HomeMy WebLinkAboutState-County Contract Amendment II A-14-705.pdf STATE OF CALIFORNIA
STANDARD AGREEMENT AMENDMENT
STD.213A DHCS(Rev.03/15)
Agreement Number Amendment Number
® Check here if additional pages are added: 63 Page(s) 14-90056 A02
Registration Number:
1. This Agreement is entered into between the State Agency and Contractor named below:
State Agency's Name (Also known as DHCS,CDHS,DHS or the State)
Department of Health Care Services
Contractors Name (Also referred to as Contractor)
County of Fresno
2. The term of this Agreement is: July 1, 2014
through June 30, 2017
3. The maximum amount of this $44,109,289
Agreement after this amendment is: Forty-Four Million, One Hundred Nine Thousand,Two Hundred Eighty-Nine Dollars
4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part
of the Agreement and incorporated herein:
1. Amendment effective date: July 1, 2015
11. Purpose of amendment: This amendment 1) modifies the terms and conditions; 2) increases funding for
Fiscal Year 2015-16; and 3) identifies the changes in Exhibit B Attachment I A2—Funding Amounts. The
contractor is performing more of the same services as outlined in the original contract.
Ill. Certain changes made in this amendment are shown as: Text additions are displayed in bold and underline.
Text deletions are displayed as strike through text(i.e.,Strike).
IV. Paragraph 3 (maximum amount payable) on the face of the original STD 213 is increased by
$1,108,847 and is amended to read:
9ellal;s}$44,109,289 (Forty-Four Million, One Hundred Nine Thousand, Two Hundred Eighty-
Nine Dollars).
(Continued on next page)
All other terms and conditions shall remain the same.
IN WITNESS WHEREOF,this Agreement has been executed by the parties hereto.
CONTRACTOR CALIFORNIA
Department of General Services
Contractors Name(It other than an individual,state whether a corporation,partnership,etc.) Use Only
County of Fresno
By(Authorized Signature) Date Signed(Do not type)
Printed Name and Title of Person Signing DaWan Utecht, Director
Address
4441 East Kings Canyon Road Fresno, CA
93702-3604
STATE OF CALIFORNIA
Agency Name
Department of Health Care Services
By(Authorized Signature) Date Signed(Do not type)
Printed Name and Title of Person Signing ® Exempt per:DGS memo dated
Don Rodriguez, Chief, Contract Management Unit 07/10/96 and Welfare and Institutions
Code 14087.4
Address
1501 Capitol Avenue, Suite 71.5195, MS 1403, P.O. Box 997413,
Sacramento CA 95899-7413
County of Fresno
#14-90056 A02
STD 213A
Page 2 of 2
V. Paragraph 4 (incorporated exhibits) on the face of the original STD 213 is amended to add
the following revised exhibit.
Exhibit A, Attachment I Al— Program Specification (41 pages)
All references to Exhibit A, Attachment I — Program Specifications in any exhibit
incorporated into this agreement shall hereinafter be deemed to read Exhibit A, Attachment
I Al —Program Specifications. Exhibit A, Attachment I is hereby replaced in its entirety by
the attached revised exhibit.
VI. Paragraph 4 (incorporated exhibits) on the face of the original STD 213 is amended to add
the following revised exhibit:
Exhibit B Al - Budget Detail and Payment Provisions (20 pages)
All references to Exhibit B— Budget Detail and Payment Provisions in any exhibit
incorporated into this agreement shall hereinafter be deemed to read Exhibit B Al— Budget
Detail and Payment Provisions. Exhibit B is hereby replaced in its entirety by the attached
revised exhibit.
VII. Paragraph 4 (incorporated exhibits) on the face of the STD 213 is amended to add the
following revised exhibit:
Exhibit B Attachment I A2— Funding Amounts (1 page)
All references to Exhibit B Attachment I Al, in any exhibit incorporated into this agreement
shall hereinafter be deemed to read Exhibit B Attachment I A2. Exhibit B Attachment I Al
is hereby replaced in its entirety by the attached revised exhibit.
VIII. All other terms and conditions shall remain the same.
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Exhibit A, Attachment I Al
Program Specifications
Part I -General
A. Additional Contract Restrictions
This Contract is subject to any additional restrictions, limitations, or conditions enacted by
the Congress, or any statute enacted by the Congress, which may affect the provisions,
terms, or funding of this Contract in any manner.
B. Nullification of Drug Medi-Cal (DMC) Treatment Program substance use disorder services
(if applicable)
The parties agree that if the Contractor fails to comply with the provisions of Welfare and
Institutions Code (W&I) Section 14124.24, all areas related to the DMC Treatment Program
substance use disorder services shall be null and void and severed from the remainder of
this Contract.
In the event the Drug Medi-Cal Treatment Program Services component of this Contract
becomes null and void, an updated Exhibit B, Attachment I A2 I will take effect reflecting the
removal of federal Medicaid funds and DMC State General Funds from this Contract. All
other requirements and conditions of this Contract will remain in effect until amended or
terminated.
C. Hatch Act
Contractor agrees to comply with the provisions of the Hatch Act (Title 5 USC, Sections
1501-1508), which limit the political activities of employees whose principal employment
activities are funded in whole or in part with federal funds.
D. No Unlawful Use or Unlawful Use Messages Regarding Drugs
Contractor agrees that information produced through these funds, and which pertains to
drug and alcohol - related programs, shall contain a clearly written statement that there
shall be no unlawful use of drugs or alcohol associated with the program. Additionally, no
aspect of a drug or alcohol - related program shall include any message on the responsible
use, if the use is unlawful, of drugs or alcohol (HSC Section 11999-11999.3). By signing
this Contract, Contractor agrees that it will enforce, and will require its Subcontractors to
enforce, these requirements.
Page 1 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
E. Noncompliance with Reporting Requirements
Contractor agrees that the State has the right to withhold payments until Contractor has
submitted any required data and reports to the State, as identified in Exhibit A, Attachment I
Al, Part I II — Reporting Requirements, or as identified in Document 1 F(a), Reporting
Requirements Matrix for Counties.
F. Limitation on Use of Funds for Promotion of Legalization of Controlled Substances
None of the funds made available through this Contract may be used for any activity that
promotes the legalization of any drug or other substance included in Schedule I of Section
202 of the Controlled Substances Act (21 USC 812).
G. Restriction on Distribution of Sterile Needles
No Substance Abuse Prevention and Treatment(SAPT) Block Grant funds made
available through this Contract shall be used to carry out any program of distributing sterile
needles or syringes for the hypodermic injection of any illegal drug unless the State
chooses to implement a demonstration syringe services program for injecting drug users.
H. Health Insurance Portability and Accountability Act (HIPAA) of 1996
If any of the work performed under this Contract is subject to the HIPAA, then Contractor
shall perform the work in compliance with all applicable provisions of HIPAA. As identified
in Exhibit G, the State and County shall cooperate to assure mutual agreement as to those
transactions between them, to which this Provision applies. Refer to Exhibit G for additional
information.
1. Trading Partner Requirements
(a) No Changes. Contractor hereby agrees that for the personal health
information (Information), it will not change any definition, data condition or
use of a data element or segment as proscribed in the federal HHS
Transaction Standard Regulation. (45 CFR Part 162.915 (a))
(b) No Additions. Contractor hereby agrees that for the Information, it will not
add any data elements or segments to the maximum data set as proscribed
in the HHS Transaction Standard Regulation. (45 CFR Part 162.915 (b))
(c) No Unauthorized Uses. Contractor hereby agrees that for the Information, it
will not use any code or data elements that either are marked "not used" in
the HHS Transaction's Implementation specification or are not in the HHS
Transaction Standard's implementation specifications. (45 CFR Part
162.915 (c))
Page 2 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
(d) No Changes to Meaning or Intent. Contractor hereby agrees that for the
Information, it will not change the meaning or intent of any of the HHS
Transaction Standard's implementation specification. (45 CFR Part 162.915
(d))
2. Concurrence for Test Modifications to HHS Transaction Standards
Contractor agrees and understands that there exists the possibility that the State or
others may request an extension from the uses of a standard in the HHS
Transaction Standards. If this occurs, Contractor agrees that it will participate in
such test modifications.
3. Adequate Testing
Contractor is responsible to adequately test all business rules appropriate to their
types and specialties. If the Contractor is acting as a clearinghouse for enrolled
providers, Contractor has obligations to adequately test all business rules
appropriate to each and every provider type and specialty for which they provide
clearinghouse services.
4. Deficiencies
Contractor agrees to cure transactions errors or deficiencies identified by the State,
and transactions errors or deficiencies identified by an enrolled provider if the
Contractor is acting as a clearinghouse for that provider. When County is a
clearinghouse, Contractor agrees to properly communicate deficiencies and other
pertinent information regarding electronic transactions to enrolled providers for
which they provide clearinghouse services.
5. Code Set Retention
Both Parties understand and agree to keep open code sets being processed or
used in this Agreement for at least the current billing period or any appeal period,
whichever is longer.
6. Data Transmission Log
Both Parties shall establish and maintain a Data Transmission Log, which shall
record any and all Data Transmission taking place between the Parties during the
term of this Contract. Each Party will take necessary and reasonable steps to
ensure that such Data Transmission Logs constitute a current, accurate, complete,
and unaltered record of any and all Data Transmissions between the Parties, and
shall be retained by each Party for no less than twenty-four (24) months following
the date of the Data Transmission. The Data Transmission Log may be maintained
on computer media or other suitable means provided that, if it is necessary to do so,
the information contained in the Data Transmission Log may be retrieved in a timely
manner and presented in readable form.
Page 3 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
I. Nondiscrimination and Institutional Safeguards for Religious Providers
Contractor shall establish such processes and procedures as necessary to comply with the
provisions of Title 42, USC, Section 300x-65 and Title 42, CFR, Part 54, (Reference
Document 1 B).
J. Counselor Certification
Any counselor providing intake, assessment of need for services, treatment or recovery
planning, individual or group counseling to participants, patients, or residents in a DHCS
licensed or certified program is required to be certified as defined in Title 9, CCR, Division
4, Chapter 8. (Document 3H)
K. Cultural and Linguistic Proficiency
To ensure equal access to quality care by diverse populations, each service provider
receiving funds from this contract shall adopt the federal Office of Minority Health Culturally
and Linguistically Appropriate Service (CLAS) national standards (Document 3V).
L. Intravenous Drug Use (IVDU) Treatment
Contractor shall ensure that individuals in need of IVDU treatment shall be encouraged to
undergo alcohol and other drug (AOD) treatment(42 USC 300x-23(b) of PHS Act).
M. Tuberculosis Treatment
Contractor shall ensure the following related to Tuberculosis (TB):
1. Routinely make available TB services to each individual receiving treatment for
alcohol and other drug use and/or abuse;
2. Reduce barriers to patients' accepting TB treatment; and,
3. Develop strategies to improve follow-up monitoring, particularly after patients leave
treatment, by disseminating information through educational bulletins and technical
assistance.
N. Trafficking Victims Protection Act of 2000
Contractor and its Subcontractors that provide services covered by this Contract shall
comply with Section 106(g) of the Trafficking Victims Protection Act of 2000 as amended
(22 U.S.C. 7104). For full text of the award term, go to:
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http://uscode.house.qov/view.xhtmI?req=granuleid:USC-prelim-title22-
section7104d&num=0&aedition=prelim
Page 4 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
O. Tribal Communities and Organizations
Contractor shall regularly assess (e.g. review population information available through
Census, compare to information obtained in CalOMS Treatment to determine whether
population is being reached, survey Tribal representatives for insight in potential barriers)
the substance use service needs of the American Indian/Alaskan Native (AI/AN) population
within the County geographic area and shall engage in regular and meaningful consultation
and collaboration with elected officials of the tribe, Rancheria, or their designee for the
purpose of identifying issues/barriers to service delivery and improvement of the quality,
effectiveness and accessibility of services available to AI/NA communities within the
County.
P. Participation of County Alcohol and Drug Program Administrators Association of California
and County Behavioral Health Director's Association of California.
Pursuant to HSC Section 11801(g), the county AOD program administrator shall
participate and represent the county in meetings of the County Alcohol and Drug Program
Administrators Association of California for the purposes of representing the counties in
their relationship with the sState with respect to policies, standards, and administration for
alcohol and other drug abuse services. Participation and representation shall also be
Provided by the County Behavioral Health Director's Association of California.
Pursuant to HSC Section 11811.5(c), the county alsehal-and dfugAOD program
administrator shall attend any special meetings called by the Director of DHCS.
Participation and representation shall also be provided by the County Behavioral
Health Director's Association of California.
Q. Youth Treatment Guidelines
Contractor will follow the guidelines in Document 1 V, incorporated by this reference, "Youth
Treatment Guidelines," in developing and implementing youth treatment programs funded
under this Exhibit, until such time new Youth Treatment Guidelines are established and
adopted. No formal amendment of this contract is required for new guidelines to apply.
R. Restrictions on Grantee Lobbying —Appropriations Act Section 503
No part of any appropriation contained in this Act shall be suedused, other than for formal
and recognized executive-legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio,
television, or video presentation designed to support or defeat legislation pending before
the Congress, eXGe t in pFese R♦atinn tG the gengFess itself or aRy State legislat ro except
in presentation to the Congress or any State legislative body itself.
No part of any appropriation contained in this Act shall be used to pay the salary or
expenses of any grant or contract recipient, or agent actin 1 4u4p@-for such recipient,
related to any activity designed to influence legislation or appropriations pending before the
Congress or any State legislature.
Page 5 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
S. Nondiscrimination in Employment and Services
By signing this Contract, Contractor certifies that under the laws of the United States and
the State of California, incorporated into this Contract by reference and made a part hereof
as if set forth in full, Contractor will not unlawfully discriminate against any person.
T. Federal Law Requirements:
1. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended, prohibiting
discrimination based on race, color, or national origin in federally funded programs.
2. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.) prohibiting
discrimination on the basis of race, color, religion, sex, handicap, familial status or
national origin in the sale or rental of housing.
3. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42 USC Sections
6101 —6107), which prohibits discrimination on the basis of age.
4. Age Discrimination in Employment Act (29 CFR Part 1625).
5. Title I of the Americans with Disabilities Act (29 CFR Part 1630) prohibiting
discrimination against the disabled in employment_
6. Title II of the Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities_
7. Title III of the Americans with Disabilities Act (28 CFR Part 36) regarding access.
8. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC Section 794),
prohibiting discrimination on the basis of handicap_
9. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part 60) regarding
nondiscrimination in employment under federal contracts and construction contracts
greater than $10,000 funded by federal financial assistance.
10. Executive Order 13166 (67 FR 41455) to improve access to federal services for
those with limited English proficiency_
11. The Drug Abuse Office and Treatment Act of 1972, as amended, relating to
nondiscrimination on the basis of drug abuse_
12. The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination
on the basis of alcohol abuse or alcoholism.
Page 6 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
U. State Law Requirements:
1. Fair Employment and Housing Act (Government Code Section 12900 et seq.) and
the applicable regulations promulgated thereunder(California Administrative Code,
Title 2, Section 7285.0 et seq.).
2. Title 2, Division 3, Article 9.5 of the Government Code, commencing with Section
11135.
3. Title 9, Division 4, Chapter 8 of the CCR, commencing with Section 10800
4. No state or federal funds shall be used by the Contractor or its Subcontractors for
sectarian worship, instruction, or proselytization. No state funds shall be used by
the Contractor or its Subcontractors to provide direct, immediate, or substantial
support to any religious activity.
5. Noncompliance with the requirements of nondiscrimination in services shall
constitute grounds for state to withhold payments under this Contract or terminate
all, or any type, of funding provided hereunder.
V. This Contract is subject to any additional restrictions, limitations, or conditions enacted by
the federal or state governments after affect the provisions, terms, or funding of this
Contract in any manner.
W. Subcontract Provisions
Contractor shall include all of the foregoing provisions in all of its subcontracts.
Page 7 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Exhibit A, Attachment 1 Al
Program Specifications
Part II—Definitions
Section 1 -General Definitions.
The words and terms of this Contract are intended to have their usual meanings unless a particular
or more limited meaning is associated with their usage pursuant to Division 10.5 of HSC, Section
11750 et seq., and Title 9, CCR, Section 9000 et seq.
A. "Available Capacity" means the total number of units of service (bed days, hours, slots,
etc.) that a Contractor actually makes available in the current fiscal year.
B. "Contractor" means the county identified in the Standard Agreement or the department
authorized by the County Board of Supervisors to administer substance use disorder
programs.
C. "Corrective Action Plan" (CAP) means the written plan of action document which the
Contractor or its subcontracted service provider develops and submits to DHCS to address
or correct a deficiency or process that is non-compliant with laws, regulations or standards.
D. "County" means the county in which the Contractor physically provides covered substance
use treatment services.
E. "County Realignment Funds" means Behavioral Health Subaccount funds received by
the county as per California Code Section 30025.
F. "Days" means calendar days, unless otherwise specified.
G. "Dedicated Capacity" means the historically calculated service capacity, by modality,
adjusted for the projected expansion or reduction in services, which the Contractor agrees
to make available to provide non-Drug Medi-Cal substance,use disorder services to
persons eligible for Contractor services.
H. "Final Allocation" means the amount of funds identified in the last allocation letter issued
by the State for the current fiscal year.
1. "Final Settlement" means permanent settlement of the Contractor's actual allowable costs
or expenditures as determined at the time of audit, which shall be completed within three
years of the date the year-end cost settlement report was accepted for interim settlement by
the State. If the audit is not completed within three years, the interim settlement shall be
considered as the final settlement.
J. "Interim Settlement" means temporary settlement of actual allowable costs or
expenditures reflected in the Contractor's year-end cost settlement report.
Page 8 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
K. "Maximum Payable" means the encumbered amount reflected on the Standard
Agreement of this Contract and supported by Exhibit B, Attachment I A2.
L. "Modality" means those necessary overall general service activities to provide substance
use disorder services as described in Division 10.5 of the HSC.
M. "Non-Drug Medi-Cal Amount" means the contracted amount of SAPT Block Grant funds
for services agreed to by the State and the Contractor.
N. "Performance" means providing the dedicated capacity in accordance with Exhibit B,
Attachment I A2, and abiding by the terms of this Exhibit A, including all applicable state
and federal statutes, regulations, and standards, including Alcohol and/or Other Drug
Certification Standards (Document 1 P), in expending funds for the provision of alcohol and
drug services hereunder.
O. "Preliminary Settlement" means the settlement of only SAPT funding for counties that do
include DMC funding.
P. "Revenue" means Contractor's income from sources other than the State allocation.
Q. "Service Area" means the geographical area under Contractor's jurisdiction.
R. "Service Element" is the specific type of service performed within the more general
service modalities. A list of the service modalities and service elements and service
elements codes is incorporated into this Contract as Document 1 H(a) "Service Code
Descriptions".
S. "State" means the Department of Health Care Services or DHCS.
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1J-. T. "Utilization" means the total actual units of service used by clients and participants.
Page 9 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Section 2— Definitions Specific to Drug Medi-Cal
The words and terms of this Contract are intended to have their usual meaning unless a specific or
more limited meaning is associated with their usage pursuant to the HSC, Title 9, and/or Title 22.
Definitions of covered treatment modalities and services are found in Title 22 (Document 2C) and
are incorporated by this reference.
A. "Administrative Costs" means the Contractor's actual direct costs, as recorded in the
Contractor's financial records and supported by source documentation, to administer the
program or an activity to provide service to the DMC program. Administrative costs do not
include the cost of treatment or other direct services to the beneficiary. Administrative costs
may include, but are not limited to, the cost of training, programmatic and financial audit
reviews, and activities related to billing. Administrative costs may include Contractor's
overhead per the approved indirect cost rate proposal pursuant to OMB Circular A-87 and
the State Controller's Office Handbook of Cost Plan Procedures.
B. "Authorization" is the approval process for DMC Services prior to the submission of a
DMC claim.
C. "Beneficiary" means a person who: (a) has been determined eligible for Medi-Cal; (b) is
not institutionalized; (c) has a substance-related disorder per the "Diagnostic and Statistical
Manual of Mental Disorders III Revised (DSM)," and/or DSM IV criteria; and (d) meets the
admission criteria to receive DMC covered services.
D. "Certified Provider" means a substance use disorder clinic and/or satellite clinic location
that has received certification to be reimbursed as a DMC clinic by the State to provide
services as described in Title 22, California Code of Regulations, Section 51341.1.
E. "Covered Services" means those DMC services authorized by Title XIX or Title XXI of the
Social Security Act; Title 22 Section 51341.1; W&I Section 14124.24; and California's
Medicaid State Plan.
F. "Direct Provider Contract" means a contract established between the State and a Drug
Medi-Cal certified provider entered into pursuant to this Agreement for the provision of Drug
Medi-Cal services.
G. "Drug Medi-Cal Program" means the state system wherein beneficiaries receive covered
services from DMC-certified substance use disorder treatment providers.
H. "Drug Medi-Cal Termination of Certification" means the provider is no longer certified to
participate in the Drug Medi-Cal program upon the State's issuance of a Drug Medi-Cal
certification termination notice. .
I. "Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT)" means
the federally mandated Medicaid benefit that entitles full-scope Medi-Cal-covered
beneficiaries less than 21 years of age to receive any Medicaid service necessary to correct
or ameliorate a defect, mental illness, or other condition, such as a substance-related
disorder, that is discovered during a health screening.
Page 10 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
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J. "Provider Certification" means the provider must be certified in order to participate in the
Medi-Cal program.
L K. "Federal Financial Participation (FFP)" means the share of federal Medicaid funds for
reimbursement of DMC services.
AFL. "Medical Necessity" means those substance use treatment services that are reasonable
and necessary to protect life, prevent significant illness or disability, or alleviate severe pain
through the diagnosis and treatment of a disease, illness, or injury or, in the case of
EPSDT, services that meet the criteria specified in Title 22, Sections 51303 and 51340.1.
N.M. "Minor Consent DMC Services" are those covered services that, pursuant to Family Code
Section 6929, may be provided to persons 12-20 years old without parental consent.
N. "Narcotic Treatment Program" means an outpatient clinic licensed by the State to provide
narcotic replacement therapy directed at stabilization and rehabilitation of persons who are
opiate-addicted and have a substance use diagnosis.
R O. "Payment Suspension" means the Drug Medi-Cal certified provider has been issued a
notice pursuant to W&I 14107.11 and is not authorized to receive payments after the
payment suspension date for DMC services, regardless of when the service was provided.
Q:P. "Perinatal DMC Services" means covered services as well as mother/child habilitative and
rehabilitative services; services access (i.e., provision or arrangement of transportation to
and from medically necessary treatment); education to reduce harmful effects of alcohol
and drugs on the mother and fetus or infant; and coordination of ancillary services (Title 22,
Section 51341.1(c) 4).
R7 Q. "Postpartum", as defined for DMC purposes, means the 60-day period beginning on the
last day of pregnancy, regardless of whether other conditions of eligibility are met. Eligibility
shall end on the last day of the calendar month in which the 60`h day occurs.
S R. "Post Service Post Payment(PSPP) Utilization Review" means the review for program
compliance and medical necessity conducted by the State after service was rendered and
paid. State may recover prior payments of Federal and State funds if such review
determines that the services did not comply with the applicable statutes, regulations, or
standards (CCR, Title 22, Gal. GeQe Reg6.Tit. 22, Section 51341.1).
S. "Projected Units of Service" means the number of reimbursable DMC units of service,
based on historical data and current capacity, the Contractor expects to provide on an
annual basis.
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County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Jol:T. "Provider of DMC Services" means any person or entity that provides direct substance
use treatment services and has been certified by State as meeting the standards for
participation in the DMC program set forth in the "DMC Certification Standards for
Substance Abuse Clinics", Document 2E and "Standards for Drug Treatment Programs
(October 21, 1981)", Document 2F.
U. "Re-certification" means the process by which the certified clinic and/or satellite program
is required to submit an application and specified documentation, as determined by DHCS,
to remain eligible to participate in and be reimbursed in through the DMC program. Re-
certification shall occur no less than every five years from date of previous DMC
certification or re-certification.
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V. "Statewide Maximum Allowances (SMA)" means the maximum amount authorized to be
paid by DMC for each covered unit of service for outpatient drug free, intensive outpatient
treatment, perinatal residential, and Naltrexone treatment services. While the rates are
approved by the State, they are subject to change through the regulation process. The
SMA for FY 2044-152015-16 is listed in the "Unit of Service"table in Exhibit B A1, Part V.
W. "Subcontract" means an agreement between the Contractor and its Subcontractors. A
Subcontractor shall not delegate its obligation to provide covered services or otherwise
subcontract for the provision of direct patient/client services.
X. "Subcontractor" means an individual or entity that is DMC certified and has entered into
an agreement with the Contractor to be a provider of covered services. It may also mean a
vendor who has entered into a procurement agreement with the Contractor to provide any
of the administrative functions related to fulfilling the Contractor's obligations under the
terms of this Exhibit A, Attachment I Al.
AA.Y. "Temporary Suspension" means the provider is temporarily suspended from participating
in the DMC program as authorized by W&I Section 14043.36(a). The provider cannot bill
for DMC services from the effective date of the temporary suspension.
Page 12 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Exhibit A, Attachment I Al
Program Specifications
Part III — Reporting Requirements
Contractor agrees that the State has the right to withhold payments until Contractor has submitted
any required data and reports to the State, as identified in this Exhibit A, Attachment I Al or as
identified in Document 1 F(a), Reporting Requirement Matrix for Counties.
A. Quarterly Federal Financial Management Report (QFFMR)
The QFFMR must be submitted to reflect quarterly SAPTBG expenditures.
For the beginning of each federal award year, the due dates are:
March 1 for the period October through December
June 1 for the period January through March
September 1 for the period April through June
December 1 for the period July through September
B. Year-End Cost Settlement Reports
Pursuant to W&I Section 14124.24 Contractor shall submit to the State, on November 1 of
each year, the following year-end cost settlement documents by paper or electronic, as
prescribed by the State, submission for the previous fiscal year:
1. Document 2P, County Certification Year-End Claim for Reimbursement
2. Document 2P(a) and 2P(b), Drug Medi-Cal Cost Report Forms for Intensive
Outpatient Treatment for Non-Perinatal or Perinatal (if applicable)
3. Document 2P(c) and 2P(d), Drug Medi-Cal Cost Report Forms for Outpatient Drug
Free Individual Counseling for Non-Perinatal or Perinatal (if applicable)
4. Document 2P(e) and 2P(f), Drug Medi-Cal Cost Report Forms for Outpatient Drug
Free Group Counseling for Non-Perinatal or Perinatal (if applicable)
5. Document 2P(g), Drug Medi-Cal Cost Report Forms for Residential for Perinatal (if
applicable)
6. Document 2P(h) and 2P(i), Drug Medi-Cal Expenditure Forms for Narcotic
Treatment Programs for Non-Perinatal or Perinatal (if applicable)
EIeGtF9RiG PFOgFaFn as preSGFibed by the State that GGRtaiRG the detailed GOSt FepeFt data.
Page 13 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
C. Drug Medi-Cal Claims and Reports
Contractors or providers that bill the State or the County for services identified in Section
51516.1 of Title 22 shall submit claims in accordance with the Department of Health Care
Services DMC Provider Billing Manual.
Claims for DMC reimbursement shall include only those services covered under Title 22,
Section 51341.1(c-d) and administrative charges that are allowed under W&IC, Sections
14132.44 and 14132.47.
1. Contractor shall certify the public expenditure reflecting the approved amount of
the 837P claim file. .
Contractor shall submit the "Certified Public Expenditure"form after the claims
have been adjudicated.
. Contractor shall submit to the State the Drug Medi-
Cal Certification Form DHCS Form DHCS 100224A (Document 4D)for each 835
transaction approved.Glaim file submi#ed for reimbursement of the federal
Medicaid funds.
2. DMC service claims shall be submitted electronically in a Health Insurance
Portability and Accountability Act (HIPAA) compliant format (837P). All adjudicated
claim information must be retrieved by the Contractor via an 835 HIPAA compliant
format(Health Care Claim Payment/Advice).
3. The following forms shall be prepared as needed and retained by the provider for
review by State staff:
(a) Multiple Billing Override Certification (MC 6700), Document 2K
(b) Good Cause Certification (MG-6065A), Document 2L(a)
(c) Good Cause Certification (W,6065B), Document 2L(b)
In the absence of good cause documented on the Good Cause Certification (MG
6065A or 6065B) form, claims that are not submitted within 30 days of the end of the
month of service shall be denied. The existence of good cause shall be determined
by the State in accordance with Title 22, CCR, Sections 51008 and 51008.5.
4. Certified Public Expenditure County Administration
Separate from direct service claims as identified in#2 above, county may submit an
invoice for administrative costs for administering the DMC program on a quarterly
basis. The form requesting reimbursement shall be submitted to DHCS.
Page 14 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
5. If while completing the Utilization Review and Quality Assurance requirements of
this Exhibit A, Attachment I Al, Part V, Section 4 any of the Contractor's skilled
professional medical and personnel and directly supporting staff meet the criteria set
forth in 42 C.F.R. 432.50(d)(1), then the Contractor shall submit a written request
that specifically demonstrates how the skilled professional medical personnel and
directly supporting staff meet all of the applicable criteria set forth in 42 C.F.R.
432.50(5)(1) and outlines the duties they will perform to assist the Department, or
the Department's skilled professional medical personnel, in activities that are directly
related to the administration of the Drug Medi-Cal Program. The Department shall
respond to the Contractor's written request within 20 days with either a written
agreement pursuant to 42 C.F.R. 432.50(d)(2) approving the request or a written
explanation as to why the Department does not agree that the Contractor's skilled
professional medical personnel and directly supporting staff do not meet the criteria
set forth in 42 C.F.R. 432.50(d)(1).
D. California Outcomes Measurement System (CaIOMS) for Treatment(CalOMS-Tx)
The CaIOMS-Tx business rules and requirements are:
1. Contractor contracts with a software vendor that complies with the CalOMS-Tx data
collection system requirements for submission of CaIOMS-Tx data. A Business
Associate Agreement (BAA) must be established between the Contractor and the
software vendor. The BAA must state that DHCS is allowed to return the processed
CalOMS-Tx data to the vendor that supplied the data to DHCS.
2. Contractor shall conduct information technology (IT) systems testing and pass State
certification testing before commencing submission of CaIOMS-Tx data. If the
Contractor subcontracts with vendor for IT services, Contractor is responsible for
ensuring that the subcontracted IT system is tested and certified by the DHCS prior
to submitting CaIOMS-Tx data. If Contractor changes or modifies the CaIOMS-Tx IT
system, then Contractor shall re-test and pass state re-certification prior to
submitting data from new or modified system.
3. Electronic submission of CalOMS-Tx data is due 45 days from the end of the last
day of the report month.
4. Contractor shall comply with data collection and reporting requirements established
by the DHCS CaIOMS-Tx Data Collection Guide (Document 3J) and all former
Department of Alcohol and Drug Programs Bulletins and DHCS Information Notices
relevant to CaIOMS-Tx data collection.
5. Contractor shall submit CaIOMS-Tx admission, discharge, annual update,
resubmissions of records containing errors or in need of correction, and "provider no
activity" report records in an electronic format approved by DHCS.
6. Contractor shall comply with the CaIOMS-Tx Data Compliance Standards
established by DHCS identified in Document 3S for reporting data content, data
quality, data completeness, reporting frequency, reporting deadlines, and reporting
method.
Page 15 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
7. Contractor shall participate in CaIOMS-Tx informational meetings, trainings, and
conference calls.
8. Contractor shall implement and maintain a system for collecting and electronically
submitting CaIOMS-Tx data.
9. Contractor shall meet the requirements as identified in Exhibit G, Privacy and
Information Security Provisions and Exhibit G, Attachment I —SSA Agreement 2014.
E. California Outcomes Measurement System-Service-{-CaK }for Prevention (CalOMS-Pv)
The CaIOMS-Pv Business Rules and Requirements are:
1. Contractors and/or Subcontractors receiving Substance Abuse Prevention
and Treatment(SAPT) Primary Prevention Set-Aside funding must input
planning, service/activity and evaluation data into CalOMS Pv. When
submitting data, Contractor must comply with the CalOMS Pv Data Quality
Standards (Document#1T).
2. Contractor must report services/activities by the date of occurrence on an
ongoing basis throughout each month. Contractor shall submit all data for
each month no later than the I Oh day of the following month. PFeveRtiGR
R;eRthly basis Ne Fnere than, eRe amok°s data shall be aggFegated iRtn 0
FepeFted sewiGe
3. Contractor must review all data input into CaIOMS Pv on a quarterly basis.
Contractor shall verify that the data meets the CaIOMS Pv Data Quality
Standards by reviewing and releasing the data. Certification is due by the last
day of the month following the end of the quarter. All GaI01VIS Pv serviGe/a
data shall be Feviewed by eaGh GeuRty and rel-----I to the State ne later thaR 30
4. Contractor must report progress to DHCS via CalOMS Pv for the goals and
obiectives in the County Strategic Prevention Plan (as described in Exhibit A,
Attachment 1 Al, Part IV, Section 1113. 2) on an annual basis by September 30
of each fiscal year.
EyalwatieR Medule within GaIGIVIS Pv shall be done OR ai; aRRual basis. This
Pt
5. If Contractor cannot meet the established due dates, a written request for an
extension must be submitted to DHCS 10-days prior to the due date.4#e
QGRtFaGt9F GaRRE)t submit gaIGIVIS Pv data by the establerhed due dates, the
Page 16 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
established due date.
6. In order to ensure that all persons responsible for CaIOMS Pv data entry have
sufficient knowledge of the CaIOMS Pv Data Quality Standards, all new
CaIOMS Pv users, whether employed by the Contractor or its Subcontractors,
shall participate in CaIOMS Pv trainings prior to inputting data into the
system. ,
and r-,A-nfeFeRGe Galls,
F. CalOMS-Tx and CalOMS-Pv General Information
1. If the Contractor experiences system or service failure or other extraordinary
circumstances that affect its ability to timely submit CalOMS-Tx and/or CalOMS-Pv
data, and or meet other CalOMS-Tx and/or CalOMS-Pv data compliance
requirements, Contractor shall report the problem in writing before the established
data submission deadlines. The written notice shall include a remediation plan that
is subject to review and approval by the State. A grace period of up to sixty (60)
days may be granted, at the State's sole discretion, for the Contractor to resolve the
problem before non-DMC payments are withheld.
2. If the State experiences system or service failure, no penalties will be assessed to
the Contractor for late data submission.
3. Contractor shall comply with the treatment and prevention data quality standards
established by the State. Failure to meet these standards on an ongoing basis may
result in withholding non-DMC funds.
4. If the Contractor submits data after the established deadlines, due to a delay or
problem, Contractor is still responsible for collecting and reporting data from time of
delay or problem.
G. Drug and Alcohol Treatment Access Report(DATAR)
The DATAR business rules and requirements are:
1. The Contractor shall be responsible for ensuring that the Contractor-operated
treatment services and all treatment providers with whom Contractor makes a
contract or otherwise pays for the services, submit a monthly DATAR report in an
electronic copy format as provided by the State.
In those instances where the Contractor maintains, either directly or indirectly, a
central intake unit or equivalent which provides intake services including a waiting
list, the Contractor shall identify and begin submitting monthly DATAR reports for
the central intake unit by a date to be specified by the State.
Page 17 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
2. The Contractor shall ensure that all DATAR reports are submitted by either
Contractor-operated treatment services and by each subcontracted treatment
provider to the State by the 10th of the month following the report activity month.
3. The Contractor shall ensure that all applicable providers are enrolled in the State's
web-based DATARWeb program for submission of data, accessible on the DHCS
website when executing the subcontract.
4. If the Contractor or its subcontractor experiences system or service failure or other
extraordinary circumstances that affect its ability to timely submit a monthly DATAR
report, and/or to meet data compliance requirements, the Contractor shall report the
problem in writing before the established data submission deadlines. The written
notice shall include a corrective action plan that is subject to review and approval by
the State. A grace period of up to sixty (60) days may be granted, at the State's
sole discretion, for the Contractor to resolve the problem before non-DMC payments
are withheld (See Exhibit B Al, Part II, Section 2).
5. If the State experiences system or service failure, no penalties will be assessed to
Contractor for late data submission.
6. The Contractor shall be considered compliant if a minimum of 95% of required
DATAR reports from the Contractor's treatment providers are received by the due
date.
H. Charitable Choice
Contractor shall submit annually the total number of referrals necessitated by religious
objection to other alternative substance abuse providers. This information must be
submitted to DHCS in a format prescribed by DHCS and at time required by DHCS
(reference ADP Bulletin 04-5).
I. Subcontractor Documentation
Contractor shall require its Subcontractors that are not licensed or certified by the State to
submit organizational documents to the State within thirty (30) days of its execution of an
initial subcontract, within ninety (90) days of the renewal or continuation of an existing
subcontract or when there has been a change in Subcontractor name or ownership.
Organizational documents shall include the Subcontractor's Articles of Incorporation or
Partnership Agreements (as applicable), and business licenses, fictitious name permits,
and such other information and documentation as may be requested by the State.
J. Failure to meet required reporting requirements shall result in:
1. The DHCS will issue a Notice of Deficiency (Deficiencies) to Contractor regarding
specified providers with a deadline to submit the required data and a request for a
Corrective Action Plan (CAP) to ensure timely reporting in the future. The State will
approve or reject the CAP or request revisions to the CAP which shall be
resubmitted to the State within thirty (30) days.
Page 18 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
2. If the Contractor has not ensured compliance with the data submission or CAP
request within the designated timeline, then the State may withhold funds until all
data is submitted. The State shall inform the Contractor when funds will be
withheld.
Page 19 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Exhibit A, Attachment I Al
Program Specifications
PART IV— Non-Drug Medi-Cal Substance Use Disorder Prevention and Treatment Services
Section 1. General Provisions
A. Restrictions on Salaries
Contractor agrees that no part of any federal funds provided under this Contract shall be
used by the Contractor or its Subcontractors to pay the salary and wages of an individual at
a rate in excess of Level I of the Executive Schedule. Salary and wages schedules may be
found at http://www.opm.gov/oca. SAPT Block Grant funds used to pay a salary in excess
of the rate of basic pay for Level I of the Executive Schedule shall be subject to
disallowance. The amount disallowed shall be determined by subtracting the individual's
actual salary from the Level I rate of basic pay and multiplying the result by the percentage
of the individual's salary that was paid with SAPT Block Grant funds (Reference: Terms
and Conditions of the SAPT Block Grant award.)
B. Primary Prevention
1. The SAPT Block Grant regulation defines "Primary Prevention Programs" as those
programs directed at"individuals who have not been determined to require
treatment for substance abuse" (45 CFR 96.121). Primary Prevention includes
strategies, programs and initiatives which reduce both direct and indirect adverse
personal, social, health, and economic consequences resulting from problematic
AOD availability, manufacture, distribution, promotion, sales, and use. The desired
result of primary prevention is to promote safe and healthy behaviors and
environments for individuals, families and communities. The Contractor shall
expend not less than its allocated amount of the
TFe�e„4SAPT3 Block Grant on primary prevention as described in the SAPT
Block Grant requirements (45 CFR 96.125). Inappropriate use of these funds for
non-primary prevention services will require repayment of SAPT Block Grant funds.
2. Contractor is required to have a current and DHCS approved County Strategic
Prevention Plan (SPP). The SPP must demonstrate that the County utilized
the Substance Abuse and Mental Health Services Administration's Strategic
Prevention Framework(SPF) in developing the plan as described at
http://captus.samhsa.gov/access-resources/about-strategic-prevention-
framework-spf. DHCS will only approve SPP's that demonstrate that the
Contractor utilized the SPF. Contractor must:
a) Follow the DHCS guidelines provided in the Strategic Prevention
Framework Plan Resource Document located in the CaIOMS Pv Library.
b) Begin preparing a new SPP at least 9-months prior to the expiration date of
the current SPP.
Page 20 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
c) Submit a timeline to DHCS for completion of the SPP that includes
proposed dates for submitting each section of the SPP. The sections are
outlined in the Strategic Prevention Framework Plan Resource Document.
d) Submit a draft to DHCS based on the timeline for each section of the SPP
for review and approval.
e) Submit to DHCS the final draft of the SPP no later than 30-days prior to the
start date of the new SPP.
f) Upload an electronic copy of the approved SPP into CalOMS Pv within 10-
days of approval.
g) Input the Problem Statements, Goals and Objectives from the SPP into
CalOMS Pv no later than 10-days after the start date of the SPP.
fepeFted.
3. Contractor shall submit a Prevention Mid-Year Budget to DHCS by January 31
of each fiscal year. The budget shall indicate how the SAPT Block Grant
Primary Prevention Set-Aside will be expended for the fiscal fear. " e-44-he
4. Friday Night Live
Contractors and Subcontractors receiving SAPT Friday Night Live (FNL)
funding must:
ial Engage in programming that meets the FNL Youth Development
Standards of Practice, Operating Principles and Core Components
outlined at hftp://fridaVnightlive.org/about-us/cfnip-overview/;
Use CalOMS Pv for all FNL reporting including Chapter Profiles, FNL
County Profiles and chapter activity;
u Follow the FNL Data Entry Instructions for CAIOMS Pv as provided by
DHCS in the CalOMS Pv Library;
Demonstrate an effort to be a Member in Good Standing (MIGS), as
provided by DHCS in conjunction with the California Friday Night Live
Partnership.
0
PFeventeeR get Aside shall be SpeRt. Examples of a PreveRtiGR Mid YeaF Budget
Proven+inn Mid Year Budget Example fer FY YX XX)
Page 21 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
C. Perinatal Services Network Guidelines 2014
Contractor shall comply with the requirements for perinatal programs funded under Exhibit
A, Attachment I At contained in Document 1 G, incorporated by this reference, "Perinatal
Services Network Guidelines 2014" until such time new Perinatal Services Network
Guidelines are established and adopted. No formal amendment of this contract is required
for new guidelines to apply.
D. Funds identified in this contract shall be used exclusively for county alcohol and drug abuse
services to the extent activities meet the requirements for receipt of federal block grant
funds for prevention and treatment of substance abuse described I subchapter XVII of
Chapter 6A of Title 42 of the United State Code. (Health and Safety Code section 18100 et.
seq.)
Section 2—Formation and Purpose
A. Authority
State and the Contractor enter into this Exhibit A, Attachment I At Part IV, by authority of
Chapter 3 of Part 1, Division 10.5 of the Health and Safety Code (HSC) and with approval
of Contractor's County Board of Supervisors(or designee) for the purpose of providing
alcohol and drug services, which will be reimbursed pursuant to Exhibit A, Attachment I Al.
State and the Contractor identified in the Standard Agreement are the only parties to this
Contract. This Contract is not intended, nor shall it be construed, to confer rights on any
third party.
B. Control Requirements
1. Performance under the terms of this Exhibit A, Attachment I At Part IV, is subject
to all applicable federal and state laws, regulations, and standards. In accepting the
State drug and alcohol combined program allocation pursuant to HSC Sections
11814(a) and (b), Contractor shall: (i) establish, and shall require its Subcontractors
to establish, written policies and procedures consistent with the following
requirements; (ii) monitor for compliance with the written procedures; and (iii) be
held accountable for audit exceptions taken by the State against the Contractor and
its Subcontractors for any failure to comply with these requirements:
(a) HSC, Division 10.5, commencing with Section 11760;
(b) Title 9, California Code of Regulations (CCR) (herein referred to as Title 9),
Division 4, commencing with Section 9000;
(c) Government Code Section 16367.8;
(d) Government Code, Article 7, Federally Mandated Audits of Block Grant
Funds Allocated to Local Agencies, Chapter 1, Part 1, Division 2, Title 5,
commencing at Section 53130;
Page 22 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
(e) Title 42 United State Code (USC), Sections 300x-21 through 300x-31, 300x-
34, 300x-53, 300x-57, and 330x-65 and 66;
(f) The Single Audit Act Amendments of 1996 (Title 31, USC Sections 7501-
7507) and the Office of Management and Budget (OMB) Circular A-133
revised June 27, 2003 and June 26, 2007.
(g) Title 45, Code of Federal Regulations (CFR), Sections 96.30 through 96.33
and Sections 96.120 through 96.137;
(h) Title 42, CFR, Sections 8.1 through 8.34;
(i) Title 21, CFR, Sections 1301.01 through 1301.93, Department of Justice,
Controlled Substances; and,
(j) State Administrative Manual (SAM), Chapter 7200 (General Outline of
Procedures).
Contractor shall be familiar with the above laws, regulations, and guidance
guidelines and shall assure that its Subcontractors are also familiar with such
requirements.
2. The provisions of this Exhibit A, Attachment I Al, Part IV, are not intended to
abrogate any provisions of law or regulation, or any standards existing or enacted
during the term of this Contract.
3. Contractor shall adhere to the applicable provisions of Title 45, CFR, Part 96,
Subparts C and L, as applicable, in the expenditure of the SAPTBG funds.
Document 1A, 45 CFR 96, Subparts C and L, is incorporated by reference.
4. Documents 1 C and 1 D(b), incorporated by this reference, contain additional
requirements that shall be adhered to by those Contractors that receive the types of
funds specified by each document. These exhibits and documents are:
(a) Document 1C, Driving-Under-the-Influence Program Requirements;
(b) Document 1 D(b), SAPT Female Offender Treatment Project (FOTP).
5. In accordance with the Fiscal Year 2011-12 State Budget Act and accompanying
law (Chapter 40, Statues of 2011 and Chapter 13, Statues of 2011, First
Extraordinary Session), contractors that provide Women and Children's Residential
Treatment Services shall comply with the program requirements (Section 2.5,
Required Supplemental/Recovery Support Services) of the Substance Abuse and
Mental Health Services Administration's Grant Program for Residential Treatment
for Pregnant and Postpartum Women, RFA found at
http://www.samhsa.gov/grants/grant-announcements/ti-14-005
Page 23 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Section 3 - Performance Provisions
A. Monitoring
1. Contractor's performance under this Exhibit A, Attachment I A2, Part IV, shall be
monitored by the State during the term of this Contract. Monitoring criteria shall
include, but not be limited to:
(a) Whether the quantity of work or services being performed conforms to
Exhibit B A2;
(b) Whether the Contractor has established and is monitoring appropriate quality
standards;
(c) Whether the Contractor is abiding by all the terms and requirements of this
Contract;
(d) Whether the Contractor is abiding by the terms of the Perinatal Services
Network Guidelines (Document 1 G); and
(e) Contractor shall conduct annual onsite monitoring reviews of services and
subcontracted services for programmatic and fiscal requirements.
Contractor shall submit copy of their monitoring and audit reports to DHCS
within two weeks of issuance. Reports should be sent by secure,
encrypted e-mail to:
SUDCountyReports(a)_dhcs.ca.gov or
Substance Use Disorder - Prevention, Treatment and Recovery
Services Division, Performance Management Branch
Department of Health Care Services
PO Box 997413 MS-2627
Sacramento CA 95899-7413;
2. Failure to comply with the above provisions shall constitute grounds for the State to
suspend or recover payments, subject to the Contractor's right of appeal, or may
result in termination of the Contract or both.
B. Performance Requirements
1. Contractor shall provide services based on funding set forth in Exhibit B, Attachment
I A2, and under the terms of this Contract.
2. Contractor shall provide services to all eligible persons in accordance with federal
and state statutes and regulations. Contractor shall assure that in planning for the
provision of services, the following barriers to services are considered and
addressed:
(a) Lack of educational materials or other resources for the provision of
Page 24 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
services;
(b) Geographic isolation and transportation needs of persons seeking services
or remoteness of services;
(c) Institutional, cultural, and/or ethnicity barriers;
(d) Language differences;
(e) Lack of service advocates;
(f) Failure to survey or otherwise identify the barriers to service accessibility;
and,
(g) Needs of persons with a disability.
3. Contractor shall comply with any additional requirements of the documents that
have been incorporated herein by reference, including, but not limited to, those on
the "List of Exhibit A, Attachment I Al Documents incorporate by Reference for
Fiscal Year 2014-152015-16"which is attached to Exhibit A, Attachment I Al.
4. Amounts awarded pursuant to Exhibit A, Attachment I Al shall be used exclusively
for providing alcohol and/or drug program services consistent with the purpose of
the funding.
5. DHCS shall issue a report to Contractor after conducting monitoring, utilization, or
auditing reviews of county or county subcontracted providers. When the DHCS
report identifies non-compliant services or processes, it shall require a CAP. The
Contractor, or in coordination with its subcontracted provider, shall submit a CAP to
DHCS within the designated timeframe specified by DHCS.
Substance Use Disorder - Prevention, Treatment and Recovery Services
Division, Performance Management Branch
Department of Health Care Services
PO Box 997413 MS-2621
Sacramento, CA 95899-7413;
Or by secure, encrypted email to: SUDCountyReports(a)_dhcs.ca.gov
6. The CAP shall include a statement of the problem and the goal of the actions the
Contractor and/orbs its subcontracted provider will take to correct the deficiency or
non-compliance. The CAP shall:
(a) Address the specific actions to correct deficiency or non-compliance
(b) Identify who/which unit(s) will act; who/which unit(s) are accountable for
acting; and
(c) Provide a timeline to complete the actions.
Page 25 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Exhibit A, Attachment I Al
Program Specifications
Part V: Drug Medi-Cal Treatment Program Substance Use Disorder Services
Section 1. Formation and Purpose
A. This Exhibit A, Attachment I Al, Part V of the Contract is entered into by and between the
State and the Contractor for the purpose of identifying and providing for covered DMC
services for substance use disorder treatment in the Contractor's service area pursuant to
Sections 11848.5(a) and (b) of the Health and Safety Code (hereinafter referred to as
HSC), Sections 14124.20, 14021.51 — 14021.53, and 14124.20— 14124.25 of the W&I ,
and Title 22 of the California Code of Regulations (hereinafter referred to as Title 22),
Sections 51341.1, 51490.1, and 51516.1.
B. It is further agreed this Contract is controlled by applicable provisions of: (a) the W&I,
Chapter 7, Sections 14000, et seq., in particular, but not limited to, Sections 14100.2,
14021, 14021.5, 14021.6, 14043, et seq., (b)Title 22, including but not limited to Sections
51490.1, 51341.1 and 51516.1; and (c) Division 4 of Title 9 of the California Code of
Regulations (hereinafter referred to as Title 9).
C. It is understood and agreed that nothing contained in this contract shall be construed to
impair the single state agency authority of DHCS.
D. The objective of this contract is to make substance use disorder treatment services
available to Medi-Cal beneficiaries through utilization of federal and state funds available
pursuant to Title XIX or Title XXI of the Social Security Act for reimbursable covered
services rendered by certified DMC providers.
E. Awards under the Medical Assistance Program (CFDA 93.778) are no longer excluded from
coverage under the HHS implementation of the A-102 Common Rule, 45 CFR part 92
(Federal Register, September 8, 2003, 68 FR 52843-52844). This change is effective for
any grant award under this program made after issuance of the initial awards for the second
quarter of Federal Fiscal Year 2004. This program also is subject to the requirements of 45
CFR part 95 and the cost principles under Office of Management and Budget Circular A-87
(as provided in Cost Principles and Procedures for Developing Cost Allocation Plans and
Indirect Cost Rates for Agreements with the Federal Government, HHS Publication ASMB
C-10, available on the Internet at o_2n.._�n naf
http://www.dol.gov/oasam/boc/ASMB C-10.pdf
Page 26 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Section 2: Covered Services
A. Covered Services
1. Contractor shall establish assessment and referral procedures and shall arrange,
provide, or subcontract for covered services in the Contractor's service area.
Covered services include:
(a) Outpatient drug-free treatment;
(b) Narcotic replacement therapy;
(c) Naltrexone treatment;
(d) Intensive Outpatient Treatment and,
(e) Perinatal Residential Substance Abuse Services (excluding room and
board).
2. Narcotic treatment program services per W&IC 14124.22:
In addition to narcotic treatment program services, a narcotic treatment program
provider who is also enrolled as a Medi-Cal provider may provide medically
necessary treatment of concurrent health conditions within the scope of the
provider's practice, to Medi-Cal beneficiaries who are not enrolled in managed care
plans. Medi-Cal beneficiaries enrolled in managed care plans shall be referred to
those plans for receipt of medically necessary medical treatment of concurrent
health conditions.
Diagnosis and treatment of concurrent health conditions of Medi-Cal beneficiaries
not enrolled in managed care plans by a narcotic treatment program provider may
be provided within the Medi-Cal coverage limits. When the services are not part of
the substance use disorder treatment reimbursed pursuant to Section 14021.51,
services shall be reimbursed in accordance with the Medi-Cal program. Services
reimbursable under this section shall include, but not limited to, all of the following:
(a) Medical treatment visits
(b) Diagnostic blood, urine, and X-rays
(c) Psychological and psychiatric tests and services
(d) Quantitative blood and urine toxicology assays
(e) Medical supplies
Page 27 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
A narcotic treatment provider, who is enrolled as a Medi-Cal fee-for-service
provider, shall not seek reimbursement from a beneficiary for substance abuse
treatment services, if services for treatment of concurrent health conditions are
billed to the Medi-Cal fee-for-service program.
3. In the event of a conflict between the definition of services contained in this Section
of the Contract, and the definition of services in Title 22, Sections 51341.1, 51490.1,
and 51516.1, the provisions of Title 22 shall govern.
4. Contractor, to the extent applicable, shall comply with "Sobky v. Smoley" (Document
2A), 855 F. Supp. 1123 (E.D. Cal 1994), incorporated by this reference.
5. Contractor shall comply with federal and state mandates to provide alcohol and
other drug treatment services deemed medically necessary for Medi-Cal eligible:
(1) pregnant and postpartum women, and (2) youth under age 21 who are eligible
under the EPSDT Program
(a) If Drug Medi-Cal services are provided to Minor Consent beneficiaries,
Contractor shall comply with California Family Code Section 6929, and
California Code of Regulations, Title 22, Sections 50147.1, 50030, 50063.5,
50157(f)(3), 50167(a)(6)(D), and 50195(d).
B. Access to Services
1. Subject to DHCS provider enrollment certification requirements, Contractor shall
maintain continuous availability and accessibility of covered services and facilities,
service sites, and personnel to provide the covered services through use of DMC
certified providers. Such services shall not be limited due to budgetary constraints.
(a) When a request for covered services is made by a beneficiary, Contractor
shall require services to be initiated with reasonable promptness. Contractor
shall have a documented system for monitoring and evaluating accessibility
of care, including a system for addressing problems that develop regarding
waiting times and appointments.
(b) The contractor shall authorize residential services in accordance with the
medical necessity criteria specified in Title 22, Section 51303 and the
coverage provisions of the approved state Medi-Cal Plan. Room and board
are not reimbursable DMC services. If services are denied, the provider shall
inform the beneficiary in accordance with Title 22, Section 51341.1 (p).
(c) Contractor shall require that treatment programs are accessible to people
with disabilities in accordance with Title 45, Code of Federal Regulations
(hereinafter referred to as CFR), Part 84 and the Americans with Disabilities
Act.
2. Covered services, whether provided directly by the Contractor or through
subcontractors with DMC certified and enrolled programs, shall be provided to
beneficiaries without regard to the beneficiaries' county of residence.
Page 28 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
3. The failure of the Contractor or its Subcontractors to comply with Section B of this
Part will be deemed a breach of this Contract sufficient to terminate this Contract for
cause. In the event the Contract is terminated, the provision of this Exhibit,
Attachment I, Part I, Section B, shall apply.
C. Payment For Services
1. The Department shall make the appropriate payments set forth in Exhibit B Al and
take all available steps to secure and pay FFP and State General Funds (SGF) to
the Contractor, once the Department receives FFP and SGF, for claims submitted
by the Contractor. The Department shall notify Contractor and allow Contractor an
opportunity to comment to the Department when questions are posed by CMS, or
when there is a federal deferral, withholding, or disallowance with respect to claims
made by the Contractor.
2. Contractor shall amend its subcontracts for covered services in order to provide
sufficient funds to match allowable federal Medicaid reimbursements for any
increase in provider DMC services to beneficiaries.
3. In the event that the Contractor fails to provide covered services in accordance with
the provisions of this Contract, at the discretion of the State, Contractor may be
required to forfeit its county realignment funds pursuant to Government Code
Section 30027.10 (a) through (d) from the Behavioral Health Subaccount that is set
aside for Drug Medi-Cal services and surrender its authority to function as the
administrator of covered services in its service area.
Section 3: Drug Medi-Cal Certification and Continued Certification
A. DMC Certification and Enrollment
1. The State will certify eligible providers to participate in the DMC program.
2. The Department shall certify any county operated or non-governmental providers.
This certification shall be performed prior to the date on which the Contractor begins
to deliver services under this contract at these sites.
3. Contractor shall require that providers of perinatal DMC services are properly
certified to provide these services and comply with the requirements contained in
Title 22, Section 51341.1, Services for Pregnant and Postpartum Women.
4. Contractor shall require all the subcontracted providers of services to be licensed,
registered, DMC certified and/or approved in accordance with applicable laws and
regulations. Contractor's subcontracts shall require that providers comply with the
following regulations and guidelines:
(a) Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
Page 29 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
(b) Drug Medi-Cal Certification Standards for Substance Abuse Clinics
(Document 2E);
(c) Title 22, CCR, Sections 51341.1, 51490.1, and 51516.1, (Document 2C);
(d) Standards for Drug Treatment Programs (October 21, 1981) (Document 2F);
(e) Title 9, CCR, Division 4, Chapter 4, Subchapter 1, Sections 10000, et seq;
and
(f) Title 22, CCR, sections 51000 et. seq.
In the event of conflicts, the provisions of Title 22 shall control if they are more
stringent.
5.
The Contractor shall notify the State of an addition or
change of information in a Providers pending DMC certification application
within 35 days of receiving notification from the Provider. The Contractor
must ensure that a new DMC certification application is submitted to the State
reflecting the change.
6. The Contractor is responsible for ensuring that any reduction of covered
services or relocations by providers are not implemented until approval is
issued by the State. Within 35 days of receiving notification of a provider's
intent to reduce covered services or relocate the Contractor shall submit or
require the provider to submit, a DMC certification application to the State.
The DMC certification application must be submitted to the State 60 days prior
to the desired effective date of the reduction of covered services or relocation
the State sbdy (60) days pFieF to the pFepesed effeGtive date. GE)RtFaGtGF shall Ret
7. If, at any time, a Subcontractor's license, registration, certification, or approval to
operate a substance use treatment program or provide a covered service is
revoked, suspended, modified, or not renewed outside of DHCS, the Contractor
must notify DHCS within two business days of knowledge of Section 3(A(7)) of
Exhibit A Attachment I Al.
Page 30 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
(a) A provider's certification to participate in the DMC program shall
automatically terminate in the event that the provider or its owners, officers
or directors are convicted of Medi-Cal fraud, abuse or malfeasance. For
purposes of this section, a conviction shall include a plea of guilty or nolo
contendere.
B. Continued Certification
1. All DMC certified providers shall be subject to continuing certification requirements
at least once every five years.
2. The Department may allow the Contractor to continue delivering covered services to
beneficiaries at a site subject to on-site review by the Department as part of the
recertification process prior to the date of the on-site review, provided the site is
operational, the certification remains valid, and has all required fire clearances.
3. State will conduct recertification on-site visits at clinics for circumstances identified
in the "Drug Medi-Cal Certification Standards for Substance Abuse Clinics"
(Document 2E). Document 2E contains the appeal process in the event the State
disapproves a provider's request for certification or recertification and shall be
included in the Contractor's subcontracts.
Section 4: Monitoring
A. State Monitoring
1. DHCS Monitoring Reviews and Financial Audits of Contractor
The Department shall monitor the Contractor's operations for compliance with the
provisions of this contract, and applicable federal and state law and regulations.
Such monitoring activities shall include, but not be limited to, inspection and auditing
of Contractor services, management systems and procedures, and books and
records, as the Department deems appropriate, at any time during the Contractor's
or facility's normal business hours. When monitoring activities identify areas of non-
compliance, the Department shall issue reports to the Contractor detailing findings,
recommendations, and corrective action.
2. Post Service Post Payment Utilization Reviews
(a) After the DMC services have been rendered and paid. the Department
shall conduct Post Service Post Payment Utilization Reviews of the
subcontracted DMC providers to determine whether the DMC services
were provided Glaims feF DIVIG seFviGes in accordance with Title 22
Section 61341.1. The DHCS shall issue the PSPP report to the Contractor
with a copy to subcontracted DMC provider. The Contractor shall be
responsible for their subcontracted providers and their county run
programs to ensure any deficiencies are remediated pursuant to Sections 1
and 2 herein. The Contractor shall attest sert+fy the deficiencies have been
remediated and are complete, pursuant to Section 4(A), Paragraph (Sp),
Page 31 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
herein.
(b) State shall GORdUGt Post SeWiGe Post Payment (PSPP) wtilizatieR Feviews in
(e}j,�L State shall take appropriate steps in accordance with Title 22, CCR, Section
51341.1 to recover payments made if subsequent investigation uncovers
evidence that the claim(s) should not have been paid or that DMC services
have been improperly utilized, and/or shall take the corrective action as
appropriate. If programmatic or fiscal deficiencies are identified, the Provider
shall be required to submit a Corrective Action Plan (CAP) to DHCS via the
Contractor for approval.
i. Pursuant to CCR, Title 22, Section 51341.1(o), all deficiencies
identified by the PGGt SeNiGe Post PaymePA4PSPP} review, whether
or not a recovery of funds results, must be corrected and a-GsrreGtive
Ast+en-Plan the entity that provided the services must submit a
(CAP) to the DMC PSPP Unit within 60 days of
the date of the PSPP report.
(1) The plan shall:
a. Address each demand for recovery of payment and/or
programmatic deficiency;
b. Provide a specific description of how the deficiency
shall be corrected; and
C. Specify the date of implementation of the corrective
action.
(2) DHCS will provide written approval of the CAP to the
Contractor with a copy to the Provider. If DHCS does not
approve the CAP, subFRi#ed by the PFE)videF via the
GeetFastOF, DHCS will provide guidance on the deficient areas
and request an updated CAP from the Contractor with a copy
to the Provider. . The
entity that provided the services must submit an updated
CAP to the DMC PSPP Unit within 30 days of notification.
(3) If the ntity that provided the
services, does not submit a CAP, or, does not implement the
approved CAP provisions within the designated timeline, then
DHCS may withhold funds from the Contractor until the
GeRtFastG the entity that provided the services is in s
tho Drn,iirlor;#e compliance with Exhibit A Attachment I
Al, Part V, Section 4(A)(2). The State shall inform the
Page 32 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Contractor when funds will be withheld.
(4)j1 Contractor and/or Subcontractor may appeal DMC dispositions concerning
demands for recovery of payment and/or programmatic deficiencies of
specific claims. Such appeals shall be handled pursuant to Title 22, CCR,
Section 51341.1(q). This section shall not apply to those grievances or
complaints arising from the financial findings of an audit or examination
made by or on behalf of the State pursuant to Exhibit B Al, Part 11, Section
3, of this Contract.
(e}J!Q State shall monitor the Subcontractor's compliance with PSPP utilization
review requirements in accordance with Title 22. Counties are also required
to monitor of the subcontractor's compliance pursuant to Section 4,
Paragraph A.2, of this contract. The federal government may also review the
existence and effectiveness of the State's utilization review system.
#)Ue Contractor shall implement and maintain compliance with the system of
review described in Title 22, Section 51341.1, for the purposes of reviewing
the utilization, quality, and appropriateness of covered services and ensuring
that all applicable Medi-Cal requirements are met.
(*Lfl Contractor shall assure that subcontractor sites must keep a record of the
clients/patients being treated at that location. Contractor shall retain client
records for a minimum of three (3)years from the date of the last face-to-
face contact. When an audit by the Federal Government or the State has
been started before the expiration of the three-year period, the client records
shall be maintained until completion of the audit and the final resolution of all
issues as a result of the audit.
3. Training
(a) DHCS's Substance Use Disorder- Prevention, Treatment, and Recovery
Services Division (SUD PTRSP) shall provide mandatory annual training to
the Contractor on the requirements of Title 22 and the Drug Medi-Cal
program requirements.
(b) Contractor may request additional Technical Assistance or training from
SUD PTRSD on an ad hoc basis.
B. Contractor Monitoring
1. Program Integrity: Contractor is responsible for ensuring program integrity of its
services and its subcontracted providers through a system of oversight, which shall
include at least the following:
(a) Compliance with state and federal law and regulations, including, but not
limited to, 42 CFR 433.32, 42 CFR 433.51, 42 CFR 431.800 et. seq., 42
CFR 440.230, 42 CFR 440.260, 42 CFR 455 et. seq., 42 CFR 456 et. seq.,
42 CFR 456.23, 22 CCR 51490, 22 CCR 51490.1, 22 CCR 51341.1, 22
Page 33 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
CCR 51159, WIC 14124.1, and WIC 14124.2,, 42 CFR 438.240(e), 42 CFR
438.240(b)(3), 42 CFR 438.240, 42 CFR 438.416, 42 CFR 438-10, and 42
CFR 438.206.
(b) Contractor shall conduct, at least annually, an PFGgFaFnFnatiG and fisGal audit
of DMC providers to assure covered services are being appropriately
rendered. The annual audit must include an on-site visit of the service
provider. Reports of the annual audit shall be provided to the Department's
Performance Management Branch at:
Substance Use Disorder- Prevention, Treatment and Recovery Services
Division, Performance Management Branch PSPP WR+t
Department of Health Care Services
PO Box 997413, MS-2621
Sacramento, CA 95899-7413;
Or by secure, encrypted email to: SUDCountyReports aQdhcs.ca.gov
Audit reports shall be provided to the State within 2 weeks of completion by
the Contractor.
Technical assistance is available to counties from DHCS SUD PTRSD.
(c) Contractor shall ensure that DATAR submissions, detailed in Part III,
Paragraph G of this contract are complied with by all treatment providers and
subcontracted treatment providers. Contractor shall attest sedi€y that each
subcontracted provider is enrolled in DATAR at the time of execution of the
subcontract.
(d) Contractor must monitor and attest serer compliance and/or completion by
Providers with CAP requirements (detailed in Section 4, Paragraph (A)(2)(c))
as required by any PSPP review. Contractor shall attest se#ify to DHCS,
using the form developed by DHCS that the requirements in the CAP have
been completed by the Contractor and/or the Provider. Submission of
DHCS Form 8049#erm by Contractor must be accomplished within the
timeline specified in the approved CAP, as noticed by DHCS.
(e) Contractor shall attest eel that DMC claims submitted to the state have
been subject to review and verification process for accuracy and legitimacy.
(45 CFR 430.30, 433.32, 433.51). Contractor shall not knowingly submit
claims for services rendered to any beneficiary after the beneficiary's date of
death, or from uncertified or decertified providers.
2. Training to DMC Subcontractors
(a) Contractor shall provide training on the requirements of Title 22 regulations
and DMC requirements at least annually to all subcontracted providers.
Attendance of any subcontracted provider at the annual trainings offered by
DHCS (specified in Section 4, paragraph (A)(3) of this contract) shall suffice
Page 34 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
to meet the requirements of this provision. Contractor shall report
compliance with this section to DHCS annually as part of the DHCS County
monitoring process.
3. Monthly Monitoring
(a) Contractor shall check the status of all providers monthly to ensure that they
are continuing active participation in the DMC program. Any subcontracted
provider who surrenders their certification or closes their facility must be
reported by the Contractor to the Department within two (2) business days of
notification or discovery.
(b) During the monthly status check, the Contractor shall monitor for a triggering
recertification event (change in ownership, change in scope of services,
remodeling of facility, or change in location) and report any triggering events
to the&State within two (2) business days of notification or discovery.
4. Program Complaints
(a) All complaints received by Contractor regarding a DMC certified facility shall
be forwarded to;
(2) 19 SiRess drnro of re Geis+ as fellews
Drug Medi-Cal Complaints are to be submitted to:
Division Chief
Substance Use Disorders Prevention, Treatment and Recovery
Services Division
Department of Health Care Services
P.O. Box 997413, MS#26012621
Sacramento, CA 95899-7413
The GomplaiRt Form is available and Gan also be submitted eRline at
curd_f nmr,lnir+can cJpv
Complaints for Residential Adult Alcoholism or Drug Abuse Recovery or
Treatment Facilities may also be made by telephoning the appropriate
licensing branch listed below:
SUD Compliance Division:
Public Number: (916) 322-2911
Toll Free Number: (877) 685-8333
Page 35 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
The Complaint Form is available and can also be submitted online at:
http://www.dhcs.ca.gov/individuals/Pages/Sud-Complaints.aspx
Lbj Counties shall be responsible for investigating complaints and providing the
results of all investigations to the Department's SUP GE)FnplaiRt GGMP!iaRGe
DiViSiGR-e-mail address by secure, encrypted e-mail to:
SUDCountyReports(5)dhcs.ca.gov within two (2) business days of
completion.
5. Record Retention
(a) Contractor shall include instructions on record retention and include in any
subcontract with providers the mandate to keep and maintain records for
each service rendered, to whom it was rendered, and the date of service,
pursuant to W&I Section 14214.1 and 42 CFR 433.32; and 22 CCR section
51341.1.
6. Subcontract Termination
(a) The Contractor must notify DHCS of the termination of any contract with a
certified subcontracted provider, and the basis for termination of the contract,
within two (2) business days.
7. Corrective Action Plan
(a) If the Contractor fails to ensure any of the foregoing oversight through an
adequate system of monitoring, utilization review, and fiscal and
programmatic controls, the Department may request a CAP from the
Contractor to address these deficiencies and a timeline for implementation.
Failure to submit a CAP or adhere to the provisions in the CAP can result in
a withhold of SAPT funds allocated to Contractor for the provision of
services, and/or termination of this contract for cause
(b) Failure to comply with Monitoring requirements shall result in:
i. DHCS shall issue a report to Contractor after conducting monitoring,
utilization, or fiscal auditing reviews of a county. When the DHCS
report identifies non-compliant services or processes, it shall require
a CAP. The Contractor shall submit a CAP to DHCS within the
following timeframes of receipt of the DHCS report.
a. The CAP shall include a statement of the problem and the
goal of the actions the Contractor or its subcontracted
provider will take to correct the deficiency or non-compliance.
The CAP shall:
(1) Address the specific actions to correct deficiency or
non-compliance;
Page 36 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Identify who/which unit(s)will act; who/which unit(s)
are accountable for acting; and
(2) Provide a timeline to complete the actions.
ii. DHCS will provide written approval of the CAP to the Contractor and
the subcontracted provider. If DHCS does not approve the CAP
submitted by the Contractor, DHCS will provide guidance on the
deficient areas and request an updated CAP from the Contractor with
a new deadline for submission.
iii. If the Contractor does not submit a CAP, or, does not implement the
approved CAP provisions within the designated timeline, then the
State may withhold funds until the Contractor is in compliance. The
State shall inform the Contractor when funds will be withheld.
Section 5: Investigations and Confidentiality of Administrative Actions
A. Contractor acknowledges that if a DMC provider is under investigation by the State or any
other state, local or federal law enforcement agency for fraud or abuse, the State may
temporarily suspend the provider from the DMC program, pursuant to W&I Section
14043.36(a). Information about a provider's administrative sanction status is confidential
until such time as the action is either completed or resolved. The DHCS may also issue a
Payment Suspension to a provider pursuant to W&I Section 14107.11 and Code of Federal
Regulations, Title 42, section 455.23. The Contractor is to withhold payments from a DMC
provider during the time a Payment Suspension is in effect.
B. Contractor shall execute the Confidentiality Agreement, attached as Document 5A. The
Confidentiality Agreement permits DHCS to communicate with Contractor concerning
subcontracted providers that are subject to administrative sanctions.
Page 37 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
EXHIBIT A, ATTACHMENT I Al
DOCUMENTS INCORPORATED BY REFERENCE
FOR FISCAL YEAR 2014 2016
The following documents are hereby incorporated by reference into the County contract though
they may not be physically attached to the contract but will be issued in a CD under separate
cover:
Document 1A: Title 45, Code of Federal Regulations 96, Subparts C and L, Substance
Abuse Prevention and Treatment Block Grant Requirements
http://www.access.goo.gov//nara/cfr/waisidx 04/45cfr96 04.html
Document 1 B: Title 42, Code of Federal Regulations, Charitable Choice Regulations
http://www.access.gpo.gov//nara/cfr/waisidx 04/42cfr54 04.html
Document 1C: Driving-Under-the-Influence Program Requirements
Document 1 D(b): SAPT Female Offender Treatment Project(FOTP)
Document 1 F(a): Reporting Requirement Matrix—County Submission Requirements for the
Department of Health Care Services
Document 1 G: Perinatal Services Network Guidelines 2014 (for Non-DMC Perinatal
Programs)
Document 1 H(a): Service Code Descriptions
Document 1 H(b): Program Code Listing
Document 1 H(c) : Funding Line Descriptions
Document 1J(a): Non-Drug Medi-Cal Audit Appeals Process
Document 1J(b): DMC Audit Appeals Process
Document 1 K: Drug and Alcohol Treatment Access Report(DATAR)
http://www.dhcs.ca.gov/provgovpart/Pages/DATAR.aspx
Document 1 P: Alcohol and/or Other Drug Program Certification Standards
(March 15, 2004)
http://www.dhcs.ca.gov/provgovpart/Pages/Facility Certification.aspx
Document 1T: CalOMS Prevention WseF MaRual-Data Quality Standards
Page 38 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Document 1V: Youth Treatment Guidelines
http://www.dhcs.ca.gov/individuals/DocumentsNouth Treatment Guidelines
Document 2A: Sobky v. Smoley, Judgment, Signed February 1, 1995
Document 2C: Title 22, California Code of Regulations
http://ccr.oal.ca.gov
Document 2E: Drug Medi-Cal Certification Standards for Substance Abuse Clinics (Updated
July 1, 2004)
0 0
042OPF
=ID0%20webpaQeQFwq%20Me&
0 eFt0
http://www.dhcs.ca.qov/services/adp/Documents/DMCA Drug Medi-
Cal Certification Standards.pdf
Document 2F: Standards for Drug Treatment Programs (October 21, 1981)
0 0
0 0 0 0 0 0 0
20PFeora s.
http://www.dhcs.ca.gov/services/adp/Documents/DMCA Standards for
Drug Treatment Programs.pdf
Document 2K: Multiple Billing Override Certification (MC 6700)
Document 2L(a): Good Cause Certification (M"065A)
Document 2L(b): Good Cause Certification (M6065B)
Document 2P: County Certification- Cost Report Year-End Claim For Reimbursement
Document 2P(a): Drug Medi-Cal Cost Report Forms—Intensive Outpatient Treatment—Non-
Perinatal (form and instructions)
Document 2P(b): Drug Medi-Cal Cost Report Forms— Intensive Outpatient Treatment—
Perinatal (form and instructions)
Document 2P(c): Drug Medi-Cal Cost Report Forms—Outpatient Drug Free Individual
Counseling — Non-Perinatal (form and instructions)
Document 2P(d): Drug Medi-Cal Cost Report Forms—Outpatient Drug Free Individual
Counseling — Perinatal (form and instructions)
Page 39 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Document 2P(e): Drug Medi-Cal Cost Report Forms—Outpatient Drug Free Group Counseling
— Non-Perinatal (form and instructions)
Document 2P(f): Drug Medi-Cal Cost Report Forms—Outpatient Drug Free Group Counseling
— Perinatal (form and instructions)
Document 2P(g): Drug Medi-Cal Cost Report Forms— Residential— Perinatal (form and
instructions)
Document 2P(h): Drug Medi-Cal Cost Report Forms— Narcotic Treatment Program—County—
Non-Perinatal (form and instructions)
Document 2P(i): Drug Medi-Cal Cost Report Forms—Narcotic Treatment Program—County—
Perinatal (form and instructions)
Document 3G: California Code of Regulations, Title 9 — Rehabilitation and Developmental
Services, Division 4—Department of Alcohol and Drug Programs, Chapter 4
— Narcotic Treatment Programs
http://www.calregs.com
Document 3H: California Code of Regulations, Title 9— Rehabilitation and Developmental
Services, Division 4— Department of Alcohol and Drug Programs, Chapter 8
—Certification of Alcohol and Other Drug Counselors
http://www.calregs.com
Document 3J: CalOMS Treatment Data Collection Guide
http://www.dhcs.ca.gov/provgovpart/Documents/CalOMS Tx Data Collection G
uide JAN%202014.pdf
Document 30: Quarterly Federal Financial Management Report (QFFMR) 2014-15
http://www.dhcs.ca.gov/provgovpart/Pages/SUD Forms.aspx
Document 3S CalOMS Treatment Data Compliance Standards
Document 3T Non-Drug Medi-Cal and Drug Medi-Cal Local Assistance Funding Matrix
Document 3T(a) SAPT Authorized and Restricted Expenditures Information (Nov 2012)
Document 3V Culturally and Linguistically Appropriate Services (CLAS) National Standards
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&Ivll D=15
Document 4A : Drug Medi-Cal Claim Submission Certification —County Contracted Provider
— DHCS Form MC 8186 with Instructions
Page 40 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit A, Attachment I Al
Document 413 : Drug Medi-Cal Claim Submission Certification—County Operated Provider—
DHCS Form MC 8187 with Instructions
Document 4D : Drug Medi-Cal Certification for Federal Reimbursement(DHCS 100224A)
Document 4E : Treatment Standards for Substance Use Diagnosis: A Guide for Services
(Spring 2010)
Document 4F : Drug Medi-Cal (DMC) Services Quarterly Claim for Reimbursement of
County Administrative Expenses (Form#MC 5312)
Document 5A : Confidentiality Agreement
Page 41 of 41
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Exhibit B Al
Budget Detail and Payment Provisions
PiSGal YeaF 2014_15
Part I —General Fiscal Provisions
Section 1 —General Fiscal Provisions
A. Fiscal Provisions
For services satisfactorily rendered, and upon receipt and approval of documentation as
identified in Exhibit A, Attachment I Al, Part III, DHCS agrees to compensate the
Contractor for actual expenditures incurred in accordance with the rates and/or allowable
costs specified herein.
B. Use of State Funds
Contractor may not use allocated Drug Medi-Cal State General Funds to pay for any non-
Drug Medi-Cal services.
C. Funding Authorization
Contractor shall bear the financial risk in providing any substance use disorder services
covered by this Contract.
D. Availability of Funds
It is understood that, for the mutual benefit of both parties, this Contract may have been
written before ascertaining the availability of congressional appropriation of funds in order to
avoid program and fiscal delays that would occur if this Contract were not executed until
after that determination. If so, State may amend the amount of funding provided for in this
Contract based on the actual congressional appropriation.
E. Subcontractor Funding Limitations
Pursuant to HSC Section 11818(2)(A), Contractor shall reimburse its Subcontractors that
receive a combination of Medi-Cal funding and other federal or county realignment funding
for the same service element and location based on the Subcontractor's actual costs in
accordance with Medicaid reimbursement requirements as specified in Title XIX or Title XXI
of the Social Security Act; Title 22, and the State's Medicaid Plan. Payments at negotiated
rates shall be settled to actual cost at year-end.
Page 1 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
F. Budget Contingency Clause
It is mutually agreed that if the Budget Act of the current year and/or any subsequent years
covered under this Agreement does not appropriate sufficient funds for the program, this
Agreement shall be of no further force and effect. In this event, DHCS shall have no liability
to pay any funds whatsoever to Contractor or to furnish any other considerations under this
Agreement and Contractor shall not be obligated to perform any provisions of this
Agreement.
If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, DHCS shall have the option to either cancel this Agreement with no liability
occurring to DHCS, or offer an agreement amendment to Contractor to reflect the reduced
amount.
G. Expense Allowability/ Fiscal Documentation
1. Invoices, received from a Contractor and accepted and/or submitted for payment by
DHCS, shall not be deemed evidence of allowable agreement costs.
2. Contractor shall maintain for review and audit and supply to DHCS upon request,
adequate documentation of all expenses claimed pursuant to this Agreement to
permit a determination of expense allowability.
3. If the allowability or appropriateness of an expense cannot be determined by DHCS
because invoice detail, fiscal records, or backup documentation is nonexistent or
inadequate according to generally accepted accounting principles, and generally
accepted governmental audit standards, all questionable costs may be disallowed
and payment may be withheld by DHCS. Upon receipt of adequate documentation
supporting a disallowed or questionable expense, reimbursement may resume for
the amount substantiated and deemed allowable.
4. Costs and/or expenses deemed unallowable are subject to recovery by DHCS.
H. Maintenance of Effort for SAPT Block Grant
1. Notwithstanding any other provision in this contract, the Director may reduce federal
funding allocations, on a dollar-for-dollar basis, to a county that has a reduced or
anticipates reduced expenditures in a way that would result in a decrease in the
federal Substance Abuse Prevention and Treatment Block Grant funds (42 U.S.C.
Sect 300x-30).
2. Prior to making any reductions pursuant to this subdivision, the Director shall notify
all counties that county underspending will reduce the federal Substance Abuse
Prevention and Treatment Block Grant maintenance of effort (MOE). Upon receipt
of notification, a county may submit a revision to the county budget initially
submitted pursuant to subdivision (a) of Section 11978 in an effort to maintain the
statewide SAPT Block Grant MOE.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
3. Pursuant to subdivision (b) of Section 11978.1, a county shall notify the Department
in writing of proposed local changes to the county's expenditure of funds. The
Department shall review and may approve the proposed local changes depending
on the level of expenditures needed to maintain the statewide SAPT Block Grant
MOE.
I. Effective the date of execution of this Contract, nothing in this Contract waives the
protections provided to Contractor under Section 36 of article XIII of the California
Constitution ("Proposition 30"). Except where specifically stated in the terms of this
contract, Contractor's performance of any additional legal requirements, including, but not
limited to court-ordered requirements and statutory or regulatory amendments, is subject to
Proposition 30's funding requirements.
Section 2—General Fiscal Provisions— Non-Drug Medi-Cal
A. Revenue Collection
Contractor shall conform to revenue collection requirements in Division 10.5 of the HSC,
Sections 11841, by raising revenues in addition to the funds allocated by the State. These
revenues include, but are not limited to, fees for services, private contributions, grants, or
other governmental funds. These revenues shall be used in support of additional alcohol
and other drug services or facilities. Each alcohol and drug program shall set and collect
client fees based on the client's ability to pay. The fee requirement shall not apply to
prevention and early intervention services. Contractor shall identify in its annual cost report
the types and amounts of revenues collected.
B. Cost Efficiencies
It is intended that the cost to the Contractor in maintaining the dedicated capacity and units
of service shall be met by the non-DMC funds allocated to the Contractor and other
Contractor or Subcontractor revenues. Amounts awarded pursuant to Exhibit A,
Attachment I At Part IV, shall not be used for services where payment has been made, or
can reasonably be expected to be made under any other state or federal compensation or
benefits program, or where services can be paid for from revenues.
Section 3—General Fiscal Provisions— Drug Medi-Cal
A. Return of Unexpended Funds
Contractor assumes the total cost of providing covered services on the basis of the
payments delineated in this Exhibit B Al, Part II. Any State General Funds or federal
Medicaid funds paid to the Contractor, but not expended for DMC services shall be returned
to the State.
B. Amendment or Cancellation Due to Insufficient Appropriation
This Contract is valid and enforceable only if sufficient funds are made available to the
State by the United States Government for the purpose of the DMC program. It is mutually
Page 3 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
agreed that if the Congress does not appropriate sufficient funds for this program, State has
the option to void this contract or to amend the Contract to reflect any reduction of funds.
C. Exemptions
Exemptions to the provisions of Item B above, of this Exhibit, may be granted by the
California Department of Finance provided that the Director of DHCS certifies in writing that
federal funds are available for the term of the contract.
D. Allowable costs
Allowable costs, as used in Section 51516.1 of Title 22 shall be determined in accordance
with Title 42, CFR Parts 405 and 413, and Centers for Medicare and Medicaid Services
(CMS), "Medicare Provider Reimbursement Manual (Publication Number 15)," which can
be obtained from the Centers for Medicare & Medicaid Services, or www.cros.hhs.gov." In
accordance with W&IC Sections 14132.44 and 14132.47, funds allocated to the Contractor
for DMC services, including funding for alcohol and other drug services for pregnant and
postpartum women pursuant to Title 22, Section 51341.1(c), may not be used as match for
targeted case management services or for Medi-Cal administrative activities.
Page 4 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Exhibit B Al
Budget Detail and Payment Provisions
Ronal YeaF 2014 15
Part II — Reimbursements
Section 1. General Reimbursement
A. Prompt Payment Clause
Payment will be made in accordance with, and within the time specified in, Government
Code Chapter 4.5, commencing with Section 927.
B. Amounts Payable
1. The amount payable under this Agreement shall not exceed the amount identified
on the Standard Agreement.
2. Reimbursement shall be made for allowable expenses up to the amount annually
encumbered commensurate with the state fiscal year in which services are
performed and/or goods are received.
3. The funds identified for the fiscal years covered by under this Section, within this
Exhibit, are subject to change depending on the availability and amount of funds
appropriated by the Legislature and the Federal Government. The amount of funds
available for expenditure by the Contractor shall be limited to the amount identified
in the final allocations issued by the State for that fiscal year or the non-DMC
amount, whichever is less. Changes to allocated funds will require written
amendment to the Contract.
4. For each fiscal year, the State may settle costs for services based on each fiscal
year year-end cost settlement report as the final amendment for the specific fiscal
year cost settlement report to the approved single state/county contract.
Section 2. Non-Drug Medi-Cal
A. Amounts Payable for Non-Drug Medi-Cal
1. State shall reimburse the Contractor monthly in arrears an amount equal to one-
twelfth of the maximum amount allowed pursuant to Exhibit B Al of the contract or
the most recent allocation based on the Budget Act Allocation, whichever is less.
Final allocations will reflect any increases or reductions in the appropriations as
reflected in the State Budget Act allocation and any subsequent allocation revisions.
2. Monthly disbursement to the Contract at the beginning of each fiscal year of the
Contract shall be based on the preliminary allocation of funds, as detailed in this
Exhibit.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
3. However, based on the expenditure information submitted by the counties in the
Quarterly Federal Financial Management Report(QFFMR) (Document 30), State
may adjust monthly payments of encumbered block grant federal funds to extend
the length of time (not to exceed 21 months) over which payments of federal funds
will be made.
4. Monthly disbursements to the Contractor at the beginning of each fiscal year of the
Contract shall be based on the preliminary allocation of funds, as detailed in Exhibit
B Al.
5. State may withhold monthly non-DMC payments if the Contractor fails to:
(a) timely submit reports and data required by the State, including but not limited
to, reports required pursuant to Exhibit A, Attachment I Al, Part III.
(b) submit the contract amendment within 90 days from issuance from the State
to the Contractor.
(c) submit and attest sef*the completion of Corrective Action Plans for
services provided pursuant to this contract.
6. Upon the State's receipt of the complete and accurate reports, data, or signed
contract, the Contractor's monthly payment shall commence with the next scheduled
monthly payment, and shall include any funds withheld due to late submission of
reports, data and/or signed contract.
7. Adjustments may be made to the total of the Contract and amounts may be withheld
from payments otherwise due to the Contractor hereunder, for nonperformance to
the extent that nonperformance involves fraud, abuse, or failure to achieve the
objectives of the provisions of Exhibit A, Attachment I Al, Part IV.
B. Payment Provisions
For each fiscal year, the total amount payable by the State to the Contractor for services
provided under Exhibit A, Attachment I Al, Part IV, shall not exceed the encumbered
amount. The funds identified for the fiscal years covered by Exhibit A, Attachment I Al,
Part IV, are subject to change depending on the availability and amount of funds
appropriated by the Legislature and the Federal Government. Changes to encumbered
funds will require written amendment to the Contract. State may settle costs for non-DMC
services based on the year-end cost settlement report as the final amendment to the
approved single state/county contract.
C. In the even a contract amendment is required pursuant to the preceding paragraph,
Contactor shall submit to the State information as identified in Exhibit E, Section 1.D. To
the extent the Contractor is notified of the State Budget Act allocation prior to the execution
of the Contract, the State and the Contractor may agree to amend the contract after the
issuance of the first revised allocation.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
D. Accrual of Interest
Any interest accrued from State-allocated funds and retained by the Contractor must be
used for the same purpose as the State allocated funds from which the interest was
accrued.
E. Expenditure Period
Substance Abuse Prevention and Treatment (SAPT) Block Grant funds are allocated based
upon the Federal Grant award period. These funds must be expended for activities
authorized pursuant to 42 USC Sections 300x-21(b) through 300x-66; and Title 45, CFR,
Subpart L, within the availability period of the grant award. Any SAPT Block Grant funds
that have not been expended by a Contractor at the end of the expenditure period identified
below shall be returned to the State for subsequent return to the Federal government.
1. The expenditure period of the FFY 2014 award is October 1, 2013 through
June 30, 2015.
2. The expenditure period of the FFY 2015 award is October 1, 2014 through
June 30, 2016.
3. The expenditure period of the FFY 2016 award is October 1, 2015 through
June 30, 2017.
4. The expenditure period of the FFY 2017 award is October 1, 2016 through
June 30, 2018.
5. The expenditure period of the FFY 2018 award is October 1, 2017 through
June 30, 2019.
F. Contractors receiving SAPT Block Grant funds shall comply with the financial management
standards contained in Title 45, CFR, Part 92, Sections 92.20(b)(1) through (6), and Title
45, CFR, Part 96, Section 96.30.
G. Non-profit Subcontractors receiving SAPT Block Grant funds shall comply with the financial
management standards contained in Title 45, CFR, Part 74, Sections 74.21(b)(1) through
(4) and (b)(7), and Part 96, Section 96.30.
H. Contractors receiving SAPT Block Grant funds shall track obligations and expenditures by
individual SAPT Block Grant award, including, but not limited to, obligations and
expenditures for primary prevention, services to pregnant women and women with
dependent children. "Obligation"shall have the same meaning as used in Title 45, CFR,
Part 92, Section 92.3."
Additionally, Contractors expending SAPT Block Grant HIV Set Aside funds for HIV Early
Intervention Services are required to collect data regarding their use of HIV Set-Aside funds
and to report this data to the State.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
I. Restrictions on the Use of Federal Block Grant Funds
Pursuant to 42 U.S.C. 300x-31, Contractor shall not use SAPT Block Grant funds provided
by the Agreement to on the following activities:
1. Provide inpatient services;
2. Make cash payment to intended recipients of health services;
3. Purchase or improve land, purchase, construct or permanently improve (other than
minor remodeling) any building or other facility or purchase major medical
equipment;
4. Satisfy any requirement for the expenditure of non-Federal funds as a condition for
the receipt of Federal funds;
5. Provide financial assistance to any entity other than a public or nonprofit private
entity;
6. Pay the salary of an individual through a grant or other extramural mechanism at a
rate in excess of level I of the Executive Salary Schedule for the award year: see
http://grants.nih.gov/grants/policy/salcap summary.htm;
7. Purchase treatment services and penal or correctional institutions of this State of
California; and
8. Supplant state funding of programs to prevent and treat substance abuse and
related activities.
Section 3. Drug Medi-Cal
A. To the extent that the Contractor provides the covered services in a satisfactory manner
and in accordance with the terms and conditions of this Contract, the State agrees to pay
the Contractor federal Medicaid funds according to Exhibit A, Attachment I Al, Part III.
Subject to the availability of such funds, Contractor shall receive federal Medicaid funds
and/or State General Funds for allowable expenditures as established by the federal
government and approved by the State, for the cost of services rendered to beneficiaries.
B. Any payment for covered services rendered pursuant to Exhibit A, Attachment I Al, Part V,
shall only be made pursuant to applicable provisions of Title XIX or Title XXI of the Social
Security Act; the W⁣ the HSC; California's Medicaid State Plan; and Sections 51341.1,
51490.1, 51516.1, and 51532 of Title 22.
C. It is understood and agreed that failure by the Contractor or its Subcontractors to comply
with applicable federal and state requirements in rendering covered services shall be
sufficient cause for the State to deny payments to and/or recover payments from the
Contractor and/or terminate the Contractor or its Subcontractor from DMC program
participation. If the State or the Department of Health and Human Services (DHHS)
disallows or denies payments for any claim, Contractor shall repay to the State the federal
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Medicaid funds and/or State General Funds it received for all claims so disallowed or
denied. The overpayment shall be recovered by any of the methods allowed in Title 22,
CCR, Sections 51047(a) and (b).
D. Before such denial, recoupment, or disallowances are made, State shall provide the
Contractor with written notice of its proposed action. Such notice shall include the reason
for the proposed action and shall allow the Contractor sixty (60) days to submit additional
information before the proposed action is taken, as required in Title 22, CCR, Section
51047(a). This requirement does not apply to the DMC Post Service Post Payment
Utilization Reviews.
E. The State shall refund to the Contractor any recovered Federal Drug Medi-Cal overpayment
that is subsequently determined to have been erroneously collected, together with interest,
in accordance with Title 22, CCR, Section 51047(e).
F. Contractor shall be reimbursed by the State on the basis of its actual net reimbursable cost,
not to exceed the unit of service maximum rate.
G. Claims submitted to the contractor by a sub-contracted provider that is not certified or
whose certification has been suspended pursuant to the Welfare and Institutions Code
section 14107.11, and Code of Federal Regulations, Title 42, section 455.23 shall not be
certified or processed for federal or state reimbursement by the contractor. Payments for
any DMC services shall be held by the Contractor until the payment suspension is resolved.
H. In the event a contract amendment is required pursuant to the preceding paragraph,
Contractor shall submit to the State information as identified in Exhibit E, Section 1.D. To
the extent the Contractor is notified of the State Budget Act allocation prior to the execution
of the Contract, the State and the Contractor may agree to amend the contract after the
issuance of the first revised allocation.
1. Reimbursement for covered services, other than NTP services, shall be limited to the lower
of:
1. the provider's usual and customary charges to the general public for the same or
similar services;
2. the provider's actual allowable costs; or
3. the DMC SMA for the modality.
J. Reimbursement to NTP's shall be limited to the lower of either the USDR rate, pursuant to
W&IC Section 14021.51(h), or the provider's usual and customary charge to the general
public for the same or similar service. However, reimbursement paid by a county to an NTP
provider for services provided to any person subject to Penal Code Sections 1210.1 or
3063.1 and for which the individual client is not liable to pay, does not constitute a usual or
customary charge to the general public. (W&IC Section 14021.51(h)(2)(A)).
Page 9 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
K. State shall reimburse the Contractor the State General Funds and/or federal Medicaid
amount of the approved DMC claims and documents submitted in accordance with Exhibit
A, Attachment I All, Part III.
L. State will adjust subsequent reimbursements to the Contractor to actual allowable costs.
Actual allowable costs are defined in the Medicare Provider Reimbursement Manual (CMS-
Pub.15), which can be obtained from the Centers for Medicare & Medicaid Services,
Baltimore, Maryland, or www.cros.hhs.gov.
M. Contractors and Subcontractors must accept, as payment in full, the amounts paid by the
State in accordance with Title 22, CCR, Section 51516.1, plus any cost sharing charges
(deductible, coinsurance, or copayment) required to be paid by the client. However,
Contractors and Subcontractors may not deny services to any client eligible for DMC
services on account of the client's inability to pay or location of eligibility. Contractors and
Subcontractors may not demand any additional payment from the State, client, or other
third party payers.
Section 4. Drug Medi-Cal Direct Provider Contracts
A. Pursuant to W&IC 14124.21, DHCS shall contract with qualified DMC providers within the
county when a county does not contract to operate DMC services, in whole or in part.
B. The State will invoice the Contractor for the county realignment share of approved DMC
claims received by the State from the State's subcontractor. Contractor shall reimburse the
State for the county realignment share of the approved DMC claims within 30 days of
receipt of the invoice. If Contractor does not reimburse the State within 30 days of receipt
of the invoice, the State may offset the amount owed from any other funding owed to
Contractor by the State or any other State agency. The parties acknowledge that the
State's subcontractor shall be responsible for repayment of any disallowed claims.
However, in no event shall the State be liable for Medicaid reimbursement for any
disallowed claims.
1. Any Contractor contracting with the State for the provision of services through NTP
providers may receive reimbursement of the NTP administrative rate.
2. As a result of the direct contract provider's settled cost report, any County
Realignment funds owed to the direct contract provider will be handled through an
invoice process to the Contractor. Additionally, as a result of the direct contract
provider's settled cost report, any County Realignment funds owed to the State will
be returned to the Contractor.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Exhibit B Al
Budget Detail and Payment Provisions
Part III - Financial Audit Requirements
Section 1. General Fiscal Audit Requirements
A. In addition to the requirements identified below, the Contractor and its Subcontracts are
required to meet the audit requirements as delineated in Exhibit C, General Terms and
Conditions, and Exhibit D(F), Special Terms and Conditions, of this Contract.
B. All expenditures of county realignment funds, state and federal funds furnished to the
Contractor and its Subcontractors pursuant to this Contract are subject to audit by the
State. Such audits shall consider and build upon external independent audits performed
pursuant to audit requirements of the Office of Management and Budget(OMB) Circular A-
133 (Revised December 2013) and/or any independent Contractor audits or reviews.
Objectives of such audits may include, but not limited to, the following:
1. To determine whether units of service claimed/reported are properly documented by
service records and accurately accumulated for claiming/reporting;
2. To validate data reported by the Contractor for prospective contract negotiations;
3. To provide technical assistance in addressing current year activities and providing
recommendation on internal controls, accounting procedures, financial records, and
compliance with laws and regulations;
4. To determine the cost of services, net of related patient and participant fees, third-
party payments, and other related revenues and funds;
5. To determine that expenditures are made in accordance with applicable state and
federal laws and regulations and contract requirements, and/or;
6. To determine the facts in relation to analysis of data, complaints, or allegations,
which may be indicative of fraud, abuse, willful misrepresentation, or failure to
achieve the Contract objectives of Exhibit C and D(F).
C. Unannounced visits may be made at the discretion of the State.
D. The refusal of the Contractor or its Subcontractors to permit access to and inspection of
electronic or print books and records, physical facilities, and/or refusal to permit interviews
with employees, as described in this part constitutes an express and immediate material
breach of this Contract and will be sufficient basis to terminate the Contract for cause or
default.
E. Reports of audits conducted by the State shall reflect all findings, recommendations,
adjustments and corrective action as a result of it's finding in any areas.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Section 2. Non-Drug Medi-Cal Financial Audits
A. Pursuant to OMB Circular A-133 §_400(d)(3), Contractor shall monitor the activities of all
of its Subcontractors to ensure that:
1. Subcontractors are complying with program requirements and achieving
performance goals
2. Subcontractors are complying with fiscal requirements, such as having appropriate
fiscal controls in place, and are using awards for authorized purposes.
B. Contractor can use a variety of monitoring mechanism, including limited scope audits, on-
site visits, progress reports, financial reports, and review of documentation support requests
for reimbursement, to meet the Contractor's monitoring objectives. The Contractor may
charge federal awards for the cost of these monitoring procedures as outlined in OMB
Circular A-133.
C. The Contractor shall submit to the State a copy of the procedures and any other monitoring
mechanism used to monitor non-profit Subcontracts at the time of the County's annual site
visit or within 60 days thereafter. Contractor shall state the frequency that non-profit
Subcontracts are monitored.
D. Limited scope audits, as defined in the OMB Circular A-133, only include agreed-upon
engagements that are (1) conducted in accordance with either the American Institute of
Certified Public Accountants generally accepted auditing standards or attestation
standards; (2) paid for and arranged by pass-through entities (counties); and (3) address
one or more of the following types of compliance requirements: (i) activities allowed or
unallowed; (ii) allowable costs/cost principals; (iii) eligibility; (9v) matching, level of effort
and earmarking; and (v) reporting.
E. On-site visits focus on compliance and controls over compliance areas. The reviewer must
make site visits to the subcontractor locations(s), and can use a variety of monitoring
mechanism to document compliance requirements. The finding and the corrective action
will require follow-up by the Contractor.
F. Contractor shall be responsible for any disallowance taken by the Federal Government, the
State, or the California State Audit, as a result of any audit exception that is related to the
Contractor's responsibilities herein. Contractor shall not use funds administered by the
State to repay one federal funding source with funds provided by another federal funding
source, to repay federal funds with state funds, or to repay state funds with federal funds.
State shall invoice Contractor 60 days after issuing the final audit report or upon resolution
of an audit appeal. Contractor agrees to develop and implement any corrective action
plans in a manner acceptable to the State in order to comply with recommendations
contained in any audit report. Such corrective action plans shall include time-specific
objectives to allow for measurement of progress and are subject to verification by the state
within one year from the date of the plan.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
If differences cannot be resolved between the State and Contractor regarding the terms of
the financial audit settlements for funds expended under Exhibit A, Attachment I All, Part
IV, Contractor may request an appeal in accordance with the appeal process described in
Document 1J(a), "Non-DMC Audit Appeal Process," incorporated by this reference. When
a financial audit is conducted by the Federal Government, the State, or the California State
Auditor directly with a Subcontractor of the Contractor, and if the Subcontractor disagrees
with audit disallowances related to its programs, claims or services, Contractor shall, at the
Subcontractor's request, request an appeal to the State in accordance with Document
1 J(a). Contractor shall include a provision in its subcontracts regarding the process by
which its Subcontractors may file an appeal via the Contractors.
G. Contractors that conduct financial audits of Subcontractors, other than a Subcontractor
whose funding consists entirely of non-Department funds, shall develop a process to
resolve disputed financial findings and notify Subcontractors of their appeal rights pursuant
to that process. This section shall not apply to those grievances or compliances arising
from the financial findings of an audit or examination made by or on behalf of the State
pursuant to Article IV of this Contract.
H. Pursuant to OMB Circular A-133, State may impose sanctions against the Contractor for
not submitting single or program-specific audit reports, or failure to comply with all other
audit requirements. The sanctions shall include:
1. Withholding a percentage of federal awards until the audit is completed satisfactorily
2. Withhold or disallowing overhead costs
3. Suspending federal awards until the audit is conducted; or
4. Terminating the federal award
Section 3. Drug Medi-Cal Financial Audits
A. In addition to the audit requirements set forth in Exhibit D(F), State may also conduct
financial audits of DMC programs, exclusive of NTP services, to accomplish any of, but not
limited to, the following audit objectives:
1. To review reported costs for validity, appropriate allocation methodology, and
compliance with Medicaid laws and regulations;
2. To ensure that only the cost of allowable DMC activities are included in reported
costs;
3. To determine the provider's usual and customary charge to the general public in
accordance with CMS (The Medicare Provider Reimbursement Manual) (CMS-
Pub.15), which can be obtained from the Centers for Medicare & Medicaid Services,
Baltimore, Maryland, or www.cros.hhs.gov, for comparison to the DMC cost per unit;
4. To review documentation of units of service and determine the final number of
approved units of service;
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
5. To determine the amount of clients' third-party revenue and Medi-Cal share of cost
to offset allowable DMC reimbursement; and,
6. To compute final settlement based on the lower of actual allowable cost, the usual
and customary charge, or the maximum allowance, in accordance with Title 22,
Section 51516.1.
B. In addition to the audit requirements set forth in Exhibit D(F), State may conduct financial
audits of NTP programs. For NTP services, the audits will address items A(3) through A(5)
above, except that the comparison of the provider's usual and customary charge in A(3) will
be to the DMC USDR rate in lieu of DMC cost per unit. In addition, these audits will
include, but not be limited to:
1. For those NTP providers required to submit a cost report pursuant to W&IC Section
14124.24, a review of cost allocation methodology between NTP and other service
modalities, and between DMC and other funding sources;
2. A review of actual costs incurred for comparison to services claimed;
3. A review of counseling claims to ensure that the appropriate group or individual
counseling rate has been used and that counseling sessions have been billed
appropriately;
4. A review of the number of clients in group sessions to ensure that sessions include
no less than four and no more than ten clients at the same time, with at least one
Medi-Cal client in attendance;
5. Computation of final settlement based on the lower of USDR rate or the provider's
usual and customary charge to the general public; and,
6. A review of supporting service, time, financial, and patient records to verify the
validity of counseling claims.
C. Contractor shall be responsible for any disallowances taken by the Federal Government,
the State, or the Bureau of State Audits as a result of any audit exception that is related to
its responsibilities. Contractor shall not use funds administered by the State to repay one
federal funding source with funds provided by another federal funding source, or to repay
federal funds with state funds, or to repay state funds with federal funds
D. Contractor agrees to promptly develop and implement any corrective action plans in a
manner acceptable to the State in order to comply with recommendations contained in any
audit report. Such corrective action plans shall include time-specific objectives to allow for
measurement of progress and are subject to verification by the State within six months from
the date of the plan.
E. Contractor, in coordination with the State, must provide follow-up on all significant findings
in the audit report, including findings relating to a Subcontractor, and submit the results to
the State.
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County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
If differences cannot be resolved between the State and the Contractor regarding the terms
of the final financial audit settlements for funds expended under Exhibit B Al, Contractor
may request an appeal in accordance with the appeal process described in the "DMC Audit
Appeal Process," Document U(b), incorporated by this reference. When a financial audit is
conducted by the Federal Government, the State, or the Bureau of State Audits directly with
a Subcontractor of the Contractor, and if the Subcontractor disagrees with audit
disallowances related to its programs, claims or services, Contractor shall, at the
Subcontractor's request, request an appeal to the State in accordance with Document
U(b). Contractor shall include a provision in its subcontracts regarding the process by
which a Subcontractor may file an audit appeal via the Contractor.
F. Providers of DMC services shall, upon request, make available to the State their fiscal and
other records to assure that such provider have adequate recordkeeping capability and to
assure that reimbursement for covered DMC services are made in accordance with Title 22,
CCR, Section 51516.1. These records include, but are not limited to, matters pertaining to:
1. Provider ownership, organization, and operation;
2. Fiscal, medical, and other recordkeeping systems;
3. Federal income tax status;
4. Asset acquisition, lease, sale, or other action;
5. Franchise or management arrangements;
6. Patient service charge schedules;
7. Costs of operation;
8. Cost allocation methodology;
9. Amounts of income received by source and purpose; and,
10. Flow of funds and working capital.
G. Contractor shall retain records of utilization review activities required in Article VI herein for
a minimum of three (3)years.
Page 15 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Exhibit B Al
Budget Detail and Payment Provisions
Part IV—Records
Section 1. General Provisions
A. Maintenance of Records
Contractor shall maintain sufficient books, records, documents, and other evidence
necessary for the State to audit contract performance and contract compliance. Contractor
shall make these records available to the State, upon request, to evaluate the quality and
quantity of services, accessibility and appropriateness of services, and to ensure fiscal
accountability. Regardless of the location or ownership of such records, they shall be
sufficient to determine if costs incurred by contractor are reasonable, allowable and
allocated appropriately. All records must be capable of verification by qualified auditors.
1. Contractor shall include in any contract with an audit firm a clause to permit access
by the State to the working papers of the external independent auditor, and require
that copies of the working papers shall be made for the State at its request.
2. Contractor shall keep adequate and sufficient financial records and statistical data to
support the year-end documents filed with the State. All records must be capable of
verification by qualified auditors.
3. Accounting records and supporting documents shall be retained for a three-year
period from the date the year-end cost settlement report was approved by the State
for interim settlement. When an audit by the Federal Government, the State, or the
California State Auditor has been started before the expiration of the three-year
period, the records shall be retained until completion of the audit and final resolution
of all issues that arise in the audit. Final settlement shall be made at the end of the
audit and appeal process. If an audit has not been completed within three years,
the interim settlement shall be considered as the final settlement.
4. Financial records shall be kept so that they clearly reflect the source of funding for
each type of service for which reimbursement is claimed. These documents
include, but are not limited to, all ledgers, books, vouchers, time sheets, payrolls,
appointment schedules, client data cards, and schedules for allocating costs. All
records must be capable of verification by qualified auditors.
5. Contractor's subcontracts shall require that all Subcontractors comply with the
requirements of Exhibit A, Attachment I Al, Part V, Section 2.
Page 16 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
6. Should a Subcontractor discontinue its contractual agreement with the Contractor,
or cease to conduct business in its entirety, Contractor shall be responsible for
retaining the Subcontractor's fiscal and program records for the required retention
period. The State Administrative Manual (SAM) contains statutory requirements
governing the retention, storage, and disposal of records pertaining to state funds.
Contractor shall follow SAM requirements located at
http://sam.dgs.ca.gov/TOC/1600.asox.
The Contractor shall retain all records required by Welfare and Institutions Code
section 14124.1, 42 CFR 433.32, and California Code of Regulations, Title 22,
Section 51341.1 et seq. for reimbursement of services and financial audit purposes.
7. In the expenditure of funds hereunder, and as required by 45 CFR Part 96,
Contractor shall comply with the requirements of SAM and the laws and procedures
applicable to the obligation and expenditure of federal and state funds.
B. Dispute Resolution Process
1. In the event of a dispute under this Exhibit A, Attachment I Al, Part IV, other than
an audit dispute, Contractor shall provide written notice of the particulars of the
dispute to the State before exercising any other available remedy. Written notice
shall include the contract number. The Director(or designee) of the State and the
County Drug or Alcohol Program Administrator(or designee) shall meet to discuss
the means by which they can effect an equitable resolution to the dispute.
Contractor shall receive a written response from the State within sixty (60) days of
the notice of dispute. The written response shall reflect the issues discussed at the
meeting and state how the dispute will be resolved.
2. In the event of a dispute over financial audit findings between the State and the
Contractor, Contractor may appeal the audit in accordance with the "non- DMC
Audit Appeal Process" (Document 1J(a)). When a financial audit by the Federal
Government, the State, or the California State Auditor is conducted directly with a
Subcontractor of the Contractor, and if the Subcontractor disagrees with audit
disallowances related to its programs, claims or services, Contractor shall, at the
Subcontractor's request, request an appeal to the State in accordance with
Document 1J(a). Contractor shall include a provision in its subcontracts regarding
the process by which a Subcontractor may file an audit appeal via the Contractor.
3. As stated in Part III, Section 3, of this Exhibit, in the event of a dispute over financial
audit findings between the State and the Contractor, Contractor may appeal the
audit in accordance with DMC Audit Appeal Process" (Document 1J(b)). When a
financial audit by the Federal Government, the State, or the California State Auditor
is conducted directly with a Subcontractor of the Contractor, and if the
Subcontractor disagrees with audit disallowances related to its programs, claims or
services, Contractor shall, at the Subcontractor's request, request an appeal to the
State in accordance with DMC Audit Appeal Process" (Document 1 J(b)). Contractor
shall include a provision in its subcontracts regarding the process by which a
Subcontractor may file an audit appeal via the Contractor.
Page 17 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
4. Contractors that conduct financial audits of Subcontractors, other than a
Subcontractor whose funding consists entirely of non-Department funds, shall
develop a process to resolve disputed financial findings and notify Subcontractors of
their appeal rights pursuant to that process. This section shall not apply to those
grievances or complaints arising from the financial findings of an audit or
examination made by or on behalf of the State pursuant to Part II of this Exhibit.
5. To ensure that necessary corrective actions are taken, financial audit findings are
either uncontested or upheld after appeal may be used by the State during
prospective contract negotiations.
Page 18 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
Exhibit B Al
Budget Detail and Payment Provisions
Part V. Drug Medi-Cal Reimbursement Rates
A. "Uniform Statewide Daily Reimbursement(USDR) Rate" means the rate for NTP
services based on a unit of service that is a daily treatment service provided pursuant to
Title 22, Sections 51341.1 and 51516.1 and Title 9, commencing with Section 10000
(Document 3G), or the rate for individual or group counseling. The following table shows
the USDR rates.
Non-Perinatal Perinatal Rate Per
Type of Unit of (Regular) Rate Per UOS
Service Service (UOS) UOS
FY 14/16 FY16/16 FY 14/15 FY15/16
NTP-Methadone
Dosing Daly $10.80 $11.44 $11.79 $13.68
NTP-Individual One 10-minute
Counseling (*) increment $13.48 $13.39 $21.06 $21.17
NTP Group One 10-minute
Counseling (') increment $2.91 3.02 $7.03 5.79
(*) The NTP contractors may be reimbursed for up to 200 minutes (20-10 minute
increments) of individual and/or group counseling per calendar month peF beRefasiary. If
medical necessity is met that requires additional NTP counseling beyond 200 minutes per
calendar month, NTP contractors may bill and be reimbursed for additional counseling (in
10 minute increments). Medical justification for the additional counseling must be clearly
documented in the patient record.
Reimbursement for covered NTP services shall be limited to the lower of the NTP's usual
and customary charge to the general public for the same or similar services or the USDR
rate.
Page 19 of 20
County Contract
County of Fresno
#14-90056 A02
Exhibit B Al
B. "Unit of Service" means a face-to-face contact on a calendar day for outpatient drug free,
intensive outpatient treatment, perinatal residential, and Naltrexone treatment services.
Only one face-to-face service contact per day is covered by DMC except in the case of
emergencies when an additional face-to-face contact may be covered for intake crisis
intervention or collateral service. To count as a unit of service, the second contact shall not
duplicate the services provided on the first contact, and each contact shall be clearly
documented in the beneficiary's record. While the rates are approved by the State, they
are subject to change through the regulation process. Units of service
fee FY 2014 are identified in the following table.
Non-Perinatal Perinatal Rate Per
Service Type of Unit of (Regular) Rate Per UOS
Service (UOS) UOS
FY 14/15 FY15/16 FY 14/15 FY15/16
Intensive Outpatient Face-to-Face Visit $56.44 $58.30 $80.78 $81.22
Treatment
Naltrexone Face-to-Face Visit
$19.06 19.06 NA
Treatment NA
Outpatient Drug Free Face-to Face Visit—
Individual er erson $67.38 66.93 $105.32 105.90
Face-to-Face Visit— $26.23 $27.14 $63.33 $52.11
Group per person
Perinatal Residential Daily— Residential NA NA $99.43 $99.97
Da
Page 20 of 20
Exhibit B,Attachment I A2
Exhibit B,Attachment 1 A2-Funding for Fiscal Year 2014-15 through FY 2016-17 Version: A02
Date: 7 1/2014
]County;Fresno lContract Number:14-90056
2014-15 Funding 2016-17 Funding
Fiscal Year 2014.15 Amount Fiscal Year 2015-16 2015-16 Funding Amount Fiscal Year 2016.17 Amount
_ A01 Original A02 Original
State General Funds 7 1 14 t 6 30 IS State General Funds 7 1 15 to 6 30 16 State General Funds 7 i 16 to 6 30 17
Drug Medi-Cal SGF 680,478 Drug Medi-Cal SGF 680,478 1120952 Drug Medi-Cal SGF 690,478
TOTAL 680,478 TOTAL "*An 1 120 952 TOTAL 680,478
SAPT Block Grant-FFY 2015 Award 10 i 14 to 6 30 16 SAPT-Block-Grant-FFY 2016 Award 10 1 15 to 6 30 17 SAPT Block Grant-FFY Z027 Award 12 1 16 to 30 18
-Discretionary 2,729,921 -Discretionary 2,729,924 2 730 66 -Discretionary 2,729,921
-Adolescent/Youth 368,427 Adolescent/Youth a68,427 368069 -Adolescent/Youth 368,427
-Prevention Set-Aside 974,072 -Prevention Set-Aside 974,072 974,072 -Prevention Set-Aside 974,072
-Friday Night Live Club Live 30,000 -Friday Night Live/Club Live 30,000 30,000 -Friday Night Live/Club Live 30,000
-HIV Set Aside 221,567 -HIV Set Aside 223,667 227 586 -HIV Set Aside 221,567
-Perintal 232,524 -Perintal 232,524 232437 -Perntal 232,524
TOTAL 4,556,511 TOTAL 4,666su 4 562 530 TOTAL 4,556,511
Druir Medl-Cal Federal Share 7 1 14 to 6 30 IS 2Drue Medl-Cal Federal Share 7 1 15 to 6 30 16 Drug Medl-Cal Federal Share 7 1 16 to 6 30 17
-Non Perinatal Federal Share 9,458,387 -Non Perinatal Federal Share 2 796,od2 458 387 •Non Perinatal Federal Share 8,796,033
-Perinatal Federal Share 79,674 -Perinatal Federal Share 79,6741 79,674 -Perinatal Federal Share 79,674
TOTAL 9,538,061 TOTAL a au:7as 9 538 061 TOTAL 8,875,707
GRAND TOTAL 14,775,050 GRANDTOTALI 15 221 543 GRAND TOTAL 14,112,696
ORIGINAL THREE-YEAR TOTAL 42, 387988
A01THREE-YEAR TOTAL 43�99j44�
A02 THREE-YEAR TOTAL 44109 289
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