
G. Needs of persons with a disability.
59. PERINATAL PRACTICE GUIDELINES
CONTRACTOR shall comply with the perinatal program requirements as outlined
in the Perinatal Practice Guidelines. The Perinatal Practice Guidelines are attached to the
Intergovernmental Agreement as Document 1G, incorporated by reference. CONTRACTOR
shall comply with the current version of these guidelines until new Perinatal Practice Guidelines
are established and adopted. The incorporation of any new Perinatal Practice Guidelines into
this Agreement shall not require a formal amendment.
60. COORDINATION AND CONTINUITY OF CARE WITH MANAGED CARE
PLANS
CONTRACTOR shall coordinate with the Managed Care Plans, Anthem and
CaIVIVA Health, when appropriate, for comprehensive physical and behavioral health screening
and collaborative treatment planning. COUNTY shall maintain MOUs with the managed care
plans to facility person served care coordination and will monitor CONTRACTORs with regard to
the effectiveness of physical health care coordination.
61. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds will be
used under the terms of this Agreement. For purposes of this section, DBH will be referred to as
the "prospective recipient".
B. This certification is required by the regulations implementing Executive
DMC Master Agreement-Amendment 11 28
Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants'
responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register
(pages 19160-19211).
1) The prospective recipient of Federal assistance funds certifies by
entering this Agreement, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this
covered transaction, unless authorized by the Federal department or agency with which this
transaction originated.
3) Where the prospective recipient of Federal assistance funds is
unable to certify to any of the statements in this certification, such prospective person served shall
attach an explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to DBH if
at any time CONTRACTOR learns that its certification in this clause of this Agreement was
erroneous when submitted or has become erroneous by reason of changed circumstances.
5) The prospective recipient further agrees that by entering into this
Agreement, it will include a clause identical to this clause of this Agreement, and titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions", in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction was
entered into.
62. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR shall comply with Public Law 103-227, also known as the Pro-
Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section
6404.5, the California Smoke-Free Workplace Law.
63. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless the State, its officers,
agents and employees from any and all claims and losses accruing or resulting to any and all
contractors, subcontractors, materialmen, laborers and any other person, firm or corporation
furnishing or supplying work, services, materials or supplies in connection with the performance
of this Agreement and from any and all claims and losses accruing or resulting to any person,
firm or corporation who may be injured or damaged by the CONTRACTOR in the performance
of this Agreement.
DMC Master Agreement-Amendment 11 29
64. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of CONTRACTOR, in the performance of
this Agreement, shall act in an independent capacity and not as officers or employees or agents
of State of California.
DMC Master Agreement-Amendment 11 30
Exhibit E1 - I
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2022-23
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential
Coordination Services Consultation Management Management 3.1 3.5
APPROVED MAXIMUM UOS RATE 51.00 53.85 51.45 52.05 153.60 153.60 39.42 164.24 185.13 188.52
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat 164.24
Bakersfield Recovery, Inc.-Capistrano 164.24
Central California Recovery 45.00 46.35 153.60 153.60 35.85
Comprehensive Addiction Programs,Inc. 43.95 153.60 153.60 145.17 138.61 151.66
Delta Care 40.50 51.45 33.00 153.60 153.60
Fresno County Hispanic Commission 43.05 153.60 153.60 111.05
Fresno New Connections 32.70 53.85 51.45 27.00 153.60 153.60
Kings View-Fresno 44.55 44.55 153.60 153.60
Mental Health Systems-FYA 39.00 38.55 37.20 153.60 153.60
Mental Health Systems-IMPACT 48.45 50.10 49.35 48.60 153.60 153.60
Mental Health Systems-Fresno First(Womens) 43.05 153.60 153.60 127.27 172.38 172.38
Mental Health Systems-Fresno First(Perinatal) 43.05 153.60 153.60 127.27 172.38 172.38
Prodigy 50.55 50.10 52.05 153.60 153.60
Promesa 48.90 46.80 49.50 153.60 153.60
Turning Point-First Street Center 36.60 35.55 36.60 153.60 153.60
Turning Point-Quest House 43.05 153.60 153.60 177.92 188.52
WestCare Outpatient-Belmont 51.00 50.70 49.65 42.75 153.60 153.60 37.20
WestCare Bakersfield Residential 40.50 153.60 153.60 163.41 120.63
WestCare Fresno Residential
Mens 35.25 153.60 153.60 164.24 156.84 163.66
Perinatal 35.25 153.601 153.601 164.24 170.78 175.84
Womens 35.25 153.601 153.601 164.24 158.83 173.87
DMC Master Agreement-Amendment II
Revised 4/11/2023 1 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 2 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 3 of 15
Exhibit E1 - I
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2023-24
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential
Coordination Services Consultation Management Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Comprehensive Addiction Programs, Inc.
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems-FYA
Mental Health Systems-IMPACT
Mental Health Systems-Fresno First Womens
Mental Health Systems-Fresno First Perinatal
Prodigy
Promesa
Recover Medical Group
Turning Point-First Street Center
Turning Point-Quest House
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
DMC Master Agreement-Amendment II
Revised 4/11/2023 4 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 5 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
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Exhibit E1 - I
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2024-25
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential
Coordination Services Consultation Management Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Comprehensive Addiction Programs, Inc.
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems-FYA
Mental Health Systems-IMPACT
Mental Health Systems-Fresno First Womens
Mental Health Systems-Fresno First Perinatal
Prodigy
Promesa
Recover Medical Group
Turning Point-First Street Center
Turning Point-Quest House
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
DMC Master Agreement-Amendment II
Revised 4/11/2023 7 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 8 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 9 of 15
Exhibit E1 - I
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2025-26
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential
Coordination Services Consultation Management Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Comprehensive Addiction Programs, Inc.
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems-FYA
Mental Health Systems-IMPACT
Mental Health Systems-Fresno First Womens
Mental Health Systems-Fresno First Perinatal
Prodigy
Promesa
Recover Medical Group
Turning Point-First Street Center
Turning Point-Quest House
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
DMC Master Agreement-Amendment II
Revised 4/11/2023 10 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 11 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 12 of 15
Exhibit E1 - I
Fresno County Department of Behavioral Health
Drug Medi-Cal Treatment Services
Approved Rates by Provider
Fiscal Year 2026-27
15-Minute Unit Day Rate
OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential
Coordination Services Consultation Management Management 3.1 3.5
APPROVED MAXIMUM UOS RATE
COUNTY APPROVED PROVIDER RATES:
Bakersfield Recovery, Inc.-Jason's Retreat
Bakersfield Recovery, Inc.-Capistrano
Central California Recover
Comprehensive Addiction Programs, Inc.
Delta Care
Fresno County Hispanic Commission
Fresno New Connections
Kings View-Fresno
Mental Health Systems-FYA
Mental Health Systems-IMPACT
Mental Health Systems-Fresno First Womens
Mental Health Systems-Fresno First Perinatal
Prodigy
Promesa
Recover Medical Group
Turning Point-First Street Center
Turning Point-Quest House
WestCare Outpatient-Belmont
WestCare Bakersfield Residential
WestCare Fresno Residential
Mens
Perinatal
Womens
DMC Master Agreement-Amendment II
Revised 4/11/2023 13 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
Revised 4/11/2023 14 of 15
Exhibit E1 - I
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DMC Master Agreement-Amendment II
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Exhibit P
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. 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 Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2) the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
DMC Master Agreement-Amendment II
1
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under the "Data
Security" clause of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to
timely disclose data breach or Security Breach; (vii) failure to comply with privacy policy;
(viii) payment card liabilities and costs; (ix) infringement of intellectual property, including
but not limited to infringement of copyright, trademark, and trade dress; (x) invasion of
privacy, including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi)funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
DMC Master Agreement-Amendment II
2
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VII.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
DMC Master Agreement-Amendment II
3
charges against any amounts owed by the County to the Contractor under this
Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
DMC Master Agreement-Amendment II
4
Exhibit Q
Data Security
1. Definitions
Capitalized terms used in this Exhibit Q have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit Q.
(C) "Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D) "Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit Q.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit Q.
DMC Master Agreement-Amendment II
Q-1
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C) The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit Q;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
DMC Master Agreement-Amendment II
Q-2
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit Q, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
DMC Master Agreement-Amendment II
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employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit Q. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
DMC Master Agreement-Amendment II
Q-4
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number: (559)600-9058, followed promptly
by email at the following email address: sholt@fresnocountyca.gov (which telephone
number and email address the County may update by providing notice to the
Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized
Person to preserve all relevant evidence) relating to the Security Breach. The notification
shall include, to the extent reasonably possible, the identification of each type and the
extent of Personal Information that has been, or is reasonably believed to have been,
breached, including but not limited to, compromised, or subjected to unauthorized Use,
Disclosure, or modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit Q, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit Q, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
DMC Master Agreement-Amendment II
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In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D) The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit Q.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit Q, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit Q.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit Q. that apply to the
Contractor with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
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Q-6
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit
Q, such certification shall state the date, time, and manner (including standard) of disposal and
by whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit Q to all such
Personal Information and copies of Personal Information. The Contractor shall not retain any
copy of any Personal Information after returning or disposing of Personal Information as
required by this section 6. The Contractor's obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractor retains if
return or disposal is not feasible and to all Personal Information that the Contractor may later
discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit Q may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee") from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions,judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit Q and the cost of pursuing any insurance
providers, arising out of or resulting from any third party claim or action against any County
Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit Q or
arising out of or resulting from the Contractor's failure to comply with any of its obligations under
this section 8. The provisions of this section 8 do not apply to the acts or omissions of the
County. The provisions of this section 8 are cumulative to any other obligation of the Contractor
to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The
provisions of this section 8 shall survive the termination of this Agreement.
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Q-7
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit Q shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit Q
is intended to confer, nor shall anything in this Exhibit Q confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
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