HomeMy WebLinkAboutAgreement A-18-292 with BAART Behavioral Health Services Inc..pdf Agreement No. 18-292
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 5th day of June 2018, by
3 and between the COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and BAART BEHAVIORAL HEALTH SERVICES, INC., a California
5 Corporation, whose mailing address is 1720 Lakepointe Drive, Suite 117, Lewisville, TX 75057
6 hereinafter referred to as "PROVIDER."
7 WHEREAS, COUNTY, through its Department of Behavioral Health, Contracts Division -
8 Substance Use Disorder Services (DBH), has determined there is a need for certain inmates of
9 COUNTY's Detention Facilities to receive Narcotic Treatment Program (NTP) services for Opioid Use
10 Disorders; and
11 WHEREAS, PROVIDER has the necessary certification, licensure and permits from the
12 Department of Health Care Services and the U.S. Drug Enforcement Administration (DEA) and is
13 willing and able to provide NTP services as required by the COUNTY, pursuant to both Title 9 and 22 of
14 the California Code of Regulations, California Health and Safety Code Sections 11750 et seq., the
15 California Alcohol and Drug Standards and per the terms and conditions of this agreement.
16 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
17 hereinafter set forth, the sufficiency of which is acknowledged, the parties agree as follows:
18 1. SERVICES
19 A. PROVIDER shall perform all services and fulfill all responsibilities for the
20 provision of NTP services as identified in Exhibit A, "Scope of Work" and in a manner consistent with
21 State and Federal laws, regulations and statues.
22 B. PROVIDER shall provide NTP services including intake, assessment, dispensing
23 of medications, education about NTP services and medications, and referral to community-based
24 services as necessary. NTP services will be delivered in accordance with medical necessity, as
25 directed by a physician, to those identified inmates in Fresno County jails who are currently enrolled in
26 an NTP program upon incarceration as well as those who are identified by jail staff as potentially
27 requiring the NTP services.
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1 C. PROVIDER shall comply with all regulations and policies of the Fresno County
2 Sheriff's Office while providing services at the Fresno County Detention Facilities.
3 D. PROVIDER shall have sufficient licensed and qualified staff to provide daily NTP
4 services throughout the term of the Agreement. PROVIDER staff providing their services at the
5 Detention Facilities shall have obtained the required Jail Clearance from the Fresno County Sheriff's
6 Office.
7 E. PROVIDER shall submit a written policy to the COUNTY describing its criteria for
8 a client/inmate being unamenable to their treatment program. PROVIDER shall notify the COUNTY
9 within three (3) days of determining a client as unamenable to their NTP services.
10 F. PROVIDER shall notify other NTP services providers if their client(s) are
11 incarcerated and obtain client treatment plans to continue services in the Detention Facilities.
12 PROVIDER shall notify the other provider when the inmate is discharged.
13 G. PROVIDER shall comply with all requirements of the Federal Department of
14 Justice National Prison Rape Elimination Act (PREA) standards.
15 H. PROVIDER shall maintain at PROVIDER's expense, a computer system
16 compatible with COUNTY's Substance Abuse Information System (SAIS), and high-speed Internet
17 connection for the purposes of submitting information required under the terms and conditions of this
18 Agreement.
19 I. COUNTY encourages PROVIDER to adopt and maintain Electronic Health
20 Records (EHR) meeting the requirements of the Health Information Technology for Economic and
21 Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act (ARRA) of 2009.
22 PROVIDER shall bear all of the costs associated with penalties and/or fines for non-compliance with
23 such regulations.
24 2. TERM
25 The term of this Agreement shall be for a period of three (3) years, commencing on the 1 st
26 day of July, 2018 through the 30th of June, 2021. This Agreement may be extended for two (2)
27 additional twelve (12) month periods upon written approval of both parties no later than thirty (30) days
28 prior to the first day of each twelve (12) month period. The DBH Director, or her designee, is authorized
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1 to execute such written approval on behalf of the COUNTY based on PROVIDER's satisfactory
2 performance.
3 3. TERMINATION
4 A. NON-ALLOCATION OF FUNDS —The terms of this Agreement, and the services
5 to be provided thereunder, are contingent on the approval of the funds by the appropriating government
6 agency. Should insufficient funds not be allocated, the services may be modified, or this Agreement
7 terminated, at any time by giving the PROVIDER thirty (30) days advance notice.
8 B. BREACH OF CONTRACT — COUNTY may immediately suspend or terminate
9 this Agreement in whole or in part, where in the determination of the COUNTY there is:
10 1) An illegal or improper use of funds;
11 2) A failure to comply with any term in this Agreement;
12 3) A substantially incorrect or incomplete report submitted to COUNTY;
13 4) Improperly performed service.
14 In no event shall any payment by the COUNTY constitute a waiver by COUNTY of any
15 breach of this Agreement or any default which may then exist on the part of the PROVIDER. Neither
16 shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach or
17 default. COUNTY shall have the right to demand of the PROVIDER the repayment to COUNTY of any
18 funds disbursed to the PROVIDER under this Agreement. The PROVIDER shall promptly refund any
19 such funds upon demand.
20 C. WITHOUT CAUSE — Under circumstances other than those set forth above, this
21 Agreement may be terminated by COUNTY or PROVIDER upon giving thirty (30) days advance written
22 notice.
23 4. COMPENSATION
24 A. COMPENSATION — In no event shall reimbursement for services performed by
25 PROVIDER under this Agreement exceed the prevailing Drug Medi-Cal reimbursement rate approved
26 by the Department of Health Care Services for each term of this agreement. It is understood that all
27 expenses incidental to PROVIDER's performance of services under this Agreement shall be borne by
28 PROVIDER.
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1 1) Reimbursement for non-perinatal and perinatal Methadone and
2 Buprenorphine is limited to the maximum allowable rate set by the State, "Drug Medi-Cal Rates for
3 Fiscal Year 2017-18" attached hereto and by this reference incorporated herein as Exhibits B-1 and B-
4 2, and updated annually. PROVIDER shall not be paid any amount in excess of the actual annual costs
5 of providing services. Monthly invoices shall be submitted in accordance with Section Five (5),
6 INVOICING, of this agreement. For periods of July 1, 2018, through June 30, 2019, July 1, 2019
7 through June 30, 2020 and July 1, 2020 through June 30, 2021, in no event shall actual services
8 performed be in excess of One Hundred Fifty Thousand and No/100 ($150,000.00) for each twelve (12)
9 month period. Should the Agreement be extended as stated in Section Two (2), TERM, for the
10 extension periods of July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023, in no
11 event shall actual services performed be in excess of One Hundred Fifty Thousand and No/100
12 ($150,000.00) for each twelve (12) month period.
13 2) Payments by COUNTY shall be in arrears, for services provided during
14 the preceding month, within forty-five (45) days after receipt, verification and approval of PROVIDER's
15 invoices by COUNTY's DBH.
16 3) PROVIDER shall be reimbursed for mileage for staff traveling for work to
17 and from PROVIDER's clinic to the COUNTY Detention Facilities. The mileage reimbursement rate
18 shall equal the prevailing rate established by the Internal Revenue Service (IRS) and used by the
19 COUNTY.
20 4) COUNTY shall reimburse PROVIDER a per trip rate of Twenty-Five
21 dollars ($25.00).
22 5) COUNTY shall reimburse PROVIDER the cost of fingerprinting
23 PROVIDER staff for Jail Clearance at a rate of Fifty-Two dollars ($52.00) per employee.
24 B. COMPLIANCE — If PROVIDER should fail to comply with any provision of this
25 Agreement, COUNTY shall be relieved of its obligation for further compensation. PROVIDER's and
26 COUNTY's obligation under this section shall survive the termination of this Agreement with respect to
27 services provided during the term of this Agreement without regard to the cause of the termination of
28 this Agreement.
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1 C. QUALITY ASSURANCE — For services rendered herein, PROVIDER shall
2 assure that an on-going quality assurance component is in place and is occurring. PROVIDER shall
3 assure that clinical records for each participant are of such detail and length that a review of said record
4 will verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates
5 that appropriate services were not provided, COUNTY reserves the right to withhold payment for the
6 applicable unit(s) of service.
7 D. PUBLIC INFORMATION — PROVIDER shall disclose its funding source in all
8 public information; however, this requirement of disclosure of funding source shall not be required in
9 spot radio or television advertising.
10 E. LOBBYING ACTIVITY— PROVIDER shall not directly or indirectly use any of the
11 funds under the Agreement for any political activity or to further the election or defeat of any candidate
12 for public office.
13 5. INVOICING
14 PROVIDER shall invoice COUNTY in arrears by the (20th) day of each month for actual
15 services rendered in the previous month. Invoices shall be emailed to SAS@co.fresno.ca.us with the
16 subject line "Jail NTP Services Analyst." Invoices shall be accompanied by monthly client roster
17 indicating units of service and other documentation and reports as indicated in Section Sixteen (16),
18 REPORTS — SUBSTANCE USE DISORDER SERVICES. Any reports or other required documentation
19 shall be in the form and in such detail as acceptable to COUNTY's DBH. No reimbursement for
20 services shall be made until the invoice is received, reviewed, and approved by COUNTY's DBH.
21 PROVIDER shall invoice COUNTY for reimbursement of cost for fingerprinting
22 PROVIDER staff for Jail Clearance. Receipts from the Sheriff's Office shall accompany claims for
23 fingerprinting cost reimbursements.
24 PROVIDER shall invoice COUNTY for mileage monthly using a standard COUNTY form
25 and providing the destination from PROVIDER's Clinic with the starting and ending mileage and miles
26 travelled for each trip.
27 If an invoice is incorrect or is otherwise not in proper form or substance, COUNTY's DBH
28 Director or her designee shall have the right to withhold payment as to only that portion of the invoice
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1 that is incorrect or improper after five (5) days prior to notice to PROVIDER. PROVIDER agrees to
2 continue to provide services for a period of ninety (90) days after notification of an incorrect or improper
3 invoice. If after said ninety (90) day period said invoice(s) is still not corrected to the satisfaction of
4 COUNTY's DBH Director, COUNTY may elect to terminate the Agreement, pursuant Section Three (3),
5 TERMINATION, of this Agreement. In addition, PROVIDER shall submit all invoices to COUNTY's DBH
6 for services provided within ninety (90) days after each 12 month period of this Agreement expires or
7 this Agreement is terminated. If invoices are not submitted within ninety (90) days after each 12 month
8 period expires or this Agreement is terminated, COUNTY's DBH shall have the right to deny payment.
9 Final general ledgers for services provided during each 12 month period of this
10 Agreement must be received within sixty (60) days after each 12 month period expires or this
11 Agreement is terminated, COUNTY's DBH shall have the right to deny payment for services covered by
12 such general ledger.
13 6. PROHIBITION ON PUBLICITY
14 None of the funds, materials, property or services provided directly or indirectly under
15 this Agreement shall be used for PROVIDER's advertising, fundraising, or publicity (i.e., purchasing of
16 tickets/tables, silent auction donations, etc) for the purpose of self-promotion. Notwithstanding the
17 above, publicity of the services described in Section One (1), SERVICES, of this Agreement shall be
18 allowed as necessary to raise public awareness about the availability of such specific services when
19 approved in advance by the DBH Director or her designee, and at a cost provided for such items as
20 written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
21 expense(s).
22 7. INDEPENDENT CONTRACTOR
23 In performance of the work, duties and obligations assumed by PROVIDER under this
24 agreement, it is mutually understood and agreed that PROVIDER, including any and all of the
25 PROVIDER's officers, agents, and employees will at all times be acting and performing as an
26 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
27 employee, joint venture, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no
28 right to control or supervise, or direct the manner or method by which PROVIDER shall perform its work
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1 and function. However, COUNTY shall retain the right to administer the Agreement so as to verify that
2 PROVIDER is performing its obligations in accordance with the terms and conditions thereof.
3 PROVIDER and COUNTY shall comply with all applicable provisions of law and the
4 rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
5 thereof.
6 Because of its status as an independent contractor, PROVIDER shall have absolutely no
7 right to employment rights and benefits available to COUNTY employees. PROVIDER shall be solely
8 liable and responsible for providing to, or on behalf of, its employees all legally-required employee
9 benefits. In addition, PROVIDER shall be solely responsible to save COUNTY harmless from all
10 matters relating to payment of PROVIDER's employees, including compliance with Social Security
11 withholding and all other regulations governing such matters. It is acknowledged that during the term of
12 this Agreement, PROVIDER may be providing services to others unrelated to the COUNTY or to the
13 Agreement.
14 8. CONFLICT OF INTEREST
15 No officer, agent, or employee of the COUNTY who exercises any function or
16 responsibility for planning and carrying out the services provided under this Agreement shall have any
17 direct or indirect personal financial interest in this Agreement. PROVIDER shall comply with all Federal,
18 State of California, and local conflict of interest laws, statutes, and regulations, which shall be
19 applicable to all parties and beneficiaries under this Agreement and any officer, agent, or employee of
20 the COUNTY.
21 9. DISCLOSURE OF SELF-DEALING TRANSACTIONS
22 This provision is only applicable if the PROVIDER is operating as a corporation (a for-
23 profit or non-profit corporation) or if during the term of this Agreement, the PROVIDER changes its
24 status to operate as a corporation.
25 Members of the PROVIDER's Board of Directors shall disclose any self-dealing
26 transactions that they are a party to while PROVIDER is providing goods or performing services under
27 this Agreement. A self-dealing transaction shall mean a transaction to which the PROVIDER is a party
28 and in which one or more of its directors has a material financial interest. Members of the Board of
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1 Directors shall disclose any self-dealing transactions that they are a party to by completing and signing
2 a Self-Dealing Transaction Disclosure Form (Exhibit C) and submitting it to the COUNTY prior to
3 commencing with the self-dealing transaction or immediately thereafter.
4 10. MODIFICATION
5 Any matters of this Agreement may be modified from time to time by written consent of
6 all parties without, in any way, affecting the remainder.
7 Notwithstanding the above, changes to Section One (1), SERVICES, as needed to
8 accommodate changes in State and Federal Law relating to mental health and substance use disorder
9 treatment may be made with the signed written approval of COUNTY's DBH Director or her designee
10 and respective PROVIDER through an amendment approved by County Counsel and Auditor.
11 11. NON-ASSIGNMENT
12 Neither party shall assign, transfer or sub-contract this Agreement not their rights or
13 duties under this Agreement without prior written consent of the other party.
14 12. HOLD HARMLESS
15 PROVIDER agrees to indemnify, save, hold harmless, and at COUNTY'S request,
16 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses,
17 damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection with the
18 performance, or failure to perform, by PROVIDER, its officers, agents, or employees under this
19 Agreement, and from any and all costs and expenses, damages, liabilities, claims, and losses occurring
20 or resulting to any person, firm, or corporation who may be injured or damaged by the performance,
21 or failure to perform, of PROVIDER, its officers, agents, or employees under this Agreement.
22 13. INSURANCE
23 Without limiting the COUNTY's right to obtain indemnification from PROVIDER or any
24 third parties, PROVIDER, at its sole expense, shall maintain in full force and effect, the following
25 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
26 arrangement or Joint Powers Agreement (JPA) throughout the term of the contract:
27 1H
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1 A. COMMERCIAL GENERAL LIABILITY
2 Commercial General Liability Insurance with limits of not less than One Million
3 Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million Dollars ($2,000,000). This
4 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
5 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
6 liability or any other liability insurance deemed necessary because of the nature of this contract.
7 B. AUTOMOBILE LIABILITY
8 Comprehensive Automobile Liability Insurance with limits for bodily injury of not
9 less than Two Hundred Fifty Thousand Dollars ($250,000.00) per person, Five Hundred Thousand Dollars
10 ($500,000.00) per accident and for property damages of not less than Fifty Thousand Dollars
11 ($50,000.00), or such coverage with a combined single limit of Five Hundred Thousand Dollars
12 ($500,000.00). Coverage should include owned and non-owned vehicles used in connection with this
13 Agreement.
14 C. PROFESSIONAL LIABILITY
15 If PROVIDER employs licensed professional staff (e.g., Ph.D., R.N., L.C.S.W.,
16 L.M.F.T) in providing services, Professional Liability Insurance with limits of not less than One Million
17 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
18 D. WORKERS COMPENSATION
19 A policy of Worker's Compensation insurance as may be required by the
20 California Labor Code.
21 PROVIDER shall obtain endorsements to the Commercial General Liability
22 insurance naming the County of Fresno, its officers, agents, and employees, individually and
23 collectively, as additional insured, but only insofar as the operations under this Agreement are
24 concerned. Such coverage for additional insured shall apply as primary insurance and any other
25 insurance, or self-insurance, maintained by COUNTY, its officers, agents, and employees shall be
26 excess only and not contributing with insurance provided under PROVIDER's policies herein. This
27 insurance shall not be cancelled or changed without a minimum of thirty (30) days advance notice given
28 to COUNTY.
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1 Within thirty (30) days for the date PROVIDER signs this Agreement, PROVIDER
2 shall provide certificates of insurance and endorsements as stated above for all of the foregoing
3 policies, as required herein, to the County of Fresno, Department of Behavioral Health, Contracts
4 Division — Substance Use Disorder Services at 3133 N. Millbrook Ave., Fresno California, 93703,
5 Attention: SLID Services Staff Analyst, stating that such Commercial General Liability insurance names
6 the County of Fresno, its officers, agents, employees, individually and collectively, as additional
7 insured, but insofar as the operations under this Agreement are concerned; that such coverage for
8 additional insured shall apply as primary insurance and any other insurance, or self-insurance,
9 maintained by COUNTY, its officers, agents, and employees, shall be in excess only and not
10 contributing with insurance provided under PROVIDER's policies herein; and that this insurance shall
11 not be cancelled or changed without minimum of thirty (30) days advance, written notice given to
12 COUNTY.
13 In the event any PROVIDER fails to keep in effect at all times insurance
14 coverage as herein provided, COUNTY may, in addition to other remedies it may have, suspend or
15 terminate the Agreement with Provider upon the occurrence of such event.
16 All policies shall be with admitted insurers licensed to do business in the State of
17 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
18 A FSC VII or better.
19 14. SUBCONTRACTS
20 PROVIDER shall be required to assume full responsibility for all services and activities
21 covered by this Agreement, whether or not PROVIDER is providing services directly. Further,
22 PROVIDER shall be the sole point of contact with regard to contractual matters, including payment of
23 any and all charges from the Agreement.
24 If PROVIDER should propose to subcontract with one or more third parties to carry out a
25 portion of the services covered by this Agreement, any such subcontract shall be in writing and
26 approved as to form and content by COUNTY's DBH Director or her designee prior to execution and
27 implementation. COUNTY's DBH Director or her designee shall have the right to reject any such
28 proposed subcontract. Any such subcontract together with all activities by or caused by PROVIDER
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1 shall not require compensation greater than the total budget contained herein. An executed copy of any
2 such subcontract shall be received by COUNTY before any implementation and shall be retained by
3 COUNTY. PROVIDER shall be responsible to COUNTY for the proper performance of any subcontract.
4 Any subcontractor shall be subject to the same terms and conditions that PROVIDER is subject to
5 under this Agreement.
6 15. NO THIRD PARTY BENEFICIARIES
7 It is understood and agreed by and between the parties that the services provided by
8 PROVIDER for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in
9 Agreement is intended to confer on any person other than the parties hereto any right under or by
10 reason of this Agreement.
11 16. REPORTS—SUBSTANCE USE DISORDER SERVICES
12 PROVIDER shall submit all information and data required by State, including, but not
13 limited to the following:
14 A. Drug and Alcohol Treatment Access Report (DATAR) and Provider Waiting List
15 Record (WLR) in an electronic format provided by the State and due no later than five (5) days after the
16 preceding month; and
17 B. CaIOMS Treatment— Submit CaIOMS treatment admission, discharge, annual
18 update, and "provider activity report" record in an electronic format through COUNTY's SAIS system,
19 and on a schedule as determined by the COUNTY which complies with State requirements for data
20 content, data quality, reporting frequency, reporting deadlines, and report method and due no later than
21 five (5) days after the preceding month. All CalOMS admissions, discharges, and annual updates must
22 be entered into the COUNTY's CaIOMS system within twenty-four (24) hours of occurrence; and
23 C. PROVIDER shall submit to COUNTY monthly fiscal and all program reports,
24 including Provider Waiting List Record (WLR), within twenty (20) days of the end of each month.
25 D. Americans with Disabilities (ADA) —Annually, upon request by DBH, PROVIDER
26 shall complete a system-wide accessibility survey in a format determined by DBH for each service
27 location and modality and shall submit an ADA Accessibility Certification and Self-Assessment,
28 including an Implementation Plan, for each service location.
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1 E. Cost Reports— On an annual basis for each fiscal year ending June 30th
2 PROVIDER shall submit a complete and accurate detailed cost report(s). Cost reports must be
3 submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the due
4 date. Submittal must also include any requested support documents such as general ledgers. All
5 reports submitted by PROVIDER to COUNTY must be typewritten. COUNTY will issue instructions for
6 completion and submittal of the annual cost report, including the relevant cost report template(s) and
7 due dates within forty-five (45) days of each fiscal year end. All cost reports must be prepared in
8 accordance with Generally Accepted Accounting Principles. Unallowable costs such as lobbying or
9 political donations must be deducted from the cost report and all invoices. If the PROVIDER does not
10 submit the cost report by the due date, including any extension period granted by the COUNTY, the
11 COUNTY may withhold payment of pending invoices until the cost report(s) has been submitted and
12 clears COUNTY desk audit for completeness and accuracy.
13 1) DMC - A DMC cost report must be submitted in a format
14 prescribed by the DHCS for the purposes of Short Doyle Medi-Cal reimbursement of total costs for all
15 programs. PROVIDER shall report costs under their approved legal entity number established during
16 the DMC certification process. Total units of service reported on the cost report will be compared to the
17 units of services entered by PROVIDER into COUNTY's data system. PROVIDER will be required to
18 correct discrepancies and resubmit to COUNTY prior to COUNTY's final acceptance of the cost report.
19 2) OTHER FUNDING SOURCES — PROVIDER will be required to
20 submit a cost report on a form(s) approved and provided by the COUNTY to reflect actual costs and
21 reimbursement for services provided through funding sources other than DMC. Contracts that include a
22 negotiated rate per unit of service will be reimbursed only for the costs of approved units of service up
23 to the negotiated unit of service rate approved in the Agreement, regardless of the contract maximum. If
24 the cost report indicates an amount due to COUNTY, PROVIDER shall submit payment with the report.
25 If an amount is due to PROVIDER COUNTY shall reimburse PROVIDER within forty-five (45) days of
26 receiving and accepting the year-end cost report.
27 3) MULTIPLE FUNDING SOURCES — If PROVIDER has multiple
28 agreements for the same services provided at the same location where at least one of the Agreements
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1 is funded through DMC and the other funding is other federal or county realignment funding, it will be
2 required to complete DMC cost reports and COUNTY approved cost reports. Such Agreements will be
3 settled for actual costs in accordance with Medicaid reimbursement requirements as specified in Title
4 XIX or Title XXI of the Social Security Act; Title 22, and the State's Medicaid Plan. During the term of
5 this Agreement and thereafter, COUNTY and PROVIDER agree to settle dollar amounts disallowed or
6 settled in accordance with DHCS and COUNTY audit settlement findings. DHCS audit process is
7 approximately eighteen (18) to thirty-six (36) months following the close of the State fiscal year.
8 COUNTY may choose to appeal DHCS settlement results and therefore reserves the right to defer
9 payback settlement with PROVIDER until resolution of the appeal.
10 In the event that PROVIDER fails to provide such reports or other information required
11 hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments until
12 there is compliance. In addition, the PROVIDER shall provide written notification and explanation to the
13 COUNTY within fifteen (15) days of any funds received from another source to conduct the same
14 services covered by this Agreement.
15 17. EVALUATION — MONITORING
16 OUTCOMES — COUNTY's DBH Director, or her designee, and DHCS or their designees
17 shall monitor and evaluate the performance of PROVIDER under this Agreement to determine to the
18 best possible degree the success or failure of the services provided under this Agreement. At the
19 discretion of the COUNTY, a subcontractor may be obtained by the COUNTY to independently
20 evaluate and monitor the performance of the PROVIDER. PROVIDER shall participate in the evaluation
21 of the program as needed, at the discretion of COUNTY.
22 COUNTY shall recapture from PROVIDER the value of any services or other
23 expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
24 discretion of the COUNTY, recoupment can be made through a future invoice reduction or
25 reimbursement by the PROVIDER.
26 PROVIDER shall participate in a review of the program at least yearly or more
27 frequently, or as needed, at the discretion of COUNTY. The PROVIDER agrees to supply all
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1 information requested by the COUNTY, DHCS, and/or the subcontractor during the program evaluation,
2 monitoring, and/or review.
3 18. DATA SECURITY
4 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
5 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
6 COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
7 into a contractual relationship with the COUNTY for the purpose of providing services under this
8 Agreement must employ adequate data security measures to protect the confidential information
9 provided to PROVIDER by the COUNTY, including but not limited to the following:
10 A. PROVIDER-OWNED MOBILE, WIRELESS, OR HANDHELD DEVICES
11 PROVIDER may not connect to COUNTY networks via personally-owned mobile,
12 wireless or handheld devices, unless the following conditions are met:
13 1) PROVIDER has received authorization by COUNTY for telecommuting
14 purposes;
15 2) Current virus protection software is in place;
16 3) Mobile device has the remote wipe feature enabled; and
17 4) A secure connection is used.
18 B. PROVIDER-OWNED COMPUTERS OR COMPUTER PERIPHERALS
19 PROVIDER may not bring PROVIDER-owned computers or computer
20 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief Information
21 Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to
22 be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
23 means of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data
24 must be encrypted.
25 C. COUNTY-OWNED COMPUTER EQUIPMENT
26 PROVIDER or anyone having an employment relationship with the COUNTY
27 may not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
28 authorization from the COUNTY's Chief Information Officer, and/or designee(s).
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1 D. PROVIDER may not store COUNTY's private, confidential or sensitive data on
2 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
3 E. PROVIDER shall be responsible to employ strict controls to ensure the integrity
4 and security of COUNTY's confidential information and to prevent unauthorized access, viewing, use or
5 disclosure of data maintained in computer files, program documentation, data processing systems, data
6 files and data processing equipment which stores or processes COUNTY data internally and externally.
7 F. Confidential client information transmitted to one party by the other by means of
8 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
9 BIT or higher. Additionally, a password or pass phrase must be utilized.
10 G. PROVIDER is responsible to immediately notify COUNTY of any violations,
11 breaches or potential breaches of security related to COUNTY's confidential information, data
12 maintained in computer files, program documentation, data processing systems, data files and data
13 processing equipment which stores or processes COUNTY data internally or externally.
14 H. COUNTY shall provide oversight to PROVIDER's response to all incidents
15 arising from a possible breach of security related to COUNTY's confidential client information provided
16 to PROVIDER. PROVIDER will be responsible to issue any notification to affected individuals as
17 required by law or as deemed necessary by COUNTY in its sole discretion. PROVIDER will be
18 responsible for all costs incurred as a result of providing the required notification.
19 19. PERINATAL SERVICES
20 PROVIDER shall comply with the requirements for "Perinatal Services Network
21 Guidelines FY 2016-17, available at the DHCS web address at:
22 http://www.dhcs.ca.gov/individuals/Pages/OWPS-SLin — and by this reference incorporated herein,
23 and the State-County Contract between DHCS and the COUNTY until such time new Perinatal
24 Services Network Guidelines and the State-County Contract are updated and adopted. No formal
25 amendment of this contract is required for new guidelines to apply.
26 PROVIDER shall comply with federal and state mandates to provide alcohol and other
27 drug treatment services deemed medically necessary for Medi-Cal eligible: (1) pregnant and
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1 postpartum women, and (2) youth under age 21 who are eligible under the Early and Periodic
2 Screening, Diagnostic, and Treatment (EPSDT) Program.
3 PROVIDER shall require that counselors of perinatal DMC services are properly certified
4 to provide these services and comply with the requirements contained in Title 22, Section 51 341 .I,
5 Services for Pregnant and Postpartum Women and Title 9 commencing with section 10360.
6 20. INTERIM SERVICES
7 PROVIDER must adhere to the State-County Contract requirement to provide Interim
8 Services in the event that an individual must wait to be placed in treatment.
9 Interim Substance Abuse Services means services that are provided until an individual is
10 admitted to a substance abuse treatment program. The purposes of the services are to reduce the
11 adverse health effects of such abuse, promote the health of the individual, and reduce the risk of
12 transmission of disease. At a minimum, interim services include counseling and education about HIV
13 and tuberculosis (TB), about the risks of needle-sharing, the risks of transmission to sexual partners
14 and infants, and about steps that can be taken to ensure the HIV and TB transmission does not occur,
15 as well as referral for HIV or TB treatment services if necessary. For pregnant women, interim services
16 also include counseling on the effects of alcohol and drug use on the fetus, as well as referral for
17 prenatal care.
18 Records must indicate evidence that Interim Services have been provided and
19 documentation will be reviewed for compliance.
20 21. REFERENCES TO LAWS AND RULES
21 In the event any law, regulation, or policy referred to in this Agreement is amended
22 during the term thereof, the parties hereto agree to comply with the amended provision as of the
23 effective date of such amendment.
24 22. STATE ALCOHOL AND DRUG REQUIREMENTS
25 A. INDEMNIFICATION
26 The PROVIDER agrees to indemnify, defend and save harmless the State, its
27 officers, agents and employees from any and all claims and losses accruing or resulting to any and all
28 contractors, subcontractors, materialmen, laborers and any other person, firm or corporation furnishing
16
1 or supplying work, services, materials or supplies in connection with the performance of this Agreement
2 and from any and all claims and losses accruing or resulting to any person, firm or corporation who may
3 be injured or damaged by the PROVIDER in the performance of this Agreement.
4 B. INDEPENDENT CONTRACTOR
5 The PROVIDER and the agents and employees of PROVIDER, in the
6 performance of this Agreement, shall act in an independent capacity and not as officers or employees
7 or agents of State of California.
8 C. CONTROL REQUIREMENTS
9 This Agreement is subject to all applicable Federal and State laws, regulations
10 and standards. PROVIDER shall establish written procedures consistent with State-County Contract
11 requirements. The provisions of this Agreement are not intended to abrogate any provisions of law or
12 regulation existing or enacted during the term of this Agreement.
13 D. CONFIDENTIALITY
14 PROVIDER shall conform to and COUNTY shall monitor compliance with all
15 State of California and Federal statutes and regulations regarding confidentiality, including but not
16 limited to confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations;
17 California Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6
18 of the California Health and Safety Code; Title 22, California Code of Regulations, section 51009; and
19 Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
20 E. REVENUE COLLECTION POLICY
21 PROVIDER shall conform to all policies and procedures regarding revenue
22 collection issued by the State under the provisions of the Health and Safety Code, Division 10.5.
23 F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
24 PROVIDER agrees that all funds paid out by the State shall be used exclusively
25 for providing alcohol and/or drug program services, administrative costs, and allowable overhead.
26 G. ACCESS TO SERVICES
27 PROVIDER shall provide accessible and appropriate services in accordance with
28 Federal and State statutes and regulations to all eligible persons.
17
1 H. REPORTS
2 PROVIDER agrees to participate in surveys related to the performance of this
3 Agreement and expenditure of funds and agrees to provide any such information in a mutually agreed
4 upon format.
5 I. AUDITS
6 All State and Federal funds furnished to the PROVIDER pursuant to this
7 Agreement along with related patient fees, third party payments, or other related revenues and funds
8 commingled with the foregoing funds are subject to audit by the State. The State may audit all alcohol
9 and drug program revenue and expenditures contained in this Agreement for the purpose of
10 establishing the basis for the subsequent year's negotiation.
11 J. RECORDS MAINTENANCE
12 1) PROVIDER shall maintain books, records, documents, and other
13 evidence necessary to monitor and audit this Agreement.
14 2) PROVIDER shall maintain adequate program and fiscal records relating
15 to individuals served under the terms of this Agreement, as required, to meet the needs of the State in
16 monitoring quality, quantity, fiscal accountability, and accessibility of services. Information on each
17 individual shall include, but not be limited to, admission records, patient and participant interviews and
18 progress notes, and records of service provided by various service locations, in sufficient detail to make
19 possible an evaluation of services provided and compliance with this Agreement.
20 23. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
21 COUNTY and PROVIDER each consider and represent themselves as covered entities
22 as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
23 191(HIPAA) and agree to use and disclose protected health information as required by law.
24 COUNTY and PROVIDER acknowledge that the exchange of protected health
25 information between them is only for treatment, payment, and health care operations.
26 COUNTY and PROVIDER intend to protect the privacy and provide for the security of
27 Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
28 Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
18
1 regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
2 Regulations) and other applicable laws.
3 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
4 PROVIDER to enter into a contract containing specific requirements prior to the
5 disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and
6 164.504(e) of the Code of Federal Regulations (CFR).
7 24. CULTURAL COMPETENCY
8 As related to Cultural and Linguistic Competence, PROVIDER shall comply with:
9 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
10 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
11 from discriminating against persons based on race, color, national origin, sex, disability or religion. This
12 is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
13 participation in federally funded programs through the provision of comprehensive and quality bilingual
14 services.
15 B. Policies and procedures for ensuring access and appropriate use of trained
16 interpreters and material translation services for all LEP consumers, including, but not limited to,
17 assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
18 procedures, and monitoring its language assistance program. The PROVIDER's procedures must
19 include ensuring compliance of any sub-contracted providers with these requirements.
20 C. PROVIDER assurances that minors shall not be used as interpreters.
21 D. PROVIDER shall provide and pay for interpreting and translation services to
22 persons participating in PROVIDER's services who have limited or no English language proficiency,
23 including services to persons who are deaf or blind. Interpreter and translation services shall be
24 provided as necessary to allow such participants meaningful access to the programs, services and
25 benefits provided by PROVIDER. Interpreter and translation services, including translation of
26 PROVIDER's "vital documents" (those documents that contain information that is critical for accessing
27 PROVIDER's services or are required by law) shall be provided to participants at no cost to the
28 participant. PROVIDER shall ensure that any employees, agents, subcontractors, or partners who
19
1 interpret or translate for a program participant, or who directly communicate with a program participant
2 in a language other than English, demonstrate proficiency in the participant's language and can
3 effectively communicate any specialized terms and concepts peculiar to PROVIDER's services.
4 E. In compliance with the State mandated Culturally and Linguistically Appropriate
5 Services standards as published by the Office of Minority Health, PROVIDER must submit to COUNTY
6 for approval, within 60 days from date of contract execution, PROVIDER's plan to address all fifteen
7 national cultural competency standards as set forth in the "National Standards on Culturally and
8 Linguistically Appropriate Services" (CLAS), attached hereto as Exhibit D, and incorporated herein by
9 this reference. County's annual on-site review of PROVIDER shall include collection of documentation
10 to ensure all national standards are implemented. As the national competency standards are updated,
11 PROVIDER's plan must be updated accordingly.
12 F. PROVIDER shall complete and submit county-issued CLAS self-assessment
13 annually. PROVIDER shall update CLAS plan as necessary.
14 25. SINGLE AUDIT CLAUSE
15 A. If PROVIDER expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or
16 more in Federal and Federal flow-through monies, PROVIDER agrees to conduct an annual audit in
17 accordance with the requirements of the Single Audit Standards as set forth in 2CFR Part 200.
18 PROVIDER shall submit said audit and management letter to COUNTY. The audit must include a
19 statement of findings or a statement that there were no findings. If there were negative findings,
20 PROVIDER must include a corrective action plan signed by an authorized individual. PROVIDER
21 agrees to take action to correct any material non-compliance or weakness found as a result of such
22 audit. Such audit shall be delivered to COUNTY's Department of Behavioral Health, Business Office
23 for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
24 received for the program. Failure to perform the requisite audit functions as required by this Agreement
25 may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with
26 a public accountant to perform said audit, or, may result in the inability of COUNTY to enter into future
27 agreements with PROVIDER. All audit costs related to this Agreement are the sole responsibility of
28 PROVIDER.
20
1 B. A single audit report is not applicable if PROVIDER's Federal contracts do not
2 exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or PROVIDER's only
3 funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
4 performed and a program audit report with management letter shall be submitted by PROVIDER to
5 COUNTY as a minimum requirement to attest to PROVIDER's solvency. Said audit report shall be
6 delivered to COUNTY's Department of Behavioral Health, Business Office for review, no later than nine
7 (9) months after the close of the fiscal year in which the funds supplied through this Agreement are
8 expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks
9 or contracting with a qualified accountant to perform said audit. All audit costs related to this
10 Agreement are the sole responsibility of PROVIDER who agrees to take corrective action to eliminate
11 any material noncompliance or weakness found as a result of such audit. Audit work performed by
12 COUNTY under this section shall be billed to the PROVIDER at COUNTY's cost, as determined by
13 COUNTY's Auditor-Controller/Treasurer-Tax Collector.
14 PROVIDER shall make available all records and accounts for inspection by COUNTY,
15 the State of California, if applicable, the Comptroller General of the United States, the Federal Grantor
16 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at least
17 three (3) years following final payment under this Agreement or the closure of all other pending matters,
18 whichever is later.
19 26. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
20 To the extent necessary to prevent disallowance of reimbursement under section
21 1861(v) (1) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[1]), until the expiration of four (4)
22 years after the furnishing of services under this Agreement, PROVIDER shall make available, upon
23 written request of the Secretary of the United States Department of Health and Human Services, or
24 upon request of the Comptroller General of the United States General Accounting Office, or any of their
25 duly authorized representatives, a copy of this Agreement and such books, documents, and records as
26 are necessary to certify the nature and extent of the costs of these services provided by PROVIDER
27 under this Agreement. PROVIDER further agrees that in the event PROVIDER carries out any of its
28 duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
21
1 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
2 Agreement shall contain a clause to the effect that until the expiration of four (4) years after the
3 furnishing of such services pursuant to such subcontract, the related organizations shall make
4 available, upon written request of the Secretary of the United States Department of Health and Human
5 Services, or upon request of the Comptroller General of the United States General Accounting Office,
6 or any of their duly authorized representatives, a copy of such subcontract and such books, documents,
7 and records of such organization as are necessary to verify the nature and extent of such costs.
8 27. COMPLIANCE WITH LAWS AND POLICIES
9 PROVIDER shall comply with all applicable rules and regulations set forth in Titles 9 and
10 22 of the California Code of Regulations, and California Health and Safety Code section 11750 et seq.
11 PROVIDER shall comply with any other Federal and State laws or guidelines applicable to
12 PROVIDER's performance under this Agreement or any local ordinances, regulations, or policies
13 applicable. Such provisions include, but are not restricted to:
14 A. PROVIDER shall provide that each client's ability to pay for services is
15 determined by the use of the method approved by COUNTY.
16 B. PROVIDER shall establish and use COUNTY's approved method of determining
17 and collecting fees from clients.
18 C. PROVIDER shall furnish client records in accordance with the applicable Federal
19 and State regulations, and with the Standards for Alcohol and Drug Treatment Programs set forth by
20 the State Department of Alcohol and Drug Programs, including in such records a treatment plan for
21 each client, and evidence of each service rendered.
22 D. PROVIDER shall submit accurate, complete and timely claims and cost reports,
23 reporting only allowable costs.
24 E. PROVIDER shall comply with statistical reporting and program evaluation
25 systems as provided in State of California regulations and in this Agreement.
26 F. PROVIDER shall comply with requirements contained in the State-County
27 Contract with DHCS by this reference incorporated herein, until such time that a new State-County
28
22
1 Contract is established. Upon amendment of the State-County Contract, the terms of the amended
2 Contract shall automatically be incorporated into this Agreement.
3 28. FEDERAL CERTIFICATIONS
4 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
5 VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS
6 A. DBH and PROVIDER recognize that Federal assistance funds will be used under
7 the terms of this Agreement. For purposes of this section, DBH will be referred to as the "prospective
8 recipient".
9 B. This certification is required by the regulations implementing Executive Order
10 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants' responsibilities. The
11 regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).
12 1) The prospective recipient of Federal assistance funds certifies by entering
13 this Agreement, that neither it nor its principals are presently debarred, suspended, proposed for
14 debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
15 Federal department or agency.
16 2) The prospective recipient of funds agrees by entering into this
17 Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person who is
18 debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
19 transaction, unless authorized by the Federal department or agency with which this transaction
20 originated.
21 3) Where the prospective recipient of Federal assistance funds is unable to
22 certify to any of the statements in this certification, such prospective participant shall attach an
23 explanation to this Agreement.
24 4) The PROVIDER shall provide immediate written notice to DBH if at any
25 time PROVIDER learns that its certification in this clause of this Agreement was erroneous when
26 submitted or has become erroneous by reason of changed circumstances.
27 5) The prospective recipient further agrees that by entering into this
28 Agreement, it will include a clause identical to this clause of this Agreement, and titled "Certification
23
1 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered
2 Transactions", in all lower tier covered transactions and in all solicitations for lower tier covered
3 transactions.
4 6) The certification in this clause of this Agreement is a material
5 representation of fact upon which reliance was placed by COUNTY when this transaction was entered
6 into.
7 29. CLEAN AIR AND WATER
8 In the event funding under this Agreement exceeds one hundred thousand dollars ($100,000.00),
9 the PROVIDER must comply with all applicable standards, orders, or requirements issued under
10 section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), section 506 of the Clean Water Act (33 U.S.C.
11 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR part 32).
12 30. ENERGY EFFICIENCY
13 The PROVIDER must comply with the mandatory standards and policies relating to energy
14 efficiency which are contained in the state energy conservation plan issued in compliance with Energy
15 Policy and Conservation Act (Pub. L. 94 163).
16 31. NON-DISCRIMINATION PROVISION
17 A. ELIGIBILITY FOR SERVICES — PROVIDER shall prepare, prominently post in its
18 facility, and make available to the DBH Director or her designee and to the public all eligibility
19 requirements to participate in the program funded under this Agreement. PROVIDER shall not
20 unlawfully discriminate in the provision of services because of race, religious creed, color, national
21 origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
22 status, sex, gender, gender identity, gender expression, age, sexual orientation, or military or veteran
23 status as provided by State of California and Federal law in accordance with Title VI of the Civil Rights
24 Act of 1964 (42 USC section 2000(d)); Age Discrimination Act of 1975 (42 USC section 1681);
25 Rehabilitation Act of 1973 (29 USC section 794); Education Amendments of 1972 (20 USC section
26 1681); Americans with Disabilities Act of 1990 (42 USC section 12132); Title 45, Code of Federal
27 Regulations, Part 84; provisions of the Fair Employment and Housing Act (California Government Code
28 section 12900); and regulations promulgated thereunder (Title 2, CCR, section 7285.0); Title 2, Division
24
1 3, Article 9.5 of the California Government Code commencing with section 11135; and Title 9, Division
2 4, Chapter 6 of the California Code of Regulations commencing with section 10800.
3 B. EQUAL OPPORTUNITY— PROVIDER shall comply with California Government
4 Code, section 12990 and California Code of Regulations, Title II, Division 4, Chapter 5, in matters
5 related to the development, implementation, and maintenance of a nondiscrimination program.
6 PROVIDER shall not discriminate against any employee or applicant for employment because race,
7 religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
8 genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual
9 orientation, or military or veteran status. Such practices include retirement, recruitment, advertising,
10 hiring, layoff, termination, upgrading, demotion, transfer, rates of pay or other forms of compensation,
11 use of facilities, and other terms and conditions of employment. PROVIDER agrees to post in
12 conspicuous places, notices available to all employees and applicants for employment setting forth the
13 provisions of the Equal Opportunity Act (42 USC section 2000(e)) in conformance with Federal
14 Executive Order No. 11246. PROVIDER agrees to comply with the provisions of the Rehabilitation Act
15 of 1973 (29 USC Section 794).
16 C. SUSPENSION OF COMPENSATION — If an allegation of discrimination occurs,
17 DBH may withhold all further funds, until PROVIDER can show by clear and convincing evidence to the
18 satisfaction of DBH that funds provided under this Agreement were not used in connection with the
19 alleged discrimination.
20 D. NEPOTISM — Except by consent of the DBH Director or her designee, no person
21 shall be employed by PROVIDER who is related by blood or marriage to or who is a member of the
22 Board of Directors or an officer of PROVIDER.
23 E. NEW FACILITIES AND DISABILITY ACCESS — New facilities shall be
24 wheelchair accessible and provide access to the disabled, consistent with Title 9, California Code of
25 Regulations, section 10820. If a new facility will be utilized, a plan ensuring accessibility to the disabled
26 must be developed. DBH shall assess, monitor, and document PROVIDER'S compliance with the
27 Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
28 recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without
25
1 regard to physical or mental disability and that PROVIDER has provided a facility accessible to the
2 physically disabled.
3 32. ASSURANCES
4 In entering into this Agreement, PROVIDER certifies that it is not currently excluded,
5 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; that it
6 has not been convicted of a criminal offense related to the provision of health care items or services;
7 nor has it been reinstated to participation in the Federal Health Care Programs after a period of
8 exclusion, suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a
9 contract, that PROVIDER is ineligible on these grounds, COUNTY will remove PROVIDER from
10 responsibility for, or involvement with, COUNTY's business operations related to the Federal Health
11 Care Programs and shall remove such PROVIDER from any position in which PROVIDER's
12 compensation, or the items or services rendered, ordered or prescribed by PROVIDER may be paid in
13 whole or part, directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds
14 at least until such time as PROVIDER is reinstated into participation in the Federal Health Care
15 Programs. Further the PROVIDER agrees to the Disclosure of Criminal History and Civil Actions and
16 Certification regarding debarment suspension and other responsibility matters primary covered
17 transactions; PROVIDER must sign an appropriate Certification regarding debarment, suspension, and
18 other responsibility matters, attached hereto as Exhibit E, incorporated herein by reference and made
19 part of this Agreement.
20 A. If COUNTY has notice that PROVIDER has been charged with a criminal offense
21 related to any Federal Health Care Program, or is proposed for exclusion during the term on any
22 contract, PROVIDER and COUNTY shall take all appropriate actions to ensure the accuracy of any
23 claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
24 COUNTY may request that PROVIDER cease providing services until resolution of the charges or the
25 proposed exclusion.
26 B. PROVIDER agrees that all potential new employees of PROVIDER or
27 subcontractors of PROVIDER who, in each case, are expected to perform professional services under
28 this Agreement, will be queried as to whether (1) they are now or ever have been excluded, suspended,
26
1 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they have been
2 convicted of a criminal offense related to the provision of health care items or services; and or (3) they
3 have been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
4 suspension, debarment, or ineligibility.
5 1) In the event the potential employee or subcontractor informs PROVIDER
6 that he or she is excluded, suspended, debarred or otherwise ineligible, or has been convicted of a
7 criminal offense relating to the provision of health care services, and PROVIDER hires or engages such
8 potential employee or subcontractor, PROVIDER will ensure that said employee or subcontractor does
9 no work, either directly or indirectly relating to services provided to COUNTY.
10 2) Notwithstanding the above, COUNTY at its discretion may terminate this
11 Agreement in accordance with Section Three (3), TERMINATION, of this Agreement, or require
12 adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
13 employee or subcontractor of PROVIDER will perform work, either directly or indirectly, relating to
14 services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
15 frame to be determined by COUNTY to protect the interests of COUNTY consumers.
16 C. PROVIDER shall verify (by asking the applicable employees and
17 subcontractors) that all current employees and existing subcontractors who, in each case, are expected
18 to perform professional services under this Agreement (1) are not currently excluded, suspended,
19 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
20 convicted of a criminal offense related to the provision of health care items or services; and (3) have not
21 been reinstated to participation in the Federal Health Care Program after a period of exclusion,
22 suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
23 PROVIDER that he or she is excluded, suspended, debarred or otherwise ineligible to participate in the
24 Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision of
25 health care services, PROVIDER will ensure that said employee or subcontractor does no work, either
26 direct or indirect, relating to services provided to COUNTY.
27 1) PROVIDER agrees to notify COUNTY immediately during the term of this
28 Agreement whenever PROVIDER learns that an employee or subcontractor who, in each case, is
27
1 providing professional services under this Agreement is excluded, suspended, debarred or otherwise
2 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense
3 relating to the provision of health care services.
4 2) Notwithstanding the above, COUNTY at its discretion may terminate this
5 Agreement in accordance with the Section Three (3), TERMINATION, of this Agreement, or require
6 adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
7 employee or subcontractor of PROVIDER will perform work, either directly or indirectly, relating to
8 services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
9 frame to be determined by COUNTY to protect the interests of COUNTY consumers.
10 D. PROVIDER agrees to cooperate fully with any reasonable requests for
11 information from COUNTY which may be necessary to complete any internal or external audits relating
12 to this Agreement.
13 E. PROVIDER agrees to reimburse COUNTY for the entire cost of any penalty
14 imposed upon COUNTY by the Federal Government as a result of PROVIDER's violation of the terms
15 of this Agreement.
16 33. AUDITS AND INSPECTIONS
17 The PROVIDER shall at any time during business hours, and as often as the COUNTY
18 may deem necessary, make available to the COUNTY for examination all of its records and data with
19 respect to the matters covered by this Agreement. The PROVIDER shall, upon request by the
20 COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to ensure
21 PROVIDER's compliance with the terms of this Agreement.
22 If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00), PROVIDER
23 shall be subject to the examination and audit of the Auditor General for a period of three (3) years after
24 final payment under contract (Government Code Section 8546.7).
25 Notwithstanding the provisions stated in Section Two (2), TERM, of this Agreement, it is
26 acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all
27 audit procedures and requirements as stated in this Agreement have been completed to the review and
28 satisfaction of COUNTY. PROVIDER shall bear all costs in connection with or resulting from any audit
28
1 and/or inspections including, but not limited to, actual costs incurred and the payment of any
2 expenditures disallowed by either COUNTY, State, or Federal governmental entities, including any
3 assessed interest and penalties.
4 34. RECORDS
5 A. RECORD ESTABLISHMENT AND MAINTENANCE — PROVIDER shall establish
6 and maintain records in accordance with State and Federal rules and regulations in addition to those
7 requirements prescribed by COUNTY with respect to all matters covered by this Agreement. Except as
8 otherwise authorized by COUNTY, PROVIDER shall retain all other records for a period of five (5)
9 years after receiving the final payment under this Agreement or the earlier termination of this
10 Agreement, or until State and/or Federal audit findings applicable to such services are resolved,
11 whichever is later.
12 B. DOCUMENTATION — PROVIDER shall maintain adequate records in sufficient
13 detail to make possible an evaluation of services, and contain all the data necessary in reporting to the
14 State of California and/or Federal agency. All client records shall be maintained pursuant to applicable
15 State of California and Federal requirements concerning confidentiality.
16 C. REPORTS — PROVIDER shall submit to COUNTY monthly fiscal and all program
17 reports as further described in Section Sixteen (16) REPORTS — SUBSTANCE USE DISORDER
18 SERVICES. PROVIDER shall submit a complete and accurate year-end cost report for each fiscal year
19 affected by this Agreement, following the end of each fiscal year affected by this Agreement.
20 PROVIDER shall also furnish to COUNTY such statements, records, reports, data, and information as
21 COUNTY may request pertaining to matters covered by this Agreement. All reports submitted by
22 PROVIDER to COUNTY must be typewritten.
23 D. SUSPENSION OF COMPENSATION — In the event that PROVIDER fails to
24 provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
25 payments until there is compliance.
26 E. DISALLOWANCES — Payments by COUNTY shall be in arrears, for services
27 provided during the preceding month, within forty-five (45) days after receipt, verification and approval
28 of PROVIDER invoices by COUNTY'S DBH Contracts Division - SLID Services. If payment for services
29
1 are denied or disallowed by State; and subsequently resubmitted to COUNTY by PROVIDER, the
2 disallowed portion will be withheld from the next reimbursement to the PROVIDER until COUNTY has
3 received has received reimbursement from State for said services.
4 F. CLIENT CONFIDENTIALITY— PROVIDER shall conform to and COUNTY shall
5 monitor compliance with all State and Federal statutes and regulations regarding confidentiality,
6 including but not limited to confidentiality of information requirements of 42 Code of Federal
7 Regulations § 2.1 et seq., Welfare and Institutions Code §§ 5328, 10850 and 14100.2, Health and
8 Safety Code §§ 11977 and 11812, Civil Code, Division 1, Part 2.6, and 22 California Code of
9 Regulations § 51009.
10 35. NOTICES
11 The persons and their addresses having authority to give and receive notices under this
12 Agreement include the following:
13 COUNTY PROVIDER
14 Director, Fresno County BAART Behavioral Health Services, Inc.
15 Department of Behavioral Health 1720 Lakepoint Dr., Ste 117
16 4441 East Kings Canyon Lewisville, TX 75057
17 Fresno, CA 93702
18 Any and all notices between the COUNTY and the PROVIDER provided for or permitted
19 under this Agreement or by law shall be in writing and shall be deemed duly served when personally
20 delivered to one of the parties, or in lieu of such personal services, when deposited in the United States
21 Mail, postage prepaid, addressed to such party.
22 36. CHANGE OF LEADERSHIP/MANAGEMENT
23 Any and all notices between COUNTY and PROVIDER provided for or permitted under
24 this Agreement or by law, shall be in writing and shall be deemed duly served when personally
25 delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
26 Mail, postage prepaid, addressed to such party.
27 In the event of any change in the status of PROVIDER's leadership or management,
28 PROVIDER shall provide written notice to COUNTY within thirty (30) days from the date of change.
30
1 Such notification shall include any new leader or manager's name, address and qualifications.
2 "Leadership or management" shall include any employee, member, or owner of PROVIDER who either
3 a) directs individuals providing services pursuant to this Agreement; b) exercises control over the
4 manner in which services are provided; or c) has authority over PROVIDER's finances.
5 37. CHARITABLE CHOICE
6 PROVIDER may not discriminate in its program delivery against a client or potential
7 client on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal to
8 actively participate in a religious practice. Any specifically religious activity or service made available to
9 individuals by the PROVIDER must be voluntary as well as separate in time and location from County
10 funded activities and services. PROVIDER shall inform County as to whether it is faith-based. If
11 PROVIDER identifies as faith-based it must submit to DBH Contracts Division - SUD Services a copy of
12 its policy on referring individuals to alternate treatment PROVIDER, and include a copy of this policy in
13 its client admission forms. The policy must inform individuals that they may be referred to an
14 alternative provider if they object to the religious nature of the program, and include a notice to SUD
15 Services. Adherence to this policy will be monitored during annual site reviews, and a review of client
16 files. If PROVIDER identifies as faith-based, by July 1 of each year PROVIDER will be required to
17 report to SUD Services the number of individuals who requested referrals to alternate providers based
18 on religious objection.
19 38. LICENSING-CERTIFICATES
20 Throughout each term of this Agreement, PROVIDER and PROVIDER's staff shall
21 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for
22 the provision of the services hereunder and required by the laws and regulations of the United States of
23 America, State of California, the County of Fresno, and any other applicable governmental agencies.
24 PROVIDER shall notify COUNTY immediately in writing of its inability to obtain or maintain such
25 licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
26 appeal related thereto. Additionally, PROVIDER and PROVIDER's staff shall comply with all applicable
27 laws, rules or regulations, as may now exist or be hereafter changed.
28
31
1 39. AOD CERTIFICATION
2 A. The COUNTY requires all COUNTY contracted providers of Alcohol and Other
3 Substance Use Disorder treatment services to obtain the California Department of Health Care
4 Services (DHCS) Alcohol and Other Drug Program (AOD) Certification. The AOD Certification
5 Standards will apply to all residential and outpatient treatment modalities. The purpose of the AOD
6 Certification Standards is to ensure an acceptable level of service quality is provided to program
7 participants.
8 B. PROVIDER shall provide proof of a completed application for AOD Certification
9 to the County within thirty (30) days from the execution date of this Agreement with the COUNTY. A
10 copy of the AOD Certification shall be submitted to the COUNTY when approved by the California
11 Department of Alcohol Drug Programs.
12 C. This AOD Certification requirement applies to every treatment facility operated by
13 the PROVIDER. PROVIDER whose agencies are nationally accredited with the Joint Commission on
14 Accreditation of Health Care Organizations (JCAHO) or the Commission on Accreditation of
15 Rehabilitative Facilities (CARF) are exempt from this requirement of AOD Certification. PROVIDER
16 shall submit a copy of their JCAHO or CARF accreditation to the COUNTY within thirty (30) days from
17 the date this Agreement is executed. PROVIDER shall notify COUNTY if at any time their JCAHO or
18 CARF accreditation lapses or becomes invalid due to any reason during the term of this Agreement.
19 PROVIDER shall apply with DHCS for AOD Certification if their JCAHO or CARF accreditation lapses
20 or becomes invalid and shall submit a copy of the completed application for AOD Certification to the
21 COUNTY within thirty (30) days from the date the JCAHO or CARF accreditation lapses or becomes
22 invalid.
23 D. COUNTY shall terminate this Agreement immediately in the event any of the
24 following occurs:
25 1) PROVIDER fails to submit a copy of the completed application for AOD
26 Certification, or a copy of either their JCAHO or CARF accreditation within thirty (30) days from the
27 execution date of this Agreement with the COUNTY.
28 2) PROVIDER's application for AOD Certification is denied by DHCS.
32
1 3) PROVIDER fails to submit to the COUNTY a copy of the AOD
2 Certification within thirty (30) days after being approved by the DHCS, or certification is not maintained
3 throughout the contract period.
4 4) PROVIDER fails to apply for AOD Certification with DHCS or fails to
5 submit to the COUNTY a copy of the completed application for AOD Certification within thirty (30) days
6 after the JCAHO or CARF accreditation lapses or becomes invalid.
7 40. COMPLAINTS
8 PROVIDER shall log complaints and the disposition of all complaints from a consumer or
9 a consumer's family. PROVIDER shall provide a summary of the complaint log entries concerning
10 COUNTY-sponsored consumers to COUNTY at monthly intervals by the fifteenth (15th) day of the
11 following month, in a format that is mutually agreed upon. PROVIDER shall post signs informing
12 consumer of their right to file a complaint or grievance. PROVIDER shall notify COUNTY of all
13 incidents reportable to state licensing bodies that affect COUNTY consumers within twenty-four (24)
14 hours of receipt of a complaint.
15 Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
16 consumers, PROVIDER shall provide COUNTY with information relevant to the complaint, investigative
17 details of the complaint, the complaint and PROVIDER's disposition of, or corrective action taken to
18 resolve the complaint.
19 41. DRUG FREE WORKPLACE
20 PROVIDER shall comply with the requirements of the Drug-Free Work Place Act of 1990
21 (California Government Code section 8350 et seq.).
22 42. CHILD ABUSE REPORTING
23 PROVIDER shall utilize a procedure acceptable to the COUNTY to ensure that all of
24 PROVIDER's employees, volunteers, consultants, subcontractors or agents performing services under
25 this Agreement shall report all known or suspected child abuse or neglect to one or more of the
26 agencies set forth in Penal Code section 11165.9. This procedure shall include having all of
27 PROVIDER's employees, volunteers, consultants, subcontractors or agents performing services under
28 this Agreement sign a statement that he or she knows of and will comply with the reporting
33
1 requirements set forth in Penal Code section 11166. The statement to be utilized by PROVIDER for
2 reporting is set forth in Exhibit F, "Notice of Child Abuse Reporting," attached hereto and by this
3 reference incorporated herein.
4 43. TRAFFICKING IN PERSONS PROVISIONS
5 PROVIDER shall conform to all Federal statutes and regulations prohibiting trafficking in
6 persons, as well as trafficking-related activities, including, but not limited to the trafficking of persons
7 provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000 (TVPA) as amended by
8 Section 1702.
9 PROVIDER, PROVIDER's employees, subrecipients, and subrecipients' employees may
10 not:
11 A. Engage in severe forms of trafficking in persons during the period of time that the
12 award is in effect;
13 B. Procure a commercial sex act during the period of time that the award is in effect;
14 or
15 C. Use forced labor in the performance of the award or subawards under the award.
16 This agreement may be unilaterally terminated, without penalty, if PROVIDER or a
17 subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or has an
18 employee who is determined by the DBH Director or her designee to have violated a prohibition of the
19 TVPA through conduct that is either associated with performance under the award or imputed to the
20 PROVIDER or their subrecipient using the standards and due process for imputing the conduct of an
21 individual to an organization that are provided in 2 C.F.R. Part 180, "OMB Guidelines to Agencies on
22 Government-wide Debarment and Suspension (Nonprocurement).
23 PROVIDER must inform the DBH Director or her designee immediately of any
24 information received from any source alleging a violation of a prohibition of the TVPA.
25 PROVIDER must sign a certification annually acknowledging the Trafficking Victims
26 Protection Act of 2000 requirements (TVPA Certification), attached hereto as Exhibit G, incorporated
27 herein by reference and made part of this Agreement and must require all employees to complete
28 annual TVPA training.
34
1 44. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
2 This provision is only applicable if PROVIDER is a disclosing entity, fiscal agent, or
3 managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
4 and 455.106(a)(1),(2).
5 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
6 the following information must be disclosed by PROVIDER by completing Exhibit H "Disclosure of
7 Ownership and Control Interest Statement," attached hereto and by this reference incorporated herein.
8 PROVIDER shall submit this form to the Department of Behavioral Health within thirty (30) days of the
9 effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via email
10 to DBHAdministration(a�_co.fresno.ca.us attention: Contracts Administration.
11 A. Name and address of any person(s)whether it be an individual or corporation
12 with an ownership or controlling interest in the disclosing entity or managed care entity.
13 1) Address must include the primary business address, every business
14 location and P.O. Box address(es).
15 2) Date of birth and Social Security Number for individuals.
16 3) Tax identification number for other corporations or entities with ownership
17 or controlling interest in the disclosing entity.
18 B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
19 interest.
20 C. Whether the person(s) with an ownership or controlling interest of the disclosing
21 entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
22 or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
23 related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
24 interest in any of its subcontractors.
25 D. Name of any other disclosing entity in which an owner of the disclosing entity has
26 an ownership or control interest.
27
28
35
1 E. The ownership of any subcontractor with whom the provider has had business
2 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
3 and
4 F. Any significant business transactions between the provider and any wholly
5 owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the
6 date of the request.
7 G. Any person(s)with an ownership or control interest in the provider, or agent or
8 managing employee of the provider; and
9 1) Has been convicted of a criminal offense related to that person's
10 involvement in any program under Medicare, Medicaid, or the title XX services program since the
11 inception of those programs.
12 H. The ownership of any subcontractor with whom the provider has had business
13 transactions totaling more than $25,000 during the 12-month period ending on the date of the request;
14 and
15 I. Any significant business transactions between the provider and any wholly
16 owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the
17 date of the request.
18 45. CONTROL REQUIREMENTS
19 Performance under this Agreement is subject to all applicable Federal and State laws,
20 regulations and standards. In accepting the State drug and alcohol combined program allocation
21 pursuant to California Health and Safety Code section 11757, PROVIDER shall establish written
22 accounting procedures consistent with applicable Federal and State laws, regulations and standards,
23 and shall be held accountable for audit exceptions taken by the State or COUNTY for failure to comply
24 with these requirements. These requirements include, but may not be limited to, those set forth in this
25 Agreement, and:
26 A. Division 10.5 of the California Health and Safety Code;
27 B. California Government Code sections 16366.1 through 16367.9 and 53130
28 through 53138;
36
1 C. Title 9, Division 4 of the California Code of Regulations;
2 D. 42 United States Code (U.S.C.) section 300x-5;
3 E. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
4 Amendments of 1996);
5 F. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and Audit
6 Requirements for Federal Awards); and
7 G. Title 45, Part 96, Subparts B, C and L of the Code of Federal Regulations (Block
8 Grants).
9 46. PROPERTY OF THE COUNTY
10 A. All purchases over Five Thousand and No/100 Dollars ($5,000.00) shall be
11 identified as fixed assets and shall be maintained in COUNTY's Asset Management System. Certain
12 purchases under Five Thousand and No/100 Dollars ($5,000.00) including but not limited to computers,
13 copiers, televisions, cameras and other sensitive items as determined by COUNTY's DBH Director or
14 designee made during the life of this Agreement shall be identified as assets that can be inventoried
15 and maintained in COUNTY's DBH Asset Inventory System. These assets shall be retained by
16 COUNTY, as COUNTY property, in the event this Agreement is terminated or upon expiration of this
17 Agreement. CONTRACTOR agrees to participate in an annual inventory of all COUNTY fixed and
18 inventoried assets and shall by physically present when fixed and inventoried assets are returned to
19 COUNTY possession at the termination or expiration of this Agreement. PROVIDER is responsible for
20 returning to COUNTY all COUNTY owned fixed and inventoried assets, or the monetary value of said
21 assets if unable to produce the assets at the expiration or termination of this Agreement.
22 PROVIDER further agrees to the following:
23 1) To maintain all items of equipment in good working order and condition,
24 normal wear and tear is expected;
25 2) To label all items of equipment, to perform periodic inventories as
26 required by COUNTY and to maintain an inventory list showing where and how the equipment is being
27 used, in accordance with procedures developed by COUNTY. All such lists shall be submitted to
28 COUNTY within ten (10) days of any request therefore; and
37
1 3) To report in writing to COUNTY immediately after discovery, the lost or
2 theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
3 and a copy of the police report submitted to COUNTY.
4 B. The purchase of any equipment by PROVIDER with funds provided hereunder
5 shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement
6 as appropriate, and must be directly related to PROVIDERS services or activity under the terms of this
7 Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from equipment
8 purchased, which are incurred by PROVIDER, if prior written approval has not been obtained from
9 COUNTY.
10 C. The terms and conditions described in this Section are not applicable to the
11 leasing of vehicles by PROVIDER with the funds provided under this Agreement.
12 47. UNLAWFUL USE OF DRUGS AND ALCOHOL
13 PROVIDER shall ensure that information provided to clients contains a clearly written
14 statement that there shall be no unlawful use of drugs or alcohol associated with PROVIDER.
15 Additionally PROVIDER shall ensure that no aspect of the program includes any message in materials,
16 curricula, teachings, or promotion of the responsible use, if the use is unlawful, of drugs or alcohol
17 pursuant to Health and Safety Code (HSC) 11999-11999.3. PROVIDER shall maintain that any
18 unlawful use of drugs and alcohol is illegal and dangerous.
19 PROVIDER must sign the Unlawful Use of Drugs and Alcohol Certification, attached
20 hereto as Exhibit I, incorporated herein by reference and made part of this Agreement agreeing to
21 uphold the obligations of HSC 11999 — 11999.3.
22 COUNTY shall enforce the requirement of"No Unlawful Use" set forth by DHCS and
23 requires PROVIDER to enforce the requirement as well.
24 This agreement may be unilaterally terminated, without penalty, if PROVIDER or a
25 subcontractor that is a private entity is determined to have violated a prohibition of the Unlawful Use of
26 Drugs and Alcohol message or has an employee who is determined by the DBH Director or her
27 designee to have violated a prohibition of the Unlawful Use of Drugs and Alcohol message.
28
38
1 48. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
2 PROVIDER shall adhere to the State-County Contract requirement that no funds shall
3 be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection
4 of any illegal drug unless the DHCS chooses to implement a demonstration syringe services program
5 for intravenous drug users.
6 49. CONFIDENTIALITY OATH
7 PROVIDER shall ensure that all of its employees sign a written confidentiality oath,
8 attached hereto as Exhibit J, before they begin employment with PROVIDER and shall renew said
9 document annually thereafter. PROVIDER shall retain each employee's written confidentiality oath for
10 COUNTY and DHCS inspection for a period of six (6) years following the termination of this agreement.
11 50. GOVERNING LAW
12 Venue for any action arising out of or related to this Agreement shall only be in Fresno
13 County, California.
14 The rights and obligations of the parties and all interpretation and performance of this
15 Agreement shall be governed in all respects by the laws of the State of California.
16 51. ENTIRE AGREEMENT
17 This Agreement, including all Exhibits, constitutes the entire Agreement between
18 PROVIDER and COUNTY with respect to the subject matter hereof and supersedes all previous
19 agreement negotiations, proposals, commitments, writings, advertisements, publications, and
20 understandings of any nature whatsoever unless expressly included in this Agreement.
21
22
23
24
25
26
27
28
39
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first
2 hereinabove written.
3
4
CONTRA OR COUNTY OF FRESNO
5 `
6 (Au#horized nat re) SoQlq*ro,- hairperson o the Board
7o ors f the County of Fresno
BAART BEHAVIORAL HEALTH SERVICES,INC.
8 Print Name &Title
9 _17201keoointe Drive. Suite 117
10
_,Lewisville.
11 Mailing Address ATTEST:
Bernice E. Seidel
12 Clerk of the Board of Supervisors
County of Fresno, State of California
13
14
15
16 By: a �, 4�n LSD
17
18
FOR ACCOUNTING USE ONLY:
19 Fund/Subclass: 0001110000
Organization: 56302081
20 Account/Program: 7295/0
21
22
23
24
25
26
27
28
40
.
Exhibit
SCOPE OF WORK
In-Custody Narcotic Treatment Program Services
ORGANIZATION: 8AART BEHAVIORAL HEALTH SERVICES, INC.
1720 Lakepoint Dc, Ste 117
LExmsv||e, TX75U57
SERVICE ADDRESS: 539N. Van Neem, Fremnm, C/\ 83728
PROGRAM DIRECTOR: Kiveugh8he|ton. (559) 488-0507
CONTRACT PERIOD: Juiy1` 2O18 through June 30. 2023
CONTRACT AMOUNT: $150.000.00onnuaUy /$750.000.00\
N_rP IN-CUSTODY F\/1S|NG SERVICES:
Narcotic Treatment Program (NTP) services will be provided to in-custody opiVid dependant
clients /18 and older) who received NTP services prior to incarceration and to those identified by
jail staff as potentially having an opioid dependence but are not currently receiving NTP
aen/|cae. Emphasis will be placed on stabilization during incarceration through the provision of
methadone dosing for clients who meet medical necessity. Additiona!|y. Bupnenorphine may be
Gd[n|n|stanad to clients who are under the care of physician who prescribed the medication
prior tuinomroenatimn.
8en/|cee must be performed within all applicable regulations and standards, including but not
limited to {}CR7-iUe 22. /\|ooho| and Other Drug (AOD) Certification 8tandmrds, CCR Title 0`
U.S. Drug Enforcement Administration ([]EA) regulations, all Department of Health Cana
8en/|cen (OMCS) K8onb3| Health Substance Use Disorder Services (K8HSUD8) |nfonnetion
Nctioaa. Fresno County GUO 8uUetinm, K8edi-Cal Certifications (Mental Health and SUD), and
any other required |mvvu, regu|ationa, po|inieo, or procedures nDGndobad by local, 8bate, or federal
agencies.
SERVICES TO BE PROVIDED
8AART will ba responsible for
^ Conducting oaaeaanlent, intnke, and dosing services seven (7) days per week during
NTP clinic hours.
, Providing jail noedino| staff adosing report daily, including dosing schedules.
~ Coordinating transportation to the primary NTP clinic, as needed.
~ Providing in-custody clients with nefeno|a and linkages to community-based substance
use disorder (GUD) tneatnnant services and other nomounoaa prior to na!eooe in order to
assist with continued engagement in treatment and or recovery man/ioea.
" Maintaining a daily census of all in-custody clients receiving NTP dosing services.
Exhibit A
Providing Fresno County with client, programmatic, and other demographic Information
upon request,
Client Centered Approach
Services provided to in-custody clients must be clinically appropriate, focused on long-term
recovery success, and include culturaJ/Iinguistic awareness while taking on an empathic,non-
judgmental, person-centered approach that fits the needs of the client.This includes referrals to
community-based treatment and recovery resources upon release from custody.
Licenses and Certifications
BAART must possess and maintain all of the necessary certifications, licenses and permits from
the Department of Health Care Services (DHCS)and U.S. Drug Enforcement Administration
(DER)for the duration of the contract.
Referrals
Clients continuing to receive NTP dosing services upon release from custody will be
referred to a community-based NTP provider for continued services based on client
preference and/or the geographic location of the treatment facility to the client's
residence.
Out-of-county clients must be referred back to their county of residence for continued services
unless they plan to establish a residence in Fresno County.These clients must transfer their
Medi-Cal benefits to Fresno County in order for the community-based treatment provider to be
eligible for reimbursement through a Fresno County contract.
Medication Management
BAART shall establish medication policies and procedures, which will inform the client of the
effects of the medication(s) as well as any side effects and risks. BAART will provide necessary
training on medication management to all staff that are involved in the care of the client.
giMEEINr2 99QQJBEM9NM:
BAART shall determine staffing levels needed to implement and maintain the program;
however, the agency must comply with CCR Title 9 regulations and any other federal, state, or
local requirements as applied to staff qualifications.
.9REIVANCES ANE) INCIPIENI MOM;
BAART must notify Fresno County of all Incidents or unusual occurrences reportable to state
licensing bodies that affect Fresno County clients within twenty-four(24) hours of the incident.
Within fifteen (15) days of a grievance or incident affecting a Fresno County-sponsored client
BAART shall submit a corrective action plan showing actions taken to resolve the complaint or
incident.
2
Exhibit A
ElMrasam OUICOM
MART must track and report the following outcome indicators to DBH on a quarterly basis in a
mutually accepted format:
1. 100% of identified in-custody clients will receive NTP dosing services within 24 hours of
initial request, and will continue to receive NTP dosing services as long as the NTP
physician deems the service medically necessary and the client is willing to participate.
2. 100%of in-custody clients receiving NTP services will be provided informational
resources about the medication they are prescribed including potential side-effects,
other services available, and the benefits of continued engagement in SUD treatment.
3. 100% of in-custody clients who receive NTP services will be provided with referrals to
appropriate community-based SUID treatment services prior to discharge from custody.
In-custody clients receiving NTP dosing services upon discharge must be referred to an
NTP. Referrals will be based on geographic location of the client's residence upon
release as well as the client's preference.
4. 100% of in-custody clients receiving NTP services will receive a satisfaction survey prior
to discharge,
S. 90% of surveys will reflect a perception of satisfactory care.
Outcomes
Outcomes related to timelessness of services, distribution of information related to NTP
services, referrals, and quality of care through survey data will be tracked utilizing the outcomes
measures mentioned above and will be made available during annual site reviews and upon
request from the County. Efficiency of services such as service delivery cost per service unit,
length of services provided, direct service hours of program staff and staff mileage will be
tracked.Attention to outcomes will be used for process improvement.
3
Exhibit B-1
Department of Health Care Services
Substance Use Disorders - Program, Prevention and Fiscal Division
Drug Medi-Cal (DMC) Rates for Fiscal Year 2017-18
Non-Perinatal DMC
Description Unit of Service (UOS) FY 2017-18
UOS Rate**
Narcotic Treatment Program (NTP)-Methadone Daily $13.11
NTP-Individual Counseling One 1 0-minute Increment $15.37
NTP-Group Counseling One 10-mInute Increment $3.43
Intensive Outpatient Treatment Face-to-Face Visit $58.53
Naltrexone Face-to-Face Visit $19.08
Outpatient Drug Free(ODF)Individual Counseling Face-to-Face Visit(Per Person) $76.91
ODF Group Counseling Face-to-Face Visit(Per Person) $30.89
Perinatal DMC
Description Unit of Service(UOS) FY 2017-18
UOS Rate,"
NTP-Methadone Daily $14.11
NTP-Individual Counseling One 10-minute Increment $16.39
NTP-Group Counseling One 10-minute Increment $4.28
Intensive Outpatient Treatment Face-to-Face Visit $84.43
Perinatal Residential Daily $90.14
ODF Individual Counseling Face-to-Face Visit(Per Person) $81.93
ODF Group Counseling Face-to-Face Visit(Per Person) $38.56
From FY 2002-03 through FY 2008-09,Naltrexone was frozen at the$2iA9(FY 1999-2000)approved rate.Counties
and service providers have not provided,submitted claims,nor reported cost for this service since FY 1997-98.For FY
2009-10,the$21.19 frozen rate was reduced by 10 percent to$19.07.Excluding county administration from the cost
data used to produce the$21.19 frozen approved rate decreased It to$19.06.Drug Medi-Cal used$19.06 as the FY
2017-18 developed rate,
FY 2009-2010 rates were adjusted by the cumulative growth of the change In the Implicit Price Deflator(IDP),In
accordance with Welfare&Institutions Code Section 14021.9(b).The 15.6 percent Is a year-to-year summation of the
change In IDP's which are as follows:0%for FY 2009-10,3.2%for FY 2010-11,2.5%for FY 2011-12,1.9%for
FY 2012-13,2.1%for FY 2013-14, 1.2%for FY 2014-16,0.4%for FY 2015-16,1.9%for FY 2016-17,and 2.4%for
FY 2017-18.
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Exhibit
Page of
SELF-DEALING"ITLANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members ofa 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.Axa>f-deaUng transaction is defined below:
"A self-dealing transaction means n transaction towhich the corporation Iso party and in which one
or more of its directors has omuteria/jnondal interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTION
(1) Enter board membees name,job title(if applicable), and date this disclosure is being made,
(2) Enter the board mernber's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County.A¢a minimum,include o 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.
(S) Form must be signed by the board member that Is Involved in the self-dealing transaction
Exhibit C
Page 1 of 2
{1}Company Board il(tember'lnformation„
Name: Date:
!ab TFtlec
=(2jCompan.VfRgep .Name) M Address',
(3};Disclosure(please describe ti a mature of the self dealing trarisastioii,you area party'to�
{4}? xp�alri'why tltls sOlf-deaI ngtransactlan is Conslstent,w.'. ahe're uirements of Corporations Cbde 5233(a,:
,' S &titfioi�lzeii�Si�neture`, .
Signature: Date:
Exhibit D
Page I of I
CULTURALLY AND UNGUIS11CALLY APPROPRIATE SERVICES
CONTRACTOR shall adhere to and develop written procedures in accordance with the below standards
adapted from the National Standards for Culturally and Linguistically Appropriate Services(CLAS)in
Health Care:
Culturally Competent Care:
1. Organizations must ensure that consumers receive from all staff members effective,
understandable,and respectful care that is provided in a manner compatible with
their cultural health beliefs and practices and preferred language.
2. Organizations must implement strategies to recruit,retain,and promote at all levels
of the organization a diverse staff and leadership that are representative of the
demographic characteristics of the service area.
3. Organizations must ensure that staff at all levels and across all disciplines receive
ongoing education and training In culturally and linguistically appropriate service
delivery.
Language Access Services:
4. Organizations must offer and provide language assistance services, including bilingual
staff and Interpreter services,at no cost to consumers with limited English proficiency
at all points of contact, in a timely manner during all hours of operation.
S. Organizations must provide to consumers in their preferred language both verbal
offers and written notices informing them of their right to receive language assistance
services.
6. Organizations must assure the competence of language assistance provided to limited
English proficient consumers by interpreters and bilingual staff. Family and friends
should not be used to provide Interpretation services(except on the request of the
consumer).
7. Organizations must make available easily understood patient-related materials and
post signage In the languages of the commonly encountered groups and/or groups
represented in the service area,
Organizational Supports:
8. Organizations must develop, implement, and promote a written strategic plan that
outlines clear goals, policies,operational plans,and management
accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
Exhibit
Page luf3
9. Organizations must conduct Initial and ongoing organizational self-assessments of
CLAS related activities and are encouraged to integrate cultural and linguistic
competence-related measures Into their Internal audits,performance Improvement
programs, consumer satisfaction Assessments, and Outcomes-Based Evaluations,
10. Organizations must ensure that data on the Individual consumer's race,ethnicity,and
spoken and written language are collected in program records, integrated into the
organizations management information systems,and periodically updated.
11. Organizations must maintain a current demographic,cultural,and epidemiological
profile of the community as well as a needs assessment to accurately plan for and
implement services that respond to the cultural and linguistic characteristics of the
service area.
12. Organizations must develop participatory,collaborative partnerships with
communities and utilize a variety of formal and Informal mechanisms to facilitate
community and consumer involvement In designing and Implementing CLAS-related
activities. '
13. Organizations must ensure that conflict and grievance resolution processes are
culturally and linguistically sensitive and capable of Identifying, preventing,and
resolving cross-cultural conflicts or complaints byconsumers.
14' Organizations must regularly make available to the public information about their
progress and successful innovations in Implementing these standards and to provide
public notice in their communities about the availability of this information.
15. Organizations must ensure communication regarding the organization's progress in
implementing and sustaining CLAS to all stakeholders,constituents,and general
public.
CONTRACTOR shall develop written procedures in accordance with the above standards. The
provisions of this Agreement are not Intended to abrogate any provisions of law or regulation existing
or enacted during the term of this Agreement,
Exhibit E
Page I 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
a 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 (ttpL1/www/epIs/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.
C:IUSERSWPRICHARDWESKTOPUiXHIBIT DISCLOSURE STATEMENTMOC
Exhibit E
Page 2o[3
CERTIFICATION ������������Q���� ���������B��������
- - - - - - ------- ---'~~~~~ DEBARMENT,
-- ----- ---~-~~O~~vA^~~~ O " ="=~R
RESPONSIBILITY �0���~��������=����B�������� ����������W���- - '-- ---- - - -'- -- ~ ~~~~~~ ~ ~~~~~°=="� " =°�� = m=°�°�"�
^���W�������°�N������
~ ~~��~���=°�� m °��°���
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 person to provide the certification naqu|nsd be/owVvU| 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 oran explanation shall disqumUfv
such person hnmmpad(c|pa�on|M this transaction,
'
3. The certification |n this clause (so material representation of fact upon which reliance was
placed when the department ar agency detemn|nedtoenterintmth' transaction. !fit 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 tothe
department or agency to which this proposal /m 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, pmrson,
primary covered transaction, principal, proposal, and voluntarily excluded, os used inthis
clause, have the meanings set out!n the Definitions and Coverage sections mf the rules
implementing Executive Order i2548. You may contact the department Vragency to which
this proposal ia being submitted for assistance inobtaining a copy of those regulations,
8. Nothing contained in the foregoing shall be construedt ire establishment of a system
u/ records /n order oz render/n good faith the certification requiredby this clause. The
knowledge and Information Pfo participant is not required to exceed that which imnormally
possessed byo prudent person ln the ordinary course nf business dealings.
0uVEn$IMpRICxxegV5SKTopiEXx|BITV|GCUOWRsGDATEMcNTo00
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 application1proposal 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: IwV6
CFO MA9�1_WHL
ififie—d-O—ame'- 9,Tlflle)_ 11-Nim e of Agency or Company)
MSERSWIPRICHARMOESKTOPEMBIT DISCLOSURE STATEMENT.000
Exhibit F
Page I of I
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.
§111 66(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 reportin requirements,
SIGNAT17— DATE
0980fadx
Exhibit G
Page I of 1
TRAFFICKING VICTIMS PROTECTION ACT OF 2000
CERTIFICATION
I, C)vVf'( as an authorized agent of
(Print1 Na, eb 60 -KAZ acknowledge the requirement to
(Organization Name)
comply with the Trafficking Victims Protection Act of 2000 (TVPA), specifically Section
106(g), which authorizes the County of Fresno to terminate a contract, without penalty,
if this organization or its employees, or a subcontractor or its employees:
• Engages in severe forms of trafficking in persons during the period of time that
the award is in effect;
• Procures a commercial sex act during the period of time that the award in in
effect; or
® Uses forced labor in the performance of the award or subawards under the
award.
I understand that the TVPA establishes human trafficking and related offenses
as federal crimes and attaches severe penalties to them. I will immediately inform the
County of Fresno, Department of Behavioral Health, Contracts Division—Substance
Use Disorder (SUD) Services immediately of any information received from any
source alleging a violation of the TVPA by either this organization or its employees, or
a subcontractor or its employees during the term of this contract.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of the TVPA and, if found in violation, will be immediately
terminated. I agree to submit this signed certification annually on behalf of the
organization acknowledging requirements under the TVPA and attesting that all
employees will receive annual TVPA training, and that documentation of training will
be placed in personnel fj s.
Signature: Date: 17,5PD(n
Title: KD
Exhibit H
Page I of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identi in information
Zmeof—entity
ntity DtBtA
Q
Address(number,street) city Sreta ZiP cede
CIIAnumber Taxpayer ID number(EIN) Te number
11. 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 XVI11,XIX, or XX?.......................................................................................................................
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII,XIX,or XX?...................................................................................... o
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, organizations, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o
111. 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."
DAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals,and provider numbers........................................................................................................... o
NAME ADDRESS PROVIDER NUMBER
Exhibit H
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... C3
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?..................................................... 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................ .............. 0
If yes,when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... 0
If yes, give date of change in operations.
V1. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... 0
VII. A. Is this facility chain affiliated? ................................................... ......................................................... ........ 0
If yes, list name,address of corporation,and EIN)
Name EIN
Address{number,name) City Slate I 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) T(de
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Attachment B Ownership in
Other Entities:BayMark Health Services,Inc.and Jason,Evan and Michelle Kietter
Name of Legal Entity DISIA(if applicable) Address EIN
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1111 Market St.
Treatment San Francisco,CA 94103-1513 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 433 Turk Street
Treatment San Francisco,CA 94102-3329 94-3303140
Addiction Research and Treatment,Inc. Family Addiction Center for Education 433 Turk Street
and Treatment FACET San Francisco,CA 94102-3329 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 795 Willow Road,BI 332
Treatment Menlo Park,CA 94025-2539 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1124 International Blvd.
Treatment Oakland,CA 94606-4331 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 3711 Sunset Lane,Stes A&B
Treatment Antioch,CA 94509-6125 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1313 Cutting Blvd.
Treatment Richmond,CA 94804-2554 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 3103 E.Cartwright Ave.
Treatment Fresno,CA 93725-9385 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1235 E Street
Treatment Fresno CA 93706-2024 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 539 N.Van Ness Ave.
Treatment Fresno CA 93728-3419 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1646 S.Court St.
Treatment Visalia CA 93277-4962 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1926 W.Beverly Blvd.
Treatment Los Angeles,CA 90057-2402 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 15229 E.Amar Rd.
Treatment La Puente,CA 91744-2066 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 11315 S.Atlantic Blvd.
Treatment L nwood,CA 90262-3007 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 4920 S.Avalon Ave.
Treatment Los Angeles,CA 90011-4004 94-3303140
Addiction Research and Treatment,Inc. Bay Area Addiction Research and 1701 Zonal Av
Treatment Los Angeles,CA 90033-1065 94-3303140
Bi-Valley Medical Clinic,Inc. 310 Harris Ave.,Suite A
Sacramento,CA 95838-3249 94-2671219
Bi-Valley Medical Clinic,Inc. 6127 Fair Oaks Blvd.
Carmichael,CA 95608-4818 94-2671219
BAART Behavioral Health Services,Inc. 1111 Market St.
San Francisco,CA 94103-1513 94-2768374
BAART Behavioral Health Services,Inc. 433 Turk Street
San Francisco,CA 94102-3329 94-2768374
BAART Behavioral Health Services,Inc. 795 Willow Road,B1332
Menlo Park,CA 94025-2539 94-2768374
BAART Behavioral Health Services,Inc. 1124 International Blvd.
Oakland,CA 94606-4331 94-2768374
BAART Behavioral Health Services,Inc. 3711 Sunset Lane,Stes A&B
Antioch,CA 94509-6125 94-2768374
BAART Behavioral Health Services,Inc. 1313 Cutting Blvd.
Richmond,CA 94604-2554 94-2768374
BAART Behavioral Health Services,Inc. 3103 E.Cartwright Ave.
Fresno,CA 93725-9385 94-2768374
BAART Behavioral Health Services,Inc. 1235 E Street
Fresno,CA 93706-2024 94-2768374
BAART Behavioral Health Services,Inc. 539 N.Van Ness Ave.
Fresno CA 93728-3419 94-2768374
BAART Behavioral Health Services,Inc. 1646 S.Court St.
Visalia,CA 93277-4962 94-2768374
BAART Behavioral Health Services,Inc. 1926 W.Beverly Blvd,
Los Angeles,CA 90057-2402 94-2768374
BAART Behavioral Health Services,Inc. 15229 E.Amar Rd.
La Puente,CA 91744-2066 94-2768374
BAART Behavioral Health Services,Inc. 11315 S.Atlantic Blvd.
Lynwood,CA 90262-3007 94-2768374
BAART Behavioral Health Services,Inc. 4920 S.Avalon Ave.
Los An eles,CA 90011-4004 94-2768374
Page 1 of 3
Name of Legal Entity DIB/A(if applicable) Address EiN
BAART Behavioral Health Services,Inc. 310 Harris Ave.,Suite A
Sacramento,CA 95838-3249 94-2768374
BAART Behavioral Health Services,Inc. 6127 Fair Oaks Blvd.
Carmichael,CA 95608-4818 94-2768374
BAART Behavioral Health Services,Inc. 1701 Zonal Av
Los Angeles,CA 90033-1065 94-2768374
BAART Behavioral Health Services,Inc. 475 Union Street
Newport,VT 05855-5499 94-2768374
BAART Behavioral Health Services,Inc. 1097 Hospital Drive
St.Johnsbury,VT 05819-2056 94-2768374
BAART Behavioral Health Services,Inc. 617 Comstock Road
Berlin,VT 05602-8294 94-2768374
BAART Behavioral Health Services,Inc. 908E W.Chandler Blvd.
Chandler,AZ 85225-2548 94-2768374
MedMark Services Inc. MedMark Services Inc.-Ft. Pierce 1901 South 25th Street,Suite 103
Ft.Pierce,FL 34947 59-2212063
MedMark Services Inc. MedMark Services Inc.-Okeechobee 1201 N.Parrot Avenue
Okeechobee,FL 34972 59-2212063
MedMark Services Inc. MedMark Services Inc.-Vero Beach 3501 SW Willoughby Boulevard
Stuart,FL 34997 59-2212063
MedMark Services Inc. MedMark Services Inc.-Boca Raton 901 Meadows Road
Boca Raton,FL 33432 59-2212063
MedMark Services Inc. MedMark Services Inc.-Stuart 372 17th Street
Vero Beach,FL 32960 59-2212063
MedMark Services Inc. MedMark Services Inc.-Delray 4800 Linton Bloulevard Building E-300
DeIrav Beach,FL 33445 59-2212063
MedMark Treatment Centers of Alabama,Inc MedMark Treatment Centers Dothan 9283 W.US Highway 84
Newton,AL 36352-8207 47-4426818
MedMark Treatment Centers of Alabama,Inc MedMark Treatment Centers Oxford 118 E.Choccolocco St
Oxford,AL 36203-1222 47-4426818
MedMark Treatment Centers of Georgia,Inc MedMark Treatment Centers- 20 Commerce Drive
Blairsville Blairsville GA 30512 27-3234645
Augusta Addiction Associates,LLC MedMark Treatment Centers- 600 Commercial Court;Suite A
Savannah Savannah,GA 31406 27-3234645
MedMark Treatment Centers of Georgia,Inc Georgia Therapy Associates 1301 Wynnton Court
Columbus,GA 31906 45-2641098
Glass Health Programs,Inc MedMark Treatment Centers- 1361 Brass Mill Road,Suite A
Belcamp Belcam ,MD 21017 52-2130200
Glass Health Programs, Inc MedMark Treatment Centers- 2 West Aylesbury Road
Timonium Timonium,MD 21093 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers- 2490 Giles Road
Daybreak Baltimore,MD 21225 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers- Cherry 2490 Giles Road
Hill Baltimore,MD 21225 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers-Essex 8909 Kelso Drive
Essex,MD 21221 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers- 821 North Eutaw Street,Suite 101
Downtown 101 Baltimore,MD 21201 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers- 821 North Eutaw Street,Suite 201
Downtown 201 Baltimore,MD 21201 52-2130200
Glass Health Programs,Inc MedMark Treatment Centers-ML 817 N.Calvert Street
Vernon Baltimore,MD 21202-3705 52-2130200
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-Ft. 5201 McCart Avenue
Worth Fort Worth,TX 76115 27-4250532
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-Waco 2210 Washington Avenue
Waco,TX 76701 27-4250532
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-San 7418 Military Drive West
Antonio San Antonio,TX 78227 27-4250532
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-El Paso 5004 Alameda Ave
El Paso TX 79905 27-4250532
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-Lufkin 216 N John Redditt Dr
Lufkin,TX 75904 27-4250532
MedMark Treatment Centers of Texas,Inc. MedMark Treatment Centers-Center 1110 Tenaha St
Center TX 75935 274250532
VCHPCS VII,LLC MedMark Treatment Centers—San 519 E Quincy St
Antonio Quincy San Antonio,TX 78215 20-4680462
MedMark Treatment Centers of Pennsylvania,Inc. MedMark Treatment Centers- 1037 Compass Circle
lGreensburg Greensburg,PA 15601-2786 81-1860333
Page 2 of 3
Name of Legal Ent D/B(A if applicable) Address EIN
MedMark Treatment Centers of Pennsylvania,Inc. MedMark Treatment Centers- 1984 Old US Hwy 22
Blairsville PA Blairsville,PA 15717-6120 81-1860333
MedMark Treatment Centers-Stockton,Inc. MedMark Treatment Centers- 1105-1107-1111 N.El Dorado Street&33 E Magnolia St
Stockton Stockton,CA 95202
20-4938126
MedMark Treatment Centers—Fresno West,Inc. MedMark Treatment Centers- Fresno 1310 M Street
West Fresno,CA 93721 20-8738449
Successful Alternatives for Addiction and MedMark Treatment Centers— 795 Fletcher Lane
Counseling Services,Inc. Hayward Hayward,CA 94544 94-3238155
Successful Alternatives for Addiction and MedMark Treatment Centers—Vallejo 1628 Broadway,Suite A&B
Counseling Services,Inc. Vallejo,CA 94590 94-3238155
MedMark Treatment Centers—Fairfield,Inc. MedMark Treatment Centers- 1143 Missouri Street
Fairfield I Fairfield,CA 94533 20-4938072
MedMark Treatment Centers—Sacramento,Inc. MedMark Treatment Centers- 7240 East Southgate Drive,Suites B,E&G
Sacramento Sacramento,CA 95823 20-4938108
Page 3 of 3
Attachment r
Page 1 of I
CERTIFICATIONUNLAWFUL USE OF DRUGS AND ALCOHOL
I, Nj4f:rkvnd:jzj , as an authorized agent of
{Print N me)
7 cknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
• The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
• All aspects of a drug- or alcohol-related program are consistent with the "no
unlawful use" message, including, but not limited to, program standards,
curricula, materials, and teachings; and
• The "no unlawful use" of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. if this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminated.
Signature: Date:
Title:
co
County f Fresno
DEPARTMENT OF BEHAVIORAL HEALTH
DAWAN UTECHT
DIRECTOR
Exhibit J
Page l of I
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH(DBH)EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information(PHI)that is necessary to carry
out my function with DBH, I , ,agree to not divulge any PHI to
unauthorized persons.Furthermore,I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel,subcontractors,and
subcontractors'personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath,I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH,surveillance and safeguarding announcements
issued by DHCS,and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
I. Exercise due care to preserve data integrity and confidentiality.
2. Treat passwords and user accounts as confidential information.
3. Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4. Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a"Privacy Incident Report"at:
http://www.dlics.ra.gay/formsrxndpubs/tawslpriv/PaaeslDHCSBusinessAssociatesOnlv.asp\and
return the completed form to: arivac ofiiccr(@dhcs.ca.rgoV.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq.and the Health Insurance Portability and
Accountability Act of 1996(HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name: �. .Agency Name:�" x
Sigrsatu �L �2 Date:
�3 &
% 3133 N Millbrook,Fresno,California 93703
FAX(559)600-7673 www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer