HomeMy WebLinkAboutAgreement A-15-156 with Reading and Beyond.pdf I
AGREEMENT NO. 15-156
I
I AGREEMENT
2 THIS AGREEMENT is made and entered into this 21 st day of_ April , 2015,
I
3 by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
4 hereinafter referred to as "COUNTY", and READING AND BEYOND, a Private Non-Profit
5 Organization, whose address is 4670 East Butler Avenue, Fresno,CA 93702, hereinafter referred
6 to as"CONTRACTOR".
7 WITNESSETH:
I
8 WHEREAS, COUNTY's Department of Behavioral Health, through its Mental Health
9 Services Act funding, is in need of supervised child care services for its mental health clients; and
10 WHEREAS, CONTRACTOR is qualified and willing to provide such services pursuant to
11 the terms and conditions of this Agreement.
12 NOW,THEREFORE, in consideration of their mutual promises,covenants and
13 conditions, hereinafter set forth,the sufficiency of which is acknowledged,the parties agree as
14 follows:
15 1. SERVICES
16 A. CONTRACTOR shall perform all services and fulfill all responsibilities as
17 specified in COUNTY's Request for Proposal (RFP)No. 952-5319 dated December 24, 2014 and
18 Addendum No. One (1)to COUNTY's RFP No. 952-5319 dated January 27, 2015, herein
19 collectively referred to as COUNTY's Revised RFP, and CONTRACTOR's Response to said
20 Revised RFP dated February 7, 2015, all incorporated herein by reference and made part of this
21 Agreement.
22 B. CONTRACTOR shall also perform all services and fulfill all responsibilities
23 as set forth in Exhibit A("Summary of Services")attached hereto and by this reference j
24 incorporated herein and made part of this Agreement.
25 C. . In the event of any inconsistency among the documents described in
26 Sections LA and 1.B hereinabove, the inconsistency shall be resolved by giving precedence in the
27 following order of priority; (1)to this Agreement, including all Exhibits, (2)to the Revised RFP;
28 and(3)to CONTRACTOR's Response to the Revised RFP. A copy of COUNTY's Revised RFP
I
- 1 - COUNTY OF FRESNO
Fresno.CA
I
I
I No. 952-5319, and CONTRACTOR's response, shall be retained and made available during the
2 term of this Agreement by COUNTY's DBH Contracts Division.
3 D. COUNTY shall be held responsible for services as set forth in the Summary of
4 Services, identified in Exhibit A, page three (3), under the heading "COUNTY SHALL BE
5 RESPONSIBLE FOR THE FOLLOWING".
6 2. TERM
7 This Agreement shall become effective on the Is'day of July 2015 and shall
8 terminate on the 301h day of June 2018.
9 Effective June 30`h, 2018, this Agreement, subject to satisfactory outcomes
10 performance and subject to available funding each year, shall be extended for two (2) additional
11 twelve (12) month periods upon the same terms and conditions herein set forth, unless written
12 notice of non-renewal is given by COUNTY or CONTRACTOR or COUNTY's DBH Director or
13 designee, not later than thirty (30) days prior to the close of the current Agreement term.
14 3. TERMINATION
15 A. Non-Allocation of Funds - The terms of this Agreement, and the services to
16 be provided thereunder, is contingent on the approval of funds by the appropriating government
17 agency. Should sufficient funds not be allocated, the services provided may be modified, or this
18 Agreement terminated at any time by giving CONTRACTOR thirty (30) days advance written
19 notice.
20 B. Breach of Contract - COUNTY may immediately suspend or terminate this
21 Agreement in whole or in part, wherein the determination of COUNTY there is:
22 1) An illegal or improper use of funds;
23 2) A failure to comply with any term of this Agreement;
24 3) A substantially incorrect or incomplete report submitted to COUNTY;
25 4) Improperly performed service.
26 In no event shall any payment by COUNTY constitute a waiver by COUNTY
27 of any breach of this Agreement or any default which may then exist on the part of
28 CONTRACTOR. Neither shall such payment impair or prejudice any remedy available to
- 2 - COUNTY OF FRESNO
Fresno,CA
I COUNTY with respect to the breach or default. The COUNTY shall have the right to demand of
2 the CONTRACTOR the repayment to the COUNTY of any funds disbursed to CONTRACTOR
3 under this Agreement, which in the judgment of COUNTY were not expended in accordance with
4 the terms of this Agreement. The CONTRACTOR shall promptly refund any such funds upon
5 demand, or at COUNTY's option such repayment shall be deducted from future payments owing to
6 CONTRACTOR under this Agreement.
7 C. Without Cause - Under circumstances other than those set forth above, this
8 Agreement may be terminated by COUNTY or CONTRACTOR upon the giving of sixty (60) days
9 advance written notice of an intention to terminate.
10 4. COMPENSATION
11 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
12 compensation as follows:
13 Payment for services provided herein shall be made upon certification or other
14 proof satisfactory to COUNTY's DBH, that services have actually been performed by
15 CONTRACTOR as specified in the Agreement. Allowable expenditures under this Agreement are
16 specifically established and identified in Exhibit B-2, for base services (Existing Services)
17 described in Section I of Exhibit A, and in Exhibit 13-1 for Expanded Services, if Expanded
18 Services are provided under this Agreement, described in Section II of Exhibit A. Exhibit B-1
19 and Exhibit B-2 are attached hereto and by this reference incorporated herein.
20 In no event shall the maximum amount of compensation paid to CONTRACTOR
21 by COUNTY exceed One Hundred Twenty Five Thousand Three Hundred Eighty Eight and
22 No/100 Dollars ($125,388) during each twelve-month period of this Agreement. In no event shall
23 total maximum compensation amount for this Agreement paid to CONTRACTOR by COUNTY
24 for actual services rendered exceed Six Hundred Twenty Six Thousand Nine Hundred Forty and
25 No/100 Dollars ($626,940) for the entire five year term of this Agreement.
26 It is understood that all expenses incidental to CONTRACTOR's performance of
27 services under this Agreement shall be borne by CONTRACTOR.
28 5. INVOICING
- 3 - COUNTY OF FRESNO
Fresno,CA
I A. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10`h) day of
2 each month for the prior month's actual expenditures rendered to DBHInvoicesna,co.fresno.ca.us.
3 B. At the discretion of COUNTY's DBH Director, or designee, if an invoice is
4 incorrect or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee,
5 shall have the right to withhold payment as to only that portion of the invoice that is incorrect or
6 improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to
7 provide services for a period of ninety (90) days after notification of an incorrect or improper
8 invoice. If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH's
9 satisfaction, COUNTY's DBH Director, or designee, may elect to terminate this Agreement,
10 pursuant to the termination provisions stated in Section Three (3) of this Agreement. In addition,
11 for invoices received ninety (90) days after the expiration of each term of this Agreement or
12 termination of this Agreement, at the discretion of COUNTY's DBH Director, or designee,
13 COUNTY's DBH shall have the right to deny payment of any additional invoices received.
14 6. INDEPENDENT CONTRACTOR
15 In performance of the work, duties and obligations assumed by CONTRACTOR
16 under this Agreement, it is mutually understood and agreed that CONTRACTOR, including any
17 and all of CONTRACTOR's officers, agents and employees will at all times be acting and
18 performing as an independent contractor, and shall act in an independent capacity and not as an
19 officer, agent, servant, employee,joint venture, partner or associate of COUNTY. Furthermore,
20 COUNTY shall have no right to control or supervise or direct the manner or method by which
21 CONTRACTOR shall perform its work and function. However, COUNTY shall retain the right to
22 administer this Agreement so as to verify that CONTRACTOR is performing its obligations in
23 accordance with the terms and conditions thereof. CONTRACTOR and COUNTY shall comply
24 with all applicable provisions of law and the rules and regulations, if any, of government authorities
25 having jurisdiction over matters which are directly or indirectly the subject of this Agreement.
26 Because of its status as an independent contractor, CONTRACTOR shall have
27 absolutely no right to employment rights and benefits available to COUNTY employees.
28 CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its
-4 - COUNTY OF FRESNO
Fresno,CA
I employees all legally-required employee benefits. In addition, CONTRACTOR shall be solely
2 responsible and save COUNTY harmless from all matters relating to payment of CONTRACTOR's
3 employees, including compliance with Social Security, withholding and all other regulations
4 governing such matters. It is acknowledged that during the term of this Agreement,
5 CONTRACTOR may be providing services to others unrelated to COUNTY or to this Agreement.
6 7. MODIFICATION
7 A. Any matters of this Agreement may be modified from time to time by the
8 written consent of CONTRACTOR and COUNTY without, in any way, affecting the remainder.
9 Notwithstanding the above, changes to line items in the budget, attached hereto as Exhibit B,that
10 do not exceed ten percent (10%) of the maximum compensation payable to the CONTRACTOR,
11 may be made with the written approval of COUNTY's DBH Director, or designee. Said budget line
12 item changes shall not result in any change to the maximum compensation amount payable to
13 CONTRACTOR, as stated herein.
14 B. CONTRACTOR hereby agrees that changes to the compensation under this
15 Agreement may be necessitated by a reduction in funding from State or Federal sources.
16 CONTRACTOR further understands that this Agreement is subject to any restrictions, limitations,
17 or enactments of all legislative bodies which affect the provisions, term, or funding of this
18 Agreement in any manner.
19 8. NON-ASSIGNMENT
20 Neither party shall assign or transfer this Agreement nor their rights or duties under
21 this Agreement without the prior written consent of the other party.
22 9. HOLD-HARMLESS
23 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's
24 request, defend COUNTY, its officers, agents and employees from any and all costs and expenses,
25 including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting
26 to COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its
27 officers, agents or employees under this Agreement, and from any and all costs and expenses,
28 including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting
- 5 - COUNTY OF FRESNO
Fresno,CA
I to any person, firm or corporation who may be injured or damaged by the performance, or failure to
2 perform, of CONTRACTOR, its officers, agents or employees under this Agreement. In addition,
3 CONTRACTOR agrees to indemnify COUNTY for Federal, State of California and/or local audit
4 exceptions resulting from non-compliance herein on the part of CONTRACTOR.
5 10. INSURANCE
6 Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or
7 any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
8 following insurance policies throughout the term of this Agreement:
9 A. Commercial General Liability
10 Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00.) per occurrence and an annual aggregate of Two Million
11 Dollars ($2,000,000.00). This policy shall be issued on a per occurrence basis.
12 COUNTY may require specific coverage including completed operations, product
liability, contractual liability, Explosion-Collapse-Underground (XCU), fire, legal
13 liability or any other liability insurance deemed necessary because of the nature of
14 the Agreement.
15 B. Automobile Liability
16 Comprehensive Automobile Liability Insurance with limits for bodily injury of not
17 less than Two Hundred Fifty Thousand Dollars ($250,000.00) per person, Five
Hundred Thousand Dollars ($500,000.00)per accident and for property damages
18 of not less than Fifty Thousand Dollars ($50,000.00), or such coverage with a
combined single limit of Five Hundred Thousand Dollars ($500,000.00).
19 Coverage should include owned and non-owned vehicles used in connection with
20 this Agreement.
21 C. Professional Liability
22 If CONTRACTOR employs licensed professional staff(e.g., Ph.D., R.N.,
23 L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000.00)per occurrence, Three
24 Million Dollars ($3,000,000.00) annual aggregate.
25 This coverage shall be issued on a per claim basis. CONTRACTOR agrees that it
26 shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
27 professional liability insurance with limits of coverage as specified herein.
28 /11
6 - COUNTY OF FRESNO
Fresno,CA
I D. Worker's Compensation
2 A policy of Worker's Compensation Insurance as may be required by the
3 California Labor Code.
4 F. Sexual Abuse/Molestation Liability
5 Sexual Abuse/Molestation Liability Insurance (including but not limited to
6 corporal punishment liability, sexual abuse and molestation liability, and child
abduction liability) with limits of not less than One Million Dollars ($1,000,000)
7 per occurrence, Two Million Dollars ($2,000,000) annual aggregate. This policy
8 shall be issued on a per occurrence basis.
9 E. Equipment Insurance
10 A policy or policies with minimum coverage(s) of Five Thousand Dollars ($5,000)
11 to replace any equipment provided by COUNTY to CONTRACTOR, or purchased
by CONTRACTOR with funds provided through this Agreement, for
12 CONTRACTOR's use in fulfilling its obligations under this Agreement. Said
policy or policies shall provide coverage(s) against loss of any such equipment
13 resulting from casualty such as fire, theft or any other disappearance, and damage
14 that renders such equipment inoperable and regardless of cause. The policy or
policies shall be endorsed naming County of Fresno as loss payee.
15
16 CONTRACTOR shall obtain endorsements to the Commercial General Liability
17 Insurance naming the County of Fresno, its officers, agents, and employees, individually and
18 collectively, as additional insured, but only insofar as the operations under this Agreement are
19 concerned. Such coverage for additional insured shall apply as primary insurance and any other
20 insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees shall
21 be in excess only and not contributing with insurance provided under the CONTRACTOR's
22 policies herein. This insurance shall not be cancelled or changed without a minimum of thirty (30)
23 days advance written notice given to COUNTY.
24 Within thirty (30) days from the date CONTRACTOR signs this Agreement,
25 CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all the
26 foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
27 3133 N. Millbrook Avenue, Fresno, California 93703, Attention: Contracts Division, stating that
28 such insurance coverages have been obtained and are in full force; that the County of Fresno, its
- 7 - COUNTY OF FRESNO
Fresno,CA
I officers, agents and employees will not be responsible for any premiums on the policies; that such
2 Commercial General Liability insurance names the County of Fresno, its officers, agents and
3 employees, individually and collectively, as additional insured, but only insofar as the operations
4 under this Agreement are concerned; that such coverage for additional insured shall apply as
5 primary insurance and any other insurance, or self-insurance, maintained by the COUNTY, its
6 officers, agents and employees, shall be excess only and not contributing with insurance provided
7 under CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed
8 without a minimum of thirty (30) days advance, written notice given to COUNTY.
9 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
10 herein provided, the COUNTY may, in addition to other remedies it may have, suspend or
11 terminate this Agreement upon the occurrence of such event.
12 All policies shall be with admitted insurers licensed to do business in the State of
13 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc.
14 rating of A FSC VII or better.
15 11. LICENSES/CERTIFICATES
16 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's
17 staff shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
18 necessary for the provision of the services hereunder and required by the laws and regulations of the
19 United States of America, State of California,the County of Fresno, and any other applicable
20 governmental agencies. CONTRACTOR shall notify COUNTY immediately in writing of its
21 inability to obtain or maintain such licenses, permits, approvals, certificates, waivers and
22 exemptions irrespective of the pendency of any appeal related thereto. Additionally,
23 CONTRACTOR and CONTRACTOR's staff shall comply with all applicable laws, rules or
24 regulations, as may now exist or be hereafter changed.
25 12. SUBCONTRACTS
26 CONTRACTOR shall obtain written approval from COUNTY's DBH Director, or
27 designee, before subcontracting any of the services delivered under this Agreement. Any
28 transferee, assignee or subcontractor will be subject to all applicable provisions of this Agreement,
- 8 - COUNTY OF FRESNO
Fresno,CA
I and all applicable State and Federal regulations. CONTRACTOR shall be held primarily
2 responsible by COUNTY for the performance of any transferee, assignee or subcontractor unless
3 otherwise expressly agreed to in writing by COUNTY. The use of subcontractors by
4 CONTRACTOR shall not entitle CONTRACTOR to any additional compensation than is provided
5 for under this Agreement.
6 13. CONFLICT OF INTEREST
7 No officer, employee or agent of COUNTY who exercises any function or
8 responsibility for planning and carrying out of the services provided under this Agreement shall
9 have any direct or indirect personal financial interest in this Agreement. CONTRACTOR shall
10 comply with all Federal, State and local conflict of interest laws, statutes and regulations, which
11 shall be applicable to all parties and beneficiaries under this Agreement and any officers, employee
12 or agent of COUNTY.
13 14. NON-DISCRIMINATION
14 During the performance of this Agreement, CONTRACTOR shall not unlawfully
15 discriminate against any employee or applicant for employment, or recipient of services, because of
16 race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status,
17 age or sex, pursuant to all applicable State and Federal statutes and regulations.
18 15. RECRUITMENT OF EMPLOYEES AND SERVICE TO CLIENTS
19 CONTRACTOR shall ensure that its employment recruitment efforts, including
20 administrative and professional staff positions, are carried out so as to adequately reflect the cultural
21 and ethnic diversity of the population of Fresno County. CONTRACTOR shall use its best efforts
22 to serve all cultural and ethnic groups residing in Fresno County. CONTRACTOR's employment
23 efforts will be monitored by COUNTY at periodic intervals.
24 16. CULTURAL COMPETENCY
25 As related to Cultural and Linguistic Competence, CONTRACTOR shall comply
26 with:
27 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45
28 C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
- 9- COUNTY OF FRESNO
Fresno,CA
I assistance from discriminating against persons based on race, color, national origin, sex, disability
2 or religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled
3 to equal access and participation in federally funded programs through the provision of
4 comprehensive and quality bilingual services.
5 B. Policies and procedures for ensuring access and appropriate use of trained
6 interpreters and material translation services for all LEP clients, including, but not limited to,
7 assessing the cultural and linguistic needs of its clients, training of staff on the policies and
8 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures
9 must include ensuring compliance of any sub-contracted providers with these requirements.
10 C. CONTRACTOR shall not use minors as interpreters.
11 D. CONTRACTOR shall provide and pay for interpreting and translation
12 services to persons participating in CONTRACTOR's services who have limited or no English
13 language proficiency, including services to persons who are deaf or blind. Interpreter and
14 translation services shall be provided as necessary to allow such participants meaningful access to
15 the programs, services and benefits provided by CONTRACTOR. Interpreter and translation
16 services, including translation of CONTRACTOR's "vital documents" (those documents that
17 contain information that is critical for accessing CONTRACTOR's services or are required by law)
18 shall be provided to participants at no cost to the participant. CONTRACTOR shall ensure that any
19 employees, agents, subcontractors, or partners who interpret or translate for a program participant,
20 or who directly communicate with a program participant in a language other than English,
21 demonstrate proficiency in the participant's language and can effectively communicate any
22 specialized terms and concepts peculiar to CONTRACTOR's services.
23 E. In compliance with the State mandated Culturally and Linguistically
24 Appropriate Services standards as published by the Office of Minority Health, CONTRACTOR
25 must submit to COUNTY for approval, within sixty (60) days from date of contract execution,
26 CONTRACTOR's plan to address all fifteen national cultural competency standards as set forth in
27 the "National Standards on Culturally and Linguistically Appropriate Services (CLAS)"
28 http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf. COUNTY's annual on-site review
- 10- COUNTY OF FRESNO
Fresno,CA
I of CONTRACTOR shall include collection of documentation to ensure all national standards are
2 implemented. As the national competency standards are updated, CONTRACTOR's plan must be
3 updated accordingly.
4 17. PERSONNEL DISCLOSURE
5 CONTRACTOR shall make available to COUNTY a current list of all personnel
6 providing services hereunder. Changes to this list will be immediately provided to COUNTY in
7 writing. The list shall provide the following information:
8 A. All full or part-time staff positions by title whose direct services are required
9 to provide the programs described herein;
10 B. A brief description of the functions of each such position and hours each
11 person in such position works each week or, for part-time positions, each day or month, as
12 appropriate;
13 C. The education and experience levels required for each position; and
14 D. The names of persons filling the identified positions.
15 18. CHILD ABUSE REPORTING ACT
16 CONTRACTOR shall establish a procedure acceptable to the COUNTY's DBH
17 Director, or designee, to ensure that all of the CONTRACTOR's employees, consultants,
18 subcontractors or agents described in the Child Abuse Reporting Act, section 11164, et seq of the
19 Penal Code, and performing services under this Agreement shall report all known or suspected
20 child abuse or neglect to a child protective agency as defined in Penal Code section 11165.9. This
21 procedure shall include:
22 A. A requirement that all CONTRACTOR's employees, consultants,
23 subcontractors or agents performing services shall sign a statement that he or she knows of and will
24 comply with the reporting requirements as defined in Penal Code section 11166(a); identified in
25 Exhibit C.
26 B. Establishing procedures to ensure reporting even when employees,
27 consultants, subcontractors, or agents who are not required to report child abuse under Penal Code
28 section 11166(a), gain knowledge of or reasonably suspect that a child has been a victim of abuse or
- COUNTY OF FRESNO
Fresno,CA
I neglect.
2 19. DEBARMENT-CERTIFICATION REGARDING DEBARMENT,
3 SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION-LOWER TIER
4 COVERED TRANSACTIONS
5 A. COUNTY and CONTRACTOR recognize that Federal assistance funds will
6 be used under the terms of this Agreement. For purposes of this Section, CONTRACTOR will be
7 referred to as the "prospective recipient".
8 B. This certification is required by the regulation implementing Executive Order
9 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participant's responsibilities.
10 The regulations were published as Part VII of the May 26, 1988 Federal Register(pages 19160-
11 19211).
12 1. The prospective recipient of Federal assistance funds certified by
13 entering into this Agreement, that neither it nor its principals are presently debarred, suspended,
14 proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
15 transaction by any Federal department or agency.
16 2. The prospective recipient of funds agrees by entering into this
17 Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person
18 who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this
19 covered transaction, unless unauthorized by the Federal department or agency with which this
20 transaction originated.
21 3. Where the prospective recipient of Federal assistance funds is unable
22 to certify to any of the statements in this certification, such prospective participant shall attach an
23 explanation to this Agreement.
24 4. The prospective recipient shall provide immediate written notice to
25 COUNTY if at any time prospective recipient learns that its certification in Section Twenty (20) of
26 this Agreement was erroneous when submitted or has become erroneous by reason of changed
27 circumstances.
28 5. The prospective recipient further agrees that by entering into this
- 12 - COUNTY OF FRESNO
Fresno,CA
I Agreement, it will include a clause identical to Section Twenty (20) of this Agreement and titled
2 "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier
3 Covered Transactions", in all lower tier covered transactions and in all solicitations for lower tier
4 covered transaction.
5 6. This assurance shall be included in every nonexempt subgrant,
6 contract, or subcontract.
7 7. The certification in Section Twenty (20) of this Agreement is a
8 material representation of fact upon which COUNTY relied in entering into this Agreement.
9 20. DISCLOSURE — CRIMINAL HISTORY AND CIVIL ACTIONS
10 CONTRACTOR is required to disclose if any of the following conditions apply to
11 them, their owners, officers, corporate managers and partners (hereinafter collectively referred to
12 as "CONTRACTOR"):
13 A. Within the three-year period preceding execution of this Agreement, they
14 have been convicted of, or had a civil judgment rendered against them for:
15 1. Fraud or a criminal offense in connection with obtaining, attempting
16 to obtain, or performing a public (federal, state, or local) transaction
17 or contract under a public transaction;
18 2. Violation of a federal or state antitrust statute;
19 3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
20 records; or
21 4. False statements or receipt of stolen property.
22 B. Within a three-year period preceding execution of this Agreement, they
23 have had a public transaction (federal, state, or local) terminated for cause or default.
24 Disclosure of the above information will not automatically eliminate
25 CONTRACTOR from further business consideration. The information will be considered as part
26 of the determination of whether to continue and/or renew this Agreement and any additional
27 information or explanation that CONTRACTOR elects to submit with the disclosed information
28 will be considered. If it is later determined that the CONTRACTOR failed to disclose required
- 13 - COUNTY OF FRESNO
Fresno,CA
I information, this Agreement may be immediately voided and terminated for material failure to
2 comply with the terms and conditions of this Agreement.
3 CONTRACTOR must sign a"Certification Regarding Debarment, Suspension, and
4 Other Responsibility Matters—Primary Covered Transactions", Exhibit D, attached hereto and by
5 this reference incorporated herein. Additionally, CONTRACTOR must immediately advise the
6 COUNTY in writing if, during the term of this Agreement: (1) CONTRACTOR becomes
7 suspended, debarred, excluded or ineligible for participation in federal or state funded programs or
8 from receiving federal funds as listed in the excluded parties list system (http://www.epls.gov); or
9 (2) any of the above listed conditions become applicable to CONTRACTOR. The CONTRACTOR
10 will indemnify, defend and hold the COUNTY harmless for any loss or damage resulting from a
11 conviction, debarment, exclusion, ineligibility or other matter listed in the signed "Certification
12 Regarding Debarment, Suspension, and Other Responsibility Matters".
13 21. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
14 INFORMATION
15 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal
16 agent, or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
17 455.104, and 455.106(a)(1),(2).
18 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
19 455.106(a)(1),(2), the following information must be disclosed by CONTRACTOR by completing
20 Exhibit E, "Disclosure of Ownership and Control Interest Statement", attached hereto and by this
21 reference incorporated herein and made part of this Agreement. CONTRACTOR shall submit this
22 form to COUNTY's DBH within thirty (30) days of the effective date of this Agreement.
23 Additionally, CONTRACTOR shall report any changes to this information within thirty-five (35)
24 days of occurrence by completing Exhibit E, "Disclosure of Ownership and Control Interest
25 Statement." Submissions shall be scanned pdf copies and are to be sent via email to
26 DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
27 22. ACKNOWLEDGEMENT
28 CONTRACTOR shall acknowledge in all public relations activities, materials and
- 1 4 - COUNTY OF FRESNO
Fresno,CA
I publications that COUNTY is the funding source for services to be provided through this
2 Agreement.
3 23. PROHIBITION ON PUBLICITY
4 None of the funds, materials, property or services provided directly or indirectly
5 under this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e.,
6 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
7 Notwithstanding the above, publicity of the services described in Section One (1) of
8 this Agreement shall be allowed as necessary to raise public awareness about the availability of
9 such specific services when approved in advance by COUNTY's DBH Director or designee and at a
10 cost to be provided in Section Four(4) of this Agreement for such items as written/printed
11 materials, the use of media(i.e., radio, television, newspapers) and any other related expense(s).
12 24. GRIEVANCES
13 CONTRACTOR shall establish procedures for handling client complaints and/or
14 grievances. Such procedures will include provisions for informing clients of their rights to a State
15 Hearing to resolve such issues.
16 CONTRACTOR shall log complaints and the disposition of all complaints from a
17 client or a client's family. CONTRACTOR shall provide a copy of the detailed complaint log
18 entries concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10`h)
19 day of the following month, in a format that is mutually agreed upon. Besides the detailed
20 complaint log, CONTRACTOR shall provide details and attach documentation of each complaint
21 with the log. CONTRACTOR shall post signs informing clients of their right to file a complaint or
22 grievance. CONTRACTOR shall notify COUNTY of all incidents reportable to state licensing
23 bodies that affect COUNTY clients within twenty-four (24) hours of receipt of a complaint.
24 Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
25 clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
26 investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or
27 corrective action taken to resolve the complaint. In addition, CONTRACTOR shall inform every
28 client of their rights as set forth in Exhibit F. CONTRACT OR shall file an incident report for all
- 15 - COUNTY OF FRESNO
Fresno,CA
I incidents involving clients, following the Protocol and using the Worksheet identified in Exhibit G.
2 25. PROPERTY OF COUNTY
3 A. COUNTY and CONTRACTOR recognizes that fixed assets are tangible and
4 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in
5 operational capacity and will benefit COUNTY for a period more than one year. Depreciation of the
6 qualified items will be on a straight-line basis.
7 For COUNTY purposes, fixed assets must fulfill three qualifications:
8 1. Asset must have life span of over one year.
9 2. The asset is not a repair part.
10 3. The asset must be valued at or greater than the capitalization
11 thresholds for the asset type:
12 Asset type Threshold
13
• land $0
• buildings and improvements $100,000
14 • infrastructure $100,000
15 • be tangible $5,000
o equipment
16 o vehicles
• or intangible asset $100,000
17 o Internally generated software
18 o Purchased software
o Easements
19 o Patents
• and capital lease $5,000
20 o Internally generated software
21 o Purchased software
o Easements
22 o Patents
23 • and capital lease $5,000
24 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is approved and
25 identified as an asset it will be tagged with a COUNTY program number. A Fixed asset log will be
26 maintained by COUNTY's Asset Management System and annual inventoried until the asset is fully
27 depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets may be
28 inventoried in comparison to COUNTY's DBH Asset Inventory System.
- 1 6 - COUNTY OF FRESNO
Fresno,CA
I B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00)
2 but more than One Thousand and No/100 Dollars ($1,000.00), with over one year life span, and are
3 mobile and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to
4 computers, copiers, televisions, cameras and other sensitive items as determined by COUNTY'S
5 DBH Director or designee. CONTRACTOR maintains a tracking system on the items and are not
6 required to be capitalize or depreciated. The items are subject to annual inventory for compliance.
7 C. Assets shall be retained by COUNTY, as COUNTY property, in the event
8 this Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to
9 participate in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination
10 or expiration of this Agreement CONTRACTOR shall be physically present when fixed and
11 inventoried assets are returned to COUNTY possession. CONTRACTOR is responsible for
12 returning to COUNTY all COUNTY owned undepreciated fixed and inventoried assets, or the
13 monetary value of said assets if unable to produce the assets at the expiration or termination of this
14 Agreement.
15 CONTRACTOR further agrees to the following:
16 1. To maintain all items of equipment in good working order and
17 condition, normal wear and tear is expected;
18 2. To label all items of equipment with COUNTY assigned program
19 number, to perform periodic inventories as required by COUNTY and to maintain an inventory list
20 showing where and how the equipment is being used, in accordance with procedures developed by
21 COUNTY. All such lists shall be submitted to COUNTY within ten (10) days of any request
22 therefore; and
23 3. To report in writing to COUNTY immediately after discovery, the
24 lost or theft of any items of equipment. For stolen items, the local law enforcement agency must be
25 contacted and a copy of the police report submitted to COUNTY.
26 D. The purchase of any equipment by CONTRACTOR with funds provided
27 hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions o
28 this Agreement as appropriate, and must be directly related to CONTRACTOR's services or
- 17 - COUNTY OF FRESNO
Fresno,CA
I activity under the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any
2 costs resulting from equipment purchased, which are incurred by CONTRACTOR, if prior written
3 approval has not been obtained from COUNTY.
4 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH
5 whenever there is any modification or change in the use of any property acquired or improved, in
6 whole or in part, using funds under this agreement. If any real or personal property acquired or
7 improved with said funds identified herein is sold and/or is utilized by CONTRACTOR for a use
8 which does not qualify under this program, CONTRACTOR shall reimburse COUNTY in an
9 amount equal to the current fair market value of the property, less any portion thereof attributable to
10 expenditures of non-program funds. These requirements shall continue in effect for the life of the
11 property. In the event the program is closed out, the requirements for this Section Twenty-One (21)
12 shall remain in effect for activities or property funded with said funds, unless action is taken by the
13 State government to relieve COUNTY of these obligations.
14 26. RECORDS
15 CONTRACTOR shall establish and maintain records in accordance with those
16 requirements prescribed by COUNTY, with respect to all matters covered by this Agreement.
17 CONTRACTOR shall retain all fiscal books, account records and client files for services performed
18 under this Agreement for at least three (3) years from date of final payment under this Agreement or
19 until all State and Federal audits are completed for that fiscal year, whichever is later.
20 27. REPORTS
21 CONTRACTOR shall submit to COUNTY within ten (10) calendar days following
22 the end of each month, all fiscal and program reports for that month. CONTRACTOR shall also
23 furnish to COUNTY such statements, records, data and information as COUNTY may request
24 pertaining to matters covered by this Agreement. In the event that CONTRACTOR fails to provide
25 reports as provided herein, it shall be deemed sufficient cause for COUNTY to withhold payments
26 until compliance is established.
27 A. Cost Documentation
28 1. All costs shall be supported by properly executed payrolls, time
- 18 - COUNTY OF FRESNO
Fresno,CA
I records, invoices, vouchers, orders, or any other accounting documents pertaining in whole or in
2 part to this Agreement and they shall be clearly identified and readily accessible. The support
3 documentation must indicate the line budget account number to which the cost is charged.
4 2. COUNTY shall notify CONTRACTOR in writing within thirty (30)
5 days of any potential State or Federal audit exception discovered during an examination. Where
6 findings indicate that program requirements are not being met and State or Federal participation in
7 this program may be imperiled in the event that corrections are not accomplished by
8 CONTRACTOR within thirty (30) days of receipt of such notice from COUNTY, written
9 notification thereof shall constitute COUNTY's intent to terminate this Agreement.
10 C. Service Documentation
11 CONTRACTOR agrees to maintain records to verify services under this
12 Agreement including names and addresses of clients served, the date of service and a description of
13 services provided on each occasion. CONTRACTOR shall complete service reports with
14 requirements set forth in Exhibit H, attached hereto and by this reference incorporated herein. These
15 records and any other document pertaining in whole or in part to this Agreement, shall be clearly
16 identified and readily accessible.
17 D. Use of Data
18 CONTRACTOR shall grant to COUNTY and the United States Department
19 Health and Human Services the royalty-free, nonexclusive and irrevocable license throughout the
20 world to publish, translate, reproduce, deliver, perform, dispose of, duplicate, use, disclose in any
21 manner and for any purpose whatsoever and to authorize others to do so, all subject data now or
22 hereafter covered by copyright. However, with respect to subject data not originated in the
23 performance of this Agreement, such license shall be only to the extent that CONTRACTOR has
24 the right to grant such license without becoming liable to pay any compensation to others because
25 of such grant. CONTRACTOR shall exert all reasonable effort to advise COUNTY at time of
26 delivery of subject data furnished under this Agreement, of all possible invasions of the right of
27 privacy therein contained, and of all portions of such subject data copied from work not composed
28 or produced in the performance of this Agreement and not licensed under this provision.
- 19 - COUNTY OF FRESNO
Fresno,CA
I As used in this clause, the term"Subject Data" means writing, sound
2 recordings, pictorial reproductions, drawings, designs or graphic representations, procedural
3 manuals, forms, diagrams, work flow charts, equipment descriptions, data files and data processing
4 of computer programs, and works of any similar nature (whether or not copyrighted or
5 copyrightable) which are first produced or developed under this Agreement. The term does not
6 include financial reports, cost analyses and similar information incidental to contract administration.
7 CONTRACTOR shall report to COUNTY promptly and in written detail,
8 each notice of claim of copyright infringement received by CONTRACTOR with respect to all
9 subject data delivered under this Agreement. CONTRACTOR shall not affix any restrictive
10 markings upon any data. If markings are affixed, COUNTY shall have the right at any time to
11 modify, remove, obliterate or ignore such markings.
12 COUNTY shall have access to any report, preliminary findings or data
13 assembled by CONTRACTOR under this Agreement. In addition, CONTRACTOR must receive
14 written permission from COUNTY prior to publication of any materials developed under this
15 Agreement and file with COUNTY a copy of all educational and training materials, curricula,
16 audio/visual aids, printed material and periodicals, assembled pursuant to this Agreement prior to
17 publication.
18 28. MONITORING
19 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director
20 and the State Department of Health Care Services, or their designees, the right to review and
21 monitor records, programs or procedures, at any time, in regard to clients, as well as the overall
22 operation of CONTRACTOR's programs, in order to ensure compliance with the terms and
23 conditions of this Agreement.
24 29. REFERENCES TO LAWS AND RULES
25 In the event any law, regulation, or policy referred to in this Agreement is amended
26 during the term thereof, the parties hereto agree to comply with the amended provision as of the
27 effective date of such amendment.
28 30. INTERPRETATION OF LAWS AND REGULATIONS
-20 - COUNTY OF FRESNO
Fresno,CA
I COUNTY reserves the right to make final interpretations or clarifications on issues
2 relating to Federal and State laws and regulations, to ensure compliance.
3 31. COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS
4 COUNTY, its officers, consultants, subcontractors, agents and employees shall
5 comply with all applicable State, Federal and local laws and regulations governing projects that
6 utilize Federal Funds.
7 CONTRACTOR recognizes that COUNTY operates its mental health programs
8 under an agreement with the State of California Department of Health Care Services, and that under
9 said agreement the State imposes certain requirements on COUNTY and its subcontractors.
10 CONTRACTOR shall adhere to the State requirements, including those identified in Exhibit I,
11 "State Mental Health Requirements", attached hereto and by this reference incorporated herein and
12 made part of this Agreement.
13 32. CONFIDENTIALITY
14 All services performed by CONTRACTOR under this Agreement shall be in strict
15 conformance with all applicable Federal, State of California and/or local laws and regulations
16 relating to confidentiality.
17 33. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
18 A. The parties to this Agreement shall comply with applicable laws and
19 regulations, including but not limited to Sections 14100.2 and 5328 et seq. of the Welfare and
20 Institutions Code, Section 431,300 et seq. of Title 42, Code of Federal Regulations, and the Health
21 Insurance Portability and Accountability Act (HIPAA), including but not limited to Section 1320 D
22 et seq, of Title 42, United States Code and its implementing regulations (including, but not limited
23 to Title 45, CFR, Parts 142,160, 162, and 164) regarding the confidentiality and security of patient
24 information.
25 B. The CONTRACTOR shall protect, from unauthorized disclosure, names and
26 other identifying information concerning persons receiving services pursuant to this Agreement,
27 except for statistical information. This pertains to any and all persons receiving services pursuant to
28 a COUNTY funded program. The CONTRACTOR shall not use such identifying information for
-21 - COUNTY OF FRESNO
Fresno.CA
I any purpose other than carrying out the CONTRACTOR obligations under this Agreement.
2 C. The CONTRACTOR shall not disclose, except as otherwise specifically
3 permitted by this Agreement, authorized by law or authorized by the client/patient, any such
4 identifying information to anyone other than the State without prior written authorization from the
5 State in accordance with State and Federal Laws.
6 D. For purposes of the above sections, identifying information shall include, but
7 not be limited to, name, identifying number, symbol, or other identifying particular assigned to the
8 individual, such as finger or voice print, or a photograph.
9 E. Notification of Electronic Breach or Improper Disclosure: During the term of
10 this Agreement, CONTRACTOR shall notify COUNTY, immediately upon discovery of any breach
11 of Medi-Cal Protected Health Information (PHI) and/or data, where the information and/or data is
12 reasonably believed to have been acquired by an unauthorized person. Immediate notification shall
13 be made to COUNTY's Information Security Officer, within two business days of discovery, at
14 (559) 494-3255. CONTRACTOR shall take prompt corrective action to cure any deficiencies and
15 any action pertaining to such unauthorized disclosure required by applicable Federal and State Laws
16 and regulations. CONTRACTOR shall investigate such breach and provide a written report of the
17 investigation to the COUNTY Information Security Officer, postmarked within the thirty (30)
18 working days of the discovery of the breach to the address below:
19
20 County of Fresno
Information Security Officer
21 2048 N. Fine Street
Fresno, CA 93727
22
23 F. Safeguards: CONTRACTOR shall implement administrative, physical, and
24 technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and
25 availability of the protected health information, including electronic PHI, that it creates, receives,
26 maintains or transmits on behalf of COUNTY; and to prevent use or disclosure of PHI other than as
27 provided for by this Agreement, CONTRACTOR shall develop and maintain a written information
28 privacy and security program that includes administrative, technical and physical safeguards
- 22 - COUNTY OF FRESNO
Fresno,CA
I appropriate to the size and complexity of the CONTRACTOR operations and the nature and scope
2 of its activities. CONTRACTOR will provide COUNTY with information concerning such
3 safeguards as COUNTY may reasonably request from time to time.
4 CONTRACTOR shall implement strong access controls and other security
5 safeguards and precautions as noted in the following to restrict logical and physical access to
6 confidential, personal (e.g., PHI) or sensitive data to authorized users only.
7 CONTRACTOR shall enforce the following administrative and technical
8 password controls on all systems used to process or store confidential, personal, or sensitive data:
9 1. Passwords must not be:
10 a. shared or written down where they are accessible or recognizable
11 by anyone else; such as taped to computer screens, stored under
12 keyboards, or visible in a work area
13 b. a dictionary word
14 c. stored in clear text
15 2. Passwords, must be:
16 a. 8 characters or more in length
17 b. changed every 90 days
18 c. changed immediately if revealed or compromised
19 d. composed of characters from at least three of the following four
20 groups from the standard keyboard:
21 (i) Upper case letters (A-Z);
22 (ii) Lowercase letters (a-z);
23 (iii) Arabic numerals (0 through 9); and
24 (iv) Non-alphanumeric characters (punctuation symbols)
25 CONTRACTOR shall implement the following security controls on each
26 workstation or portable computing device (e.g., laptop computer) containing confidential, personal,
27 or sensitive data:
28 1. network-based firewall and/or personal firewall
-23 - COUNTY OF FRESNO
Fresno,CA
1 2. continuously updated anti-virus software
2 3. patch management process including installation of all operating
3 system/software vendor security patches.
4 CONTRACTOR shall utilize a commercial encryption solution that has
5 received FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on
6 portable electronic media (including, but not limited to, CDs and thumb drives) and on portable
7 computing devices (including, but not limited to, laptop and notebook computers).
8 CONTRACTOR shall not transmit confidential, personal, or sensitive data
9 via e-mail or other internet transport protocol unless the data is encrypted by a solution that has
10 been validated by the National Institute of Standards and Technology (MIST) as conforming to the
11 Advanced Encryption Standard (AES) Algorithm.
12 G. Mitigation of Harmful Effects. CONTRACTOR shall mitigate, to the extent
13 practicable, any harmful effect that is known to CONTRACTOR of a use or disclosure of PHI by
14 CONTRACTOR or its subcontractors in violation of the requirements of these Provisions.
15 H. Contractor's Contractors. CONTRACTOR shall ensure that any contractors,
16 including subcontractors, to whom CONTRACTOR provides PHI received from or created or
17 received by CONTRACTOR on behalf of COUNTY, agree to the same restrictions and conditions
18 that apply to CONTRACTOR with respect to such PHI; and to incorporate, when applicable, the
19 relevant provisions of these Provisions into each subcontract or sub award to such agents or
20 subcontractors..
21 I. Employee Training and Discipline. CONTRACTOR shall train and use
22 reasonable measures to ensure compliance with the requirements of these Provisions by employees
23 who assist in the performance of functions or activities on behalf of COUNTY under this
24 Agreement and use or disclose PHI; and discipline such employees who intentionally violate any
25 provisions of these Provisions, including termination of employment.
26 J. Termination for Cause. Upon COUNTY's knowledge of a material breach of
27 these Provisions by CONTRACTOR, COUNTY shall either:
28 1. Provide an opportunity for CONTRACTOR to cure the breach or end
-24 - COUNTY OF FRE5NO
Fresno,CA
I the violation and terminate this Agreement if CONTRACTOR does not cure the breach or end the
2 violation within the time specified by COUNTY; or
3 2. Immediately terminate this Agreement if CONTRACTOR has
4 breached a material term of these Provisions and cure is not possible.
5 3. If neither cure nor termination is feasible, the COUNTY Privacy
6 Officer shall report the violation to the Secretary of the U.S. Department of Health and Human
7 Services.
8 K. Judicial or Administrative Proceedings. COUNTY may terminate this
9 Agreement in accordance with Section Three (3) of this Agreement, if(1) CONTRACTOR is found
10 guilty in a criminal proceeding for a violation of the HIPAA Privacy or Security Rule or (2) a
11 finding or stipulation that the CONTRACTOR has violated a privacy or security standard or
12 requirement of HIPAA; or other security or privacy laws in an administrative or civil proceeding in
13 which the CONTRACTOR is a party.
14 L. Effect of Termination. Upon termination or expiration of this Agreement for
15 any reason, CONTRACTOR shall return or destroy all PHI received from COUNTY (or created or
16 received by CONTRACTOR on behalf of COUNTY)that CONTRACTOR still maintains in any
17 form, and shall retain no copies of such PHI or, if return or destruction is not feasible, it shall
18 continue to extend the protections of these Provisions to such information, and limit further use of
19 such PHI to those purposes that make the return or destruction of such PHI infeasible. This
20 provision shall apply to PHI that is in the possession of subcontractors or agents of
21 CONTRACTOR.
22 M. Disclaimer. COUNTY makes no warranty or representation that compliance
23 by CONTRACTOR with these Provisions, HIPAA or the HIPAA regulations will be adequate or
24 satisfactory for CONTRACTOR's own purposes or that any information in CONTRACTOR's
25 possession or control, or transmitted or received by CONTRACTOR, is or will be secure from
26 unauthorized use or disclosure. CONTRACTOR is solely responsible for all decisions made by
27 CONTRACTOR regarding the safeguarding of PHI.
28 N. Amendment. The parties acknowledge that Federal and State laws relating to
-25 - COUNTY OF FRESNO
Fresno,CA
I electronic data security and privacy are rapidly evolving and that amendment of these Provisions
2 may be required to provide for procedures to ensure compliance with such developments. The
3 parties specifically agree to take such action as is necessary to implement the standards and
4 requirements of HIPAA, the HIPAA regulations and other applicable laws relating to the security or
5 privacy of PHI. Upon COUNTY's request, CONTRACTOR agrees to promptly enter into
6 negotiations with COUNTY concerning an amendment to these Provisions embodying written
7 assurances consistent with the standards and requirements of HIPAA, the HIPAA regulations or
8 other applicable laws. COUNTY may terminate this Agreement upon thirty (30) days written notice
9 in the event (i) CONTRACTOR does not promptly enter into negotiations to amend these
10 Provisions when requested by COUNTY pursuant to this Section or (ii) CONTRACTOR does not
11 enter into an amendment providing assurances regarding the safeguarding of PHI that COUNTY in
12 its sole discretion, deems sufficient to satisfy the standards and requirements of HIPAA and the
13 HIPAA regulations.
14 O. No Third-Party Beneficiaries. Nothing express or implied in the terms and
15 conditions of these Provisions is intended to confer, nor shall anything herein confer, upon any
16 person other than COUNTY or CONTRACTOR and their respective successors or assignees, any
17 rights, remedies, obligations or liabilities whatsoever.
18 P. Interpretation. The terms and conditions in these Provisions shall be
19 interpreted as broadly as necessary to implement and comply with HIPAA, the HIPAA regulations
20 and applicable State laws. The parties agree that any ambiguity in the terms and conditions of these
21 Provisions shall be resolved in favor of a meaning that complies and is consistent with HIPAA and
22 the HIPAA regulations.
23 Q. Regulatory References: A reference in the terms and conditions of these
24 Provisions to a section in the HIPAA regulations means the section as in effect or as amended.
25 R. Survival. The respective rights and obligations of CONTRACTOR as stated
26 in this Section shall survive the termination or expiration of this Agreement.
27 S. No Waiver of Obligations. No change, waiver or discharge of any liability or
28 obligation hereunder on any one or more occasions shall be deemed a waiver of performance of any
-26 - COUNTY OF FRESNO
Fresno,CA
I continuing or other obligation, or shall prohibit enforcement of any obligation on any other
2 occasion.
3 34. DATA SECURITY
4 For the purpose of preventing the potential loss, misappropriation or inadvertent
5 disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
6 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
7 contractual relationship with the COUNTY for the purpose of providing services under this
8 Agreement must employ adequate data security measures to protect the confidential information
9 provided to the CONTRACTOR by the COUNTY, including but not limited to the following:
10 A. CONTRACTOR-Owned Mobile/Wireless/Handheld Devices may not
11 be connected to COUNTY networks via personally owned mobile, wireless or handheld devices,
12 except when authorized by COUNTY for telecommuting and then only if virus protection software
13 currency agreements are in place, and if a secure connection is used.
14 B. CONTRACTOR-Owned Computers or Computer Peripherals may not
15 be brought into the COUNTY for use without prior authorization from the COUNTY's Chief
16 Information Officer and/or designee(s), including and not limited to mobile storage devices. Data
17 must be stored on a secure server approved by the COUNTY and transferred by means of a VPN
18 (Virtual Private Network) connection, or another type of secure connection of this type if any data is
19 approved to be transferred.
20 C. COUNTY-Owned Computer Equipment— CONTRACTOR or anyone
21 having an employment relationship with the COUNTY may not use COUNTY computers or
22 computer peripherals on non-COUNTY premises without prior authorization from the COUNTY's
23 Chief Information Officer and/or designee(s).
24 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive
25 data on any hard-disk drive.
26 E. CONTRACTOR is responsible to employ strict controls to insure the
27 integrity and security of the COUNTY's confidential information and to prevent unauthorized
28 access to data maintained in computer files, program documentation, data processing systems, data
-27 - COUNTY OF FRESNO
Fresno,CA
I files and data processing equipment which stores or processes COUNTY data internally and
2 externally.
3 F. Confidential client information transmitted to one party by the other by
4 means of electronic transmissions must be encrypted according to Advanced Encryption Standards
5 (AES) of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
6 G. CONTRACTOR is responsible to immediately notify COUNTY of any
7 breaches or potential breaches of security related to COUNTY's confidential information, data
8 maintained in computer files, program documentation, data processing systems, data files and data
9 processing equipment which stores or processes COUNTY data internally or externally.
10 H. In the event of a breach of security related to COUNTY's confidential client
11 information provided to CONTRACTOR, COUNTY will manage the response to the incident,
12 however, CONTRACTOR will be responsible to issue any notification to affected individuals as
13 required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will
14 be responsible for all costs incurred as a result of providing the required notification.
15 35. COMPLIANCE
16 CONTRACTOR shall comply with all requirements of the "Fresno County Mental
17 Health Compliance Program and Contractor Code of Conduct and Ethics" as set forth in Exhibit J,
18 attached hereto and incorporated herein by reference. Within thirty (30) days of entering into this
19 Agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees,
20 agents and subcontractors providing services under this Agreement certify in writing, that he or she
21 has received, read, understood, and shall abide by the requirements set forth in Exhibit J.
22 CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents and
23 subcontractors providing services under this Agreement shall certify in writing that he or she has
24 received, read, understood, and shall abide by the requirements set forth in Exhibit J.
25 CONTRACTOR understands that the promotion of and adherence to the Code of Conduct is an
26 element in evaluating the performance of CONTRACTOR and its employees, agents and
27 subcontractors.
28 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
-28 - COUNTY OF FRESNO
Fresno,CA
I employees, agents and subcontractors providing services under this Agreement shall complete
2 general compliance training and appropriate employees, agents and subcontractors shall complete
3 documentation and billing or billing/reimbursement training. All new employees, agents and
4 subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is
5 required to attend training shall certify in writing that he or she has received the required training.
6 The certification shall specify the type of training received and the date received. The certification
7 shall be provided to the COUNTY's Compliance Officer at 3133 N. Millbrook, Fresno, CA 93703.
8 CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
9 COUNTY by the Federal Government as a result of CONTRACTOR's violation of the terms of this
10 Agreement.
11 36. ASSURANCES
12 In entering into this Agreement, CONTRACTOR certifies that it nor any of its
13 officers are not currently excluded, suspended, debarred, or otherwise ineligible to participate in the
14 Federal Health Care Programs: that it or any of its officers have not been convicted of a criminal
15 offense related to the provision of health care items or services; nor has it or its officers been
16 reinstated to participation in the Federal Health Care Programs after a period of exclusion,
17 suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract,
18 that CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from
19 responsibility for, or involvement with, COUNTY's business operations related to the Federal
20 Health Care Programs and shall remove such CONTRACTOR from any position in which
21 CONTRACTOR's compensation, or the items or services rendered, ordered or prescribed by
22 CONTRACTOR may be paid in whole or part, directly or indirectly, by Federal Health Care
23 Programs or otherwise with Federal Funds at least until such time as CONTRACTOR is reinstated
24 into participation in the Federal Health Care Programs.
25 A. If COUNTY has notice that CONTRACTOR or its officers has been charged
26 with a criminal offense related to any Federal Health Care Program, or is proposed for exclusion
27 during the term on any contract, CONTRACTOR and COUNTY shall take all appropriate actions to
28 ensure the accuracy of any claims submitted to any Federal Health Care Program. At its discretion
29 - COUNTY OF FRESNO
Fresno,CA
I given such circumstances, COUNTY may request that CONTRACTOR cease providing services
2 until resolution of the charges or the proposed exclusion.
3 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR
4 or subcontractors of CONTRACTOR who, in each case, are expected to perform professional
5 services under this Agreement, will be queried as to whether (1) they are now or ever have been
6 excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care
7 Programs; (2)they have been convicted of a criminal offense related to the provision of health care
8 items or services; and or (3)they have been reinstated to participation in the Federal Health Care
9 Programs after a period of exclusion, suspension, debarment, or ineligibility.
10 1. In the event the potential employee or subcontractor informs
11 CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or
12 has been convicted of a criminal offense relating to the provision of health care services, and
13 CONTRACTOR hires or engages such potential employee or subcontractor, CONTRACTOR will
14 ensure that said employee or subcontractor does no work, either directly or indirectly relating to
15 services provided to COUNTY.
16 2. Notwithstanding the above, COUNTY at its discretion may terminate
17 this Agreement in accordance with Section Four (4) of this Agreement, or require adequate
18 assurance (as defined by COUNTY)that no excluded, suspended or otherwise ineligible employee
19 or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
20 services provided to COUNTY. Such demand for adequate assurance shall be effective upon a
21 time frame to be determined by COUNTY to protect the interests of COUNTY clients.
22 C. CONTRACTOR shall verify (by asking the applicable employees and
23 subcontractors)that all current employees and existing subcontractors who, in each case, are
24 expected to perform professional services under this Agreement (1) are not currently excluded,
25 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
26 have not been convicted of a criminal offense related to the provision of health care items or
27 services; and (3) have not been reinstated to participation in the Federal Health Care Program after a
28 period of exclusion, suspension, debarment, or ineligibility. In the event any existing employee or
- 30 - COUNTY OF FRESNO
Fresno,CA
I subcontractor informs CONTRACTOR that he or she is excluded, suspended, debarred or otherwise
2 ineligible to participate in the Federal Health Care Programs, or has been convicted of a criminal
3 offense relating to the provision of health care services, CONTRACTOR will ensure that said
4 employee or subcontractor does no work, either direct or indirect, relating to services provided to
5 COUNTY.
6 1. CONTRACTOR agrees to notify COUNTY immediately during the
7 term of this Agreement whenever CONTRACTOR learns that an employee or subcontractor who,
8 in each case, is providing professional services under Section (1)this Agreement is excluded,
9 suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs, or is
10 convicted of a criminal offense relating to the provision of health care services.
11 2. Notwithstanding the above, COUNTY at its discretion may terminate
12 this Agreement in accordance with the Termination Section Four(4) of this Agreement, or require
13 adequate assurance (as defined by COUNTY)that no excluded, suspended or otherwise ineligible
14 employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly,
15 relating to services provided to COUNTY. Such demand for adequate assurance shall be effective
16 upon a time frame to be determined by COUNTY to protect the interests of COUNTY clients.
17 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
18 information from COUNTY which may be necessary to complete any internal or external audits
19 relating to CONTRACTOR's compliance with the provisions of this Section.
20 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any
21 penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's
22 violation of CONTRACTOR's obligations as described in this Section.
23 37. DISCLOSURE OF SELF-DEALING TRANSACTIONS
24 This provision is only applicable if the CONTRACTOR is operating as a corporation
25 (a for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR
26 changes its status to operate as a corporation.
27 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
28 transactions that they are a party to while CONTRACTOR is providing goods or performing
- 31 - COUNTY OF FRESNO
Fresno,CA
I services under this agreement. A self-dealing transaction shall mean a transaction to which the
2 CONTRACTOR is a party and in which one or more of its directors has a material financial
3 interest. Members of the Board of Directors shall disclose any self-dealing transactions that they
4 are a party to by completing and signing a Self-Dealing Transaction Disclosure Form (Exhibit K)
5 attached hereto and by this reference incorporated herein and made part of this Agreement) and
6 submitting it to the COUNTY prior to commencing with the self-dealing transaction or immediately
7 thereafter.
8 38. AUDITS AND INSPECTIONS
9 CONTRACTOR shall at any time during business hours, and as often as COUNTY
10 may deem necessary, make available to COUNTY for examination all of its records and data with
11 respect to the matters covered by this Agreement. CONTRACTOR shall, upon request to
12 COUNTY, permit COUNTY to audit and inspect all such records and data necessary to ensure
13 CONTRACTOR's compliance with the terms of this Agreement.
14 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
15 CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a
16 period of three (3) years after final payment under contract (Government Code section 8546.7).
17 Notwithstanding the term provision stated in Section Two (2) of this Agreement, it is
18 acknowledged by the parties hereto that this Agreement shall continue in full force and effect until
19 all audit procedures and requirements as stated in this Agreement have been completed to the
20 review and satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or
21 resulting from any audit and/or inspection including but not limited to actual costs incurred and the
22 payment of any expenditures disallowed by either COUNTY, State or Federal governmental
23 entities, including any assessed interest and penalties.
24 39. NOTICES
25 The persons having authority to give and receive notices under this Agreement and
26 their addresses include the following:
27 ///
28
- 32 - COUNTY OF FRESNO
Fresno,CA
I COUNTY CONTRACTOR
2 Director, Department of Executive Director
Behavioral Health Reading and Beyond
3 4411 E. Kings Canyon Road 4670 E. Butler Avenue
Fresno, CA 93702-3604 Fresno, CA 93702
4
5 Any and all notices between COUNTY and CONTRACTOR provided for or
6 permitted under this Agreement, or by law, shall be in writing and shall be deemed duly serviced
7 when personally delivered to one of the parties, or in lieu of such personal service, when deposited
8 in the United States Mail, postage prepaid, addressed to such party.
9 40. GOVERNING LAW
10 Venue for any action arising out of or related to this Agreement is to be in Fresno
11 County, California. The rights and obligations of the parties and all interpretation and performance
12 of this Agreement shall be governed in all respects by the laws of the State of California.
13 41. ENTIRE AGREEMENT
14 This Agreement, including all Exhibits, COUNTY's Revised RFP No. 952-5319,
15 and CONTRACTOR's response thereto, constitutes the entire agreement between CONTRACTOR
16 and COUNTY with respect to the subject matter hereof and supersedes all previous agreement
17 negotiations, proposals, commitments, writings, advertisements, publications and understandings of
18 any nature whatsoever unless expressly included in this Agreement.
19 ///
20 /!!
21 ///
22 //!
23 /lI
24
25
26
27 ///
28
- 33 - COUNTY OF FRESNO
Fresno,CA
i
i
i
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the
2 day and year first hereinabove written.
3 ATTEST:
4
5 CONTRACTOR: COUNTY OF FRESNO:
6 READING AND BEYOND
8 By: By: •
9 �am : v� Chairman, Board of Supervi o
10 Title: ExtGutvG bi-recter
11 Chairman of the Board, or President, or
12 Executive Director, or any Vice President
13 BERNICE E. SEIDEL, Clerk
14 Board of Supervisors
15 By:
16 Print Name: Q,e k n ej C,90.ti By: �
17 Title: G'O it tr o Ue',r
18 Secretary(of Corporation), or Controller,
19 or any Assistant Secretary, or Chief
Financial Officer, or any Assistant Treasurer
20
21 PLEASE SEE ADDITIONAL
22 SIGNATURE PAGE ATTACHED
I
23 Mailing Address:
24 4670 E. Butler Avenue
25 Fresno, CA 93702
Phone: (559) 600-6185
26 Contact: Luis Santana,Executive Director
27
28
i
-34- COUNTY OF FRESNO
Fresno,CA
I
I APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
2
3
4 By:
5
6 APPROVED AS TO ACCOUNTING FORM:
7 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
8
9 '
10 By:
11
12 DEPARTMENT OF BEHAVIORAL HEALTH
13 REVIEWED AND RECOMMENDED FOR APPROVAL:
14
15 By: A4&_6_�qtklc�
16 DAWAN UTECHT, DIRECTOR
17 DEPARTMENT OF BEHAVIORAL HEALTH
18
19
20
21 Fund/Subclass: 0001/10000
Organization: 56304311
22 Account/Program: 7295/0
23
FY 2015-16: $125,388
24 FY 2016-17: $125,388
25 FY 2017-18: $125,388
FY 2018-19: $125,388
26 FY 2019-20: $125,388
27
28
-35 - COUNTY OF FRESNO
Fresno,CA
Exhibit A
Page 1 of 3
SUMMARY OF SERVICES
ORGANIZATION: Reading and Beyond
SERVICES: SUPERVISED CHILD CARE SERVICES
CONTACT PERSON: Luis Santana, Executive Director
4670 E. Butler Avenue
Fresno, CA 93702
Phone: (559) 600-6185
CONTRACT PERIOD: July 1, 2015—June 30, 2020
CONTRACT AMOUNT: FY 2015-16: not to exceed $125,388
FY 2016-17: not to exceed $125,388
FY 2017-18: not to exceed $125,388
FY 2018-19: not to exceed $125,388
FY 2019-20: not to exceed $125,388
Reading and Beyond will operate and provide supervision of children at the two following sites: The West
Fresno Regional Center and Heritage Center - DBH Supervised Children's Rooms. The goal of the
program is to provide DBH clients with temporary, on-site child care to support their ability to receive
County mental health services. Additionally, care and supervision of children shall be provided with the
utmost regard for health and safety while promoting a fun, positive and educational atmosphere.
I. EXISTING SERVICES:
Contractor agrees to provide the following base services:
A. Continuously operate, supervise and staff the Heritage Center Supervised Children's Room Monday
through Friday, 8:00 a.m. through 5:00 p.m. and the West Fresno Regional Center Supervised
Children's Room Monday through Friday 10:00 a.m. through 2:00 p.m. on each and every COUNTY
business day, by providing care and supervision to children placed in the Supervised Children's
Rooms in accordance with the procedures set forth in the CONTRACTOR's Program Handbook,
prepared by the CONTRACTOR, which is incorporated herein by reference. However, if at closing
time any child/children remain unclaimed by their parent or guardian in the Supervised Children's
Rooms, then at least one (1) Site Coordinator shall continue to provide care and supervision until all
such children are retrieved from the Supervised Children's Rooms by their parents or guardians.
NOTE: If a child's parent or guardian leaves the building without their child, CONTRACTOR's staff
shall immediately notify law enforcement and COUNTY's Child Protective Services.
B. Staff the Heritage Center-DBH Supervised Children's Room with one (1) Site Coordinator serving a
nine (9) hour shift, inclusive of a one hour lunch break, and staff the West Fresno Regional Center
Supervised Children's Room with one (1) Site Coordinator serving a four (4) hour shift, each
providing services as required under this Agreement.
C. Staff the Heritage-DBH Supervised Children's Room with one (1) part-time Site Aide serving a five
(5) hour shift providing services as required under this Agreement.
D. Ensure at all times at least one (1) staff will be present in the Supervised Children's Room at each
site.
Exhibit A
Page 2of3
E. Ensure the Site Coordinator shall be certified in cardiopulmonary resuscitation.
F. Ensure the Site Coordinator shall receive 15 hours of Health and Safety Training.
G. Ensure all of CONTRACTOR's staff assigned to the supervised Children's rooms complete the
Health Insurance Portability and Accountability Act(HIPAA) annual training.
H. Ensure at least one CONTRACTOR's staff on site staff shall be fluent in Spanish. There shall be one
Spanish-speaking staff present nine hours a day from 8:00 a.m. to 5:00 p.m., including the lunch
break, at the Heritage Center-DBH Supervised Children's Room and there shall be one Spanish-
speaking staff present four hours a day from 10:00 a.m. to 2:00 p.m. at the West Fresno Regional
Center Supervised Children's Room.
I. Ensure all CONTRACTOR employees and agents providing services in the Supervised Children's
Room shall undergo a criminal history investigation and clearance, which shall include fingerprinting.
Such investigation and clearance shall be to the satisfaction of the COUNTY's DBH Director or
designee, before any such persons may perform any services in the Supervised Children's Rooms.
CONTRACTOR shall also obtain from each of its employees and agents his or her legally-authorized
written consent for the COUNTY's DBH Director or designee, to obtain the results of any criminal
history investigation and clearance conducted herein.
J. Ensure all CONTRACTOR's employees, consultants, subcontractors or agents performing services
under this Agreement shall report all known or suspected child abuse or neglect to a child protective
agency as defined in Penal Code section 11165.9.
This procedure shall include:
• A requirement that all CONTRACTOR's employees, consultants, subcontractors or agents
performing services shall sign a statement that he or she knows of and will comply with the
reporting requirements as defined in Penal Code section 11166(a), identified in Exhibit C.
• Establishing procedures to ensure reporting even when employees, consultants,
subcontractors, or agents who are not required to report child abuse under Penal Code
section 11166(a), gain knowledge of or reasonably suspect that a child has been a victim of
abuse or neglect.
K. CONTRACTOR shall develop systems and procedures, subject to approval of the COUNTY's DBH
Director or designee, for assuring children and their parents/guardians are appropriately identified
during the time the child is in the Supervised Children's Room. Such procedures will include, at a
minimum: positive identification of the parent/guardian at the time of the child's arrival and
confirmation of identity and authority when the child is retrieved; mechanisms for assuring adequate
supplies are made available by parents for the child, such as diapers, baby seats and special care
instructions.
L. Provide all requested program service information timely (Monthly Financial Reports and Activity
Reports and other information as required by DBH).
M. Meet with DBH staff monthly or as often as needed for service coordination, probiem/issue
resolution, information sharing, and review of services.
Il. EXPANDED SERVICES:
Exhibit A
Page 3 of 3
The West Fresno Regional Center Supervised Children's Room utilizes two areas for child care
supervision: the larger area (Child Care Room) on Mondays, Wednesdays, and Fridays and the smaller
area (Perinatal Waiting Room) on Tuesdays and Thursdays. Should DBH acquire the ability to utilize the
lamer area for the full week Monday through Friday and to expand the hours to a full day from 8:00 AM
to 5:00 PM, CONTRACTOR agrees to provide the following additional services:
A. Continuously operate, supervise and staff the West Fresno Regional Center Supervised Children's
Room Monday through Friday 8:00 a.m. through 5:00 p.m. on each and every COUNTY business day.
B. Staff the West Fresno Regional Center Supervised Children's Room with one (1) Site Coordinator
serving a nine (9) hour shift, inclusive of a one hour lunch break.
C. Staff the West Fresno Regional Center Supervised Children's Room with one (1) part-time Site Aide
serving a five (5) hour shift.
D. Ensure at least one CONTRACTOR's staff on site staff shall be fluent in Spanish. There shall be one
Spanish-speaking staff present nine hours a day from 8:00 a.m. to 5:00 p.m., including the lunch break,
at the West Fresno Regional Center Supervised Children's Room.
III. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
COUNTY shall provide electricity and telephone service restricted to the 559 service area and routine
security and janitorial service commensurate with the level and quality of such services provided to the
Heritage Center and West Fresno Regional Center buildings.
Exhibit B-1
Page 1 of 2
Department of Behavioral Health
Reading and Beyond Budget
MHSA Supervised Children's Rooms- Heritage and West Fresno Regional Center
Fiscal Year 2015-16 through Fiscal Year 2019-20
Expanded Services($125,388)
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 FT Site Coordinators @$13.00/hour(2,080 hours) 1.00 $27,040 $27,040
0002 FT Site Coordinators @$12.00/hour(2,080 hours) 1.00 $24,960 $24,960
0003 PT Site Coordinators @ $11.50/hour(1,040 hours) 0.50 $11,960 $11,960
0004 PT Site Coordinators @ $11.00/hour(1,040 hours) 0.50 $11,440 $11,440
0005 Substitute @$9/hour($10/hour 1/1/16) (estimated 312 hours) 0.15 $2,964 $2,964
0006 Program Management 0.07 $3,609 $3,609
SALARY TOTAL 3.22 $3,609 $78,364 $81,973
PAYROLL TAXES:
0031 FICA/MEDICARE @ 7.65%x$81,973 $276 $5,995 $6,271
0032 SUI @ 6.2%x$28,987 $112 $1,685 $1,797
PAYROLL TAX TOTAL $388 $7,680 $8,068
EMPLOYEE BENEFITS:
0040 Retirement(4%of$33,613) $144 $1,200 $1,345
0041 Workers Compensation $34 $3,981 $4,015
0042 Health Insurance(medical, vision, Itd, dental) $381 $9,518 $9,899
Annual Leave Benefit $45/mo avg x 2.07 FTE x 12 mo) $38 $1,080 $1,118
EMPLOYEE BENEFITS TOTAL $598 $15,779 $16,377
SALARY& BENEFITS GRAND TOTAL $106,418
OPERATING EXPENSES:
1063 Printing/Reproduction $50
1066 Office Supplies& Equipment $120
1068 Food $780
1069 Program Supplies-Therapeutic $660
1072 Staff Mileage/vehicle maintenance $65
OPERATING EXPENSES TOTAL $1,675
FINANCIAL SERVICES EXPENSES:
1173 Other-Administrative Overhead $17,295
FINANCIAL SERVICES TOTAL $17,295
TOTAL PROGRAM EXPENSES $125,388
MHSA FUNDS TOTAL -$125,388
TOTAL PROGRAM REVENUE -$125,388
Exhibit B-1
Page 2 of 2
Department of Behavioral Health
Reading and Beyond Budget Narrative - Expenses
MHSA Supervised Children's Rooms - Heritage and West Fresno Regional Center
Fiscal Year 2015-16 through Fiscal Year 2019-20
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Personnel Salaries: (1 FTE Site Coordinator @ $13.00/hour, 1 FTE Site Coordinator @
$12.00/hour, 0.50 FTE Site Coordinator @ $11.50/hour, 0.50 FTE Site Coordinator @
$11.00/hr, 0.15 FTE Site Substitute @ $9.00/hour (then $10/hr eff 1/1/2016) - estimated 6
hours per week, 0.07 FTE Program Manager @ $51,500 annual salary)
Payroll Taxes: (FICA/Medicare @ 7.65% of$81,973, SUI @ 6.2% of$28,987)
Employee Benefits:
Retirement Contribution 4% of$33,613
Workers Compensation 0.95% of$3,609 and 5.08% of$78,364
Health Insurance - $454/month x 0.07 FTE program manager,
$454/month x 12 months x 1 FTE Site Coordinator
$407/month x 10 months x 1 FTE Site Coordinator
Annual Leave Benefit $45 per month average x 2.07 FTE
$106,418.00
Operating Expenses - Line Items 1060-1077
Printing/Reproduction - Copy/Printing Costs - $4.17 per month average x 12 months = $50.00
Office Supplies and Equipment - $10.00 per month average x 12 months = $120.00
Food - Snacks/Food for children - $65.00 per month average x 12 months = $780.00
Program Supplies - $55.00 per month average x 12 months = $660.00
Staff mileage - $5.42 per month average x 12 months- $65.00
$1,675.00
Financial Services Expenses — Line Items 1080-1085
Other-Administrative Overhead - 13.79% of total program budget.
$17,295.00
TOTAL PROGRAM EXPENSE: $125,388.00
Exhibit B 2.
Page 1 of 2
Department of Behavioral Health
Reading and Beyond Budget
MHSA Supervised Children's Rooms-Heritage and West Fresno Regional Center
Fiscal Year 2015-16 through Fiscal Year 2019-20
Existing Services($81,516)
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Site Coordinator @ $13.00/hour(2,080 hours) 1.00 $27,040 $27,040
0002 Site Coordinator @ $11.50/hour(1,040 hours) 0.50 $11,960 $11,960
0003 Site Aide @$9/hour($10/hour 1/1/16) (1,040) 0.50 $9,880 $9,880
0004 Substitute @$9/hour($10/hour 1/1/16) (estimated 208 hours) As Needed $1,976 $1,976
0005 Program Management 0.04 $2,060 $2,060
SALARY TOTAL 2.04 $2,060 $50,856 $52,916
PAYROLL TAXES:
0031 FICA/MEDICARE @ 7.65%x$52,916 $158 $3,890 $4,048
0032 SUI @ 6.2% x$19,938 $64 $1,172 $1,236
PAYROLL TAX TOTAL $221 $5,063 $5,284
EMPLOYEE BENEFITS:
0040 Retirement(4%of$39,980) $82 $1,477 $1,559
0041 Workers Compensation $20 $2,583 $2,603
0042 Health Insurance(medical, vision, Itd, dental) $218 $5,448 $5,666
Annual Leave Benefit($60/mo avg x 1.04 FTE x 12 mo) 1 $29 $720 $749
EMPLOYEE BENEFITS TOTAL $349 $10,228 $10,577
SALARY& BENEFITS GRAND TOTAL $68,777
OPERATING EXPENSES:
1063 Printing/Reproduction $50
1066 Office Supplies& Equipment $120
1068 Food $720
1069 Program Supplies-Therapeutic $540
1072 Staff Mileage/vehicle maintenance $65
OPERATING EXPENSES TOTAL $1,495
FINANCIAL SERVICES EXPENSES:
1173 Other-Administrative Overhead $11,244
FINANCIAL SERVICES TOTAL $11,244
TOTAL PROGRAM EXPENSES $81,516
MHSA FUNDS TOTAL -$81,516
TOTAL PROGRAM REVENUE -$81,516
Exhibit B-2
Page 2 of 2
Department of Behavioral Health
Reading and Beyond Budget Narrative - Expenses
MHSA Supervised Children's Rooms - Heritage and West Fresno Regional Center
Fiscal Year 2015-16 through Fiscal Year 2019-20
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Personnel Salaries: (1 FTE Site Coordinator @ $13.00/hour, 0.50 FTE Site Coordinator @
$11.50/hour, 0.50 FTE Site Aide @ $9.00/hr (then $10/hr eff 1/1/2016), 0.10 FTE Site
Substitute @ $9.00/hour (then $10/hr eff 1/1/2016) - estimated 4 hours per week, 0.04 FTE
Program Manager @ $51,500 annual salary)
Payroll Taxes: (FICA/Medicare @ 7.65% of$52,916, SUI @ 6.2% of$19,938)
Employee Benefits:
Retirement Contribution 4% of $39,980
Workers Compensation 0.95% of$2,060 and 5.08% of$50,856
Health Insurance - $454/month x 0.04 FTE program manager
and $454/month x 12 months x 1 FTE Site Coordinator
Annual Leave Benefit $60 per month average x 1.04 FTE
$68,777,00
Operating Expenses - Line Items 1060-1077
Printing/Reproduction - Copy/Printing Costs - $4.17 per month average x 12 months = $50.00
Office Supplies and Equipment - $10.00 per month average x 12 months = $12U0
Food - Snacks/Food for children - $60.00 per month average x 12 months = $720.00
Program Supplies- $45.00 per month average x 12 months = $540.00
Staff mileage- $5.42 per month average x 12 months- $65.00
$1,495.00
Financial Services Expenses— Line Items 1080-1085
Other-Administrative Overhead - 13.79% of total program budget.
$11,244.00
TOTAL PROGRAM EXPENSE: $81.516.00
Exhibit C
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and Reading and Beyond
(CONTRACTOR), related to the supervision and care of children placed in the
Fairgrounds Intake Office, Heritage Center-DSS, Heritage Center-DBH, Selma Regional
Center, West Fresno Regional Center, and Coalinga Regional Center Children's
Rooms, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section (§)
11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect" includes physical injury inflicted by other than accidental means upon
a child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined
in P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the
victim of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to
any police department or sheriffs department (not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Social Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a "reasonable suspicion" means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child
does not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse.
(P.C. §11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
4 LA��� v.?/�5 i
NATURE DATE
Exhibit D
1 of 2
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.
Exhibit D
2 of 2
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;
(c) (d) 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.
Signature: Date: 0� 4�5 / /,65
Luis SdAts IA. C�( rttlor- P%W:AJ 4okJ &JOAJ
(Printed Name & Title) (Name ol Agency or
Company)
Exhibit E
Page 1 of 2
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
( )
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
byTitles 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?...............................................................................I...... 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)........... a
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
i I -
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
Exhibit E
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
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 EIN
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 EIN
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
Exhibit F
Page 1 of 2
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 their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
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.
Exhibit F
Page 2 of 2
Informal provider problem resolution process—the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
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.
Exhibit G
Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
GRIEVANCES AND INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit G
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen?(date/time) Where did this happen?
Name/DMH#
1. Background information of the incident:
2. Method of investigation: (chart review,face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen?Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome Severity: Nonexistent11 inconsequential ❑ consequential ® death ® not applicable11 unknown
4. Response:a)corrective action, b)Plan of Action, c)other
Completed by(print name)
Completed by(signature) Date completed
Reviewed by Supervisor(print name)
Supervisor Signature Date
Fxhibit H
PROGRAM SERVICE OUTCOMES
Reporting Requirements
Closely monitor the utilization of the services provided at each site, including, but not limited
to:
• Number of children supervised on an hourly, daily, weekly and monthly basis;
• Demographic breakdown of children supervised;
• Number of children turned away due to capacity limitations;
• And referring clinician.
Closely monitor the success of the services provided, including, but not limited to:
• parent/guardian satisfaction;
• clinician satisfaction;
• And any additional data showing bidder's progress with meeting objectives.
All data collected will be submitted to the County in monthly reports. Contractor will work
closely with the County to analyze the data and make necessary adjustments to service
delivery and reporting requirements before the start of each new fiscal year.
Annual and monthly reports requested by the County and utilized by the Contractor to
measure program goals/success are to be developed by the County and Contractor and
approved by the Department of Behavioral Health (DBH) Director or designee.
Additional program outcomes developed by Contractor will be established and approved by
DBH prior to commencement of program operations.
Exhibit I
Page 1 of 2
STATE MENTAL 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
Program (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,
0374 f dbh
Exhibit I
Page 2 of 2
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
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
0374 f dbh
Exhibit J
Page 1 of 3
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, each contractor, contractor's employee and subcontractor 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:
I. 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, consumers, 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.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit J
Page 2 of 3
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.
Exhibit J
Page 3 of 3
Fresno County Mental HealM Compllanco 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: / /
Exhibit K
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "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 utilized 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.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit K
Page 2 of 2
(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: