HomeMy WebLinkAboutAgreement A-23-316 Master Agreement.pdf Agreement No. 23-316
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between
3 each School District listed in Exhibit B, political subdivisions of the State of California ("School
4 Districts"), and the County of Fresno, a political subdivision of the State of California ("County").
5 Recitals
6 The existing partnership between County and various School Districts in Fresno County
7 has increased access to mental health services for students on school sites. The County of
8 Fresno, on behalf of the Department of Behavioral Health (DBH), recognizes the need to
9 provide County DBH staff and contracted provider staff access to school districts to serve
10 children and youth in the metropolitan (metro) and rural areas who are enrolled in Kindergarten
11 through High School. County and contracted provider staff will provide children's mental health
12 services. Children and youth with Serious Emotional Disturbance (SED) who also experience
13 co-occurring mental health and alcohol abuse and/or discipline issues will be included among
14 those served.
15 The parties therefore agree as follows:
16 Article 1
17 School District's Services
18 1.1 Inter-Agency Agreement Purpose and Intent. The School Districts shall perform
19 all of the services provided in Exhibit A to this Agreement, titled "Scope of Work".
20 1.2 The School Districts agree that mental health services provided by County and its
21 contracted providers, under this Agreement are not intended to serve Special Education
22 Students determined to be "Emotional Disturbed" as defined by the individuals with Disability
23 Act who have an IEP, and that County is not providing these mental health services as a
24 contractor of School District. School Districts shall be solely responsible for the mental health
25 treatment requirements of the IEP.
26 1.3 Representation. The School Districts represent that they are qualified, ready,
27 willing, and able to perform all of the services provided in this Agreement.
28
1
1 1.4 Compliance with Laws. The School Districts shall, at its own cost, comply with all
2 applicable federal, state, and local laws and regulations in the performance of its obligations
3 under this Agreement, including but not limited to workers compensation, labor, and
4 confidentiality laws and regulations.
5 1.5 Definitions.
6 (A) For purposes of this agreement, the parties agree that the definitions set forth at
7 California Code of regulations (CCR) Title 9, Division 1, Ch. 1, Article 1, §1810.100 and
8 §1810.247 shall govern the meaning of all Terms utilized in this agreement.
9 (B) "Children's mental health services" shall be defined as outpatient mental health
10 services, case management, crisis intervention, de-escalation, and rehabilitative
11 services. This includes individual, group, and family therapy.
12 (C) "Pupils" served refers to all children with mental health needs who are eligible or
13 are receiving children's mental health services from or through County at schools within
14 the jurisdictional boundaries. However, this shall not include pupils as defined in CCR
15 Title 2, Division 9, Chapter 1, Article 1, §60010 and §60020 for which mental health
16 services are required to be provided or arranged by the school as a service component
17 of a pupils Individualized Education Program (IEP).
18 (D) "Medically necessary mental health services" refer to the criteria in accordance
19 with CCR, Title 9, Division 1, Chapter 11, Article 2, §1830.205.
20 Article 2
21 County's Responsibilities
22 2.1 The County shall work collaboratively with the School District staff to assign County
23 DBH staff and contracted providers to provide mental health services to students at the
24 designated school sites.
25 2.2 County shall also participate in meeting with the School Districts, as needed, to
26 discuss progress, access, and/or other supportive services.
27
28
2
1 Article 3
2 Compensation
3 3.1 The County and the School Districts agree under this Agreement as described in this
4 section, that the services of this agreement shall be performed without compensation or
5 payment of any monetary consideration by any of the parties.
6 Article 4
7 Term of Agreement
8 4.1 Term. This Agreement is effective on July 1, 2023 and terminates on June 30,
9 2026except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
10 below.
11 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
12 year periods only upon written approval of both parties at least 30 days before the first day of
13 the next one-year extension period. The County's DBH Director or his or her designee is
14 authorized to sign the written approval on behalf of the County based on the School Districts
15 satisfactory performance. The extension of this Agreement by the County is not a waiver or
16 compromise of any default or breach of this Agreement by the School Districts existing at the
17 time of the extension whether or not known to the County.
18 Article 5
19 Notices
20 5.1 Contact Information. The persons and their addresses having authority to give and
21 receive notices provided for or permitted under this Agreement include the following:
22
For the County:
23 Director
County of Fresno
24 1925 E. Dakota Ave
Fresno, CA 93726
25
For the School Districts:
26 See Exhibit B
27 5.2 Change of Contact Information. Either party may change the information in section
28 5.1 by giving notice as provided in section 5.3.
3
1 5.3 Method of Delivery. Each notice between the County and the School District
2 provided for or permitted under this Agreement must be in writing, state that it is a notice
3 provided under this Agreement, and be delivered either by personal service, by first-class
4 United States mail, by an overnight commercial courier service, by telephonic facsimile
5 transmission, or by Portable Document Format (PDF) document attached to an email.
6 (A) A notice delivered by personal service is effective upon service to the recipient.
7 (B) A notice delivered by first-class United States mail is effective three County
8 business days after deposit in the United States mail, postage prepaid, addressed to the
9 recipient.
10 (C)A notice delivered by an overnight commercial courier service is effective one
11 County business day after deposit with the overnight commercial courier service,
12 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
13 the recipient.
14 (D)A notice delivered by telephonic facsimile transmission or by PDF document
15 attached to an email is effective when transmission to the recipient is completed (but, if
16 such transmission is completed outside of County business hours, then such delivery is
17 deemed to be effective at the next beginning of a County business day), provided that
18 the sender maintains a machine record of the completed transmission.
19 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
20 nothing in this Agreement establishes, waives, or modifies any claims presentation
21 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
22 of Title 1 of the Government Code, beginning with section 810).
23 Article 6
24 Termination and Suspension
25 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
26 contingent on the approval of funds by the appropriating government agency. If sufficient funds
27 are not allocated, then the County, upon at least 30 days' advance written notice to the School
28 District, may:
4
1 (A) Modify the services provided by the School District under this Agreement; or
2 (B) Terminate this Agreement.
3 6.2 Termination for Breach.
4 (A) Upon determining that a breach (as defined in paragraph (C) below) has
5 occurred, the County may give written notice of the breach to the School District. The
6 written notice may suspend performance under this Agreement, and must provide at
7 least 30 days for the School District to cure the breach.
8 (B) If the School District fails to cure the breach to the County's satisfaction within
9 the time stated in the written notice, the County may terminate this Agreement
10 immediately.
11 (C) For purposes of this section, a breach occurs when, in the determination of the
12 County, the School District has:
13 (1) Obtained or used funds illegally or improperly;
14 (2) Failed to comply with any part of this Agreement;
15 (3) Submitted a substantially incorrect or incomplete report to the County; or
16 (4) Improperly performed any of its obligations under this Agreement.
17 6.3 Termination without Cause. In circumstances other than those set forth above,
18 either Party may terminate this Agreement by giving at least 30 days advance written notice to
19 the other Party.
20 6.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
21 under this Article 6 is without penalty to or further obligation of the County.
22 Article 7
23 Independent Contractor
24 7.1 Status. In performing under this Agreement, the School Districts, including its
25 officers, agents, employees, and volunteers, is at all times acting and performing as an
26 independent contractor, in an independent capacity, and not as an officer, agent, servant,
27 employee, joint venturer, partner, or associate of the County.
28
5
1 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
2 manner or method of the School District's performance under this Agreement, but the County
3 may verify that the School District is performing according to the terms of this Agreement.
4 7.3 Benefits. Because of its status as an independent contractor, the School District has
5 no right to employment rights or benefits available to County employees. The School District is
6 solely responsible for providing to its own employees all employee benefits required by law. The
7 School District shall save the County harmless from all matters relating to the payment of
8 School District's employees, including compliance with Social Security withholding and all
9 related regulations.
10 7.4 Services to Others. The parties acknowledge that, during the term of this
11 Agreement, the School Districts may provide services to others unrelated to the County.
12 Article 8
13 Indemnity and Defense
14 8.1 Indemnity. The School Districts shall indemnify and hold harmless and defend the
15 County (including its officers, agents, employees, and volunteers) against all claims, demands,
16 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
17 liabilities of any kind to the County, the School District, or any third party that arise from or relate
18 to the performance or failure to perform by the School District (or any of its officers, agents,
19 subcontractors, or employees) under this Agreement. The County may conduct or participate in
20 its own defense without affecting the School District's obligation to indemnify and hold harmless
21 or defend the County.
22 8.2 Survival. This Article 8 survives the termination of this Agreement.
23 Article 9
24 Insurance
25 9.1 The School Districts shall comply with all the insurance requirements in Exhibit D to
26 this Agreement.
27
28
6
1 Article 10
2 Inspections, Audits, and Public Records
3 10.1 Inspection of Documents. The School Districts shall make available to the County,
4 and the County may examine at any time during business hours and as often as the County
5 deems necessary, all of the School Districts records and data with respect to the matters
6 covered by this Agreement, excluding attorney-client privileged communications. The School
7 District shall, upon request by the County, permit the County to audit and inspect all of such
8 records and data to ensure the School Districts compliance with the terms of this Agreement.
9 10.2 Public Records. The County is not limited in any manner with respect to its public
10 disclosure of this Agreement or any record or data that the School Districts may provide to the
11 County. The County's public disclosure of this Agreement or any record or data that the School
12 Districts may provide to the County may include but is not limited to the following:
13 (A) The County may voluntarily, or upon request by any member of the public or
14 governmental agency, disclose this Agreement to the public or such governmental
15 agency.
16 (B) The County may voluntarily, or upon request by any member of the public or
17 governmental agency, disclose to the public or such governmental agency any record or
18 data that the School District may provide to the County, unless such disclosure is
19 prohibited by court order.
20 (C)This Agreement, and any record or data that the School District may provide to
21 the County, is subject to public disclosure under the Ralph M. Brown Act (California
22 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
23 (D)This Agreement, and any record or data that the School District may provide to
24 the County, is subject to public disclosure as a public record under the California Public
25 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
26 with section 6250) ("CPRA").
27 (E) This Agreement, and any record or data that the School District may provide to
28 the County, is subject to public disclosure as information concerning the conduct of the
7
1 people's business of the State of California under California Constitution, Article 1,
2 section 3, subdivision (b).
3 (F) Any marking of confidentiality or restricted access upon or otherwise made with
4 respect to any record or data that the School District may provide to the County shall be
5 disregarded and have no effect on the County's right or duty to disclose to the public or
6 governmental agency any such record or data.
7 10.3 Public Records Act Requests. If the County receives a written or oral request
8 under the CPRA to publicly disclose any record that is in the School District's possession or
9 control, and which the County has a right, under any provision of this Agreement or applicable
10 law, to possess or control, then the County may demand, in writing, that the School Districts
11 deliver to the County, for purposes of public disclosure, the requested records that may be in
12 the possession or control of the School District. Within five (5) business days after the County's
13 demand, the School District shall (a) deliver to the County all of the requested records that are
14 in the School District's possession or control, together with a written statement that the School
15 District, after conducting a diligent search, has produced all requested records that are in the
16 School District's possession or control, or (b) provide to the County a written statement that the
17 School District, after conducting a diligent search, does not possess or control any of the
18 requested records. The School Districts shall cooperate with the County with respect to any
19 County demand for such records. If the School District wishes to assert that any specific record
20 or data is exempt from disclosure under the CPRA or other applicable law, it must deliver the
21 record or data to the County and assert the exemption by citation to specific legal authority
22 within the written statement that it provides to the County under this section. The School
23 District's assertion of any exemption from disclosure is not binding on the County, but the
24 County will give at least 10 days' advance written notice to the School District before disclosing
25 any record subject to the School District's assertion of exemption from disclosure. The School
26 District shall indemnify the County for any court-ordered award of costs or attorney's fees under
27 the CPRA that results from the School District's delay, claim of exemption, failure to produce
28
8
1 any such records, or failure to cooperate with the County with respect to any County demand for
2 any such records.
3 Article 11
4 Disclosure of Self-Dealing Transactions
5 11.1 Applicability. This Article 11 applies if the School District is operating as a
6 corporation, or changes its status to operate as a corporation.
7 11.2 Duty to Disclose. If any member of the School District's board of directors is party to
8 a self-dealing transaction, he or she shall disclose the transaction by completing and signing a
9 "Self-Dealing Transaction Disclosure Form" (Exhibit C to this Agreement) and submitting it to
10 the County before commencing the transaction or immediately after.
11 11.3 Definition. "Self-dealing transaction" means a transaction to which the School
12 District is a party and in which one or more of its directors, as an individual, has a material
13 financial interest.
14 Article 12
15 Complaints
16 12.1 Documentation. School Districts shall log complaints and the disposition of all
17 complaints from a client or a client's family. School Districts shall provide a copy of the detailed
18 complaint log entries concerning County-sponsored clients to County at monthly intervals by the
19 tenth (10th) day of the following month, in a format that is mutually agreed upon. Besides the
20 detailed complaint log, School Districts shall provide details and attach documentation of each
21 complaint with the log. School Districts shall notify County of all incidents reportable to state
22 licensing bodies that affect County clients within twenty-four (24) hours of receipt of a complaint.
23 Within ten (10) days after each incident or complaint affecting County clients, School Districts
24 shall provide County with information relevant to the complaint, investigative details of the
25 complaint, the complaint and School District's disposition of, or corrective action taken to resolve
26 the complaint.
27 12.2 Incident Reporting. School Districts shall file an incident report for all incidents
28 involving clients, following the protocol identified in Exhibit G.
9
1 Article 13
2 Federal and State Laws
3 13.1 Health Insurance Portability and Accountability Act. The School Districts shall
4 comply with the Business Associate Agreement requirements in Exhibit E.
5 13.2 Child Abuse Reporting Act. School Districts shall establish a procedure acceptable
6 to the County's DBH Director, or his or her designee, to ensure that all of the School Districts
7 employees, consultants, subcontractors, or agents described in the Child Abuse Reporting Act,
8 section 1116 et seq. of the Penal Code, and performing services under this Agreement shall
9 report all known or suspected child abuse or neglect to a child protective agency as defined in
10 Penal Code section 11165.9. This procedure shall include:
11 (A) A requirement that all School District employees, consultants, subcontractors, or
12 agents performing services shall sign a statement that he or she knows of and will
13 comply with the reporting requirements as defined in Penal Code section 11166(a).
14 (B) Establishing procedures to ensure reporting even when employees, consultants,
15 subcontractors, or agents who are not required to report child abuse under Penal Code
16 section 11166(a), gain knowledge of or reasonably suspect that a child has been a
17 victim of abuse or neglect.
18 13.3 Compliance with State Requirements. School District recognize that County
19 operate its mental health programs under an agreement with the State of California Department
20 of Health Care Services, and that under said agreement the State imposes certain requirements
21 on County and School Districts. School Districts shall adhere to all State Requirements,
22 including those identified in Exhibit F to this Agreement, titled "Behavioral Health
23 Requirements."
24 Article 14
25 General Terms
26 14.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
27 Agreement may not be modified, and no waiver is effective, except by written agreement signed
28
10
1 by both parties. The School Districts acknowledge that County employees have no authority to
2 modify this Agreement except as expressly provided in this Agreement.
3 14.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
4 under this Agreement without the prior written consent of the other party.
5 14.3 Governing Law. The laws of the State of California govern all matters arising from
6 or related to this Agreement.
7 14.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
8 County, California. School Districts consent to California jurisdiction for actions arising from or
9 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
10 brought and maintained in Fresno County.
11 14.5 Construction. The final form of this Agreement is the result of the parties' combined
12 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
13 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
14 against either party.
15 14.6 Days. Unless otherwise specified, "days" means calendar days.
16 14.7 Headings. The headings and section titles in this Agreement are for convenience
17 only and are not part of this Agreement.
18 14.8 Severability. If anything in this Agreement is found by a court of competent
19 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
20 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
21 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
22 intent.
23 14.9 Nondiscrimination. During the performance of this Agreement, the School District
24 shall not unlawfully discriminate against any employee or applicant for employment, or recipient
25 of services, because of race, religious creed, color, national origin, ancestry, physical disability,
26 mental disability, medical condition, genetic information, marital status, sex, gender, gender
27 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
28 all applicable State of California and federal statutes and regulation.
11
1 14.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
2 of the School District under this Agreement on any one or more occasions is not a waiver of
3 performance of any continuing or other obligation of the School District and does not prohibit
4 enforcement by the County of any obligation on any other occasion.
5 14.11 Separate Agreement. It is mutually understood by the parties that this Agreement
6 does not, in any way, create a joint venture among School Districts. By execution of this
7 Agreement, School Districts understand that a separate Agreement is formed between each
8 individual School District and County.
9 14.12 Addition/Deletion of Providers. The County reserves the right at any time during
10 the term of this Agreement to add School Districts to and remove School Districts from the list
11 contained on Exhibit B. It is understood that any such additions and removals will not affect the
12 other School Districts, and therefore such additions and removals may be made by County
13 without notice or approval of other School Districts under this Agreement. The County's DBH
14 Director, or designee, may remove a School District from the agreement where there is mutual
15 written consent between the DBH Director and School District.
16 14.13 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
17 between the School Districts and the County with respect to the subject matter of this
18 Agreement, and it supersedes all previous negotiations, proposals, commitments, writings,
19 advertisements, publications, and understandings of any nature unless those things are
20 expressly included in this Agreement. If there is any inconsistency between the terms of this
21 Agreement without its exhibits and the terms of the exhibits, then the inconsistency will be
22 resolved by giving precedence first to the terms of this Agreement without its exhibits, and then
23 to the terms of the exhibits.
24 14.14 No Third-Party Beneficiaries. This Agreement does not and is not intended to
25 create any rights or obligations for any person or entity except for the parties.
26 14.15 Authorized Signature. The School District represents and warrants to the County
27 that:
28
12
1 (A) The School District is duly authorized and empowered to sign and perform its
2 obligations under this Agreement.
3 (B) The individual signing this Agreement on behalf of the School District is duly
4 authorized to do so and his or her signature on this Agreement legally binds the School
5 District to the terms of this Agreement.
6 14.16 Electronic Signatures. The parties agree that this Agreement may be executed by
7 electronic signature as provided in this section.
8 (A) An "electronic signature" means any symbol or process intended by an individual
9 signing this Agreement to represent their signature, including but not limited to (1) a
10 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
11 electronically scanned and transmitted (for example by PDF document) version of an
12 original handwritten signature.
13 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
14 equivalent to a valid original handwritten signature of the person signing this Agreement
15 for all purposes, including but not limited to evidentiary proof in any administrative or
16 judicial proceeding, and (2) has the same force and effect as the valid original
17 handwritten signature of that person.
18 (C)The provisions of this section satisfy the requirements of Civil Code section
19 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
20 Part 2, Title 2.5, beginning with section 1633.1).
21 (D) Each party using a digital signature represents that it has undertaken and
22 satisfied the requirements of Government Code section 16.5, subdivision (a),
23 paragraphs (1) through (5), and agrees that each other party may rely upon that
24 representation.
25 (E) This Agreement is not conditioned upon the parties conducting the transactions
26 under it by electronic means and either party may sign this Agreement with an original
27 handwritten signature.
28
13
1 14.17 Counterparts. This Agreement may be signed in counterparts, each of which is an
2 original, and all of which together constitute this Agreement.
3 [SIGNATURE PAGE FOLL0INS]
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
14
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
SCHOOL DISTRCTS COUNTY OF FRESNO
3
PLEASE SEE ADDITIONAL SIGNATURE
4 PAGES ATTACHED
5 Sal ui t ro, hairman of the Board of
Sup isor the County of Fresno
6
Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
By:
10 Deputy
11 For accounting use only:
12 Org No.: 5630
Account No.: 7295
13 Fund No.: 0001
Subclass No.: 10000
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
15
1 FI BAUGH LAS DELTAS JOINT UNIFIED SCHOOL DISTRICT
2 A"
3 Autl4rized Signature
4 oil m1*6110112
Print
5
6 Title
7 . 1//12/
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24 7l� !'/' / 6 ri ve
25
26 Phone No: x /3011
27 Contact: Betty Carmona, Director of Student Services
28
16
1 FO]J4'LE `N IES S OL DISTRICT
2 Sn
3 Authorized Signature
4 �► �-
Print
5 GXautiV e- ►� �'�Ut 1 ti ��S a e
6 v
Title
7 5�z�117-
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24 ri F 441, .AC Ay o
26 Phone No: 5 ' , 3 4' uo?C)
27 Contact: COXQCA)(G blacky_6t it &Xvlcep
28
17
1 KINGS CANYON JOINT UNIFIED SCHOOL DISTRICT
2
3 A o11rized Signature
4 V0�
Print
5 r�1
6 Title
7 "JS - 20)3
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24
25 3�r - PDU
26 Phone No: -
27 Contact: Ju
28
18
1 KERMAN UNIFIED SCHOOL DISTRICT
2
R---
3 Authorized Signature
4 Gordon Pacheco
Print
5
Superintendent
6 Title
7 5/18/2023
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24 15218 W. Whitesbridge Avenue
25 Kerman, CA 93630
26 Phone No: (559) 843-9001
27 Contact: Barbara Kramer
28
19
1 PARLIER UNIFIED SCHOOL DISTRICT
2 — -Z
3 Authorized Signature
4 Dr. Rafael lni uez
Print
5
Superintendent
6 Title
7 May 23, 2023 _
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24 900 S. Newmark Avenue
25 Parlier, CA 93648
26 Phone No: 559.646.2731
27 Contact: Kathi Felder-Guerrero
28
20
1 SELMA UNI=Va
OOL DISTRICT
2 �
3 11 Authorized Signatur
4 I Uj
ANDeCA,-
Print
5 I kSIST-&N 15 uper 1111T T
6 Title
8 Date
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 Mailing Address:
24 li 3036 Thompson Ave.
25 i Selma, CA 93662
26 Phone No:
559-898-6500
27 Contact: Andrea Affrunti
28
21
i
Exhibit A
1 Scope of Work
2 Project Description
3 This Agreement formalizes a partnership between Fresno County (County) and various
4 School Districts in Fresno County to increase access to mental health services for students of
5 the Districts by having Children's Mental Health Services on school sites in Fresno, Clovis and
6 in the rural communities of Fresno County. The target population of school-based mental health
7 treatment services is Medi-Cal and uninsured students who are un-served or underserved
8 through traditional mental health programs. Services are provided by the Department of
9 Behavioral Health, School Based Team (SBT), and its contracted providers, for both
10 metropolitan (metro) and rural areas.
11 This collaboration will also increase mental health crisis support in Rural and Metro
12 areas to provide crisis response for school districts by utilizing a mobile crisis response team.
13 Law enforcement will only be requested if there are safety concerns. Services will be provided
14 by the designated contractor who will also provide post crisis follow up services to the students
15 served.
16 The County's Department of Behavioral Health Director, or designee, or the school
17 districts, may request to convene for review and revision of the program design as policies and
18 regulations change.
19 Selection of School Sites
20 The selection of school sites is a collaborative decision by the School Districts and
21 Department of Behavioral Health (DBH) with priority given to those with a high percentage of
22 Medi-Cal and uninsured pupils and where there are little or no mental health resources on their
23 campuses.
24 The School District will identify an educational coordinator to work collaboratively with
25 DBH staff to identify school sites to be served prior to school year based on:
26 i) The degree of unmet mental health needs and lack of mental health resources
27 available on campus.
28
A-1
Exhibit A
1 ii) The number of referrals received from the school during the current school year and
2 the caseload capacity and amount of direct client services provided by the DBH
3 clinician at each of his/her assigned school site.
4 iii) The ability of the school to provide a confidential space for the DBH staffs to meet
5 with children and families that include a telephone, electrical outlet for a computer lap
6 top and printer. School sites that do not have appropriate confidential space may not
7 continue to receive SBT services. The number of designated school sites per District
8 will be determined by a review of the previous school year's referral rate and access
9 to appropriate confidential space.
10 iv) Support by school staffs to facilitate attendance to scheduled mental health
11 appointments.
12 v) Determine the plan for continuation of mental health services during school holidays,
13 State testing, summer breaks, etc.
14 vi) Determine the transition of mental health services when school-based mental health
15 services are discontinued.
16 vii) The District Coordinator/ school administrative staff and DBH will develop guidelines
17 as to the selection/de-selection process of designated school sites within each
18 school district.
19 To avoid a disruption in the therapeutic relationship between the student and clinicians, it
20 is advisable that the Districts and DBH mutually agree to changes in the schools to be served
21 no later than 30 days prior to the end of the school year. This early identification of schools will
22 enable mental health services to begin during the summer in advance of the start of the school
23 year.
24 Rural: schools under each district will be included in the MOU, to allow for flexibility of
25 the assigned rural clinical staff to be able to meet the needs of rural clients in various school
26 sites, based on current caseload need. The need will be monitored by the Clinical Supervisor
27 and clinical staff, and they will have ongoing contact to meet the needs of the rural communities.
28 Confidential Space
A-2
Exhibit A
1 Confidential space ensures children's mental health services can be conducted in the
2 manner that fulfills State and Federal confidentiality requirements. Confidential space may also
3 be requested by mental health crisis support programs for post crisis follow up services.
4 a) Ideal locations shall:
5 i) Not allow the conversation between the student, therapist and/or family to be heard
6 outside of the confidential space.
7 ii) Not be accessed by school staffs during therapy sessions.
8 iii) Have curtains or other coverings to protect confidentiality if there are windows that
9 are viewable by anyone outside of the area/room, in accordance with the school and
10 DBH policies.
11 iv) Promotes the safety and well-being of each student and be maintained in good
12 working order.
13 v) Room size: large enough to conduct individual and family sessions upon request.
14 vi) Provide telephone in the confidential office/space used by the DBH clinician or case
15 manager for their day-to-day work, consultations, and collaborations regarding their
16 clients/students. If no phones are available, a hand-held two-way radio will be
17 provided to the DBH clinician with training on how to use it for the clinician's safety
18 and that of the students.
19 Referral Process
20 For Central, Clovis and Fresno Unified School Districts (Metro SBT): The Administration
21 of the school sites shall educate school staff regarding referrals for mental health services by
22 the second week of the fall semester. Each school site will designate a staff person to
23 coordinate the referral process. The staff coordinator shall be responsible for speaking with the
24 parent or legal guardian of the student (if student is a minor) and the student that a referral for
25 children's mental health services has been made. If the parent objects to the mental health
26 referral, the referral process will not proceed. The mental health (MH) clinician will determine
27 the student's insurance eligibility obtain parental consent before determining the medical
28 necessity of each referral. The MH clinician will keep track of each referral and provide the Staff
A-3
Exhibit A
1 coordinator of the status of each referral monthly. The Staff coordinator and the MH clinician will
2 convene with associated staff to discuss stability and well-being of each referred student.
3 Meetings to increase communication and collaboration between appropriate school
4 staffs and the school-based clinicians will be held as needed to discuss the student's progress
5 toward meeting mental health treatment goals and other supportive services that may be
6 needed.
7 Rural School Districts (Rural SBT): Referrals will be generated by school staff,
8 parents/legal guardians, Department of Social Services - Social Workers, community agencies,
9 County, DBH in-house programs, contract providers, self-referrals, etc. The referrals will be
10 given to the assigned rural clinical staff. For each rural school campus, the DBH clinical staff
11 will interface with school staff on each campus in which they utilize space, as needed.
12 DBH shall abide by the following procedures and timeliness:
13 a) Upon receipt of a referral from the school, the DBH staff shall review the
14 appropriateness of the referral and begin the intake process within five (5) working days
15 by contacting the parent/legal guardian.
16 b) Upon completion of the intake process, a mental health assessment will be scheduled.
17 c) It is understood that the provision of mental health services is voluntary, and the families
18 may decline services at any point in the treatment process.
19 d) Parents who do not keep their scheduled appointment will be contacted and rescheduled
20 based on scheduling availability and acuity of impairment experienced by the student
21 receiving services.
22 e) Each student's access to treatment services will be triaged based on acuity and urgency
23 to initiate mental health services.
24 f) Parent/legal guardian are expected to participate in assessment, treatment planning and
25 ongoing treatment services as determined by the MH clinician,
26 g) The Parent/legal guardian will be advised at the conclusion of the assessment interview
27 whether or not their child's symptoms meet Medi-Cal medical necessity criteria and
28 when treatment services will begin.
A-4
Exhibit A
1 h) If no services are warranted, the rationale will be explained to both the parent/legal
2 guardian and the Staff Coordinator.
3 i) The DBH Clinician will inform the Staff Coordinator when program capacity has been
4 reached, services can be provided, and/or other options that may be available.
5 Monitoring
6 DBH will monitor the number and outcome of referrals and students engaged in mental
7 health services and communicate with school staff to determine if any changes in the day-to-day
8 operations are needed. Rural school sites within a community will be monitored by the clinical
9 staff and Clinical Supervisor and changes will be made based on the need of the clients and
10 communities involved. Staff will determine school sites based on caseload need.
11 DBH procedures for ongoing treatment
12 1. DBH will provide a list of DBH staff and contracted staff members approved to be on
13 school sites for campus screening purposes.
14 2. The DBH clinician will work collaboratively with school staff to determine an appropriate
15 schedule for ongoing services that will not negatively impact the student's educational
16 needs.
17 3. School staff will advise DBH staff if student is present and shall assist with having the
18 student summoned for his/her appointment.
19 4. At Rural school sites, assigned clinical staff will be responsible to work with each
20 individual school staff on each campus or agencies regarding appointments and
21 availability of the students on campus.
22
23
24
25
26
27
28
A-5
Exhibit B
SCHOOL DISTRICTS
The following is the list of SCHOOL DISTRICTS, where the COUNTY will be providing
children's mental health services:
FIREBAUGH-LAS DELTAS UNIFIED SCHOOL DISTRICT
1976 Morris Kyle Drive
Firebaugh, CA 93622-9711
Phone No.: (559) 659-1476 x1304
Contact: Betty Carmona
https://www.fldusd.orgy
FOWLER UNIFIED SCHOOL DISTRICT
658 E. Adams Ave
Fowler, CA 93625
Phone No.: (559) 834-6080
Contact: Rick Romero
https://www.fowlerusd.org
KERMAN UNIFIED SCHOOL DISTRICT
15218 W. Whitesbridge Ave, Kerman CA 93630
Kerman, CA 93630-1029
Phone No.: (559) 843-9001
Contact: Barbara Kramer
https://www.kermanusd.com/
KINGS CANYON UNIFIED SCHOOL DISTRICT
1502 1 Street,
Reedley, CA 93654
Phone No.: (559) 305-7010
Contact: Sergio Rodriguez
https://www.kcusd.com/
PARLIER UNIFIED SCHOOL DISTRICT
900 Newmark Ave.
Parlier, CA 93648-2034
Phone No.: (559) 646-2731
Fax: (559) 888-0210
Contact: Kathi Felder-Guerrero
https://www.parlierunified.org/
SELMA UNIFIED SCHOOL DISTRICT
3036 Thompson Ave
Selma, CA 93662
Phone No.: (559) 898-6500
B-1
Exhibit B
Contact: Andrea Affrunti
https://www.selmausd.org/
B-2
Exhibit C
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("County Contractor"), must disclose any self-dealing transactions
that they are a party to while providing goods, performing services, or both for the County. A
self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest."
The definition above will be used for purposes of completing this disclosure form.
Instructions
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
C-1
Exhibit C
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a
party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of
Corporations Code § 5233 (a)
(5) Authorized Signature
Signature: Date:
C-2
Exhibit D
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) Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(C) 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.
If the Contractor is a governmental entity, it may satisfy the policy requirements above through a
program of self-insurance, including an insurance pooling arrangement or joint exercise of
powers agreement.
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
D-1
Exhibit D
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.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(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
charges against any amounts owed by the County to the Contractor under this
Agreement.
D-2
Exhibit D
(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.
D-3
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
1. The County is a "Covered Entity," and the School District is a "Business
Associate," as these terms are defined by 45 CFR 160.103. In connection with providing
services under the Agreement, the parties anticipate that the School District will create and/or
receive Protected Health Information ("PHI") from or on behalf of the County. The parties enter
into this Business Associate Agreement (BAA) to comply with the Business Associate
requirements of HIPAA, to govern the use and disclosures of PHI under this Agreement. "HIPAA
Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR
Parts 160 and 164.
The parties to this Agreement shall be in strict conformance with all applicable federal
and State of California laws and regulations, including, but not limited to California Welfare and
Institutions Code sections 5328, 10850, and 14100.2 et seq.; 42 CFR 2; 42 CFR 431; California
Civil Code section 56 et seq.; the Health Insurance Portability and Accountability Act of 1996, as
amended ("HIPAA"), including, but not limited to, 45 CFR Parts160, 45 CFR 162, and 45 CFR
164; the Health Information Technology for Economic and Clinical Health Act ("HITECH")
regarding the confidentiality and security of patient information, including, but not limited to 42
USC 17901 et seq.; and the Genetic Information Nondiscrimination Act ("GINA") of 2008
regarding the confidentiality of genetic information.
Except as otherwise provided in this Agreement, the School District, as a business
associate of the County, may use or disclose Protected Health Information ("PHI") to perform
functions, activities or services for or on behalf of the County, as specified in this Agreement,
provided that such use or disclosure shall not violate HIPAA Rules. The uses and disclosures of
PHI may not be more expansive than those applicable to the County, as the "Covered Entity"
under the HIPAA Rules, except as authorized for management, administrative or legal
responsibilities of the School District.
2. The School District, including its subcontractors and employees, shall protect
from unauthorized access, use, or disclosure of names and other identifying information,
including genetic information, concerning persons receiving services pursuant to this
Agreement, except where permitted in order to carry out data aggregation purposes for health
E-1
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
care operations [45 CFR §§ 164.504(e)(2)(i), 164.504(e)(2)(ii)(A), and 164.504(e)(4)(i)]. This
pertains to any and all persons receiving services pursuant to a County-funded program. This
requirement applies to electronic PHI. The School District shall not use such identifying
information or genetic information for any purpose other than carrying out the School District's
obligations under this Agreement.
3. The School District, including its subcontractors and employees, shall not
disclose any such identifying information or genetic information to any person or entity, except
as otherwise specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part
164 or other law, required by the Secretary of the United States Department of Health and
Human Services ("Secretary"), or authorized by the client/patient in writing. In using or
disclosing PHI that is permitted by this Agreement or authorized by law, the School District shall
make reasonable efforts to limit PHI to the minimum necessary to accomplish intended purpose
of use, disclosure or request.
4. For purposes of the above sections, identifying information shall include, but not
be limited to, name, identifying number, symbol, or other identifying particular assigned to the
individual, such as fingerprint or voiceprint, or photograph.
5. For purposes of the above sections, genetic information shall include genetic
tests of family members of an individual or individual(s), manifestation of disease or disorder of
family members of an individual, or any request for or receipt of genetic services by individual or
family members. Family member means a dependent or any person who is first, second, third,
or fourth degree relative.
6. The School District shall provide access, at the request of the County, and in the
time and manner designated by the County, to PHI in a designated record set (as defined in 45
CFR § 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR §
164.524 regarding access by individuals to their PHI. With respect to individual requests,
access shall be provided within thirty (30) days from request. Access may be extended if the
School District cannot provide access and provides the individual with the reasons for the delay
E-2
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
and the date when access may be granted. PHI shall be provided in the form and format
requested by the individual or the County.
The School District shall make any amendment(s) to PHI in a designated record set at
the request of the County or individual, and in the time and manner designated by the County in
accordance with 45 CFR § 164.526.
The School District shall provide to the County or to an individual, in a time and manner
designated by the County, information collected in accordance with 45 CFR § 164.528, to permit
the County to respond to a request by the individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
7. The School District shall report to the County, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security
incident, or breach of unsecured PHI not permitted by this Agreement of which the School
District becomes aware, immediately and without reasonable delay and in no case later than
two (2) business days of discovery. Immediate notification shall be made to the County's
Information Security Officer and Privacy Officer and the County's Department of Public Health
("DPH") HIPAA Representative, within two (2) business days of discovery. The notification shall
include, to the extent possible, the identification of each individual whose unsecured PHI has
been, or is reasonably believed to have been, accessed, acquired, used, disclosed, or
breached. The School District shall take prompt corrective action to cure any deficiencies and
any action pertaining to such unauthorized disclosure required by applicable federal and State
laws and regulations. The School District shall investigate such breach and is responsible for all
notifications required by law and regulation or deemed necessary by the County and shall
provide a written report of the investigation and reporting required to the County's Information
Security Officer and Privacy Officer and the County's DPH HIPAA Representative.
This written investigation and description of any reporting necessary shall be
postmarked within the thirty (30)working days of the discovery of the breach to the addresses
below:
County of Fresno County of Fresno County of Fresno
Department of Public Health Department of Public Health Department of Internal
E-3
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA Representative Privacy Officer Services
(559) 600-6439 (559) 600-6405 Information Security Officer
P.O. Box 11867 P.O. Box 11867 (559) 600-5800
Fresno, California 93775 Fresno, California 93775 2048 North Fine Street
Fresno, California 93727
8. The School District shall make its internal practices, books, and records relating
to the use and disclosure of PHI received from the county, or created or received by the School
District on behalf of the County, in compliance with Parts the HIPAA Rules. The School District
shall make its internal practices, books, and records relating to the use and disclosure of PHI
received from the County, or created or received by the School District on behalf of the County,
available to the Secretary upon demand.
The School District shall cooperate with the compliance and investigation reviews
conducted by the Secretary. PHI access to the Secretary must be provided during the School
District's normal business hours; however, upon exigent circumstances access at any time must
be granted. Upon the Secretary's compliance or investigation review, if PHI is unavailable to
the School District and in possession of a subcontractors of the School District, the School
District must certify to the Secretary its efforts to obtain the information from the subcontractors.
9. Safeguards
The School District shall implement administrative, physical, and technical safeguards as
required by the HIPAA Security Rule, Subpart C of 45 CFR Part 164, that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI, including electronic
PHI, that it creates, receives, maintains or transmits on behalf of the County and to prevent
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by
this Agreement. The School District shall conduct an accurate and thorough assessment of the
potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic PHI.
The School District shall develop and maintain a written information privacy and security
program that includes administrative, technical and physical safeguards appropriate to the size
and complexity of the School District's operations and the nature and scope of its activities.
Upon the County's request, the School District shall provide the County with information
concerning such safeguards.
E-4
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
The School District shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential,
personal (e.g., PHI) or sensitive data to authorized users only. Said safeguards and
precautions shall include the following administrative and technical password controls for all
systems used to process or store confidential, personal, or sensitive data:
A. Passwords must not be:
(1) Shared or written down where they are accessible or recognizable by anyone
else; such as taped to computer screens, stored under keyboards, or visible
in a work area;
(2) A dictionary word; or
(3) Stored in clear text
B. Passwords must be:
(1) Eight (8) characters or more in length;
(2) Changed every ninety (90) days;
(3) Changed immediately if revealed or compromised; and
(4) Composed of characters from at least three (3) of the following four (4)
groups from the standard keyboard:
a) Upper case letters (A-Z);
b) Lowercase letters (a-z);
c) Arabic numerals (0 through 9); and
d) Non-alphanumeric characters (punctuation symbols).
The School District shall implement the following security controls on each workstation
or portable computing device (e.g., laptop computer) containing confidential, personal, or
sensitive data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
3. Patch management process including installation of all operating system/software
vendor security patches.
E-5
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
The School District shall utilize a commercial encryption solution that has received FIPS
140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
The School District shall not transmit confidential, personal, or sensitive data via e-mail
or other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the
Advanced Encryption Standard (AES)Algorithm. The School District must apply appropriate
sanctions against its employees who fail to comply with these safeguards. The School District
must adopt procedures for terminating access to PHI when employment of employee ends.
10. Mitigation of Harmful Effects
The School District shall mitigate, to the extent practicable, any harmful effect that is
suspected or known to the School District of an unauthorized access, viewing, use, disclosure,
or breach of PHI by the School District or its subcontractors in violation of the requirements of
these provisions. The School District must document suspected or known harmful effects and
the outcome.
11. The School District's Subcontracotrs
The School District shall ensure that any of its School Districts, including subcontractors,
if applicable, to whom the School District provides PHI received from or created or received by
the School District on behalf of the County, agree to the same restrictions, safeguards, and
conditions that apply to the School District with respect to such PHI and to incorporate, when
applicable, the relevant provisions of these provisions into each subcontract or sub-award to
such agents or subcontractors.
Nothing in this section 11 or this exhibit authorizes the School District to perform
services under this Agreement using subcontractors.
12. Employee Training and Discipline
The School District shall train and use reasonable measures to ensure compliance with
the requirements of these provisions by employees who assist in the performance of functions
E-6
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
or activities on behalf of the County under this Agreement and use or disclose PHI, and
discipline such employees who intentionally violate any provisions of these provisions, which
may include termination of employment.
13. Termination for Cause
Upon the County's knowledge of a material breach of these provisions by the School
District, the County will either:
A. Provide an opportunity for the School District to cure the breach or end
the violation, and the County may terminate this Agreement if the School District does not cure
the breach or end the violation within the time specified by the County; or
B. Immediately terminate this Agreement if the School District has breached
a material term of this exhibit and cure is not possible, as determined by the County.
C. If neither cure nor termination is feasible, the County's Privacy Officer will
report the violation to the Secretary of the U.S. Department of Health and Human Services.
14. Judicial or Administrative Proceedings
The County may terminate this Agreement if: (1) the School District is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or
(2) there is a finding or stipulation in an administrative or civil proceeding in which the School
District is a party that the School District has violated a privacy or security standard or
requirement of the HITECH Act, HIPAA or other security or privacy laws.
15. Effect of Termination
Upon termination or expiration of this Agreement for any reason, the School District shall
return or destroy all PHI received from the County (or created or received by the School District
on behalf of the County) that the School District still maintains in any form, and shall retain no
copies of such PHI. If return or destruction of PHI is not feasible, the School District shall
continue to extend the protections of these provisions to such information, and limit further use
of such PHI to those purposes that make the return or destruction of such PHI infeasible. This
provision applies to PHI that is in the possession of subcontractors or agents, if applicable, of
the School District. If the School District destroys the PHI data, a certification of date and time
E-7
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
of destruction shall be provided to the County by the School District.
16. Compliance with Other Laws
To the extent that other state and/or federal laws provide additional, stricter and/or more
protective privacy and/or security protections to PHI or other confidential information covered
under this BAA, the School District agrees to comply with the more protective of the privacy and
security standards set forth in the applicable state or federal laws to the extent such standards
provide a greater degree of protection and security than HIPAA Rules or are otherwise more
favorable to the individual.
17. Disclaimer
The County makes no warranty or representation that compliance by the School District
with these provisions, the HITECH Act, or the HIPAA Rules, will be adequate or satisfactory for
the School District's own purposes or that any information in the School District's possession or
control, or transmitted or received by the School District, is or will be secure from unauthorized
access, viewing, use, disclosure, or breach. The School District is solely responsible for all
decisions made by the School District regarding the safeguarding of PHI.
18. Amendment
The parties acknowledge that Federal and State laws relating to electronic data security
and privacy are rapidly evolving and that amendment of this exhibit may be required to provide
for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards
and requirements of the HIPAA Rules, the HITECH Act and other applicable laws relating to the
security or privacy of PHI. The County may terminate this Agreement upon thirty (30) days
written notice in the event that the School District does not enter into an amendment providing
assurances regarding the safeguarding of PHI that the County in its sole discretion, deems
sufficient to satisfy the standards and requirements of the HIPAA Rules, and the HITECH Act.
19. No Third-Party Beneficiaries
Nothing expressed or implied in the provisions of this exhibit is intended to confer, and
nothing in this exhibit does confer, upon any person other than the County or the School District
E-8
Exhibit E
Health Insurance Portability and Accountability Act (HIPAA)
and their respective successors or assignees, any rights, remedies, obligations or liabilities
whatsoever.
20. Interpretation
The provisions of this exhibit shall be interpreted as broadly as necessary to implement
and comply with the HIPAA Rules, and applicable State laws. The parties agree that any
ambiguity in the terms and conditions of these provisions shall be resolved in favor of a meaning
that complies and is consistent with the HIPAA Rules.
21. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
Rules means the section as in effect or as amended.
22. Survival
The respective rights and obligations of the School District as stated in this exhibit
survive the termination or expiration of this Agreement.
23. No Waiver of Obligation
Change, waiver or discharge by the County of any liability or obligation of the School
District under this exhibit on any one or more occasions is not a waiver of performance of any
continuing or other obligation of the School District and does not prohibit enforcement by the
County of any obligation on any other occasion.
E-9
Exhibit F
Page 1 of 17
BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit F
Page 2 of 17
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990
(a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a
drug-free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and
Exhibit F
Page 3 of 17
CONTRACTOR may be ineligible for award of any future State agreements if the
department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing
to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against CONTRACTOR within the
immediately preceding two (2) year period because of CONTRACTOR's failure to
comply with an order of a Federal court, which orders CONTRACTOR to comply
with an order of the National Labor Relations Board. (Pub. Contract Code
§10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will
comply with the requirements of Section 6072 of the Business and Professions
Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number
of hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as
set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
Exhibit F
Page 4 of 17
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR's records, documents, agents or employees, or
premises if reasonably required by authorized officials of the contracting
agency, the Department of Industrial Relations, or the Department of
Justice to determine the contractor's compliance with the requirements
under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has
any questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code M 0411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
Exhibit F
Page 5 of 17
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against
liability for Worker's Compensation or to undertake self-insurance in accordance
with the provisions, and CONTRACTOR affirms to comply with such provisions
before commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which
prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
Exhibit F
Page 6 of 17
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air
pollution control district; (2) subject to cease and desist order not subject to
review issued pursuant to Section 13301 of the Water Code for violation of waste
discharge requirements or discharge prohibitions; or (3) finally determined to be
in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of CONTRACTOR or its subcontractors, and may, at any time,
inspect the premises, physical facilities, and equipment where Medicaid-related
activities or work is conducted. The right to audit under this section exists for ten
(10) years from the final date of the contract period or from the date of
completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's
Death Master File, the National Plan and Provider Enumeration System
(NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award
Management (SAM), and any other databases as the State or Secretary may
prescribe. These databases must be consulted upon contracting and no less
frequently than monthly thereafter. If the State finds a party that is excluded, it
must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under
this part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
Exhibit F
Page 7 of 17
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. In collaboration with the County, Contractor will work to ensure
that individuals to whom the Contractor provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in BHIN 21-073. Specifically, the
Contractor will ensure that the clinical record for each client
includes information as a whole indicating that client's
presentation and needs are aligned with the criteria applicable to
their age at the time of service provision as specified below.
ii. For enrolled clients under 21 years of age, Contractor shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled clients who meet either of the
following criteria, (1) or (11) below. If a client under age 21 meets
the criteria as described in (1) below, the beneficiary meets criteria
to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The client has a condition placing them at high risk for a
mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The client has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the client's condition as described in subparagraph (11 a-
d) above is due to one of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM)
and the International Classification of Diseases and
Related Health Problems (ICD).
b. A suspected mental health disorder that has not yet
been diagnosed.
Exhibit F
Page 8 of 17
c. Significant trauma placing the client at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For clients 21 years of age or older, Contractor shall provide
covered SMHS for clients who meet both of the following criteria,
(a) and (b) below:
1. The client has one or both of the following:
a. Significant impairment, where impairment is defined
as distress, disability, or dysfunction in social,
occupational, or other important activities.
b. A reasonable probability of significant deterioration
in an important area of life functioning.
2. The client's condition as described in paragraph (a) is due
to either of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the DSM and
ICD.
b. A suspected mental disorder that has not yet been
diagnosed.
c. ADDITIONAL CLARIFICATIONS
i. Criteria
1. A clinically appropriate and covered mental health
prevention, screening, assessment, treatment, or recovery
service listed within Exhibit A of this Agreement can be
provided and submitted to the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included in an individual
treatment plan; or
c. The client had a co-occurring substance use
disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims,
including SMHS claims, include a current Centers for
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
d. MEDICAL NECESSITY
i. Contractor will ensure that services provided are medically
necessary in compliance with BHIN 21-073 and pursuant to
Welfare and Institutions Code section 14184.402(a). Services
provided to a client must be medically necessary and clinically
appropriate to address the client's presenting condition.
Documentation in each client's chart as a whole will demonstrate
Exhibit F
Page 9 of 17
medical necessity as defined below, based on the client's age at
the time of service provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the
standards set forth in Section 1396d(r)(5) of Title 42 of the United
States Code.
e. COORDINATION OF CARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to this Agreement are coordinated among all
providers who are serving the client, including all other SMHS
providers, as well as providers of Non-Specialty Mental Health
Services (NSMHS), substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services as applicable to ensure a client-centered
and whole-person approach to services.
ii. Contractor shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link clients 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.
iv. Contractor shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA
and California law compliant client authorization to share client
information with and among all other providers involved in the
client's care, in satisfaction of state and federal privacy laws and
regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health
Services can be provided concurrently, if those services are
clinically appropriate, coordinated, and not duplicative. When a
client meets criteria for both NSMHS and SMHS, the client should
receive services based on individual clinical need and established
therapeutic relationships. Clinically appropriate and covered
SMHS can also be provided when the client has a co-occurring
mental health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that clients receive
timely mental health services without delay. Services are
reimbursable to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
Exhibit F
Page 10 of 17
SMHS access criteria are met, even if the assessment
ultimately indicates the client does not meet criteria for
SMHS.
2. If Contractor is serving a client receiving both SMHS and
NSMHS, Contractor holds responsibility for documenting
coordination of care and ensuring that services are non-
duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016
and 22-017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) is necessary due to a client's
specific needs and circumstances that could seriously jeopardize
the client's life or health, or ability to attain, maintain, or regain
maximum function.
b. DOCUMENTATION REQUIREMENTS
i. Contractor will follow all documentation requirements as specified
in Article 4.2-4.8 inclusive in compliance with federal, state and
County requirements.
ii. All Contractor documentation shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from face-to-face
time and provide this information to County upon request.
Services must be identified as provided in-person, by telephone,
or by telehealth.
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractor agrees to
satisfy the chart documentation requirements set forth in BHIN 22-
019 and the contract between County and DHCS. Failure to
comply with documentation standards specified in this Article
require corrective action plans.
c. ASSESSMENT
i. Contractor shall ensure that all client medical records include an
assessment of each client's need for mental health services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the client's medical record.
Exhibit F
Page 11 of 17
iii. For clients aged 6 through 20, the Child and Adolescent Needs
and Strengths (CANS), and for clients aged 3 through 18, the
Pediatric Symptom Checklist-35 (PSC-35) tools are required at
intake, every six months during treatment, and at discharge, as
specified in DHCS MHSUDS INs 17-052 and 18-048.
iv. The time period for providers to complete an initial assessment
and subsequent assessments for SMHS are up to clinical
discretion of County; however, Contractor's providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of
the DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractor shall use the ICD diagnosis
code(s) to submit a claim for SMHS to receive reimbursement
from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by
CMS and may be updated during the term of this Agreement.
Changes to the lists of ICD diagnoses do not require an
amendment to this Agreement, and County may implement these
changes as provided by CMS
e. PROBLEM LIST
i. Contractor will create and maintain a Problem List for each client
served under this Agreement. The problem list is a list of
symptoms, conditions, diagnoses, and/or risk factors identified
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
ii. Contractor must document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CT®) U.S. Edition, September 2022 Release, and ICD-
1 0-CM 2023.
iii. A problem identified during a service encounter may be addressed
by the service provider during that service encounter and
subsequently added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
added. However, Contractor shall update the problem list within a
reasonable time such that the problem list reflects the current
issues facing the client, in accordance with generally accepted
standards of practice and in specific circumstances specified in
BHIN 22-019.
f. TREATMENT AND CARE PLANS
i. Contractor is not required to complete treatment or care plans for
clients under this Agreement, except in the circumstances
Exhibit F
Page 12 of 17
specified in BHIN 22-019 and additional guidance from DHCS that
may follow after execution of this Agreement.
g. PROGRESS NOTES
i. Contractor shall create progress notes for the provision of all
SMHS services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the
service code selected for the service type as indicated by the
service code description.
iii. Progress notes shall include all elements specified in BHIN 22-
019, whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business
days of providing a service, with the exception of notes for crisis
services, which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that
are billed on a daily basis, such as residential and day treatment
services, if applicable.
h. TRANSITION OF CARE TOOL
i. Contractor shall use a Transition of Care Tool for any clients
whose existing services will be transferred from Contractor to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractor, as specified in BHIN 22-065, in order to ensure
continuity of care.
ii. Determinations to transition care or add services from an MCP
shall be made in alignment with County policies and via a client-
centered, shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
Services.aspx, or obtain a copy of that tool provided by the
County. Contractor may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Transition of Care Tool, including the specific wording and order of
fields, shall remain identical to the DHCS provided form. The only
exception to this requirement is when the tool is translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations must ensure that
client confidentiality is maintained.
Exhibit F
Page 13 of 17
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for clients served by Contractor under this
Agreement must include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractor. Such consent must be obtained at least
once prior to initiating applicable health care services and consent
must include all elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices,
and Contractor must allow access to all materials needed to
adequately monitor Contractor's adherence to telehealth
standards and requirements.
3. CLIENT PROTECTIONS
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor must be immediately forwarded to the
County's Managed Care Department or other designated persons
via a secure method (e.g., encrypted email or by fax) to allow
ample time for the Managed Care staff to acknowledge receipt of
the grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and clients
do not need to use the term "grievance" for a complaint to be
captured as an expression of dissatisfaction and, therefore, a
grievance.
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) must be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs must be issued to clients anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice must have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. The Contractor must inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings must be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor must provide clients any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor must maintain records of grievances and appeals and
must review the information as part of its ongoing monitoring
procedures. The record must be accurately maintained in a
Exhibit F
Page 14 of 17
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor must comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
4. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess client/family
satisfaction based on County's guidance. The Contractor shall
assess client/family satisfaction by:
1. Surveying client/family satisfaction with the Contractor's
services at least annually.
2. Evaluating client grievances, appeals and State Hearings
at least annually.
3. Evaluating requests to change persons providing services
at least annually.
4. Informing the County and clients of the results of
client/family satisfaction activities.
ii. Contractor, if applicable, shall implement mechanisms to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan
with documented annual evaluations and documented revisions
as needed. The QI Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed QI actions, and ensure follow-up of QI processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
Exhibit F
Page 15 of 17
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor must have hours of operation during which
services are provided to Medi-Cal clients that are no less
than the hours of operation during which the provider
offers services to non-Medi-Cal clients. If the Contractor's
provider only serves Medi-Cal clients, the provider must
provide hours of operation comparable to the hours the
provider makes available for Medi-Cal services that are not
covered by the Agreement or another County.
2. Appointments data, including wait times for requested
services, must be recorded and tracked by Contractor, and
submitted to the County on a monthly basis in a format
specified by the County. Appointments' data should be
submitted to the County's Quality Management
Department or other designated persons.
3. Urgent care appointments for services that do not require
prior authorization must be provided to clients within 48
hours of a request. Urgent appointments for services that
do require prior authorization must be provided to clients
within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) must be
made available to Medi-Cal clients within 10 business days
from the date the client or a provider acting on behalf of
the client, requests an appointment for a medically
necessary service. Non-urgent psychiatry appointments
(for both adult and children/youth) must be made available
to Medi-Cal clients within 15 business days from the date
the client or a provider acting on behalf of the client,
requests an appointment for a medically necessary
service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the client's record that a longer waiting period will not
have a detrimental impact on the health of the client.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
Exhibit F
Page 16 of 17
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal clients on behalf of Contractor,
are registered through DHCS' Provider Application and Validation
for Enrollment (PAVE) portal, pursuant to BHIN 20-071
requirements, the 21st Century Cures Act and the CMS Medicaid
and Children's Health Insurance Program (CHIP) Managed Care
Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PIED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
5. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for clients served through this Agreement
shall contain a warning banner regarding the PHI or PII contained
within the EHR. Contractors that utilize an EHR shall maintain all
parts of the clinical record that are not stored in the EHR, including
but not limited to the following examples of client signed
documents: discharge plans, informing materials, and health
questionnaire.
iv. Contractor entering data into any county electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
6. PROGRAM INTEGRITY
Exhibit F
Page 17 of 17
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
ii. Contractor must file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and must make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
Exhibit G
Page 1 of 9
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
• The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Exhibit G
Page 2 of 9
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
coati Incident Reporting System
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder(SUD) services)to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
• Do away with submitting a paper version with a signature.
• This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, the responsibility is to:
• Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
• Review incident for clarity, missing information and add in additional information deemed
appropriate.
• Notify DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountyca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Exhibit G
Page 3 of 9
F C O i Iresrrodbhloq±andrrger.coMrl<adentsl:t=9&{,=t&Ir_tBZbepckdcd5072bb18Wcdrrt_r�•IF.
LogicManager
Incident Report
Please complete this form
Cli-tint—ti.n
Na..of Facility'
Name of Reporting Party
Facility Address'
Facility Phone Number'
Mortal Hoalth or Subst nco Um Disorder Program?
Client Fust Name'
Choir.Last Name
•_ C 1) i�....LL
Cbent Dialect Blrin
Client Address
Clientln
Gender
Coudty of
Origin-Summery
Subtect u
incident Itheck all that apply)
if mher•spaufy I,-fire,pot—rig,ep.damic outbreaks,othai catastrophesi Bents Natjeopardice the welfare and safetyof clients,staffand tot members of the community):
oe:cripUan of the Incident
Exhibit G
Page 4 of 9
Similar to the paper version, multiple incident categories can be selected
incident It heck all IhalapplyI
Medical EmerZ.-y.c Death of CUant
Nom¢IdelNomlclde attempt
AWOL;Elopement from locked facility
Violence!Abuw Assault(toward others,client and+or p,.p.ny
Attempted Suit,&pewlhng in wilous injury)
Injury(self-lnlNted or by accident)
Medication Error
E C Q i Iresrtt>VWt.loywman.gM.can(ncitMntsllt-A&u-1&k-10?Dtd:Scdcd5072b6tO6k tlneM1d7d6e
Dm.of Incld.nt'
Time of l—dent-
Location of I—d.nt-
May People Directly Involved in Incident iuillm-es,vt^
Did the Injured Party seek Medical Attention'
Attach any add.l.—I details
FA}LCd. m Drop Ell.Nor.
Reported By Name
Reported by Email'
Reported Dn
10130l2019
Exhibit G
Page 5 of 9
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
F C' n a fremnAbhJngitmansger.comru. ��9khtrkyl5{)/?bbtR(.AtlfeeMdTMe
AdS.E1�Y or Drop File Nor.
Reported 0y Nam'
Reported By Email
R.p.a.d On
1000/2019
Fall—Up
Atit.n Taken Ithetk all that apply)
Please apeofy d other
D—hpUon of Action Takon-
Quit—,
Similar to the paper version, multiple Action Taken categories can be selected.
- c.uow ui.
Atllon Taken ithetk all that appi'y'
law Enfol[ement Contacted• Called 9llJEMs
Consulted with Phytxian
First AIdiCPR Administered
Chen)ramevee from buliding
Parent+legal Guardlan Contacted
Other
When done entering all the information,simply click submit.
Any fields that have a red asterisk, require information and will prevent submission of the form if left blank.
A
A"Thank you for your submission"statement will pop up if an incident is successfully submitted. Click"Reload the
Form" to submit another incident.
'LogicManager
Thank you for your submission)
RELOAD THE FORM
Exhibit G
Page 6 of 9
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
11,d�C/30/2Ctd�J:.LL AM
SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@ log icmanager.com>
Notification-
To 08H Incident Reporting
01f there are problems with how this message is displayed,click here to view it in a web
o Click here to download pictures.To help protect your privacy,Outlook prevented autom c download of some pictures in this message.
CAUTION!!!-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
❑x "hit-,u a op and hdd hee maw..km awr hdp prprenvwr
Wtlmk pre.mbtd wmnaEc d-d1h'u p-ban Me
rnhmK
lv,rN nc.
Hi W.Ar-al.,
You have received a notification through LogicManager.Please see the details
below-
Type:Incident Report
Subject:102
Not cation To:Mlla Arevalo
Open this incident in LogicManaaer
If using Internet Explorer,cfick here to open the notification
This email was generated by LogicManager If you have any technical issues,
please email supportolotlicmanacter.com.
Enter in email address and password. First time users will be prompted to set up a password.
4 11 fresnodbh.my.logionanager.com
_LogicManager
Forgot your password?
Exhibit G
Page 7 of 9
Once logged in,the main screen will show reviewer task(incidents to review). Click on analyst/supervisor follow up
to view the incident.
Your Task List
TASNNI E s""' ,T.,.L,
A
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Analyst Follow Up
-V'[Rfn[.Irv.w
•w Mv..f eeT
_ryyuYw,
tv a«Mr.e Nwor'
The next tab is Summary: No edits can be made to this section.
Analyst FuIIuw Uy
s—
walOe.r a -
.oa«wrvr•nn.v*.,was..or.�...�a,�.aui....�>,we......mri..o+�ayrM..,..,.a.,na.>..�.:,e...e.e,...e..et,..tw.m n
e.unp.e.eI rM�Htl�l`
B 1 v 6 Il ? d e D
One Cllnaler['
w>br�w.
ruewwwexr.�n
r
[uawn�weenr
r
Exhibit G
Page 8 of 9
The next tab is Follow up: This section can be edited. Add to the areas below or make corrections to these fields. Be
E w en edits are made.Then Cancel to Exit out f the incident.
Analyst Follow Up
o-.rwn r>t.n cn.0 aunm+vdr-
u.
w.aysoa+r rt o-�ri
Oev.MWn d Artvn taaen
.O+eO m.wmMOn
uvvr o!Ororh[ar.[a.Var(aaM lO-]tl�
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up
0
ham. rya soy,« oa>do>« oom>a.a a.
e� 1
!b�rnmm�.,r
Dmp like hae o!66 on the 4CA O--,tG!op.—
1-kmni soon.:In]i null
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted, the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHlncidentReporting@fresnocountyca.gov
Exhibit G
Page 9 of 9
To get back to the home view, click on the Logic Manager icon at any time. Any incidents
show on this screen, click on the next incident and start the review process again.
Your Task La[
TASKNRae 0 . _.v,