HomeMy WebLinkAboutCombined BAI 44 and A-23-281 with JDT Consultants.pdf Co�,�,
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0 185G o' Board Agenda Item 44
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DATE: June 20, 2023
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
Sanja Bugay, Director, Department of Social Services
SUBJECT: Agreements to include State Mandated CalAIM Payment Structure Changes and
Term Extensions
RECOMMENDED ACTION(S):
1. Approve and Authorize the Chairman to execute the following agreements and with various
contractors for California Advancing and Innovating Medi-Cal required payment structure
changes including one year and/or possible 12-month term extensions with no payment
structure changes, all effective July 1,2023:
a. Agreement with Central Star Behavioral Health, Inc.for Wraparound Services to Child
Welfare Mental Health
b. Agreement with Fresno County Superintendent of Schools for Specialty Mental Health
Treatment and Prevention and Early Intervention Services Agreement
c. Agreement with Turning Point of Central California, Inc.for Rural Full Service
Partnership, Outpatient,and Intensive Case Management Services
d. Agreement with Central Star Behavioral Health, Inc.for 24/7 Crisis Residential Treatment
Services
e. Agreement with Comprehensive Youth Services, Exceptional Parents Unlimited, and
Pacific Clinics(formerly Uplift Family Services)for the Bright Beginnings Full Service
Partnership services for Youth
f. Master Agreement with Various Providers for Short-Term Residential Therapeutic
Program Specialty Mental Health Services to Child Welfare Youth
g. Agreement with Central Star Behavioral Health, Inc.for Full Service Partnership
services for Transitional Age Youth ages 16-24
h. Agreement with Comprehensive Youth Services for Functional Family Therapy Services
L Agreement with Pacific Clinics (formerly Uplift Family Services)for Assertive Community
Treatment Services for Youth
j. Agreement with JDT Consultants, Inc. for Therapeutic Behavioral Services
k. Master Agreement with Various Providers for mandated mental health services to Child
Welfare Youth
I. Master Agreement with various providers for Specialized Residential Mental Health
Services
m. Agreement with Mental Health Services, Inc. dba TURN Behavioral Health Services for
Co-Occurring Mental Health and Substance Use Disorder Services Full Service
Partnership Services
n. Master Agreement including The Fresno Center,for Cultural Specific Services for Full
Service Partnership, Outpatient, and Intensive Case Management Services
2. Make a finding that it is in the best interest of the County to waive the competitive bidding
County of Fresno Page 1 File Number:23-0495
File Number:23-0495
process consistent with Administrative Policy No. 34 for unusual or extraordinary circumstances
given the non-competitive nature of the Specialized Residential Health Services Master
Agreementfor fraRSONG-RiRg funding fr-Orn a►erminatin contract to , new „tract based on
familiarity with ♦he incline involved population.
Approval of the first recommended action will allow the Department of Behavioral Health (DBH)to adhere to
new Department of Health Care Services (DHCS)implemented California Advancing and Innovating
Medi-Cal(CaIAIM)regulations including Medi-Cal payment reform changes throughout the Behavioral Health
System of Care. Some of the applicable agreements require a term extension for one year and/or a possible
12-month extension based upon satisfactory performance in order to allow the Department time to
appropriately analyze the impacts of the payment reform and CaIAIM changes to the County and the
subcontracted providers. The first recommended action will supersede expiring contracts and make the
applicable payment reform changes to contract language for various contractors. All recommended actions
will become effective on July 1, 2023, with no increase in Net County Cost. This item is county-wide.
The second recommended action will allow the DBH to transition funding from one contract whose program
is sunsetting to another program that has years of experience providing similar services to the justice
involved population.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, existing
individuals served by expiring contracts will experience a gap in services and/or the County will not be able
to adhere to compliance of the new CaIAIM regulations required of all subcontracted providers within the
Behavioral Health System of Care. If contracts expire, DBH would be left without a provider network to serve
the community; DBH has insufficient clinical staff to provide these services due to an approximately 30%
vacancy rate and could not absorb the population in county-operated programs nor could we hire fast
enough to staff clinics to serve the population without gaps in services.
SUSPENSION OF COMPETITION:
The Supersede Agreement to County Agreement No. 19-406 for a Master Agreement with various licensed
facilities for Specialized Residential Services requires a Suspension of Competition. The Master Agreement
is with various licensed facilities certified to provide placements and specialized residential services for
seriously emotionally disturbed (SED)youth and adults with severe and persistent mental health conditions,
including individuals suffering with eating disorders, pursuant to Welfare Institutions Code (WIC)and
California Code of Regulations (CCR). County DBH is seeking to add residential service providers located
both in Fresno and out of County onto this Master Agreement. DBH will contract with any licensed facility
that is reviewed and is determined to meet the needs of the Conservator Team. Expanding Fresno County's
options for provision of services will ensure a wider network to meet the needs of persons served. The
Internal Services Division - Purchasing concurs with the Department's request to suspend the competitive
bidding process.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions.Attachment A includes
the FY 2023-24 contract amounts, the maximum compensation amounts, and funding sources of each
contract included herein.
Each of the contracts identified within the Attachment will be fully funded by their existing funding sources
including, but not limited to: Medi-Cal Federal Financial Participation, Mental Health Realignment funds, and
Mental Health Services Act funds (Community Services and Supports and/or Prevention and Early
Intervention).
County of Fresno page 2 File Number.23-0495
File Number:23-0495
Sufficient appropriations and estimated revenues are included in DBH's Org 5630 FY 2023-24
Recommended Budget and will be included in all future recommended budgets throughout the remainder of
the contract terms.
DISCUSSION:
CalAIM is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more
equitable, coordinated, and person-centered approach to maximizing their health and life trajectory. The
three goals of CalAIM are: 1)identify and manage comprehensive needs through whole person care
approaches and social drivers or health, 2)improve quality outcomes, reduced health disparities, and
transform the delivery system through value-based initiatives, modernization, and payment reform, and 3)
make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity
and increasing flexibility.
Under the CalAIM transformation effort, the County is required to change existing payment methods from
cost-based reimbursement to a fee-for-service (FFS)structure beginning July 1, 2023. DBH has existing
agreements with various contractors that deliver specialty mental health services(SMHS)and drug Medi-Cal
(DMC)services, and they each need to be amended or superseded to include the new FFS payment
structures along with other CalAIM related requirements and language updates for compliance.
DHCS set the County's rates which are inclusive of County's costs for administering the Medi-Cal services
programs, submitting claims to the State, and other functions. It is the authority of the DBH, as the
Behavioral Health Plan, to set the rates that we will pay within our network of subcontracted providers.
DBH, in conjunction with the California Mental Health Services Authority(CalMHSA)-a Joint Powers of
Authority(JPA)formed in 2009 by counties throughout the state to work on collaborative, multi-county
projects-established rates after analysis of the market, risks to the County, and many other factors
including rates for different modalities of services such as:
• Outpatient services-both specialty mental health services(SMHS)and substance use disorder
(SUD)services under Drug Medi-Cal (DMC)
• Crisis stabilization services
• Inpatient psychiatric services
• 24-hour services(residential)
• Mobile crisis
• Inpatient psychiatric services
• Drug Medi-Cal Organized Delivery System(ODS)inpatient services
• Narcotic Treatment Program(NTP)services.
In addition to the changes in how subcontracted providers will be paid with the new FFS structure, some
organizational providers will be eligible for one-time payments for transitional optimization, based on
deliverables determined by DBH. These deliverables are listed in each contract's scope of work and the
providers may opt in during the first quarter of FY 2023-24. These one-time funds will help providers with
cashflow and will incentivize them to take prudent business actions necessary to be successful under the
CalAIM Payment Reform.
The recommended supersede agreements have updated contract language that removes the current
cost-based reimbursement structures and associated language along with removal of related cost
settlement language and replaces it with the required FFS payment structure and other associated language
so DBH will be compliant with CalAIM requirements.
The recommended action will provide flexibility with term deadlines and payment structures to maintain the
current service levels provided to the individuals served throughout the Behavioral Health System of Care.
County of Fresno Page 3 File Number.23-0495
File Number:23-0495
The agreements identified are currently in either their final year with a June 30, 2023 expiration date or are in
the fourth year of their contract with an expiration date of June 30, 2024.Approval of this recommended
action will allow for supersede agreements that will provide an additional one-year contract period and/or a
one-year possible extension period based upon satisfactory performance through June 30, 2025.
These recommended supersede agreement are due to insufficient time to complete the competitive bid
process for expiring agreements, complete resulting agreements, and amend all other necessary
agreements for Payment Reform due to the delays in receiving the rate information from the State. These
supersede agreements will allow the DBH additional time to ensure services are being delivered and
maintaining continuity of care for persons served in the community while we make this historic transition to a
new method of funding. The recommended actions will also allow the DBH time to analyze the effects of the
changes of both CalAIM requirements and Payment Reform on the DBH's subcontracted providers.
• Attachment A includes the information for 14 recommended supersede agreements to contracts
that are expiring either on June 30, 2023 or June 30, 2024 plus payment reform changes including:
contractor name,services provided, Board Agreement No. (including any related amendments), and
maximum compensation for FY 2023-24.
The requested agreements will become effective July 1,2023.
Recommended Action 1 c, a supersede agreement with the Fresno County Superintendent of Schools
(FCSS), includes modifications to the standard County boilerplate language. The modifications made were
needed for FCSS to ensure they abided by their restrictions and responsibilities as a public entity. The
modifications are outlined below and have been reviewed by County Counsel and County Risk departments
and include changes to the Term, Notices, Termination, Indemnity, Insurance, Data Security and Public
Records Articles within the recommended agreement.
Several agreements within the first recommended action include additional language within the modification
clause of the agreements that allows the DBH Director, or designee, the authority to make changes to the
agreement in order to accommodate changes in the law and/or to increase the rates during the course of
the agreement(s).Additionally, the Master Agreements within the first recommended action also include
language that grants authority to the DBH Director, or designee,to terminate the agreements with individual
providers with mutual consent of the DBH Director and the Contractor.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of this agenda item and related supersede agreements and
amendments at the May 17, 2023 meeting.
REFERENCE MATERIAL:
BAI#32 February 28, 2023
BAI#35, November 29, 2022
BAI#24, November 8, 2022
BAI#33,August 9, 2022
BAI#36, April 13, 2022
BAI #27, June 8, 2021
BAI #30, July 7, 2020
BAI#31.1,April 28, 2020
BAI#22, January 7, 2020
BAI#26,August 20, 2019
BAI#39, June 18, 2019
BAI#36, December 11, 2018
County of Fresno Page 4 File Number.23-0495
File Number:23-0495
BAI#33, December 11, 2018
BAI#28, December 11, 2018
BAI#32, October 23, 2018
BAI#33, October 9, 2018
BAI#39,August 7, 2018
BAI#45, July 10, 2018
BAI#33, June 12, 2018
BAI #9, June 5, 2018
BAI #68, June 5, 2018
BAI #18, May 1, 2018
BAI#34, November 14, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
Attachment A
Suspension of Competition
On file with Clerk-Agreement with CSBH
On file with Clerk-Agreement with FCSS
On file with Clerk-Agreement with Turning Point
On file with Clerk-Agreement with CSBH
On file with Clerk-Agreement with CYS, EPU and PC
On file with Clerk-Master Agreement for STRTP Services
On file with Clerk-Agreement with CSBH
On file with Clerk-Agreement with CYS
On file with Clerk-Agreement with PC
On file with Clerk-Agreement with JDT Consultants, Inc.
On file with Clerk-Master Agreement for Child Welfare Youth
On file with Clerk- Master Agreement for SRMH Services
On file with Clerk-Agreement with MHS
On file with Clerk-Master Agreement for Cultural Specific Services
CAO ANALYST:
Ronald Alexander
County of Fresno Page 5 File Number.23-0495
Agreement No. 23-281
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between
3 JDT Consultants, Inc., a California Corporation ("Contractor"), and the County of Fresno, a
4 political subdivision of the State of California ("County").
5 Recitals
6 A. The County, through its Department of Behavioral Health (DBH) is a Mental Health Plan
7 (MHP) and is in need of a Contractor to provide Therapeutic Behavioral Services (TBS) to
8 certain County Medi-Cal beneficiaries; and
9 B. Contractor is qualified and willing to provide such TBS pursuant to the terms and
10 conditions of the Agreement.
11 C. County entered into Agreement No. 18-699 with Contractor on December 11, 2018, and
12 an Amendment to said Agreement on November 8, 2022, collectively Agreement No. 22-506;
13 and
14 D. Changes to the agreement are necessary due the Department of Health Care Services'
15 implementation of California Advancing and Innovating Medi-Cal (CalAIM), which includes a
16 new billing structure that Contractors must utilize; and
17 E. This Agreement shall replace, restate, and supersede Agreement No. 22-506 in its
18 entirety.
19 The parties therefore agree as follows:
20 Article 1
21 Contractor's Services
22 1.1 Scope of Services. The Contractor shall perform all of the services provided in
23 Exhibit A to this Agreement, titled "Scope of Services."
24 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
25 able to perform all of the services provided in this Agreement.
26 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
27 applicable federal, state, and local laws and regulations in the performance of its obligations
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1
1 under this Agreement, including but not limited to workers compensation, labor, and
2 confidentiality laws and regulations.
3 Contractor shall provide services in conformance with all applicable State and Federal
4 statutes, regulations and subregulatory guidance, as from time to time amended, including but
5 not limited to:
6 (A) California Code of Regulations, Title 9;
7 (B) California Code of Regulations, Title 22;
8 (C) California Welfare and Institutions Code, Division 5;
9 (D) United States Code of Federal Regulations, Title 42, including but not limited to
10 Parts 438 and 455;
11 (E) United States Code of Federal Regulations, Title 45;
12 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable;
13 (G)Balanced Budget Act of 1997;
14 (H) Health Insurance Portability and Accountability Act (HIPAA); and
15 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory
16 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and
17 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of
18 County's, state or federal contracts governing services for persons served.
19 In the event any law, regulation, or guidance referred to in this section 1.3 is amended
20 during the term of this Agreement, the parties agree to comply with the amended authority as of
21 the effective date of such amendment without amending this Agreement.
22 Contractor recognizes that County operates its mental health programs under an
23 agreement with DHCS, and that under said agreement the State imposes certain requirements
24 on County and its subcontractors. Contractor shall adhere to all State requirements, including
25 those identified in Exhibit B, "Behavioral Health Requirements".
26 1.4 Meetings. Contractor shall participate in monthly, or as needed, workgroup meetings
27 consisting of staff from County's DBH to discuss service requirements, data reporting, training,
28 policies and procedures, overall program operations and any problems or foreseeable problems
2
1 that may arise. Contractor shall also participate in other County meetings, such as but not
2 limited to quality improvement meetings, provider meetings, Behavioral Health Board meetings,
3 bi-monthly contractor meetings, etc. Schedule for these meetings may change based on the
4 needs of the County.
5 1.5 Organizational Provider. Contractor shall maintain requirements as a Mental Health
6 Plan (MHP) organizational provider throughout the term of this Agreement, as described in
7 Article 16 of this Agreement. If for any reason, this status is not maintained, County may
8 terminate this Agreement pursuant to Article 7 of this Agreement.
9 1.6 Staffing. Contractor agrees that prior to providing services under the terms and
10 conditions of this Agreement, Contractor shall have staff hired and in place for program services
11 and operations or County may, in addition to other remedies it may have, suspend referrals or
12 terminate this Agreement, in accordance with Article 7 of this Agreement.
13 1.7 Credentialing and Recredentialing. Contractor and their respective staff must
14 follow the uniform process for credentialing and recredentialing of service providers established
15 by County, including disciplinary actions such as reducing, suspending, or terminating provider's
16 privileges. Failure to comply with specified requirements can result in suspension or termination
17 of an individual or provider.
18 Upon request, the Contractor must demonstrate to the County that each of its providers
19 are qualified in accordance with current legal, professional, and technical standards, and that
20 they are appropriately licensed, registered, waivered, and/or certified.
21 Contractor must not employ or subcontract with providers debarred, suspended or
22 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in
23 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set
24 forth in 42 C.F.R. §438.610. See Article 12 below.
25 Contractor is required to verify and document at a minimum every three years that each
26 network provider that delivers covered services continues to possess valid credentials, including
27 verification of each of the credentialing requirements as per the County's uniform process for
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1 credentialing and recredentialing. If any of the requirements are not up-to-date, updated
2 information should be obtained from network providers to complete the re-credentialing process.
3 1.8 Criminal Background Check. Contractor shall ensure that all providers and/or
4 subcontracted providers consent to a criminal background check, including fingerprinting to the
5 extent required under state law and 42 C.F.R. § 455.434(a). Contractor shall provide evidence
6 of completed consents when requested by the County, DHCS or the US Department of Health &
7 Human Services (US DHHS).
8 1.9 Guiding Principles. Contractor shall align programs, services, and practices with
9 the vision, mission, and guiding principles of the DBH, as further described in Exhibit C, "Fresno
10 County Department of Behavioral Health Guiding Principles of Care Delivery",.
11 1.10 Clinical Leadership. Contractor shall send to County upon execution of this
12 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their
13 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to
14 oversee services based on the level of care and program design presented herein shall be
15 included in this plan. A description and monitoring of this plan shall be provided.
16 1.11 Timely Access. It is the expectation of the County that Contractor provide timely
17 access to services that meet the State of California standards for care. Contractor shall track
18 timeliness of services to persons served and provide a monthly report showing the monitoring or
19 tracking tool that captures this data. County and Contractor shall meet to go over this monitoring
20 tool, as needed but at least on a monthly basis. County shall take corrective action if there is a
21 failure to comply by Contractor with timely access standards. Contractor shall also provide
22 tracking tools and measurements for effectiveness, efficiency, and persons served satisfaction
23 as further detailed in Exhibit A.
24 1.12 Electronic Health Record. Contractor may maintain its records in County's
25 electronic health record (EHR) system in accordance with Exhibit D, "Documentation Standards
26 for Person Served Records", as licenses become available. The person served record shall
27 begin with registration and intake, and include person served authorizations, assessments,
28 plans of care, and progress notes, as well as other documents as approved by County. County
4
1 shall be allowed to review records of all and any services provided. If Contractor determines to
2 maintain its records in the County's EHR, it shall provide County's DBH Director, or designee,
3 with a thirty (30) day notice. If at any time Contractor chooses not to maintain its records in the
4 County's EHR, it shall provide County's DBH Director, or designee, with thirty (30) days
5 advance written notice and Contractor will be responsible for obtaining its own system, at its
6 own cost, for electronic health records management.
7 Disclaimer
8 County makes no warranty or representation that information entered into the County's
9 DBH EHR system by Contractor will be accurate, adequate, or satisfactory for Contractor's own
10 purposes or that any information in Contractor's possession or control, or transmitted or
11 received by Contractor, is or will be secure from unauthorized access, viewing, use, disclosure,
12 or breach. Contractor is solely responsible for person served information entered by Contractor
13 into the County's DBH EHR system. Contractor agrees that all Private Health Information (PHI)
14 maintained by Contractor in County's DBH EHR system will be maintained in conformance with
15 all HIPAA laws, as stated in section 17.1, "Health Insurance Portability and Accountability Act."
16 1.13 Records. Contractor shall maintain records in accordance with Exhibit D,
17 "Documentation Standards for Client Records". All persons served's records shall be
18 maintained for a minimum of 10 years from the date of the end of this Agreement.
19 1.14 Access to Records. Contractor shall provide County with access to all
20 documentation of services provided under this Agreement for County's use in administering this
21 Agreement. Contractor shall allow County, CMS, the Office of the Inspector General, the
22 Controller General of the United States, and any other authorized Federal and State agencies to
23 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
24 records, documents, and the premises, equipment and facilities maintained by the Contractor
25 pertaining to such services at any time and as otherwise required under this Agreement.
26 1.15 Quality Improvement Activities and Participation. Contractor shall comply with
27 the County's ongoing comprehensive Quality Assessment and Performance Improvement
28 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established
5
1 outcomes by following structural and operational processes and activities that are consistent
2 with current practice standards.
3 Contractor shall participate in quality improvement (QI) activities, including clinical and
4 non-clinical performance improvement projects (PIPs), as requested by the County in relation to
5 State and Federal requirements and responsibilities, to improve health outcomes and
6 individuals' satisfaction over time. Other QI activities include quality assurance, collection and
7 submission of performance measures specified by the County, mechanisms to detect both
8 underutilization and overutilization of services, individual and system outcomes, utilization
9 management, utilization review, provider appeals, provider credentialing and re-credentialing,
10 and person served grievances. Contractor shall measure, monitor, and annually report to the
11 County its performance.
12 1.16 Rights of Persons Served. Contractor shall comply with applicable laws and
13 regulations relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal.
14 Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The Contractor shall
15 ensure that its subcontractors comply with all applicable patients' rights laws and regulations.
16 Article 2
17 Reporting
18 2.1 Reports. The Contractor shall submit the following reports:
19 (A) Outcome Reports
20 Contractor shall submit to County clinical program performance outcome reports,
21 as requested.
22 Outcome reports and outcome requirements are subject to change at County's
23 discretion. Contractor shall provide outcomes as stated in Exhibit A and E.
24 (B) Staffing Report
25 Contractor shall submit monthly staffing reports due by the 10th of each month
26 that identify all direct service and support staff by first and last name, applicable
27 licensure/certifications, and full-time hours worked to be used as a tracking tool to
28
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1 determine if Contractor's program is staffed according to the requirements of this
2 Agreement.
3 (C)Additional Reports
4 Contractor shall also furnish to County such statements, records, reports, data,
5 and other information as County may request pertaining to matters covered by this
6 Agreement. In the event that Contractor fails to provide such reports or other
7 information required hereunder, it shall be deemed sufficient cause for County to
8 withhold monthly payments until there is compliance. In addition, Contractor shall
9 provide written notification and explanation to County within five (5) days of any funds
10 received from another source to conduct the same services covered by this Agreement.
11 2.2 Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
12 California Department of Health Care Services (DHCS), or their designees, the right to review
13 and monitor records, programs, or procedures, at any time, in regard to persons served, as well
14 as the overall operation of Contractor's programs, in order to ensure compliance with the terms
15 and conditions of this Agreement.
16 Article 3
17 County's Responsibilities
18 3.1 The County shall provide oversight and collaborate with Contractor, other County
19 Departments and community agencies to help achieve program goals and outcomes. In addition
20 to contractor monitoring of program, oversight includes, but not limited to, coordination with
21 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
22 County shall participate in evaluating the progress of the overall program, levels of care
23 components, and the efficiency of collaboration with the Contractor staff and will be available to
24 Contractor for ongoing consultation.
25 County shall receive and analyze statistical outcome data from Contractor throughout
26 the term of contract on a monthly basis. County shall notify the Contractor when additional
27 participation is required. The performance outcome measurement process will not be limited to
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1 survey instruments but will also include, as appropriate, persons served and staff surveys, chart
2 reviews, and other methods of obtaining required information.
3 Article 4
4 Compensation, Invoices, and Payments
5 4.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
6 the performance of its services under this Agreement as described in Exhibit F to this
7 Agreement, titled "Compensation."
8 4.2 Specialty Mental Health Services Maximum Compensation. The maximum
9 compensation payable to the Contractor under this Agreement for the period of July 1, 2023
10 through June 30, 2024 for Specialty Mental Health Services is Four Million Eight Hundred Thirty
11 Thousand and No/100 Dollars ($4,830,000.00), which is not a guaranteed sum but shall be paid
12 only for services rendered and received. The maximum compensation payable to the Contractor
13 under this Agreement for the period of July 1, 2024 through June 30, 2025 for Specialty Mental
14 Health Services is Four Million Eight Hundred Thirty Thousand and No/100 Dollars
15 ($4,830,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
16 received.
17 4.3 Transition Optimization Funds. If Contractor opts to apply for transition
18 optimization funds, the maximum amount payable for transition optimization for the period of
19 July 1, 2023 through June 30, 2024 shall not exceed Two-Hundred Fifty Thousand and No/100
20 Dollars ($250,000.00) split among all current agreements between the Contractor and the
21 County for Medi-Cal billable specialty mental health and substance use disorder services as
22 further described in the Scope of Work/Services. All final invoices for transition optimization
23 funds shall be submitted by July 15, 2024. Invoices submitted thereafter, shall not be eligible for
24 payment.
25 4.4 Total Maximum Compensation. In no event shall the maximum contract amount for
26 all the services provided by the Contractor to County under the terms and conditions of this
27 Agreement be in excess of Nine Million Nine Hundred Ten Thousand and No/100 Dollars
28 ($9,910,000.00) during the entire term of this Agreement.
8
1 The Contractor acknowledges that the County is a local government entity and does so
2 with notice that the County's powers are limited by the California Constitution and by State law,
3 and with notice that the Contractor may receive compensation under this Agreement only for
4 services performed according to the terms of this Agreement and while this Agreement is in
5 effect, and subject to the maximum amount payable under this section. The Contractor further
6 acknowledges that County employees have no authority to pay the Contractor except as
7 expressly provided in this Agreement.
8 The Contractor will be compensated for performance of its services under this
9 Agreement as provided in this Article. The Contractor is not entitled to any compensation except
10 as expressly provided in this Agreement.
11 4.5 Rate Categories. The program service components for the Contractor(s) shall be
12 categorized under one or more of the following rate categories and as indicated on Exhibit F:
13 (A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
14 provide less than fifty percent (50%) of services in the field. In the field services are
15 those services that do not occur through telehealth and do not occur in designated sites
16 in which the Contractor is afforded regular access. Designated sites shall be identified by
17 the Contractor and approved by County's DBH Director, or designee, in writing.
18 (B) Field Based: Field based programs shall be defined as programs that provide
19 more than fifty percent (50%) of services in the field.
20 (C) Full-Service Partnership/Assisted Outpatient Therapy/Therapeutic Behavioral
21 Health Services (FSP/AOT/TBS): FSP/AOT/TBS programs shall provide services in
22 accordance with level of care standards and general requirements as described in
23 Exhibit A.
24 DBH shall continuously monitor the programs and analyze data to review accuracy of
25 rate categories assigned and may only reassign rate categories with the written agreement of
26 both parties pursuant to Article 24.
27 4.6 Specialty Mental Health Services Claiming. Contractor shall enter claims data into
28 the County's billing and transactional database system by the fifteenth (15t") of every month for
9
1 actual services rendered in the previous month. Contractor shall use Current Procedural
2 Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as
3 provided in the DHCS Billing Manual available at
4 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
5 amended.
6 Claims shall be complete and accurate and must include all required information
7 regarding the claimed services. Claims data entry into the County's electronic health record
8 system shall be the responsibility of Contractor. County shall monitor the volume of services,
9 billing amounts and service types entered into County's electronic health record/information
10 system. Any and all audit exceptions resulting from the provision and reporting of specialty
11 mental health services by Contractor shall be the sole responsibility of Contractor. Contractor
12 will comply with all applicable policies, procedures, directives, and guidelines regarding the use
13 of County's electronic health record/information system.
14 Contractor must provide all necessary data to allow County to bill Medi-Cal, and any
15 other third-party source, for services and meet State and Federal reporting requirements. The
16 necessary data can be provided by a variety of means, including but not limited to: 1) direct data
17 entry into County's electronic health record/information system; 2) providing an electronic file
18 compatible with County's electronic health record/information system; or 3) integration between
19 County's electronic health record/information system and Contractor's information system(s).
20 Contractor shall maximize the Federal Financial Participation (FFP) reimbursement by claiming
21 all possible Medi-Cal services and correcting denied services for resubmission as needed.
22 4.7 Applicable Fees. Contractor shall not charge any persons served or third-party
23 payers any fee for service unless directed to do so by the County's DBH Director, or designee,
24 at the time the individual is referred for services. When directed to charge for services,
25 Contractor shall use the uniform billing and collection guidelines prescribed by DHCS.
26 Contractor will perform eligibility and financial determinations, in accordance with DHCS'
27 Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless directed
28 otherwise by the County's DBH Director, or designee.
10
1 Contractor shall not submit a claim to, or demand or otherwise collect reimbursement
2 from, the person served or persons acting on behalf of the person served for any specialty
3 mental health or related administrative services provided under this Contract, except to collect
4 other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9,
5 §1810.365(c)
6 The Contractor must not bill persons served, for covered services, any amount greater
7 than would be owed if the County provided the services directly as per and otherwise not bill
8 persons served as set forth in 42 C.F.R. § 438.106.
9 If a person served has dual coverage, such as other health coverage (OHC) or Federal
10 Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
11 have validation of claiming with no response for ninety (90) days after the claim was mailed
12 before the service can be entered into the County's electronic health record/information system.
13 Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
14 pay in each month. A copy of explanation of benefits or CMS 1500 form is required as
15 documentation. Contractor must comply with all laws and regulations governing the Federal
16 Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42
17 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers
18 for Medicare and Medicaid Services as they relate to participation, coverage and claiming
19 reimbursement. Contractor will be responsible for compliance as of the effective date of each
20 Federal, State or local law or regulation specified.
21 4.8 Invoices. The Contractor shall submit monthly invoices, in arrears by the fifteenth
22 (15t") day of each month, in the format directed by the County. The Contractor shall submit
23 invoices electronically to: 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh-
24 invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with
25 a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH Director,
26 or designee, if an invoice is incorrect or is otherwise not in proper form or substance, County's
27 DBH Director, or designee, shall have the right to withhold payment as to only the portion of the
28 invoice that is incorrect or improper after five (5) days prior notice to Contractor. Contractor
11
1 agrees to continue to provide services for a period of ninety (90) days after notification of an
2 incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not corrected
3 to County satisfaction, County's DBH Director, or designee, may elect to terminate this
4 Agreement, pursuant to the termination provisions stated in Article 7 of this Agreement.
5 4.9 Specialty Mental Health Services Claimable Services. For claimable services,
6 invoices shall be based on claims entered into the County's billing and transactional database
7 system for the prior month.
8 Monthly payments for claimed services shall only be based on the units of time assigned
9 to each CPT or HCPCS code entered in the County's billing and transactional database
10 multiplied by the practitioner service rates in Exhibit F.
11 County's payments to Contractor for performance of claimed services are provisional
12 and subject to adjustment until the completion of all settlement activities. County's adjustments
13 to provisional payments for claimed services shall be based on the terms, conditions, and
14 limitations of this Agreement or the reasons for recoupment set forth in Article 4 and 13.
15 Any claimable services submitted beyond six (6) months from the month of service may
16 be ineligible for payment.
17 4.10 Corrective Action Plans. Contractors shall enter services into the County's billing
18 and transactional database and submit invoices in accordance with the deadlines listed above
19 and information shall be accurate. Failure to meet the requirements set forth above will result in
20 a corrective action plan at the discretion of the County's DBH Director, or designee, and may
21 result in financial penalties or termination of agreement per Article 7.
22 4.11 Payment. Payments shall be made by County to Contractor in arrears, for services
23 provided during the preceding month, within forty-five (45) days after the date of receipt,
24 verification, and approval by County. All final invoices and/or any final budget modification
25 requests shall be submitted by Contractor within sixty (60) days following the final month of
26 service for which payment is claimed. No action shall be taken by County on claims submitted
27 beyond the sixty (60) day closeout period. Any compensation which is not expended by
28
12
1 Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to
2 County.
3 4.12 Specialty Mental Health Services Payments. Payment shall be made upon
4 certification and other proof satisfactory to County that services have actually been performed
5 by Contractor as specified in this Agreement and/or after receipt and verification of actual
6 services provided.
7 4.13 Recoupments and Audits. County shall recapture from Contractor the value of any
8 services or other expenditures determined to be ineligible based on the County or State
9 monitoring results. The County reserves the right to enter into a repayment agreement with
10 Contractor, with total monthly payments not to exceed twelve (12) months from the date of the
11 repayment agreement, to recover the amount of funds to be recouped. The County has the
12 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of
13 the repayment agreement. The repayment agreement may be made with the signed written
14 approval of County's DBH Director, or designee, and respective Contractor through a
15 repayment agreement. The monthly repayment amounts may be netted against the Contractor's
16 monthly billing for services rendered during the month, or the County may, in its sole discretion,
17 forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
18 and County may seek requital from any other means, including, but not limited to, a separate
19 contract or agreement with Contractor.
20 Contractor shall be held financially liable for any and all future disallowances/audit
21 exceptions due to Contractor's deficiency discovered through the State audit process and
22 County utilization review for services provided during the course of this Agreement. At County's
23 election, the disallowed amount will be remitted within forty-five (45) days to County upon
24 notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
25 receive reimbursement for any units of services rendered that are disallowed or denied by the
26 Fresno County MHP utilization review process or through the State of California DHCS audit
27 and review process, cost report audit settlement if applicable, for Medi-Cal eligible beneficiaries.
28 4.14 Incidental Expenses. The Contractor is solely responsible for all of its costs and
13
1 expenses that are not specified as payable by the County under this Agreement. If Contractor
2 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for
3 further compensation.
4 4.15 Restrictions and Limitations. This Agreement shall be subject to any restrictions,
5 limitations, and/or conditions imposed by County or state or federal funding sources that may in
6 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also
7 contingent upon sufficient funds being made available by County, state, or federal funding
8 sources for the term of the Agreement. If the federal or state governments reduce financial
9 participation in the Medi-Cal program, County agrees to meet with Contractor to discuss
10 renegotiating the services required by this Agreement.
11 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
12 over and is not available for services provided in subsequent years.
13 In the event that funding for these services is delayed by the State Controller, County
14 may defer payments to Contractor. The amount of the deferred payment shall not exceed the
15 amount of funding delayed by the State Controller to the County. The period of time of the
16 deferral by County shall not exceed the period of time of the State Controller's delay of payment
17 to County plus forty-five (45) days.
18 4.16 Additional Financial Requirements. County has the right to monitor the
19 performance of this Agreement to ensure the accuracy of claims for reimbursement and
20 compliance with all applicable laws and regulations.
21 Contractor must comply with the False Claims Act employee training and policy
22 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
23 Department of Health and Human Services may specify.
24 Contractor agrees that no part of any federal funds provided under this Agreement shall
25 be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
26 Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as from
27 time to time amended.
28
14
1 Federal Financial Participation is not available for any amount furnished to an Excluded
2 individual or entity, or at the direction of a physician during the period of exclusion when the
3 person providing the service knew or had reason to know of the exclusion, or to an individual or
4 entity when the County failed to suspend payments during an investigation of a credible
5 allegation of fraud [42 U.S.C. section 1396b(i)(2)].
6 Contractor must maintain financial records for a minimum period of ten (10) years or until
7 any dispute, audit or inspection is resolved, whichever is later. Contractor will be responsible for
8 any disallowances related to inadequate documentation.
9 4.17 Contractor Prohibited from Redirection of Contracted Funds. Contractor may
10 not redirect or transfer funds from one funded program to another funded program under which
11 Contractor provides services pursuant to this Agreement except through a duly executed
12 amendment to this Agreement.
13 Contractor may not charge services delivered to an eligible person served under one
14 funded program to another funded program unless the person served is also eligible for services
15 under the second funded program.
16 4.18 Financial Audit Report Requirements for Pass-Through Entities. If County
17 determines that Contractor is a "subrecipient" (also known as a "pass-through entity") as defined
18 in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the applicable cost
19 principles and administrative requirements including claims for payment or reimbursement by
20 County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. Contractor
21 shall observe and comply with all applicable financial audit report requirements and standards.
22 Financial audit reports must contain a separate schedule that identifies all funds included
23 in the audit that are received from or passed through the County. County programs must be
24 identified by Agreement number, Agreement amount, Agreement period, and the amount
25 expended during the fiscal year by funding source.
26 Contractor will provide a financial audit report including all attachments to the report and
27 the management letter and corresponding response within six months of the end of the audit
28
15
1 year to the County's DBH Director, or designee. The County's Director, or designee is
2 responsible for providing the audit report to the County Auditor.
3 Contractor must submit any required corrective action plan to the County simultaneously
4 with the audit report or as soon thereafter as it is available. The County shall monitor
5 implementation of the corrective action plan as it pertains to services provided pursuant to this
6 Agreement.
7 Article 5
8 Term of Agreement
9 5.1 Term. This Agreement is effective on July 1, 2023 and terminates on June 30, 2024
10 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension,"
11 below.
12 5.2 Extension. The term of this Agreement may be extended for no more than a one-
13 year period only upon written approval of both parties at least thirty (30) days before the first day
14 of the one-year extension period. The County's DBH Director, or designee, is authorized to sign
15 the written approval on behalf of the County based on the Contractor's satisfactory
16 performance. The extension of this Agreement by the County is not a waiver or compromise of
17 any default or breach of this Agreement by the Contractor existing at the time of the extension
18 whether or not known to the County.
19 Article 6
20 Notices
21 6.1 Contact Information. The persons and their addresses having authority to give and
22 receive notices provided for or permitted under this Agreement include the following:
23
For the County:
24 Director
County of Fresno
25 1925 E. Dakota Avenue
Fresno, CA 93726
26
For the Contractor:
27 Jana D. Todd, LCSW
JDT Consultants, Inc.
28 4205 West Figarden Drive
Fresno, CA 93722
16
1
2 6.2 Change of Contact Information. Either party may change the information in section
3 6.1 by giving notice as provided in section 6.3.
4 6.3 Method of Delivery. Each notice between the County and the Contractor provided
5 for or permitted under this Agreement must be in writing, state that it is a notice provided under
6 this Agreement, and be delivered either by personal service, by first-class United States mail, by
7 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
8 Document Format (PDF) document attached to an email.
9 (A) A notice delivered by personal service is effective upon service to the recipient.
10 (B) A notice delivered by first-class United States mail is effective three (3) County
11 business days after deposit in the United States mail, postage prepaid, addressed to the
12 recipient.
13 (C)A notice delivered by an overnight commercial courier service is effective one (1)
14 County business day after deposit with the overnight commercial courier service,
15 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
16 the recipient.
17 6.4 Claims Presentation. For all claims arising from or related to this Agreement,
18 nothing in this Agreement establishes, waives, or modifies any claims presentation
19 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
20 of Title 1 of the Government Code, beginning with section 810).
21 6.5 Notification of Changes. Contractor shall notify County in writing of any change in
22 organizational name, Head of Service or principal business at least fifteen (15) business days in
23 advance of the change. Contractor shall notify County of a change of service location at least
24 six (6) months in advance to allow County sufficient time to comply with site certification
25 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing
26 by the County, and no further amendment of the Agreement shall be necessary provided that
27 such change of address does not conflict with any other provisions of this Agreement.
28
17
1 Contractor must immediately notify County of a change in ownership, organizational
2 status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
3 services in a and in no event more than fifteen (15) days of the change.
4 Article 7
5 Termination and Suspension
6 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
7 contingent on the approval of funds by the appropriating government agency. If sufficient funds
8 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
9 Contractor, may:
10 (A) Modify the services provided by the Contractor under this Agreement; or
11 (B) Terminate this Agreement.
12 7.2 Termination for Breach.
13 (A) Upon determining that a breach (as defined in paragraph (C) below) has
14 occurred, the County may give written notice of the breach to the Contractor. The written
15 notice may suspend performance under this Agreement and must provide at least thirty
16 (30) days for the Contractor to cure the breach.
17 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
18 time stated in the written notice, the County may terminate this Agreement immediately.
19 (C) For purposes of this section, a breach occurs when, in the determination of the
20 County, the Contractor has:
21 (1) Obtained or used funds illegally or improperly;
22 (2) Failed to comply with any part of this Agreement;
23 (3) Submitted a substantially incorrect or incomplete report to the County; or
24 (4) Improperly performed any of its obligations under this Agreement.
25 7.3 Termination without Cause. In circumstances other than those set forth above, the
26 County may terminate this Agreement by giving at least thirty (30) days advance written notice
27 to the Contractor.
28
18
1 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
2 under this Article 7 is without penalty to or further obligation of the County.
3 7.5 County's Rights upon Termination. Upon termination for breach under this Article
4 7, the County may demand repayment by the Contractor of any monies disbursed to the
5 Contractor under this Agreement that, in the County's sole judgment, were not expended in
6 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
7 demand. This section survives the termination of this Agreement.
8 In the event this Agreement is terminated, Contractor shall be entitled to compensation
9 for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
10 and conditions of this Agreement through and including the effective date of termination. This
11 provision shall not limit or reduce any damages owed to the County due to a breach of this
12 Agreement by Contractor.
13 Article 8
14 Informing Materials for Persons Served
15 8.1 Basic Information Requirements. Contractor shall provide information in a manner
16 and format that is easily understood and readily accessible to the persons served (42 C.F.R. §
17 438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
18 understood language, format, and alternative formats that take into consideration the special
19 needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor shall inform the
20 persons served that information is available in alternate formats and how to access those
21 formats in compliance with 42 C.F.R. § 438.10.
22 Contractor shall provide the required information in this section to each individual
23 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental
24 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, §
25 1810.360(e)).
26 Contractor shall utilize the County's website that provides the content required in this
27 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth
28 in 42 C.F.R. § 438.10.
19
1 Contractor shall use the DHCS/County-developed beneficiary handbook and persons
2 served notices.(42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)).
3 8.2 Electronic Submission. Persons served information required in this section may
4 only be provided electronically by the Contractor if all of the following conditions are met:
5 (A) The format is readily accessible;
6 (B) The information is placed in a location on the Contractor's website that is
7 prominent and readily accessible;
8 (C)The information is provided in an electronic form which can be electronically
9 retained and printed;
10 (D)The information is consistent with the content and language requirements of this
11 Agreement;
12 (E) The individual is informed that the information is available in paper form without
13 charge upon request and the Contractor shall provide it upon request within five (5)
14 business days (42 C.F.R. § 438.10(c)(6)).
15 8.3 Language and Format. Contractor shall provide all written materials, including
16 taglines, for persons served or potential persons served in a font size no smaller than twelve
17 (12) point (42 C.F.R. 438.10(d)(6)(ii)).
18 Contractor shall ensure its written materials that are critical to obtaining services are
19 available in alternative formats, upon request of the person served or potential person served at
20 no cost.
21 Contractor shall make its written materials that are critical to obtaining services,
22 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance
23 notices, denial and termination notices, and the Contractor's mental health education materials,
24 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)).
25 (A) Contractor shall notify persons served, prospective persons served, and
26 members of the public that written translation is available in prevalent languages free of
27 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst.
28 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)).
20
1 Contractor shall make auxiliary aids and services available upon request and free of
2 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
3 Contractor shall make oral interpretation and auxiliary aids, such as Teletypewriter
4 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free
5 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5).
6 Taglines for written materials critical to obtaining services must be printed in a conspicuously
7 visible font size, no smaller than twelve (12) point font.
8 8.4 Beneficiary Informing Materials. Each person served must receive and have
9 access to the beneficiary informing materials upon request by the individual and when first
10 receiving SMHS from Contractor. Beneficiary informing materials include but are not limited to:
11 (A) Consumer Handbook
12 (B) Provider Directory
13 (C) Grievance form
14 (D)Appeal/Expedited Appeal form
15 (E) Advance Directives brochure
16 (F) Change of Provider form
17 (G)Suggestions brochure
18 (H) Notice of Privacy Practices
19 (1) Notices of Adverse Benefit Determination (NOABDs — Including Denial and
20 Termination notices)
21 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving
22 individuals under the age of 21)
23 (K) Contractor shall ensure beneficiary informing material are displayed in the
24 threshold languages of Fresno County at all service sites, including but not limited to the
25 following:
26 (1) Consumer Handbook
27 (2) Provider Directory
28 (3) Grievance form
21
1 (4) Appeal/Expedited Appeal form
2 (5) Advance Directives brochure
3 (6) Change of Provider form
4 (7) Suggestions brochure
5 All beneficiary informing written materials will use easily understood language and
6 format (i.e. material written and formatted at a 6th grade reading level), and will use a font size
7 no smaller than 12 point. All beneficiary informing written materials shall inform beneficiaries of
8 the availability of information in alternative formats and how to make a request for an alternative
9 format. Inventory and maintenance of all beneficiary informing materials will be maintained by
10 the County's DBH Managed Care Division. Contractor will ensure that its written materials
11 include taglines or that an additional taglines document is available.
12 8.5 Beneficiary Handbook. Contractor shall provide each persons served with a
13 beneficiary handbook at the time the individual first accesses services and thereafter upon
14 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
15 business days after receiving notice of enrollment.
16 Contractor shall give each individual notice of any significant change to the information
17 contained in the beneficiary handbook at least thirty (30) days before the intended effective date
18 of change as per BHIN 22-060.
19 8.6 Accessibility. Required informing materials must be electronically available on
20 Contractor's website and must be physically available at the Contractor's facility lobby for
21 individuals' access.
22 Informing materials must be made available upon request, at no cost, in alternate
23 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and
24 American Sign Language) and must be provided to persons served within five (5) business
25 days. Large print materials shall be in a minimum of eighteen (18) point font size.
26 Informing materials will be considered provided to the individual if Contractor does one
27 or more of the following:
28
22
1 (A) Mails a printed copy of the information to the persons served's mailing address
2 before the individual receives their first specialty mental health service;
3 (B) Mails a printed copy of the information upon the individual's request to their
4 mailing address;
5 (C) Provides the information by email after obtaining the persons served's agreement
6 to receive the information by email;
7 (D) Posts the information on the Contractor's website and advises the person served
8 in paper or electronic form that the information is available on the internet and includes
9 applicable internet addresses, provided that individuals with disabilities who cannot
10 access this information online are provided auxiliary aids and services upon request and
11 at no cost; or,
12 (E) Provides the information by any other method that can reasonably be expected
13 to result in the person served receiving that information. If Contractor provides informing
14 materials in person, when the individual first receives specialty mental health services,
15 the date and method of delivery shall be documented in the persons served's file.
16 8.7 Provider Directory. Contractor must follow the County's provider directory policy, in
17 compliance with MHSUDS IN 18-020.
18 Contractor must make available to persons served, in paper form upon request and
19 electronic form, specified information about the County provider network as per 42 C.F.R. §
20 438.10(h). The most current provider directory is electronically available on the County website
21 and is updated by the County no later than thirty (30) calendar days after information is received
22 to update provider information. A paper provider directory must be updated at least monthly as
23 set forth in 42 C.F.R. § 438.10(h)(3)(i).
24 Any changes to information published in the provider directory must be reported to the
25 County within two (2) weeks of the change.
26 Contractor will only need to report changes/updates to the provider directory for
27 licensed, waivered, or registered mental health providers.
28
23
1 Article 9
2 Independent Contractor
3 9.1 Status. In performing under this Agreement, the Contractor, including its officers,
4 agents, employees, and volunteers, is at all times acting and performing as an independent
5 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
6 venturer, partner, or associate of the County.
7 9.2 Verifying Performance. The County has no right to control, supervise, or direct the
8 manner or method of the Contractor's performance under this Agreement, but the County may
9 verify that the Contractor is performing according to the terms of this Agreement.
10 9.3 Benefits. Because of its status as an independent contractor, the Contractor has no
11 right to employment rights or benefits available to County employees. The Contractor is solely
12 responsible for providing to its own employees all employee benefits required by law. The
13 Contractor shall save the County harmless from all matters relating to the payment of
14 Contractor's employees, including compliance with Social Security withholding and all related
15 regulations.
16 9.4 Services to Others. The parties acknowledge that, during the term of this
17 Agreement, the Contractor may provide services to others unrelated to the County.
18 9.5 Operating Costs. Contractor shall provide all personnel, supplies, and operating
19 expenses of any kind required for the performance of this Agreement.
20 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this
21 Agreement, the Contractor will be performing hiring, training, and credentialing of staff, and
22 County will be performing additional staff credentialing to ensure compliance with State and
23 Federal regulations.
24 9.7 Subcontracts. Contractor shall obtain written approval from County's Department of
25 Behavioral Health Director, or designee, before subcontracting any of the services delivered
26 under this Agreement. County's Department of Behavioral Health Director, or designee, retains
27 the right to approve or reject any request for subcontracting services. Any transferee, assignee,
28 or subcontractor will be subject to all applicable provisions of this Agreement, and all applicable
24
1 State and Federal regulations. Contractor shall be held primarily responsible by County for the
2 performance of any transferee, assignee, or subcontractor unless otherwise expressly agreed to
3 in writing by County's Department of Behavioral Health Director, or designee. The use of
4 subcontractors by Contractor shall not entitle Contractor to any additional compensation that is
5 provided for under this Agreement.
6 Contractor shall remain legally responsible for the performance of all terms and
7 conditions of this Agreement, including, without limitation, all SMHS provided by third parties
8 under subcontracts, whether approved by the County or not.
9
10 Article 10
11 Indemnity and Defense
12 10.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
13 County (including its officers, agents, employees, and volunteers) against all claims, demands,
14 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
15 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
16 the performance or failure to perform by the Contractor (or any of its officers, agents,
17 subcontractors, or employees) under this Agreement. The County may conduct or participate in
18 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
19 defend the County.
20 10.2 Survival. This Article 10 survives the termination of this Agreement.
21 Article 11
22 Insurance
23 11.1 The Contractor shall comply with all the insurance requirements in Exhibit G to this
24 Agreement.
25 Article 12
26 Assurances
27 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal
28 Health Care Program.
25
1 (A) In entering into this Agreement, Contractor certifies that it is not excluded from
2 participation in Federal Health Care Programs under either Section 1128 or 1128A of the
3 Social Security Act. Failure to so certify will render all provisions of this Agreement null
4 and void and may result in the immediate termination of this Agreement.
5 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not
6 employ or subcontract with providers or have other relationships with providers excluded
7 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
8 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct initial
9 and monthly exclusion and suspension searches of the following databases and provide
10 evidence of these completed searches when requested by County, DHCS or the US
11 Department of Health and Human Services (DHHS):
12 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
13 Individuals/Entities (LEIE) Federal Exclusions
14 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
15 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
16 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration
17 System (NPPES)
18 (4) any other database required by DHCS or US DHHS.
19 (C) In entering into this Agreement, Contractor certifies, that Contractor does not
20 employ staff or individual contractors/vendors that are on the Social Security
21 Administration's Death Master File. Contractor shall check the database prior to
22 employing staff or individual contractors/vendors and provide evidence of these
23 completed searches when requested by the County, DHCS or the US DHHS.
24 (D) Contractor is required to notify County immediately if Contractor becomes aware
25 of any information that may indicate their (including employees/staff and individual
26 contractors/vendors) potential placement on an exclusions list.
27 (E) Contractor shall screen and periodically revalidate all network providers in
28 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
26
1 (F) Contractor must confirm the identity and determine the exclusion status of all its
2 providers, as well as any person with an ownership or control interest, or who is an
3 agent or managing employee of the contracted agency through routine checks of federal
4 and state databases. This includes the Social Security Administration's Death Master
5 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and
6 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
7 455.436.
8 (G) If Contractor finds a provider that is excluded, it must promptly notify the County
9 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
10 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded
11 provider as an overpayment, and any such inappropriate payments may be subject to
12 recovery.
13 Article 13
14 Inspections, Audits, and Public Records
15 13.1 Inspection of Documents. The Contractor shall make available to the County, and
16 the County may examine at any time during business hours and as often as the County deems
17 necessary, all of the Contractor's records and data with respect to the matters covered by this
18 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
19 request by the County, permit the County to audit and inspect all of such records and data to
20 ensure the Contractor's compliance with the terms of this Agreement.
21 13.2 State Audit Requirements. If the compensation to be paid by the County under this
22 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
23 California State Auditor, as provided in Government Code section 8546.7, for a period of three
24 years after final payment under this Agreement. This section survives the termination of this
25 Agreement.
26 13.3 Internal Auditing. Contractors of sufficient size as determined by County shall
27 institute and conduct a Quality Assurance Process for all services provided hereunder. Said
28
27
1 process shall include at a minimum a system for verifying that all services provided and claimed
2 for reimbursement shall meet SMHS definitions and be documented accurately.
3 In addition, Contractors with medication prescribing authority shall adhere to County's
4 medication monitoring review practices. Contractor shall provide County with notification and a
5 summary of any internal audit exceptions and the specific corrective actions taken to sufficiently
6 reduce the errors that are discovered through Contractor's internal audit process. Contractor
7 shall provide this notification and summary to County as requested by the County.
8 13.4 Confidentiality in Audit Process. Contractor and County mutually agree to
9 maintain the confidentiality of Contractor's records and information of persons served, in
10 compliance with all applicable State and Federal statutes and regulations, including but not
11 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall
12 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable
13 statutes.
14 Contractor's fiscal records shall contain sufficient data to enable auditors to perform a
15 complete audit and shall be maintained in conformance with standard procedures and
16 accounting principles.
17 Contractor's records shall be maintained as required by DBH and DHCS on forms
18 furnished by DHCS or the County. All statistical data or information requested by the County's
19 DBH Director, or designee, shall be provided by the Contractor in a complete and timely
20 manner.
21 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor files to
22 ensure appropriate clinical documentation, high quality service provision and compliance with
23 applicable federal, state and county regulations.
24 Such audits may result in requirements for Contractor to reimburse County for services
25 previously paid in the following circumstances:
26 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation
27 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
28 section 14107.11, subdivision (d).
28
1 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the Medicare
2 Managed Care Manual available at https://www.cros.gov/Regulations-and-
3 Guidance/Guidance/Manuals
4 (B) Overpayment of Contractor by County due to errors in claiming or
5 documentation.
6 (C) Other reasons specified in the SMHS Reasons for Recoupment document
7 released annually by DHCS and posted on the DHCS BHIN website.
8 Contractor shall reimburse County for all overpayments identified by Contractor, County,
9 and/or state or federal oversight agencies as an audit exception within the timeframes required
10 by law or Country or state or federal agency. Funds owed to County will be due within forty-five
11 (45) days of notification by County, or County shall withhold future payments until all excess
12 funds have been recouped by means of an offset against any payments then or thereafter owing
13 to County under this or any other Agreement between the County and Contractor.
14 13.6 Cooperation with Audits. Contractor shall cooperate with County in any review
15 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This
16 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits.
17 In addition, Contractor shall comply with all requests for any documentation or files
18 including, but not limited to, files for persons served.
19 Contractor shall notify the County of any scheduled or unscheduled external evaluation
20 or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
21 all parts of external review processes.
22 Contractor shall allow inspection, evaluation and audit of its records, documents and
23 facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
24 has been notified that an audit or investigation of this Agreement has been commenced, until
25 such time as the matter under audit or investigation has been resolved, including the exhaustion
26 of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and 438.2301(3)(i-iii).
27 13.7 Single Audit Clause. If Contractor expends Seven Hundred Fifty Thousand and
28 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, Contractor
29
1 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
2 Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. Contractor shall
3 submit said audit and management letter to County. The audit must include a statement of
4 findings or a statement that there were no findings. If there were negative findings, Contractor
5 must include a corrective action plan signed by an authorized individual. Contractor agrees to
6 take action to correct any material non-compliance or weakness found as a result of such audit.
7 Such audit shall be delivered to County's DBH Finance Division for review within nine (9)
8 months of the end of any fiscal year in which funds were expended and/or received for the
9 program. Failure to perform the requisite audit functions as required by this Agreement may
10 result in County performing the necessary audit tasks, or at County's option, contracting with a
11 public accountant to perform said audit, or may result in the inability of County to enter into
12 future agreements with Contractor. All audit costs related to this Agreement are the sole
13 responsibility of Contractor.
14 A single audit report is not applicable if Contractor's Federal contracts do not exceed the
15 Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractor's
16 only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
17 must be performed and a program audit report with management letter shall be submitted by
18 Contractor to County as a minimum requirement to attest to Contractor solvency. Said audit
19 report shall be delivered to County's DBH Finance Division for review no later than nine (9)
20 months after the close of the fiscal year in which the funds supplied through this Agreement are
21 expended. Failure to comply with this Act may result in County performing the necessary audit
22 tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
23 this Agreement are the sole responsibility of Contractor who agrees to take corrective action to
24 eliminate any material noncompliance or weakness found as a result of such audit. Audit work
25 performed by County under this paragraph shall be billed to Contractor at County cost, as
26 determined by County's Auditor-Controller/Treasurer-Tax Collector.
27 Contractor shall make available all records and accounts for inspection by County, the
28 State of California, if applicable, the Controller General of the United States, the Federal Grantor
30
1 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
2 least three (3) years following final payment under this Agreement or the closure of all other
3 pending matters, whichever is later.
4 13.8 Public Records. The County is not limited in any manner with respect to its public
5 disclosure of this Agreement or any record or data that the Contractor may provide to the
6 County. The County's public disclosure of this Agreement or any record or data that the
7 Contractor may provide to the County may include but is not limited to the following:
8 (A) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose this Agreement to the public or such governmental
10 agency.
11 (B) The County may voluntarily, or upon request by any member of the public or
12 governmental agency, disclose to the public or such governmental agency any record or
13 data that the Contractor may provide to the County, unless such disclosure is prohibited
14 by court order.
15 (C)This Agreement, and any record or data that the Contractor may provide to the
16 County, is subject to public disclosure under the Ralph M. Brown Act (California
17 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
18 (D)This Agreement, and any record or data that the Contractor may provide to the
19 County, is subject to public disclosure as a public record under the California Public
20 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
21 with section 6250) ("CPRA").
22 (E) This Agreement, and any record or data that the Contractor may provide to the
23 County, is subject to public disclosure as information concerning the conduct of the
24 people's business of the State of California under California Constitution, Article 1,
25 section 3, subdivision (b).
26 (F) Any marking of confidentiality or restricted access upon or otherwise made with
27 respect to any record or data that the Contractor may provide to the County shall be
28
31
1 disregarded and have no effect on the County's right or duty to disclose to the public or
2 governmental agency any such record or data.
3 13.9 Public Records Act Requests. If the County receives a written or oral request
4 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
5 and which the County has a right, under any provision of this Agreement or applicable law, to
6 possess or control, then the County may demand, in writing, that the Contractor deliver to the
7 County, for purposes of public disclosure, the requested records that may be in the possession
8 or control of the Contractor. Within five business days after the County's demand, the
9 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
10 possession or control, together with a written statement that the Contractor, after conducting a
11 diligent search, has produced all requested records that are in the Contractor's possession or
12 control, or (b) provide to the County a written statement that the Contractor, after conducting a
13 diligent search, does not possess or control any of the requested records. The Contractor shall
14 cooperate with the County with respect to any County demand for such records. If the
15 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
16 CPRA or other applicable law, it must deliver the record or data to the County and assert the
17 exemption by citation to specific legal authority within the written statement that it provides to
18 the County under this section. The Contractor's assertion of any exemption from disclosure is
19 not binding on the County, but the County will give at least 10 days' advance written notice to
20 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
21 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
22 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
23 failure to produce any such records, or failure to cooperate with the County with respect to any
24 County demand for any such records.
25 Article 14
26 Right to Monitor
27 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of
28 California or any subdivision or appointee thereof, including the Auditor General, shall have
32
1 absolute right to review and audit all records, books, papers, documents, corporate minutes,
2 financial records, staff information, records of persons served, other pertinent items as
3 requested, and shall have absolute right to monitor the performance of Contractor in the delivery
4 of services provided under this Agreement. Full cooperation shall be given by the Contractor in
5 any auditing or monitoring conducted, according to this agreement.
6 14.2 Accessibility. Contractor shall make all of its premises, physical facilities,
7 equipment, books, records, documents, agreements, computers, or other electronic systems
8 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished
9 under the terms of this Agreement, or determinations of amounts payable available at any time
10 for inspection, examination, or copying by County, the State of California or any subdivision or
11 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of
12 Inspector General, the United States Controller General, or their designees, and other
13 authorized federal and state agencies. This audit right will exist for at least ten years from the
14 final date of the Agreement period or in the event the Contractor has been notified that an audit
15 or investigation of this Agreement has commenced, until such time as the matter under audit or
16 investigation has been resolved, including the exhaustion of all legal remedies, whichever is
17 later (42 CFR §438.230(c)1(3)(I)-(ii)).
18 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
19 evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud or
20 similar risk. The Department's inspection shall occur at the Contractor's place of business,
21 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)).
22 14.3 Cooperation. Contractor shall cooperate with County in the implementation,
23 monitoring and evaluation of this Agreement and comply with any and all reporting requirements
24 established by County. Should County identify an issue or receive notification of a complaint or
25 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request
26 information from Contractor to ensure compliance with laws, regulations, and requirements, as
27 applicable.
28
33
1 14.4 Probationary Status. County reserves the right to place Contractor on probationary
2 status, as referenced in the Probationary Status Article, should Contractor fail to meet
3 performance requirements; including, but not limited to violations such as high disallowance
4 rates, failure to report incidents and changes as contractually required, failure to correct issues,
5 inappropriate invoicing, untimely and inaccurate data entry, not meeting performance outcomes
6 expectations, and violations issued directly from the State. Additionally, Contractor may be
7 subject to Probationary Status or termination if agreement monitoring and auditing corrective
8 actions are not resolved within specified timeframes.
9 14.5 Record Retention. Contractor shall retain all records and documents originated or
10 prepared pursuant to Contractor's performance under this Agreement, including grievance and
11 appeal records, and the data, information and documentation specified in 42 C.F.R. parts
12 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term
13 end date of this Agreement or until such time as the matter under audit or investigation has
14 been resolved. Records and documents include but are not limited to all physical and electronic
15 records and documents originated or prepared pursuant to Contractor's or subcontractor's
16 performance under this Agreement including working papers, reports, financial records and
17 documents of account, records of persons served, prescription files, subcontracts, and any
18 other documentation pertaining to covered services and other related services for persons
19 served.
20 14.6 Record Maintenance. Contractor shall maintain all records and management books
21 pertaining to service delivery and demonstrate accountability for agreement performance and
22 maintain all fiscal, statistical, and management books and records pertaining to the program.
23 Records should include, but not be limited to, monthly summary sheets, sign-in sheets, and
24 other primary source documents. Fiscal records shall be kept in accordance with Generally
25 Accepted Accounting Principles and must account for all funds, tangible assets, revenue and
26 expenditures. Fiscal records must also comply with the Code of Federal Regulations (CFR),
27 Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles,
28 and Audit Requirements for Federal Awards.
34
1 All records shall be complete and current and comply with all Agreement requirements.
2 Failure to maintain acceptable records per the preceding requirements shall be considered
3 grounds for withholding of payments for billings submitted and for termination of Agreement.
4 Contractor shall maintain records of persons served and community service in
5 compliance with all regulations set forth by local, state, and federal requirements, laws, and
6 regulations, and provide access to clinical records by County staff.
7 Contractor shall comply with the Article 18 and Article 1 regarding relinquishing or
8 maintaining medical records.
9 Contractor shall agree to maintain and retain all appropriate service and financial
10 records for a period of at least ten (10) years from the date of final payment, the final date of the
11 contract period, final settlement, or until audit findings are resolved, whichever is later.
12 14.7 Financial Reports. Contractor shall submit audited financial reports on an annual
13 basis to the County. The audit shall be conducted in accordance with Generally Accepted
14 Accounting Principles and generally accepted auditing standards.
15 14.8 Agreement Termination. In the event the Agreement is terminated, ends its
16 designated term or Contractor ceases operation of its business, Contractor shall deliver or make
17 available to County all financial records that may have been accumulated by Contractor or
18 subcontractor under this Agreement, whether completed, partially completed or in progress
19 within seven (7) calendar days of said termination/end date.
20 14.9 Facilities and Assistance. Contractor shall provide all reasonable facilities and
21 assistance for the safety and convenience of the County's representatives in the performance of
22 their duties. All inspections and evaluations shall be performed in such a manner that will not
23 unduly delay the work of Contractor.
24 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial
25 provisions of the Agreement, delegated activities or obligations, or application of other remedies
26 permitted by state or federal law when the County or DHCS determines Contractor has not
27 performed satisfactorily.
28
35
1 14.11 Site Inspection. Without limiting any other provision related to inspections or audits
2 otherwise set forth in this Agreement, Contractor shall permit authorized County, state, and/or
3 federal agency(ies), through any authorized representative, the right to inspect or otherwise
4 evaluate the work performed or being performed hereunder including subcontract support
5 activities and the premises which it is being performed. Contractor shall provide all reasonable
6 assistance for the safety and convenience of the authorized representative in the performance
7 of their duties. All inspections and evaluations shall be made in a manner that will not unduly
8 delay the work of the Contractor.
9 Article 15
10 Complaint Logs and Grievances
11 15.1 Documentation. Contractor shall log complaints and the disposition of all complaints
12 from a person served or their family. Contractor shall provide a copy of the detailed complaint
13 log entries concerning County-sponsored persons served to County at monthly intervals by the
14 tenth (10th) day of the following month, in a format that is mutually agreed upon. Contractor
15 shall allow beneficiaries or their representative to file a grievance either orally, or in writing at
16 any time with the Mental health Plan. In the event Contractor is notified by a beneficiary or their
17 representative of a discrimination grievance, subcontractor shall report discrimination
18 grievances to the Mental Health Plan within 24 hours. The Contractor shall not require a
19 beneficiary or their representative to file a Discrimination Grievance with the Mental Health Plan
20 before filing the complaint directly with the DHCS Office of Civil Rights and the U.S. Health and
21 Human Services Office for Civil Rights.Rights of Persons Served. Contractor shall post signs
22 informing persons served of their right to file a complaint or grievance, appeals, and expedited
23 appeals. In addition, Contractor shall inform every person served of their rights as set forth in
24 Exhibit H.
25 15.2 Incident Reporting. Contractor shall file an incident report for all incidents involving
26 persons served, following the protocol identified in Exhibit I.
27
28
36
1 Article 16
2 Compliance
3 16.1 Compliance. Contractor agrees to comply with County's Contractor Code of
4 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit J. Within
5 thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of
6 Contractor's employees, agents, and subcontractors providing services under this Agreement
7 certify in writing, that he or she has received, read, understood, and shall abide by the
8 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of
9 hire, all new employees, agents, and subcontractors providing services under this Agreement
10 shall certify in writing that he or she has received, read, understood, and shall abide by the
11 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and
12 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
13 Contractor and its employees, agents, and subcontractors.
14 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
15 employees, agents, and subcontractors providing services under this Agreement shall complete
16 general compliance training, and appropriate employees, agents, and subcontractors shall
17 complete documentation and billing or billing/reimbursement training. All new employees,
18 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
19 Each individual who is required to attend training shall certify in writing that he or she has
20 received the required training. The certification shall specify the type of training received and
21 the date received. The certification shall be provided to County's DBH Compliance Officer at
22 1925 E. Dakota Ave, Fresno, California 93726. Contractor agrees to reimburse County for the
23 entire cost of any penalty imposed upon County by the Federal Government as a result of
24 Contractor's violation of the terms of this Agreement.
25 16.2 Compliance with State Medi-Cal Requirements. Contractor shall be required to
26 maintain Mental Health Plan organizational provider certification by Fresno County. Contractor
27 must meet Medi-Cal organization provider standards as listed in Exhibit K, "Medi-Cal
28
37
1 Organizational Provider Standards". It is acknowledged that all references to Organizational
2 Provider and/or Provider in Exhibit K shall refer to Contractor.
3 16.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor will
4 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the
5 effective date of this Agreement through County to provide reimbursable services to Medi-Cal
6 eligible persons served. In addition, Contractor shall work with the County's DBH to execute the
7 process if not currently certified by County for credentialing of staff. During this process, the
8 Contractor will obtain a legal entity number established by the DHCS, a requirement for
9 maintaining Mental Health Plan organizational provider status throughout the term of this
10 Agreement. Contractor will be required to become Medi-Cal certified prior to providing services
11 to Medi-Cal eligible persons served and seeking reimbursement from the County. Contractor
12 will not be reimbursed by County for any services rendered prior to certification.
13 Contractor shall provide direct specialty mental health services in accordance with the
14 Mental Health Plan. Contractor must comply with the "Fresno County Mental Health Plan
15 Compliance Program and Code of Conduct" set forth in Exhibit J.
16 Contractor may provide direct specialty mental health services using unlicensed staff as
17 long as the individual is approved as a provider by the Mental Health Plan, is supervised by
18 licensed staff, works within his/her scope and only delivers allowable direct specialty mental
19 health services. It is understood that each service is subject to audit for compliance with
20 Federal and State regulations, and that County may be making payments in advance of said
21 review. In the event that a service is disapproved, County may, at its sole discretion, withhold
22 compensation or set off from other payments due the amount of said disapproved services.
23 Contractor shall be responsible for audit exceptions to ineligible dates of services or incorrect
24 application of utilization review requirements.
25 16.4 Network Adequacy. The Contractor shall ensure that all services covered under this
26 Agreement are available and accessible to persons served in a timely manner and in
27 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206
28 (a), (c)).
38
1 Contractor shall submit, when requested by County and in a manner and format
2 determined by the County, network adequacy certification information to the County, utilizing a
3 provided template or other designated format.
4 Contractor shall submit updated network adequacy information to the County any time
5 there has been a significant change that would affect the adequacy and capacity of services.
6 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42
7 C.F.R. §438.3 (1), the Contractor shall provide a person served the ability to choose the person
8 providing services to them.
9 16.5 Compliance Program, Including Fraud Prevention and Overpayments.
10 Contractor shall have in place a compliance program designed to detect and prevent fraud,
11 waste and abuse, as per 42 C.F.R. § 438.608(a)(1), that must include:
12 (A) Written policies, procedures, and standards of conduct that articulate the
13 organization's commitment to comply with all applicable requirements and standards
14 under the Agreement, and all applicable federal and state requirements.
15 (B) A Compliance Office (CO) who is responsible for developing and implementing
16 policies, procedures, and practices designed to ensure compliance with the
17 requirements of this Agreement and who reports directly to the CEO and the Board of
18 Directors.
19 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior
20 management level charged with overseeing the organization's compliance program and
21 its compliance with the requirements under the Agreement.
22 (D)A system for training and education for the Compliance Officer, the organization's
23 senior management, and the organization's employees for the federal and state
24 standards and requirements under the Agreement.
25 (E) Effective lines of communication between the Compliance Officer and the
26 organization's employees.
27 (F) Enforcement of standards through well-publicized disciplinary guidelines.
28
39
1 (G)The establishment and implementation of procedures and a system with
2 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt
3 response to compliance issues as they are raised, investigation of potential compliance
4 problems as identified in the course of self-evaluation and audits, corrections of such
5 problems promptly and thoroughly to reduce the potential for recurrence and ongoing
6 compliance with the requirements under the Agreement.
7 (H)The requirement for prompt reporting and repayment of any overpayments
8 identified.
9 16.6 Reporting. Contractor must have administrative and management arrangements or
10 procedures designed to detect and prevent fraud, waste and abuse of federal or state health
11 care funding. Contractor must report fraud and abuse information to the County including but
12 not limited to:
13 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7),
14 (B) All overpayments identified or recovered, specifying the overpayment due to
15 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2),
16 (C) Information about changes in a persons served's circumstances that may affect
17 the person served's eligibility including changes in the their residence or the death of the
18 person served as per 42 C.F.R. § 438.608(a)(3).
19 (D) Information about a change in the Contractor's circumstances that may affect the
20 network provider's eligibility to participate in the managed care program, including the
21 termination of this Agreement with the Contractor as per 42 C.F.R. § 438.608(a)(6).
22 Contractor shall implement written policies that provide detailed information about the
23 False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68) of the
24 Act, including information about rights of employees to be protected as whistleblowers.
25 Contractor shall make prompt referral of any potential fraud, waste or abuse to County or
26 potential fraud directly to the State Medicaid Fraud Control Unit.
27
28
40
1 16.7 Overpayments. County may suspend payments to Contractor if DHCS or County
2 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42
3 C.F.R. §438.608 (a)(8)).
4 Contractor shall report to County all identified overpayments and reason for the
5 overpayment, including overpayments due to potential fraud. Contractor shall return any
6 overpayments to the County within 60 calendar days after the date on which the overpayment
7 was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)).
8 Article 17
9 Federal and State Laws
10 17.1 Health Insurance Portability and Accountability Act. County and Contractor each
11 consider and represent themselves as covered entities as defined by the U.S. Health Insurance
12 Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
13 disclose Protected Health Information (PHI) as required by law.
14 County and Contractor acknowledge that the exchange of PHI between them is only for
15 treatment, payment, and health care operations.
16 County and Contractor intend to protect the privacy and provide for the security of PHI
17 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
18 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
19 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and
20 other applicable laws.
21 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
22 Contractor to enter into a agreement containing specific requirements prior to the disclosure of
23 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e)
24 of the Code of Federal Regulations.
25 17.2 Physical Accessibility. In accordance with the accessibility requirements of section
26 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must
27 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
28 beneficiaries with physical or mental disabilities.
41
1 Article 18
2 Data Security
3 18.1 Data Security Requirements. Contractor shall comply with data security
4 requirements in Exhibit L to this Agreement.
5 Article 19
6 Publicity Prohibition
7 19.1 Self-Promotion. None of the funds, materials, property, or services provided directly
8 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
9 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-
10 promotion.
11 19.2 Public Awareness. Notwithstanding the above, publicity of the services described in
12 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
13 availability of such specific services when approved in advance by County's DBH Director, or
14 designee, and at a cost to be provided in Exhibit F for such items as written/printed materials,
15 the use of media (i.e., radio, television, newspapers), and any other related expense(s).
16 Communication products must follow DBH graphic standards, including typefaces and colors, to
17 communicate our authority and project a unified brand. This includes all media types and
18 channels and all materials on and offline that are created as part of DBH's efforts to provide
19 information to the public.
20 Article 20
21 Disclosure of Self-Dealing Transactions
22 20.1 Applicability. This Article 21 applies if the Contractor is operating as a corporation,
23 or changes its status to operate as a corporation.
24 20.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
25 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
26 "Self-Dealing Transaction Disclosure Form" (Exhibit M to this Agreement) and submitting it to
27 the County before commencing the transaction or immediately after.
28
42
1 20.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
2 a party and in which one or more of its directors, as an individual, has a material financial
3 interest.
4 Article 21
5 Disclosure of Ownership and/or Control Interest Information
6 21.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
7 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
8 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
9 21.2 Duty to Disclose. Contractor must disclose the following information as requested in
10 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
11 Exhibit N:
12 (A) Disclosure of 5% or More Ownership Interest:
13 (1) In the case of corporate entities with an ownership or control interest in the
14 disclosing entity, the primary business address as well as every business location
15 and P.O. Box address must be disclosed. In the case of an individual, the date of
16 birth and Social Security number must be disclosed.
17 (2) In the case of a corporation with ownership or control interest in the
18 disclosing entity or in any subcontractor in which the disclosing entity has a five
19 percent (5%) or more interest, the corporation tax identification number must be
20 disclosed.
21 (3) For individuals or corporations with ownership or control interest in any
22 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
23 the disclosure of familial relationship is required.
24 (4) For individuals with five percent (5%) or more direct or indirect ownership
25 interest of a disclosing entity, the individual shall provide evidence of completion of a
26 criminal background check, including fingerprinting, if required by law, prior to
27 execution of Contract. (42 C.F.R. § 455.434)
28 (B) Disclosures Related to Business Transactions:
43
1 (1) The ownership of any subcontractor with whom Contractor has had business
2 transactions totaling more than $25,000 during the 12-month period ending on the
3 date of the request.
4 (2) Any significant business transactions between Contractor and any wholly
5 owned supplier, or between Contractor and any subcontractor, during the 5-year
6 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
7 (C) Disclosures Related to Persons Convicted of Crimes:
8 (1) The identity of any person who has an ownership or control interest in the
9 provider or is an agent or managing employee of the provider who has been
10 convicted of a criminal offense related to that person's involvement in any program
11 under the Medicare, Medicaid, or the Title XXI services program since the inception
12 of those programs. (42 C.F.R. § 455.106.)
13 (2) County shall terminate the enrollment of Contractor if any person with five
14 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
15 has been convicted of a criminal offense related to the person's involvement with
16 Medicare, Medicaid, or Title XXI program in the last 10 years.
17 Contractor must provide disclosure upon execution of Contract, extension for renewal,
18 and within 35 days after any change in Contractor ownership or upon request of County. County
19 may refuse to enter into an agreement or terminate an existing agreement with Contractor if
20 Contractor fails to disclose ownership and control interest information, information related to
21 business transactions and information on persons convicted of crimes, or if Contractor did not
22 fully and accurately make the disclosure as required.
23 Contractor must provide the County with written disclosure of any prohibited affiliations
24 under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers or have
25 other relationships with providers Excluded from participation in Federal Health Care Programs,
26 including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610.
27 21.3 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
28 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this
44
1 Agreement where any person with five (5) percent or greater direct or indirect ownership interest
2 in Contractor has been convicted of a criminal offense related to that person's involvement with
3 the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County may terminate
4 this Agreement where any person with five (5) percent or greater direct or indirect ownership
5 interest in the Contractor did not submit timely and accurate information and cooperate with any
6 screening method required in CFR, Title 42, Section 455.416.
7 Article 22
8 Disclosure of Criminal History and Civil Actions
9 22.1 Applicability. Contractor is required to disclose if any of the following conditions
10 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
11 referred to as "Contractor"):
12 (A) Within the three (3) year period preceding the Agreement award, they have been
13 convicted of, or had a civil judgment tendered against them for:
14 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
15 or performing a public (federal, state, or local) transaction or contract under a public
16 transaction;
17 (2) Violation of a federal or state antitrust statute;
18 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
19 or
20 (4) False statements or receipt of stolen property.
21 (B) Within a three (3) year period preceding their Agreement award, they have had a
22 public transaction (federal, state, or local) terminated for cause or default.
23 22.2 Duty to Disclose. Disclosure of the above information will not automatically
24 eliminate Contractor from further business consideration. The information will be considered as
25 part of the determination of whether to continue and/or renew this Agreement and any additional
26 information or explanation that Contractor elects to submit with the disclosed information will be
27 considered. If it is later determined that the Contractor failed to disclose required information,
28
45
1 any contract awarded to such Contractor may be immediately voided and terminated for
2 material failure to comply with the terms and conditions of the award.
3 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
4 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit O.
5 Additionally, Contractor must immediately advise the County in writing if, during the term of the
6 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
7 participation in Federal or State funded programs or from receiving federal funds as listed in the
8 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
9 become applicable to Contractor. Contractor shall indemnify, defend, and hold County
10 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility,
11 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
12 Responsibility Matters.
13 Article 23
14 Cultural and Linguistic Competency
15 23.1 General. All services, policies and procedures must be culturally and linguistically
16 appropriate. Contractor must participate in the implementation of the most recent Cultural
17 Competency Plan for the County and shall adhere to all cultural competency standards and
18 requirements. Contractor shall participate in the County's efforts to promote the delivery of
19 services in a culturally competent and equitable manner to all individuals, including those with
20 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and
21 regardless of gender, sexual orientation, or gender identity including active participation in the
22 County's Diversity, Equity and Inclusion Committee.
23 23.2 Policies and Procedures. Contractor shall comply with requirements of policies and
24 procedures for ensuring access and appropriate use of trained interpreters and material
25 translation services for all limited and/or no English proficient beneficiaries, including, but not
26 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
27 policies and procedures, and monitoring its language assistance program. Contractor's policies
28
46
1 and procedures shall ensure compliance of any subcontracted providers with these
2 requirements.
3 23.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation
4 is available for any language and written translation is available in prevalent languages and that
5 auxiliary aids and services are available upon request, at no cost and in a timely manner for
6 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities.
7 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to
8 interpret or facilitate communication; however, if the beneficiary refuses language assistance
9 services, the Contractor must document the offer, refusal, and justification in the beneficiary's
10 file.
11 23.4 Interpreter Qualifications. Contractor shall ensure that employees, agents,
12 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
13 communicate with a beneficiary in a language other than English (1) have completed annual
14 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the
15 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
16 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic
17 principles. As requested by County, Contractor shall identify all who interpret for or provide
18 direct communication to any program beneficiary in a language other than English and identify
19 when the Contractor last monitored the interpreter for language competence.
20 23.5 CLAS Standards. Contractor shall submit to County for approval, within ninety (90)
21 days from date of contract execution, Contractor's plan to address all fifteen (15) National
22 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the
23 Office of Minority Health and as set forth in Exhibit P "National Standards on Culturally and
24 Linguistically Appropriate Services". As the CLAS standards are updated, Contractor's plan
25 must be updated accordingly. As requested by County, Contractor shall be responsible for
26 conducting an annual CLAS self-assessment and providing the results of the self-assessment to
27 the County. The annual CLAS self-assessment instruments shall be reviewed by the County
28 and revised as necessary to meet the approval of the County.
47
1 23.6 Training Requirements. Cultural competency training for Contractor staff should be
2 substantively integrated into health professions education and training at all levels, both
3 academically and functionally, including core curriculum, professional licensure, and continuing
4 professional development programs. As requested by County, Contractor shall report on the
5 completion of cultural competency trainings to ensure direct service providers are completing a
6 minimum of twelve (12) hours of cultural competency training annually.
7 23.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that
8 includes staff at all agency levels to discuss cultural competence. Contractor shall designate a
9 representative from Contractor's team to attend County's Diversity, Equity and Inclusion
10 Committee.
11 Article 24
12 General Terms
13 24.1 Modification. Except as provided in Article 7, "Termination and Suspension," this
14 Agreement may not be modified, and no waiver is effective, except by written agreement signed
15 by both parties. The Contractor acknowledges that County employees have no authority to
16 modify this Agreement except as expressly provided in this Agreement.
17 (A) Notwithstanding the above, non-material changes to services, staffing, and
18 responsibilities of the Contractor, as needed, to accommodate changes in the laws
19 relating to service requirements and specialty mental health treatment, may be made
20 with the signed written approval of County's DBH Director, or designee, and Contractor
21 through an amendment approved by County's County Counsel and the County's Auditor-
22 Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in any
23 change to the maximum compensation amount payable to Contractor, as stated herein.
24 (B) In addition, changes to service rates on Exhibit F that do not exceed 3% of the
25 approved rate, or that are needed to accommodate state-mandated rate increase, may
26 be made with the written approval of the DBH Director, or designee. These rate
27 changes may not add or alter any other terms or conditions of the Agreement. Said
28
48
1 modifications shall not result in any change to the annual maximum compensation
2 amount payable to Contractor, as stated herein.
3 24.2 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 24.3 Governing Law. The laws of the State of California govern all matters arising from
6 or related to this Agreement.
7 24.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
8 County, California. Contractor consents 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 24.5 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 24.6 Days. Unless otherwise specified, "days" means calendar days.
16 24.7 Headings. The headings and section titles in this Agreement are for convenience
17 only and are not part of this Agreement.
18 24.8 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 24.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
24 not unlawfully discriminate against any employee or applicant for employment, or recipient of
25 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.
49
1 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
2 beneficiaries are provided without use of any policy or practice that has the effect of
3 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
4 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
5 genetic information, health status or need for health care services, or mental or physical
6 disability.
7 24.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
8 of the Contractor under this Agreement on any one or more occasions is not a waiver of
9 performance of any continuing or other obligation of the Contractor and does not prohibit
10 enforcement by the County of any obligation on any other occasion.
11 24.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
12 between the Contractor and the County with respect to the subject matter of this Agreement,
13 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
14 publications, and understandings of any nature unless those things are expressly included in
15 this Agreement. If there is any inconsistency between the terms of this Agreement without its
16 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
17 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
18 exhibits.
19 24.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to
20 create any rights or obligations for any person or entity except for the parties.
21 24.13 Authorized Signature. The Contractor represents and warrants to the County that:
22 (A) The Contractor is duly authorized and empowered to sign and perform its
23 obligations under this Agreement.
24 (B) The individual signing this Agreement on behalf of the Contractor is duly
25 authorized to do so and his or her signature on this Agreement legally binds the
26 Contractor to the terms of this Agreement.
27 24.14 Electronic Signatures. The parties agree that this Agreement may be executed by
28 electronic signature as provided in this section.
50
1 (A) An "electronic signature" means any symbol or process intended by an individual
2 signing this Agreement to represent their signature, including but not limited to (1) a
3 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
4 electronically scanned and transmitted (for example by PDF document) version of an
5 original handwritten signature.
6 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
7 equivalent to a valid original handwritten signature of the person signing this Agreement
8 for all purposes, including but not limited to evidentiary proof in any administrative or
9 judicial proceeding, and (2) has the same force and effect as the valid original
10 handwritten signature of that person.
11 (C)The provisions of this section satisfy the requirements of Civil Code section
12 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
13 Part 2, Title 2.5, beginning with section 1633.1).
14 (D) Each party using a digital signature represents that it has undertaken and
15 satisfied the requirements of Government Code section 16.5, subdivision (a),
16 paragraphs (1) through (5), and agrees that each other party may rely upon that
17 representation.
18 (E) This Agreement is not conditioned upon the parties conducting the transactions
19 under it by electronic means and either party may sign this Agreement with an original
20 handwritten signature.
21 24.15 Counterparts. This Agreement may be signed in counterparts, each of which is an
22 original, and all of which together constitute this Agreement.
23 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
4CSUTANTS, INC. COUNTY OF FRESNO
3
4
5 Jana Tod , EO & President Sal, ui ro, hairman of the Board of
6
Su sor the County of Fresno
55�v_
Attest:
7 Bernice E. Seidel
ydia Rodriguez, Chief Financial Officer Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
4205 W. Figarden Drive. By: _
10 Fresno, CA 93722 Deputy
11
12
13 For accounting use only:
14 Org No.. 56302666
Account No.: 7295
15 Fund No.: 0001
Subclass No.:10000
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24
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52
Exhibit A
Scope of Services
ORGANIZATION: JDT Consultants, Inc.
ADDRESS: 4205 West Figarden Drive, Fresno, CA 93722
TELEPHONE: (559) 221-1680
CONTACT PERSON: Jana Todd, CEO/President
CONTRACT PERIOD: July 1, 2023 —June 30, 2024
with one (1) optional twelve (12) month renewal
SUMMARY OF SERVICES:
Therapeutic Behavioral Services are focused on the resolution of target behaviors or symptoms
which jeopardize existing placements, are a barrier to transitioning to a lower level of residential
placement, and are barriers to the completion of specific treatment goals.
TARGET POPULATION:
Children /youth up to age 21 that are experiencing emotional or behavioral challenges in their
current living environment or experiencing a stressful life transition. TBS is only available to
those children/youth with full-scope Medi-Cal benefits who are receiving ongoing mental health
services.
TBS is available to children/youth who meet one or more of the following:
1. Experiencing behaviors that they find hard to manage and may jeopardize their
placement;
2. Currently living in a group home;
3. At risk of psychiatric hospitalization, or have been psychiatrically hospitalized within
the last 24 months; and
4. Transitioning to a lower level placement.
DEFINITIONS
A. "Person served" shall mean any person who has been determined to be eligible to
receive full scope Medi-Cal benefits by the State of California through Fresno County
and is under twenty-one (21) years of age; meets MHP medical necessity criteria as
defined in 9 C.C.R. 1830.205; is a person served of the class certified by the U.S.
District Court in Emily Q. v. Bonta, supra; and meets the criteria for needing TBS as
defined in DMH Letter No. 99-03.
B. "Therapeutic Behavioral Services" shall mean one-to-one mental health services for
persons served with serious behavioral problems who are experiencing a stressful
transition or life crisis and need additional short-term support to prevent placement in a
A-1
Exhibit A
group home of Rate Classification Level (RCL) 12 through 14 or a locked facility for the
treatment of mental health needs, including acute care; or to enable a transition from any
of those levels to a lower level of residential care. TBS is focused on resolution of target
behaviors or symptoms which jeopardize existing placements, are a barrier to
transitioning to a lower level of residential placement, and are barriers to the completion
of specific treatment goals. TBS is to be decreased when indicated and discontinued
when the identified behavioral benchmarks have been reached or when reasonable
progress toward the behavioral benchmarks is not being achieved and is not reasonably
expected to be achieved. When applicable, a plan for transition to adult services when
the beneficiary turns 21 years old and is no longer eligible for therapeutic behavioral
services will be developed, which addresses assisting parents and/or caregivers with
skills and strategies to provide continuity of care when the services are discontinued.
C. "Covered Services" shall mean only those services set forth in Section 3 of this Exhibit.
D. "Not Reimbursable Conditions" shall mean:
a) When TBS are solely: a)for the convenience of the family or other
caregivers, physician or teacher; b) to provide supervision or to assure
compliance with terms and conditions of probation; c) to ensure the
child/youth's physical safety or the safety of others, e.g., suicide watch;
or d) to address conditions that are not part of the person served's
mental health condition.
b) For persons served who probably do not need these services since they
can sustain non-impulsive self-directed behavior, handle themselves
appropriately in social situations with peers, and are able to
appropriately handle transitions during the day.
c) For persons served who will never be able to sustain non-impulsive self-
directed behavior and engage in appropriate community activities
without full time supervision.
d) When the person served is an inpatient of a hospital, psychiatric health
facility, nursing facility, Institute of Mental Disease (IMD), or crisis
residential program.
E. "Excluded Services" shall mean all those services which are not "Covered Services".
F. "TBS Rates" shall mean the schedule of prevailing reimbursement rates of payment for
Contractor services as included in Exhibit F attached to the Agreement.
G. "Licensed Staff' shall mean any mental health professional, licensed in the State of
California as a Psychiatrist, Psychologist, Clinical Social Worker, Marriage Family
Therapist, or a Registered Nurse with a Master's Degree certified to render TBS to
persons served.
H. "Waivered or Registered Staff' shall mean any employee who has a waiver of
psychologist licensure as required and approved by the Department of Mental Health or
has registered with the applicable state licensing authority to obtain supervised clinical
A-2
Exhibit A
hours for Marriage Family Therapy or Social Worker licensure, approved to render TBS
to person served.
I. "TBS Coach" shall mean a person who has successfully completed twelve (12) semester
units from an accredited college or university in any of the following disciplines: Social
Work, Psychology, Rehabilitation Counseling, Education Counseling, or Marriage Family
Therapy; or successful completion of six (6) semester units from an accredited college or
university in any of the following disciplines: Social Work, Psychology, Rehabilitation
Counseling, Education Counseling, or Marriage Family Therapy and one (1) year of full-
time experience working with persons served in human services settings; or a Bachelor's
Degree in a non-mental health related field, but with at least one year of full-time
experience working with children/youth. A TBS Coach must be approved by the County
to render TBS pursuant to the terms and conditions of this Agreement.
J. "TBS Plan of Care" shall mean a series of short term interventions which address
specific behaviors or symptoms identified during assessment and the goals and
objectives of TBS.
K. "Fresno County Mental Health Plan Organizational Provider Manual", hereinafter
referred to as "the Provider Manual" shall mean the Provider Manual, together with any
amendments or changes thereto. The Provider Manual is developed and maintained by
staff within the Managed Care Division. The Provider Manual may be updated from time
to time. Contractor will receive a copy of the Provider Manual and any updates, upon
execution of this Agreement and whenever changes are made by County. The Provider
Manual and any updates thereto made during the term of this Agreement are
incorporated herein and made a part of this Agreement.
L. "Katie A Class" is defined as children in California who:
a) Are in foster care or are at imminent risk of foster care placement, and
b) Have an open Child Welfare case defined as any of the following:
a. Child is in foster care or;
b. Child has a voluntary family maintenance case (pre or
post, returning home, in foster or relative placement
including both court ordered and by voluntary agreement;
and
c) Meets Medi-Cal medical necessity for mental health services
M. "Katie A Sub-Class" is identified as children in California who, due to behavioral health
needs, children/youth in or considered for:
a) Wraparound
b) Therapeutic Foster Care
c) Specialized care rate
d) Other intensive EPSDT services, including but not limited to TBS or
crisis stabilization/intervention
e) STRTP placement
A-3
Exhibit A
f) Psychiatric Hospital or 24-hour mental health treatment facility
placement (e.g., psychiatric inpatient hospital, community residential
treatment facility)
g) 3 or more placements within 24 months
QUALIFICATIONS
A. Licensed Mental Health Staff
Any mental health professional licensed in the State of California as a Psychiatrist,
Psychologist, Clinical Social Worker, Marriage Family Therapist, or as a Registered
Nurse with a Master's Degree, who is employed by Contractor may serve persons
served provided he/she is certified and in good standing to provide services under
the California Medi-Cal Program including compliance with the relevant standards of
participation contained in 22 C.C.R., Division 3, Subdivision1, Chapter 3, Article 3,
sections 51200, et seq.
B. Waivered or Registered Staff
1. Any waivered or registered mental health worker who is employed by Contractor
and meets the qualifications set by County may provide services under the
California Medi-Cal Program including those requirements contained in 9 C.C.R.,
section 1810.254 (Waivered/Registered Professional).
2. A Licensed Mental Health Staff in accordance with laws and regulations
governing the registration or waiver must supervise Waivered, Registered Staff,
and TBS Coaches.
C. TBS Coach
1. Contractor staff serving as a TBS Coach shall complete the Fresno County
Mental Health Plan Therapeutic Behavioral Coach Application Checklist. In
addition, a fingerprint check request is required. If the Coach is already a current
employee of a local facility licensed by social services, which requires a
fingerprint check, a letter from that facility saying that the Coach is currently an
employee in good standing can substitute for a new fingerprint check.
2. Each TBS Coach is required to complete training on confidentiality, child abuse
reporting, non-violent crisis intervention, cardiopulmonary resuscitation (CPR)
and State or MHB-approved TBS training.
3. The TBS Coach personnel file shall include the following: completed and
approved Coach application, supporting documents regarding education or
experience, fingerprint check request, signed statement regarding training on
confidentiality and child abuse reporting and current CPR certificate. These
documents must be available to the MHP upon request.
SERVICES
A. Contractor shall:
1. Perform all services and fulfill all responsibilities as outlined in the Provider
Manual, and in accordance with the DMH Letters No. 99-03 and other relevant
letters published from time to time by DMH, California Code of Regulations and
Emily Q. v. Bonta decision, and the Medi-Cal Manual for Intensive Care
A-4
Exhibit A
Coordination (ICC), Intensive Home Based Services (IHBS) and Therapeutic
Foster Care (TFC) for Katie A. Subclass persons served, as incorporated herein.
2. Serves as the TBS Coordinator or designate other licensed mental health staff,
and make arrangements to meet the caregiver for Assessment and Plan
Development within three (3) working days of receipt of referral from County and
schedule a tentative review date within two (2) to three (3) weeks of the
beginning of services.
3. Provide the TBS Plan of Care to the referring licensed mental health clinician or
"Therapist," as an addendum to the current Plan of Care.
4. Provide the TBS Coach, who is responsible to meet with the person served at the
agreed upon times and follow the intervention plan and adhere to ethical
standards as outlined in the Provider Manual.
5. Provide services established in the Plan of Care, which may include such
activities as behavioral modeling, structure and support, and one-to-one
behavioral interventions, which assist the person served in engaging in
appropriate activities, minimizing impulsivity and increasing social and
community competencies by building or reinstating those daily living skills that
will assist the person served to live successfully in the community.
6. Serve as a positive role model and assist in developing the person served's
ability to sustain self-directed appropriate behavior, internalize a sense of social
responsibility, and/or enable participation proactively in community activities.
These activities/interventions may include but are not limited to:
a) Providing immediate behavioral reinforcements
b) Providing time-structuring activities
c) Preventing inappropriate responses
d) Providing appropriate time-out strategies
e) Providing coping strategies and other behavioral interventions
f) Collaboration with and support of the family caregivers' efforts to
provide a positive environment for the person served
7. Complete all TBS forms as required in the Provider Manual to include the
"Fresno County Mental Health Plan TBS Assessment and Plan of Care" and
"Fresno County Mental Health Plan TBS Progress Notes". Any applicable Notice
of Action forms required by DMH shall be completed and submitted to County.
8. Perform all services and fulfill all responsibilities as outlined in the Medi-Cal
Manual for Intensive Care Coordination (ICC), Intensive Home-Based Services
(IHBS) and Therapeutic Foster Care (TFC)for Katie A. Subclass person serveds
including but not limited to attending an Intensive Care Coordination meeting to
coordinate mental health services and potentially attending Child Family Team
meeting.
A-5
Exhibit A
a) Intensive Care Coordination meetings are populated similarly to Child
Family Team Meetings. More than one mental health
provider/practitioner may participate in the meeting, however, there
must be an identified mental health Intensive Care Coordination
coordinator that ensures participation by the child or youth, family or
caregiver and significant others so that the child/youth's assessment
and plan addresses the child/youth's needs and strengths in the context
of the values and philosophy of the Core Practice Model.
9. Ensure staff is knowledgeable about the cultures and communities in which they
work and sensitive to and aware of multicultural issues. All services provided to
children and their families shall be delivered in a culturally sensitive and
competent manner.
10. Develop and maintain positive communication and working relationships with
TBS Team persons served.
11. Serve on the TBS team to review and modify the Plan of Care, interventions and
goals for TBS as needed until the targeted behaviors are reduced or eliminated.
12. Track costs for TBS and verify hours worked and billed to County are consistent
with time documented in the progress note for each person served.
B. County shall:
1. Perform all services and fulfill all responsibilities as outlined in the Provider
Manual, and in accordance with the DMH Letters No. 99-03 and other relevant
letters and other written communications published from time to time by DMH,
California Code of Regulations and Emily Q. v. Bonta decision and the Medi-Cal
Manual for Intensive Care Coordination (ICC), Intensive Home Based Services
(IHBS) and Therapeutic Foster Care (TFC) for Katie A. Subclass persons served,
as incorporated herein.
2. Provide oversight, support, coordination, authorization, and ongoing monitoring
of TBS for the County Plan.
3. Notify Contractor of their responsibilities through DMH letters and other written
communications, the Provider Manual, teleconferences, formal and informal
trainings, and individual consultations.
4. Receive TBS referrals from the Department of Behavioral Health, person
served's mental health provider, Child Protective Services case managers,
parents, guardians, or foster parents and determine whether the person served
meets the criteria for Medi-Cal reimbursement for TBS.
5. Assign the person served to Contractor and approve the initial authorization
request and subsequent authorization requests within fourteen (14) calendar
A-6
Exhibit A
days of receipt or within three (3) calendar days for expedited requests upon
Contractor submission to County.
6. Provide individual consultation on a regular basis and facilitate monthly meetings
of the TBS team.
7. Conduct site certifications, documentation and billing audits upon execution of
this Agreement and annually thereafter.
PRIOR AUTHORIZATION
A. Prior authorization from County shall be required prior to the time TBS one-to-one direct
services are rendered with the exception of the two-hour assessment, pursuant to the
terms and conditions of this Agreement, and as described in the Provider Manual. Prior
authorization shall be required for the initial and each subsequent authorization period,
to include a specified number of hours during such authorization period. County shall
not be obligated to compensate Contractor for services rendered during a non-
authorized period, for services provided in excess of an authorized period, for services in
excess of the number of authorized hours, or for services provided to ineligible
individuals.
B. Contractor shall not admit, treat, refer, or transfer a person served without prior
authorization and approval of the MHP.
SERVICE LOCATIONS
Contractor shall perform TBS at MHP approved locations within and outside of Fresno County,
depending upon the placement of the person served and at times convenient and locations
suitable to person served (i.e., at a person served's home, school, or community).
PROGRAM OUTCOMES/PERFORMANCE OUTCOME MEASUREMENTS
Contractor is required to submit measurable outcomes on an annual basis, as identified in
County's DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures, in
Exhibit E. Performance outcomes measures must be approved by DBH and satisfy all State
and local mandates. DBH shall provide technical assistance and support in defining
measurable outcomes. All performance indicators shall reflect the four (4) domains identified by
the Commission Accreditation of Rehabilitation Facilities (CARF).
DBH collects data about the characteristics of the persons served and measures service
delivery performance indicators in each of the following CARF DOMAINS: At minimum, one
performance indicator shall be identified for each of the four CARF domains listed below.
A. Effectiveness --A performance dimension that assesses the degree to which an
intervention or services have achieved the desired outcome/result/quality of care through
A-7
Exhibit A
measuring change over time. The results achieved and outcomes observed are for
persons served.
Examples of indicators include: Persons get a job with benefits, or receive supports
needed to live in the community, increased function, activities, or participation, and
improvement of health, employment/earnings, or plan of care goal attainment.
B. Efficiency -- Relationship between results and resources used, such as time, money,
and staff. The demonstration of the relationship between results and the resources used
to achieve them. A performance dimension addressing the relationship between the
outputs/results and the resources used to deliver the service.
Examples of indicators include: Direct staff cost per person served, amount of time it
takes to achieve an outcome, gain in scores per days of service, service hours per
person achieving some positive outcome, total budget (actual cost) per person served,
length of stay and direct service hours of clinical and medical staff.
C. Access -- Organizations' capacity to provide services of those who desire or need
services. Barriers or lack thereof for persons obtaining services. The ability of persons
served to receive the right service at the right time. A performance dimension addressing
the degree to which a person needing services is able to access those services.
Examples of indicators include: Timeliness of program entry (From 1 st request for
service to 1 st service), ongoing wait times/wait lists, minimizing barriers to getting
services, and no-show/cancellation rates.
D. Satisfaction -- Satisfaction measures are usually orientated towards consumers, family,
staff, and stakeholders. The degree to which persons served, the County and other
stakeholders are satisfied with services. A performance dimension that describes reports
or ratings from persons served about services received from an organization.
Examples of indicators include: opinion of persons served or other key stakeholders in
regards to access, process, or outcome of services received, Consumer and/or
Treatment Perception Survey.
DBH may adjust the performance and outcome measures periodically throughout the duration of
the Agreement, as needed, to best measure the program as determined by County. Contractor
must utilize a computerized tracking system with which performance and outcome measures
and other relevant client person served data, such as demographics, will be maintained.
The outcome measures and indicators provided below represent County DBH and DSS
program goals to be achieved by the Contractor in addition to Contractor's developed outcomes.
A. Timeliness of Service —Contractor will respond to referrals within a proper
timeframe, in order to engage with the persons served as soon as possible.
a. Timely access to services from referral to assessment.
b. 100% of all assessments will be signed/completed within thirty (30) days.
A-8
Exhibit A
c. Timely access to service from assessment to ongoing treatment
d. Timely access to services from referral to medication evaluation, when
appropriate
B. Access and Engagement— Contractor will ensure that persons served have access
to treatment, that the person served is actively involved in treatment, and that every
effort is made to aid the client persons served in successfully completing treatment.
a. Contractor will provide services in a location determined by the needs/preference
of the person served and clinical appropriateness.
b. Contractor will track the number, type, and location of services per person
served.
c. Contractor will actively provide ICC and IHBS services.
d. Clinician attendance at 100% of team meetings.
C. Wellness, Recovery, and Resiliency Supports — a collaborative approach to
treatment strategies to aid in the successful completion of treatment, reunification,
and reduction in recidivism.
a. Effectiveness of discharge planning as demonstrated by referral and linkage to
other County programs, community providers, and community resources.
TRANSITION OPTIMIZATION FUNDS
One-time Transition Optimization Funds will be available to specialty mental health providers
and Drug Medi-Cal providers within FY 2023-24 to encourage Contractors to identify and
implement organization changes during the first year of CaIAIM Payment Reform to improve
outcomes for persons served and create operational efficiencies. Contractor is expected to
utilize the strategies, tools and knowledge learned to their programming and continue to
improve services for the population served.
Drug Medi-Cal Transition Optimization funds will be provided through County Realignment.
a. Fundinq Allocation Methodology
i. Each participating contractor is eligible to apply for an allocation of Transition
Optimization Funds up to the maximum amounts stated in Article 4 of the Agreement
and further described below. Transition optimization funds will only be available from
July 1, 2023 through June 30, 2024 and payments shall be on a quarterly basis.
ii. Payments will be disbursed upon review and approval by DBH of each deliverable
described below. Quarterly progress reports shall be submitted to DBH in order to
show progress as outlined in the submitted plans and deliverables.
A-9
Exhibit A
iii. Payments will be dependent on Contractor demonstrating progress toward meeting
deliverables described in this exhibit. Contractors who fail to submit progress reports
by stated deadlines, or who do not demonstrate adequate progress made, may be
determined ineligible for that quarter's payment at the sole discretion of the County.
iv. All invoices will be submitted on a quarterly basis within fifteen (15) days following
the end of the quarter. Invoices submitted thereafter may not be eligible for payment.
b. Responsibilities
i. Letter of Intent
Contractor shall submit a letter of intent to DBH by July 31, 2023 identifying the
selected Transition Optimization Activity(ies) and commitment to meet the
deliverable deadlines as described below. The letter shall include all current Medi-
Cal billable specialty mental health and substance use disorder services agreements
the Contractor has with the County.
The County shall respond to the Contractor's letter of intent within 30 days. The
County's response shall include a breakdown of anticipated payments, as
determined by the County, depending on the Transition Optimization Activity(ies)
chosen and depending on the number of current Medi-Cal billable specialty mental
health and substance use disorder services agreements the Contractor has with the
County.
ii. Quarterly Reports
Contractor shall submit quarterly progress reports and invoices. Reports shall be
submitted on the dates indicated in the Schedule of Deliverables below. Invoices are
due 15 days after the end of each quarter. All activities shall be completed by June
30, 2024. The report shall include updated plans/tools and progress Contractor has
made toward the Transition Optimization Activity(ies) described in each Contractors'
letter of intent.
iii. Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool, and
Electronic Health Record
1. Q1 Reports: July-Sept:
a. Letter of Intent: Due July 31, 2023
b. Fiscal Monitoring Tool, Equity Gap Analysis, and Electronic Health
Record Implementation Plans (if applicable): Due September 30, 2023
c. Fiscal Monitoring Tool Identified Practices and Strategies (if applicable):
Due September 30, 2023
A-10
Exhibit A
2. Q2 Report: Oct-Dec: Due January 15, 2024
3. Q3 Report: Jan-Mar: Due April 15, 2024
4. Q4 Report: Apr-June: Due July 15, 2024
iv. All deliverables will be reviewed and approved by DBH prior to payment.
c. Eligible Transition Optimization Activities
i. Fiscal Monitoring Tools: Contractor shall submit to DBH a draft of their fiscal
monitoring tool that shall be used monthly on an ongoing basis to evaluate fiscal
health of the organization. Tools shall, at a minimum, monitor costs, productivity
targets and identify one or more practice pattern(s) the organization is employing to
increase direct care time to the Medi-Cal population.
1. Fiscal Monitoring Tools and Implementation Plan: Contractor shall develop
fiscal monitoring tools that will be used monthly to ensure their organizational
fiscal health and implementation plan. Fiscal monitoring tools drafts and
implementation plan shall be submitted to DBH by September 30, 2023.
a. Identified Practice: Identify at least one process improvement that shall be
modified by September 30, 2023.
b. Quarterly Progress Reports: Quarterly progress reports shall be
submitted including but not limited to a narrative of progress, obstacles,
alternative solutions and outcomes.
c. Funding for this activity shall be available up to $25,000 for the initial
agreement with Contractor and up to another$10,000 for each additional
agreement. County shall provide further details on deliverables and
payment schedule in County's response to the Contractor's letter of
intent.
ii. Equity Gap Analysis: Contractor shall produce a report identifying the race/ethnicity
of population served in fiscal year 2022-23 compared to the County's population as
provided by the County. Contractor shall identify key disparities in both persons
served and amount of services and frequency of transitions to other levels of care
received. Contractor shall identify three (3) strategies they shall employ during FY
2023-24 to reduce the disparities among underserved population.
1. Report on Underserved Population: Contractor shall submit an Equity Gap
Report to the Department containing including, but not limited to, the
following:
A-11
Exhibit A
a. Identify if it serves specific population within its program(s) and identify
whom the program(s) currently served based on data.
b. Staffing/workforce information and demographics. Report the
staffing/workforce supporting the different programs and populations
served by the provider in Fresno County. This data is to evaluate how the
staffing reflects the populations it is serving.
c. Comparison of the county penetration rates to the demographics of
persons served by the Contractor and program(s) under agreement with
DBH.
d. Data on retention of persons served by demographics. Total persons
served and the average length of stay by demographics of the persons
served in programs.
i. Which populations are remaining in the programs by demographics,
which ones are having the shortest stays.
ii. How long is the average length of stay by the demographics.
e. Identify what data points the Contractor is missing at this time that
challenges its ability to thoroughly assess its equity gap analysis.
Examples: Data is not collected, Data that is missing or under reported,
data not captured in its processes, etc.
2. Equity Improvement Implementation Plan: Contractor shall submit an Equity
Improvement Implementation Plan related to improving health equity by
September 30, 2023. The plan shall include the following items at a minimum:
a. Contractor shall select three strategies from below:
i. Plan shall include specific efforts including, but not limited to, the
following and timelines to increase access to underserved groups.
1. Outreach/Engagement with underserved communities
2. Active attendance/participation in DBH's Diversity Equity and
Inclusion (DEI) workgroup
3. Plan for retention of persons served in programs who are
underrepresented
4. Improvement of demographic data collection including Sexual
Orientation Gender Identity (SOGI)/LGBTQ data.
ii. Plan shall address workforce capacity to render services to more
underserved populations, through:
A-12
Exhibit A
1. Development of bilingual personnel
2. Recruitment plan for more diverse workforce to reflect
populations served.
3. Training for workforce to increase capacity to be culturally
responsive
4. Development workforce pool for the future that can be bilingual
and bicultural
b. Timeline for each effort shall be included in the plan.
c. Contractor shall identify the measurement to be used to demonstrate
successful implementation of plan. Measure may be identified by the
Contractor to best support their plan and goals.
d. Contractor shall develop and submit policies and procedures to formally
support equity effort.
3. Quarterly Progress Reports: Use available data including but not limited to,
External Quality Review Organization (EQRO) and EHR data to evaluate the
strategies deployed. Quarterly progress reports shall be submitted including
but not limited to a narrative of the progress, obstacles, alternative solutions
and outcomes. The final quarter shall include a comprehensive final report on
the outcomes.
4. Funding for this activity shall be available up to $25,000 for the initial
agreement with Contractor and up to another$10,000 for each additional
agreement. County shall provide further details on deliverables and payment
schedule in County's response to the Contractor's letter of intent.
iii. Electronic Health Record (EHR): The implementation and expansion of the
SmartCare EHR is an essential component of improving oversight with the
implementation of payment reform. Furthermore, a standardized EHR will improve
continuity of care, create transparency across the system, remove obstacles for
individuals accessing services and improve the overall outcomes for persons served.
For Contractors who plan to opt in to use SmartCare or have previously opted into
DBH's former EHR and intend to transition to SmartCare, user fees and costs shall
be waived during FY 2023-2024 and FY 2024-2025.
1. Option One: Current EHR Users
a. Strategic Plan: Contractors utilizing DBH's EHR as their current EHR, and
who will continue to utilize SmartCare beginning July 1, 2023, shall
provide a plan, including, but not limited to, how they will optimize Medi-
Cal billing, illustrate how they will utilize the information in the EHR to
A-13
Exhibit A
improve care for persons served, and a training plan for their organization
by September 30, 2023.
b. Quarterly Progress Reports: Quarterly progress reports shall be
submitted, including, but not limited to, a narrative on the progress,
obstacles, alternative solutions and outcomes.
c. Total compensation for this Electronic Health Record activity, Option 1,
shall not exceed $50,000.00 split among all current agreements between
the Contractor and the County for Medi-Cal billable specialty mental
health and substance use disorder services. County shall provide further
details on deliverables and payment schedule in County's response to the
Contractor's letter of intent.
2. Option Two: Non-EHR Users
a. Contractor shall submit an implementation plan by September 30, 2023
regarding how they will transition to utilizing the SmartCare EHR by June
30, 2024. The plan shall include, at a minimum, an identified Go Live
Date, plan on how the current record system will be maintained and
utilized, training plan including number of individuals, and additional
supports. The Go Live Date must occur by June 30, 2024 to receive final
payment. Contractor shall work closely with DBH to identify needs,
assignments, collaboration opportunities to transition.
b. For Option 2, the Contractor shall not be reimbursed more than $200,000
split among all current agreements between the Contractor and the
County for Medi-Cal billable specialty mental health and substance use
disorder services. The total maximum compensation available for this
option, shall include costs for maintaining current electronic health
record/record system and additional supports and training costs per user.
Contractor shall transition both specialty mental health and Drug Medi-Cal
programming to the County's EHR and shall be required to use the
County's EHR for future eligibility agreements with DBH. County shall
provide further details on deliverables and payment schedule in County's
response to the Contractor's letter of intent.
A-14
Exhibit B
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.
B-1
Exhibit B
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.
B-2
Exhibit B
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and 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
B-3
Exhibit B
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
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 M 0410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
B-4
Exhibit B
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
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.
B-5
Exhibit B
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.
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.
B-6
Exhibit B
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
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 individual
includes information as a whole indicating that individual'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 individuals 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 individuals who meet either of
the following criteria, (1) or (11) below. If an individual 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 individual 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 individual 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 individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
B-7
Exhibit B
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.
c. Significant trauma placing the individual at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For individuals 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 individual 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 individual'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 individual 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
B-8
Exhibit B
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 individual's presenting condition.
Documentation in each individual's chart as a whole will
demonstrate 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 individual, 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 individual s 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 the
individual's information with and among all other providers
involved in the individual's care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
B-9
Exhibit B
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 individual
should receive services based on individual clinical need and
established therapeutic relationships. Clinically appropriate and
covered SMHS can also be provided when the individual has a co-
occurring mental health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s
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
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving a individual 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 an
individual's specific needs and circumstances that could seriously
jeopardize the individual 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.
B-10
Exhibit B
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 individuals' medical records
include an assessment of each individual'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 individual's medical record.
iii. For individuals aged 6 through 21, the Child and Adolescent
Needs and Strengths (CANS), and for individual s 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
individual 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,
B-11
Exhibit B
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CTO) U.S. Edition, September 2022 Release, and ICD-
10-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
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 individual
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 person-
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-
B-12
Exhibit B
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/provqovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations must ensure that
client confidentiality is maintained.
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 individuals 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
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
B-13
Exhibit B
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 individuals 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 individuals 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
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 person
served/family satisfaction based on County's guidance. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating person served's grievances, appeals and State
Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
B-14
Exhibit B
4. Informing the County and individuals 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 County's QI
Work Plan with documented annual evaluations and documented
revisions as needed. The Ql 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 Ql actions, and ensure follow-up of Ql processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
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 individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. 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.
B-15
Exhibit B
3. Urgent care appointments for services that do not require
prior authorization must be provided to individual s 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 individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, 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 individual s within 15 business
days from the date the client or a provider acting on behalf
of the individual, 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 individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
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)
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal individuals 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 PED
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.
B-16
Exhibit B
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 individuals 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
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
B-17
Exhibit B
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.
B-18
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
C-1
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 01-02-2020
C-2
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 01-02-2020
C-3
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
C-4
Exhibit D
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the person served's record; however, there is no
requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
A. Assessments
1. The following areas will be included as a part of a comprehensive person served's
record:
• Presenting problems, including impairments in function, and current mental
status exam.
• Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
• Behavioral health history including mental health history, substance use/abuse,
and previous services
• Medical history including physical health conditions, medications, and
developmental history
• Psychosocial factors including family, social and life circumstances, cultural
considerations
• Strengths, risks, and protective factors, including safety planning
• Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
• The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
2. Timeliness/Frequency Standard for Assessment
• The time period to complete an initial assessment and subsequent assessments
for SMHS is up to clinical discretion.
• Assessments shall be completed within a reasonable time and in accordance
with generally accepted standards of practice.
B. Problem list
The use of a Problem List has largely replaced the use of treatment plans and is
therefore required to be part of the person served's record. The problem list shall be
updated on an ongoing basis to reflect the current presentation of the person in care.
The problem list shall include, but is not limited to, the following:
• Diagnoses identified by a provider acting within their scope of practice
• Problems identified by a provider acting within their scope of practice
• Problems or illnesses identified by the person in care and/or significant support
person if any
• The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
Rev 04/2023 D-1
Exhibit D
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
• Identifies a course of action to respond to the assessed needs of the person in
care
• Includes development of a transition plan when the person in care has achieved
the goals of the care plan
• Peer support services must be based on an approved care plan
• Must be provided in a narrative format in the person's progress notes
• Updated at least annually
2. Services requiring Treatments Plans
• Intensive Home-Based Services (IHBS)
• Intensive Care Coordination (ICC)
• Therapeutic Behavioral Services (TBS)
• Must have specific observable and/or specific quantifiable goals
• Must identify the proposed type(s) of intervention
• Must be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the person served's plan is used to establish that the services are
provided under the direction of an approved category of staff, and if the below
staff are not the approved category,
➢ a physician
➢ a licensed/"waivered" psychologist
➢ a licensed/ "associate" social worker
➢ a licensed/ registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ Person served's plans will be consistent with the diagnosis, and the focus of
intervention will be consistent with the person served's plan goals, and there will
be documentation of the person served's participation in and agreement with
the plan. Examples of the documentation include, but are not limited to,
reference to the person served's participation and agreement in the body of the
plan, person served's signature on the plan, or a description of the person
served's participation and agreement in progress notes.
➢ Person served's signature on the plan will be used as the means by which the
Contractor documents the participation of the person served. When the person
served's signature is required on the person served's plan and the person
Rev 04/2023 D-2
Exhibit D
served refuses or is unavailable for signature, the person served's plan will
include a written explanation of the refusal or unavailability.
➢ The Contractor will give a copy of the person served's plan to the person served
on request.
D. Progress Notes
1. Providers shall create progress notes for the provision of all SMHS. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. Progress notes shall include:
• The type of service rendered.
• A narrative describing the service, including how the service addressed the
beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or
risk factors).
• The date that the service was provided to the beneficiary.
• Duration of the service, including travel and documentation time.
• Location of the beneficiary at the time of receiving the service.
• A typed or legibly printed name, signature of the service provider and date of
signature.
• ICD 10 code
• Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) code.
• Next steps including, but not limited to, planned action steps by the provider or by
the beneficiary, collaboration with the beneficiary, collaboration with other
provider(s) and any update to the problem list as appropriate.
2. Timeliness/Frequency of Progress Notes
• Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis services, which shall be completed within 24 hours.
• A note must be completed for every service contact
Rev 04/2023 D-3
Exhibit E
coU Department of Behavioral Health
t Policy and Procedure Guide
O 1856 O
FRV`' PPG 1.2.7
Section: Mental Health
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht(Director of Behavioral Health), Francisco Escobedo (Sr.Staff Analyst-QA), Kannika
Toonnachat(Division Manager-Technology and Quality Management)
POLICY: It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE: To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1. Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,families and communities in Fresno County who are affected by,or are at risk
of,mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3128116
1 � age
E-1
Exhibit E
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
2. Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4. Objective (Goal): Intended results or the impact of learning, programs, or activities.
5. Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
III. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
2 1 P a g e
E-2
Exhibit E
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy Title:Performance Outcome Measures
a. Effectiveness of services — How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services —The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access — Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders— Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
3 1 P a g e
E-3
Exhibit F
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
FSP,AOT,and TBS
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1,140.98
Physicians Assistant $511.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LVN $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
Other Qualified Providers-Other Designated MH staff that bill
medical $223.41
Exhibit G
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
G-1
Exhibit G
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under Article 18
of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose
data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment
card liabilities and costs; (ix) infringement of intellectual property, including but not
limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy,
including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi) funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
G-2
Exhibit G
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(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.
G-3
Exhibit G
(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.
G-4
Exhibit H
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information at intake and annually
thereafter.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
H-1
Exhibit H
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
H-2
Exhibit I
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=1 82beOc5cdcd 5072 bb 1 864cdee
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.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, Contractor shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
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.
I-1
Exhibit I
cot,, Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
ti 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@fresnocountVca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
1-2
Exhibit I
F C 4 A fresnodbh.logicmanager.com/incidentsf?t=9&p=1&k=182be0dcdcd5072bblBWdee4d3d6e
LogicManager
Incident Report
Please complete this form
- Client Information
Name of Facility'
Name of Reporting Party'
Facility Address'
Facility Phone Number'
Mental Health or Substance Use Disorder Program?
Client First Name'
Client Last Name'
i
Client Date of Birth
Client Address
i
ClientlD
i
Gender-
County of origin'
- Summary
Subject 0
Incident(check all that apply)'
If Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
i
Description of the incident'
1-3
Exhibit I
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Incident(check all that apply)'
Medical Emergency x Deathof Client x
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Violence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-inflicted or by accident)
Medication Error
F C 4 A fresnodbh.logicmamgeccom/incidents/?t-9&p-i&k-182be0c5cdcd5072bbl864cdee4d3d6e
Date of Incident'
Time of Incident'
_-
Location of Incident'
En to
Key People Directly Involved in Incident(witnesses,staff)'
Did the Injured Party seek Medical Attention?
Sele[t aotlor
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Fnter zxf
Reported By Email'
EMU:t
Reported On
10/30/2019
1-4
Exhibit I
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E ? C 4 itfresnodbh.logicmanager.com ina - t &&k=182beOc5cdcd50F2bbl864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
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Description of Action Taken'
Outcome
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Follow Up
Action Taken(check all that apply)'
Law Enforcement Contacted x Called 911/EMS
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
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t
1-5
Exhibit I
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1-6
Exhibit I
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Analyst Follow Up In Progress metl test SYSTEM L..—na r
1-7
Exhibit I
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Analyst Follow Up
Tasty Details CII<ntlnbemNon
xameolva�iliry'
Nameof nepoNn[Pany
facility vnone xumber'
%e .Health or Sub.—Use Disorder 1m mt-
MentalNealth
Clint LartName'
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sxgnt o
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If Otherspetlfy(I.e.fire,polso1116.epiEemlc outbreaks,othef<1-1phes/events matjeopardlx the welrarcand safety of clients,—Id/ol membenorthe commumty):
D—ptbn of-InClde t-
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Task ID:3135ource:]03:null K < 3 > N CANCEL
1-8
Exhibit I
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Action Taken(check all that apply)'
Law Enforcement contacted M
Please specityif other
DescnpNon ofAcb-Taken'
f
Outcome'
f
added information
cause fdeath-cancer per wmner30-31-1
Task ID:313 source:103:null cc c 1� CANC
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1-9
Exhibit I
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1-10
Exhibit J
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, Contractor, Contractor' employees and subcontractors must
sign the Contractor Acknowledgment and Agreement form and return this form to the Compliance
Officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
County.
3. Treat County employees, persons served, and other mental health contractors fairly
and with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
J-1
Exhibit J
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
J-2
Exhibit J
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature: Date:
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date:
J-3
Exhibit K
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
Contractor shall be required to maintain organizational provider certification by the host county.
A copy of this renewal certificate must be furnished to County within thirty (30) days of receipt of
certificate from host county. The Contractor must meet Medi-Cal organization provider
standards as stated below. It is acknowledged that all references to Organizational Provider
and/or Provider below shall refer to the Contractor.
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2. The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6. The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7. The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
K-1
Exhibit K
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
10. The County may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three years. The County may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
K-2
Exhibit L
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit L.
(C) "Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D) "Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit L.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit L.
L-1
Exhibit L
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C) The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit L;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
L-2
Exhibit L
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit L, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
L-3
Exhibit L
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit L. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
L-4
Exhibit L
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a)fresnocountyca.gov, 559-600-5900, (559) 600-
4645, dbhcontractedservices(a)fresnocountyca.gov,
dbhforensicservices(a)fresnocountyca.gov (which telephone number and email address
the County may update by providing notice to the Contractor), and (ii) preserve all
relevant evidence (and cause any affected Authorized Person to preserve all relevant
evidence) relating to the Security Breach. The notification shall include, to the extent
reasonably possible, the identification of each type and the extent of Personal
Information that has been, or is reasonably believed to have been, breached, including
but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or
modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit L, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
L-5
Exhibit L
including taking any corrective action under this Exhibit L, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D) The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit L.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit L, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit L.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit L. that apply to the
Contractor with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
L-6
Exhibit L
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit
L, such certification shall state the date, time, and manner (including standard) of disposal and
by whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit L to all such
Personal Information and copies of Personal Information. The Contractor shall not retain any
copy of any Personal Information after returning or disposing of Personal Information as
required by this section 6. The Contractor's obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractor retains if
return or disposal is not feasible and to all Personal Information that the Contractor may later
discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit L may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee") from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit L and the cost of pursuing any insurance
providers, arising out of or resulting from any third party claim or action against any County
Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit L or
arising out of or resulting from the Contractor's failure to comply with any of its obligations under
this section 8. The provisions of this section 8 do not apply to the acts or omissions of the
L-7
Exhibit L
County. The provisions of this section 8 are cumulative to any other obligation of the Contractor
to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The
provisions of this section 8 shall survive the termination of this Agreement.
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit L shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit L
is intended to confer, nor shall anything in this Exhibit L confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
L-8
Exhibit M
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).
M-1
Exhibit M
(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:
M-2
Exhibit N
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
l )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME ADDRESS PROVIDER NUMBER
N-1
Exhibit N
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... 71 n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name FIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name FIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
N-2
Exhibit O
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
O-1
Exhibit O
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signa _ Date:Vw
(Printed Nam itle (Name of Agency or Company))
l��r
O-2
Exhibit P
1
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices,preferred languages,health literacy,and other communication needs.
Governance,Leadership,and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and
allocated resources.
3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in
the service area.
4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate
timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing.
7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement,Continuous Improvement,and Accountability:
9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's
planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts
or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public.
��� 1 Think Cultural Health
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Office of Minority Health contact@thinkculturalhealth.hhs.gov
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P-1
Exhibit P
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.'Currently,individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which
individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice,one of the most modifiable factors is the lack of culturally and linguistically
appropriate services,broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Of all the forms of
Health inequities result in disparities that directly affect the quality of life for all individuals. Health
disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in
the issue not only an individual concern but also a public health concern. In the United States,it health care is the most
has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane.
inadequate and/or inequitable care is$1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr.
the quality of care and services.5,6 By providing a structure to implement culturally and linguistically
appropriate services,the National CLAS Standards will improve an organization's ability to address
health care disparities.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa
2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www.
hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?topicid=39
4. LaVeist,T A.,Gaskin,D.J.,&Richard,P(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www.
jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.pdf
5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved
from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.pdf
6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The
Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf
7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http://
minorityhealth.hhs.gov/npa/f les/Plans/HHS/H HS_Plan_complete.pdf
8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of
Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
��� 1 Think Cultural Health
F
S(_ U.S.Deportment of https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
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P-2