HomeMy WebLinkAboutAgreement A-23-285 Cultural Specific Services.pdf Agreement No. 23-285
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between
3 each Contractor(s), listed in Exhibit A"List of Contractor(s)s", ("Contractor(s)s"), and the County
4 of Fresno, a political subdivision of the State of California ("County").
5 Recitals
6 A. Through its Department of Behavioral Health (DBH), Mental Health Services Act
7 (MHSA), Community Services and Supports (CSS) component, and through input from the
8 MSHA community stakeholder process, culturally competent and linguistically accessible
9 specialty mental services for target cultural/ethnic/linguistic unserved and/or underserved
10 populations with serious emotional disturbance (SED) and/or serious mental illness (SMI) in
11 Fresno County. Furthermore, development of community based training sites for bilingual and
12 bicultural graduate, post master, doctoral and/or post-doctoral students, who require supervised
13 clinical hours to be eligible for State licensing in social work, marriage and family counseling,
14 professional clinical counseling, or clinical psychology is needed to expand these services.
15 Contractor(s)(s) are qualified and willing to provide said services.
16 B. County entered into Agreement No.18-599 with Contractor(s) on October 23, 2018,
17 Amendment I Agreement No. 23-077 on February 28, 2023, collectively Agreement No. 18-599;
18 C. Changes to the agreement are necessary due the Department of Health Care Services'
19 implementation of California Advancing and Innovating Medi-Cal (CalAIM), which includes a
20 new billing structure that Contractor(s)s must utilize;
21 D. This Agreement shall replace, restate, and supersede Agreement No. 18-599 in its
22 entirely.
23 The parties therefore agree as follows:
24 Article 1
25 Contractor(s)'s Services
26 1.1 Scope of Services. The Contractor(s) shall perform all of the services provided in
27 Exhibit B to this Agreement, titled "Scope of Services." Contractor(s) shall also perform all
28 services and fulfill all responsibilities as set forth in their individual "Scope of Work" documents
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1 approved by the County's DBH Director or designee, and attached as Exhibits B-1 et seq. In
2 addition, all services identified as Full Service Partnership (FSP) services shall be performed in
3 accordance with Exhibit C, "Full Service Partnership Service Delivery Model", attached hereto
4 and by this reference incorporated herein.
5 1.2 Representation. The Contractor(s) represents that it is qualified, ready, willing, and
6 able to perform all of the services provided in this Agreement.
7 1.3 Compliance with Laws. The Contractor(s) shall, at its own cost, comply with all
8 applicable federal, state, and local laws and regulations in the performance of its obligations
9 under this Agreement, including but not limited to workers compensation, labor, and
10 confidentiality laws and regulations.
11 Contractor(s) shall provide services in conformance with all applicable State and Federal
12 statutes, regulations and subregulatory guidance, as from time to time amended, including but
13 not limited to:
14 (A) California Code of Regulations, Title 9;
15 (B) California Code of Regulations, Title 22;
16 (C) California Welfare and Institutions Code, Division 5;
17 (D) United States Code of Federal Regulations, Title 42, including but not limited to
18 Parts 438 and 455;
19 (E) United States Code of Federal Regulations, Title 45;
20 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable;
21 (G)Balanced Budget Act of 1997;
22 (H) Health Insurance Portability and Accountability Act (HIPAA); and
23 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory
24 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and
25 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of
26 County's, state or federal contracts governing services for persons served.
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1 In the event any law, regulation, or guidance referred to in this section 1.3 is amended
2 during the term of this Agreement, the parties agree to comply with the amended authority as of
3 the effective date of such amendment without amending this Agreement.
4 Contractor recognizes that County operates its mental health programs under an
5 agreement with DHCS, and that under said agreement the State imposes certain requirements
6 on County and its subcontractors. Contractor shall adhere to all State requirements, including
7 those identified in Exhibit D, "Behavioral Health Requirements", attached hereto and by this
8 reference incorporated herein and made part of this Agreement.
9 1.4 Meetings. Contractor(s) shall participate in monthly, or as needed, workgroup
10 meetings consisting of staff from County's DBH to discuss service requirements, data reporting,
11 training, policies and procedures, overall program operations and any problems or foreseeable
12 problems that may arise. Contractor(s) shall also participate in other County meetings, such as
13 but not limited to quality improvement meetings, provider meetings, Behavioral Health Board
14 meetings, bi-monthly Contractor(s) meetings, etc. Schedule for these meetings may change
15 based on the needs of the County.
16 1.5 Organizational Provider. Contractor(s) shall maintain requirements as a Mental
17 Health Plan (MHP) organizational provider throughout the term of this Agreement, as described
18 in Article 17 of this Agreement. If for any reason, this status is not maintained, County may
19 terminate this Agreement pursuant to Article 7 of this Agreement.
20 1.6 Staffing. Contractor(s) agrees that prior to providing services under the terms and
21 conditions of this Agreement, Contractor(s) shall have staff hired and in place for program
22 services and operations or County may, in addition to other remedies it may have, suspend
23 referrals or terminate this Agreement, in accordance with Article 7 of this Agreement.
24 1.7 Credentialing and Recredentialing. Contractor(s) and their respective staff must
25 follow the uniform process for credentialing and recredentialing of service providers established
26 by County, including disciplinary actions such as reducing, suspending, or terminating provider's
27 privileges. Failure to comply with specified requirements can result in suspension or termination
28 of an individual or provider.
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1 Upon request, the Contractor(s) must demonstrate to the County that each of its
2 providers are qualified in accordance with current legal, professional, and technical standards,
3 and that they are appropriately licensed, registered, waivered, and/or certified.
4 Contractor(s) must not employ or subcontract with providers debarred, suspended or
5 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in
6 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set
7 forth in 42 C.F.R. §438.610. See Article 12 below.
8 Contractor(s) is required to verify and document at a minimum every three years that
9 each network provider that delivers covered services continues to possess valid credentials,
10 including verification of each of the credentialing requirements as per the County's uniform
11 process for credentialing and recredentialing. If any of the requirements are not up-to-date,
12 updated information should be obtained from network providers to complete the re-credentialing
13 process.
14 1.8 Criminal Background Check. Contractor(s) shall ensure that all providers and/or
15 subcontracted providers consent to a criminal background check, including fingerprinting to the
16 extent required under state law and 42 C.F.R. § 455.434(a). Contractor(s) shall provide
17 evidence of completed consents when requested by the County, DHCS or the US Department
18 of Health & Human Services (US DHHS).
19 1.9 Guiding Principles. Contractor(s) shall align programs, services, and practices with
20 the vision, mission, and guiding principles of the DBH, as further described in Exhibit E, "Fresno
21 County Department of Behavioral Health Guiding Principles of Care Delivery", attached hereto
22 and by this reference incorporated herein and made part of this Agreement.
23 1.10 Clinical Leadership. Contractor(s) shall send to County upon execution of this
24 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their
25 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to
26 oversee services based on the level of care and program design presented herein shall be
27 included in this plan. A description and monitoring of this plan shall be provided.
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1 1.11 Timely Access. It is the expectation of the County that Contractor(s) provide timely
2 access to services that meet the State of California standards for care. Contractor(s) shall track
3 timeliness of services to persons served and provide a monthly report showing the monitoring or
4 tracking tool that captures this data. County and Contractor(s) shall meet to go over this
5 monitoring tool, as needed but at least on a monthly basis. County shall take corrective action if
6 there is a failure to comply by Contractor(s) with timely access standards. Contractor(s) shall
7 also provide tracking tools and measurements for effectiveness, efficiency, and persons served
8 satisfaction as further detailed in Exhibit B and B-1, et seq..
9 1.12 Electronic Health Record. Contractor(s) may maintain its records in County's
10 electronic health record (EHR) system in accordance with Exhibit F, "Documentation Standards
11 for Persons Served Records", as licenses become available. The person served record shall
12 begin with registration and intake, and include person served authorizations, assessments,
13 plans of care, and progress notes, as well as other documents as approved by County. County
14 shall be allowed to review records of all and any services provided. If Contractor(s) determines
15 to maintain its records in the County's EHR, it shall provide County's DBH Director, or his or her
16 designee, with a thirty (30) day notice. If at any time Contractor(s) chooses not to maintain its
17 records in the County's EHR, it shall provide County's DBH Director, or designee, with thirty (30)
18 days advance written notice and Contractor(s)will be responsible for obtaining its own system,
19 at its own cost, for electronic health records management.
20 Disclaimer
21 County makes no warranty or representation that information entered into the County's
22 DBH EHR system by Contractor(s)will be accurate, adequate, or satisfactory for Contractor(s)'s
23 own purposes or that any information in Contractor(s)'s possession or control, or transmitted or
24 received by Contractor(s), is or will be secure from unauthorized access, viewing, use,
25 disclosure, or breach. Contractor(s) is solely responsible for person served information entered
26 by Contractor(s) into the County's DBH EHR system. Contractor(s) agrees that all Private
27 Health Information (PHI) maintained by Contractor(s) in County's DBH EHR system will be
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1 maintained in conformance with all HIPAA laws, as stated in section 18.1, "Health Insurance
2 Portability and Accountability Act."
3 1.13 Records. Contractor(s) shall maintain records in accordance with Exhibit F,
4 "Documentation Standards for Persons Served Records".AII persons served's records shall be
5 maintained for a minimum of 10 years from the date of the end of this Agreement.
6 1.14 Access to Records. Contractor(s) shall provide County with access to all
7 documentation of services provided under this Agreement for County's use in administering this
8 Agreement. Contractor(s) shall allow County, CMS, the Office of the Inspector General, the
9 Controller General of the United States, and any other authorized Federal and State agencies to
10 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
11 records, documents, and the premises, equipment and facilities maintained by the Contractor(s)
12 pertaining to such services at any time and as otherwise required under this Agreement.
13 1.15 Quality Improvement Activities and Participation. Contractor(s) shall comply with
14 the County's ongoing comprehensive Quality Assessment and Performance Improvement
15 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established
16 outcomes by following structural and operational processes and activities that are consistent
17 with current practice standards.
18 Contractor(s) shall participate in quality improvement (QI) activities, including clinical and
19 non-clinical performance improvement projects (PIPs), as requested by the County in relation to
20 State and Federal requirements and responsibilities, to improve health outcomes and
21 individuals' satisfaction over time. Other QI activities include quality assurance, collection and
22 submission of performance measures specified by the County, mechanisms to detect both
23 underutilization and overutilization of services, individual and system outcomes, utilization
24 management, utilization review, provider appeals, provider credentialing and re-credentialing,
25 and person served grievances. Contractor(s) shall measure, monitor, and annually report to the
26 County its performance.
27 1.16 Rights of Persons Served. Contractor shall comply with applicable laws and
28 regulations relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal.
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1 Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The Contractor shall
2 ensure that its subcontractors comply with all applicable patients' rights laws and regulations.
3 Article 2
4 Reporting
5 2.1 Reports. The Contractor(s) shall submit the following reports:
6 (A) Outcome Reports
7 Contractor(s) shall submit to County clinical program performance outcome
8 reports, as requested.
9 Outcome reports and outcome requirements are subject to change at County's
10 discretion. Contractor(s) shall provide outcomes as stated in Exhibit B, Exhibits B-1 et
11 seq. and Exhibit G.
12 (B) Staffing Report
13 Contractor(s) shall submit monthly staffing reports due by the 10th of each month
14 that identify all direct service and support staff by first and last name, applicable
15 licensure/certifications, and full-time hours worked to be used as a tracking tool to
16 determine if Contractor(s)'s program is staffed according to the requirements of this
17 Agreement.
18 (C) Mental Health Services Act (MHSA) Reporting
19 Contractor(s) shall adhere to MHSA reporting including but not limited to fiscal,
20 outcomes, and demographics as described in Exhibit B and Exhibits B-1 et seq..
21 (D)Additional Reports
22 Contractor(s) shall also furnish to County such statements, records, reports,
23 data, and other information as County may request pertaining to matters covered by this
24 Agreement. In the event that Contractor(s) fails to provide such reports or other
25 information required hereunder, it shall be deemed sufficient cause for County to
26 withhold monthly payments until there is compliance. In addition, Contractor(s) shall
27 provide written notification and explanation to County within five (5) days of any funds
28 received from another source to conduct the same services covered by this Agreement.
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1 2.2 Monitoring. Contractor(s) agrees to extend to County's staff, County's DBH and the
2 California Department of Health Care Services (DHCS), or their designees, the right to review
3 and monitor records, programs, or procedures, at any time, in regard to persons served, as well
4 as the overall operation of Contractor(s)'s programs, in order to ensure compliance with the
5 terms and conditions of this Agreement.
6 Article 3
7 County's Responsibilities
8 3.1 The County shall provide oversight and collaborate with Contractor(s), other County
9 Departments and community agencies to help achieve program goals and outcomes. In addition
10 to Contractor(s) monitoring of program, oversight includes, but not limited to, coordination with
11 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
12 County shall receive and analyze statistical outcome data from Contractor(s) throughout
13 the term of contract on a monthly basis. County shall notify the Contractor(s)when additional
14 participation is required. The performance outcome measurement process will not be limited to
15 survey instruments but will also include, as appropriate, persons served and staff surveys, chart
16 reviews, and other methods of obtaining required information.
17 Article 4
18 Compensation, Invoices, and Payments
19 4.1 The County agrees to pay, and the Contractor(s) agrees to receive, compensation
20 for the performance of its services under this Agreement as described in Exhibit H to this
21 Agreement, titled "Compensation."
22 4.2 Specialty Mental Health Services Maximum Compensation. The maximum
23 compensation payable to the Contractor(s) under this Agreement for the period of July 1, 2023
24 through June 30, 2024 is Two Million, One Hundred Ninety Four Thousand, and Four Hundred
25 Forty Three and No/100 Dollars ($2,194,443.00), which is not a guaranteed sum, but shall be
26 paid only for services rendered and received. The maximum compensation payable to the
27 Contractor(s) under this Agreement for the period of July 1, 2024 through June 30, 2025 is Two
28 Million, One Hundred Ninety Four Thousand, and Four Hundred Forty Three and No/100 Dollars
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1 ($2,194,443.00), which is not a guaranteed sum, but shall be paid only for services rendered
2 and received.
3 4.3 Cost Reimbursement Maximum Compensation. The maximum compensation
4 payable to the Contractor(s) under this Agreement for the period of July 1, 2023 through June
5 30, 2024 is Forty Two Thousand and No/100 Dollars ($42,000.00). The maximum compensation
6 payable to the Contractor(s) under this Agreement for the period of July 1, 2024 through June
7 30, 2025 is Forty Two Thousand and No/100 Dollars ($42,000.00).
8 4.4 Transition Optimization Funds. If Contractor opts to apply for transition
9 optimization funds, the maximum amount payable for transition optimization for the period of
10 July 1, 2023, through June 30, 2024 shall not exceed Two-Hundred Fifty Thousand and No/100
11 Dollars ($250,000.00) split among all current agreements between the Contractor and the
12 County for Medi-Cal billable specialty mental health and substance use disorder services as
13 further described in the Scope of Work/Services. All final invoices for transition optimization
14 funds shall be submitted by July 15, 2024. Invoices submitted thereafter, shall not be eligible for
15 payment.
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17 4.5 Total Maximum Compensation. In no event shall the maximum contract amount for
18 all the services provided by the Contractor(s) to County under the terms and conditions of this
19 Agreement be in excess of Four Million, Seven Hundred Seventy-Two Thousand, and Eight
20 Hundred Eighty-Six and No/100 Dollars ($4,772,886.00) during the entire term of this
21 Agreement.
22 The Contractor(s) acknowledges that the County is a local government entity and does so with
23 notice that the County's powers are limited by the California Constitution and by State law, and
24 with notice that the Contractor(s) may receive compensation under this Agreement only for
25 services performed according to the terms of this Agreement and while this Agreement is in
26 effect, and subject to the maximum amount payable under this section. The Contractor(s)
27 further acknowledges that County employees have no authority to pay the Contractor(s) except
28 as expressly provided in this Agreement.
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1 4.6 Rate Categories. The program service components for the Contractor(s) shall be
2 categorized under one or more of the following rate categories and as indicated on Exhibit H:
3 (A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
4 provide less than fifty percent (50%) of services in the field. In the field services are
5 those services that do not occur through telehealth and do not occur in designated sites
6 in which the Contractor(s) is afforded regular access. Designated sites shall be identified
7 by the Contractor(s) and approved by County's DBH Director or designee in writing.
8 (B) Field Based: Field based programs shall be defined as programs that provide
9 more than fifty percent (50%) of services in the field.
10 (C) Full-Service Partnership/Assisted Outpatient Therapy/Therapeutic Behavioral
11 Health Services (FSP/AOT/TBS): FSP/AOT/TBS programs shall provide services in
12 accordance with level of care standards and general requirements as described in the
13 Scope of Work/Services, if applicable.
14 DBH shall continuously monitor the programs and analyze data to review accuracy of
15 rate categories assigned and may only reassign rate categories with the written agreement of
16 both parties pursuant to Article 25.
17 4.7 Specialty Mental Health Services Claiming. Contractor(s) shall enter claims data
18 into the County's billing and transactional database system by the fifteenth (15th) of every month
19 for actual services rendered in the previous month. Contractor(s) shall use Current Procedural
20 Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as
21 provided in the DHCS Billing Manual available at
22 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-LibrarV.aspx, as from time to time
23 amended.
24 Claims shall be complete and accurate and must include all required information
25 regarding the claimed services. Claims data entry into the County's electronic health record
26 system shall be the responsibility of Contractor(s). County shall monitor the volume of services,
27 billing amounts and service types entered into County's electronic health record/information
28 system. Any and all audit exceptions resulting from the provision and reporting of specialty
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1 mental health services by Contractor(s) shall be the sole responsibility of Contractor(s).
2 Contractor(s) will comply with all applicable policies, procedures, directives, and guidelines
3 regarding the use of County's electronic health record/information system.
4 Contractor(s) must provide all necessary data to allow County to bill Medi-Cal, and any
5 other third-party source, for services and meet State and Federal reporting requirements. The
6 necessary data can be provided by a variety of means, including but not limited to: 1) direct data
7 entry into County's electronic health record/information system; 2) providing an electronic file
8 compatible with County's electronic health record/information system; or 3) integration between
9 County's electronic health record/information system and Contractor(s)'s information system(s).
10 Contractor(s) shall maximize the Federal Financial Participation (FFP) reimbursement by
11 claiming all possible Medi-Cal services and correcting denied services for resubmission as
12 needed.
13 4.8 Applicable Fees. Contractor(s) shall not charge any persons served or third-party
14 payers any fee for service unless directed to do so by the County's DBH Director or designee at
15 the time the individual is referred for services. When directed to charge for services,
16 Contractor(s) shall use the uniform billing and collection guidelines prescribed by DHCS.
17 Contractor(s) will perform eligibility and financial determinations, in accordance with
18 DHCS' Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless
19 directed otherwise by the County's DBH Director or designee.
20 Contractor(s) shall not submit a claim to, or demand or otherwise collect reimbursement
21 from, the person served or persons acting on behalf of the person served for any specialty
22 mental health or related administrative services provided under this Contract, except to collect
23 other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9,
24 §1810.365(c).
25 The Contractor(s) must not bill persons served, for covered services, any amount
26 greater than would be owed if the County provided the services directly as per and otherwise
27 not bill persons served as set forth in 42 C.F.R. § 438.106.
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1 If a person served has dual coverage, such as other health coverage (OHC) or Federal
2 Medicare, Contractor(s)will be responsible for billing the carrier and obtaining a payment/denial
3 or have validation of claiming with no response for ninety (90) days after the claim was mailed
4 before the service can be entered into the County's electronic health record/information system.
5 Contractor(s) must report all third-party collections for Medicare, third-party or client-pay or
6 private-pay in each month. A copy of explanation of benefits or CMS 1500 form is required as
7 documentation. Contractor(s) must comply with all laws and regulations governing the Federal
8 Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42
9 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers
10 for Medicare and Medicaid Services as they relate to participation, coverage and claiming
11 reimbursement. Contractor(s) will be responsible for compliance as of the effective date of each
12 Federal, State or local law or regulation specified.
13 4.9 Invoices. The Contractor(s) shall submit monthly invoices, in arrears by the fifteenth
14 (15th) day of each month, in the format directed by the County. The Contractor(s) shall submit
15 invoices electronically to: 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh-
16 invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with
17 a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH Director
18 or designee, if an invoice is incorrect or is otherwise not in proper form or substance, County's
19 DBH Director, or designee, shall have the right to withhold payment as to only the portion of the
20 invoice that is incorrect or improper after five (5) days prior notice to Contractor(s). Contractor(s)
21 agrees to continue to provide services for a period of ninety (90) days after notification of an
22 incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not corrected
23 to County satisfaction, County's DBH Director, or designee, may elect to terminate this
24 Agreement, pursuant to the termination provisions stated in Article 7 of this Agreement.
25 Specialty Mental Health Services Claimable Services. For claimable services,
26 invoices shall be based on claims entered into the County's billing and transactional database
27 system for the prior month.
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1 Monthly payments for claimed services shall only be based on the units of time assigned
2 to each CPT or HCPCS code entered in the County's billing and transactional database
3 multiplied by the practitioner service rates in Exhibit H.
4 County's payments to Contractor(s) for performance of claimed services are provisional
5 and subject to adjustment until the completion of all settlement activities. County's adjustments
6 to provisional payments for claimed services shall be based on the terms, conditions, and
7 limitations of this Agreement or the reasons for recoupment set forth in Article 4 and 13.
8 Any claimable services submitted beyond six (6) months from the month of service may
9 be ineligible for payment.
10 Cost Reimbursement Based Invoices. Invoices for cost reimbursement services shall
11 be based on actual expenses incurred in the month of service. Contractor(s) shall submit
12 monthly invoices and general ledgers to County that itemize the line item charges for monthly
13 program costs. The invoices and general ledgers will serve as tracking tools to determine if
14 Contractor(s)'s costs are in accordance with its budgeted cost. Failure to submit reports and
15 other supporting documentation shall be deemed sufficient cause for County to withhold
16 payments until there is compliance.
17 Contractor(s) must report all revenue collected from a third-party, client-pay or private-
18 pay in each monthly invoice. In addition, Contractor(s) shall submit monthly invoices for
19 reimbursement that equal the amount due less any revenue collected and/or unallowable cost
20 such as lobbying or political donations from the monthly invoice reimbursements.
21 Travel shall be reimbursed based on actual expenditures and reimbursement shall be at
22 Contractor(s)'s adopted rate, not to exceed the Federal Internal Revenue Services (IRS)
23 published rate.
24 Corrective Action Plans. Contractor(s)s shall enter services into the County's billing
25 and transactional database and submit invoices in accordance with the deadlines listed above
26 and information shall be accurate. Failure to meet the requirements set forth above will result in
27 a corrective action plan at the discretion of the County's DBH Director, or designee, and may
28 result in financial penalties or termination of agreement per Article 7.
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1 4.10 Payment. Payments shall be made by County to Contractor(s) in arrears, for
2 services provided during the preceding month, within forty-five (45) days after the date of
3 receipt, verification, and approval by County. All final invoices and/or any final budget
4 modification requests shall be submitted by Contractor(s) within sixty (60) days following the
5 final month of service for which payment is claimed. No action shall be taken by County on
6 claims submitted beyond the sixty (60) day closeout period. Any compensation which is not
7 expended by Contractor(s) pursuant to the terms and conditions of this Agreement shall
8 automatically revert to County.
9 4.11 Specialty Mental Health Services Payments. Payment shall be made upon
10 certification and other proof satisfactory to County that services have actually been performed
11 by Contractor(s) as specified in this Agreement and/or after receipt and verification of actual
12 services provided.
13 4.12 Cost Reimbursement Payments. Payment shall be made upon certification or other
14 proof satisfactory to County that services have actually been performed by Contractor(s) as
15 specified in this Agreement and/or after receipt and verification of actual expenditures incurred
16 by Contractor(s) for monthly program costs, as identified in the budget narratives and budgets
17 identified in Exhibit H, in the performance of this Agreement. County shall not be obligated to
18 make any payments under this Agreement if the request for payment is received by County
19 more than sixty (60) days after this Agreement has terminated or expired.
20 4.13 Recoupments and Audits. County shall recapture from Contractor(s) the value of
21 any services or other expenditures determined to be ineligible based on the County or State
22 monitoring results. The County reserves the right to enter into a repayment agreement with
23 Contractor(s), with total monthly payments not to exceed twelve (12) months from the date of
24 the repayment agreement, to recover the amount of funds to be recouped. The County has the
25 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of
26 the repayment agreement. The repayment agreement may be made with the signed written
27 approval of County's DBH Director, or designee, and respective Contractor(s) through a
28 repayment agreement. The monthly repayment amounts may be netted against the
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1 Contractor(s)'s monthly billing for services rendered during the month, or the County may, in its
2 sole discretion, forego a repayment agreement and recoup all funds immediately. This remedy
3 is not exclusive, and County may seek requital from any other means, including, but not limited
4 to, a separate contract or agreement with Contractor(s).
5 Contractor(s) shall be held financially liable for any and all future disallowances/audit
6 exceptions due to Contractor(s)'s deficiency discovered through the State audit process and
7 County utilization review for services provided during the course of this Agreement. At County's
8 election, the disallowed amount will be remitted within forty-five (45) days to County upon
9 notification or shall be withheld from subsequent payments to Contractor(s). Contractor(s) shall
10 not receive reimbursement for any units of services rendered that are disallowed or denied by
11 the Fresno County Mental Health Plan (Mental Health Plan) utilization review process or
12 through the State of California DHCS audit and review process, cost report audit settlement if
13 applicable, for Medi-Cal eligible beneficiaries.
14 4.14 Incidental Expenses. The Contractor(s) is solely responsible for all of its costs and
15 expenses that are not specified as payable by the County under this Agreement. If Contractor(s)
16 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for
17 further compensation.
18 4.15 Restrictions and Limitations. This Agreement shall be subject to any restrictions,
19 limitations, and/or conditions imposed by County or state or federal funding sources that may in
20 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also
21 contingent upon sufficient funds being made available by County, state, or federal funding
22 sources for the term of the Agreement. If the federal or state governments reduce financial
23 participation in the Medi-Cal program, County agrees to meet with Contractor(s) to discuss
24 renegotiating the services required by this Agreement.
25 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
26 over and is not available for services provided in subsequent years.
27 In the event that funding for these services is delayed by the State Controller, County
28 may defer payments to Contractor(s). The amount of the deferred payment shall not exceed the
15
1 amount of funding delayed by the State Controller to the County. The period of time of the
2 deferral by County shall not exceed the period of time of the State Controller's delay of payment
3 to County plus forty-five (45) days.
4 4.16 Additional Financial Requirements. County has the right to monitor the
5 performance of this Agreement to ensure the accuracy of claims for reimbursement and
6 compliance with all applicable laws and regulations.
7 Contractor(s) must comply with the False Claims Act employee training and policy
8 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
9 Department of Health and Human Services may specify.
10 Contractor(s) agrees that no part of any federal funds provided under this Agreement
11 shall be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of
12 the Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as
13 from time to time amended.
14 Federal Financial Participation is not available for any amount furnished to an Excluded
15 individual or entity, or at the direction of a physician during the period of exclusion when the
16 person providing the service knew or had reason to know of the exclusion, or to an individual or
17 entity when the County failed to suspend payments during an investigation of a credible
18 allegation of fraud [42 U.S.C. section 1396b(i)(2)].
19 Contractor(s) must maintain financial records for a minimum period of ten (10) years or
20 until any dispute, audit or inspection is resolved, whichever is later. Contractor(s) will be
21 responsible for any disallowances related to inadequate documentation.
22 4.17 Contractor(s) Prohibited from Redirection of Contracted Funds. Contractor(s)
23 may not redirect or transfer funds from one funded program to another funded program under
24 which Contractor(s) provides services pursuant to this Agreement except through a duly
25 executed amendment to this Agreement.
26 Contractor(s) may not charge services delivered to an eligible person served under one
27 funded program to another funded program unless the person served is also eligible for services
28 under the second funded program.
16
1 4.18 Financial Audit Report Requirements for Pass-Through Entities. If County
2 determines that Contractor(s) is a "subrecipient" (also known as a "pass-through entity") as
3 defined in 2 C.F.R. § 200 et seq., Contractor(s) represents that it will comply with the applicable
4 cost principles and administrative requirements including claims for payment or reimbursement
5 by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time.
6 Contractor(s) shall observe and comply with all applicable financial audit report requirements
7 and standards.
8 Financial audit reports must contain a separate schedule that identifies all funds included
9 in the audit that are received from or passed through the County. County programs must be
10 identified by Agreement number, Agreement amount, Agreement period, and the amount
11 expended during the fiscal year by funding source.
12 Contractor(s)will provide a financial audit report including all attachments to the report
13 and the management letter and corresponding response within six months of the end of the
14 audit year to the County's DBH Director or designee. The County's Director or designee is
15 responsible for providing the audit report to the County Auditor.
16 Contractor(s) must submit any required corrective action plan to the County
17 simultaneously with the audit report or as soon thereafter as it is available. The County shall
18 monitor implementation of the corrective action plan as it pertains to services provided pursuant
19 to this Agreement.
20 Article 5
21 Term of Agreement
22 5.1 Term. This Agreement is effective on July 1, 2023, and terminates on June 30, 2024
23 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension,"
24 below.
25 5.2 Extension. The term of this Agreement may be extended for no more than a one-
26 year period only upon written approval of both parties at least 30 days before the first day of the
27 one-year extension period. The County's DBH Director or designee is authorized to sign the
28 written approval on behalf of the County based on the Contractor(s)'s satisfactory performance.
17
1 The extension of this Agreement by the County is not a waiver or compromise of any default or
2 breach of this Agreement by the Contractor(s) existing at the time of the extension whether or
3 not known to the County.
4 Article 6
5 Notices
6 6.1 Contact Information. The persons and their addresses having authority to give and
7 receive notices provided for or permitted under this Agreement include the following:
8
For the County:
9 Director
County of Fresno
10 1925 E. Dakota Avenue
Fresno, CA 93726
11
For the Contractor(s):
12 See Exhibit A
13 6.2 Change of Contact Information. Either party may change the information in section
14 6.1 by giving notice as provided in section 6.3.
15 6.3 Method of Delivery. Each notice between the County and the Contractor(s)
16 provided for or permitted under this Agreement must be in writing, state that it is a notice
17 provided under this Agreement, and be delivered either by personal service, by first-class
18 United States mail, by an overnight commercial courier service, by telephonic facsimile
19 transmission, or by Portable Document Format (PDF) document attached to an email.
20 (A) A notice delivered by personal service is effective upon service to the recipient.
21 (B) A notice delivered by first-class United States mail is effective three (3) County
22 business days after deposit in the United States mail, postage prepaid, addressed to the
23 recipient.
24 (C)A notice delivered by an overnight commercial courier service is effective one (1)
25 County business day after deposit with the overnight commercial courier service,
26 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
27 the recipient.
28
18
1 6.4 Claims Presentation. For all claims arising from or related to this Agreement,
2 nothing in this Agreement establishes, waives, or modifies any claims presentation
3 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
4 of Title 1 of the Government Code, beginning with section 810).
5 6.5 Notification of Changes. Contractor(s) shall notify County in writing of any change
6 in organizational name, Head of Service or principal business at least fifteen (15) business days
7 in advance of the change. Contractor(s) shall notify County of a change of service location at
8 least six (6) months in advance to allow County sufficient time to comply with site certification
9 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing
10 by the County, and no further amendment of the Agreement shall be necessary provided that
11 such change of address does not conflict with any other provisions of this Agreement.
12 Contractor(s) must immediately notify County of a change in ownership, organizational
13 status, licensure, or ability of Contractor(s) to provide the quantity or quality of the contracted
14 services in a and in no event more than 15 days of the change.
15 Article 7
16 Termination and Suspension
17 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
18 contingent on the approval of funds by the appropriating government agency. If sufficient funds
19 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
20 Contractor(s), may:
21 (A) Modify the services provided by the Contractor(s) under this Agreement; or
22 (B) Terminate this Agreement.
23 7.2 Termination for Breach.
24 (A) Upon determining that a breach (as defined in paragraph (C) below) has
25 occurred, the County may give written notice of the breach to the Contractor(s). The
26 written notice may suspend performance under this Agreement and must provide at
27 least thirty (30) days for the Contractor(s) to cure the breach.
28
19
1 (B) If the Contractor(s) fails to cure the breach to the County's satisfaction within the
2 time stated in the written notice, the County may terminate this Agreement immediately.
3 (C) For purposes of this section, a breach occurs when, in the determination of the
4 County, the Contractor(s) has:
5 (1) Obtained or used funds illegally or improperly;
6 (2) Failed to comply with any part of this Agreement;
7 (3) Submitted a substantially incorrect or incomplete report to the County; or
8 (4) Improperly performed any of its obligations under this Agreement.
9 7.3 Termination without Cause. In circumstances other than those set forth above, the
10 County may terminate this Agreement by giving at least thirty (30) days advance written notice
11 to the Contractor(s).
12 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
13 under this Article 7 is without penalty to or further obligation of the County.
14 7.5 County's Rights upon Termination. Upon termination for breach under this Article
15 7, the County may demand repayment by the Contractor(s) of any monies disbursed to the
16 Contractor(s) under this Agreement that, in the County's sole judgment, were not expended in
17 compliance with this Agreement. The Contractor(s) shall promptly refund all such monies upon
18 demand. This section survives the termination of this Agreement.
19 In the event this Agreement is terminated, Contractor(s) shall be entitled to
20 compensation for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant
21 to the terms and conditions of this Agreement through and including the effective date of
22 termination. This provision shall not limit or reduce any damages owed to the County due to a
23 breach of this Agreement by Contractor(s).
24 Article 8
25 Informing Materials for Persons Served
26 8.1 Basic Information Requirements. Contractor(s) shall provide information in a
27 manner and format that is easily understood and readily accessible to the persons served (42
28 C.F.R. § 438.1 0(c)(1)). Contractor(s) shall provide all written materials for persons served in
20
1 easily understood language, format, and alternative formats that take into consideration the
2 special needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor(s) shall
3 inform the persons served that information is available in alternate formats and how to access
4 those formats in compliance with 42 C.F.R. § 438.10.
5 Contractor(s) shall provide the required information in this section to each individual
6 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental
7 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, §
8 1810.360(e)).
9 Contractor(s) shall utilize the County's website that provides the content required in this
10 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth
11 in 42 C.F.R. § 438.10.
Contractor(s) shall use the DHCS/County-developed beneficiary handbook and persons
12 served notices.(42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)).
13 8.2 Electronic Submission. Persons served information required in this section may
14 only be provided electronically by the Contractor(s) if all of the following conditions are met:
15 (A) The format is readily accessible;
16 (B) The information is placed in a location on the Contractor(s)'s website that is
17 prominent and readily accessible;
18 (C)The information is provided in an electronic form which can be electronically
retained and printed;
19
(D)The information is consistent with the content and language requirements of this
20 Agreement;
21 (E) The individual is informed that the information is available in paper form without
22 charge upon request and the Contractor(s) shall provide it upon request within five (5)
23 business days (42 C.F.R. § 438.10(c)(6)).
8.3 Language and Format. Contractor(s) shall provide all written materials, including
24
taglines, for persons served or potential persons served in a font size no smaller than twelve
25
(12) point (42 C.F.R. 438.10(d)(6)(ii)).
26
Contractor(s) shall ensure its written materials that are critical to obtaining services are
27
available in alternative formats, upon request of the person served or potential person served at
28 no cost.
21
1 Contractor(s) shall make its written materials that are critical to obtaining services,
2 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance
3 notices, denial and termination notices, and the Contractor(s)'s mental health education
materials, available in the prevalent non-English languages in the County (42 C.F.R. §
4 438.10(d)(3)).
5 (A) Contractor(s) shall notify persons served, prospective persons served, and
6 members of the public that written translation is available in prevalent languages free of
7 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst.
8 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)).
Contractor(s) shall make auxiliary aids and services available upon request and free of
9 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
10 Contractor(s) shall make oral interpretation and auxiliary aids, such as Teletypewriter
11 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free
12 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5).
13 Taglines for written materials critical to obtaining services must be printed in a conspicuously
visible font size, no smaller than twelve (12) point font.
14
8.4 Beneficiary Informing Materials. Each person served must receive and have
15
access to the beneficiary informing materials upon request by the individual and when first
16
receiving SMHS from Contractor(s). Beneficiary informing materials include but are not limited
17
to:
18 (A) Consumer Handbook
19
(B) Provider Directory
20
(C) Grievance form
21 (D)Appeal/Expedited Appeal form
22
(E) Advance Directives brochure
23
(F) Change of Provider form
24
(G)Suggestions brochure
25
(H) Notice of Privacy Practices
26
(1) Notices of Adverse Benefit Determination (NOABDs — Including Denial and
27
Termination notices)
28
22
1 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving
2 individuals under the age of 21)
3 (K) Contractor shall ensure beneficiary informing material are displayed in the
4 threshold languages of Fresno County at all service sites, including but not limited to the
5 following:
6 (1) Consumer Handbook
7 (2) Provider Directory
8 (3) Grievance form
9 (4) Appeal/Expedited Appeal form
10 (5) Advance Directives brochure
11 (6) Change of Provider form
12 (7) Suggestions brochure
13 All beneficiary informing written materials will use easily understood language and
14 format (i.e. material written and formatted at a 6th grade reading level), and will use a font size
15 no smaller than 12 point. All beneficiary informing written materials shall inform beneficiaries of
16 the availability of information in alternative formats and how to make a request for an alternative
17 format. Inventory and maintenance of all beneficiary informing materials will be maintained by
18 the County's DBH Managed Care Division. Contractor will ensure that its written materials
19 include taglines or that an additional taglines document is available.
20 8.5 Beneficiary Handbook. Contractor(s) shall provide each persons served with a
21 beneficiary handbook at the time the individual first accesses services and thereafter upon
22 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
23 business days after receiving notice of enrollment.
24 Contractor(s) shall give each individual notice of any significant change to the
25 information contained in the beneficiary handbook at least thirty (30) days before the intended
26 effective date of change as per BHIN 22-060.
27
28
23
1 8.6 Accessibility. Required informing materials must be electronically available on
2 Contractor(s)'s website and must be physically available at the Contractor(s)'s facility lobby for
3 individuals' access.
4 Informing materials must be made available upon request, at no cost, in alternate
5 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and
6 American Sign Language) and must be provided to persons served within five (5) business
7 days. Large print materials shall be in a minimum of eighteen (18) point font size.
8 Informing materials will be considered provided to the individual if Contractor(s) does
9 one or more of the following:
10 (A) Mails a printed copy of the information to the persons served's mailing address
before the individual receives their first specialty mental health service;
11
(B) Mails a printed copy of the information upon the individual's request to their
12 mailing address;
13 (C) Provides the information by email after obtaining the persons served's agreement
14 to receive the information by email;
15 (D) Posts the information on the Contractor(s)'s website and advises the person
served in paper or electronic form that the information is available on the internet and
16
includes applicable internet addresses, provided that individuals with disabilities who
17 cannot access this information online are provided auxiliary aids and services upon
18 request and at no cost; or,
19 (E) Provides the information by any other method that can reasonably be expected
20 to result in the person served receiving that information. If Contractor(s) provides
informing materials in person, when the individual first receives specialty mental health
21 services, the date and method of delivery shall be documented in the persons served's
22 file.
23 8.7 Provider Directory. Contractor(s) must follow the County's provider directory policy,
24 in compliance with MHSUDS IN 18-020.
25 Contractor(s) must make available to persons served, in paper form upon request and
26 electronic form, specified information about the County provider network as per 42 C.F.R. §
27 438.10(h). The most current provider directory is electronically available on the County website
and is updated by the County no later than thirty (30) calendar days after information is received
28
24
1 to update provider information. A paper provider directory must be updated at least monthly as
2 set forth in 42 C.F.R. § 438.10(h)(3)(i).
3 Any changes to information published in the provider directory must be reported to the
County within two (2) weeks of the change.
4 Contractor(s)will only need to report changes/updates to the provider directory for
5 licensed, waivered, or registered mental health providers.
6 Article 9
7 Independent Contractor
8 9.1 Status. In performing under this Agreement, the Contractor(s), including its officers,
9 agents, employees, and volunteers, is at all times acting and performing as an independent
10 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
11 venturer, partner, or associate of the County.
12 9.2 Verifying Performance. The County has no right to control, supervise, or direct the
13 manner or method of the Contractor(s)'s performance under this Agreement, but the County
14 may verify that the Contractor(s) is performing according to the terms of this Agreement.
15 9.3 Benefits. Because of its status as an independent contractor, the Contractor(s) has
16 no right to employment rights or benefits available to County employees. The Contractor(s) is
17 solely responsible for providing to its own employees all employee benefits required by law. The
18 Contractor(s) shall save the County harmless from all matters relating to the payment of
19 Contractor(s)'s employees, including compliance with Social Security withholding and all related
20 regulations.
21 9.4 Services to Others. The parties acknowledge that, during the term of this
22 Agreement, the Contractor(s) may provide services to others unrelated to the County.
23 9.5 Operating Costs. Contractor(s) shall provide all personnel, supplies, and operating
24 expenses of any kind required for the performance of this Agreement.
25 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this
26 Agreement, the Contractor(s) will be performing hiring, training, and credentialing of staff, and
27 County will be performing additional staff credentialing to ensure compliance with State and
28 Federal regulations.
25
1 9.7 Subcontracts. Contractor(s) shall obtain written approval from County's Department
2 of Behavioral Health Director, or designee before subcontracting any of the services delivered
3 under this Agreement. County's Department of Behavioral Health Director, or designee retains
4 the right to approve or reject any request for subcontracting services. Any transferee, assignee,
5 or subcontractor will be subject to all applicable provisions of this Agreement, and all applicable
6 State and Federal regulations. Contractor(s) shall be held primarily responsible by County for
7 the performance of any transferee, assignee, or subcontractor unless otherwise expressly
8 agreed to in writing by County's Department of Behavioral Health Director, or designee. The use
9 of subcontractors by Contractor(s) shall not entitle Contractor(s) to any additional compensation
10 that is provided for under this Agreement.
11 Contractor(s) shall remain legally responsible for the performance of all terms and
12 conditions of this Agreement, including, without limitation, all SMHS provided by third parties
13 under subcontracts, whether approved by the County or not.
14
15 Article 10
16 Indemnity and Defense
17 10.1 Indemnity. The Contractor(s) shall indemnify and hold harmless and defend the
18 County (including its officers, agents, employees, and volunteers) against all claims, demands,
19 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
20 liabilities of any kind to the County, the Contractor(s), or any third party that arise from or relate
21 to the performance or failure to perform by the Contractor(s) (or any of its officers, agents,
22 subcontractors, or employees) under this Agreement. The County may conduct or participate in
23 its own defense without affecting the Contractor(s)'s obligation to indemnify and hold harmless
24 or defend the County.
25 10.2 Survival. This Article 10 survives the termination of this Agreement.
26
27
28
26
1 Article 11
2 Insurance
3 11.1 The Contractor(s) shall comply with all the insurance requirements in Exhibit I to this
4 Agreement.
5 Article 12
6 Assurances
7 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal
8 Health Care Program.
9 (A) In entering into this Agreement, Contractor(s) certifies that it is not excluded from
10 participation in Federal Health Care Programs under either Section 1128 or 1128A of the
11 Social Security Act. Failure to so certify will render all provisions of this Agreement null
12 and void and may result in the immediate termination of this Agreement.
13 (B) In entering into this Agreement, Contractor(s) certifies, that the Contractor(s)
14 does not employ or subcontract with providers or have other relationships with providers
15 excluded from participation in Federal Health Care Programs, including Medi-
16 Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. Contractor(s)
17 shall conduct initial and monthly exclusion and suspension searches of the following
18 databases and provide evidence of these completed searches when requested by
19 County, DHCS or the US Department of Health and Human Services (DHHS):
20 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
21 Individuals/Entities (LEIE) Federal Exclusions
22 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
23 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
24 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration
25 System (NPPES)
26 (4) any other database required by DHCS or US DHHS.
27 (C) In entering into this Agreement, Contractor(s) certifies, that Contractor(s) does
28 not employ staff or individual Contractor(s)s/vendors that are on the Social Security
27
1 Administration's Death Master File. Contractor(s) shall check the database prior to
2 employing staff or individual Contractor(s)s/vendors and provide evidence of these
3 completed searches when requested by the County, DHCS or the US DHHS.
4 (D) Contractor(s) is required to notify County immediately if Contractor(s) becomes
5 aware of any information that may indicate their (including employees/staff and individual
6 Contractor(s)s/vendors) potential placement on an exclusions list.
7 (E) Contractor(s) shall screen and periodically revalidate all network providers in
8 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
9 (F) Contractor(s) must confirm the identity and determine the exclusion status of all
10 its providers, as well as any person with an ownership or control interest, or who is an
11 agent or managing employee of the contracted agency through routine checks of federal
12 and state databases. This includes the Social Security Administration's Death Master
13 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and
14 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
15 455.436.
16 (G) If Contractor(s)finds a provider that is excluded, it must promptly notify the
17 County as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor(s) shall not certify or pay
18 any Excluded provider with Medi-Cal funds, must treat any payments made to an
19 excluded provider as an overpayment, and any such inappropriate payments may be
20 subject to recovery.
21 Article 13
22 Inspections, Audits, and Public Records
23 13.1 Inspection of Documents. The Contractor(s) shall make available to the County,
24 and the County may examine at any time during business hours and as often as the County
25 deems necessary, all of the Contractor(s)'s records and data with respect to the matters
26 covered by this Agreement, excluding attorney-client privileged communications. The
27 Contractor(s) shall, upon request by the County, permit the County to audit and inspect all of
28
28
1 such records and data to ensure the Contractor(s)'s compliance with the terms of this
2 Agreement.
3 13.2 State Audit Requirements. If the compensation to be paid by the County under this
4 Agreement exceeds $10,000, the Contractor(s) is subject to the examination and audit of the
5 California State Auditor, as provided in Government Code section 8546.7, for a period of three
6 years after final payment under this Agreement. This section survives the termination of this
7 Agreement.
8 13.3 Internal Auditing. Contractor(s)s of sufficient size as determined by County shall
9 institute and conduct a Quality Assurance Process for all services provided hereunder. Said
10 process shall include at a minimum a system for verifying that all services provided and claimed
11 for reimbursement shall meet SMHS definitions and be documented accurately.
12 In addition, Contractor(s)s with medication prescribing authority shall adhere to County's
13 medication monitoring review practices. Contractor(s) shall provide County with notification and
14 a summary of any internal audit exceptions and the specific corrective actions taken to
15 sufficiently reduce the errors that are discovered through Contractor(s)'s internal audit process.
16 Contractor(s) shall provide this notification and summary to County as requested by the County.
17 13.4 Confidentiality in Audit Process. Contractor(s) and County mutually agree to
18 maintain the confidentiality of Contractor(s)'s records and information of persons served, in
19 compliance with all applicable State and Federal statutes and regulations, including but not
20 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor(s) shall
21 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable
22 statutes.
23 Contractor(s)'s fiscal records shall contain sufficient data to enable auditors to perform a
24 complete audit and shall be maintained in conformance with standard procedures and
25 accounting principles.
26 Contractor(s)'s records shall be maintained as required by DBH and DHCS on forms
27 furnished by DHCS or the County. All statistical data or information requested by the County's
28
29
1 DBH Director or designee shall be provided by the Contractor(s) in a complete and timely
2 manner.
3 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor(s) files
4 to ensure appropriate clinical documentation, high quality service provision and compliance with
5 applicable federal, state and county regulations.
6 Such audits may result in requirements for Contractor(s) to reimburse County for
7 services previously paid in the following circumstances:
8 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation
9 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
10 section 14107.11, subdivision (d).
11 (2) Definitions for "fraud," "waste," and "abuse" can also be found in the Medicare
12 Managed Care Manual available at https://www.cros.gov/Regulations-and-
13 Guidance/Guidance/Manuals
14 (B) Overpayment of Contractor(s) by County due to errors in claiming or
15 documentation.
16 (C) Other reasons specified in the SMHS Reasons for Recoupment document
17 released annually by DHCS and posted on the DHCS BHIN website.
18 Contractor(s) shall reimburse County for all overpayments identified by Contractor(s),
19 County, and/or state or federal oversight agencies as an audit exception within the timeframes
20 required by law or Country or state or federal agency. Funds owed to County will be due within
21 forty-five (45) days of notification by County, or County shall withhold future payments until all
22 excess funds have been recouped by means of an offset against any payments then or
23 thereafter owing to County under this or any other Agreement between the County and
24 Contractor(s).
25 13.6 Cooperation with Audits. Contractor(s) shall cooperate with County in any review
26 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This
27 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits.
28
30
1 In addition, Contractor(s) shall comply with all requests for any documentation or files
2 including, but not limited to, files for persons served..
3 Contractor(s) shall notify the County of any scheduled or unscheduled external
4 evaluation or site visits when it becomes aware of such visit. County shall reserve the right to
5 attend any or all parts of external review processes.
6 Contractor(s) shall allow inspection, evaluation and audit of its records, documents and
7 facilities for ten (10) years from the term end date of this Agreement or in the event
8 Contractor(s) has been notified that an audit or investigation of this Agreement has been
9 commenced, until such time as the matter under audit or investigation has been resolved,
10 including the exhaustion of all legal remedies, whichever is later pursuant to 42 C.F.R.§§
11 438.3(h) and 438.2301(3)(i-iii).
12 13.7 Single Audit Clause. If Contractor(s) expends Seven Hundred Fifty Thousand and
13 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies,
14 Contractor(s) agrees to conduct an annual audit in accordance with the requirements of the
15 Single Audit Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200.
16 Contractor(s) shall submit said audit and management letter to County. The audit must include a
17 statement of findings or a statement that there were no findings. If there were negative findings,
18 Contractor(s) must include a corrective action plan signed by an authorized individual.
19 Contractor(s) agrees to take action to correct any material non-compliance or weakness found
20 as a result of such audit. Such audit shall be delivered to County's DBH Finance Division for
21 review within nine (9) months of the end of any fiscal year in which funds were expended and/or
22 received for the program. Failure to perform the requisite audit functions as required by this
23 Agreement may result in County performing the necessary audit tasks, or at County's option,
24 contracting with a public accountant to perform said audit, or may result in the inability of County
25 to enter into future agreements with Contractor(s). All audit costs related to this Agreement are
26 the sole responsibility of Contractor(s).
27 A single audit report is not applicable if Contractor(s)'s Federal contracts do not exceed
28 the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
31
1 Contractor(s)'s only funding is through Drug-related Medi-Cal. If a single audit is not applicable,
2 a program audit must be performed and a program audit report with management letter shall be
3 submitted by Contractor(s) to County as a minimum requirement to attest to Contractor(s)
4 solvency. Said audit report shall be delivered to County's DBH Finance Division for review no
5 later than nine (9) months after the close of the fiscal year in which the funds supplied through
6 this Agreement are expended. Failure to comply with this Act may result in County performing
7 the necessary audit tasks or contracting with a qualified accountant to perform said audit. All
8 audit costs related to this Agreement are the sole responsibility of Contractor(s) who agrees to
9 take corrective action to eliminate any material noncompliance or weakness found as a result of
10 such audit. Audit work performed by County under this paragraph shall be billed to Contractor(s)
11 at County cost, as determined by County's Auditor-Controller/Treasurer-Tax Collector.
12 Contractor(s) shall make available all records and accounts for inspection by County, the
13 State of California, if applicable, the Controller General of the United States, the Federal Grantor
14 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
15 least three (3) years following final payment under this Agreement or the closure of all other
16 pending matters, whichever is later.
17 13.8 Public Records. The County is not limited in any manner with respect to its public
18 disclosure of this Agreement or any record or data that the Contractor(s) may provide to the
19 County. The County's public disclosure of this Agreement or any record or data that the
20 Contractor(s) may provide to the County may include but is not limited to the following:
21 (A) The County may voluntarily, or upon request by any member of the public or
22 governmental agency, disclose this Agreement to the public or such governmental
23 agency.
24 (B) The County may voluntarily, or upon request by any member of the public or
25 governmental agency, disclose to the public or such governmental agency any record or
26 data that the Contractor(s) may provide to the County, unless such disclosure is
27 prohibited by court order.
28
32
1 (C)This Agreement, and any record or data that the Contractor(s) may provide to the
2 County, is subject to public disclosure under the Ralph M. Brown Act (California
3 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
4 (D)This Agreement, and any record or data that the Contractor(s) may provide to the
5 County, is subject to public disclosure as a public record under the California Public
6 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
7 with section 6250) ("CPRA").
8 (E) This Agreement, and any record or data that the Contractor(s) may provide to the
9 County, is subject to public disclosure as information concerning the conduct of the
10 people's business of the State of California under California Constitution, Article 1,
11 section 3, subdivision (b).
12 (F) Any marking of confidentiality or restricted access upon or otherwise made with
13 respect to any record or data that the Contractor(s) may provide to the County shall be
14 disregarded and have no effect on the County's right or duty to disclose to the public or
15 governmental agency any such record or data.
16 13.9 Public Records Act Requests. If the County receives a written or oral request
17 under the CPRA to publicly disclose any record that is in the Contractor(s)'s possession or
18 control, and which the County has a right, under any provision of this Agreement or applicable
19 law, to possess or control, then the County may demand, in writing, that the Contractor(s)
20 deliver to the County, for purposes of public disclosure, the requested records that may be in
21 the possession or control of the Contractor(s). Within five business days after the County's
22 demand, the Contractor(s) shall (a) deliver to the County all of the requested records that are in
23 the Contractor(s)'s possession or control, together with a written statement that the
24 Contractor(s), after conducting a diligent search, has produced all requested records that are in
25 the Contractor(s)'s possession or control, or (b) provide to the County a written statement that
26 the Contractor(s), after conducting a diligent search, does not possess or control any of the
27 requested records. The Contractor(s) shall cooperate with the County with respect to any
28 County demand for such records. If the Contractor(s) wishes to assert that any specific record
33
1 or data is exempt from disclosure under the CPRA or other applicable law, it must deliver the
2 record or data to the County and assert the exemption by citation to specific legal authority
3 within the written statement that it provides to the County under this section. The Contractor(s)'s
4 assertion of any exemption from disclosure is not binding on the County, but the County will give
5 at least 10 days' advance written notice to the Contractor(s) before disclosing any record
6 subject to the Contractor(s)'s assertion of exemption from disclosure. The Contractor(s) shall
7 indemnify the County for any court-ordered award of costs or attorney's fees under the CPRA
8 that results from the Contractor(s)'s delay, claim of exemption, failure to produce any such
9 records, or failure to cooperate with the County with respect to any County demand for any such
10 records.
11 Article 14
12 Right to Monitor
13 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of
14 California or any subdivision or appointee thereof, including the Auditor General, shall have
15 absolute right to review and audit all records, books, papers, documents, corporate minutes,
16 financial records, staff information, records of persons served, other pertinent items as
17 requested, and shall have absolute right to monitor the performance of Contractor(s) in the
18 delivery of services provided under this Agreement. Full cooperation shall be given by the
19 Contractor(s) in any auditing or monitoring conducted, according to this agreement.
20 14.2 Accessibility. Contractor(s) shall make all of its premises, physical facilities,
21 equipment, books, records, documents, agreements, computers, or other electronic systems
22 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished
23 under the terms of this Agreement, or determinations of amounts payable available at any time
24 for inspection, examination, or copying by County, the State of California or any subdivision or
25 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of
26 Inspector General, the United States Controller General or their designees, and other
27 authorized federal and state agencies. This audit right will exist for at least ten years from the
28 final date of the Agreement period or in the event the Contractor(s) has been notified that an
34
1 audit or investigation of this Agreement has commenced, until such time as the matter under
2 audit or investigation has been resolved, including the exhaustion of all legal remedies,
3 whichever is later (42 CFR §438.230(c)(3)(I)-(ii)).
4 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
5 evaluate, and audit the Contractor(s) at any time if there is a reasonable possibility of fraud or
6 similar risk. The Department's inspection shall occur at the Contractor(s)'s place of business,
7 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)).
8 14.3 Cooperation. Contractor(s) shall cooperate with County in the implementation,
9 monitoring and evaluation of this Agreement and comply with any and all reporting requirements
10 established by County. Should County identify an issue or receive notification of a complaint or
11 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request
12 information from Contractor(s) to ensure compliance with laws, regulations, and requirements,
13 as applicable.
14 14.4 Probationary Status. County reserves the right to place Contractor(s) on
15 probationary status, as referenced in the Probationary Status Article, should Contractor(s) fail to
16 meet performance requirements; including, but not limited to violations such as high
17 disallowance rates, failure to report incidents and changes as contractually required, failure to
18 correct issues, inappropriate invoicing, untimely and inaccurate data entry, not meeting
19 performance outcomes expectations, and violations issued directly from the State. Additionally,
20 Contractor(s) may be subject to Probationary Status or termination if agreement monitoring and
21 auditing corrective actions are not resolved within specified timeframes.
22 14.5 Record Retention. Contractor(s) shall retain all records and documents originated
23 or prepared pursuant to Contractor(s)'s performance under this Agreement, including grievance
24 and appeal records, and the data, information and documentation specified in 42 C.F.R. parts
25 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term
26 end date of this Agreement or until such time as the matter under audit or investigation has
27 been resolved. Records and documents include but are not limited to all physical and electronic
28 records and documents originated or prepared pursuant to Contractor(s)'s or subcontractor's
35
1 performance under this Agreement including working papers, reports, financial records and
2 documents of account, records of persons served, prescription files, subcontracts, and any
3 other documentation pertaining to covered services and other related services for persons
4 served.
5 14.6 Record Maintenance. Contractor(s) shall maintain all records and management
6 books pertaining to service delivery and demonstrate accountability for agreement performance
7 and maintain all fiscal, statistical, and management books and records pertaining to the
8 program. Records should include, but not be limited to, monthly summary sheets, sign-in
9 sheets, and other primary source documents. Fiscal records shall be kept in accordance with
10 Generally Accepted Accounting Principles and must account for all funds, tangible assets,
11 revenue and expenditures. Fiscal records must also comply with the Code of Federal
12 Regulations (CFR), Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative
13 Requirements, Cost Principles, and Audit Requirements for Federal Awards.
14 All records shall be complete and current and comply with all Agreement requirements.
15 Failure to maintain acceptable records per the preceding requirements shall be considered
16 grounds for withholding of payments for billings submitted and for termination of Agreement.
17 Contractor(s) shall maintain records of persons served and community service in
18 compliance with all regulations set forth by local, state, and federal requirements, laws, and
19 regulations, and provide access to clinical records by County staff.
20 Contractor(s) shall comply with the Article 18 and Article 1 regarding relinquishing or
21 maintaining medical records.
22 Contractor(s) shall agree to maintain and retain all appropriate service and financial
23 records for a period of at least ten (10) years from the date of final payment, the final date of the
24 contract period, final settlement, or until audit findings are resolved, whichever is later.
25 14.7 Financial Reports. Contractor(s) shall submit audited financial reports on an annual
26 basis to the County. The audit shall be conducted in accordance with Generally Accepted
27 Accounting Principles and generally accepted auditing standards.
28
36
1 14.8 Agreement Termination. In the event the Agreement is terminated, ends its
2 designated term or Contractor(s) ceases operation of its business, Contractor(s) shall deliver or
3 make available to County all financial records that may have been accumulated by Contractor(s)
4 or subcontractor under this Agreement, whether completed, partially completed or in progress
5 within seven (7) calendar days of said termination/end date.
6 14.9 Facilities and Assistance. Contractor(s) shall provide all reasonable facilities and
7 assistance for the safety and convenience of the County's representatives in the performance of
8 their duties. All inspections and evaluations shall be performed in such a manner that will not
9 unduly delay the work of Contractor(s).
10 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial
11 provisions of the Agreement, delegated activities or obligations, or application of other remedies
12 permitted by state or federal law when the County or DHCS determines Contractor(s) has not
13 performed satisfactorily.
14 14.11 Site Inspection. Without limiting any other provision related to inspections or audits
15 otherwise set forth in this Agreement, Contractor(s) shall permit authorized County, state, and/or
16 federal agency(ies), through any authorized representative, the right to inspect or otherwise
17 evaluate the work performed or being performed hereunder including subcontract support
18 activities and the premises which it is being performed. Contractor(s) shall provide all
19 reasonable assistance for the safety and convenience of the authorized representative in the
20 performance of their duties. All inspections and evaluations shall be made in a manner that will
21 not unduly delay the work of the Contractor(s).
22 Article 15
23 Complaints Logs and Grievances
24 15.1 Documentation. Contractor(s) shall log complaints and the disposition of all
25 complaints from a person served or their family. Contractor(s) shall provide a copy of the
26 detailed complaint log entries concerning County-sponsored persons served to County at
27 monthly intervals by the tenth (10th) day of the following month, in a format that is mutually
28 agreed upon. Contractor shall allow beneficiaries or their representative to file a grievance either
37
1 orally, or in writing at any time with the Mental health Plan. In the event Contractor is notified by
2 a beneficiary or their representative of a discrimination grievance, subcontractor shall report
3 discrimination grievances to the Mental Health Plan within 24 hours. The Contractor shall not
4 require a beneficiary or their representative to file a Discrimination Grievance with the Mental
5 Health Plan before filing the complaint directly with the DHCS Office of Civil Rights and the U.S.
6 Health and Human Services Office for Civil Rights.
7 15.2 Rights of Persons Served. Contractor(s) shall post signs informing persons served
8 of their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
9 Contractor(s) shall inform every person served of their rights as set forth in Exhibit J.
10 15.3 Incident Reporting. Contractor(s) shall file an incident report for all incidents
11 involving persons served, following the protocol identified in Exhibit K.
12 Article 16
13 Property of County
14 16.1 Applicability. Article 16 shall only apply to the program components and services
15 provided under operational costs.
16 16.2 Fixed Assets. County and Contractor(s) recognize that fixed assets are tangible and
17 intangible property obtained or controlled under County for use in operational capacity and will
18 benefit County for a period more than one (1) year.
19 16.3 Agreement Assets. Assets shall be tracked on an agreement by agreement basis.
20 All of these assets shall fall into the "Equipment" category unless funding source allows for
21 additional types of assets. At a minimum, the following types of items are considered to be
22 assets:
23 (A) Computers (desktops and laptops)*
24 (B) Copiers, cell phones, tablets, and other devices with any HIPAA data
25 (C) Modular furniture
26 (D)Any items over$500 or more with a lifespan of at least two (2) years:
27 (1) Televisions
28 (2) Washers/Dryers
38
1 (3) Printers
2 (4) Digital Cameras
3 (5) Other equipment/furniture
4 (6) Items in total when purchased or used as a group fall into one or more of the
5 above categories
6 (E) Items of sensitive nature shall be purchased and allocated to a single agreement.
7 All items containing HIPAA data are considered sensitive.
8 Contractor(s) shall ensure proper tracking for contact assets that include the following
9 asset attributes at a minimum:
10 (A) Description of the asset;
11 (B) The unique identifier of the asset if applicable, i.e., serial number;
12 (C)The acquisition date;
13 (D)The quantity of the asset;
14 (E) The location of the asset or to whom the asset is assigned;
15 (F) The cost of the asset at the time of acquisition;
16 (G)The source of grant funding if applicable;
17 (H)The disposition date, and
18 (1) The method of disposition (surplus, transferred, destroyed, lost)
19 All Contract assets shall be returned to the Department at the end of the agreement
20 period.
21 16.4 Retention and Maintenance. Assets shall be retained by County, as County
22 property, in the event this Agreement is terminated or upon expiration of this Agreement.
23 Contractor(s) agrees to participate in an annual inventory of all County fixed and inventoried
24 assets. Upon termination or expiration of this Agreement, Contractor(s) shall be physically
25 present when fixed and inventoried assets are returned to County possession. Contractor(s) is
26 responsible for returning to County all County owned undepreciated fixed and inventoried
27 assets, or the monetary value of said assets if unable to produce the assets at the expiration or
28 termination of this Agreement. Contractor(s) further agrees to the following:
39
1 Maintain all items of equipment in good working order and condition, normal wear and
2 tear excepted;
3 Label all items of equipment with County assigned program number, to perform periodic
4 inventories as required by County and to maintain an inventory list showing where and how the
5 equipment is being used in accordance with procedures developed by County. All such lists
6 shall be submitted to County within ten (10) days of any request therefore; and
7 Report in writing to County immediately after discovery, the loss or theft of any items of
8 equipment. For stolen items, the local law enforcement agency must be contacted, and a copy
9 of the police report submitted to County.
10 16.5 Equipment Purchase. The purchase of any equipment by Contractor(s) with funds
11 provided hereunder shall require the prior written approval of County's DBH Director or
12 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly
13 related to Contractor(s)'s services or activity under the terms of this Agreement. County may
14 refuse reimbursement for any costs resulting from equipment purchased, which are incurred by
15 Contractor(s), if prior written approval has not been obtained from County.
16 16.6 Modification. Contractor(s) must obtain prior written approval from County's DBH
17 whenever there is any modification or change in the use of any property acquired or improved,
18 in whole or in part, using funds under this Agreement. If any real or personal property acquired
19 or improved with said funds identified herein is sold and/or is utilized by Contractor(s) for a use
20 which does not qualify under this Agreement, Contractor(s) shall reimburse County in an
21 amount equal to the current fair market value of the property, less any portion thereof
22 attributable to expenditures of funds not provided under this Agreement. These requirements
23 shall continue in effect for the life of the property. In the event this Agreement expires, the
24 requirements for this Article shall remain in effect for activities or property funded with said
25 funds, unless action is taken by the State government to relieve County of these obligations.
26
27
28
40
1 Article 17
2 Compliance
3 17.1 Compliance. Contractor(s) agrees to comply with County's Contractor(s) Code of
4 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit L. Within
5 thirty (30) days of entering into this Agreement with County, Contractor(s) shall ensure all of
6 Contractor(s)'s employees, agents, and subcontractors providing services under this Agreement
7 certify in writing, that he or she has received, read, understood, and shall abide by the
8 Contractor(s) Code of Conduct and Ethics. Contractor(s) shall ensure that within thirty (30)
9 days of hire, all new employees, agents, and subcontractors providing services under this
10 Agreement shall certify in writing that he or she has received, read, understood, and shall abide
11 by the Contractor(s) Code of Conduct and Ethics. Contractor(s) understands that the promotion
12 of and adherence to the Contractor(s) Code of Conduct is an element in evaluating the
13 performance of Contractor(s) and its employees, agents, and subcontractors.
14 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
15 employees, agents, and subcontractors providing services under this Agreement shall complete
16 general compliance training, and appropriate employees, agents, and subcontractors shall
17 complete documentation and billing or billing/reimbursement training. All new employees,
18 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
19 Each individual who is required to attend training shall certify in writing that he or she has
20 received the required training. The certification shall specify the type of training received and
21 the date received. The certification shall be provided to County's DBH Compliance Officer at
22 1925 E. Dakota Ave, Fresno, California 93726. Contractor(s) agrees to reimburse County for
23 the entire cost of any penalty imposed upon County by the Federal Government as a result of
24 Contractor(s)'s violation of the terms of this Agreement.
25 17.2 Compliance with State Medi-Cal Requirements. Contractor(s) shall be required to
26 maintain Mental Health Plan organizational provider certification by Fresno County.
27 Contractor(s) must meet Medi-Cal organization provider standards as listed in Exhibit M, "Medi-
28 Cal Organizational Provider Standards", attached hereto and by this reference incorporated
41
1 herein and made part of this Agreement. It is acknowledged that all references to
2 Organizational Provider and/or Provider in Exhibit M shall refer to Contractor(s).
3 17.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor(s) will
4 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the
5 effective date of this Agreement through County to provide reimbursable services to Medi-Cal
6 eligible persons served. In addition, Contractor(s) shall work with the County's DBH to execute
7 the process if not currently certified by County for credentialing of staff. During this process, the
8 Contractor(s) will obtain a legal entity number established by the DHCS, a requirement for
9 maintaining Mental Health Plan organizational provider status throughout the term of this
10 Agreement. Contractor(s) will be required to become Medi-Cal certified prior to providing
11 services to Medi-Cal eligible persons served and seeking reimbursement from the County.
12 Contractor(s) will not be reimbursed by County for any services rendered prior to certification.
13 Contractor(s) shall provide direct specialty mental health services in accordance with the
14 Mental Health Plan. Contractor(s) must comply with the "Fresno County Mental Health Plan
15 Compliance Program and Code of Conduct" set forth in Exhibit L.
16 Contractor(s) may provide direct specialty mental health services using unlicensed staff
17 as long as the individual is approved as a provider by the Mental Health Plan, is supervised by
18 licensed staff, works within his/her scope and only delivers allowable direct specialty mental
19 health services. It is understood that each service is subject to audit for compliance with
20 Federal and State regulations, and that County may be making payments in advance of said
21 review. In the event that a service is disapproved, County may, at its sole discretion, withhold
22 compensation or set off from other payments due the amount of said disapproved services.
23 Contractor(s) shall be responsible for audit exceptions to ineligible dates of services or incorrect
24 application of utilization review requirements.
25 17.4 Network Adequacy. The Contractor(s) shall ensure that all services covered under
26 this Agreement are available and accessible to persons served in a timely manner and in
27 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206
28 (a), (c)).
42
1 Contractor(s) shall submit, when requested by County and in a manner and format
2 determined by the County, network adequacy certification information to the County, utilizing a
3 provided template or other designated format.
4 Contractor(s) shall submit updated network adequacy information to the County any time
5 there has been a significant change that would affect the adequacy and capacity of services.
6 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42
7 C.F.R. §438.3 (1), the Contractor(s) shall provide a person served the ability to choose the
8 person providing services to them.
9 17.5 Compliance Program, Including Fraud Prevention and Overpayments.
10 Contractor(s) shall have in place a compliance program designed to detect and prevent fraud,
11 waste and abuse, as per 42 C.F.R. § 438.608(a)(1), that must include:
12 (A) Written policies, procedures, and standards of conduct that articulate the
13 organization's commitment to comply with all applicable requirements and standards
14 under the Agreement, and all applicable federal and state requirements.
15 (B) A Compliance Office (CO) who is responsible for developing and implementing
16 policies, procedures, and practices designed to ensure compliance with the
17 requirements of this Agreement and who reports directly to the CEO and the Board of
18 Directors.
19 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior
20 management level charged with overseeing the organization's compliance program and
21 its compliance with the requirements under the Agreement.
22 (D)A system for training and education for the Compliance Officer, the organization's
23 senior management, and the organization's employees for the federal and state
24 standards and requirements under the Agreement.
25 (E) Effective lines of communication between the Compliance Officer and the
26 organization's employees.
27 (F) Enforcement of standards through well-publicized disciplinary guidelines.
28
43
1 (G)The establishment and implementation of procedures and a system with
2 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt
3 response to compliance issues as they are raised, investigation of potential compliance
4 problems as identified in the course of self-evaluation and audits, corrections of such
5 problems promptly and thoroughly to reduce the potential for recurrence and ongoing
6 compliance with the requirements under the Agreement.
7 (H)The requirement for prompt reporting and repayment of any overpayments
8 identified.
9 17.6 Reporting. Contractor(s) must have administrative and management arrangements
10 or procedures designed to detect and prevent fraud, waste and abuse of federal or state health
11 care funding. Contractor(s) must report fraud and abuse information to the County including but
12 not limited to:
13 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7),
14 (B) All overpayments identified or recovered, specifying the overpayment due to
15 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2),
16 (C) Information about changes in a persons served's circumstances that may affect
17 the person served's eligibility including changes in the their residence or the death of the
18 person served as per 42 C.F.R. § 438.608(a)(3).
19 (D) Information about a change in the Contractor(s)'s circumstances that may affect
20 the network provider's eligibility to participate in the managed care program, including
21 the termination of this Agreement with the Contractor(s) as per 42 C.F.R. §
22 438.608(a)(6).
23 Contractor(s) shall implement written policies that provide detailed information about the
24 False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68) of the
25 Act, including information about rights of employees to be protected as whistleblowers.
26 Contractor(s) shall make prompt referral of any potential fraud, waste or abuse to County
27 or potential fraud directly to the State Medicaid Fraud Control Unit.
28
44
1 17.7 Overpayments. County may suspend payments to Contractor(s) if DHCS or County
2 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42
3 C.F.R. §438.608 (a)(8)).
4 Contractor(s) shall report to County all identified overpayments and reason for the
5 overpayment, including overpayments due to potential fraud. Contractor(s) shall return any
6 overpayments to the County within 60 calendar days after the date on which the overpayment
7 was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)).
8 Article 18
9 Federal and State Laws
10 18.1 Health Insurance Portability and Accountability Act. County and Contractor(s)
11 each consider and represent themselves as covered entities as defined by the U.S. Health
12 Insurance Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to
13 use and disclose Protected Health Information (PHI) as required by law.
14 County and Contractor(s) acknowledge that the exchange of PHI between them is only
15 for treatment, payment, and health care operations.
16 County and Contractor(s) intend to protect the privacy and provide for the security of PHI
17 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
18 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
19 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and
20 other applicable laws.
21 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
22 Contractor(s) to enter into a agreement containing specific requirements prior to the disclosure
23 of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and
24 164.504(e) of the Code of Federal Regulations.
25 18.2 Physical Accessibility. In accordance with the accessibility requirements of section
26 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor(s) must
27 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
28 beneficiaries with physical or mental disabilities.
45
1 Article 19
2 Data Security
3 19.1 Data Security Requirements. Contractor(s) shall comply with data security
4 requirements in Exhibit N to this Agreement.
5
6 Article 20
7 Publicity Prohibition
8 20.1 Self-Promotion. None of the funds, materials, property, or services provided directly
9 or indirectly under this Agreement shall be used for Contractor(s)'s advertising, fundraising, or
10 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.)for the purpose of self-
11 promotion.
12 20.2 Public Awareness. Notwithstanding the above, publicity of the services described in
13 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
14 availability of such specific services when approved in advance by County's DBH Director or
15 designee .Communication products must follow DBH graphic standards, including typefaces
16 and colors, to communicate our authority and project a unified brand. This includes all media
17 types and channels and all materials on and offline that are created as part of DBH's efforts to
18 provide information to the public.
19 Article 21
20 Disclosure of Self-Dealing Transactions
21 21.1 Applicability. This Article 21 applies if the Contractor(s) is operating as a
22 corporation, or changes its status to operate as a corporation.
23 21.2 Duty to Disclose. If any member of the Contractor(s)'s board of directors is party to
24 a self-dealing transaction, he or she shall disclose the transaction by completing and signing a
25 "Self-Dealing Transaction Disclosure Form" (Exhibit O to this Agreement) and submitting it to
26 the County before commencing the transaction or immediately after.
27
28
46
1 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor(s)
2 is a party and in which one or more of its directors, as an individual, has a material financial
3 interest.
4 Article 22
5 Disclosure of Ownership and/or Control Interest Information
6 22.1 Applicability. This provision is only applicable if Contractor(s) is disclosing entities,
7 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
8 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
9 22.2 Duty to Disclose. Contractor(s) must disclose the following information as
10 requested in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest
11 Statement, Exhibit P:
12 (A) Disclosure of 5% or More Ownership Interest:
13 (1) In the case of corporate entities with an ownership or control interest in the
14 disclosing entity, the primary business address as well as every business location
and P.O. Box address must be disclosed. In the case of an individual, the date of
15
birth and Social Security number must be disclosed.
16 (2) In the case of a corporation with ownership or control interest in the
17 disclosing entity or in any subcontractor in which the disclosing entity has a five
18 percent (5%) or more interest, the corporation tax identification number must be
19 disclosed.
(3) For individuals or corporations with ownership or control interest in any
20 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
21 the disclosure of familial relationship is required.
22 (4) For individuals with five percent (5%) or more direct or indirect ownership
23 interest of a disclosing entity, the individual shall provide evidence of completion of a
24 criminal background check, including fingerprinting, if required by law, prior to
execution of Contract. (42 C.F.R. § 455.434)
25
(B) Disclosures Related to Business Transactions:
26 (1) The ownership of any subcontractors with whom Contractor(s) has had
27 business transactions totaling more than $25,000 during the 12-month period ending
28 on the date of the request.
47
1 (2) Any significant business transactions between Contractor(s) and any wholly
2 owned supplier, or between Contractor(s) and any subcontractor, during the 5-year
3 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
(C) Disclosures Related to Persons Convicted of Crimes:
4
(1) The identity of any person who has an ownership or control interest in the
5 provider or is an agent or managing employee of the provider who has been
6 convicted of a criminal offense related to that person's involvement in any program
7 under the Medicare, Medicaid, or the Title XXI services program since the inception
8 of those programs. (42 C.F.R. § 455.106.)
(2) County shall terminate the enrollment of Contractor(s) if any person with five
9
percent (5%) or greater direct or indirect ownership interest in the disclosing entity
10 has been convicted of a criminal offense related to the person's involvement with
11 Medicare, Medicaid, or Title XXI program in the last 10 years.
12 22.3 Contractor(s) must provide disclosure upon execution of Contract, extension for
13 renewal, and within 35 days after any change in Contractor(s) ownership or upon request of
14 County. County may refuse to enter into an agreement or terminate an existing agreement with
15 Contractor(s) if Contractor(s) fails to disclose ownership and control interest information,
16 information related to business transactions and information on persons convicted of crimes, or
17 if Contractor(s) did not fully and accurately make the disclosure as required.
18 22.4 Contractor(s) must provide the County with written disclosure of any prohibited
19 affiliations under 42 C.F.R. § 438.610. Contractor(s) must not employ or subcontract with
20 providers or have other relationships with providers Excluded from participation in Federal
21 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42
22 C.F.R. §438.610.
23 22.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
24 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this
25 Agreement where any person with five (5) percent or greater direct or indirect ownership interest
26 in Contractor(s) has been convicted of a criminal offense related to that person's involvement
27 with the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County may
28 terminate this Agreement where any person with five (5) percent or greater direct or indirect
48
1 ownership interest in the Contractor(s) did not submit timely and accurate information and
2 cooperate with any screening method required in CFR, Title 42, Section 455.416
3 Article 23
4 Disclosure of Criminal History and Civil Actions
5 23.1 Applicability. Contractor(s) is required to disclose if any of the following conditions
6 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
7 referred to as "Contractor(s)"):
8 (A) Within the three (3) year period preceding the Agreement award, they have been
9 convicted of, or had a civil judgment tendered against them for:
10 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
11 or performing a public (federal, state, or local) transaction or contract under a public
12 transaction;
13 (2) Violation of a federal or state antitrust statute;
14 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
15 or
16 (4) False statements or receipt of stolen property.
17 (B) Within a three (3) year period preceding their Agreement award, they have had a
18 public transaction (federal, state, or local) terminated for cause or default.
19 23.2 Duty to Disclose. Disclosure of the above information will not automatically
20 eliminate Contractor(s)from further business consideration. The information will be considered
21 as part of the determination of whether to continue and/or renew this Agreement and any
22 additional information or explanation that Contractor(s) elects to submit with the disclosed
23 information will be considered. If it is later determined that the Contractor(s)failed to disclose
24 required information, any contract awarded to such Contractor(s) may be immediately voided
25 and terminated for material failure to comply with the terms and conditions of the award.
26 Contractor(s) must sign a "Certification Regarding Debarment, Suspension, and Other
27 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit Q attached
28 hereto and by this reference incorporated herein. Additionally, Contractor(s) must immediately
49
1 advise the County in writing if, during the term of the Agreement: (1) Contractor(s) becomes
2 suspended, debarred, excluded or ineligible for participation in Federal or State funded
3 programs or from receiving federal funds as listed in the excluded parties list system
4 (http://www.epls.gov); or (2) any of the above listed conditions become applicable to
5 Contractor(s). Contractor(s) shall indemnify, defend, and hold County harmless for any loss or
6 damage resulting from a conviction, debarment, exclusion, ineligibility, or other matter listed in
7 the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
8 Article 24
9 Cultural and Linguistic Competency
10 24.1 General.All services, policies and procedures must be culturally and linguistically
11 appropriate. Contractor(s) must participate in the implementation of the most recent Cultural
12 Competency Plan for the County and shall adhere to all cultural competency standards and
13 requirements. Contractor(s) shall participate in the County's efforts to promote the delivery of
14 services in a culturally competent and equitable manner to all individuals, including those with
15 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and
16 regardless of gender, sexual orientation, or gender identity including active participation in the
17 County's Diversity, Equity and Inclusion Committee.
18 24.2 Policies and Procedures. Contractor(s) shall comply with requirements of policies
19 and procedures for ensuring access and appropriate use of trained interpreters and material
20 translation services for all limited and/or no English proficient beneficiaries, including, but not
21 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
22 policies and procedures, and monitoring its language assistance program. Contractor(s)'s
23 policies and procedures shall ensure compliance of any subcontracted providers with these
24 requirements.
25 24.3 Interpreter Services. Contractor(s) shall notify its beneficiaries that oral
26 interpretation is available for any language and written translation is available in prevalent
27 languages and that auxiliary aids and services are available upon request, at no cost and in a
28 timely manner for limited and/or no English proficient beneficiaries and/or beneficiaries with
50
1 disabilities. Contractor(s) shall avoid relying on an adult or minor child accompanying the
2 beneficiary to interpret or facilitate communication; however, if the beneficiary refuses language
3 assistance services, the Contractor(s) must document the offer, refusal, and justification in the
4 beneficiary's file.
5 24.4 Interpreter Qualifications. Contractor(s) shall ensure that employees, agents,
6 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
7 communicate with a beneficiary in a language other than English (1) have completed annual
8 training provided by County at no cost to Contractor(s); (2) have demonstrated proficiency in the
9 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
10 specific to Contractor(s)'s services; and (4) adheres to generally accepted interpreter ethic
11 principles. As requested by County, Contractor(s) shall identify all who interpret for or provide
12 direct communication to any program beneficiary in a language other than English and identify
13 when the Contractor(s) last monitored the interpreter for language competence.
14 24.5 CLAS Standards. Contractor(s) shall submit to County for approval, within ninety
15 (90) days from date of contract execution, Contractor(s)'s plan to address all fifteen (15)
16 National Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by
17 the Office of Minority Health and as set forth in Exhibit R "National Standards on Culturally and
18 Linguistically Appropriate Services", attached hereto and incorporated herein by reference and
19 made part of this Agreement. As the CLAS standards are updated, Contractor(s)'s plan must
20 be updated accordingly. As requested by County, Contractor(s) shall be responsible for
21 conducting an annual CLAS self-assessment and providing the results of the self-assessment to
22 the County. The annual CLAS self-assessment instruments shall be reviewed by the County
23 and revised as necessary to meet the approval of the County.
24 24.6 Training Requirements. Cultural competency training for Contractor(s) staff should
25 be substantively integrated into health professions education and training at all levels, both
26 academically and functionally, including core curriculum, professional licensure, and continuing
27 professional development programs. As requested by County, Contractor(s) shall report on the
28
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1 completion of cultural competency trainings to ensure direct service providers are completing a
2 minimum of twelve (12) hours of annual cultural competency training.
3 24.7 Continuing Cultural Competence. Contractor(s) shall create and sustain a forum
4 that includes staff at all agency levels to discuss cultural competence. Contractor(s) shall
5 designate a representative from Contractor(s)'s team to attend County's Diversity, Equity and
6 Inclusion Committee.
7 Article 25
8 General Terms
9 25.1 Modification. Except as provided in Article 7, "Termination and Suspension," this
10 Agreement may not be modified, and no waiver is effective, except by written agreement signed
11 by both parties. The Contractor(s) acknowledges that County employees have no authority to
12 modify this Agreement except as expressly provided in this Agreement.
13 (A) Notwithstanding the above, non-material changes to services, staffing, and
14 responsibilities of the Contractor(s), as needed, to accommodate changes in the laws
15 relating to service requirements and specialty mental health treatment, may be made
16 with the signed written approval of County's DBH Director, or designee, and
17 Contractor(s) through an amendment approved by County's County Counsel and the
18 County's Auditor-Controller/Treasurer-Tax Collector's Office. Said modifications shall not
19 result in any change to the maximum compensation amount payable to Contractor(s), as
20 stated herein.
21 (B) In addition, changes to line items and expense category subtotals, as set forth in
22 Exhibit H, that when added together during the term of the agreement do not exceed ten
23 percent (10%) of the total maximum compensation payable to Contractor(s), may be
24 made with the written approval of Contractor(s) and County's DBH Director or designee.
25 Changes to service rates on Exhibit H that do not exceed 3% of the approved rate, or
26 that are needed to accommodate state-mandated rate increases, may be made with the
27 written approval of the DBH Director or designee. These rate changes may not add or
28 alter any other terms or conditions of the Agreement. Said modifications shall not result
52
1 in any change to the maximum compensation amount payable to Contractor(s), as
2 stated herein.
3 25.2 Separate Agreement. It is mutually understood by the parties that this Agreement
4 does not, in any way, create a joint venture among Contractor(s)s. By execution of this
5 Agreement, Contractor(s)s understand that a separate Agreement is formed between each
6 individual Contractor(s) and County.
7 25.3 Addition/Deletion of Providers. The County reserves the right at any time during
8 the term of this Agreement to add Contractor(s)s to and remove Contractor(s)s from the list
9 contained on Exhibit A. It is understood that any such additions and removals will not affect
10 compensation paid to the other Contractor(s)s, and therefore such additions and removals may
11 be made by County without notice or approval of other Contractor(s)s under this Agreement.
12 The County's DBH Director, or designee, may remove a Contractor(s) from the agreement
13 where there is mutual written consent between the DBH Director and Contractor(s).
14 25.4 Non-Assignment. Neither party may assign its rights or delegate its obligations
15 under this Agreement without the prior written consent of the other party.
16 25.5 Governing Law. The laws of the State of California govern all matters arising from
17 or related to this Agreement.
18 25.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
19 County, California. Contractor(s) consents to California jurisdiction for actions arising from or
20 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
21 brought and maintained in Fresno County.
22 25.7 Construction. The final form of this Agreement is the result of the parties' combined
23 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
24 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
25 against either party.
26 25.8 Days. Unless otherwise specified, "days" means calendar days.
27 25.9 Headings. The headings and section titles in this Agreement are for convenience
28 only and are not part of this Agreement.
53
1 25.10 Severability. If anything in this Agreement is found by a court of competent
2 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
3 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
4 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
5 intent.
6 25.11 Nondiscrimination. During the performance of this Agreement, the Contractor(s)
7 shall not unlawfully discriminate against any employee or applicant for employment, or recipient
8 of services, because of race, religious creed, color, national origin, ancestry, physical disability,
9 mental disability, medical condition, genetic information, marital status, sex, gender, gender
10 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
11 all applicable State of California and federal statutes and regulation.
12 Contractor(s) shall take affirmative action to ensure that services to intended Medi-Cal
13 beneficiaries are provided without use of any policy or practice that has the effect of
14 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
15 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
16 genetic information, health status or need for health care services, or mental or physical
17 disability.
18 25.12 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
19 of the Contractor(s) under this Agreement on any one or more occasions is not a waiver of
20 performance of any continuing or other obligation of the Contractor(s) and does not prohibit
21 enforcement by the County of any obligation on any other occasion.
22 25.13 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
23 between the Contractor(s) and the County with respect to the subject matter of this Agreement,
24 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
25 publications, and understandings of any nature unless those things are expressly included in
26 this Agreement. If there is any inconsistency between the terms of this Agreement without its
27 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
28
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1 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
2 exhibits.
3 25.14 No Third-Party Beneficiaries. This Agreement does not and is not intended to
4 create any rights or obligations for any person or entity except for the parties.
5 25.15 Authorized Signature. The Contractor(s) represents and warrants to the County
6 that:
7 (A) The Contractor(s) is duly authorized and empowered to sign and perform its
8 obligations under this Agreement.
9 (B) The individual signing this Agreement on behalf of the Contractor(s) is duly
10 authorized to do so and his or her signature on this Agreement legally binds the
11 Contractor(s) to the terms of this Agreement.
12 25.16 Electronic Signatures. The parties agree that this Agreement may be executed by
13 electronic signature as provided in this section.
14 (A) An "electronic signature" means any symbol or process intended by an individual
15 signing this Agreement to represent their signature, including but not limited to (1) a
16 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
17 electronically scanned and transmitted (for example by PDF document) version of an
18 original handwritten signature.
19 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
20 equivalent to a valid original handwritten signature of the person signing this Agreement
21 for all purposes, including but not limited to evidentiary proof in any administrative or
22 judicial proceeding, and (2) has the same force and effect as the valid original
23 handwritten signature of that person.
24 (C)The provisions of this section satisfy the requirements of Civil Code section
25 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
26 Part 2, Title 2.5, beginning with section 1633.1).
27 (D) Each party using a digital signature represents that it has undertaken and
28 satisfied the requirements of Government Code section 16.5, subdivision (a),
55
1 paragraphs (1) through (5), and agrees that each other party may rely upon that
2 representation.
3 (E) This Agreement is not conditioned upon the parties conducting the transactions
4 under it by electronic means and either party may sign this Agreement with an original
5 handwritten signature.
6 25.17 Counterparts. This Agreement may be signed in counterparts, each of which is an
7 original, and all of which together constitute this Agreement.
8 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
COUNTY OF FRESNO
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5 Sal u t o, airman of the Board of
Su sor he County of Fresno
6
Attest:
7 Bernice Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
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By: Cf"`
10 Deputy
11 For accounting use only:
12 Org No.:5630
Account No.:7295
13 Fund No.:0001
Subclass No.:
14 10000
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22 Please see additional signature
pages attached.
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1
2 The Fresno Center
3 n
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Pao Yang, President and CEO
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7 Jensen Vang, Chief Financial Officer
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9 4879 E. Kings Canyon Road
Fresno, CA 93727
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11 For accounting use only:
12 Org No.: 56304524/4540
Account No.: 7295
13 Fund No.: 0001
Subclass No.: 10000
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Exhibit A
List of Contractors
Contractor Exhibit B subpart
1. The Fresno Center Exhibit B-1
Business Type: Private, non-profit, 501 (c)(3) corporation
Business Address: 4879 E. Kings Canyon Road
Fresno, CA 93727
Contact: Pao Yang, President/CEO
Service Address: 4879 E. Kings Canyon Road
Fresno, CA 93727
Target Population: Southeast Asian Children/Youth, Adult
and Older Adult
Level of Care: Outpatient/Intensive Case Management
and Full Service
Partnership
A-1
Exhibit B
Page 1 of 15
MENTAL HEALTH SERVICES ACT COMMUNITY SERVICES AND SUPPORTS
CULTURAL SPECIFIC SERVICES
PROGRAM OVERVIEW
CONTRACT SERVICES: Cultural Specific Services
CONTRACTOR(S): See Exhibit A
I. BACKGROUND
County, on behalf of the Department of Behavioral Health (DBH), Mental Health Services Act
(MHSA), Community Services and Supports (CSS), has developed a Master Agreement for
Cultural Specific Services that are a unique blend of traditional mental health services and non-
traditional culture based treatments and supports in an integrated model for seriously
emotionally disturbed (SED) children/youth and seriously mentally ill (SMI) adult persons served
in Fresno County's culturally diverse, underserved and unserved populations.
Program Intent and Goals - Based upon the MHSA community/stakeholder input process
resulted in the priority to enhance cultural services and the integration with primary care service
centers for the community. This Agreement seeks to expand culturally competent and
linguistically accessible community-based specialty mental health services provided by licensed
and unlicensed/waivered mental health professionals to SED/SMI persons served and their
families. Acute shortage of licensed mental health professionals, who are of
culturally/ethnic/linguistically-specific descent, has been identified as a barrier to linguistic
access and culturally competent services in an individual/family driven service model that
promotes wellness and recovery. Culturally specific specialty mental health programs will
secure and maintain culturally and linguistically competent mental health staff for intended
populations through development and establishment of clinical training sites.
The Affordable Care Act significantly increased access to Medi-Cal for many community
members and services for individuals with mild to moderate impairments by making services
now readily available through managed care health plans. However, there remains a great
need for services to individuals with serious mental illness across many unique cultural
populations.
The intention of this Agreement is for organizations with specific and unique experience in
working with cultural/ethnic/linguistic populations to develop comprehensive specialty mental
health programs for the SED/SMI individuals and their families in those populations. This
Cultural Specific Services Agreement is expected to increase the number of cultures served,
breadth of service, number of persons served, and the levels of care provided through
programs that are a unique blend of traditional mental health services and non-traditional
culture based treatments and supports. This integrated model shall service more than one
level of care and provide holistic behavioral health care immersed in individual culture.
SED/SMI persons served who prefer to receive care within the context of their identified
culture shall be fully immersed in a comprehensive program.
II. TARGET POPULATION
Priority target populations identified to receive cultural/ethnic/linguistic specialty mental health
services include, but may not be limited to: African-Americans; American Indian/Alaska
Exhibit B
Page 2 of 15
Native; Asian Pacific Islanders; Lesbian, Gay, Bisexual, Transgender and Questioning
(LGBTQ); Punjabi; Southeast Asians; and refugee populations. Cultural Specific Services,
while targeting these specific unserved and underserved groups, should be able to link all age
groups, populations, and cultures to appropriate services as needed. There should be no
exclusion criteria.
Program services will target adults and older adults who are SMI and may include a family
system approach that also targets children and adolescents who are SED. Contractor(s) shall
specify target age ranges to be served, including SMI adults, SMI older adults, SED youth
and/or the SED TAY population. At a minimum, services to SMI adults and older adults must
be provided. Service populations are identified for each Contractor in Exhibit A and Exhibits
B-1 et seq.
Other characteristics of the target population will depend on the levels of care to be provided
by each individual Contractor. Contractor(s) shall identify the levels of care to be provided for
their specific intended population, which may include outpatient (OP), intensive case
management (ICM) and/or full service partnership (FSP) services. Individuals who fall under
the FSP criteria include those who are in danger of homelessness, hospitalizations, out of
home placements, incarcerations or emergency room visits, are in need of high level of
services and potentially provide services on a twenty-four (24) hour, seven (7) day a week
schedule.
Referrals for the Cultural Specific Services program will come from County-operated and
contracted programs, other community organizations, and individual self-referrals. DBH
persons served will be prioritized; Contractor(s) will be responsible for contacting DBH first
whenever an opening becomes available. Enrollment into the FSP component will be
approved through DBH Urgent Care and Wellness Center.
III. LOCATION OF SERVICES
Services are to be delivered wherever the intended target population resides, which may be
Fresno/Clovis metro areas, County rural areas, or both. Network adequacy standards for time
and distance under the Centers for Medicare and Medicaid Services (CMS) Medicaid
Managed Care Final Rule must be applied. See also Mental Health Substance Use Disorder
Services (MHSUDS) Info Notice No. 18-011. Contractor(s) shall provide a plan for
transportation or access to services for rural areas, if not the place of residence for the
majority of the intended population.
Services can be delivered in the home, community, school or other community-based settings
as determined by collaborating with all relevant parties. Telehealth, mobile services, and co-
location in natural supports and gathering places for the intended population are additional
options to increase the frequency of individuals obtaining needed services, as some persons
served and families are reluctant to seek services from traditional mental health settings.
Satellite sites in rural communities are also strongly recommended.
IV. DESCRIPTION OF SERVICES
A. Culturally/Ethnically/Linguistically Competent Specialty Mental Health Services
Contractor(s) shall deliver a comprehensive specialty mental health program for the SED/SMI
individuals in their identified target population. Contractor(s) will detail any non-traditional
culture based treatments and supports to be provided. Traditional mental health services
Exhibit B
Page 3 of 15
include but are not limited to: outpatient specialty mental health services, intensive case
management, crisis outreach services, medication evaluation, peer support, and supported
independent permanent housing. Contractor(s) will identify the different levels of care for
which they will provide services, with a minimum of outpatient and intensive case
management. Contractor(s) will state a minimum caseload per level of care service.
1. OP services are provided to persons served who are Medi-Cal eligible and who meet
the State Department of Health Care Services' (DHCS) medical necessity criteria, and
with services designated and provided regardless of payer source. OP services may
include assessment, case management, individual, group and family therapies,
collateral services, plan development, and rehabilitation services. For individuals who
have mild to moderate impairment or need medications only and do not require
specialty mental health services, the Contractor(s) is expected to work with other
programs such as DBH Urgent Care and Wellness Center, managed care health plans
or other like agencies to develop a collaborative agreement for the provision or
transition of needed services.
a) Ensure Contractor(s) staff provides appropriate age, culture, gender and language
services and accommodations for physical disability(ies) to persons served.
b) Make appropriate referrals and linkages to addiction services that are beyond that
of the Cultural Specific Services program for individuals with coexisting alcohol,
tobacco and drug abuse and other addictive symptoms.
c) Provide support to the individual's family and other members of the individual's
social network to help them manage the symptoms and illness of the individual and
reduce the level of family and social stress associated with the illness.
d) Coordinate services with other community mental health and non-mental health
providers, as well as other medical professionals. Methods for service coordination
and communication between Contractor(s) and other service providers serving the
same persons served shall be developed and implemented consistent with Fresno
County confidentiality rules.
e) Transport persons served to and from service site(s), as needed.
2. ICM services include case management and community based crisis intervention
services available eight (8) hours a day, five (5) days a week, and a minimum of one
(1) person-to-person contact a week with each enrolled individual. ICM services
include assisting persons served with accessing all entitlements or benefits for which
they are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers, etc.), development of family
support and involvement whenever possible, individual referral to supported education
and employment opportunities, transportation service when it is critical to initially
access a support service or gain entitlements or benefits, medication evaluation and
provision of peer support services.
a) Provide the following:
• Assist persons served with accessing all entitlements or benefits for which they
are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers etc.).
• Develop family support and involvement whenever possible.
Exhibit B
Page 4 of 15
• Refer persons served to supported education and employment opportunities.
• Provide transportation service when it is critical to access a support service or
gain entitlements or benefits.
b) Provide Medication Evaluation either in person or via tele-psychiatry.
c) Assist persons served to locate appropriate housing in the community.
d) Refer or provide peer support activities.
e) Provide services for co-occurring substance use disorders.
• Identify alcohol, tobacco and drug abuse effects and patterns.
• Education regarding the interaction of alcohol, tobacco and drug use with
psychiatric symptoms and medications.
• Developing motivation for deceasing alcohol, tobacco and drug use.
• Achieving periods of abstinence and stability.
• Use of clinical interventions and peer support recovery groups and activities.
• Assisting persons served to achieve an alcohol, tobacco and drug free life style.
• Education regarding relapse prevention.
f) Develop individual self-directed plan of care.
g) Transport persons served to and from service site, as needed.
3. FSP services (see Exhibit C — FSP Service Delivery Model) are provided to persons
served at any given point in time that have SED/SMI and who have had recent
admission to the County's crisis intervention services and/or acute inpatient services,
or have been incarcerated. Contractor(s) will work with County's DBH to have their
FSP program registered with DHCS and the Data Collection and Reporting (DCR)
system. The FSP program includes case management and crisis outreach services
available twenty-four (24) hours a day, seven (7) days a week both telephonically and
in person, and a minimum of three (3) person-to-person contacts a week with each
individual. The staffing ratio is not more than one (1) staff to fifteen (15) persons
served.
a) Coordinate with law enforcement and courts services, as needed.
b) Be available to provide the following services, including but not limited to:
• Personal service coordination and supportive counseling.
• Ongoing assessment of the individual's mental illness symptoms and response
to treatment.
Exhibit B
Page 5 of 15
• Education of the individual regarding his/her mental illness and the effects
(including side effects) of prescribed medications.
• Symptom management efforts directed to helping the individual identify the
symptoms and their occurrence patterns, and development of methods
(internal, behavioral, adaptive) to lessen their effects.
• Provision, both on planned and on an "as needed" basis, of such psychological
support as is necessary to help persons served accomplish their personal goals
and cope with the stresses of day-to-day living.
c) Be available to provide crisis assessment and intervention twenty-four (24) hours
per day, seven (7) days per week throughout the year, including telephone and
face-to-face contact as needed. The following crisis response measures shall also
be followed:
• Response to crisis shall be rapid and flexible.
• When crisis housing is necessary for short-term care and inpatient treatment
(either voluntary or involuntary), the staff shall collaborate with the treatment
staff in such facilities. Support shall be provided to the maximum extent
possible, including accompanying the individual to the facility, remaining with
the individual during assessment, and beginning the process of planning with
the individual for discharge to the community as soon as possible.
d) Provide services in the areas of medication prescription, administration, monitoring,
and documentation.
• The psychiatrist shall assess each individual's mental illness symptoms and
behavior and prescribe appropriate medication, regularly review and document
symptoms as well as the individual's response to the prescribed medications,
educate the individual and family members, and monitor, treat and document
any medication side effects.
• The nurse shall establish medication policies and procedures which identify
processes to administer medications, train other team members, and assess
regularly other team members' competency in this area.
• All FSP team staff shall assess and document individual's mental illness
symptoms and behavior in response to medication and shall monitor for
medication side effects during the provision of observed self-administration and
during ongoing face-to-face contacts.
• Regarding residents of Residential Care Facilities, the team shall collaborate
with staff at these facilities to ensure persons served at these locations are
taking prescribed medications and the staff is monitoring their response to the
medication(s). Furthermore, the staff shall review the facility records (after
receiving written consent from the individual) and shall regularly collaborate
with facility staff about treatment plans, goals, objectives and interventions.
Exhibit B
Page 6 of 15
e) Provide whatever direct assistance is necessary and reasonable to ensure that the
individual obtains the basic necessities of daily life, such as food, housing, clothing,
medical services, and other financial support.
f) Ensure that each FSP team member shall have in their possession during regular
working hours (and appropriate on-call hours) an adequate amount of financial
resources to make emergency purchases of food, shelter, clothing, prescriptions,
transportation, or other items for consumers, as needed. The team shall have
access to larger flexible funding accounts for assistance with housing deposits,
furniture purchases, and other items, with sound accounting practices for recording
and monitoring the use of these funds.
g) Assist the individual with establishing a payee or payee service. The FSP team
may utilize individual assistance funds to assist persons served with short-term
loans or grants, as necessary. The team shall link persons served to appropriate
social services, provide transportation as necessary, and link the individual to
appropriate legal advocacy representation.
h) Provide training, instruction, support and assistance to the individual in developing
personal skills, including but not limited to, the ability to:
• Carry out personal hygiene tasks.
• Perform household chores, including housekeeping, cooking, laundry and
shopping;
• Develop or improve money management skills;
• Use community transportation; and
• Locate, finance and maintain safe, clean and affordable housing.
i) Develop and support the individual's participation in recreation, social activities,
and relationships. Priority shall be given to supporting persons served in
establishing positive social relationships in normative community settings. Staff
shall assist persons served in establishing positive social relationships and
participating in social/recreational activities in the community. Such services shall
include, but not be limited to, assisting persons served in:
• Developing social skills and the skills and other skills needed to develop
meaningful personal relationships;
• Planning appropriate and productive use of leisure time including familiarizing
persons served with available social and recreational opportunities;
• Interacting with landlords, neighbors and others effectively and appropriately;
• Developing assertiveness and self-esteem; and
• Using existing self-help centers, groups, spiritual, and recreational groups to
combat isolation and withdrawal experienced by many persons coping with
severe mental illness.
Exhibit B
Page 7 of 15
j) Provide alcohol, tobacco and drug abuse services for co-occurring persons served,
as clinically appropriate and in accordance with harm reduction principles. This will
include, but is not limited to individual and group interventions to assist persons
served in:
• Identifying alcohol, tobacco, and drug abuse effects and patterns;
• Recognizing interactive effects of alcohol, tobacco, and drug use, psychiatric
symptoms and psychotropic medications;
• Developing coping skills and alternatives to minimize alcohol, tobacco and drug
use;
• Achieving periods of abstinence and/or decreased risk behaviors and increased
stability;
• Attending appropriate recovery or self-help meetings: and
• Achieving an alcohol and drug free lifestyle, as desired.
k) Act to minimize the individual's involvement in the criminal justice system, with
services to include, but not be limited to;
• Helping the individual identify precipitants to individual's criminal involvement;
• Providing necessary treatment, support and education to help eliminate
unlawful activities or criminal involvement that may be a consequence of the
individual's mental illness; and
• Collaborating with police, court personnel, and jail/prison officials to ensure
appropriate collaboration and clinical support through the legal processes.
1) Assist the individual, family and other members of the individual's social network to
relate in a positive and supportive manner through such means as:
• Education about the individual's severe mental illness and their role in the
therapeutic process and treatment services and supports;
• Supportive counseling;
• Intervention to resolve conflict;
• Referral, as appropriate, of the family to therapy, self-help and other family
support services; and
m) Coordinate with other community mental health and non-mental health providers,
as well as other medical professionals. Staff shall provide the following functions
for all persons served:
• Development of formal and informal affiliations with other human service
providers including, mental health, physical health care, addiction treatment
providers, and inpatient units;
Exhibit B
Page 8 of 15
• Involvement of other pertinent agencies, the individual's family, and members
of the individual's social network in the coordination of the assessment, and in
the development, implementation and revision of service plans;
• Advocacy and assistance to persons served to obtain needed benefits and
services, such as supplemental security income, general relief, housing
subsidies, food stamps, medical assistance, and legal services;
• Coordination of meetings of the individual's service providers in the community;
• Maintenance of ongoing communication with all other agencies serving the
individual, including hospitals, primary care physicians, rehabilitation services
and housing providers as required;
• Maintenance of working relationships with other community services, such as
education, law enforcement and social services;
• Maintenance of the clinical treatment relationship with the individual on a
continuing basis whether the individual is in the hospital, in the community,
involved with other agencies or the criminal justice system; and
• Methods for service coordination and communication between the team and
other service providers serving the same persons served shall be developed
and implemented consistent with Fresno County confidentiality rules.
n) Monitor service outcomes to determine if the individual has meaningful use of their
time, stays in school or maintains employment, has reduced numbers of
hospitalizations, incarcerations, and periods of homelessness. DBH will use State-
identified criteria for measuring these outcomes. The treatment team will be
monitored to ensure appropriate service delivery and adherence to MHSA
philosophies.
o) Provide comprehensive services, including intensive mental health treatment,
rehabilitation, and case management with the goal of increasing adaptive
functioning in the community and preventing unnecessary re-admissions to
Institutes of Mental Disease (IMD), acute inpatient facilities, or other higher levels
of care.
p) Employment and Education - FSP program will assist the individual in accessing
and participating in the employment and education programs offered in the
community, as appropriate. In order to facilitate individual participation in
community education and employment programs FSP shall include, but is not
limited to:
• Collaboration with and education of community providers as it relates to
individual's mental illness, abilities, levels of functioning, educational and
employment interest, and potential effects of the individual's mental health
symptoms on participation, in education and work;
Exhibit B
Page 9 of 15
• Encouragement and individual rehabilitation related to the integration,
practicing, follow through and problem solving as it relates to continued
education and employment;
• Individual supportive counseling and education to assist the individual, his/her
family, and support system in identifying, managing, and coping with the
symptoms of mental illness that may interfere with his/her work or education
experience;
• On-the-job or work-related crisis intervention;
• Crisis intervention in the educational setting;
• Work/education-related supportive services, such as assistance with grooming
and personal hygiene, securing appropriate clothing, wake-up calls, and
transportation; and
• The team staff shall also link with the supportive services for additional and
ongoing support related to education and employment.
q) Housing - The FSP team will empower persons served to take an active role in the
recovery process. The FSP team will provide housing options and maintain
persons served in maintaining a stable residence by providing needed services,
accessing resources, and encouraging persons served to be independent,
productive and responsible.
• The team shall provide whatever direct assistance is necessary to ensure that
the individual obtains the basic necessities of daily life, including but not limited
to:
o Safe, clean, affordable housing;
o Food and clothing;
o Medical and dental services; and
o Securing appropriate financial support, which may include Supplemental
Security Income (SSI), Social Security Disability Insurance (SSDI), General
Relief (GR), and money management or payee services.
• Contractor(s) shall ensure that team members have rapid access to flexible
spending funds for items such as security deposits, furniture, and/or other items
required for independent living.
• Contractor(s) will provide housing services, as needed, to ensure that persons
served maintain their housing. The vendor shall provide:
o Training and assistance to individual in locating, securing and inhabiting
housing which is appropriate to their level of functioning;
o Training and instruction, including individual support, problem solving, skill
development, modeling and supervision, in the home and in community
Exhibit B
Page 10 of 15
settings, to teach the individual to manage finances and maintain safe, clean,
affordable housing;
o Supportive and independent housing for the individual with the goal to have
every individual in secure housing that is appropriate for his/her level of ability
and need that is sustainable, as soon as reasonable possible;
4. Contractor(s) will establish a program to provide rent subsidies for independent
housing needed while developing a plan for sustainable housing based on
individual need and ability.
The concepts of wellness and recovery shall be embedded in Cultural Specific Services
through interventions that will focus on the strengths of the individual and family, and work
toward the goal of enhancing those strengths and self-sufficiency. All services should be
scheduled according to the needs, preferences, ability, and convenience of the individual and
family.
Contractor(s) that include SED youth in the target population shall provide Intensive Care
Coordination (ICC) and Intensive Home Based Services (IHBS) when medically necessary.
Contractor(s) shall also utilize the Pediatric Symptom Checklist (PSC-35) and California Child
and Adolescent Needs and Strengths (CANS 50) in accordance with Welfare and Institutions
Code Section 14707.5.
Reaching Recovery shall be implemented for individuals who are 18 years of age or older for
all levels of services including OP, ICM, and FSP. Reaching Recovery provides outcome
tools that consist of a set of clinical measures for adult individuals with mental illness that
promotes engagement and progression towards recovery. Contractor(s) will work with
County's DBH to receive training to implement Reaching Recovery as appropriate.
Contractor(s) shall demonstrate full capability to comply with Electronic Health Record (EHR)
standards in accordance with Health Information Portability and Accountability Act (HIPAA)
requirements. It is strongly recommended but not required that Contractor(s) use the
County's EHR (AVATAR) as their EHR. Should Contractor(s) choose to use their own
established EHR, Contractor(s) shall make accommodations to ensure secure transfer of data
from the individual Contractor to the County.
Contractor(s) shall develop a plan to continually engage targeted populations through
outreach and engagement services, distribute literature/informational brochures in appropriate
languages, and request feedback as to how access to care could be improved for the
intended population. Contractor(s) shall collaborate with agencies that are recognized and
accepted by the target population. Contractor(s) will collaborate with County in outreach to
target populations as requested. All printed material (flyers, brochures, banners, etc.) and
media outreach associated with the program must include the County's logo or state that the
program is funded by the County, and must be approved by DBH Director or designee prior to
use/circulation.
Contractor(s) shall participate in the DBH Cultural Competency Committee and Mental
Health Contracted Providers Meetings, and encouraged to participate in other local planning
organizations, initiatives, activities and assessments.
B. Clinical Training Services
Exhibit B
Page 11 of 15
In addition to providing specialty mental health services, Contractor(s) will establish, maintain
and further develop clinical training opportunities that will educate and train second-year
graduate, post-master, doctoral and/or post-doctoral students in social work, marriage and
family therapy, professional clinical counseling, and/or clinical psychology. Supervised clinical
experience services must meet Board of Behavioral Sciences (BBS) and/or California Board
of Psychology licensure requirements.
Contractor(s) will enhance community mental health services within priority populations by
integrating primary care provider services (physical health care) for the access and provision
of culturally competent services that address physical health care issues on an as needed
basis. Contractor(s) shall collaborate with various local colleges and universities to work with
students and associates who are representative of the priority populations, and who may
ultimately increase the numbers of qualified, culturally competent, licensed, mental health
service providers in the Fresno community.
C. Cultural Competency
Contractor(s) shall place importance on individual-identified values, beliefs and family
histories, consider what effects they may or may not have on the individual's recovery, and
use that information to guide the persons served' wellness and recovery plans. Treatments
and support services will be provided within the most relevant and meaningful cultural,
gender-sensitive, and age-appropriate context. Program staff shall have the skills, knowledge
and attitudes to meet all of the cultural and linguistic needs of their diverse persons served.
When appropriate, the program(s) will also provide intensive supports to families of persons
served as a way of meeting the needs of culturally and linguistically diverse communities. In
addition, the program(s) will collaborate with diverse communities to explore varying
perspectives on mental illness and wellness and recovery.
D. Additional Required Service Approaches
Contractor(s)' programs, services, and practices must align with DBH's vision, mission, and
Guiding Principles of Care Delivery, attached as Exhibit E DBH's principles of care delivery
define and guide a system that strives for excellence in the provision of behavioral health
services where the values of wellness, resiliency, and recovery are central to the development
of programs, services, and workforce. The principles provide the clinical framework that
influences decision-making on all aspects of care delivery including program design and
implementation, service delivery, training of the workforce, allocation of resources, and
measurement of outcomes. Contractor(s) must adhere to any and all applicable statutes as
stated in MHSUDS Notice 18-011. Contractor(s) must also use any standardized tools, such
as the "Columbia Suicide Severity Risk" assessment tool, as directed by DBH. SSI/SSDI
Outreach, Access, and Recovery (SOAR) is recommended as a strategy to increase access to
disability income benefit programs administered by the Social Security Administration (SSA)
for eligible adults who are experiencing or at risk of homelessness and have SMI, medical
impairment, and/or a co-occurring substance use disorder.
Contractor(s) must be thoroughly familiar with MHSA provisions, including but not limited to
State MHSA regulations, policy interpretations, and definitions. The State's MHSA policies
and procedures and other informational items may be referenced at the following website
(http://mhsoac.ca.gov/act). MHSA CSS funds will be used to reach the
unserved/underserved, new persons served, and existing persons served and their family
members who receive services through Fresno County DBH and other contracted services.
Exhibit B
Page 12 of 15
V. STAFFING
Contractor(s) staffing plans/patterns must be sufficient to deliver the level of services, as
described in each individual Contractor's scope of work. A background check on all staff
providing direct services must be completed via the DBH Managed Care credentialing process
prior to billing for Medi-Cal mental health services. Supervisors and services of the clinical
training program must meet BBS and/or California Board of Psychology standards.
Contractor(s) are encouraged to hire and recruit persons served/family members that have
previously received or experienced behavioral health services. Peer support services are
required as part of the program design.
An FSP team will include (but not be limited to) the following:
• Classifications:
o Team Leader/Program Director
o Licensed Mental Health Clinician
o Personal Service Coordinator/Case Manager
o Peer Support Specialist
o Registered Nurse
o Psychiatrist
o Program Assistant
• Staff-to-individual ratio shall not fall below 1:10 or exceed 1:15 (one Full-Time
Equivalent staff person for every ten to fifteen persons served). Psychiatrists, Program
Assistants and other indirect staff are not to be included in the ratio.
• The psychiatrist must meet with persons served on a minimum monthly basis and be
available during normal business hours and on-call during off-hour periods. This
position may be subcontracted out.
• Staff members working directly with persons served will provide outreach outside of
the office setting and have the capacity to provide as many contacts as needed with
persons served to meet their recovery/resiliency and wellness goals.
VI. HOURS OF OPERATION
Hours of operation must ensure availability to persons served and families as needed and
necessary. A minimum of eight (8) hours, five (5) days per week is required. Should persons
served/family members require services during non-traditional hours, Contractor(s) will work
to accommodate the persons served/family members in the most appropriate manner.
Contractor(s) are encouraged to provide details of business hours outside of traditional
business hours.
If Contractor(s) provide FSP services, they must provide a plan to detail coverage for twenty-
four (24) hours/day and seven (7) days/week appropriate for the percentage of persons
served under FSP services.
Exhibit B
Page 13 of 15
VII. AVERAGE INDIVIDUAL LENTH OF STAY
Contractor(s) shall describe expected average individual length of stay based on applicable
evidence-based, community-based, and/or cultural-based promising or emerging practice for
each modality of service level to be provided.
VII. FUNDING
Funding Use— MHSA CSS guidelines stipulated by the DHCS specifically limit how CSS
funds may be used.
VIII. PROGRAM OUTCOMES/PERFORMANCE OUTCOME MEASURES
Services and Performance Measures - Under the provision of the MHSA CSS component,
County's DBH receives funding to expand, develop and create successful CSS programs for
children, transitional aged youth, adults, and older adults in a culturally, ethically, and
linguistically competent approach for underserved and unserved populations. Culturally
specific approaches by Contractor(s) to these services, and their performance measures and
outcome goals are identified and detailed in Exhibits B-1 et seq.
All Contractor(s) shall comply with all project monitoring and compliance protocols, procedures,
data collection methods, and reporting requirements requested by the County. Contractor(s)
shall use performance outcome measures for evaluating program and system effectiveness to
ensure services and service delivery strategies are positively impacting the service population.
In addition, these measures shall be used to ensure Cultural Specific Services are in alignment
with MHSA guiding principles which are inclusive of: an integrated service experience;
community collaboration; cultural competence; individual/family driven service; and wellness,
resilience, and recovery focused services.
Goals of the program include less utilization of more costly crisis services, and minimization or
avoidance of more severe outcomes such as substance use disorder, hospitalization or
incarceration.
Performance outcome measures shall be tracked on an ongoing basis and used to update the
County monthly (by the 101" of the month following the report period). In addition, performance
outcome measures are reported to the County annually in accumulative reports for overall
program and contract evaluation. Forms and tools used to gather and report data reflecting
services provided, populations served, and impact of those services are to be developed by the
County and Contractor(s). Contractor(s) will work closely with the County to analyze the data
and make necessary adjustments to service delivery and reporting requirements before the start
of each new fiscal year.
Contractor(s)' specific performance measures and outcome goals are identified and detailed
in Exhibit B-1 et seq. Measurable outcomes may be reviewed for input and approval by a
designated DBH work group upon contract execution and adjusted as needed each new fiscal
year. The purpose of this review process is to ensure a comprehensive system wide
approach to the evaluation of programs through an effective outcome reporting process.
DBH collects data about the characteristics of the persons served and measures service
delivery performance indicators in each of the following CARF DOMAINS. At minimum, one
performance indicator will be identified for each of the four CARF domains listed below.
Exhibit B
Page 14 of 15
1. Effectiveness: A performance dimension that assesses the degree to which an
intervention or services have achieved the desired outcome/result/quality of care through
measuring change over time. The results achieved and outcomes observed are for
persons served.
Examples of indicators include: Persons get a job with benefits, or receive supports
needed to live in the community, increased function, activities, or participation, and
improvement of health, employment/earnings, or plan of care goal attainment.
2. Efficiency: Relationship between results and resources used, such as time, money, and
staff. The demonstration of the relationship between results and the resources used to
achieve them. A performance dimension addressing the relationship between the
outputs/results and the resources used to deliver the service.
Examples of indicators include: Direct staff cost per person served, amount of time it
takes to achieve an outcome, gain in scores per days of service, service hours per
person achieving some positive outcome, total budget (actual cost) per person served,
length of stay and direct service hours of clinical and medical staff.
3. Access: Organizations' capacity to provide services of those who desire or need
services. Barriers or lack thereof for persons obtaining services. The ability of persons
served to receive the right service at the right time. A performance dimension
addressing the degree to which a person needing services is able to access those
services.
Examples of indicators include: Timeliness of program entry (From 1st request for
service to 1 st service), ongoing wait times/wait lists, minimizing barriers to getting
services, and no-show/cancellation rates.
4. Satisfaction: Satisfaction Measures are usually orientated towards consumers, family,
staff, and stakeholders. The degree to which persons served, County and other
stakeholders are satisfied with services. A performance dimension that describes
reports or ratings from persons served about services received from an organization.
Examples of indicators include: opinion of persons served or other key stakeholders in
regards to access, process, or outcome of services received, Consumer and/or
Treatment Perception Survey.
Final selected measures will be agreed upon in contract negotiations along with liquidated
damages. Contractor(s) must address each of the categories referenced above and may
additionally propose other performance and outcome measures that are deemed best to
evaluate the services provided to persons served and/or to evaluate overall program
performance. Separate performance and outcomes measures are expected for specialty
mental health services and clinical training services. DBH may adjust the performance and
outcome measures periodically throughout the duration of the agreement, as needed, to best
measure the program as determined by County. Contractor(s) shall utilize and integrate
clinical tools as directed by DBH. The CANS 50 and PSC-35 will be used as the assessment
and screening tools for children and youth. Reaching Recovery are outcome tools for adults.
Contractor(s) must utilize a computerized tracking system with which performance and
outcome measures and other relevant individual data, such as demographics, will be
Exhibit B
Page 15 of 15
maintained. The data tracking system may be incorporated into the Contractor(s)' EHR or be
a stand-alone database. DBH must be afforded read-only access to the data tracking system,
if applicable. DBH prefers that the Contractor(s) utilize its current EHR (Avatar) with full
access being provided by DBH. However, if the Contractor(s) is unable or unwilling to utilize
DBH's current EHR, arrangements must be made to ensure that an interface to transfer all
necessary reporting and outcome information is developed to meet the needs of DBH.
Additional Reporting Requirements
Contractor(s) will be responsible for meeting with DBH on a monthly basis, or more often as
agreed upon between DBH and Contractor(s), for contract and performance monitoring.
Contractor(s) will be required to submit monthly reports to the County that will include, but not
be limited to: dollars billed for Medi-Cal and MHSA (non-Medi-Cal) persons served; actual
expenses; the number of persons served served/anticipated to be served; utilization of
services by persons served; and staff composition. These reports will be due within thirty (30)
days after the last day of the previous month or payments may be delayed.
Additional reporting is required for FSPs by DHCS. DHCS uses the FSP Data Collection and
Reporting (DCR) system to ensure adequate research and evaluation regarding the
effectiveness of services being provided and the achievement of the outcome measures.
Contractor(s) who provide FSP services will need to report individual/partner information and
outcomes of the FSP program directly into the DCR system. An Efficiency Domain review
cost per client for each twelve (12) month period is also required.
EXHIBIT B-1
MENTAL HEALTH SERVICES ACT COMMUNITY SERVICES AND SUPPORTS
CULTURAL SPECIFIC SERVICES
SCOPE OF WORK
CONTRACTOR: The Fresno Center
CONTACT: Pao Yang, President/CEO
pyanq(@fresnocenter.orq
SITE ADDRESS: 4879 E. Kings Canyon Road, Fresno, Ca 93727
SERVICES: Cultural Specific Services (Living Well Center)
Outpatient/Intensive Case Management (OP/ICM) Component 1 and Full
Service Partnership Component 2
PROJECT DESCRIPTION
The Fresno Center shall utilize culturally and linguistically capable, qualified mental health
practitioners to provide three levels of care, outpatient (OP), intensive case management (ICM),
and Full Service Partnership (FSP) services, to the Southeast Asian (SEA) community, particularly
those of Hmong, Laotian, Vietnamese or Cambodian descent, through the "Living Well Center"
(LWC). Program services are designed to serve SEA individuals that have serious emotional
disturbances (SED) or serious mental illness (SMI), and are in need of on-going community-based
services. The Fresno Center will use SEA non-licensed/waivered mental health clinicians, under
clinical direction and oversight by licensed clinicians, to increase capacity of persons served and
the volume of specialty mental health services to the SEA population. The LWC shall primarily
serve Fresno County Medi-Cal-eligible children, adults and older adults with mental health
treatment focusing on individuals with SED or SMI, and having problems coping with the
assimilation process. The mental health services shall be provided in appropriate SEA languages
accordingly to serve targeted population.
All referrals to The Fresno Center for FSP services shall be approved by County's Department of
Behavioral Health (DBH) Urgent Care Wellness Center.
In addition, The Fresno Center shall maintain a clinical supervision/training program for SEA
graduate, post-graduate, doctoral and post-doctoral students. The goal of the program is to
increase the number of licensed mental health professionals of SEA descent whose bi-lingual and
bi-cultural capacity will allow greater accessibility to mental health services for those who are of
Hmong, Laotian, Vietnamese or Cambodian descent.
TARGET POPULATION
Participation for LWC is on a voluntary basis. The target population shall include children/youth
(ages 0-18), adults (19-64), older adult (ages 65 & older) individuals who are of SEA descent and
are in need of culturally competent, linguistically accessible mental health services. Contractor
may expand the target population in accordance with the Scope of Work in Exhibit B with written
approval from DBH Director or Designee.
A minimum caseload consisting of 30 SEA persons served shall be enrolled in the FSP component
throughout each twelve (12) month period of this Agreement.
B-1-1
EXHIBIT B-1
LOCATION OF SERVICES
The current physical site for the LWC is centrally located in an area that is known as "Ban
Vinai/Asian Village", where many Southeast Asians live and shop. Additionally, there are
accessible public transit bus routes and plenty of open parking spaces.
LWC services may be expanded to include service delivery in the home, community, school or
other community-based settings, as some individuals and families are reluctant to seek services
from traditional mental health settings, or if other barriers like transportation and childcare become
barriers. This expansion in terms of location of services may also include telehealth, mobile
services, and co-location in natural supports and gathering places for the SEA population. These
locations will be determined in collaboration with the person served and treating clinician, and with
approval of the program director.
DESCRIPTION OF SERVICES
The Fresno Center shall:
A. Create, maintain and further develop a specialty mental health service site that utilizes
innovative approaches to building community trust within the SEA population, while
providing a clinical training program for qualified participants.
B. Train existing health care providers on mental health issues and how they may be
masked as physical health care complaints and symptoms, and on appropriate methods
for making referrals for mental health services within the cultural context of the person
served.
Specific to the delivery of Outpatient/intensive Case Management Specialty Mental Health
Services, The Fresno Center shall:
A. Increase the numbers of persons served with new and innovative education, outreach
and outpatient/intensive case management specialty mental health services specific to
the Fresno County SEA community in a manner that overcomes mental health stigma,
and supports and promotes wellness and recovery.
B. Provide outpatient/intensive case management specialty mental health services with a
focus on:
1. Innovative engagement and culturally specific services that address traditional
barriers to mental health access and engagement by the SEA population;
2. Assisting individuals to deal with cultural issues of assimilation and developing a
plan for the future;
3. Individuals who are reluctant to seek mental health treatment in a traditional setting;
and
4. Individuals who are Medi-Cal eligible and/or have difficulty accessing care.
C. Provide clinical mental health services driven by culturally sensitive approaches that may
include, but are not limited to:
B-1-2
EXHIBIT B-1
1. Domestic violence education and increased awareness to associated mental health
issues;
2. Issues related to parenting and family impacts when there is associated gang
violence; and
3. The impact of mental health issues to addictive behaviors that include gambling and
substance use.
D. Provide services that specifically address stigma and discrimination within the SEA
population, in an effort to better engage the community in the treatment of and recovery
from mental illness.
E. Treatment will be provided in a culturally competent manner to enhance individual self-
esteem and self-determination.
F. Provide individualized care plans that address specific cultural issues specific to age and
gender.
G. Emphasize family-driven services.
H. Utilize a variety of treatment approaches, including but not limited to:
1. Language and ethnic specific individual, family and group therapy;
2. Women's groups dealing with past and present trauma lead by female mental health
clinicians;
3. Other mental health groups that are gender specific, only involving mental health
professionals of the same gender; and
4. Family therapy with focus on youth/adolescents or transition age youth (ages 16-
24), enforcing the cultural importance of the family and the historic role of parents.
I. Provide mental health services in a culturally appropriate manner that respects gender
roles, the role of family members; respect for birth order and age within a cultural context;
and the ability to communicate in the individuals' native language.
J. Provide culturally sensitive environment/location that has community support and is not
directly related or co-located with traditional County mental health program services.
K. Increase opportunity for service provision without the use of an interpreter, thus
increasing trust and engagement within the treatment relationship.
L. Mental health services provided by clinicians with similar cultural backgrounds to better
understand and support treatment needs.
M. Provide mental health services that may focus on issues such as stigma, domestic
violence, gang affiliation and violence, exposure to trauma, addictive behaviors in an
effort to specifically address barriers to wellness and recovery that are met by the SEA
population.
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EXHIBIT B-1
N. Employ staff that are representative of SEA population and are qualified to recognize
symptoms being addressed that include, but are not limited to: trauma leading to
migration, change to socio-economic status, change in roles based on age and gender
due to 'norms' in cultural where relocated.
O. Use and/or recognition of traditional healing practices.
P. Take into consideration the following during the initial assessment:
1. Sexual orientation of the person served;
2. Gender roles within the SEA culture, with sensitivity toward female and male
interactions with others outside of their families in a cultural context;
3. Age within the SEA community with preference given to people who are the most
senior;
4. Birth order also plays a significant role in terms of family interactions with older
sibling taking priority over younger siblings;
5. Culturally defined role designations and attitudes are often a source of conflict as
second generation children began assimilating into mainstream Western culture;
Q. Provide outreach to SEA persons to be served and their family members through
networks of community leaders and through collaborative relationship with Federally
Qualified Health Center (FQHC) outpatient clinic(s). Provide and document referrals and
linkages to necessary physical health care providers.
R. Focus on recovery principles to make the persons served more self-reliant and resilient.
S. Establish a collaborative with existing community-based organizations, community
leaders and faith-based organizations in the SEA community.
T. Establish a process with primary care providers to generate referrals for mental health
services.
U. Utilize the Southeast Asian Cross Cultural Counseling Model (SEA CCCM) to increase
persons' served knowledge and capacity, gradually improve their condition, stabilize
them, and then ultimately help them to have a balanced and satisfactory life.
1. Cognitive Behavioral Therapy (CBT) Component. Counselors and clinicians will
help SEA children/youth to identify and replace unhealthy thinking/beliefs, and avoid
engaging in miserable and negative thoughts and behaviors.
2. Positive Psychology Component. Counselors and clinicians will help the SEA
children/youths to focus on positive emotions, thoughts, and wellness. For example
being grateful, having hope, having happiness, having inspiration, practicing
wellness, empowering self and having inner peace.
3. Skills Building Component. Counselors and peer support will teach SEA
children/youths about assertiveness, effective communication, working effectively
with others, problem solving skills, and relaxation techniques.
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EXHIBIT B-1
4. Cultural Strengths Component. SEA youths will be able to use their own cultural
values, practices, and beliefs to help them cope with their daily life changes. Focus
in on showing respect (Filial Piety!), practicing fairness (Relationship!), having
compassion (i.e. exchanging knowledge/labor, having empathy & kindness, doing
good deeds, and maintaining continuity with relatives and neighbors) (Happiness!),
cultural identity, and celebrating their culture (A Sense of Belonging!). These are
emphasis and practiced as they come to session everywhere by staff, clinicians and
counselors.
Specific to the delivery of Full Service Partnership Services, The Fresno Center shall:
A. Support the individual needs of the person served, using "whatever it takes" to help move
them out of high risk and low engagement behavior into engagement and self-care.
B. Document cultural practices and behaviors that resemble closely to hospitalization and
ER utilization such as increased use of alternative healing practices, shaman, and herbal
medicines.
C. Meet individuals on the streets, in their homes, at community centers, in hospitals and
clinics, and anywhere the person served might be, or at unconventional times, in order to
provide services "where the person served is at".
D. Provide the following, but not limited to:
1. 24/7 Crisis Response
2. Daily Program Rehabilitation/Support
3. Intensive Case Management
4. Social/Recreational Activities
5. Assess me nt/Treatme nt Planning
6. Individual Therapy
7. Educational Groups
8. Peer Support Groups
9. Psycho-pharmalogical Treatment
10. Housing Support
11. Hospitalization Support
12. Probation/Court Engagement
E. Provide transportation assistance, such as helping to purchase bus passes so individuals
can access services, go to school or seek employment.
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EXHIBIT B-1
F. Advocacy, such as negotiating with medical providers to get individuals seen more quickly
to minimize distress in the waiting room.
G. Community integration activities, such as facilitating self-care.
H. Housing related activities, such as supporting the individual through the housing process
with help assembling written documentation, making reminder calls, accompany
individuals to housing program interviews, writing letters of support or purchasing furniture
for individuals' homes to make it more comfortable for them.
I. Support assistance and services to seek and participate in cultural activities and
events, and alternative healing and practices within the community.
Specific to Clinical Supervision Program, The Fresno Center shall:
A. Facilitate the training/supervision of new SEA mental health professionals by providing a
supervised clinical environment where the new SEA professional may gain valuable field
experience under the terms and conditions of this Agreement.
B. Provide a clinical training site that will provide qualified and supervised training to SEA
post-master associates, to secure required hours necessary for completion of the State
licensing examination and for SEA graduate students to fulfill degree requirements in the
field of mental health or social work.
C. Keep records of student participation, including entrance into program, progress within,
and departure/completion of the program.
D. All direct services provided within this project shall be provided by licensed mental health
professionals, post-master degree associates or by students as part of their graduate
training program. Services provided will include assessment and mental health services
(individual, family, and group therapy) as designed by an individual-driven wellness and
recovery treatment plan that addresses personal goals.
E. Increase the number of student interns to successfully enter and complete the clinical
training program and obtain required licensure.
F. Provide clinical training environment, licensed oversight and documentation of required
hours of clinical training for all individuals within the clinical training program (associates,
graduate students, post-graduate students, waivered/registered staff, non-licensed staff),
at no additional cost to County.
STAFFING LEVEL
The Fresno Center shall adhere to the FSP staffing requirements.
HOURS OF OPERATION
The Living Well Center will operate from Monday through Saturday; Monday through Friday from 8
AM to 6 PM and Saturday from 8 AM to 12 PM. On-call services will be available 24 hours/7 days
a week for individuals in the FSP component.
PROGRAM OBJECTIVES AND OUTCOMES
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EXHIBIT B-1
The Fresno Center will utilize a computerized tracking system with which outcome measures and
other relevant individual data, such as demographics, will be maintained.
Efficiency
Service delivery cost per service unit, length of stay in the program, and direct service hours of
clinical and medical staff. These can be calculated internally on a monthly basis.
Effectiveness
Outcomes in following tables address the quality of service and care provided to the persons
served. Reduction in Homelessness, Incarceration, probation attendance, hospitalization,
psychiatric hospitalization, increase in employment and improvement in education.
Access
Timeliness of program entry (from first request for service to first service), ongoing wait
times/wait lists, minimizing barriers to getting services, convenience of service hours and
locations, and number of persons served. These can be captured internally on a monthly
basis.
Satisfaction and Feedback from Persons Served and Stakeholders
Individuals are informed at intake of the protocol and procedure to address grievances and
concerns. These are places where they can share their thoughts and opinion of the services.
The Fresno Center will also take part in completing the State semi-annual Consumer
Perception Surveys. No show/cancellation rates and services to first scheduled appointment
after first assessment can measure engagement and satisfaction of persons served.
Outcome Measures Indicators Frequency Level of
q y Care/Program
Service timeliness is 10 business days Average length of time from Monthly OP/ICM/FSP
from the initial service request to first first request for service to
service for Outpatient and 15 for first clinical
psychiatry appointment. assessment/outpatient
service or psychiatry.
Evidence of improved access to mental Number/Percentage of Monthly OP/ICM/FSP
health services of all persons engaged individuals being
linked/engaged to services
(i.e., PCP,
Medi-Cal, SSI).
Within 30 days of an individual's Number of individuals with Monthly OP/ICM/FSP
enrollment in the program, provide plan of care created with 30
evidence of a plan of care developed in days.
the individual's preferred language,
approved, authorized and signed by the
individual.
Within one year of being enrolled in the Number of persons served Monthly ICM/FSP
program, 100% of individuals who did receiving SSI.
not have SSI will have completed
applications to receive SSI. The Fresno
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EXHIBIT B-1
Center will provide this data to County
on a monthly basis by the 10th of each
month regarding SSI status.
Within six months of being enrolled in Number of persons served Bi-annually OP/ICM/FSP
the program, 100% of persons served with linkages services to a
will have documented linkages to a Primary Care Physician.
Primary Care Physician.
Individuals receiving services shall have Number of persons served, Monthly FSP
zero (0) days of homelessness after enrolled and received
being enrolled in the program, unless services, that were
the individual declined housing homeless at intake, during,
assistance. The Fresno Center will or after engaging in
notify County of individual's decline and services.
document accordingly. The Fresno
Center must have clear documentation
of efforts to house persons served in
appropriate setting.
90% of those receiving services will not Number of persons served, Annual FSP
access higher level of care. enrolled and received
services, that have not
required a higher level of
care.
90% of those receiving services will Number of persons served Annual OP/ICM
become more physically active through actively participating in on
participating in healthy walking and physical types of activities.
exercising and other therapeutic arts
and crafts activities.
75% of those engaged in services will Number of persons served Annual OP/ICM
show stabled or improvement in their who self-reported their
well-being. condition stabilized or
im roved.
90% reduction in days of in-patient Number of FSP persons Annual FSP
psychiatric hospitalizations for persons served that were not in in-
served after being enrolled in FSP patient psychiatric hospital.
compared to the year before being
enrolled in the FSP.
Within 30 days enrollment in the FSP, Number of FSP persons Monthly FSP
100% of persons served will have served with individualized
participated in forming their service plan.
individualized service plan.
Increase the number of mental health Number of hours Annual Clinical
professionals of SEA descent qualified accumulated by students Supervision
for licensure through hours earned. A and by the number of Program
minimum of four (4) student interns students that obtain valid
shall enter and complete, or show California licensure in their
satisfactory progress towards respective field that have
completion of, required clinical hours or completed the required
completion of the intern program. hours within the clinical
training/supervision
program.
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EXHIBIT B-1
FSP Outcomes Measurement Method Data Source
ChildlYouth
Indicator 1 — Living situation: homeless or shelter; FSP: Change over time CANS
justice system placement
Indicator 2— Education attendance; suspensions; FSP: Change over time CANS
expulsions
Indicator 3— Legal status; moved out of home; FSP: Change over time CANS
reunited
Indicator 4 — Number of emergency room FSP: Change over time CANS
visits; physical health and mental health
Indicator 5 - Self rating on improvement in FSP: Point in time MHSIP
functioning (symptoms, housing situation,
school or work, social situations, relations
with family, dealing with crises, control over
life, dealing with problems)
Adult
Indicator 1 — Living situation: homeless or shelter; FSP: Change overtime Chart/File
justice system placement; independent;
number of moves; hospitalization
Indicator 2 — Employment, if applicable FSP: Change overtime Chart/File
Indicator 3— Number of arrests FSP: Change overtime Chart/File
Indicator 4 — Number of emergency room FSP: Change overtime Chart/File
visits; physical health and mental health
Indicator 5—Self rating on improvement in FSP: Point in time MHSIP/
functioning (symptoms, housing situation, Reaching
school or work, social situations, relations recovery
with family, dealing with crises, control over
life, dealing with problems)
Older Adult
Indicator 1 — Living situation: homeless or FSP: Change overtime Chart/File
shelter; number of moves; hospitalization
Indicator 2 — Number of emergency room FSP: Change overtime Chart/File
visits; physical health and mental health
Indicator 3 —Activities of daily living FSP: Change overtime Chart/File
Indicator 4 — Instrumental activities of daily living FSP: Change overtime Chart/File
Indicator 5— Self rating on improvement in FSP: Point in time MHSIP/
functioning (symptoms, housing situation, Reaching
school or work, social situations, relations Recovery
with family, dealing with crises, control over
life, dealing with problems)
Additional Reporting Requirements for FSP program
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EXHIBIT B-1
Contractor will be responsible for meeting with DBH on a monthly basis, or more often as agreed
upon between DBH and Contractor, for contract and performance monitoring. Contractor will be
required to submit monthly reports to the County that will include, but not be limited to: dollars
billed for Medi-Cal and MHSA (non-Medi-Cal) persons served; actual expenses; the number of
persons served served/anticipated to be served; utilization of services by persons served; and
staff composition. These reports will be due within thirty (30) days after the last day of the
previous month or payments may be delayed.
Additional reporting is required for FSPs by DHCS. DHCS uses the FSP Data Collection and
Reporting (DCR) system to ensure adequate research and evaluation, regarding the
effectiveness of services being provided and the achievement of the outcome
measures. Contractor will need to report individual/partner information and outcomes of the FSP
program directly into the DCR system. Data will be submitted through an online interface using
specific forms. The Partnership Assessment Form gathers baseline information about the partner
and is completed once the partnership is established. Key Event Tracking provides a snapshot of
changes in key quality of life areas and is tracked on a continuous basis throughout the course of
the FSP. The Quarterly Assessment collects updated information about changes in quality of life
areas and is completed every three (3) months from the date the partnership is established.
Continuous improvement is a core tenant of the Department and MHSA. Over the past few
years, County DBH participated in a statewide FSP evaluation project. The result of the project
required that DBH and Contractor should add another question to the State required DCR data
as follows:
New question added to the DCR effective July 1, 2023:
Question: "How often do you get the social and emotional support that you need?"
Answer: Response options will be; always, usually, sometimes, rarely, or never.
DELIVERABLES
Due by the 101" of Each Month:
1. Completed Activity Log for prior month activities and Caseload Report.
2. Staffing report— identifying staff name, title/classification, hire date, certification
date, licensure and expiration date, bilingual status, and full-time status/hours.
Due as Requested and/or Necessary:
1. All printed material (flyers, brochures, banners, etc.) and media outreach associated
with the program must include the County's logo and/or state that the program is
funded by the County, and must be approved by DBH Director or designee prior to
use/circulation.
2. Miscellaneous reports as requested by County, DBH Director or designee,
Behavioral Health Board, State, or other auditing and/or reporting entity.
TRANSITION OPTIMIZATION FUNDS
A. One-time Transition Optimization Funds will be available to specialty mental health
providers and Drug Medi-Cal providers within FY 2023-24 to encourage Contractors to
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EXHIBIT B-1
identify and implement organization changes during the first year of CalAIM Payment
Reform to improve outcomes for persons served and create operational efficiencies.
Contractor is expected to utilize the strategies, tools and knowledge learned to their
programming and continue to improve services for the population served.
B. Funding Allocation Methodology
• Each participating contractor is eligible to apply for an allocation of Transition
Optimization Funds up to the maximum amounts stated in Article 4 of the
Agreement and further described below. Transition optimization funds will only be
available from July 1, 2023 through June 30, 2024 and payments shall be on a
quarterly basis.
• Payments will be disbursed upon review and approval by DBH of each deliverable
described below. Quarterly progress reports shall be submitted to DBH in order to
show progress as outlined in the submitted plans and deliverables.
• Payments will be dependent on Contractor demonstrating progress toward
meeting deliverables described in this exhibit. Contractors who fail to submit
progress reports by stated deadlines, or who do not demonstrate adequate
progress made, may be determined ineligible for that quarter's payment at the sole
discretion of the County.
• All invoices will be submitted on a quarterly basis within fifteen (15) days following
the end of the quarter. Invoices submitted thereafter may not be eligible for
payment.
C. Responsibilities
• Letter of Intent
o Contractor shall submit a letter of intent to DBH by July 31, 2023
identifying the selected Transition Optimization Activity(ies) and
commitment to meet the deliverable deadlines as described below.
The letter shall include all current Medi-Cal billable specialty mental
health and substance use disorder services agreements the
Contractor has with the County.
o The County shall respond to the Contractor's letter of intent within
30 days. The County's response shall include a breakdown of
anticipated payments, as determined by the County, depending on
the Transition Optimization Activity(ies) chosen and depending on
the number of current Medi-Cal billable specialty mental health and
substance use disorder services agreements the Contractor has
with the County.
• Quarterly Reports
o Contractor shall submit quarterly progress reports and invoices.
Reports shall be submitted on the dates indicated in the Schedule
of Deliverables below. Invoices are due 15 days after the end of
each quarter. All activities shall be completed by June 30, 2024.
The report shall include updated plans/tools and progress
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EXHIBIT B-1
Contractor has made toward the Transition Optimization
Activity(ies) described in each Contractors' letter of intent.
• Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool, and
Electronic Health Record
o Q1 Reports: July-Sept:
a. Letter of Intent: Due July 31, 2023
b. Fiscal Monitoring Tool, Equity Gap Analysis, and Electronic
Health Record Implementation Plans (if applicable): Due
September 30, 2023
c. Fiscal Monitoring Tool Identified Practices and Strategies (if
applicable): Due September 30, 2023
o Q2 Report: Oct-Dec: Due January 15, 2024
o Q3 Report: Jan-Mar: Due April 15, 2024
o Q4 Report: Apr-June: Due July 15, 2024
• All deliverables will be reviewed and approved by DBH prior to payment.
D. Eligible Transition Optimization Activities:
(1) Fiscal Monitoring Tools: Contractor shall submit to DBH a draft of their fiscal
monitoring tool that shall be used monthly on an ongoing basis to evaluate fiscal
health of the organization. Tools shall, at a minimum, monitor costs, productivity
targets and identify one or more practice pattern(s) the organization is employing to
increase direct care time to the Medi-Cal population.
• Fiscal Monitoring Tools and Implementation Plan: Contractor shall develop fiscal
monitoring tools that will be used monthly to ensure their organizational fiscal
health and implementation plan. Fiscal monitoring tools drafts and implementation
plan shall be submitted to DBH by September 30, 2023.
o Identified Practice: Identify at least one process improvement that
shall be modified by September 30, 2023.
• Quarterly Progress Reports: Quarterly progress reports shall be submitted
including but not limited to a narrative of progress, obstacles, alternative solutions
and outcomes.
• Funding for this activity shall be available up to $25,000 for the initial agreement
with Contractor and up to another $10,000 for each additional agreement. County
shall provide further details on deliverables and payment schedule in County's
response to the Contractor's letter of intent.
(2) Equity Gap Analysis: Contractor shall produce a report identifying the race/ethnicity
of population served in fiscal year 2022-23 compared to the County's population as
provided by the County. Contractor shall identify key disparities in both persons
served and amount of services and frequency of transitions to other levels of care
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EXHIBIT B-1
received. Contractor shall identify three (3) strategies they shall employ during FY
2023-24 to reduce the disparities among underserved population.
• Report on Underserved Population: Contractor shall submit an Equity Gap Report
to the Department containing including, but not limited to, the following:
o Identify if it serves specific population within its program(s) and
identify whom the program(s) currently served based on data.
o Staffing/workforce information and demographics. Report the
staffing/workforce supporting the different programs and
populations served by the provider in Fresno County. This data is to
evaluate how the staffing reflects the populations it is serving.
o Comparison of the county penetration rates to the demographics of
persons served by the Contractor and program(s) under agreement
with DBH.
o Data on retention of persons served by demographics. Total
persons served and the average length of stay by demographics of
the persons served in programs.
o Which populations are remaining in the programs by demographics,
which ones are having the shortest stays.
o How long is the average length of stay by the demographics.
o Identify what data points the Contractor is missing at this time that
challenges its ability to thoroughly assess its equity gap analysis.
Examples: Data is not collected, Data that is missing or under
reported, data not captured in its processes, etc.
• Equity Improvement Implementation Plan: Contractor shall submit an Equity
Improvement Implementation Plan related to improving health equity by
September 30, 2023. The plan shall include the following items at a minimum:
o Contractor shall select three strategies from below:
a. Plan shall include specific efforts including, but not limited to,
the following and timelines to increase access to
underserved groups.
b. Outreach/Engagement with underserved communities
c. Active attendance/participation in DBH's Diversity Equity and
Inclusion (DEI) workgroup
d. Plan for retention of persons served in programs who are
underrepresented
e. Improvement of demographic data collection including
Sexual Orientation Gender Identity (SOLI)/LGBTQ data
o Plan shall address workforce capacity to render services to more
underserved populations, through:
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EXHIBIT B-1
a. Development of bilingual personnel
b. Recruitment plan for more diverse workforce to reflect
populations served.
c. Training for workforce to increase capacity to be culturally
responsive
d. Development workforce pool for the future that can be
bilingual and bicultural
o Timeline for each effort shall be included in the plan.
o Contractor shall identify the measurement to be used to demonstrate
successful implementation of plan. Measure may be identified by the
Contractor to best support their plan and goals.
o Contractor shall develop and submit policies and procedures to formally
support equity effort.
• Quarterly Progress Reports: Use available data including but not limited to,
External Quality Review Organization (EQRO) and EHR data to evaluate the
strategies deployed. Quarterly progress reports shall be submitted including but
not limited to a narrative of the progress, obstacles, alternative solutions and
outcomes. The final quarter shall include a comprehensive final report on the
outcomes.
• Funding for this activity shall be available up to $25,000 for the initial agreement
with Contractor and up to another $10,000 for each additional agreement. County
shall provide further details on deliverables and payment schedule in County's
response to the Contractor's letter of intent.
(3) Electronic Health Record (EHR): The implementation and expansion of the
SmartCare EHR is an essential component of improving oversight with the
implementation of payment reform. Furthermore, a standardized EHR will improve
continuity of care, create transparency across the system, remove obstacles for
individuals accessing services and improve the overall outcomes for persons served.
For Contractors who plan to opt in to use SmartCare or have previously opted into
DBH's former EHR and intend to transition to SmartCare, user fees and costs shall be
waived during FY 2023-2024 and FY 2024-2025.
• Option One: Current EHR Users
o Strategic Plan: Contractors utilizing DBH's EHR as their current EHR, and who
will continue to utilize SmartCare beginning July 1, 2023, shall provide a plan,
including, but not limited to, how they will optimize Medi-Cal billing, illustrate
how they will utilize the information in the EHR to improve care for persons
served, and a training plan for their organization by September 30, 2023.
o Quarterly Progress Reports: Quarterly progress reports shall be submitted,
including, but not limited to, a narrative on the progress, obstacles, alternative
solutions and outcomes.
o Total compensation for this Electronic Health Record activity, Option 1, shall
not exceed $50,000.00 split among all current agreements between the
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EXHIBIT B-1
Contractor and the County for Medi-Cal billable specialty mental health and
substance use disorder services. County shall provide further details on
deliverables and payment schedule in County's response to the Contractor's
letter of intent.
• Option Two: Non-EHR Users
o Contractor shall submit an implementation plan by September 30, 2023
regarding how they will transition to utilizing the SmartCare EHR by June 30,
2024. The plan shall include, at a minimum, an identified Go Live Date, plan on
how the current record system will be maintained and utilized, training plan
including number of individuals, and additional supports. The Go Live Date
must occur by June 30, 2024 to receive final payment. Contractor shall work
closely with DBH to identify needs, assignments, collaboration opportunities to
transition.
o For Option 2, the Contractor shall not be reimbursed more than $200,000 split
among all current agreements between the Contractor and the County for
Medi-Cal billable specialty mental health and substance use disorder services.
The total maximum compensation available for this option, shall include costs
for maintaining current electronic health record/record system and additional
supports and training costs per user. Contractor shall transition both specialty
mental health and Drug Medi-Cal programming to the County's EHR and shall
be required to use the County's EHR for future eligibility agreements with DBH.
County shall provide further details on deliverables and payment schedule in
County's response to the Contractor's letter of intent.
B-1-15
Exhibit C
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
Full Service Partnerships (FSP) are designed as a partnership between enrollees and the
service provider. The FSP service delivery ethic incorporates recovery and cultural competence
into the services and supports offered to consumers. In this partnership, the service provider
commits to do "whatever it takes" and to "meet the client where they are" in order to assist the
enrollee achieve their personal recovery/resiliency and wellness goals.
1. The Target Population is consistent with the population identified in the Fresno
County MHSA Community Planning Process.
The target population must meet requirements for SMI/SED diagnosis, and must address
reduction of specific ethnic disparities, as indicated in the MHSA Community Services and
Supports proposal.
The target population will include clients who are not currently served and meet one or more of
the following criteria:
• Homeless.
• At risk of homelessness— such as youth aging out of foster care orpersons coming out
of jail.
• Involved in the criminal justice system (including adults with child protection issues).
• Frequent users of hospital and emergency room services.
or are so underserved that they are at risk of:
• Homelessness—such as persons living in institutions or nursing homes.
• Criminal justice involvement.
• Institutionalization.
Diagnoses that serve as criteria for inclusion in the target population will be based on definitions
found in California Welfare and Institutions Code Section 5600.3 defining seriously emotionally
disturbed mental disorder or serious mental disorder. The operational definition of"diagnosis"
for programs serving the chronically homeless may also include: co-occurring disorders,
personality disorders, general anxiety/mood disorders, and Post Traumatic Stress Disorder.
2. FSP Program Components:
All MHSA FSP Programs must include the following in their program descriptions:
• Providers who are part of the multidisciplinary, community based "treatment"
teams serve as an ally to the consumer's recovery process. The partnership allows
clients and family members opportunities for informed choice.
o The team description must demonstrate commitment and capacity to do
"whatever it takes" to assist the enrolled member, specifically:
■ Low staff to client ratio (approximately 1:12 or the ratio that has been
specified in the RFP's scope of work).
■ 24/7 availability of the multidisciplinary team.
■ Team culture is created where each member of the team knows each
client and the clients are familiar with each member of the team.
■ Members of the team speak the client's language, are familiar with
community resources that reflect the healing beliefs of the client's culture,
and are positioned to assist the client make meaningful connection with
those resources.
Exhibit C
EXHIBIT C
Page 2of4
■ Crisis response comes from a person known to the client.
■ Staff is given the administrative flexibility and flex-funding to connect
consumers with non-mental health services and same day needs.
Examples include: housing; primary care; dual disorder services;
education services and supports; vocational services and supports; payee
services/benefits advocacy; community recreational activities (YMCA
classes, libraries, movie theaters, etc.); social services; food;
transportation; and clothing.
■ Availability of Integrated Dual Diagnosis Treatment or other dual recovery
intervention that will provide effective treatment for the target population.
• Outreach and engagement. The team's outreach and engagement strategy must be
voluntary and driven by the values of client culture. This means that consumers will be
engaged "where they are" in terms of their community location, their need for clinical and
non-clinical services/supports and their phase of recovery. Outreach workers will have
culturally competent language skills and will function as an ally to the consumer's
decision to receive services. Peer Support will be included in the outreach and
engagement of new clients.
• Procedures for enrollment and dis-enrollment will be easily understood, clearly
communicated and non-coercive. Enrollment is voluntary. A condition of enrollment
is that the client indicates that they want services from the assertive-community
treatment model team.
• Each adult, older adult, and transition age youth enrollee must have a Personal
Service Coordinator (PSC). The PSC is an ally to the enrollee and acts as a "single
point of responsibility" within the multidisciplinary team for coordinating services and
supports.
"Personal Service Coordinators (PSCs) for adults— case managers for children and
youth—must have a caseload that is low enough so that: (1) their availability to the
individual and family is appropriate to their service needs, (2) they are able to provide
intensive services and supports when needed, and (3) they can give the individual
served and/or family member considerable personal attention...PSCs/case managers
must be culturally competent, and know the community resources of the client's racial
ethnic community." (Source: DMH Planning Requirements, Section III Identifying
Populations for Full Service Partnerships, Aug 2005)
• Each enrollee must have an Integrated Services and Supports Plan (ISSP) that is
developed with their Personal Services Coordinator. This ISSP is a planning tool
that builds on the consumer's strengths. It includes goals and provides a map of the
steps that the enrollee identifies as necessary to move along his/her recovery path.
"Integrated Services and Supports Plans must operationalize the five fundamental
concepts (identified in section three of this exhibit) and should reflect community
collaboration, be culturally competent, be client/family driven with a
wellness/recovery/resiliency focus and they must provide an integrated service
experience for the client/family. In addition, the ISSP will be person/child-centered, and
give individuals and their families'sufficient information to allow them to make informed
choices about the services in which they participate. Services should also include
linkage to, or provision of, all needed services or benefits as defined by the client and or
family in consultation with the PSC/case manager. This includes the capability of
increasing or decreasing service intensity as needed." (Source: DMH Planning
EXHIBIT C
Page 3of4
Requirements, Section III Identifying Populations for Full Service Partnerships, Aug
2005
• Peer support services will be made available to the client. At least two staff(a
minimum of 1 FTE) who act in peer support roles will be employed in each MHSA
program.
o The enrollee is given significant access to peer recovery and self-help services.
Tools such as Advanced Directives are made available to adult and older adult
clients, and Wellness Recovery Action Plans (WRAP) are made available to
adult, transition age youth and older adult clients.
o Peer Counselors are included as equal partners in the multidisciplinary team, and
play a critical role in developing the recovery culture and client orientation of the
team.
3. The Five (5) Core MHSA Concepts are embedded in each program.
Concept 1: Recovery/Resiliency Orientation: FSPs will embody the values of
recovery and resiliency (i.e., hope, personal responsibility, self-advocacy, choice,
respect) and the program principles of recovery and resiliency, including:
• Client-driven goal setting and Individualized Services and Supports Plans.
• Providers are allies to the client's recovery process.
• A harm-reduction approach to substance use that encourages recovery and
abstinence but does not penalize consumers or withdraw help from them if
they are using.
• A built in understanding and expectation of setbacks as part of recovery.
• Links to a range of services that are part of the consumers "pathway to
wellness" (i.e., employment, health care, peer support, housing, medications,
food and clothing).
Concept 2: Cultural Competence Orientation: The program's structure, staffing and
service delivery values will reflect the cultural values and orientation of the program's
target populations.
The FSP program will embody principals of cultural competence including:
■ Diverse staff, representative of the primary ethnic groups to be reached through the
program.
■ Staff trained regarding common access barriers for racial and ethnic groups targeted
(including the impact of housing discrimination).
■ Links to community-based organizations that share the healing beliefs and practices
of ethnic communities served by the FSP.
The FSP program must also be able to deal with gender and sexual orientation diversity.
Training in sensitivity to gender and sexuality issues is a key component for staff on the
team.
Concept 3: Community Collaboration: FSP Collaborations ensure that community
resources are made available to enrollees. These collaborations include subcontracts
between the vendor and other agencies, memoranda of understanding with community
non-profits and businesses regarding providing services to clients, and informal
relationships built between FSP staff and community stakeholders that result in
improved access and decreased discrimination.
EXHIBIT C
Page 4of4
Concept 4: Client/Family Driven program: In FSPs, the Integrated Services and
Supports Plan (ISSP) is used by adult clients and families of children and youth to
identify their needs and preferences which lead to the services and supports that will be
most effective for them. Providers work in full partnership with clients to develop these
ISSPs. Their needs and preferences drive the policy and financing decisions that affect
them.
Concept 5: Integrated Service Experience: FSP programs were incorporated into the
MHSA to ensure that these dollars funded "integrated service experiences". This means
that services are "seamless" to clients and that clients do not have to negotiate multiple
agencies and funding sources to get critical needs met and to move towards recovery
and develop resiliency. Services are delivered, or at a minimum, coordinated through a
single agency or a system of care. The integrated service experience centers on the
individual/family, uses a strength-based approach, and includes multi-agency programs
and joint planning to best address the individual/family's needs using the full range of
community-based treatment, case management, and interagency system components
required by children/transition age youth/adults/older adults.
Exhibit D
BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Mental Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of, or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
D-1
Exhibit D
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractor can show clear and convincing evidence to the
satisfaction of County that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent of County's Department of Behavioral Health Director,
or designee, no person shall be employed by Contractor who is related by
blood or marriage to, or who is a member of the Board of Directors or an
officer of Contractor.
5. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied
with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and
CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
A. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
D-2
Exhibit D
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractor has made
false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against Contractor within the immediately
preceding two (2) year period because of Contractor's failure to comply with an
order of a Federal court, which orders Contractor to comply with an order of the
National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to
public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. Contractor further declares under penalty of
perjury that they adhere to the Sweatfree Code of Conduct as set forth on
D-3
Exhibit D
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to the
Contractor's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to
determine the Contractor's compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies
that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following
provisions regarding current or former state employees. If Contractor has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code M 0410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
D-4
Exhibit D
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If Contractor violates any provisions of above paragraphs, such action by
Contractor shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware
of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
D-5
Exhibit D
6. RESOLUTION: A County, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
Contractor shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control
district; (2) subject to cease and desist order not subject to review issued
pursuant to Section 13301 of the Water Code for violation of waste discharge
requirements or discharge prohibitions; or (3)finally determined to be in violation
of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
Contractors that are not another state agency or other governmental entity.
9. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of Contractor or its subcontractors, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid-related activities or
work is conducted. The right to audit under this section exists for ten (10) years
from the final date of the contract period or from the date of completion of any
audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of Contractor, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases must be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it must promptly
notify the Contractor and take action consistent with § 438.610(c).
The State must ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
D-6
Exhibit D
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. In collaboration with the County, Contractor will work to ensure
that individuals to whom the Contractor provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in BHIN 21-073. Specifically, the
Contractor will ensure that the clinical record for each individual
includes information as a whole indicating that individual's
presentation and needs are aligned with the criteria applicable to
their age at the time of service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled individuals who meet either of
the following criteria, (1) or (11) below. If an individual under age 21
meets the criteria as described in (1) below, the beneficiary meets
criteria to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The individual has a condition placing them at high risk for
a mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
D-7
Exhibit D
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM)
and the International Classification of Diseases and
Related Health Problems (ICD).
b. A suspected mental health disorder that has not yet
been diagnosed.
c. Significant trauma placing the individual at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for clients who meet both of the following criteria,
(a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined
as distress, disability, or dysfunction in social,
occupational, or other important activities.
b. A reasonable probability of significant deterioration
in an important area of life functioning.
2. The individual's condition as described in paragraph (a) is
due to either of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the DSM and
ICD.
b. A suspected mental disorder that has not yet been
diagnosed.
c. ADDITIONAL CLARIFICATIONS
i. Criteria
1. A clinically appropriate and covered mental health
prevention, screening, assessment, treatment, or recovery
service listed within Exhibit A of this Agreement can be
provided and submitted to the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included in an individual
treatment plan; or
c. The individual had a co-occurring substance use
disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims,
including SMHS claims, include a current Centers for
D-8
Exhibit D
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
d. MEDICAL NECESSITY
i. Contractor will ensure that services provided are medically
necessary in compliance with BHIN 21-073 and pursuant to
Welfare and Institutions Code section 14184.402(a). Services
provided to a client must be medically necessary and clinically
appropriate to address the individual's presenting condition.
Documentation in each individual's chart as a whole will
demonstrate medical necessity as defined below, based on the
client's age at the time of service provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the
standards set forth in Section 1396d(r)(5) of Title 42 of the United
States Code.
e. COORDINATION OF CARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to this Agreement are coordinated among all
providers who are serving the individual, including all other SMHS
providers, as well as providers of Non-Specialty Mental Health
Services (NSMHS), substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services as applicable to ensure a client-centered
and whole-person approach to services.
ii. Contractor shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services
and supports, including but not limited to educational, social,
prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage
education, cultural sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA
and California law compliant client authorization to share the
individual's information with and among all other providers
involved in the individual's care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
D-9
Exhibit D
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health
Services can be provided concurrently, if those services are
clinically appropriate, coordinated, and not duplicative. When a
client meets criteria for both NSMHS and SMHS, the individual
should receive services based on individual clinical need and
established therapeutic relationships. Clinically appropriate and
covered SMHS can also be provided when the individual has a co-
occurring mental health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s
receive timely mental health services without delay. Services are
reimbursable to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving a individual receiving both SMHS
and NSMHS, Contractor holds responsibility for
documenting coordination of care and ensuring that
services are non-duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016
and 22-017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) is necessary due to an
individual's specific needs and circumstances that could seriously
jeopardize the individual s life or health, or ability to attain,
maintain, or regain maximum function.
b. DOCUMENTATION REQUIREMENTS
i. Contractor will follow all documentation requirements as specified
in Article 4.2-4.8 inclusive in compliance with federal, state and
County requirements.
ii. All Contractor documentation shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from face-to-face
time and provide this information to County upon request.
D-10
Exhibit D
Services must be identified as provided in-person, by telephone,
or by telehealth.
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractor agrees to
satisfy the chart documentation requirements set forth in BHIN 22-
019 and the contract between County and DHCS. Failure to
comply with documentation standards specified in this Article
require corrective action plans.
c. ASSESSMENT
i. Contractor shall ensure that all individuals' medical records
include an assessment of each individual's need for mental health
services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individuals aged 6 through 21, the Child and Adolescent
Needs and Strengths (CANS), and for individual s aged 3 through
18, the Pediatric Symptom Checklist-35 (PSC-35) tools are
required at intake, every six months during treatment, and at
discharge, as specified in DHCS MHSUDS INs 17-052 and 18-
048.
iv. The time period for providers to complete an initial assessment
and subsequent assessments for SMHS are up to clinical
discretion of County; however, Contractor's providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of
the DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractor shall use the ICD diagnosis
code(s) to submit a claim for SMHS to receive reimbursement
from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by
CMS and may be updated during the term of this Agreement.
Changes to the lists of ICD diagnoses do not require an
amendment to this Agreement, and County may implement these
changes as provided by CMS
e. PROBLEM LIST
i. Contractor will create and maintain a Problem List for each
individual served under this Agreement. The problem list is a list of
symptoms, conditions, diagnoses, and/or risk factors identified
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
ii. Contractor must document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
D-11
Exhibit D
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CTO) U.S. Edition, September 2022 Release, and ICD-
10-CM 2023.
iii. A problem identified during a service encounter may be addressed
by the service provider during that service encounter and
subsequently added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
added. However, Contractor shall update the problem list within a
reasonable time such that the problem list reflects the current
issues facing the client, in accordance with generally accepted
standards of practice and in specific circumstances specified in
BHIN 22-019.
f. TREATMENT AND CARE PLANS
i. Contractor is not required to complete treatment or care plans for
clients under this Agreement, except in the circumstances
specified in BHIN 22-019 and additional guidance from DHCS that
may follow after execution of this Agreement.
g. PROGRESS NOTES
i. Contractor shall create progress notes for the provision of all
SMHS services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the
service code selected for the service type as indicated by the
service code description.
iii. Progress notes shall include all elements specified in BHIN 22-
019, whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business
days of providing a service, with the exception of notes for crisis
services, which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that
are billed on a daily basis, such as residential and day treatment
services, if applicable.
h. TRANSITION OF CARE TOOL
i. Contractor shall use a Transition of Care Tool for any individual
whose existing services will be transferred from Contractor to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractor, as specified in BHIN 22-065, in order to ensure
continuity of care.
ii. Determinations to transition care or add services from an MCP
shall be made in alignment with County policies and via a person-
centered, shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
D-12
Exhibit D
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
Services.aspx, or obtain a copy of that tool provided by the
County. Contractor may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Transition of Care Tool, including the specific wording and order of
fields, shall remain identical to the DHCS provided form. The only
exception to this requirement is when the tool is translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
https://www.dhcs.ca.gov/provqovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations must ensure that
client confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for individuals served by Contractor under this
Agreement must include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractor. Such consent must be obtained at least
once prior to initiating applicable health care services and consent
must include all elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices,
and Contractor must allow access to all materials needed to
adequately monitor Contractor's adherence to telehealth
standards and requirements.
3. CLIENT PROTECTIONS
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor must be immediately forwarded to the
County's Managed Care Department or other designated persons
via a secure method (e.g., encrypted email or by fax) to allow
ample time for the Managed Care staff to acknowledge receipt of
the grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
D-13
Exhibit D
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) must be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs must be issued to individuals anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice must have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. The Contractor must inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings must be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor must provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor must maintain records of grievances and appeals and
must review the information as part of its ongoing monitoring
procedures. The record must be accurately maintained in a
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor must comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
4. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating person served's grievances, appeals and State
Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
D-14
Exhibit D
4. Informing the County and individuals of the results of
client/family satisfaction activities.
ii. Contractor, if applicable, shall implement mechanisms to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a County's QI
Work Plan with documented annual evaluations and documented
revisions as needed. The Ql Work Plan shall evaluate the impact
and effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed Ql actions, and ensure follow-up of Ql processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor must have hours of operation during which
services are provided to Medi-Cal individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. If the
Contractor's provider only serves Medi-Cal clients, the
provider must provide hours of operation comparable to
the hours the provider makes available for Medi-Cal
services that are not covered by the Agreement or another
County.
2. Appointments data, including wait times for requested
services, must be recorded and tracked by Contractor, and
submitted to the County on a monthly basis in a format
specified by the County. Appointments' data should be
submitted to the County's Quality Management
Department or other designated persons.
D-15
Exhibit D
3. Urgent care appointments for services that do not require
prior authorization must be provided to individual s within
48 hours of a request. Urgent appointments for services
that do require prior authorization must be provided to
clients within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) must be
made available to Medi-Cal individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, requests an appointment for a
medically necessary service. Non-urgent psychiatry
appointments (for both adult and children/youth) must be
made available to Medi-Cal individual s within 15 business
days from the date the client or a provider acting on behalf
of the individual, requests an appointment for a medically
necessary service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal individuals on behalf of
Contractor, are registered through DHCS' Provider Application
and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20-
071 requirements, the 21st Century Cures Act and the CMS
Medicaid and Children's Health Insurance Program (CHIP)
Managed Care Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
D-16
Exhibit D
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
5. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for individuals served through this
Agreement shall contain a warning banner regarding the PHI or
PII contained within the EHR. Contractors that utilize an EHR shall
maintain all parts of the clinical record that are not stored in the
EHR, including but not limited to the following examples of client
signed documents: discharge plans, informing materials, and
health questionnaire.
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
6. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
D-17
Exhibit D
ii. Contractor must file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and must make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
D-18
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
E-1
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 01-02-2020
E-2
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 01-02-2020
E-3
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
E-4
Exhibit F
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the person served's record; however, there is no
requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
A. Assessments
1. The following areas will be included as a part of a comprehensive person served's
record:
• Presenting problems, including impairments in function, and current mental
status exam.
• Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
• Behavioral health history including mental health history, substance use/abuse,
and previous services
• Medical history including physical health conditions, medications, and
developmental history
• Psychosocial factors including family, social and life circumstances, cultural
considerations
• Strengths, risks, and protective factors, including safety planning
• Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
• The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
2. Timeliness/Frequency Standard for Assessment
• The time period to complete an initial assessment and subsequent assessments
for SMHS is up to clinical discretion.
• Assessments shall be completed within a reasonable time and in accordance
with generally accepted standards of practice.
B. Problem list
The use of a Problem List has largely replaced the use of treatment plans and is
therefore required to be part of the person served's record. The problem list shall be
updated on an ongoing basis to reflect the current presentation of the person in care.
The problem list shall include, but is not limited to, the following:
• Diagnoses identified by a provider acting within their scope of practice
• Problems identified by a provider acting within their scope of practice
• Problems or illnesses identified by the person in care and/or significant support
person if any
• The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
Rev 04/2023 F-1
Exhibit F
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
• Identifies a course of action to respond to the assessed needs of the person in
care
• Includes development of a transition plan when the person in care has achieved
the goals of the care plan
• Peer support services must be based on an approved care plan
• Must be provided in a narrative format in the person's progress notes
• Updated at least annually
2. Services requiring Treatments Plans
• Intensive Home-Based Services (IHBS)
• Intensive Care Coordination (ICC)
• Therapeutic Behavioral Services (TBS)
• Must have specific observable and/or specific quantifiable goals
• Must identify the proposed type(s) of intervention
• Must be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the person served's plan is used to establish that the services are
provided under the direction of an approved category of staff, and if the below
staff are not the approved category,
➢ a physician
➢ a licensed/ "waivered" psychologist
➢ a licensed/ "associate" social worker
➢ a licensed/ registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ Person served's plans will be consistent with the diagnosis, and the focus of
intervention will be consistent with the person served's plan goals, and there will
be documentation of the person served's participation in and agreement with
the plan. Examples of the documentation include, but are not limited to,
reference to the person served's participation and agreement in the body of the
plan, person served's signature on the plan, or a description of the person
served's participation and agreement in progress notes.
➢ Person served's signature on the plan will be used as the means by which the
Contractor documents the participation of the person served. When the person
served's signature is required on the person served's plan and the person
Rev 04/2023 F-2
Exhibit F
served refuses or is unavailable for signature, the person served's plan will
include a written explanation of the refusal or unavailability.
➢ The Contractor will give a copy of the person served's plan to the person served
on request.
D. Progress Notes
1. Providers shall create progress notes for the provision of all SMHS. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. Progress notes shall include:
• The type of service rendered.
• A narrative describing the service, including how the service addressed the
beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or
risk factors).
• The date that the service was provided to the beneficiary.
• Duration of the service, including travel and documentation time.
• Location of the beneficiary at the time of receiving the service.
• A typed or legibly printed name, signature of the service provider and date of
signature.
• ICD 10 code
• Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) code.
• Next steps including, but not limited to, planned action steps by the provider or by
the beneficiary, collaboration with the beneficiary, collaboration with other
provider(s) and any update to the problem list as appropriate.
2. Timeliness/Frequency of Progress Notes
• Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis services, which shall be completed within 24 hours.
• A note must be completed for every service contact
Rev 04/2023 F-3
Exhibit G
coU Department of Behavioral Health
t Policy and Procedure Guide
O 1856 O
FRV`' PPG 1.2.7
Section: Mental Health
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht(Director of Behavioral Health), Francisco Escobedo (Sr.Staff Analyst-QA), Kannika
Toonnachat(Division Manager-Technology and Quality Management)
POLICY: It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE: To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1. Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,families and communities in Fresno County who are affected by,or are at risk
of,mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3128116
1 �
G-1
Exhibit G
coU EFe artment of Behavioral Health
r Policy and Procedure Guide
O 1$56 O
P CE Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
FPolicy Title: Performance Outcome Measures
2. Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4. Objective (Goal): Intended results or the impact of learning, programs, or activities.
5. Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
III. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
2 1 P a g e
G-2
Exhibit G
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1$56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy Title:Performance Outcome Measures
a. Effectiveness of services — How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services —The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access — Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders— Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
3 1 P a g e
G-3
Exhibit H
Specialty Mental Health Outpatient Rates for Contracted Providers
Field Based
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $988.85
Physicians Assistant $443.50
Nurse Practitioner $491.73
RN $401.65
Certified Nurse Specialist $491.73
LVN $211.00
Pharmacist $473.34
Licensed Psychiatric Technician $180.89
Psychologist/Pre-licensed Psychologist $397.68
LPHA(MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT LCSW
LPCC) $257.35
Occupational Therapist $342.58
Mental Health Rehab Specialist $193.62
Peer Recovery Specialist $203.30
Other Qualified Providers-Other Designated MH staff that bill
medical $193.62
FSP AOT TBS
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1 140.98
Physicians Assistant $511.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LVN $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
LPHA(MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT LCSW
LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
Other Qualified Providers-Other Designated MH staff that bill
medical $223.41
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Fresno Center
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 $
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 0.00 1 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $ $ $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALAR 0�n*`affAg AT§aTQTAL: Admin Program Total
Fresno County Department of Behavioral Health H-2 Revised 2/7/2020
Exhibit H
$ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/01 #DIV/0!
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 30,000
2003 Client Transportation&Support -
2004 Clothing,Food,&Hygiene 2,500
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients 1,500
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify):Client Flexible Support Expenditure Support 4,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 38,000
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 Other(Student Stipends) 4,000
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL:j$ 4,000
6000:INDIRECT EXPENSES
Acct#I Line iR r iv Amount
�]
Fresno County Department of Behavioral Health H_3 Revised 2/7/2020
Exhibit H
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes)
6008 Personnel(indirect Salaries Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE 0.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 s $
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 42,000
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 ISABG 1 $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 42,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $ 42,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 42,000
NET PROGRAM COST: $
Contract Budget Narrative
Fresno County Department of Behavioral Health H4 Revised 2/7/2020
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Fresno Center
Fiscal Year(FY)2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health H-5 Revised 2/7/2020
Exhibit H
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/NaQaet/D�ftadpM&tv%ovnty FTE 76
Fresno County Department of Behavioral Health H-g Revised 2/7/2020
Exhibit H
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Contract Budget Narrative
Fresno County Department of Behavioral Health H-7 Revised 2/7/2020
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Fresno Center
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 38,000
2001 Child Care -
2002 Client Housing Support 30,000 Client Housing Support Expenditures(SFC 70)
For cost of providing housing supports.including housing subsidies for permanent,
transitional and temporary housing:master leases;motel and other housing vouchers
and shelters;rental security deposits:first and last month rental payments;and eviction
prevention and other fiscal housing supports.
Estimated @$30,000 annually.
2003 Client Transportation&Support
Contract Budget Narrative
Fresno County Department of Behavioral Health H-8 Revised 2/7/2020
Exhibit H
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2004 Clothing,Food,&Hygiene 2,500 Clothing,Food&Hygiene(SFC 72)
To provide supports to clients,which may include food vouchers and other items
necessary for daily living(such as,clothing,hygiene,etc.).Estimated @$2,500 annually
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 1,500 Household Items(SFC 72)
To provide supports for clients with household items need.Estimated at$1,500
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify):Client Flexible Support Expenditure 4,000 Client Flexible Support Expenditures Support(SFC 72)
Support To provide supports to clients and their caregivers,may include vouchers,goods,
services,and other family support services.Also maybe use for personal/community
integration to assist clients in achieving their treatment goals and in supporting their
integration into the larger community.Items may include,but are not limited to
socialization and recreational activities.This funding may also be used for medical,
dental and optical care,prescriptions,and laboratory tests when the client does not
have insurance to pay for such care.Estimated @$4,000 annually
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Others ecif
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 4,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services
5005 Other(Student Stipends) 4,000 To train 4 graduate students in mental health work force @ 500 per semester for 2
semesters x 4 students=$4,000
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
Fresno County Department of Behavioral Health H-9 Revised 2/7/2020
Exhibit H
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 42,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 42,000
BUDGET CHECK: -
Contract Budget Narrative
Fresno County Department of Behavioral Health H-10 Revised 2/7/2020
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Freso Center
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 $
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 0.00 1 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $ $ $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALAR 0�n*`affAg AT§aTQTAL: Admin Program Total
Fresno County Department of Behavioral Health H-11 Revised 2/7/2020
Exhibit H
$ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/01 #DIV/0!
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 30,000
2003 Client Transportation&Support -
2004 Clothing,Food,&Hygiene 2,500
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients 1,500
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify) 4,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 38,000
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 Other(Student Stipends) 4,000
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL:j$ 4,000
6000:INDIRECT EXPENSES
Acct#I Line iR r iv Amount
�]
Fresno County Department of Behavioral Health H-12 Revised 2/7/2020
Exhibit H
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes)
6008 Personnel(indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE 0.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 42,000
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 ISABG 1 $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 42,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $ 42,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 42,000
NET PROGRAM COST: $
Contract Budget Narrative
Fresno County Department of Behavioral Health H-13 Revised 2/7/2020
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Fresno Center
Fiscal Year(FY)2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Con ract Budget Narrative
Fresno County Department of Behavioral Health H-14 Revised 2/7/2020
Exhibit H
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
budgetCon raCI iv
Fresno County Department of Behavioral Health H-15 Revised 2/7/2020
Exhibit H
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Contract Budget Narrative
Fresno County Department of Behavioral Health H-16 Revised 2/7/2020
Exhibit H
Living Well Center-FSP-Cultural Specific Services
The Fresno Center
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 38,000
2001 Child Care -
2002 Client Housing Support 30,000 Client Housing Support Expenditures(SFC 70)
For cost of providing housing supports.including housing subsidies for permanent,
transitional and temporary housing:master leases;motel and other housing vouchers
and shelters;rental security deposits:first and last month rental payments;and eviction
prevention and other fiscal housing supports.
Estimated @$30,000 annually.
2003 Client Transportation&Support
Contract Budget Narrative
Fresno County Department of Behavioral Health H-17 Revised 2/7/2020
Exhibit H
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2004 Clothing,Food,&Hygiene 2,500 Clothing,Food&Hygiene(SFC 72)
To provide supports to clients,which may include food vouchers and other items
necessary for daily living(such as,clothing,hygiene,etc.).Estimated @$2,500 annually
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 1,500 Household Items(SFC 72)
To provide supports for clients with household items need.Estimated at$1,500
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify):Client Flexible Support Expenditure 4,000 Client Flexible Support Expenditures Support(SFC 72)
Support To provide supports to clients and their caregivers,may include vouchers,goods,
services,and other family support services.Also maybe use for personal/community
integration to assist clients in achieving their treatment goals and in supporting their
integration into the larger community.Items may include,but are not limited to
socialization and recreational activities.This funding may also be used for medical,
dental and optical care,prescriptions,and laboratory tests when the client does not
have insurance to pay for such care.Estimated @$4,000 annually
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Others ecif
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 4,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services
5005 Other(Student Stipends) 4,000 To train 4 graduate students in mental health work force @ 500 per semester for 2
semesters x 4 students=$4,000
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
Fresno County Department of Behavioral Health H-18 Revised 2/7/2020
Exhibit H
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 42,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 42,000
BUDGET CHECK: -
Contract Budget Narrative
Fresno County Department of Behavioral Health H-19 Revised 2/7/2020
Exhibit I
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor(s) or any third
parties, Contractor(s), at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor(s) shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor(s)'s
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor(s)
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor(s) shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse / molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor(s).
I-1
Exhibit I
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor(s)'s obligations under [identify
the Article, section, or exhibit containing data security obligations] of this Agreement; (iv)
system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security
Breach; (vii)failure to comply with privacy policy; (viii) payment card liabilities and costs;
(ix) infringement of intellectual property, including but not limited to infringement of
copyright, trademark, and trade dress; (x) invasion of privacy, including release of
private information; (xi) information theft; (xii) damage to or destruction or alteration of
electronic information; (xiii) cyber extortion; (xiv) extortion related to the Contractor(s)'s
obligations under this Agreement regarding electronic information, including Personal
Information; (xv) fraudulent instruction; (xvi) funds transfer fraud; (xvii) telephone fraud;
(xviii) network security; (xix) data breach response costs, including Security Breach
response costs; (xx) regulatory fines and penalties related to the Contractor(s)'s
obligations under this Agreement regarding electronic information, including Personal
Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor(s) signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor(s) shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor(s) has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor(s)'s policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
1-2
Exhibit I
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor(s).
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor(s) shall provide to the County, or ensure that the policy
requires the insurer to provide to the County, written notice of any cancellation or change
in the policy as required in this paragraph. For cancellation of the policy for nonpayment
of premium, the Contractor(s) shall, or shall cause the insurer to, provide written notice
to the County not less than 10 days in advance of cancellation. For cancellation of the
policy for any other reason, and for any other change to the policy, the Contractor(s)
shall, or shall cause the insurer to, provide written notice to the County not less than 30
days in advance of cancellation or change. The County in its sole discretion may
determine that the failure of the Contractor(s) or its insurer to timely provide a written
notice required by this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor(s) has or obtains
insurance with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor(s) shall deliver, or cause its broker or
producer to deliver, to the County's Risk Manager certificates of insurance and
endorsements for all of the coverages that have such broader coverage, higher limits, or
both, as required under this Agreement.
(E) Waiver of Subrogation. The Contractor(s) waives any right to recover from the County,
its officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor(s) is
solely responsible to obtain any policy endorsement that may be necessary to
accomplish that waiver, but the Contractor(s)'s waiver of subrogation under this
paragraph is effective whether or not the Contractor(s) obtains such an endorsement.
(F) County's Remedy for Contractor(s)'s Failure to Maintain. If the Contractor(s) fails to
keep in effect at all times any insurance coverage required under this Agreement, the
County may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor(s). The County may offset such
charges against any amounts owed by the County to the Contractor(s) under this
Agreement.
1-3
Exhibit I
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
1-4
Exhibit J
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information at intake and annually
thereafter.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
J-1
Exhibit J
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
J-2
Exhibit K
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the Contractor can submit an incident using the reporting portal at
any time. No login is required.
• The designated administrator of the Contractor can add information to the follow up
section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the Contractor's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, Contractor shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the Contractor
should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract
analyst.
K-1
Exhibit K
co�,� Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Incident Reporting System
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
• Do away with submitting a paper version with a signature.
• This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer,the responsibility is to:
• Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
• Review incident for clarity, missing information and add in additional information deemed
appropriate.
• Notify DBHlncidentReporting@fresnocountVca.gov if there is additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountVca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
K-2
Exhibit K
E 0 Q Y fresnodbh.IogicmanagecmmAncidents/?t=9&p=l&k=182be0c5cdcd5072bbl8Wdee4d3d,,_
LogicManager
Incident Report
Please complete this form
Client Information
Name of Facility'
Name of Reporting Party'
Facility Address'
Facility Phone Number'
i
Mental Health or Substance Use Disorder Program?'
Client First Name'
Client Last Name-
F4 C 4 .,, .. t I .. :.. ..... ...
i
Client Date of Bi rth
Client Address
Client I
Gender'
County of Origin'
Summary
Subject O
Incident(check all that apply)'
If Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
Description of the incident'
K-3
Exhibit K
Similar to the paper version, multiple incident categories can be selected
Incident(check all that apply)'
Medical Emergency x Deathof Client x
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Violence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-Inflicted or by accident)
Medication Error
<— C 4 A fresnodbh.logicmaoegeccom/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
Date of Incident'
Time of Incident'
Etereexi
i
Location of Incident'
Enter=xt
Key People Directly Involved in Incident(witnesses,staff)'
F,-
Did the Injured Party seek Medical Attention?
Select ontio r
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Enterexl
Reported By Email'
Fnter zxt
i
Reported On
10/30/2019
K-4
Exhibit K
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
0 fresnodbh.logicmanageccom mcl - =1&k=182beOc5cdcd5072bb1864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
Please specify if other
Description of Action Taken'
msr te:.,
Outcome
Similar to the paper version, multiple Action Taken categories can be selected.
Follow Up
Action Taken(check all that apply)'
Law Enforcement Contacted% Called 911/EMS%
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
K-5
Exhibit K
A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the
Form"to submit another incident.
LogicManager
Thank you for your submission
r
RELOAD THE FORM
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
Wed 10/3(12n1911 SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com>
QNotification-
To O DBH Incident Reporting
0If there are problems with how this message is displayed,click here to view it in a web
Click here to download pictures.To help protect your privacy,Outlook prevented autom ocrdownload of some pictures in this message.
CAUTIONM-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
x�right-cfrk>dp and Auld hnem dwnbd Picwr-.Tu Arb �tVdr
Outlmk Prevtled aumnvtic danbd dei PiWnfmntlx
Lv,eH ,Inc.
Hi Mila Arevalo,
You have received a notification through LogicManager.Please see the details
below.
Type:Incident Report
Subject:102:
Notification To:Mila Arevalo
Ocen this incident in LoaicManaaer
If using Internet Explorer,click here to open the notification
This email was generated by LogicManager.If you have any technical issues,
please email su000rtliffioaicmanauercom.
K-6
Exhibit K
Enter in email address and password. First time users will be prompted to set up a password.
C Q O fresnodbh.my.logicmanager.com/login
LogicManager
Forgot your password?
Once logged in,the main screen will show reviewer task(incidents to review). Click on analyst/supervisor follow up
to view the incident.
A
Your Task List
a
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE-
Analyst Follow Up In Progress —dhi[ SYSTEM-,V,Managci
K-7
Exhibit K
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Analyst Follow Up
Task Detailz Client lnkrmaxon
AA TEST FACI III
nameof facility'
xame WaeportinBpaxy'
sacillry AEErcas'
sacniry vhone xumx.'
The next tab is Sum ary: No edits can be made to this section.
Analyst Follow Up
Task Deta ils Client Information Summ ry Follow Up Doan
bj t 0
Inclbenl(check all that apply)•
Oeath of Dllmt lc
If Other specify(Ia fire,po�sonm6.epbemx outbreaks,oVIk,—Urtropkes/ewntslhalleopardlk,the xrclhrcan0 safety olcllenb,uAff,.E/or membefsoflhe c —ly)
De criptlon aflhe ind—t'
B I / u $ ❑ — — — le E B Q
D.A.lnclEent'
10130121013
Time onneiaent'
f
k«auon ormBlaenr
f
Task ID:3135ource:103:null « B 3 CANCEL
K-8
Exhibit K
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
sure to E w en edits are made.Then Cancel to Exi ut of the incident.
Analyst Follow Up
Task Details CI—tlnformatmn Summary Follow Up Documents
Action Taken(check all that apply)'
Law Enforcement Contacted X
Pleasespecifyifother
D—,,poon of Action Taken'
f
Outcome'
f
added inrormadon
cause of deem-cancer per caroner 10-31-19�
Task ID:313 Source:—null �c c t� CANC
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up
Task Details Client Information Summary Follow Up Documents
---�' ® Add Document "
Name Type Source Upload Date Uploaded By
CAi
No documents yet.
Drop files here or click on the Add Document dmpdown.
< 5 > » CA 11 C E L
Task ID:313 Source:103:null
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHlncidentReporting@fresnocountycagov
K-9
Exhibit K
To get back to the home view, click on the Lo is Manager icon at any time. Any incidents that still need review will
show on this screen, click o c incident and start the review process again.
Lr
,icManager pi—
Your Task List
4
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE
M,W F,11—Up MProgress meE hzf SYSTEM Lo®cManager
K-10
Exhibit L
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, Contractor, Contractor' employees and subcontractors must
sign the Contractor Acknowledgment and Agreement form and return this form to the Compliance
Officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
County.
3. Treat County employees, persons served, and other mental health contractors fairly
and with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
L-1
Exhibit L
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
L-2
Exhibit L
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature: Date:
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date:
L-3
Exhibit M
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
Contractor shall be required to maintain organizational provider certification by the host county.
A copy of this renewal certificate must be furnished to County within thirty (30) days of receipt of
certificate from host county. The Contractor must meet Medi-Cal organization provider
standards as stated below. It is acknowledged that all references to Organizational Provider
and/or Provider below shall refer to the Contractor.
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2. The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6. The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7. The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
M-1
Exhibit M
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
10. The County may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three years. The County may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
M-2
Exhibit N
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit L.
(C)"Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D)"Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit N.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit N.
N-1
Exhibit N
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C)The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit N;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
N-2
Exhibit N
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit N, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
N-3
Exhibit N
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit N. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
N-4
Exhibit N
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a)fresnocountyca.gov, 559-600-5900, (559) 600-
4645, dbh contracted services(Qfresnocountyca.gov,
dbhforensicservices(a�fresnocountyca.gov (which telephone number and email address
the County may update by providing notice to the Contractor), and (ii) preserve all
relevant evidence (and cause any affected Authorized Person to preserve all relevant
evidence) relating to the Security Breach. The notification shall include, to the extent
reasonably possible, the identification of each type and the extent of Personal
Information that has been, or is reasonably believed to have been, breached, including
but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or
modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit N, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
N-5
Exhibit N
including taking any corrective action under this Exhibit N, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D)The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit N.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit N, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit N.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit N. that apply to the
Contractor with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
N-6
Exhibit N
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit
N, such certification shall state the date, time, and manner (including standard) of disposal and
by whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit N to all such
Personal Information and copies of Personal Information. The Contractor shall not retain any
copy of any Personal Information after returning or disposing of Personal Information as
required by this section 6. The Contractor's obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractor retains if
return or disposal is not feasible and to all Personal Information that the Contractor may later
discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit N may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee")from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit N and the cost of pursuing any insurance
providers, arising out of or resulting from any third party claim or action against any County
Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit N or
arising out of or resulting from the Contractor's failure to comply with any of its obligations under
this section 8. The provisions of this section 8 do not apply to the acts or omissions of the
N-7
Exhibit N
County. The provisions of this section 8 are cumulative to any other obligation of the Contractor
to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The
provisions of this section 8 shall survive the termination of this Agreement.
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit N shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit N
is intended to confer, nor shall anything in this Exhibit N confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
N-8
Exhibit O
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
Contractor(s)'s board of directors ("County Contractor(s)"), must disclose any self-dealing
transactions that they are a party to while providing goods, performing services, or both for the
County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest."
The definition above will be used for purposes of completing this disclosure form.
Instructions
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
O-1
Exhibit O
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a
party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of
Corporations Code § 5233 (a)
(5) Authorized Signature
Signature: Date:
O-2
Exhibit P
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) Telephone number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVI 11, XIX, or XX?...................................................................................... n n
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 71
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: n Sole proprietorship n Partnership o Corporation
71 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........................................................................................................... >
71
NAME ADDRESS PROVIDER NUMBER
P-1
Exhibit P
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
P-2
Exhibit Q
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Q-1
Exhibit Q
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Q-2
Exhibit R
1
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices,preferred languages,health literacy,and other communication needs.
Governance,Leadership,and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and
allocated resources.
3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in
the service area.
4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate
timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing.
7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement,Continuous Improvement,and Accountability:
9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's
planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts
or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public.
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Exhibit R
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.'Currently,individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which
individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice,one of the most modifiable factors is the lack of culturally and linguistically
appropriate services,broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Of all the forms of
Health inequities result in disparities that directly affect the quality of life for all individuals. Health
disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in
the issue not only an individual concern but also a public health concern. In the United States,it health care is the most
has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane.
inadequate and/or inequitable care is$1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr.
the quality of care and services.5,6 By providing a structure to implement culturally and linguistically
appropriate services,the National CLAS Standards will improve an organization's ability to address
health care disparities.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa
2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www.
hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?topicid=39
4. LaVeist,T A.,Gaskin,D.J.,&Richard,P(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www.
jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.pdf
5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved
from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.pdf
6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The
Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf
7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http://
minorityhealth.hhs.gov/npa/f les/Plans/HHS/H HS_Plan_complete.pdf
8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of
Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
��� 1 Think Cultural Health
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