HomeMy WebLinkAboutAgreement A-23-159 Amendment I to NDMCO Master Agreement.pdf Agreement No. 23-159
1 AMENDMENT I TO AGREEMENT
2 THIS AMENDMENT I (hereinafter "Amendment") is dated April 11, 2023 , by and between the
3 COUNTY OF FRESNO, a Political Subdivision of the State of California, Fresno, California (hereinafter
4 "COUNTY'), and each Contractor listed in Exhibit A-1, "Non-DMC Outpatient Services Vendor List,"
5 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 22-177, effective
11 July 1, 2022 (hereinafter collectively referred to as "Agreement") wherein CONTRACTOR agreed to
12 provide adult perinatal and non-perinatal outpatient Substance Use Disorder (SUD) treatment
13 services; and
14 WHEREAS, the California Department of Health Care Services (DHCS) has issued new
15 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 Fourteen (14), is deleted in its entirety and replaced with the
22 following:
23 11
1. SERVICES
24 A. CONTRACTOR shall provide all services and fulfill all responsibilities for the
25 provision of adult outpatient SUD treatment services, as described in Exhibit B, Modality of Service
26 Descriptions, attached hereto and incorporated by this reference, at State certified locations to eligible
27 persons served of Fresno County, as identified in this Agreement, including all Exhibits incorporated
28 herein by reference and made part of this Agreement.
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1 B. CONTRACTOR shall comply with requirements stated within the SABG
2 Application as listed in Exhibit C, SABG Specific Requirements, attached hereto and by this reference
3 incorporated herein; and with all other provisions set forth in the SABG Application, made available by
4 the Department of Behavioral Health (DBH)) at the following web address and by this reference
5 incorporated herein: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
6 providers/contract-providers/substance-use-disorder-providers. CONTRACTOR is referred to therein
7 as "Subcontractor" and COUNTY is referred to therein as "Contractor."
8 C. CONTRACTOR shall comply with the Fresno County Substance Use Disorder
9 (FCSUD) Provider Manual, herein after referred to as the "Provider Manual" and by this reference
10 incorporated herein, available at the DBH website at
11 https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
12 providers/substance-use-disorder-providers. No formal amendment of this agreement is required for
13 changes to the Provider Manual to apply.
14 D. CONTRACTOR shall align program, services, and practices with the vision and
15 mission within Exhibit D, DBH Guiding Principles of Care Delivery, attached hereto and by this
16 reference incorporated herein. Contractor may be required to utilize and integrate clinical tools such as
17 Reaching Recovery at DBH's discretion. Employees involved in a crisis incident should be offered
18 appropriate Employee Assistance Program (EAP) or similar related wellness and recovery assistance.
19 In conjunction with the County DBH's Guiding Principles of Care Delivery and wellness of the
20 workforce, Contractors shall align their practices around this vision and ensure needed debriefing
21 services are offered to all employees involved in a crisis incident. Employees shall be afforded all
22 services to strengthen their recovery and wellness related to the crisis incident. Appropriate follow-up
23 with the employee shall be carried out and a plan for workforce wellness shall be submitted to the
24 County's DBH.
25 E. CONTRACTORs must complete intake for all persons served (including persons
26 served referred by Drug Court or Probation) within timeframes specified below from initial contact:
27 1) Outpatient and Intensive Outpatient within ten (10) business days;
28 2) Contractors shall comply with reporting requirements of Court or Probation
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1 relating to a persons served status change and treatment progress if an
2 appropriate Release of Information (ROI) is in place; and
3 3) Conduct persons served outpatient intake within ten (10) days from
4 referral or initial contact.
5 F. CONTRACTOR shall maintain, at CONTRACTOR's cost, a computer system
6 compatible with COUNTY's current billing and electronic health record (EHR) system for the provision
7 of submitting information required under the terms and conditions of this Agreement. CONTRACTOR
8 shall complete billing and EHR data entry as follows: initial contact, when applicable; admissions;
9 California Outcomes Measurement System (CaIOMS) reporting; American Society of Addiction
10 Medicine (ASAM) level of care reporting; discharge; and no show/missed appointments and referrals.
11 G. CONTRACTOR's staff will be required to attend regularly occurring meetings
12 such as Diversity, Equity and Inclusion Committee and All Provider Meetings and trainings on an as-
13 needed basis, which includes but is not limited to, trainings related to SUD treatment, fiscal processes,
14 cultural competency, compliance, and reporting requirements. Refer to the Annual Provider Training
15 Plan available on the provider webpage at: https://www.co.fresno.ca.us/departments/behavioral-
16 health/home/for-providers/contract-providers/substance-use-disorder-providers.
17 H. CONTRACTOR shall ensure staff, including all subcontracted staff providing or
18 administering SUD services are trained on the compliance requirements of applicable statues,
19 regulations and relevant BHINs prior to the delivery of services. CONTRACTOR shall ensure all staff
20 administering services meet California State education, training and work experience requirements set
21 forth in the Counselor Certification Regulations, Cal Code Regs, tit. 9, div. 4, chapter 8 and have
22 completed American Society of Addiction Medicine (ASAM) foundational training. Ongoing training on
23 requirements shall be completed per the Fresno County SUD Annual Training Plan available on the
24 provider webpage at: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-
25 providers/contract-providers/substance-use-disorder-providers."
26 2. That Section Two (2) of the Agreement, beginning on Page Three (3), Line Fifteen
27 (15) through Line Twenty-Four (24), is deleted in its entirety and replaced with the following:
28 "2. ADDITIONS/DELETIONS OF CONTRACTOR(S)
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1 The COUNTY reserves the right at any time during the term of this Agreement to add
2 new CONTRACTOR(S) to those listed in Revised Exhibit A, "Non-DMC Outpatient Services Vendor
3 List." It is understood that any such additions will not affect compensation paid to the other
4 CONTRACTOR(S), and therefore such additions may be made with COUNTY without notice to or
5 approval from other CONTRACTOR(S) under this Agreement. These same provisions shall apply to
6 the deletion of any CONTRACTOR listed in Revised Exhibit A, "Non-DMC Outpatient Services Vendor
7 List," except that deletions shall be made by written mutual agreement between the COUNTY and the
8 particular CONTRACTOR to be deleted or shall be in accordance with the provisions of Section Four
9 (4), TERMINATION, of this Agreement."
10 3. That Section Six (6) of the Agreement, beginning on Page Nine (9), Line Three (3) with
11 the word "A." and ending on Line Seven (7) with the word "DBH" be is deleted in its entirety and
12 replaced with the following:
13 "A. In addition to billing, CONTRACTOR(s) shall submit on a monthly basis by the
14 twenty-fifth (25th), an Operational Expense Report, per modality of service, along with a general
15 ledger, payroll register and supporting documentation for any line items selected. For the purposes of
16 verifying that costs are allowable and equitable, CONTRACTOR shall submit any additional
17 documentation as deemed necessary by DBH.
18 CONTRACTOR shall use the accrual method of accounting in preparation of all
19 financial documents, forms, and reports. Accounting must be in accordance with Generally Accepted
20 Accounting Principles."
21 4. That Section Nine (9) of the Agreement, beginning on Page Ten (10), Line Eighteen
22 (18) through Twenty-Eight (28), is deleted in its entirety and replaced with the following
23 119. PROHIBITION ON PUBLICITY
24 None of the funds, materials, property or services provided directly or indirectly under
25 this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e.,
26 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
27 Notwithstanding the above, publicity of the services described in Section One (1), SERVICES, of this
28 Agreement shall be allowed as necessary to raise public awareness about the availability of such
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1 specific services when approved in advance by the DBH Director, or his or her designee, and at a cost
2 to be provided for such items as written/printed materials, the use of media (i.e., radio, television,
3 newspapers) and any other related expense(s). Communication products must follow DBH graphic
4 standards, including typefaces and colors, to communicate our authority and project a unified brand.
5 This includes all media types and channels and all materials on and offline that are created as part of
6 DBH's efforts to provide information to the public.
7 CONTRACTOR shall notify COUNTY of any community event of which CONTRACTOR
8 is the primary organizer at least thirty (30) days in advance of said event. CONTRACTOR shall
9 disclose and supply COUNTY with all written/printed/digital materials and media used in the marketing
10 and operation of this event. CONTRACTOR shall provide all materials to COUNTY at least two weeks
11 prior to the date of the event. COUNTY reserved the right to review and approve all CONTRACTOR
12 submitted materials."
13 5. That Section Seventeen (17) of the Agreement, beginning on Page Seventeen (17),
14 Line Five (5) through Page Nineteen (19), Line Sixteen (16), is deleted in its entirety and replaced with
15 the following:
16 "17. INSURANCE
17 CONTRACTOR shall comply with all the insurance requirements in Exhibit P to this
18 Agreement. Exhibit P is attached and incorporated by this reference."
19 6. That Section Eighteen (18), of the Agreement beginning on Page Nineteen (19), Line
20 Seventeen (17) through Line Twenty-Eight (28), is deleted in its entirety and replaced with the
21 following:
22 18. HOLD HARMLESS
23 The Contractor shall indemnify and hold harmless and defend the County (including its
24 officers, agents, employees, and volunteers) against all claims, demands, injuries, damages, costs,
25 expenses (including attorney fees and costs), fines, penalties, and liabilities of any kind to the County,
26 the Contractor, or any third party that arise from or relate to the performance or failure to perform by
27 the Contractor (or any of its officers, agents, subcontractors, or employees) under this Agreement. The
28 County may conduct or participate in its own defense without affecting the Contractor's obligation to
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1 indemnify and hold harmless or defend the County. This clause survives the termination of this
2 Agreement."
3 7. That Section Twenty-One (21) of the Agreement, beginning on Page Twenty-Two (22),
4 Line Twenty (20) with the word "COUNTY" and ending on Line Twenty-Six (26) with the word
5 "immediately" be deleted in its entirety and replaced with the following:
6 "COUNTY shall recapture from CONTRACTOR the value of any services or other
7 expenditures determined to be ineligible based on the COUNTY or State monitoring results. The
8 COUNTY reserves the right to enter into a repayment agreement with CONTRACTOR, with total
9 monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to
10 recover the amount of funds to be recouped. The COUNTY has the discretion to extend the repayment
11 plan up to a total of twenty-four (24) months from the date of the repayment agreement. The
12 repayment agreement may be made with the signed written approval of COUNTY's DBH Director, or
13 his or her designee, and respective CONTRACTOR through a repayment agreement. The monthly
14 repayment amounts may be netted against the CONTRACTOR's monthly billing for services rendered
15 during the month, or the COUNTY may, in its sole discretion, forego a repayment agreement and
16 recoup all funds immediately. This remedy is not exclusive, and COUNTY may seek requital from any
17 other means, including, but not limited to, a separate contract or agreement with CONTRACTOR."
18 8. That Section Twenty-Six (26) of the Agreement, beginning on Page Twenty-Nine (29),
19 Line One (1) and ending on Page Thirty (30), Line Seventeen (17) be deleted in its entirety and
20 replaced with the following:
21 "26. DATA SECURITY
22 CONTRACTOR shall comply with all the data security requirements in Exhibit Q to this
23 Agreement. Exhibit Q is attached and incorporated by this reference."
24 9. That all references in the Agreement to "Exhibit A" shall be deemed references to
25 "Exhibit A-I", attached and incorporated by this reference.
26 10. That all references in the Agreement to "Exhibit B" shall be deemed references to
27 "Exhibit B-I", attached hereto and incorporated herein by this reference.
28
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1 11. That all references in the Agreement to "Exhibit C" shall be deemed references to
2 "Exhibit C-I", attached and incorporated by this reference.
3 12. COUNTY and CONTRACTOR agree that this Amendment is sufficient to amend the
4 Agreement and, that upon execution of this Amendment, the Agreement and this Amendment together
5 shall be considered the Agreement.
6 13. The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
7 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
8 in full force and effect.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I as of the day and
2 year first hereinabove written.
3
CONTRACTOR COUNTY OFFRESNO
4
5
6 SEE FOLLOWING SIGNATURE PAGES 941 Q i ero, hairman of the Board of
Sc4 is 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
19
20 FOR ACCOUNTING USE ONLY:
21
22 Fund: 0001
23 Subclass: 10000
24 ORG: 56302081
25 Account: 7295/0
26
27
28
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The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: CENTRAL CALIFORNIA RECOVERY, INC.
By y J�.�—
Print Name: (,J14AR-Z
Title: "I—S
Chairman of the Board, President, or Vice President
Date:
B ea"'6""
Y
Print Name: �e—
Title:
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date:
Non-DMC Outpatient Master Agreement-Amendment 1 - 9 -
The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: DELTA CARE, INC.
Print Name: fz) ,,A,
Title: c , v E i c e C-r-- o Q
Chairman of the Board, President, or Vice President
3-21-2023
Date:
By
Print Name: Y ' , v u �C 'N l ( � L'kj
Title: G
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date:
3-21.-2023
Non-DMC Outpatient Master Agreement-Amendment I
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The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: FRESNO NEW CONNECTIONS, INC.
By C�,,•�t�fL
Print Name: si, �(n ��' ��s73
Title: \\6Q(:�,G,,A
Chairman of the Board, President, or Vice President
Date: 3
By
Print Name: (5y,G�)A
Title: ����� Auv\ L,("-
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: -? / ! 7D Z;
Non-DMC Outpatient Master Agreement-Amendment
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DocuSign Envelope ID:4C7B45CE-295F-45AE-8DOD-AA1335E55EDA
The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: KINGS VIEW
rDocuSigned by:
+�.,u.,lc
By
Print Name: Amanda Nugent Divine
Title: CEO
Chairman of the Board, President, or Vice President
Date: 3/23/2023
DocuSigned by:
By
Print Name: Michael Kosareff
Title: CFO
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3/23/2023
Non-DMC Outpatient Master Agreement-Amendment I
The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: MENTAL HEALTH SYSTEMS, INC.
dba TURN Behavioral Health Services
17aWaf G CaUaahah
By Jame,C Cella,c,6an Jr(M ll 17CLG13 14:13 PDT}
Print Name:
James C Callaghan Jr
Title:
CEO President
Chairman of the Board, President, or Vice President
Date: Mar 17, 2023
By tcao•r: _..rott!Mm 20,2023 14:00 PDT;i
Print Name: tracey mcdermott
Title: CFO
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: Mar 20,2023
Non-DMC Outpatient Master Agreement-Amendment I
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The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: PROMESA BEHAVIORAL HEALTH, INC.
By
Print Name: MILIkKEl p�iZ r7ANat��i_
Title: PAES1DtrST
Chairman of the Board, President, or Vice President
Date: 3 Z r Z3
B �
Y
Print Name: 11zc� Ol MS GAS
Title: S EGA A R:i/Ti?e,*Ju 2-&P—
Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
Date: 3'1 2-1 ) 2-3
Non-DMC Outpatient Master Agreement-Amendment 1
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The parties are signing this Amendment I to Agreement No. 22-177 on the date stated in the
introductory clause.
Provider: WESTCARE CALIFORNIA, INC.
By
Print Name:'�lq -Lkk)
Title:
Chairman of the Board, President, or Vice President
Date: 03/17/2023
By
P` rint Nam
Title: e , CNc",-
Secretary (of Corporation), Assistant S�N-etary,
Chief Financial Officer, or Assistant Treasurer
Date: C)3�� cq-c)22
Non-DMC Oulpallent Master Agreement-Amendment 1
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Non-DMC Outpatient Master Agreement-Amendment 1 - 16 -
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Non-DMC Outpatient Master Agreement-Amendment 1 - 17 -
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Non-DMC Outpatient Master Agreement-Amendment 1 - 18 -
Fresno County Department of Behavioral Health Exhibit A-1
Non-DMC Outpatient Services Vendor List
Provider Maximum Annual Allocations
VENDOR CONTACT PHONE NUMBER TYPE OF BUSINESS Contract Max Contract Max Contract Max Contract Max Contract Max
FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26 FY 2026-27
Central California Recovery,Inc. President
Remitto: Dale White (559)681-1947 501(c)3 Non-Profit Corporation $120,000 $120,000 $120,000 $120,000 $120,000
2204 W.Shaw Ave.#202 (559)273-2942
Fresno,CA 93712
Delta Care Executive Director
Remit to: (559)276-7558 501(c)3 Non-Profit Corporation $200,000 $200,000 $200,000 $200,000 $200,000
4705 N.Sonora Ave.#213
Fresno,Ca 93722
Fresno New Connections,Inc. Executive Director
Remit to: Carrie Christensen (559)248-1548 501(c)3 Non-profit Corporation $200,000 $200,000 $200,000 $200,000 $200,000
4412 N.Cedar Ave.#208
Fresno,CA 93726
Kings View Chief Financial Officer
Remit to: (559)251-0100 x3011 501(c)3 Non-profit Corporation $60,000 $60,000 $60,000 $60,000 $60,000
7270 N.Financial Drive,#110
Fresno,CA 93720
Mental Health Systems,Inc. CEO
Remit to: James Callaghan (858)573-2600 501(c)3 Non-profit Corporation $25,000 $25,000 $25,000 $25,000 $25,000
9465 Farnham St. CFO
San Diego,CA 92123 Joelle Verbestel
Promesa Behavioral Health CEO
Remit to: Lisa Weigant (559)439-5437 501(c)3 Non-profit Corporation $200,000 $200,000 $200,000 $200,000 $200,000
7220 N.Marks Ave,#110
Fresno,Ca 93712
WestCare California,Inc. Chief Operating Officer
Remit to: Shawn A.Jenkins (559)251-4800 501(c)3 Non-profit Corporation $75,000 $75,000 $75,000 $75,000 $75,000
2900 N.Gateway Blvd,200
Fresno,CA 93727
$880,000 $880,000 $880,000 $880,000 $880,000
**A list of current provider sites can be found at:
https://www.co.fresno.ca.us/depa rtments/behaviora I-health/su bstance-use-disorder-services
NQn-QMC Outpatient Master Agreement-Amendment I
Revised 04/11/2023
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.
Non-DMC Outpatient Master Agreement-Amendment I
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.
Non-DMC Outpatient Master Agreement-Amendment 1 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
Non-DMC Outpatient Master Agreement-Amendment 1 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
Non-DMC Outpatient Master Agreement-Amendment 1 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:
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment 1 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
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment 1 9
SUBSTANCE ABUSE PREVENTION AND TREATMENT (SABG)
SPECIFIC REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes Substance Use Disorder
(SUD)treatment services available throughout the county to eligible persons served through funds
provided under an Substance Abuse Block Grant (SABG)with the California Department of Health
Care Services. The County, and all contracted providers, must comply with the terms of the SABG
application, and any amendments thereto, including but not limited to the following:
1. STATE ALCOHOL AND DRUG REQUIREMENTS
A. 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.
B. 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.
C. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding confidentiality, including but not
limited to confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations;
California Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and
10.6 of the California Health and Safety Code; Title 22, California Code of Regulations, section
51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
CONTRACTOR shall ensure that all of its employees sign a written
Confidentiality Oath, attached hereto as Attachment A, before they begin employment with
CONTRACTOR and shall renew said document annually thereafter. CONTRACTOR shall retain
each employee's written confidentiality oath for COUNTY and DHCS inspection for a period of six
(6) years following the termination of this agreement.
D. REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures regarding
revenue collection issued by the State under the provisions of the Health and Safety Code, Division
10.5.
E. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be used
exclusively for providing alcohol and/or drug program services, administrative costs, and allowable
Non-DMC Outpatient Master Agreement-Amendment 1 1
overhead.
F. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
G. 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.
H. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S) pursuant to
this Agreement along with related patient fees, third party payments, or other related revenues and
funds commingled with the foregoing funds are subject to audit by the State. The State may audit all
alcohol and drug program revenue and expenditures contained in this Agreement for the purpose of
establishing the basis for the subsequent year's negotiation.
I. RECORDS MAINTENANCE
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 include in any contract with an audit firm a
clause to permit access by DHCS to the working papers of the external independent auditor and
require that copies of the working papers shall be made for DHCS at its request.
2. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State laws,
regulations and standards. CONTRACTOR(S) shall establish written procedures consistent with
the Control requirements. The provisions of this Agreement are not intended to abrogate any
provisions of law or regulation existing or enacted during the term of this Agreement.
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, State
Government's Role to Alleviate Problems Related to the Inappropriate Use of Alcoholic
Beverages and Other Drug Use.
B. California Code of Regulations (CCR), Title 9, Division 4, commencing with
Chapter 1(herein referred to as Title 9).
Non-DMC Outpatient Master Agreement-Amendment 1 2
C. Government Code (GC), Title 2, Division 4, Part 2, Chapter 2, Article 1.7,
Federal Block Grant Funds.
D. GC, Title 5, Division 2, Part 1, Chapter 1, Article 7, Federally Mandated
Audits of Block Grant Funds Allocated to Local Agencies, commencing with Section 53130.
E. United State Code (USC), Title 42, Chapter 6A, Subchapter XVII, Part B,
Subpart ii, commencing with Section 300x-21, Block Grants for Prevention and Treatment of
Substance Abuse.
F. Code of Federal Regulations (CFR), Title 45, Part 75, Uniform
Administration Requirements, Cost Principles, and Audit Requirements for Federal Awards.
G. CFR, Title 45, Part 96, Block Grants.
H. CFR, Title 42, Part 2, Confidentiality of Substance Use Disorder Patient
Records.
I. Title 42, CFR, Part 8, Medication Assisted Treatment for Opioid Use
Disorders.
J. CFR, Title 21, Chapter II, Drug Enforcement Administration, Department of
Justice.
K. State Administrative Manual (SAM), Chapter 7200, General Outline of
Procedures.
3. MINIMUM QUALITY DRUG TREATMENT STANDARDS
CONTRACTOR shall comply with the Minimum Quality Drug Treatment Standards
for SABG for all SUD treatment programs. The Minimum Quality Drug Treatment Standards are
attached hereto and by this reference incorporated herein as Attachment D.
4. SALARY RESTRICTION
CONTRACTOR agrees that no part of any federal funds provided under this
Contract shall be used by CONTRACTOR to pay the salary and wages of an individual at a rate
in excess of Level II of the Executive Schedule as found online at:
https://grants.nih.gov/qrants/policy/salcap summary.htm.
Executive salaries shall be provided to COUNTY in the annual Provider Risk
Assessment and/or upon request.
SABG funds used to pay a salary in excess of the rate of basic pay for Level I of the
Executive Schedule shall be subject to disallowance. The amount disallowed shall be determined
by subtracting the individual's actual salary from the Level I rate of basic pay and multiplying the
result by the percentage of the individual's salary that was paid with SABG funds (Reference:
Terms and Conditions of the SABG award).
Note that indirect costs can only be allocated to SABG contracted services using
any of the following cost allocation methodologies; percentage of direct cost, percentage of direct
salary cost, or federally-approved indirect cost rate.
Non-DMC Outpatient Master Agreement-Amendment 1 3
5. PERINATAL PRACTICE GUIDELINES
CONTRACTOR shall comply with the perinatal program requirements as outlined in
the current version of the Perinatal Practice Guidelines available online at:
https://www.dhcs.ca.gov/individuals/Pages/Perinatal-Services.aspx
6. RESTRICTIONS ON USE OF SUBSTANCE ABUSE BLOCK GRANT (SABG)
FUNDS TO PAY FOR SERVICES REIMBURSABLE BY MEDI-CAL
CONTRACTOR shall ensure that billing SABG funds only occurs for services that are
not reimbursable by Medi-Cal. If CONTRACTOR utilizes SABG funds to pay for a service included
in the DMC-ODS, CONTRACTOR shall maintain documentation sufficient to demonstrate that Medi-
Cal reimbursement was not available. This documentation shall be provided to COUNTY at the time
of billing and retained in the person served's file for review.
7. BARRIERS TO SERVICES
CONTRACTOR shall provide services to all eligible persons in accordance with
state and federal statutes and regulations. CONTRACTOR shall assure 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 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.
8. RISK ASSESSMENT
CONTRACTOR shall comply with the sub-recipient pre-award risk assessment requirements
contained in 45 CFR 72.205. COUNTY shall review the merit and risk associated with each
potential CONTRACTOR annually prior to making an award. COUNTY shall perform and
document annual sub-recipient pre-award risk assessments for each CONTRACTOR and retain
documentation for audit purposes.
9. CALIFORNIA OUTCOMES MEASUREMENT SYSTEM FOR TREATMENT
(CALOMS-TX)
CONTRACTOR shall comply with the CalOMS-Tx data collection requirements for
submission of data to COUNTY. CONTRACTOR shall submit adimission, discharge, annual
update, resubmission of records containing errors or in need of correction, and "provider no
activity" report records in a format approved by COUNTY.
Non-DMC Outpatient Master Agreement-Amendment 1 4
10. CAPACITY REPORTING
CONTRACTOR shall ensure that if their program reaches or exceeds 90 percent of
dedicated capacity CONTRACTOR shall report this information to COUNTY and
DHCSOWPS@dhcs.ca.gov within four days of reaching capacity.
11. DRUG AND ALCOHOL TREATMENT ACCESS REPORT (DATAR)
CONTRACTOR shall submit monthly DATAR reports by the 5th of the month
following the report activity month. CONTRACTOR shall be considered compliant if a minimum of
95 percent of required DATAR reports are received by the due date.
12. CHARITABLE CHOICE
CONTRACTOR shall document the total number of referrals necessitated by
religious objection to other alternative SUD providers. CONTRACTOR may not discriminate in its
program delivery against a person served or potential person served on the basis of religion or
religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious
practice. Any specifically religious activity or service made available to individuals by the
CONTRACTOR must be voluntary as well as separate in time and location from County funded
activities and services. CONTRACTOR shall inform County as to whether it is faith-based. If
CONTRACTOR identifies as faith-based it must submit to DBH Contracts Division—Substance Use
Disorder(SUD) Services a copy of its policy on referring individuals to alternate treatment
CONTRACTOR and include a copy of this policy in its admission forms. The policy must inform
individuals that they may be referred to an alternative provider if they object to the religious nature
of the program and include a notice to SUD Services. Adherence to this policy will be monitored
during annual site reviews, and a review of person served files. If CONTRACTOR identifies as
faith-based, by July 1 of each year CONTRACTOR will be required to report to SUD Services the
number of individuals who requested referrals to alternate providers based on religious objection.
13. DRUG FREE WORKPLACE
CONTRACTOR shall comply with the requirements of the Drug-Free Work Place Act
of 1990 (California Government Code section 8350).
14. SUBCONTRACT PROVISIONS
The following contract provisions are required to be included in all agreements
verbatim by the Department of Health Care Services. Any references to "County" in the foregoing
clauses shall apply to the CONTRACTORS noted in Exhibit A of this agreement.
A. ADDITIONAL CONTRACT RESTRICTIONS
This Contract is subject to any additional restrictions, limitations, or
conditions enacted by the Congress, or any statute enacted by the Congress, which may affect the
provisions, terms, or funding of this Contract in any manner.
B. HATCH ACT
County agrees to comply with the provisions of the Hatch Act (USC, Title 5,
Part III, Subpart F., Chapter 73, Subchapter III), which limit the political activities of employees
whose principal employment activities are funded in whole or in part with federal funds.
Non-DMC Outpatient Master Agreement-Amendment 1 5
C. NO UNLAWFUL USE OR UNLAWFUL MESSAGE REGARDING DRUGS
County agrees that information produced through these funds, and which
pertains to drugs 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 (HSC, Division 10.7, Chapter 1429, Sections 11999-11999.3). By
signing this Enclosure, County agrees that it will enforce, and will require its subcontractors to
enforce, these requirements.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol
Certification, attached hereto as Attachment B, incorporated herein by reference and made part of
this Agreement, agreeing to uphold the obligations of HSC 11999 — 11999.3.
This agreement may be unilaterally terminated, without penalty, if
CONTRACTOR or a subcontractor that is a private entity is determined to have violated a
prohibition of the Unlawful Use of Drugs and Alcohol message or has an employee who is
determined by the DBH Director or her designee to have violated a prohibition of the Unlawful Use
of Drugs and Alcohol message.
D. LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION
OF CONTROLLED SUBSTANCES
None of the funds made available through this Contract 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).
E. DEBARMENT AND SUSPENSION
COUNTY shall not subcontract with or employ any party listed on the
government wide exclusions in the System for Award Management (SAM), in accordance with the
OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp. p.
189) and 12689 (3 CFR part 1989., p. 235), "Debarment and Suspension." SAM exclusions
contain the names of parties debarred, suspended, or otherwise excluded by agencies, as well as
parties declared ineligible under statutory or regulatory authority other than Executive Order
12549.
The County shall advise all subcontractors of their obligation to comply with
applicable federal debarment and suspension regulations, in addition to the requirements set forth
in 42 CFR Part 1001.
If a County subcontracts or employs an excluded party, DHCS has the right
to withhold payments, disallow costs, or issue a CAP, as appropriate, pursuant to HSC Code
11817.8(h).
F. RESTRICTION ON DISTRUBUTION OF STERILE NEEDLES
No SABG funds made available through this Contract shall be used to carry
out any program that includes the distribution of sterile needles or syringes for the hypodermic
injection of any illegal drug unless DHCS chooses to implement a demonstration syringe services
program for injecting drug users.
Non-DMC Outpatient Master Agreement-Amendment 1 6
G. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(HIPAA) OF 1996
All work performed under this Contract is subject to HIPAA, County shall
perform the work in compliance with all applicable provisions of HIPAA. As identified in Exhibit E,
DHCS and County shall cooperate to assure mutual agreement as to those transactions between
them, to which this provision applies. Refer to Exhibit E for additional information.
1. Trading Partner Requirements
a) No Changes. County hereby agrees that for the personal
health information (Information), it will not change any definition, data condition or use of a data
element or segment as proscribed in the Federal Health and Human Services (HHS) Transaction
Standard Regulation (45 CFR 162.915 (a)).
b) No Additions. County hereby agrees that for the Information,
it will not add any data elements or segments to the maximum data set as proscribed in the HHS
Transaction Standard Regulation (45 CFR 162.915 (b)).
c) No Unauthorized Uses. County hereby agrees that for the
Information, it will not use any code or data elements that either are marked "not used" in the HHS
Transaction's Implementation specification or are not in the HHS Transaction Standard's
implementation specifications (45 CFR 162.915 (c)).
d) No Changes to Meaning or Intent. County hereby agrees that
for the Information, it will not change the meaning or intent of any of the HHS Transaction
Standard's implementation specification (45 CFR 162.915 (d)).
2. Concurrence for Test Modifications to HHS Transaction Standards
County 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, County agrees that it will participate in such test modifications.
3. Adequate Testing
County is responsible to adequately test all business rules
appropriate to their types and specialties. If the County is acting as a clearinghouse for enrolled
providers, County has obligations to adequately test all business rules appropriate to each and
every provider type and specialty for which they provide clearinghouse services.
4. Deficiencies
County agrees to correct transactions, errors, or deficiencies
identified by DHCS, and transactions errors or deficiencies identified by an enrolled provider if the
County is acting as a clearinghouse for that provider. When County is a clearinghouse, County
agrees to properly communicate deficiencies and other pertinent information regarding electronic
transactions to enrolled providers for which they provide clearinghouse services.
5. Code Set Retention
Non-DMC Outpatient Master Agreement-Amendment 1
Both parties understand and agree to keep open code sets being
processed or used in this Contract for at least the current billing period or any appeal period,
whichever is longer.
6. Data Transmission Log
Both parties 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 Contract. Each party will 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 it is necessary to
do so, the information contained in the Data Transmission Log may be retrieved in a timely
manner and presented in readable form.
H. NONDISCRIMINATION AND INSTITUTIONAL SAFEGUARDS FOR
RELIGIOUS PROVIDERS
County shall establish such processes and procedures as necessary to
comply with the provisions of USC, Title 42, Section 300x-65 and CFR, Title 42, Part 54.
These regulations prohibit discrimination against nongovernmental
organizations and certain individuals on the basis of religion in the distribution of government
funds to provide substance abuse services and to allow the organizations to accept the funds to
provide the services to the individuals without impairing the religious character of the organizations
or the religious freedom of the individuals.
I. COUNSELOR CERTIFICATION
Any counselor or registrant providing intake, assessment of need for
services, treatment or recovery planning, individual or group counseling to participants, patients, or
residents in a DHCS licensed or certified program is required to be registered or certified as
defined in CCR, Title 9, Division 4, Chapter 8.
J. CULTURAL AND LINGUISTIC PROFICIENCY
To ensure equal access to quality care by diverse populations, each service
provider receiving funds from this Contract shall adopt the Federal Office of Minority Health
Culturally and Linguistically Appropriate Service (CLAS) national standards as outlined online at:
htti)s://minoritvhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53https://thinkcuIturalhealth.hhs.gov/c
las/standards
CONTRACTOR must comply with 42 CFR 438.206(c)(2). 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
provide effective, equitable, understandable and respectful quality of care and services that are
responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and
other communication needs.
K. INTRAVENOUS DRUG USE (IVDU) TREATMENT
Non-DMC Outpatient Master Agreement-Amendment 1 8
County shall ensure that individuals in need of IVDU treatment shall be
encouraged to undergo AOD treatment (42 USC 300x-23 (45 CFR 96.126(e)).
L. TUBERCULOSIS TREATMENT
County shall ensure the following related to Tuberculosis (TB):
1. Routinely make available TB services to individuals receiving
treatment.
2. Reduce barriers to patients' accepting TB treatment.
3. Develop strategies to improve follow-up monitoring, particularly after
patients leave treatment, by disseminating information through educational bulletins and technical
assistance.
M. TRAFFICKING VICTIMS PROTECTION ACT OF 2000
County and its subcontractors that provide services covered by this Contract
shall comply with the Trafficking Victims Protection Act of 2000 (USC, Title 22, Chapter 78,
Section 7104) as amended by section 1702 of Pub. L. 112-239.
CONTRACTOR, CONTRACTOR's employees, subrecipients, and subrecipients' employees may
not:
1. Engage in severe forms of trafficking in persons during the period of
time that the award is in effect;
2. Procure a commercial sex act during the period of time that the
award is in effect; or
3. 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 (Nonprocurement).
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 C,
incorporated herein by reference and made part of this Agreement and must require all
employees to complete annual TVPA training.
N. TRIBAL COMMUNITIES AND ORGANIZATIONS
Non-DMC Outpatient Master Agreement-Amendment 1 9
County shall regularly review population information available through
Census, compare to information obtained in the California Outcome Measurement System for
Treatment (CalOMS-Tx) to determine whether the population is being reached, and survey Tribal
representatives for insight in potential barriers to the substance use service needs of the American
Indian/Alaskan Native (AI/AN) population within the County geographic area. Contractor shall also
engage in regular and meaningful consultation and collaboration with elected officials of the tribe,
Rancheria, or their designee for the purpose of identifying issues/barriers to service delivery and
improvement of the quality, effectiveness, and accessibility of services available to AI/AN
communities within the County.
O. MARIJUANA RESTRICTION
Grant funds may not be used, directly or indirectly, to purchase, prescribe,
or provide marijuana or treatment using marijuana. Treatment in this context includes the
treatment of opioid use disorder. Grant funds also cannot be provided to any individual who or
organization that provides or permits marijuana use for the purposes of treating substance use or
mental disorders. See, e.g., 45 CFR. § 75.300(a) (requiring HHS to "ensure that Federal funding is
expended . . . in full accordance with U.S. statutory . . . requirements."); 21 USC § 812(c) (10) and
841 (prohibiting the possession, manufacture, sale, purchase or distribution of marijuana). This
prohibition does not apply to those providing such treatment in the context of clinical research
permitted by the DEA and under an FDA-approved investigational new drug application where the
article being evaluated is marijuana or a constituent thereof that is otherwise a banned controlled
substance under Federal law.
P. PARTICIPATION OF COUNTY BEHAVIORAL HEALTH DIRECTOR'S
ASSOCIATION OF CALIFORNIA
The County AOD Program Administrator shall participate and represent the
County in meetings of the County Behavioral Health Director's Association of California for the
purposes of representing the counties in their relationship with DHCS with respect to policies,
standards, and administration for AOD abuse services.
The County AOD Program Administrator shall attend any special meetings
called by the Director of DHCS. Participation and representation shall also be provided by the
County Behavioral Health Director's Association of California.
Q. ADOLESCENT BEST PRACTICES GUIDELINES
County must utilize DHCS guidelines in developing and implementing youth
treatment programs funded under this Enclosure The Adolescent Best Practices Guidelines can
be found at:
https://www.dhcs.ca.gov/Documents/CSD CMHCS/Adol%20Best%2OPractices%2OGuide/AdolBe
stPracGuideOCTOBER2020.pdf
R. BYRD ANTI-LOBBYING AMENDMENT (31 USC 1352)
County certifies that it will not and has not used Federal appropriated funds
to pay any person or organization for influencing or attempting to influence an officer or employee
of any agency, a member of Congress, officer or employee of Congress, or an employee of a
member of Congress in connection with obtaining any Federal contract, grant or any other award
Non-DMC Outpatient Master Agreement-Amendment 1 10
covered by 31 USC 1352. County shall also disclose to DHCS any lobbying with non-Federal
funds that takes place in connection with obtaining any Federal award.
S. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
County certifies that under the laws of the United States and the State of
California, County will not unlawfully discriminate against any person.
T. FEDERAL LAW REQUIREMENTS
1. 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.
2. 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.
3. Age Discrimination Act of 1975 (45 CFR Part 90), as amended 42
USC Sections 6101 6107), which prohibits discrimination on the basis of age.
4. Age Discrimination in Employment Act (29 CFR Part 1625).
5. Title I of the Americans with Disabilities Act (29 CFR Part 1630)
prohibiting discrimination against the disabled in employment.
6. Title II of the Americans with Disabilities Act (28 CFR Part 35)
prohibiting discrimination against the disabled by public entities.
7. Title III of the Americans with Disabilities Act (28 CFR Part 36)
regarding access.
8. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC
Section 794), prohibiting discrimination on the basis of individuals with disabilities.
9. 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.
10. Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
11. The Drug Abuse Office and Treatment Act of 1972, as amended,
relating to nondiscrimination on the basis of drug abuse.
12. Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR
Part 2, Subparts A— E)
U. STATE LAW REQUIREMENTS
1. Fair Employment and Housing Act (Government Code Section
12900 et seq.) and the applicable regulations promulgated thereunder (2 CCR 7285.0 et seq.).
2. Title 2, Division 3, Article 9.5 of the Government Code, commencing
with Section 11135.
Non-DMC Outpatient Master Agreement-Amendment I 11
3. Title 9, Division 4, Chapter 8 of the CCR, commencing with Section
13000.
4. No federal funds shall be used by the County or its subcontractors
for sectarian worship, instruction, or prose lytization. No federal funds shall be used by the County
or its subcontractors to provide direct, immediate, or substantial support to any religious activity.
V. ADDITIONAL CONTRACT RESTRICTIONS
1. Noncompliance with the requirements of nondiscrimination in
services shall constitute grounds for DHCS to withhold payments under this Contract or terminate
all, or any type, of funding provided hereunder.
2. This Contract is subject to any additional restrictions, limitations, or
conditions enacted by the federal or state governments that affect the provisions, terms, or funding
of this Contract in any manner.
W. INFORMATION ACCESS FOR INDIVIDUALS WITH LIMITED ENGLISH
PROFICIENCY
1. County shall comply with all applicable provisions of the Dymally-
Alatorre Bilingual Services Act (Government Code sections 7290-7299.8) regarding access to
materials that explain services available to the public as well as providing language interpretation
services.
2. County shall comply with the applicable provisions of Section 1557
of the Affordable Care Act (45 CFR Part 92), including, but not limited to, 45 CFR 92.201, when
providing access to: (a) materials explaining services available to the public, (b) language
assistance, (c) language interpreter and translation services, or (d) video remote language
interpreting services.
15. FEDERAL DEBARMENT AND SUSUPENSTION CERTIFICATION
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
Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants'
responsibilities. The regulations were published as Part VI 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
Non-DMC Outpatient Master Agreement-Amendment 1 12
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.
C. CONTRACTOR shall not employ or subcontract with any party listed in the
government wide exclusions in the System for Award Management (SAM) in accordance with the
OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp. p.
189) and 12689 (3 CFR part 1989., p. 235), "Debarment and Suspension." SAM exclusions
contain the names of parties debarred, suspended, or otherwise excluded by agencies, as well as
parties declared ineligible under statutory or regulatory authority other than Executive Order
12549. If CONTRACTOR employs or subcontracts an excluded party, DHCS has the right to
withhold payments, disallow costs, or issue a CAP, as appropriate, pursuant to HSC Code
11817.8(h).
D. If CONTRACTOR subcontracts or employs an excluded party, COUNTY
and DHCS have the right to withhold payments, disallow costs, or issue a CAP, as appropriate,
pursuant to HSC Code 11817.8(h).
1) By signing this Agreement, the Contractor/Grantee agrees to comply
with applicable federal suspension and debarment regulations including, but not limited to 2 CFR
180, 2 CFR 376
2) By signing this Agreement, the Contractor certifies to the best of its
knowledge and belief, that it and its principals:
(a) Are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded by any federal department or agency;
(b) Have not within a three-year period preceding this
application/proposal/agreement been convicted of or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) violation of Federal or State antitrust statutes; or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making
false statements, tax evasion, receiving stolen property, making false claims, obstruction of justice,
or the commission of any other offense indicating a lack of business integrity or business honesty
Non-DMC Outpatient Master Agreement-Amendment 1 13
that seriously affects its business honesty;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with commission of any of the offenses
enumerated in Paragraph b(2) herein; and
(d) Have not within a three-year period preceding this
application/proposal/agreement had one or more public transactions (Federal, State or local)
terminated for cause or default.
(e) Have not, within a three-year period preceding this
application/proposal/agreement, engaged in any of the violations listed under 2 CFR Part 180,
Subpart C as supplemented by 2 CFR Part 376.
(f) Shall not knowingly enter into any lower tier covered
transaction with a person who is proposed for debarment under federal regulations (i.e., 48 CFR
part 9, subpart 9.4), debarred, suspended, declared ineligible, or voluntarily excluded from
participation in such transaction, unless authorized by the State.
(g) Will include a clause entitled, "Debarment and Suspension
Certification" that essentially sets forth the provisions herein, in all lower tier covered transactions
and in all solicitations for lower tier covered transactions.
E. If the Contractor is unable to certify to any of the statements in this
certification, the Contractor shall submit an explanation to the DBH Program Contract Manager.
F. The terms and definitions herein have the meanings set out in 2 CFR Part
180 as supplemented by 2 CFR Part 376.
G. If the Contractor knowingly violates this certification, in addition to other
remedies available to the Federal Government, the DBH may terminate this Agreement for cause
or default.
16. SMOKING-FREE WORKPLACE CERTIFICATION
(Applicable to federally funded agreements and subcontracts, that provide health,
day care, early childhood development services, education or library services to children under 18
directly or through local governments.)
A. Public Law 103-227, also known as the Pro-Children Act of 1994 (Act),
requires that smoking not be permitted in any portion of any indoor facility owned or leased or
contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of
18, if the services are funded by federal programs either directly or through state or local
governments, by federal grant, contract, loan, or loan guarantee. The law also applies to children's
services that are provided in indoor facilities that are constructed, operated, or maintained with
such federal funds. The law does not apply to children's services provided in private residences;
portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole
source of applicable federal funds is Medicare or Medicaid; or facilities where WIC coupons are
redeemed.
B. Failure to comply with the provisions of the law may result in the imposition
of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an
Non-DMC Outpatient Master Agreement-Amendment 1 14
administrative compliance order on the responsible party.
C. By signing this Agreement, Contractor certifies that it will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used for
the provision of services for children as defined by the Act. The prohibitions herein are effective
December 26, 1994.
D. Contractor further agrees that it will insert this certification into any
subawards entered into that provide for children's services as described in the Act.
17. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable accommodations, and
accessible equipment for persons served with physical or mental disabilities are provided to all
persons served in accordance with CFR Title 45, Part 84 and the American with Disabilities Act.
18. INTERIM SERVICES
CONTRACTOR must adhere to the State-County Contract requirement to provide
Interim Services in the event that an individual must wait to be placed in treatment.
Interim Substance Abuse Services means services that are provided until an
individual is admitted to a substance abuse treatment program. The purposes of the services are to
reduce the adverse health effects of such abuse, promote the health of the individual, and reduce
the risk of transmission of disease. At a minimum, interim services include counseling and education
about HIV and tuberculosis (TB), about the risks of needle-sharing, the risks of transmission to
sexual partners and infants, and about steps that can be taken to ensure the HIV and TB
transmission does not occur, as well as referral for HIV or TB treatment services if necessary. For
pregnant women, interim services also include counseling on the effects of alcohol and drug use on
the fetus, as well as referral for prenatal care.
Records must indicate evidence that Interim Services have been provided and
documentation will be reviewed for compliance.
Non-DMC Outpatient Master Agreement-Amendment 1 15
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,
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment 1 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
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment 1 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.
Non-DMC Outpatient Master Agreement-Amendment I
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
Non-DMC Outpatient Master Agreement-Amendment I 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)
Non-DMC Outpatient Master Agreement-Amendment I Q-3
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
Non-DMC Outpatient Master Agreement-Amendment I 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.
Non-DMC Outpatient Master Agreement-Amendment I Q-5
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.
Non-DMC Outpatient Master Agreement-Amendment I 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.
Non-DMC Outpatient Master Agreement-Amendment I 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.
Non-DMC Outpatient Master Agreement-Amendment I Q_g