HomeMy WebLinkAboutAgreement A-16-295 with each Provider listed in Exhibit A List ofProviders.pdf Agreement No. 16-295
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 7th day of June 2016,by and between the
3 COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter referred to as
4 "COUNTY", and each Provider listed in Exhibit A,"List of Providers," attached hereto and by this
5 reference incorporated herein, collectively hereinafter referred to as "PROVIDERS", and such additional
6 PROVIDERS as may, from time to time during the term of this Agreement,be added by COUNTY.
7 Reference in this Agreement to "party"or"parties"shall be understood to refer to COUNTY and each
8 PROVIDER,unless otherwise specified.
9 WITNESSETH:
10 WHEREAS, COUNTY,through its Department of Behavioral Health(DBH), Contracts Division—
11 Substance Use Disorder(SUD) Services,has determined there is a need for certain Fresno County residents
12 to receive long-term residential alcohol and SUD treatment services; and
13 WHEREAS, COUNTY is authorized to contract with privately operated agencies for the
14 provision of alcohol and SUD treatment services, pursuant to Title 9, Division 4 of the California Code
15 of Regulations and Division 10.5 (commencing with Section 11750) of the California Health and Safety
16 Code; and
17 WHEREAS, PROVIDER is willing and able to provide services required by COUNTY,pursuant
18 to the terms and conditions of this Agreement.
19 NOW, THEREFORE, in consideration of their mutual covenants and conditions,the parties
20 hereto agree as follows:
21 1. SERVICES
22 A. PROVIDER shall perform all services and fulfill all responsibilities for the provision
23 of long-term residential and residential perinatal SUD treatment services for adults, as identified in this
24 Agreement, COUNTY's Request for Statement of Qualifications (RFSQ) #952-5424 dated January 14,
25 2016;Addendum No. One(1)dated January 20, 2016; and Addendum No. Two (2) dated February 10,
26 2016,hereinafter collectively referred to as COUNTY Revised RFSQ #952-5424, and PROVIDER's
27 response to said RFSQ #952-5424, dated February 22,2016, all incorporated herein by reference and made
28 part of this Agreement.
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I B. In the event of any inconsistency among these documents,the inconsistency shall be
2 resolved by giving precedence in the following order of priority: 1)to this Agreement, including any
3 Exhibits; 2)to the Revised RFSQ No. 952-5424, and; 3)to the Response to the Revised RFSQ. A copy of
4 COUNTY's Revised RFSQ#952-5424, and PROVIDER's response shall be retained and made available
5 during the term of this Agreement by COUNTY's Purchasing Division.
6 C. PROVIDER(S) serving clients referred by Drug Court or Probation shall carry out
7 the following:
8 1. Provide transportation to the treatment facility immediately upon request;
9 2. Accommodate Probation staff visits following the client's enrollment to
10 residential services;
11 3. Comply with reporting requirements of Court or Probation relating to client
12 status change and treatment progress; and,
13 4. Conduct client intake within forty-eight(48)hours of referral or contact.
14 D. PROVIDER shall maintain, at PROVIDER's cost, a computer system compatible
15 with COUNTY's Substance Abuse Information System(SAIS) for the provision of submitting information
16 required under the terms and conditions of this Agreement. PROVIDER shall complete required SAIS data
17 entry as follows: Registrations and admissions must be complete within five(5)business days of program
18 completion or dismissal.
19 E. PROVIDER's administrative level agency representative,who is duly authorized to
20 act on behalf of the PROVIDER, must attend regularly scheduled monthly Behavioral Health Board
21 Substance Use Disorder Committee meetings and regularly scheduled PROVIDER meetings.
22 F. PROVIDER's staff may also be required to attend meetings and trainings on an as-
23 needed basis, which may include but are not limited to SUD treatment and fiscal trainings provided by
24 the State of California.
25 2. TERM
26 The term of this Agreement shall be for a period of three (3) years, commencing on the 1st
27 day of July, 2016 through and including the 30th day of June, 2019. This Agreement may be extended for
28 two (2) consecutive twelve (12) month periods upon written approval of both parties no later than thirty
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1 (30)days prior to the first day of the next twelve(12)month extension period. The DBH Director,or her
2 designee, is authorized to execute such written approval on behalf of COUNTY based on PROVIDER'S
3 satisfactory performance.
4 3. TERMINATION
5 A. NON-ALLOCATION OF FUNDS—The terms of this Agreement, and the services
6 to be provided thereunder, are contingent on the approval of funds by the appropriating government agency.
7 Should sufficient funds not be allocated,the services provided may be modified, or this Agreement
8 terminated, at any time by giving the PROVIDER thirty(30)days advance written notice.
9 B. BREACH OF CONTRACT—COUNTY may immediately suspend or terminate this
10 Agreement in whole or in part,where in the determination of COUNTY there is:
11 1. An illegal or improper use of funds;
12 2. A failure to comply with any term of this Agreement;
13 3. A substantially incorrect or incomplete report submitted to COUNTY;
14 4. Improperly performed service.
15 In no event shall any payment by COUNTY constitute a waiver by COUNTY of any breach
16 of this Agreement or any default which may then exist on the part of the PROVIDER. Neither shall such
17 payment impair or prejudice any remedy available to COUNTY with respect to the breach or default.
18 COUNTY shall have the right to demand of the PROVIDER the repayment to COUNTY of any funds
19 disbursed to the PROVIDER under this Agreement,which in the judgment of COUNTY were not
20 expended in accordance with the terms of this Agreement. The PROVIDER shall promptly refund any
21 such funds upon demand.
22 C. WITHOUT CAUSE—Under circumstances other than those set forth above,this
23 Agreement may be terminated by COUNTY or any one (1)PROVIDER upon giving thirty(30) days
24 advance written notice.
25 4. COMPENSATION
26 A. COMPENSATION—For claims submitted for services rendered under this
27 Agreement, COUNTY agrees to pay PROVIDER(S) and PROVIDER(S) agrees to receive
28 compensation for costs associated with the delivery of Residential and/or Residential Perinatal services
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I provided by PROVIDER in accordance with the rate per unit of service comprised of cost per bed slot
2 and treatment rates, maximum annual compensation and number of allocated bed slots as identified in
3 Exhibit B, "Rates," attached hereto and by this reference incorporated herein, contingent upon
4 confirmation of funding. The daily allocated bed average is defined as the number of beds allocated to
5 this Agreement on a daily basis or is also defined as the number of participants that can be served per
6 day. In no event shall the total compensation for actual service performed under this Agreement be in
7 excess of Three Million Eight Hundred Fifty Thousand and No/100 Dollars ($3,850,000) for each
8 twelve (12) month period from date of execution through June 30, 2021, as set forth in the rate table
9 identified as Exhibit B. Annual reimbursement per bed per day shall not exceed the daily rates
10 identified in Exhibit B regardless of the total maximum compensation of this Agreement. Annual
11 increases of no more than 1.5%of the previous year's total budget will be reimbursed to PROVIDER(S)
12 who requested this increase and provided justification in their budget narrative. It is understood that all
13 expenses incidental to PROVIDER's performance of services under this Agreement shall be borne by
14 PROVIDER.
15 B. The contract maximum amount as identified in this Agreement may be reduced
16 based upon State, Federal, and local funding availability. In the event of such action, the COUNTY's
17 DBH Director or her designee shall notify the PROVIDER in writing of the reduction in the maximum
18 amount within thirty (30) days.
19 In the event that funding for these services is delayed by the State Controller,
20 COUNTY may defer payment to PROVIDER. The amount of the deferred payment shall not exceed the
21 amount of funding delayed by the State Controller to the COUNTY. The deferral by COUNTY shall
22 not exceed the period of time of the State Controller's delay of payment to COUNTY plus forty-five
23 (45) days. In addition, if the State of California does not allocate funding for services described in the
24 terms and conditions of this Agreement, DBH-SUD Services shall not be obligated to reimburse
25 PROVIDER for services performed.
26 C. PAYMENTS —PROVIDER may not exceed the above stated maximum allocated
27 bed days for the department. PROVIDER shall complete the year end cost report in accordance to
28 Section Thirty-Seven(37), RECORDS, Subsection C of this Agreement at the end of the fiscal year to
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I reflect the actual cost and reimbursement for services provided. Regardless of the contract maximum,
2 PROVIDER will be reimbursed only for costs up to the negotiated bed day rate herein. Within forty-
3 five (45) days of the reconciliation by COUNTY, PROVIDER shall make payment to COUNTY or
4 COUNTY shall reimburse PROVIDER as appropriate.
5 Payment by COUNTY shall be in arrears, based on PROVIDER's monthly
6 invoices submitted for services provided during the preceding month, within forty-five (45) days after
7 receipt and verification of PROVIDER's monthly invoices by COUNTY's DBH, Contracts Division—
8 SUD Services. If payment for services are denied or disallowed by State and subsequently resubmitted
9 to COUNTY by PROVIDER,payments will not be issued to PROVIDER until COUNTY has received
10 reimbursement from State for said services.
11 D. QUALITY ASSURANCE—For services rendered herein, PROVIDER shall
12 assure that an on-going quality assurance component is in place and is occurring. PROVIDER shall
13 assure that clinical records for each participant are of such detail and length that a review of said record
14 will verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates
15 that appropriate services were not provided, COUNTY reserves the right to withhold payment for the
16 applicable unit(s) of service.
17 E. COMPLIANCE—If PROVIDER should fail to comply with any provision of this
18 Agreement, COUNTY shall be relieved of its obligation for further compensation. PROVIDER's and
19 COUNTY's obligations under this section shall survive the termination of this Agreement with respect
20 to services provided during the term of this Agreement without regard to the cause of termination of this
21 Agreement.
22 F. PUBLIC INFORMATION—PROVIDER shall disclose its funding source in all
23 public information; however, this requirement of disclosure of funding source shall not be required in
24 spot radio or television advertising.
25 G. LOBBYING ACTIVITY—PROVIDER shall not directly or indirectly use any
26 of the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
27 support or defeat legislation pending before the Congress of the United States or the Legislature of the
28 State of California.
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I H. POLITICAL ACTIVITY—PROVIDER shall not directly or indirectly use any
2 of the funds under this Agreement for any political activity or to further the election or defeat of any
3 candidate for public office.
4 I. FUNDING SOURCES —It shall be the obligation of PROVIDER to determine
5 and claim all revenue possible from private pay sources and third party payers. PROVIDER shall not
6 use any funds under this Agreement for services covered by Drug Medi-Cal or other health insurance
7 for eligible beneficiaries. PROVIDER shall claim all Drug Medi-Cal covered services for eligible
8 beneficiaries through the Drug Medi-Cal claiming process. COUNTY will only reimburse PROVIDER
9 for services rendered that are not covered by Drug Medi-Cal, other insurance or other revenue sources.
10 PROVIDER shall not use any funds under this Agreement to the extent that a
11 participant is eligible for Medi-Cal, insurance or other revenue reimbursement for services rendered.
12 Any revenues generated by PROVIDER in excess of the amounts budgeted in this
13 Agreement may be utilized to expand/enhance the services during COUNTY's fiscal years in which
14 revenues are collected or in the following COUNTY fiscal year. Additional revenues will be considered
15 separate and distinct from COUNTY's payment to PROVIDER. The manner and means of service
16 expansion/enhancement shall be subject to the prior written approval of COUNTY's DBH Director or
17 her designee. PROVIDER shall disclose all sources of revenue to COUNTY. Under no circumstances
18 will COUNTY funded staff time be used for fund-raising purposes.
19 J. COST OF LIVING ADJUSTMENT—PROVIDER shall not utilize any funds
20 provided under this Agreement for cost of living adjustments to PROVIDER's employee compensation
21 in excess of what is approved in the budget submitted with the RFSQ response.
22 5. INVOICING
23 PROVIDER shall invoice COUNTY by the twentieth(20th)of each month for actual services
24 rendered in the previous month in accordance with the established rates in Exhibit B, attached hereto and
25 incorporated by this reference.
26 Invoices shall be submitted via e-mail to the assigned staff analyst and to
27 SASgco.fresno.ca.us.
28 If an invoice is incorrect or is otherwise not in proper form or substance, COUNTY's DBH
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I Director or her designee shall have the right to withhold payment as to only that portion of the invoice that
2 is incorrect or improper after five(5)days prior notice to PROVIDER. PROVIDER agrees to continue to
3 provide services for a period of ninety(90)days after notification of an incorrect or improper invoice. If
4 after said ninety(90) day period said invoice(s)is still not corrected to COUNTY'S DBH Director's or her
5 designee's satisfaction, COUNTY'S DBH,Director or her designee may elect to terminate this Agreement,
6 pursuant to the termination provisions stated in Section Three(3), TERMINATION of this Agreement. In
7 addition,PROVIDER shall submit all invoices to COUNTY's DBH Director or her designee for services
8 provided within ninety(90)days after each twelve(12)month period expires or this Agreement is
9 terminated. If invoices are not submitted within ninety(90)days after each twelve(12)month period
10 expires or this Agreement is terminated, COUNTY's DBH Director or her designee shall have the right to
11 deny payment on such invoices.
12 6. PROHIBITION ON PUBLICITY
13 None of the funds,materials,property or services provided directly or indirectly under this
14 Agreement shall be used for PROVIDER's advertising, fundraising, or publicity(i.e.,purchasing of
15 tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the above,
16 publicity of the services described in Section One(1) of this Agreement shall be allowed as necessary to
17 raise public awareness about the availability of such specific services when approved in advance by the
18 DBH Director or her designee, and at a cost to be provided for such items as written/printed materials,the
19 use of media(i.e.,radio,television,newspapers) and any other related expense(s).
20 7. INDEPENDENT CONTRACTOR
21 In performance of the work, duties and obligations assumed by PROVIDER under this
22 Agreement, it is mutually understood and agreed that PROVIDER, including any and all of the
23 PROVIDER's officers, agents, and employees will at all times be acting and performing as an independent
24 contractor, and shall act in an independent capacity and not as an officer, agent, servant, employee,joint
25 venturer,partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right to control or
26 supervise or direct the manner or method by which PROVIDER shall perform its work and function.
27 However, COUNTY shall retain the right to administer this Agreement so as to verify that PROVIDER is
28 performing its obligations in accordance with the terms and conditions thereof.
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I PROVIDER and COUNTY shall comply with all applicable provisions of law and the rules
2 and regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
3 Because of its status as an independent contractor,PROVIDER shall have absolutely no right
4 to employment rights and benefits available to COUNTY employees. PROVIDER shall be solely liable
5 and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
6 addition,PROVIDER shall be solely responsible and save COUNTY harmless from all matters relating to
7 payment of PROVIDER's employees, including compliance with Social Security withholding and all other
8 regulations governing such matters. It is acknowledged that during the term of this Agreement,
9 PROVIDER may be providing services to others unrelated to the COUNTY or to this Agreement.
10 8. CONFLICT OF INTEREST
11 No officer, agent,or employee of COUNTY who exercises any function or responsibility for
12 planning and carrying out the services provided under this Agreement shall have any direct or indirect
13 personal financial interest in this Agreement. PROVIDER shall comply with all Federal, State of
14 California, and local conflict of interest laws, statutes, and regulations,which shall be applicable to all
15 parties and beneficiaries under this Agreement and any officer, agent, or employee of COUNTY.
16 9. DISCLOSURE OF SELF-DEALING TRANSACTIONS
17 This provision is only applicable if the PROVIDER is operating as a corporation(a for-profit
18 or non-profit corporation)or if during the term of this agreement,the PROVIDER changes its status to
19 operate as a corporation.
20 Members of the PROVIDER's Board of Directors shall disclose any self-dealing
21 transactions that they are a party to while PROVIDER is providing goods or performing services under this
22 Agreement. A self-dealing transaction shall mean a transaction to which the PROVIDER is a party and in
23 which one or more of its directors has a material financial interest. Members of the Board of Directors shall
24 disclose any self-dealing transactions that they are a party to by completing and signing a Self-Dealing
25 Transaction Disclosure Form (Exhibit C) and submitting it to the COUNTY prior to commencing with the
26 self-dealing transaction or immediately thereafter.
27
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1 10. PROPERTY OF COUNTY
2 A. PROVIDER shall submit purchase invoices for the purchase of any fixed assets with
3 their monthly invoices. All purchases over Five Thousand and No/100 Dollars ($5,000.00), and certain
4 purchases under Five Thousand and No/100 Dollars($5,000.00) such as fans, calculators, cameras,VCRs,
5 DVDs and other sensitive items as determined by COUNTY's DBH Director, or her designee, made during
6 the life of this Agreement shall be identified as assets that can be inventoried and maintained in
7 COUNTY's DBH Asset Inventory System. These assets shall be retained by COUNTY, as COUNTY
8 property, in the event this Agreement is terminated or upon expiration of this Agreement. PROVIDER
9 agrees to participate in an annual inventory of all COUNTY fixed assets and shall be physically present
10 when fixed assets are returned to COUNTY's possession at the termination or expiration of this Agreement.
11 PROVIDER is responsible for returning to COUNTY all COUNTY owned fixed assets, or the monetary
12 value of said fixed assets if unable to produce the fixed assets at the expiration or termination of this
13 Agreement.
14 B. The purchase of any equipment by PROVIDER with funds provided hereunder
15 shall require the prior written approval of COUNTY's DBH Director or her designee, shall fulfill the
16 provisions of this Agreement as appropriate, and must be directly related to PROVIDER's services or
17 activity under the terms of this Agreement. COUNTY's DBH Director or her designee may refuse
18 reimbursement for any costs resulting from equipment purchased, which are incurred by PROVIDER, if
19 prior written approval has not been obtained from COUNTY.
20 C. The terms and conditions described in this Section are not applicable to the leasing
21 of vehicles by PROVIDER with the funds provided under this Agreement.
22 11. MODIFICATION
23 Any matters of this Agreement may be modified from time to time by the written consent of
24 all the parties without, in any way, affecting the remainder.
25 Notwithstanding the above, changes to Section 1, SERVICES, as needed to accommodate
26 changes in State and Federal Law relating to mental health treatment services may be made with the signed
27 written approval of COUNTY's DBH Director or designee and respective PROVIDER(S)through an
28
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I amendment approved by County Counsel and Auditor. Said changes shall not result in any change to the
2 maximum compensation amount payable by COUNTY to PROVIDER(S), as stated herein.
3 The COUNTY's DBH Director or her designee may modify the maximum amount to be
4 consistent with available State and Federal funding, as stated in Section Four(4) COMPENSATION in this
5 agreement. PROVIDER further understands that this Agreement is subject to any restrictions, limitations,
6 or enactments of all legislative bodies which affect the provisions,term or funding of this Agreement in any
7 manner.
8 12. NON-ASSIGNMENT
9 Neither party shall assign,transfer or sub-contract this Agreement nor their rights or duties
10 under this Agreement without the prior written consent of the other party.
11 13. HOLD HARMLESS
12 PROVIDER agrees to indemnify, save,hold harmless, and at COUNTY'S request,defend
13 the COUNTY,its officers, agents, and employees from any and all costs and expenses, damages, liabilities,
14 claims, and losses occurring or resulting to COUNTY in connection with the performance, or failure to
15 perform,by PROVIDER, its officers, agents, or employees under this Agreement, and from any and all
16 costs and expenses,damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
17 corporation who may be injured or damaged by the performance, or failure to perform, of PROVIDER, its
18 officers, agents,or employees under this Agreement.
19 PROVIDER agrees to indemnify COUNTY for Federal, State of California audit
20 exceptions resulting from noncompliance herein on the part of the PROVIDER.
21 14. INSURANCE
22 Without limiting the COUNTY's right to obtain indemnification from PROVIDER or any
23 third parties,PROVIDER, at its sole expense, shall maintain in full force and effect,the following
24 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
25 arrangement or Joint Powers Agreement(JPA)throughout the term of the Agreement:
26 A. COMMERCIAL GENERAL LIABILITY
27 Commercial General Liability Insurance with limits of not less than One Million
28 Dollars($1,000,000.00)per occurrence and an annual aggregate of Two Million Dollars ($2,000,000.00).
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I This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
2 completed operations,products liability, contractual liability, Explosion-Collapse-Underground, fire legal
3 liability or any other liability insurance deemed necessary because of the nature of this contract. In addition
4 to the Commercial General Liability coverage, PROVIDER shall provide an insurance policy for sexual
5 abuse and molestation liability with these same limits.
6 B. AUTOMOBILE LIABILITY
7 Comprehensive Automobile Liability Insurance with limits for bodily injury of not
8 less than Five Hundred Thousand Dollars($500,000.00)per person, One Million Dollars ($1,000,000.00)
9 per accident and for property damages of not less than One Hundred Thousand Dollars ($100,000.00), or
10 such coverage with a combined single limit of One Million Dollars($1,000,000.00). Coverage should
11 include owned and non-owned vehicles used in connection with this Agreement.
12 C. PROFESSIONAL LIABILITY
13 If PROVIDER employs licensed professional staff, (e.g.,Ph.D., R.N., L.C.S.W.,L
14 M.F.T.)in providing services,Professional Liability Insurance with limits of not less than One Million
15 Dollars($1,000,000.00)per occurrence, Three Million Dollars($3,000,000.00) annual aggregate.
16 PROVIDER agrees that it shall maintain, at its sole expense, in full force and effect for a period of three(3)
17 years following the termination of this Agreement, one or more policies of professional liability insurance
18 with limits of coverage as specified herein.
19 D. WORKER'S COMPENSATION
20 A policy of Worker's Compensation insurance as may be required by the California
21 Labor Code.
22 PROVIDER shall obtain endorsements to the Commercial General Liability insurance
23 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
24 additional insured,but only insofar as the operations under this Agreement are concerned. Such coverage
25 for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
26 maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
27 insurance provided under PROVIDER's policies herein. This insurance shall not be cancelled or changed
28 without a minimum of thirty(30) days advance written notice given to COUNTY.
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I Within thirty(30) days from the date PROVIDER signs this Agreement,PROVIDER shall
2 provide certificates of insurance and endorsements as stated above for all of the foregoing policies, as
3 required herein,to the County of Fresno,Department of Behavioral Health, Contracts Division- Substance
4 Use Disorder Services at 3133 N. Millbrook Ave., Fresno, California, 93703,Attention: SUD Services
5 Staff Analyst, stating that such insurance coverages have been obtained and are in full force; that the
6 County of Fresno, its officers, agents and employees will not be responsible for any premiums on the
7 policies;that such Commercial General Liability insurance names the County of Fresno,its officers, agents
8 and employees, individually and collectively, as additional insured,but only insofar as the operations under
9 this Agreement are concerned; that such coverage for additional insured shall apply as primary insurance
10 and any other insurance, or self-insurance,maintained by COUNTY, its officers, agents and employees,
11 shall be excess only and not contributing with insurance provided under PROVIDER's policies herein; and
12 that this insurance shall not be cancelled or changed without a minimum of thirty(30)days advance,
13 written notice given to COUNTY.
14 In the event any PROVIDER fails to keep in effect at all times insurance coverage as herein
15 provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
16 with PROVIDER upon the occurrence of such event.
17 All policies shall be with admitted insurers licensed to do business in the State of California.
18 Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
19 better.
20 15. SUBCONTRACTS
21 PROVIDER shall be required to assume full responsibility for all services and activities
22 covered by this Agreement,whether or not PROVIDER is providing services directly. Further,
23 PROVIDER shall be the sole point of contact with regard to contractual matters, including payment of any
24 and all charges resulting from this Agreement.
25 If PROVIDER should propose to subcontract with one or more third parties to carry out a
26 portion of services covered by this Agreement, any such subcontract shall be in writing and approved as to
27 form and content by COUNTY's DBH Director or her designee prior to execution and implementation.
28 COUNTY's DBH Director or her designee shall have the right to reject any such proposed subcontract.
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I Any such subcontract together with all activities by or caused by PROVIDER shall not require
2 compensation greater than the total budget contained herein. An executed copy of any such subcontract
3 shall be received by COUNTY before any implementation and shall be retained by COUNTY.
4 PROVIDER shall be responsible to COUNTY for the proper performance of any subcontract. Any
5 subcontractor shall be subject to the same terms and conditions that PROVIDER is subject to under this
6 Agreement.
7 It is expressly recognized that PROVIDER cannot engage in the practice of medicine. If any
8 medical services are to be provided in connection with the services under this Agreement, such medical
9 services shall be performed by an independent contract physician. In this instance,the requirements of the
10 Confidential Medical Information Act(Civil Code 56 et seq.) shall be met.
11 If PROVIDER hires an independent contract physician,PROVIDER shall require and
12 ensure that such independent contract physician carries Professional Liability(Medical Malpractice)
13 Insurance,with limits of not less than One Million Dollars ($1,000,000.00)per occurrence, Three Million
14 Dollars($3,000,000.00) annual aggregate.
15 16. NO THIRD PARTY BENEFICIARIES
16 It is understood and agreed by and between the parties that the services provided by
17 PROVIDER for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
18 Agreement is intended to confer on any person other than the parties hereto any right under or by reason of
19 this Agreement.
20 17. REPORTS—SUBSTANCE USE DISORDER SERVICES
21 PROVIDER(S) shall submit all information and data required by State, including, but not
22 limited to the following:
23 A. Drug and Alcohol Treatment Access Report (DATAR) and Provider Waiting List
24 Record (WLR) in an electronic format provided by the State and due no later than five (5) days after the
25 preceding month; and
26 B. CalOMS Treatment — Submit CalOMS treatment admission, discharge, annual
27 update, and "provider activity report" record in an electronic format through COUNTY's SAIS system,
28 and on a schedule as determined by the COUNTY which complies with State requirements for data
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I content, data quality, reporting frequency, reporting deadlines, and report method and due no later than
2 five (5) days after the preceding month. All CalOMS admissions, discharges, and annual updates must
3 be entered into the COUNTY's CalOMS system within twenty-four(24) hours of occurrence; and
4 C. PROVIDER(S) shall submit to COUNTY monthly fiscal and all program reports,
5 including Provider Waiting List Record (WLR), within twenty(20) days of the end of each month.
6 D. Americans with Disabilities (ADA)—Annually,upon request by DBH,
7 PROVIDER(S) shall complete a system-wide accessibility survey in a format determined by DBH for
8 each service location and modality and shall submit an ADA Accessibility Certification and Self-
9 Assessment, including an Implementation Plan, for each service location.
10 E. Cost Reports—On an annual basis for each fiscal year ending June 30th
11 PROVIDER(S) shall submit a complete and accurate detailed cost report(s). Cost reports must be
12 submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the due
13 date. Submittal must also include any requested support documents such as general ledgers. All reports
14 submitted by PROVIDER(S) to COUNTY must be typewritten. COUNTY will issue instructions for
15 completion and submittal of the annual cost report, including the relevant cost report template(s) and
16 due dates within forty-five (45) days of each fiscal year end. All cost reports must be prepared in
17 accordance with Generally Accepted Accounting Principles. Unallowable costs such as lobbying or
18 political donations must be deducted from the cost report and all invoices. If the PROVIDER(S) does
19 not submit the cost report by the due date, including any extension period granted by the COUNTY, the
20 COUNTY may withhold payment of pending invoices until the cost report(s)has been submitted and
21 clears COUNTY desk audit for completeness and accuracy.
22 1. DMC -A DMC cost report must be submitted in a format prescribed by the
23 DHCS for the purposes of Short Doyle Medi-Cal reimbursement of total costs for all programs.
24 PROVIDER(S) shall report costs under their approved legal entity number established during the DMC
25 certification process. Total units of service reported on the cost report will be compared to the units of
26 services entered by PROVIDER(S) into COUNTY's data system. PROVIDER(S) will be required to
27 correct discrepancies and resubmit to COUNTY prior to COUNTY's final acceptance of the cost report.
28 2. OTHER FUNDING SOURCES—PROVIDER(S) will be required to
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I submit a cost report on a form(s) approved and provided by the COUNTY to reflect actual costs and
2 reimbursement for services provided through funding sources other than DMC. Contracts that include a
3 negotiated rate per unit of service will be reimbursed only for the costs of approved units of service up
4 to the negotiated unit of service rate approved in the Agreement, regardless of the contract maximum. If
5 the cost report indicates an amount due to COUNTY, PROVIDER(S) shall submit payment with the
6 report. If an amount is due to PROVIDER(S) COUNTY shall reimburse PROVIDER within forty-five
7 (45) days of receiving and accepting the year-end cost report.
8 3. MULTIPLE FUNDING SOURCES —PROVIDER(S)who has multiple
9 agreements for the same services provided at the same location where at least one of the Agreements is
10 funded through DMC and the other funding is other federal or county realignment funding will be
11 required to complete DMC cost reports and COUNTY approved cost reports. Such Agreements will be
12 settled for actual costs in accordance with Medicaid reimbursement requirements as specified in Title
13 XIX or Title XXI of the Social Security Act; Title 22, and the State's Medicaid Plan.
14 During the term of this Agreement and thereafter, COUNTY and PROVIDER(S) agree to
15 settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit settlement
16 findings. DHCS audit process is approximately eighteen(18) to thirty-six (36) months following the
17 close of the State fiscal year. COUNTY may choose to appeal DHCS settlement results and therefore
18 reserves the right to defer payback settlement with PROVIDER(S)until resolution of the appeal.
19 In the event that PROVIDER(S) fails to provide such reports or other information required
20 hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments until there
21 is compliance. In addition,the PROVIDER shall provide written notification and explanation to the
22 COUNTY within fifteen(15)days of any funds received from another source to conduct the same services
23 covered by this Agreement.
24 18. EVALUATION—MONITORING
25 OUTCOMES—COUNTY's DBH Director, or her designee, and DHCS or their designees
26 shall monitor and evaluate the performance of PROVIDER under this Agreement to determine to the best
27 possible degree the success or failure of the services provided under this Agreement. At the discretion of
28 the COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and monitor
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I the performance of the PROVIDER. PROVIDER shall participate in the evaluation of the program as
2 needed, at the discretion of COUNTY.
3 COUNTY shall recapture from PROVIDER the value of any services or other expenditures
4 determined to be ineligible based on the COUNTY or State monitoring results. At the discretion of the
5 COUNTY,recoupment can be made through a future invoice reduction or reimbursement by the
6 PROVIDER.
7 PROVIDER shall participate in a program review of the program at least yearly or more
8 frequently, or as needed, at the discretion of COUNTY. The PROVIDER agrees to supply all information
9 requested by the COUNTY,DHCS, and/or the subcontractor during the program evaluation,monitoring,
10 and/or review.
11 19. DATA SECURITY
12 For the purpose of preventing the potential loss,misappropriation or inadvertent access,
13 viewing,use or disclosure of COUNTY data including sensitive or personal client information; abuse of
14 COUNTY resources; and/or disruption to COUNTY operations,individuals and/or agencies that enter into
15 a contractual relationship with the COUNTY for the purpose of providing services under this Agreement
16 must employ adequate data security measures to protect the confidential information provided to
17 PROVIDER by the COUNTY, including but not limited to the following:
18 A. PROVIDER-OWNED MOBILE,WIRELESS, OR HANDHELD DEVICES
19 PROVIDER may not connect to COUNTY networks via personally-owned mobile,
20 wireless or handheld devices,unless the following conditions are met:
21 1. PROVIDER has received authorization by COUNTY for telecommuting
22 purposes;
23 2. Current virus protection software is in place;
24 3. Mobile device has the remote wipe feature enabled; and
25 4. A secure connection is used.
26 B. PROVIDER-OWNED COMPUTERS OR COMPUTER PERIPHERALS
27 PROVIDER may not bring PROVIDER-owned computers or computer peripherals
28 into the COUNTY for use without prior authorization from the COUNTY's Chief Information Officer,
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I and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
2 transferred, data must be stored on a secure server approved by the COUNTY and transferred by means of
3 a Virtual Private Network(VPN) connection,or another type of secure connection. Said data must be
4 encrypted.
5 C. COUNTY-OWNED COMPUTER EQUIPMENT
6 PROVIDER or anyone having an employment relationship with the COUNTY may
7 not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
8 authorization from the COUNTY's Chief Information Officer, and/or designee(s).
9 D. PROVIDER may not store COUNTY's private, confidential or sensitive data on any
10 hard-disk drive,portable storage device, or remote storage installation unless encrypted.
I I E. PROVIDER shall be responsible to employ strict controls to ensure the integrity and
12 security of COUNTY's confidential information and to prevent unauthorized access,viewing,use or
13 disclosure of data maintained in computer files,program documentation, data processing systems, data files
14 and data processing equipment which stores or processes COUNTY data internally and externally.
15 F. Confidential client information transmitted to one party by the other by means of
16 electronic transmissions must be encrypted according to Advanced Encryption Standards(AES) of 128 BIT
17 or higher. Additionally, a password or pass phrase must be utilized.
18 G. PROVIDER is responsible to immediately notify COUNTY of any violations,
19 breaches or potential breaches of security related to COUNTY's confidential information,data maintained
20 in computer files,program documentation, data processing systems,data files and data processing
21 equipment which stores or processes COUNTY data internally or externally.
22 H. COUNTY shall provide oversight to PROVIDER's response to all incidents arising
23 from a possible breach of security related to COUNTY's confidential client information provided to
24 PROVIDER. PROVIDER will be responsible to issue any notification to affected individuals as required
25 by law or as deemed necessary by COUNTY in its sole discretion. PROVIDER will be responsible for all
26 costs incurred as a result of providing the required notification.
27
28 ///
1 20. PERINATAL SERVICES
2 PROVIDER shall comply with the requirements for "Perinatal Services Network
3 Guidelines 2014," at: hqp://www.dhcs.ca.gov/individuals/Pages/OWPS-SUD.aspx and by this
4 reference incorporated herein, and the State-County Contract between DHCS and the COUNTY until
5 such time new Perinatal Services Network Guidelines and the State-County Contract are updated and
6 adopted. No formal amendment of this contract is required for new guidelines to apply.
7 PROVIDER shall comply with federal and state mandates to provide alcohol and other
8 drug treatment services deemed medically necessary for Medi-Cal eligible: (1)pregnant and postpartum
9 women, and(2) youth under age 21 who are eligible under the Early and Periodic Screening,
10 Diagnostic, and Treatment (EPSDT) Program.
11 PROVIDER shall require that providers of perinatal DMC services are properly certified
12 to provide these services and comply with the requirements contained in Title 22, Section 51 341 .I,
13 Services for Pregnant and Postpartum Women and Title 9 commencing with section 10360.
14 21. INTERIM SERVICES
15 PROVIDER must adhere to the State-County Contract requirement to provide Interim
16 Services in the event that an individual must wait to be placed in treatment.
17 Interim Substance Abuse Services means services that are provided until an individual is
18 admitted to a substance abuse treatment program. The purposes of the services are to reduce the adverse
19 health effects of such abuse,promote the health of the individual, and reduce the risk of transmission of
20 disease. At a minimum, interim services include counseling and education about HIV and tuberculosis
21 (TB), about the risks of needle-sharing,the risks of transmission to sexual partners and infants, and about
22 steps that can be taken to ensure the HIV and TB transmission does not occur, as well as referral for HIV or
23 TB treatment services if necessary. For pregnant women, interim services also include counseling on the
24 effects of alcohol and drug use on the fetus, as well as referral for prenatal care.
25 Records must indicate evidence that Interim Services have been provided and documentation
26 will be reviewed for compliance.
27
28 ///
1 22. REFERENCES TO LAWS AND RULES
2 In the event any law,regulation, or policy referred to in this Agreement is amended during
3 the term thereof,the parties hereto agree to comply with the amended provision as of the effective date of
4 such amendment.
5 23. STATE ALCOHOL AND DRUG REQUIREMENTS
6 A. INDEMNIFICATION
7 The PROVIDER agrees to indemnify, defend and save harmless the State, its
8 officers, agents and employees from any and all claims and losses accruing or resulting to any and all
9 contractors, subcontractors,materialmen, laborers and any other person, firm or corporation furnishing or
10 supplying work, services,materials or supplies in connection with the performance of this Agreement and
11 from any and all claims and losses accruing or resulting to any person, firm or corporation who may be
12 injured or damaged by the PROVIDER in the performance of this Agreement.
13 B. INDEPENDENT CONTRACTOR
14 The PROVIDER and the agents and employees of PROVIDER, in the performance
15 of this Agreement, shall act in an independent capacity and not as officers or employees or agents of State
16 of California.
17 C. CONTROL REQUIREMENTS
18 This Agreement is subject to all applicable Federal and State laws,regulations and
19 standards. PROVIDER(S) shall establish written procedures consistent with State-County Contract
20 requirements. The provisions of this Agreement are not intended to abrogate any provisions of law or
21 regulation existing or enacted during the term of this Agreement.
22 D. CONFIDENTIALITY
23 PROVIDER shall conform to and COUNTY shall monitor compliance with all State
24 of California and Federal statutes and regulations regarding confidentiality, including but not limited to
25 confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations; California
26 Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
27 California Health and Safety Code; Title 22, California Code of Regulations, section 51009; and Division
28 1, Part 2.6, Chapters 1-7 of the California Civil Code.
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I E. REVENUE COLLECTION POLICY
2 PROVIDER shall conform to all policies and procedures regarding revenue
3 collection issued by the State under the provisions of the Health and Safety Code,Division 10.5.
4 F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
5 PROVIDER agrees that all funds paid out by the State shall be used exclusively for
6 providing alcohol and/or drug program services, administrative costs, and allowable overhead.
7 G. ACCESS TO SERVICES
8 PROVIDER shall provide accessible and appropriate services in accordance with
9 Federal and State statutes and regulations to all eligible persons.
10 H. REPORTS
11 PROVIDER agrees to participate in surveys related to the performance of this
12 Agreement and expenditure of funds and agrees to provide any such information in a mutually agreed upon
13 format.
14 I. AUDITS
15 All State and Federal funds furnished to the PROVIDER(S)pursuant to this
16 Agreement along with related patient fees,third party payments, or other related revenues and funds
17 commingled with the foregoing funds are subject to audit by the State. The State may audit all alcohol and
18 drug program revenue and expenditures contained in this Agreement for the purpose of establishing the
19 basis for the subsequent year's negotiation.
20 J. RECORDS MAINTENANCE
21 1) PROVIDER shall maintain books,records, documents, and other evidence
22 necessary to monitor and audit this Agreement.
23 2) PROVIDER shall maintain adequate program and fiscal records relating to
24 individuals served under the terms of this Agreement, as required,to meet the needs of the State in
25 monitoring quality, quantity, fiscal accountability, and accessibility of services. Information on each
26 individual shall include,but not be limited to, admission records,patient and participant interviews and
27 progress notes, and records of service provided by various service locations, in sufficient detail to make
28 possible an evaluation of services provided and compliance with this Agreement.
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1 24. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
2 COUNTY and PROVIDER each consider and represent themselves as covered entities as
3 defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
4 191(HIPAA) and agree to use and disclose protected health information as required by law.
5 COUNTY and PROVIDER acknowledge that the exchange of protected health
6 information between them is only for treatment,payment, and health care operations.
7 COUNTY and PROVIDER intend to protect the privacy and provide for the security of
8 Protected Health Information (PHI)pursuant to the Agreement in compliance with HIPAA, the Health
9 Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
10 regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
11 Regulations) and other applicable laws.
12 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
13 PROVIDER to enter into a contract containing specific requirements prior to the disclosure of PHI, as
14 set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of
15 Federal Regulations (CFR).
16 25. CULTURAL COMPETENCY
17 As related to Cultural and Linguistic Competence, PROVIDER shall comply with the
18 following:
19 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part
20 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance from
21 discriminating against persons based on race, color,national origin, sex, disability or religion. This is
22 interpreted to mean that a limited English proficient(LEP) individual is entitled to equal access and
23 participation in federally funded programs through the provision of comprehensive and quality bilingual
24 services.
25 B. Policies and procedures for ensuring access and appropriate use of trained
26 interpreters and material translation services for all LEP consumers, including,but not limited to, assessing
27 the cultural and linguistic needs of its consumers,training of staff on the policies and procedures, and
28 monitoring its language assistance program. The PROVIDER's procedures must include ensuring
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I compliance of any sub-contracted providers with these requirements.
2 C. PROVIDER assurances that minors shall not be used as interpreters.
3 D. PROVIDER shall provide and pay for interpreting and translation services to persons
4 participating in PROVIDER's services who have limited or no English language proficiency, including
5 services to persons who are deaf or blind. Interpreter and translation services shall be provided as
6 necessary to allow such participants meaningful access to the programs, services and benefits provided by
7 PROVIDER. Interpreter and translation services, including translation of PROVIDER's "vital documents"
8 (those documents that contain information that is critical for accessing PROVIDER's services or are
9 required by law) shall be provided to participants at no cost to the participant. PROVIDER shall ensure
10 that any employees, agents, subcontractors, or partners who interpret or translate for a program participant,
11 or who directly communicate with a program participant in a language other than English, demonstrate
12 proficiency in the participant's language and can effectively communicate any specialized terms and
13 concepts peculiar to PROVIDER's services.
14 E. In compliance with the State mandated Culturally and Linguistically Appropriate
15 Services standards as published by the Office of Minority Health,PROVIDER must submit to COUNTY
16 for approval,within 60 days from date of contract execution,PROVIDER's plan to address all fifteen
17 national cultural competency standards as set forth in the"National Standards on Culturally and
18 Linguistically Appropriate Services"(CLAS), attached hereto as Exhibit D, and incorporated herein by this
19 reference. County's annual on-site review of PROVIDER shall include collection of documentation to
20 ensure all national standards are implemented. As the national competency standards are updated,
21 PROVIDER's plan must be updated accordingly.
22 F. PROVIDER shall complete and submit county-issued CLAS self-assessment
23 annually. PROVIDER shall update CLAS plan as necessary.
24 26. SINGLE AUDIT CLAUSE
25 A. If PROVIDER expends Seven Hundred Fifty Thousand Dollars($750,000.00) or
26 more in Federal and Federal flow-through monies,PROVIDER agrees to conduct an annual audit in
27 accordance with the requirements of the Single Audit Standards as set forth in 2CFR Part 200.
28 PROVIDER shall submit said audit and management letter to COUNTY. The audit must include a
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I statement of findings or a statement that there were no findings. If there were negative findings,
2 PROVIDER must include a corrective action plan signed by an authorized individual. PROVIDER agrees
3 to take action to correct any material non-compliance or weakness found as a result of such audit. Such
4 audit shall be delivered to COUNTY's Department of Behavioral Health, Business Office for review within
5 nine(9)months of the end of any fiscal year in which funds were expended and/or received for the
6 program. Failure to perform the requisite audit functions as required by this Agreement may result in
7 COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a public
8 accountant to perform said audit, or,may result in the inability of COUNTY to enter into future agreements
9 with PROVIDER. All audit costs related to this Agreement are the sole responsibility of PROVIDER.
10 B. A single audit report is not applicable if PROVIDER's Federal contracts do not
11 exceed the Seven Hundred Fifty Thousand Dollars($750,000.00) requirement or PROVIDER's only
12 funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
13 performed and a program audit report with management letter shall be submitted by PROVIDER to
14 COUNTY as a minimum requirement to attest to PROVIDER's solvency. Said audit report shall be
15 delivered to COUNTY's Department of Behavioral Health,Business Office for review,no later than nine
16 (9)months after the close of the fiscal year in which the funds supplied through this Agreement are
17 expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks or
18 contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement are
19 the sole responsibility of PROVIDER who agrees to take corrective action to eliminate any material
20 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
21 section shall be billed to the PROVIDER at COUNTY's cost, as determined by COUNTY's Auditor-
22 Controller/Treasurer-Tax Collector. To maintain the integrity of the audits,PROVIDER is required to
23 change its auditor(Certified Public Accountant)at least every three(3)years.
24 C. PROVIDER shall make available all records and accounts for inspection by
25 COUNTY,the State of California, if applicable,the Comptroller General of the United States,the Federal
26 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
27 least three(3)years following final payment under this Agreement or the closure of all other pending
28 matters,whichever is later.
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1 27. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
2 To the extent necessary to prevent disallowance of reimbursement under section 1861(v) (1)
3 (1)of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]),until the expiration of four(4)years
4 after the furnishing of services under this Agreement,PROVIDER shall make available,upon written
5 request of the Secretary of the United States Department of Health and Human Services, or upon request of
6 the Comptroller General of the United States General Accounting Office, or any of their duly authorized
7 representatives, a copy of this Agreement and such books, documents, and records as are necessary to
8 certify the nature and extent of the costs of these services provided by PROVIDER under this Agreement.
9 PROVIDER further agrees that in the event PROVIDER carries out any of its duties under this Agreement
10 through a subcontract,with a value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over
11 a twelve(12)month period,with a related organization, such Agreement shall contain a clause to the effect
12 that until the expiration of four(4)years after the furnishing of such services pursuant to such subcontract,
13 the related organizations shall make available,upon written request of the Secretary of the United States
14 Department of Health and Human Services, or upon request of the Comptroller General of the United
15 States General Accounting Office, or any of their duly authorized representatives, a copy of such
16 subcontract and such books, documents, and records of such organization as are necessary to verify the
17 nature and extent of such costs.
18 28. COMPLIANCE WITH LAWS AND POLICIES
19 PROVIDER shall comply with all applicable rules and regulations set forth in Titles 9 and
20 22 of the California Code of Regulations, and California Health and Safety Code section 11750 et seq.
21 PROVIDER shall comply with any other Federal and State laws or guidelines applicable to PROVIDER's
22 performance under this Agreement or any local ordinances,regulations, or policies applicable. Such
23 provisions include,but are not restricted to:
24 A. PROVIDERS who are subject to Fresno County Administrative Policy No. 5 agree
25 to limit administrative cost to a maximum of fifteen percent(15%)of the total program budget and
26 employee benefits costs to a maximum of twenty percent(20%) of total salaries as described in Section 4
27 COMPENSATION. Failure to conform to this provision will be grounds for contract termination at the
28 option of COUNTY.
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I B. PROVIDER shall furnish client records in accordance with the applicable Federal
2 and State regulations, and with the Standards for Alcohol and Drug Treatment Programs set forth by the
3 State Department of Alcohol and Drug Programs, including in such records a treatment plan for each client,
4 and evidence of each service rendered.
5 C. PROVIDER shall submit accurate, complete and timely claims and cost reports,
6 reporting only allowable costs.
7 D. PROVIDER shall comply with statistical reporting and program evaluation systems
8 as provided in State of California regulations and in this Agreement.
9 E. PROVIDER shall comply with requirements contained in the State-County Contract
10 with DHCS by this reference incorporated herein,until such time that a new State-County Contract is
11 established. Upon amendment of the State-County Contract,the terms of the amended Contract shall
12 automatically be incorporated into this Agreement.
13 29. FEDERAL CERTIFICATIONS
14 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
15 VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS
16 A. DBH and PROVIDER recognize that Federal assistance funds will be used under the
17 terms of this Agreement. For purposes of this section, DBH will be referred to as the "prospective
18 recipient".
19 B. This certification is required by the regulations implementing Executive Order
20 12549,Debarment and Suspension,29 CFR Part 98, section 98.510,Participants'responsibilities. The
21 regulations were published as Part VII of the May 26, 1988 Federal Register(pages 19160-19211).
22 1. The prospective recipient of Federal assistance funds certifies by entering this
23 Agreement,that neither it nor its principals are presently debarred, suspended,proposed for debarment,
24 declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department
25 or agency.
26 2. The prospective recipient of funds agrees by entering into this Agreement,
27 that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
28 suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction,unless
-25-
I authorized by the Federal department or agency with which this transaction originated.
2 3. Where the prospective recipient of Federal assistance funds is unable to
3 certify to any of the statements in this certification, such prospective participant shall attach an explanation
4 to this Agreement.
5 4. The prospective recipient shall provide immediate written notice to DBH if at
6 any time prospective recipient learns that its certification in this clause of this Agreement was erroneous
7 when submitted or has become erroneous by reason of changed circumstances.
8 5. The prospective recipient further agrees that by entering into this Agreement,
9 it will include a clause identical to this clause of this Agreement, and titled"Certification Regarding
10 Debarment, Suspension,Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions", in all
I I lower tier covered transactions and in all solicitations for lower tier covered transactions.
12 6. The certification in this clause of this Agreement is a material representation
13 of fact upon which reliance was placed by COUNTY when this transaction was entered into.
14 30. CLEAN AIR AND WATER
15 In the event funding under this Agreement exceeds one hundred thousand dollars
16 ($100,000.00),the PROVIDER must comply with all applicable standards, orders, or requirements issued
17 under section 306 of the Clean Air Act(42 U.S.C. 1857 (h)), section 506 of the Clean Water Act(33 U.S.C.
18 1368),Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR part 32).
19 31. SMOKING PROHIBITION REQUIREMENTS
20 PROVIDER shall comply with Public Law 103-227, also known as the Pro-Children Act of
21 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5,the California
22 Smoke-Free Workplace Law.
23 32. ENERGY EFFICIENCY
24 The PROVIDER must comply with the mandatory standards and policies relating to energy
25 efficiency which are contained in the state energy conservation plan issued in compliance with Energy
26 Policy and Conservation Act(Pub. L. 94 163).
27
28
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1 33. NON-DISCRIMINATION PROVISION
2 A. ELIGIBILITY FOR SERVICES—PROVIDER shall prepare,prominently post in its
3 facility, and make available to the DBH Director or her designee and to the public all eligibility
4 requirements to participate in the program funded under this Agreement. PROVIDER shall not unlawfully
5 discriminate in the provision of services because of race,religious creed, color,national origin, ancestry,
6 physical disability,mental disability,medical condition, genetic information,marital status, sex, gender,
7 gender identity, gender expression, age, sexual orientation, or military or veteran status as provided by State
8 of California and Federal law in accordance with Title VI of the Civil Rights Act of 1964(42 USC section
9 2000(d));Age Discrimination Act of 1975 (42 USC section 1681); Rehabilitation Act of 1973 (29 USC
10 section 794); Education Amendments of 1972 (20 USC section 1681);Americans with Disabilities Act of
11 1990(42 USC section 12132); Title 45, Code of Federal Regulations,Part 84;provisions of the Fair
12 Employment and Housing Act(California Government Code section 12900); and regulations promulgated
13 thereunder(Title 2, CCR, section 7285.0); Title 2, Division 3,Article 9.5 of the California Government
14 Code commencing with section 11135; and Title 9,Division 4, Chapter 6 of the California Code of
15 Regulations commencing with section 10800.
16 B. EQUAL OPPORTUNITY—PROVIDER shall comply with California Government
17 Code, section 12990 and California Code of Regulations, Title II,Division 4, Chapter 5, in matters related
18 to the development, implementation, and maintenance of a nondiscrimination program. PROVIDER shall
19 not discriminate against any employee or applicant for employment because race,religious creed, color,
20 national origin, ancestry,physical disability, mental disability, medical condition, genetic information,
21 marital status, sex, gender, gender identity, gender expression, age, sexual orientation,or military or veteran
22 status. Such practices include retirement,recruitment, advertising,hiring, layoff,termination,upgrading,
23 demotion,transfer,rates of pay or other forms of compensation,use of facilities, and other terms and
24 conditions of employment. PROVIDER agrees to post in conspicuous places,notices available to all
25 employees and applicants for employment setting forth the provisions of the Equal Opportunity Act(42
26 USC section 2000(e)) in conformance with Federal Executive Order No. 11246. PROVIDER agrees to
27 comply with the provisions of the Rehabilitation Act of 1973 (29 USC Section 794).
28 C. SUSPENSION OF COMPENSATION—If an allegation of discrimination occurs,
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I DBH may withhold all further funds,until PROVIDER can show by clear and convincing evidence to the
2 satisfaction of DBH that funds provided under this Agreement were not used in connection with the alleged
3 discrimination.
4 D. NEPOTISM—Except by consent of the DBH Director or her designee,no person
5 shall be employed by PROVIDER who is related by blood or marriage to or who is a member of the Board
6 of Directors or an officer of PROVIDER.
7 E. NEW FACILITIES AND DISABILITY ACCESS—New facilities shall be
8 wheelchair accessible and provide access to the disabled, consistent with Title 9, California Code of
9 Regulations, section 10820. If a new facility will be utilized, a plan ensuring accessibility to the disabled
10 must be developed. DBH shall assess,monitor, and document PROVIDER'S compliance with the
11 Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
12 recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without
13 regard to physical or mental disability and that PROVIDER has provided a facility accessible to the
14 physically disabled.
15 34. ASSURANCES
16 In entering into this Agreement,PROVIDER certifies that it is not currently excluded,
17 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs;that it has
18 not been convicted of a criminal offense related to the provision of health care items or services; nor has it
19 been reinstated to participation in the Federal Health Care Programs after a period of exclusion, suspension,
20 debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract,that PROVIDER is
21 ineligible on these grounds, COUNTY will remove PROVIDER from responsibility for, or involvement
22 with, COUNTY's business operations related to the Federal Health Care Programs and shall remove such
23 PROVIDER from any position in which PROVIDER's compensation, or the items or services rendered,
24 ordered or prescribed by PROVIDER may be paid in whole or part, directly or indirectly,by Federal
25 Health Care Programs or otherwise with Federal Funds at least until such time as PROVIDER is reinstated
26 into participation in the Federal Health Care Programs. Further the PROVIDER agrees to the Disclosure of
27 Criminal History and Civil Actions and Certification regarding debarment suspension and other
28 responsibility matters primary covered transactions; PROVIDER must sign an appropriate Certification
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I regarding debarment, suspension, and other responsibility matters, attached hereto as Exhibit E,
2 incorporated herein by reference and made part of this Agreement.
3 A. If COUNTY has notice that PROVIDER has been charged with a criminal offense
4 related to any Federal Health Care Program, or is proposed for exclusion during the term on any contract,
5 PROVIDER and COUNTY shall take all appropriate actions to ensure the accuracy of any claims
6 submitted to any Federal Health Care Program. At its discretion given such circumstances, COUNTY may
7 request that PROVIDER cease providing services until resolution of the charges or the proposed exclusion.
8 B. PROVIDER agrees that all potential new employees of PROVIDER or
9 subcontractors of PROVIDER who, in each case, are expected to perform professional services under this
10 Agreement,will be queried as to whether(1)they are now or ever have been excluded, suspended,
I I debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
12 convicted of a criminal offense related to the provision of health care items or services; and or(3)they have
13 been reinstated to participation in the Federal Health Care Programs after a period of exclusion, suspension,
14 debarment,or ineligibility.
15 1. In the event the potential employee or subcontractor informs PROVIDER
16 that he or she is excluded, suspended, debarred or otherwise ineligible, or has been convicted of a criminal
17 offense relating to the provision of health care services, and PROVIDER hires or engages such potential
18 employee or subcontractor,PROVIDER will ensure that said employee or subcontractor does no work,
19 either directly or indirectly relating to services provided to COUNTY.
20 2. Notwithstanding the above, COUNTY at its discretion may terminate this
21 Agreement in accordance with Section Three(3)TERMINATION of this Agreement, or require adequate
22 assurance(as defined by COUNTY)that no excluded, suspended or otherwise ineligible employee or
23 subcontractor of PROVIDER will perform work,either directly or indirectly,relating to services provided
24 to COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
25 by COUNTY to protect the interests of COUNTY consumers.
26 C. PROVIDER shall verify(by asking the applicable employees and subcontractors)
27 that all current employees and existing subcontractors who, in each case, are expected to perform
28 professional services under this Agreement(1)are not currently excluded, suspended, debarred, or
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I otherwise ineligible to participate in the Federal Health Care Programs; (2)have not been convicted of a
2 criminal offense related to the provision of health care items or services; and(3)have not been reinstated to
3 participation in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
4 ineligibility. In the event any existing employee or subcontractor informs PROVIDER that he or she is
5 excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs,or
6 has been convicted of a criminal offense relating to the provision of health care services,PROVIDER will
7 ensure that said employee or subcontractor does no work, either direct or indirect,relating to services
8 provided to COUNTY.
9 1. PROVIDER agrees to notify COUNTY immediately during the term of this
10 Agreement whenever PROVIDER learns that an employee or subcontractor who, in each case, is providing
11 professional services under this Agreement is excluded, suspended,debarred or otherwise ineligible to
12 participate in the Federal Health Care Programs, or is convicted of a criminal offense relating to the
13 provision of health care services.
14 2. Notwithstanding the above, COUNTY at its discretion may terminate this
15 Agreement in accordance with Section Three(3)TERMINATION of this Agreement, or require adequate
16 assurance(as defined by COUNTY)that no excluded, suspended or otherwise ineligible employee or
17 subcontractor of PROVIDER will perform work,either directly or indirectly,relating to services provided
18 to COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
19 by COUNTY to protect the interests of COUNTY consumers.
20 D. PROVIDER agrees to cooperate fully with any reasonable requests for information
21 from COUNTY which may be necessary to complete any internal or external audits relating to this
22 Agreement.
23 E. PROVIDER agrees to reimburse COUNTY for the entire cost of any penalty
24 imposed upon COUNTY by the Federal Government as a result of PROVIDER's violation of
25 PROVIDER's violation of the terms of this Agreement.
26 35. AUDITS AND INSPECTIONS
27 The PROVIDER shall at any time during business hours, and as often as the COUNTY may
28 deem necessary,make available to the COUNTY for examination all of its records and data with respect to
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I the matters covered by this Agreement. The PROVIDER shall,upon request by the COUNTY,permit the
2 COUNTY to audit and inspect all of such records and data necessary to ensure PROVIDER's compliance
3 with the terms of this Agreement.
4 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),PROVIDER
5 shall be subject to the examination and audit of the Auditor General for a period of three (3)years after final
6 payment under contract(Government Code Section 8546.7).
7 Notwithstanding the provisions stated in Section Two(2)TERM of this Agreement, it is
8 acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all audit
9 procedures and requirements as stated in this Agreement have been completed to the review and
10 satisfaction of COUNTY. PROVIDER shall bear all costs in connection with or resulting from any audit
11 and/or inspections including,but not limited to, actual costs incurred and the payment of any expenditures
12 disallowed by either COUNTY, State, or Federal governmental entities, including any assessed interest and
13 penalties.
14 36. RECORDS
15 A. RECORD ESTABLISHMENT AND MAINTENANCE—PROVIDER shall
16 establish and maintain records in accordance with State and Federal rules and regulations in addition to
17 those requirements prescribed by COUNTY with respect to all matters covered by this Agreement. Except
18 as otherwise authorized by COUNTY, PROVIDER shall retain all other records for a period of five(5)
19 years after receiving the final payment under this Agreement or the earlier termination of this Agreement,
20 or until State and/or Federal audit findings applicable to such services are resolved,whichever is later.
21 B. DOCUMENTATION—PROVIDER shall maintain adequate records in sufficient
22 detail to make possible an evaluation of services, and contain all the data necessary in reporting to the State
23 of California and/or Federal agency. All client records shall be maintained pursuant to applicable State of
24 California and Federal requirements concerning confidentiality.
25 C. REPORTS—PROVIDER shall submit to COUNTY monthly fiscal and all program
26 reports as further described in Section Seventeen(17)REPORTS—Substance Use Disorder Services.
27 PROVIDER shall submit a complete and accurate year-end cost report for each fiscal year affected by this
28 Agreement, following the end of each fiscal year affected by this Agreement. PROVIDER shall also
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I furnish to COUNTY such statements,records,reports, data, and information as COUNTY may request
2 pertaining to matters covered by this Agreement. All reports submitted by PROVIDER to COUNTY must
3 be typewritten.
4 D. SUSPENSION OF COMPENSATION—In the event that PROVIDER fail to
5 provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
6 payments until there is compliance.
7 E. DISALLOWANCES—Payments by COUNTY shall be in arrears, for services
8 provided during the preceding month,within forty-five(45)days after receipt,verification and approval of
9 PROVIDER invoices by COUNTY'S DBH-SUD Services. If payment for services are denied or
10 disallowed by State; and subsequently resubmitted to COUNTY by PROVIDER,the disallowed portion
11 will be withheld from the next reimbursement to the PROVIDER until COUNTY has received
12 reimbursement from State for said services.
13 F. CLIENT CONFIDENTIALITY—PROVIDER shall conform to and COUNTY shall
14 monitor compliance with all State and Federal statutes and regulations regarding confidentiality, including
15 but not limited to confidentiality of information requirements of 42 Code of Federal Regulations § 2.1 et
16 seq.,Welfare and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety Code §§ 11977 and
17 11812, Civil Code,Division 1,Part 2.6, and 22 California Code of Regulations § 51009.
18 37. NOTICES
19 The persons and their addresses having authority to give and receive notices under this
20 Agreement include the following:
21 COUNTY PROVIDER
22 Director,Fresno County See Exhibit A
Department of Behavioral Health
23 4441 East Kings Canyon
24 Fresno, CA 93702
25 Any and all notices between the COUNTY and the PROVIDER provided for or permitted
26 under this Agreement or by law shall be in writing and shall be deemed duly served when personally
27 delivered to one of the parties,or in lieu of such personal services,when deposited in the United States
28 Mail,postage prepaid, addressed to such party.
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1 38. CHANGE OF LEADERSHIP/MANAGEMENT
2 Any and all notices between COUNTY and PROVIDER provided for or permitted under this
3 Agreement or by law, shall be in writing and shall be deemed duly served when personally delivered to one
4 of the parties, or in lieu of such personal service,when deposited in the United States Mail,postage prepaid,
5 addressed to such party.
6 In the event of any change in the status of PROVIDER's leadership or management,
7 PROVIDER shall provide written notice to COUNTY within thirty(30)days from the date of change.
8 Such notification shall include any new leader or manager's name, address and qualifications. "Leadership
9 or management"shall include any employee,member, or owner of PROVIDER who either a) directs
10 individuals providing services pursuant to this Agreement;b) exercises control over the manner in which
11 services are provided; or c)has authority over PROVIDER's finances.
12 39. CHARITABLE CHOICE
13 PROVIDER may not discriminate in its program delivery against a client or potential client
14 on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal to actively
15 participate in a religious practice. Any specifically religious activity or service made available to
16 individuals by the PROVIDER must be voluntary as well as separate in time and location from County
17 funded activities and services. PROVIDER shall inform County as to whether it is faith-based. If
18 PROVIDER identifies as faith-based it must submit to Substance Use Disorder Services a copy of its
19 policy on referring individuals to alternate treatment PROVIDER, and include a copy of this policy in its
20 client admission forms. The policy must inform individuals that they may be referred to an alternative
21 provider if they object to the religious nature of the program, and include a notice to SUD Services.
22 Adherence to this policy will be monitored during annual site reviews, and a review of client files. If
23 PROVIDER identifies as faith-based,by July 1 of each year PROVIDER will be required to report to SUD
24 Services the number of individuals who requested referrals to alternate providers based on religious
25 objection.
26 40. LICENSING-CERTIFICATES
27 Throughout each term of this Agreement, PROVIDER and PROVIDER's staff shall
28 maintain all necessary licenses,permits, approvals, certificates,waivers and exemptions necessary for the
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I provision of the services hereunder and required by the laws and regulations of the United States of
2 America, State of California,the County of Fresno, and any other applicable governmental agencies.
3 PROVIDER shall notify COUNTY immediately in writing of its inability to obtain or maintain such
4 licenses,permits, approvals, certificates,waivers and exemptions irrespective of the pendency of any
5 appeal related thereto. Additionally,PROVIDER and PROVIDER's staff shall comply with all applicable
6 laws,rules or regulations,as may now exist or be hereafter changed.
7 41. AOD CERTIFICATION
8 A. The COUNTY requires all COUNTY contracted providers of Substance Use
9 Disorder treatment services to obtain the California Department of Health Care Services(DHCS)Alcohol
10 and Other Drug Program(AOD) Certification. The AOD Certification Standards will apply to all
11 residential and outpatient treatment modalities. The purpose of the AOD Certification Standards is to
12 ensure an acceptable level of service quality is provided to program participants.
13 B. PROVIDER shall provide proof of a submitted complete application for AOD
14 Certification to the County within thirty(30)days from the execution date of this Agreement with the
15 COUNTY. A copy of the AOD Certification shall be submitted to the COUNTY when approved by the
16 California Department of Alcohol Drug Programs.
17 C. This AOD Certification requirement applies to every treatment facility operated by
18 the PROVIDER. PROVIDERS whose agencies are nationally accredited with the Joint Commission on
19 Accreditation of Health Care Organizations (JCAHO) or the Commission on Accreditation of
20 Rehabilitative Facilities(CARF) are exempt from this requirement of AOD Certification. PROVIDER
21 shall submit a copy of their JCAHO or CARF accreditation to the COUNTY within thirty(30) days from
22 the date this Agreement is executed. PROVIDER shall notify COUNTY if at any time their JCAHO or
23 CARF accreditation lapses or becomes invalid due to any reason during the term of this Agreement.
24 PROVIDER shall apply with DHCS for AOD Certification if their JCAHO or CARF accreditation lapses
25 or becomes invalid and shall submit a copy of the submitted complete application for AOD Certification to
26 the COUNTY within thirty(30)days from the date the JCAHO or CARF accreditation lapses or becomes
27 invalid.
28 D. COUNTY shall terminate this Agreement immediately in the event any of the
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I following occurs:
2 1. PROVIDER fails to submit a copy of the completed application for AOD
3 Certification,or a copy of either their JCAHO or CARF accreditation within thirty(30) days from the
4 execution date of this Agreement with the COUNTY.
5 2. PROVIDER's application for AOD Certification is denied by DHCS.
6 3. PROVIDER fails to submit to the COUNTY a copy of the AOD Certification
7 within thirty(30) days after being approved by the DHCS, or certification is not maintained throughout the
8 contract period.
9 4. PROVIDER fails to apply for AOD Certification with DHCS or fails to
10 submit to the COUNTY a copy of the submitted complete application for AOD Certification within thirty
11 (30) days after the JCAHO or CARF accreditation lapses or becomes invalid.
12 42. COMPLAINTS
13 PROVIDER shall log complaints and the disposition of all complaints from a consumer or a
14 consumer's family. PROVIDER shall provide a summary of the complaint log entries concerning
15 COUNTY-sponsored consumers to COUNTY at monthly intervals by the fifteenth(15th)day of the
16 following month, in a format that is mutually agreed upon. PROVIDER shall post signs informing
17 consumer of their right to file a complaint or grievance. PROVIDER shall notify COUNTY of all incidents
18 reportable to state licensing bodies that affect COUNTY consumers within twenty-four(24)hours of
19 receipt of a complaint.
20 Within fifteen(15)days after each incident or complaint affecting COUNTY-sponsored
21 consumers, PROVIDER shall provide COUNTY with information relevant to the complaint, investigative
22 details of the complaint,the complaint and PROVIDER's disposition of,or corrective action taken to
23 resolve the complaint.
24 43. DRUG FREE WORKPLACE
25 PROVIDER shall comply with the requirements of the Drug-Free Work Place Act of 1990
26 (California Government Code section 8350).
27
28
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1 44. CHILD ABUSE REPORTING
2 PROVIDER shall utilize a procedure acceptable to the COUNTY to ensure that all of
3 PROVIDER's employees,volunteers, consultants, subcontractors or agents performing services under this
4 Agreement shall report all known or suspected child abuse or neglect to one or more of the agencies set
5 forth in Penal Code section 11165.9. This procedure shall include having all of PROVIDER's employees,
6 volunteers, consultants, subcontractors or agents performing services under this Agreement sign a statement
7 that he or she knows of and will comply with the reporting requirements set forth in Penal Code section
8 11166. The statement to be utilized by PROVIDER for reporting is set forth in Exhibit F, attached hereto
9 and by this reference incorporated herein.
10 45. TRAFFICKING IN PERSONS PROVISIONS
11 PROVIDER shall conform to all Federal statutes and regulations prohibiting trafficking in
12 persons, as well as trafficking-related activities, including,but not limited to the trafficking of persons
13 provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000 (TVPA).
14 PROVIDER,PROVIDER's employees, subrecipients, and subrecipients' employees may
15 not:
16 A. Engage in severe forms of trafficking in persons during the period of time that the
17 award is in effect;
18 B. Procure a commercial sex act during the period of time that the award is in effect; or
19 C. Use forced labor in the performance of the award or subawards under the award.
20 This agreement may be unilaterally terminated,without penalty, if PROVIDER or a
21 subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or has an
22 employee who is determined by the DBH Director or her designee to have violated a prohibition of the
23 TVPA through conduct that is either associated with performance under the award or imputed to the
24 PROVIDER or their subrecipient using the standards and due process for imputing the conduct of an
25 individual to an organization that are provided in 2 C.F.R. Part 180, "OMB Guidelines to Agencies on
26 Government-wide Debarment and Suspension(Nonprocurement).
27 PROVIDER must inform the DBH Director or her designee immediately of any information
28 received from any source alleging a violation of a prohibition of the TVPA.
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1 46. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
2 INFORMATION
3 This provision is only applicable if PROVIDER is a disclosing entity, fiscal agent, or
4 managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
5 and 455.106(a)(1),(2).
6 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
7 the following information must be disclosed by PROVIDER by completing Exhibit G "Disclosure of
8 Ownership and Control Interest Statement," attached hereto and by this reference incorporated herein.
9 PROVIDER shall submit this form to the Department of Behavioral Health within thirty(30) days of the
10 effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via email
11 to DBHAdministration(a,co.fresno.ca.us attention: Contracts Administration.
12 A. Name and address of any person(s)whether it be an individual or corporation with
13 an ownership or controlling interest in the disclosing entity or managed care entity.
14 1. Address must include the primary business address, every business location
15 and P.O. Box address(es).
16 2. Date of birth and Social Security Number for individuals.
17 3. Tax identification number for other corporations or entities with ownership
18 or controlling interest in the disclosing entity.
19 B. Any subcontractor(s) in which the disclosing entity has five (5)percent or more
20 interest.
21 C. Whether the person(s)with an ownership or controlling interest of the disclosing
22 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling or
23 child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
24 related to a person(parent, spouse, sibling or child) with ownership or has five (5)percent or more
25 interest in any of its subcontractors.
26 D. Name of any other disclosing entity in which an owner of the disclosing entity has
27 an ownership or control interest.
28 E. The ownership of any subcontractor with whom the provider has had business
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I transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
2 and
3 F. Any significant business transactions between the provider and any wholly owned
4 supplier, or between the provider and any subcontractor, during the 5-year period ending on the date of
5 the request.
6 G. Any person(s) with an ownership or control interest in the provider, or agent or
7 managing employee of the provider; and
8 1. Has been convicted of a criminal offense related to that person's
9 involvement in any program under Medicare, Medicaid, or the title XX services program since the
10 inception of those programs.
11 H. The ownership of any subcontractor with whom the provider has had business
12 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
13 and
14 I. Any significant business transactions between the provider and any wholly
15 owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the
16 date of the request.
17 47. CONTROL REQUIREMENTS
18 Performance under this Agreement is subject to all applicable Federal and State laws,
19 regulations and standards. In accepting the State drug and alcohol combined program allocation
20 pursuant to California Health and Safety Code section 11757, PROVIDER shall establish written
21 accounting procedures consistent with applicable Federal and State laws, regulations and standards, and
22 shall be held accountable for audit exceptions taken by the State or COUNTY for failure to comply with
23 these requirements. These requirements include, but may not be limited to, those set forth in this
24 Agreement, and:
25 A. Division 10.5 of the California Health and Safety Code;
26 B. California Government Code sections 16366.1 through 16367.9 and 53130
27 through 53138;
28 C. Title 9, Division 4 of the California Code of Regulations;
-38-
I D. 42 United States Code (U.S.C.) section 300x-5;
2 E. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
3 Amendments of 1996);
4 F. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and Audit
5 Requirements for Federal Awards); and
6 G. Title 45, Part 96, Subparts B, C and L of the Code of Federal Regulations (Block
7 Grants).
8 48. ADDITIONS/DELETIONS OF PROVIDER(S)
9 COUNTY's DBH Director or her designee reserves the right at any time during the term of
10 this Agreement to add new PROVIDER(S)to those listed in Exhibit A. It is understood any such additions
11 will not affect compensation paid to the other PROVIDER(S), and therefore such additions may be made
12 by COUNTY without notice to or approval from other PROVIDER(S)under this Agreement. These same
13 provisions shall apply to the deletion of any PROVIDER listed in Exhibit A, except that deletions shall be
14 made by written mutual agreement between the COUNTY and the particular PROVIDER to be deleted, or
15 shall be in accordance with the provisions of Section Three(3)TERMINATION of this Agreement.
16 49. SEPARATE AGREEMENT
17 It is mutually understood by the parties that this Agreement does not, in any way, create a
18 joint venture among PROVIDER(S). By execution of this Agreement, PROVIDER(S)understands that
19 a separate Agreement is formed between each individual PROVIDER and COUNTY.
20 50. GOVERNING LAW
21 Venue for any action arising out of or related to this Agreement shall only be in Fresno
22 County, California.
23 The rights and obligations of the parties and all interpretation and performance of this
24 Agreement shall be governed in all respects by the laws of the State of California.
25 51. ENTIRE AGREEMENT:
26 This Agreement, including all Exhibits, COUNTY's Revised RFSQ No. 952-5424 and
27 PROVIDER's responses thereto, constitutes the entire Agreement between PROVIDER and COUNTY
28 with respect to the subject matter hereof and supersedes all previous agreement negotiations,proposals,
-39-
I commitments,writings, advertisements,publications, and understandings of any nature whatsoever unless
2 expressly included in this Agreement.
3
4
5
6 ///
7 ///
8
9
10
12
13
14
15
16
17
18
19
20
21
22
23
24 ///
25 ///
26 ///
27 ///
28 ///
-40-
I IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first
2 hereinabove written.
3
4 ATTEST:
5 COUNTY OF FRESNO PROVIDER(S):
6
7
By,-- SEE EXHIBIT A
8 Ernest Buddy Mendes, Chairman
9 Board of Supervisors
10
I Date: 7wwe_ `1 2.17110
12
13
14 BERNICE E. SEIDEL, Clerk
15 Board of Supervisors
16 By &X!&� .t
17
18
19 Date: t t�v.slr �7. 2DIL o
20
21
22 PLEASE SEE ADDITIONAL
SIGNATURE PAGES ATTACHED
23
24
25
26
27
28
-41-
I APPROVED AS TO LEGAL FORM:
2 DANIEL C. CEDERBORG, COUNTY COUNSEL
3 r - ...,
4 By: ' v
5
6
7 APPROVED AS TO ACCOUNTING FORM:
8 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
9
10
11 By: G"'QL
12
13
14 REVIEWED AND RECOMMENDED FOR
15 APPROVAL:
16
17 �
By:
18 DAWAN UTECHT,Director
19 Department of Behavioral Health
20
21
22 The following is for COUNTY's use:
23
Fund/Subclass: 0001/10000
24
25 Organization: 56302081
26 Account/Program: 7295/0
27
28 yl
-42-
I Provider: COMPREHENSIVE ADDICTION PROGRAMS, INC.
2
3
4 By
5
6 Print Name:
7
Title: �J
8 Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13
14
By
15
Print Name:
16
17 017y eC —L-c Z.--
Title:
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20 /S �1 (sz
Date:
21
22
23
24
25
26
27
28
-43-
I Provider: FRESNO COUNTY HISPANIC COMMISSION,INC.
2
3
4 By e�/w•—o
5 ,�n
6 Print Name: /VM6 e A1AVAkgd
7 Title: C19A1014 A/V
8 Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13
14 By
15
Print Name: ' Dgy4 p
16
17 '
Title: y�pCGL7!
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20
Date:
21
22
23
24
25
26
27
28
-44-
I Provider: KING OF KINGS COMMUNITY CENTER
2
4 By
5 �! f
6 Print Name: JESSE RODRIGUEZ, JR.
7
Title: Chairman of the Board of Directors
8 Chairman of the Board, President, or Vice President
9
10 Date: May 5, 2016
11
12
13
14 Byt
15
Print Name: WILLIE LEWIS
16
17 Title: Secretary of the Board of Directors
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20
Date: _ May 5, 2016
21
22
23
24
25
26
27
28
-45-
I Provider: MENTAL HEALTH SYSTEMS,INC.
2
3
4 By
5
5 Print Name: �� A
7 Title:
8 Chairman of the Board, President, or Vice President
9
10 Date: Zo
11
12
13
14 By
15 -}-� J�
Print Name: D �` �Jlt�� �n 1 a'
16
17
Title: �
18 Secretary (of Corpor tion), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20 5 Date:
21
22
23
24
25
26
27
28
-46-
I Provider: SPIRIT OF WOMAN OF CALIFORNIA,INC.
2
3
4 By
5
6 Print Name:
7 �� w8 Title:
Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13
By
14
15
Print Name:
16
17 Title: '
18 Secretary(of Cor ration), Assistant Secretary,
19 Chief Financial Officer, or Assistant Treasurer
20
Date:
21
22
23
24
25
26
27
28
-47-
I Provider: TURNING POINT OF CENTRAL CALIFORNIA, INC.
2
3
4 By
5
6 Print Name: X.IYA )W-1) �S
7
8 Title: CA
9 Chairman of the Board, President, or Vice President
10 Date:
11
12
13 By
14
15
Print Name: 13"-
16
17
Title: G o
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20C��6
Date:
21
22
23
24
25
26
27
28
-48-
I Provider: WESTCARE CALIFORNIA,INC.
2
3
4 By
5
6 Print Name: f
7
8 Title:
9 Chairman of the Board,President, or Vice President
10 Date:
11
12 f
13
� k
14
15 f
4.
Runt Name: f`/A j,-W A
16
17
Title:� ,�� � ; _�n ���
18 Secretary(of Corporation), Assistant Secretary, ,
Chief Financial Officer,or Assistant Treasurer
19
20 Date: (--)G i L
21
22
23
24
25
26
27
28
-49-
Exhibit A
Adult and/or Perinatal Residential Vendor List
VENDOR PHONE NUMBER SITE LOCATION
Comprehensive Addiction Programs, Inc. (559) 264-5096 2445 W. Whites Bridge Rd.
Remit to: Fresno, CA 93706
2445 W. Whites Bridge Rd.
Fresno, CA 93706
Fresno County Hispanic Commission, Inc. (559) 268-6480 1414 W. Kearney Blvd.
Remit to: Fresno, CA 93706
1803 Broadway St.
Fresno, CA 93721
King of Kings Community Center (559) 442-0400 2267 S. Geneva Ave.
Remit to: Fresno, CA 93706
2302 Martin Luther King Jr. Blvd.
Fresno, CA 93706
Mental Health Systems, Inc. (559) 264-7521 2550 W. Clinton Ave.
Remit to: Fresno, CA 93705
9465 Farnham St.
San Diego, CA 92123
Spirit of Woman of California, Inc. (559) 233-4353 327 W. Belmont Ave.
Remit to: Fresno, CA 93728
327 W. Belmont Ave.
Fresno, CA 93728
Turning Point of Central California, Inc. (559) 233-5096 2731 W. Olive Ave.
Remit to: Fresno, CA 93728
PO Box 7447
Visalia, CA 93290
WestCare California, Inc. (559) 265-4800 2772 S. Martin Luther King Jr. Blvd
Remit to: Fresno, CA 93706
PO Box 12107
Fresno, CA 93776
5/13/2016 1 of 1
Exhibit B
Adult and/or Perinatal Residential Services
Vendor Rates
Treatment/Bed Slot Combined Rate per Bed Day
VENDOR FY 2016-17 FY 2017-18 FY 2018-19 FY 2019-20 FY 2020-21
Comprehensive Addiction Programs, Inc.
Men's Residential 81.86 83.02 84.33 85.60 86.88
Women's Residential 81.86 83.02 84.33 85.60 86.88
Fresno County Hispanic Commission, Inc.
Men's Residential (Spanish monolingual) 77.22 77.22 77.22 77.22 77.22
King of Kings Community Center
Men's Residential 74.03 74.03 72.66 72.66 72.66
Mental Health Systems, Inc.
Women's Residential 84.54 84.54 84.54 84.54 84.54
Residential Perinatal 91.17 91.17 91.17 91.17
Spirit of Woman of California, Inc.
Residential Perinatal 86.96 88.23 89.47 90.80 92.03
Turning Point of Central California, Inc.
Men's Residential 80.72 80.97 81.22 81.47 81.73
WestCare California, Inc.
Men's Residential 69.89 69.89 69.89 69.89 69.89
Women's Residential 71.36 71.36 71.36 71.36 71.36
Residential Perinatal 1 94.59 1 94.59 1 94.59 1 94.59 1 94.59
Exhibit C
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit C
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
(5)Authorized Signature
Signature: Date:
Exhibit D
National Standards for Culturally and Linguistically Page 1 of
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
I. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
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Exhibit D
The Case for the Enhanced National CLAS Standards Page 2 of 2
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
I THINK
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Exhibit E
Page 1 of 3
DISCLOSURE - CRIMINAL HISTORY & CIVIL ACTIONS:
In their proposal, the bidder is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively
referred to as "Bidder"):
• Within the three-year period preceding the proposal, they have been convicted of, or
had a civil judgment rendered against them for:
o fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (federal, state, or local) transaction or contract under a
public transaction;
o violation of a federal or state antitrust statute;
o embezzlement, theft, forgery, bribery, falsification, or destruction of records; or
o false statements or receipt of stolen property
• Within a three-year period preceding their proposal, they have had a public transaction
(federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate a Bidder from
consideration. The information will be considered as part of the determination of whether to
award the contract and any additional information or explanation that a Bidder elects to submit
with the disclosed information will be considered. If it is later determined that the Bidder failed
to disclose required information, any contract awarded to such Bidder may be immediately
voided and terminated for material failure to comply with the terms and conditions of the
award.
Any Bidder who is awarded a contract must sign an appropriate Certification Regarding
Debarment, Suspension, and Other Responsibility Matters, pages 2 and 3 of this Exhibit,
Additionally, the Bidder awarded the contract must immediately advise the County in writing if,
during the term of the agreement: (1) Bidder becomes suspended, debarred, excluded or
ineligible for participation in federal or state funded programs or from receiving federal funds
as listed in the excluded parties list system (http://www/eels/qov); or (2) any of the above
listed conditions become applicable to Bidder. The Bidder will indemnify, defend and hold the
County harmless for any loss or damage resulting from a conviction, debarment, exclusion,
ineligibility or other matter listed in the signed Certification Regarding Debarment,
Suspension, and Other Responsibility Matters.
G:\SUBSTANCE ABUSE SERVICES\REPS\EY 15-WRESIDENTIALRESQ\CONIRAC T AND EXF1 BM\E,XF1 BIT E-DISCLOSURE CRIMNALHISTORY&
CIVILACIIONS.DOC
Exhibit E
Page 2 of 3
CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED
TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
G:\SUBSTANCE ABUSE SERVICES\REPS\EY 15-WRESIDENTIALRESQ\CONIRAC T AND EXF1 BM\E,XF1 BIT E-DISCLOSURE CRIMNALHISTORY&
CIVILACIIONS.DOC
Exhibit E
Page 3 of 3
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
G:\SUBSTANCE ABUSE SERVICES\RFPS\FY 15-16\RESIDENTIALRFSQ\CONIRAC T AND EXFI BM\EXF[BIT E-DISCLOSURE CRIMNALHISTORY&
CIVILACIIONS.DOC
Exhibit F
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section (§) 11165.9.
For purposes of the undersigned's child abuse reporting requirements, "child
abuse or neglect" includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any
police department or sheriff's department(not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services' 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a"reasonable suspicion"means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
SIGNATURE DATE
0980fadx
Exhibit G
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
)
Il. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
byTitles XVIII, XIX, or XX?......................................................................................................................... n n
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... n n
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVII I providers only)........... n n
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: n Sole proprietorship n Partnership n Corporation
n Unincorporated Associations n Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... n n
NAME ADDRESS PROVIDER NUMBER
Exhibit G
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit G
Page 3 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF
OWNERSHIP AND CONTROL INTEREST STATEMENT
A full and accurate disclosure of ownership and financial interest is required. Failure to submit requested information may result in a refusal by the Secretary or
appropriate State agency to enter into an agreement or contract with any such institution or in termination of existing agreements.
General Instructions Controlling interest is defined as the operational direction or
management of a disclosing entity which may be maintained by any or
Please answer all questions as of the current date. If the yes block for all of the following devices:the ability or authority,expressed or
any item is checked,list requested additional information under the reserved,to amend or change the corporate identity(i.e.,joint venture
Remarks section on page 2,referencing the item number to be agreement,unincorporated business status)of the disclosing entity;the
continued.If additional space is needed use an attached sheet. ability or authority to nominate or name members of the Board of
Return the original and second and third copies to the State Directors or Trustees of the disclosing entity;the ability or authority,
agency;retain the first copy for your files. expressed or reserved,to amend or change the by-laws,constitution,
This form is to be completed annually.Any substantial delay in or other operating or management direction of the disclosing entity;the
completing the form should be reported to the State survey agency. right to control any or all of the assets or other property of the
disclosing entity upon the sale or dissolution of that entity;the ability or
DETAILED INSTRUCTIONS authority,expressed or reserved,to control the sale of any or all of the
assets,to encumber such assets by way of mortgage or other
indebtedness,to dissolve the entity,or to arrange for the sale or
These instructions are designed to clarify certain questions on the form. transfer of the disclosing entity to new ownership or control.
Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory. IT Items IV—VII-Changes in Provider Status
IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED
ACCURATELY AND THAT ALL INFORMATION BE CURRENT. Change in provider status is defined as any change in management
control.Examples of such changes would include:a change in Medical
Item I-Under identifying information specify in what capacity the entity is or Nursing Director,a new Administrator,contracting the operation of
doing business as(DBA),example,name of trade or corporation. the facility to a management corporation,a change in the composition
of the owning partnership which under applicable State law is not
Item II-Self-explanatory. considered a change in ownership,or the hiring or dismissing of any
employees with 5 percent or more financial interest in the facility or in
Item III-List the names of all individuals and organizations having an owning corporation,or any change of ownership.
direct or indirect ownership interests,or controlling interest separately or For Items IV—VII,if the yes box is checked,list additional information
in combination amounting to an ownership interest of 5 percent or more requested under Remarks.Clearly identify which item is being continued.
in the disclosing entity.
Direct ownership interest is defined as the possession of stock,equity in
capital or any interest in the profits of the disclosing entity.A Item IV-(a&b)If there has been a change in ownership within the
disclosing entity is defined as a Medicare provider or supplier,or other last year or if you anticipate a change,indicate the date in the
entity that furnishes services or arranges for furnishing services under appropriate space.
Medicaid or the Maternal and Child Health program,or health related
services under the social services program.
Indirect ownership interest is defined as ownership interest in an entity Item V-If the answer is yes,list name of the management firm and
that has direct or indirect ownership interest in the disclosing entity. employer identification number(EIN),or the name of the leasing
The amount of indirect ownership in the disclosing entity that is held by organization.A management company is defined as any organization
any other entity is determined by multiplying the percentage of that operates and manages a business on behalf of the owner of that
ownership interest at each level.An indirect ownership interest must be business,with the owner retaining ultimate legal responsibility for
reported if it equates to an ownership interest of 5 percent or more in the operation of the facility.
disclosing entity.Example:if A owns 10 percent of the stock in a
corporation that owns 80 percent of the stock of the disclosing entity,
A's interest equates to an 8 percent indirect ownership and must be Item VI-If the answer is yes,identify which has changed
reported. (Administrator,Medical Director,or Director of Nursing)and the date
the change was made.Be sure to include name of the new
Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is
either owned,controlled,or operated under lease or contract by an
organization consisting of two or more free-standing health care facilities
organized within or across State lines which is under the ownership or
through any other device,control and direction of a common party.
Chain affiliates include such facilities whether public, private,charitable
or proprietary.They also include subsidiary organizations and holding
corporations.Provider-based facilities,such as hospital-based home
health agencies,are not considered to be chain affiliates