HomeMy WebLinkAboutAgreement A-15-319 with FCOE_Violet Heintz.pdfAgreement No.15-319
AGREEMENT '--.. 1
2 This Agreement is made and entered into this 1 ~ +h day of :::Iu.l~ , 2015, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and FRESNO COUNTY SUPERINTENDENT OF SCHOOLS, hereinafter
5 referred to as "CONTRACTOR" for the purpose of defining each agency's roles and responsibilities
6 at the Violet Heintz Education Academy (VHEA) 4939 E. Yale Avenue, Fresno, CA, 93727.
7 WITNESSETH:
8 WHEREAS, COUNTY, through its Department ofBehavioral Health Children's Mental
9 Health Division (DBH-CMH), recognizes the need to provide services related to mental well-being;
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11 WHEREAS, CONTRACTOR desires to partner mental health treatment services with existing
12 educational services for its students who attend VHEA-Day Reporting Center (DRC), and are ordered
13 by the court or are referred by other collaborative partners (i.e. Probation, Substance Abuse Providers,
14 VHEA staff, parents, and students).
15 WHEREAS, COUNTY, through its DBH-CMH, is qualified and willing to assign one clinician
16 and one Community Mental Health Specialist (CMHS) to VHEA-DRC to provide such mental health
17 treatment services.
18 WHEREAS, CONTRACTOR is a public school district which also coordinates its own mental
19 health services within the jurisdictional boundaries specific to CONTRACTOR.
20 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
21 hereto agree as follows:
22 1. DEFINITIONS
23 A. For purposes of this Agreement, the parties agree that the definitions set forth at
24 California Code ofRegulations (CCR) Title 9, Division 1, Ch. 1., Article 1, §1810.100 and §1810.247
2 5 shall govern the meaning of all terms utilized in this Agreement.
26 1. "Children's mental health services" shall be defmed as outpatient mental
2 7 health services, case management, crisis intervention, and rehabilitative services. This includes
2 8 individual, group and family therapy.
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1 2. "Pupils" shall refer to all children with mental health needs who are
2 eligible to receive children's mental health services from or through the COUNTY at VHEA and are
3 eligible for Medi-cal or are uninsured.
4 3. "Medically necessary mental health services" refer to the criteria in
5 accordance with CCR, Title 9, Division 1, Chapter 11, Article 2, §1830.205.
6 4. The mental health services provided herein will not be a service
7 component of a pupil's Individualized Education Program (IEP) for pupils as defined in CCR Title 2,
8 Division 9, Chapter 1, Article 1, §60010 which are required to be provided or arranged by
9 CONTRACTOR.
10 2. COVERED SERVICES
11 The parties agree to the terms and conditions set forth in Exhibit A "Inter-Agency
12 Agreement -Purpose and Intent" attached hereto and by this reference incorporated herein and made
13 part of this Agreement. CONTRACTOR shall provide for office treatment facilities that meet Medi-
14 Cal Site Certification Standards, secured and private office spaces, storage space, telephone/s, use of
15 copy machine as needed, a designated posting board near the office space; keys similar to all
16 collaborative agencies and other Fresno County employees; and during regular business hours, all
17 approved DBH employees shall be provided with easy and unrestricted access to the building and the
18 facility.
19 CONTRACTOR agrees that mental health services provided by COUNTY under this
2 0 agreement are not provided as a subcontractor of CONTRACTOR. CONTRACTOR shall be solely
21 responsible for the mental health treatment requirements of the IEP.
22 3. TERM
2 3 This Agreement shall become effective upon execution and shall terminate on the 30th
2 4 day of June 30, 2016.
2 5 This Agreement shall automatically be extended for two (2) additional twelve (12)
2 6 month periods upon the same terms and conditions herein set forth, unless written notice of non-
27 renewal is given by COUNTY, CONTRACTOR, or COUNTY's DBH Director, or designee not later
2 8 than thirty (30) days prior to the close of the current Agreement term.
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4. TERMINATION
A. Non Allocation of Funds-The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving the CONTRACTOR sixty (60) days advance written notice.
B. Breach of Contract-COUNTY may immediately suspend or terminate this
7 Agreement in whole or in part, where in the determination of COUNTY there is:
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A failure to comply with any term of this Agreement;
A substantially incorrect or incomplete report submitted to COUNTY; or
Improperly performed service.
Without Cause-Under circumstances other than those set forth above, this
12 Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director, or
13 designee, upon the giving of sixty (60) days advance written notice of an intention to terminate.
14 5. COMPENSATION
15 The services and obligations conducted pursuant to the terms and conditions of this
16 Agreement shall be performed without payment of any monetary consideration by any of the parties,
1 7 one to the other.
18 6. INDEPENDENT CONTRACTOR
19 In performance of the work, duties, and obligations assumed by CONTRACTOR under
20 this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
21 CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
2 2 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
23 employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have
2 4 no right to control or supervise or direct the manner or method by which CONTRACTOR shall
2 5 perform its work and function. However, COUNTY shall retain the right to administer this
2 6 Agreement so as to verify that CONTRACTOR is performing its obligations in accordance with the
2 7 terms and conditions thereof. CONTRACTOR and COUNTY shall comply with all applicable
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provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction
over matters which are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees
all legally required employee benefits. In addition, CONTRACTOR shall be solely responsible and
save COUNTY harmless from all matters relating to payment of CONTRACTOR's employees,
including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be
providing services to others unrelated to the COUNTY or to this Agreement.
7. MODIFICATION
12 Any matters of this Agreement may be modified from time to time by the written
13 consent of all the parties without, in any way, affecting the remainder.
14 It is mutually understood that the parties agree to review this Agreement annually and to
15 revise this Agreement as appropriate so as to assure services are delivered to the satisfaction of the
16 parties.
17 8. NON ASSIGNMENT
18 Neither party shall assign, transfer or subcontract this Agreement nor their rights or
19 duties under this Agreement without the prior written consent of the other party.
20 9. MUTUAL HOLD HARMLESS
21 COUNTY shall defend, hold harmless, and indemnify CONTRACTOR, its governing
2 2 board, officers, administrators, agents, employees, and consultants of an from any and all liabilities,
2 3 claims, demands, costs, losses, damages, or expenses, including reasonable attorneys' fees and court
2 4 costs, including but not limited to consequential damages, loss of use, extra expense, cost of facilities,
2 5 dead, sickness, or injury to any person, or damage to any property from any cause whatsoever arising
2 6 from or connected with the provision of service hereunder, that arise out of or result from, in whole or
2 7 in part, the negligent, wrongful, or willful acts or omissions of the COUNTY, its agents, employees,
2 8 subcontractors, consultants or representatives.
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1 CONTRACTOR shall defend, hold harmless, and indemnify the COUNTY, its
2 governing board, officers, administrators, agents, employees, and consultants of and from any and all
3 liabilities, claims, demands, costs, losses, damages, or expenses, including reasonable attorneys' fees
4 and court costs, including but not limited to consequential damages, loss of use, extra expense, costs
5 of facilities, death, sickness, or injury to any person, or damage to any property from any cause
6 whatsoever arising from or connected with the provision of service hereunder, that arise out of or
7 result from, in whole or in part, the negligent, wrongful, or willful acts or omissions of
8 CONTRACTOR, its agents, employees, subcontractors, consultants or representatives.
9 Notwithstanding the above, should the COUNTY, through its DBH, Children's Mental
1 0 Health Division, be name a party to a fair hearing, including any hearing or mediation held pursuant to
11 20 USC 1415 or Education Code section 56500 et seq., CONTRACTOR will pay for the legal
12 representation of COUNTY in such fair hearing case, as well as any award of attorneys fees made
13 against, or agreed to by, COUNTY. COUNTY shall have the right to legal representation of its
14 choosing.
15 10. CONFIDENTIALITY
16 All services performed by CONTRACTOR under this Agreement and any information
17 CONTRACTOR creates, receives, or maintains pertaining to protected health information shall be in
18 strict conformance with all applicable Federal, State of California and/or local laws and regulations
19 relating to confidentiality.
2 0 Confidentiality of Pupil Records -The COUNTY agrees to obtain the written consent of
21 the pupil's parent/legal guardian or other person lawfully charged with the care and custody of the
2 2 pupil to allow the exchange of necessary educational and medical information while insuring the
2 3 confidentiality of each pupil's record. A copy of the parent/legal guardian's written consent form will
24 be kept in the COUNTY's DBH client file. No PHI or other confidential information shall be
2 5 disclosed by COUNTY to CONTRACTOR without such written consent, or in the event that such
2 6 written consent is given, it may be withdrawn.
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11. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
12. COMPLIANCE WITH STATE REQUIREMENTS
6 CONTRACTOR recognizes that COUNTY operates its mental health programs under
7 an agreement with the State of California Department of Health Care Services, and that under said
8 agreement the State imposes certain requirements on COUNTY and such will affect CONTRACTOR.
9 CONTRACTOR shall adhere to all State Requirements, including those identified in Exhibit B "State
1 0 Mental Health Requirements", attached hereto and by this reference incorporated herein.
11 13. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
12 COUNTY and CONTRACTOR each consider and represent themselves as covered
13 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
14 Law 104-191(HIPAA) and agree to use and disclose protected health information as required by law.
15 COUNTY and CONTRACTOR acknowledge that the exchange of protected health
16 information between them is only for treatment, payment, and health care operations.
17 COUNTY and CONTRACTOR intend to protect the privacy and provide for the
18 security of Protected Health Information (PHI) pursuant to the Agreement in compliance with HIP AA,
19 the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005
20 (HITECH), and regulations promulgated thereunder by the U.S. Department of Health and Human
21 Services (HIP AA Regulations) and other applicable laws.
22 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
2 3 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of
24 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) ofthe
25 Code ofFederal Regulations (CFR).
26 14. NON-DISCRIMINATION
27 During the performance ofthis Agreement CONTRACTOR shall not unlawfully
2 8 discriminate against any employee or applicant for employment, or recipient of services, because of
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race, religion, color, national origin, ancestry, physical disability, medical condition, marital status,
age or gender, pursuant to all applicable State of California and Federal statutes and regulations.
15. SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among CONTRACTOR. By execution of this Agreement, CONTRACTOR
understands that a separate Agreement is formed between each individual CONTRACTOR site and
COUNTY.
16. ENGLISH PROFICIENCY
9 COUNTY shall provide interpreting and translation services to persons participating in
10 COUNTY mental health services who have limited or no English language proficiency, including
11 services to persons who are deaf or blind. Interpreter and translation services shall be provided as
12 necessary to allow such participants meaningful access to the program, services and benefits provided
13 by COUNTY. Interpreter and translation services, including translation of COUNTY "vital
14 documents" (those documents that contain information that is critical for accessing COUNTY services
15 or are required by law) shall be provided to participants at no cost to the participant. COUNTY shall
16 ensure that any employees, agents, schools, or partners who interpret or translate for a program
1 7 participant, or who directly communicate with a program participant in a language other than English,
18 demonstrate proficiency in the participant's language and can effectively communicate any specialized
19 terms and concepts peculiar to COUNTY mental health services.
20 17. INSURANCE
21 Without limiting the indemnification of each party as stated in Section 9 above, it is
22 understood and agreed that COUNTY and CONTRACTOR shall each maintain, at their sole expense,
2 3 insurance policies or self-insurance programs including, but not limited to, an insurance pooling
2 4 arrangement and/or Joint Powers Agreement to fund their respective liabilities throughout the term of
2 5 this Agreement. Coverage shall be provided for general liability, automobile liability, and workers'
2 6 compensation exposure. Evidence of Insurance, e.g., Certificates of Insurance or other similar
2 7 documentation, shall not be required of either party under this Agreement.
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Additionally, CONTRACTOR, at its sole expense, shall maintain in full force and effect
the following insurance policies throughout the term of this Agreement:
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Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1 ,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
Child Abuse/Molestation and Social Services Coverage
COLLEGE shall have either separate policies or umbrella policy with
endorsements covering Child Abuse/Molestation and Social Services Liability
coverage or have a specific endorsement on their General Commercial liability
policy covering Child Abuse/Molestation and Social Services Liability. The
policy limits for these policies shall be $1,000,000 per occurrence with
$2,000,000 annual aggregate. The policies are to be on a per occurrence basis.
DISCLOSURE-CRIMINAL HISTORY AND CIVIL ACTIONS
16 CONTRACTOR is required to disclose if any of the following conditions apply to
1 7 them, their owners, officers, corporate managers and partners:
18 A. Within the three-year period preceding the Agreement award, they have been
19 convicted of, or had a civil judgment rendered against them for:
20 1. Fraud or a criminal offense in connection with obtaining, attempting to
21 obtain, or performing a public (federal, state, or local) transaction or contract under a public
2 2 transaction;
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Violation of a federal or state antitrust statute;
Embezzlement, theft, forgery, bribery, falsification, or destruction of
False statements or receipt of stolen property.
Within a three-year period preceding their Agreement award, they have had a
2 8 public transaction (federal, state, or local) terminated for cause or default.
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Disclosure ofthe above information will not automatically eliminate CONTRACTOR
from further business consideration. The information will be considered as part of the determination
of whether to continue and/or renew the contract and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later
determined that the CONTRACTOR failed to disclose required information, any contract awarded to
such CONTRACTOR may be immediately voided and terminated for material failure to comply with
the terms and conditions of the award.
CONTRACTOR must sign an appropriate "Certification Regarding Debarment,
Suspension, and Other Responsibility Matters", Exhibit C attached hereto and by this reference
incorporated herein. Additionally, CONTRACTOR must immediately advise the COUNTY in writing
if, during the term of the Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or
ineligible for participation in federal or state funded programs or from receiving federal funds as listed
in the excluded parties list system (http://www/epls/gov); or (2) any of the above listed conditions
become applicable to CONTRACTOR. The CONTRACTOR will indemnity, defend and hold the
COUNTY harmless for any loss or damage resulting from a conviction, debarment, exclusion,
ineligibility or other matter listed in the signed Certification Regarding Debarment, Suspension, and
Other Responsibility Matters.
19. DISCLOSURE OF SELF-DEALING TRANSACTIONS
19 This provision is only applicable if CONTRACTOR is operating as a corporation (a for-profit
2 0 or non-profit corporation) or if during the term of this agreement, CONTRACTOR changes its status
21 to operate as a corporation.
22 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
2 3 transactions that they are a party to while CONTRACTOR is providing goods or performing services
2 4 under this agreement. A self-dealing transaction shall mean a transaction to which the
2 5 CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
2 6 Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
2 7 by completing and signing a "Self-Dealing Transaction Disclosure Form" Exhibit D and submitting it
2 8 to the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter."
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1 20. AUDITS AND INSPECTIONS
2 The CONTRACTOR shall at any time during business hours, and as often as the
3 COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
4 data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request
5 by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to
6 ensure CONTRACTOR compliance with the terms of this Agreement.
7 21. COMPLAINTS
8 CONTRACTOR shall log complaints and the disposition of all complaints from a pupil
9 or a pupil's family. CONTRACTOR shall provide a copy of the detailed complaint log entries
1 0 concerning COUNTY -sponsored pupils to COUNTY DBH at monthly intervals by the tenth (1Oth)
11 day of the following month, in a format that is mutually agreed upon. Besides the detailed complaint
12 log, CONTRACTOR shall provide details and attach documentation of each complaint with the log.
13 CONTRACTOR shall post signs informing pupil of their right to file a complaint or grievance.
14 CONTRACTOR shall notify COUNTY DBH of all incidents reportable to state licensing bodies that
15 affect COUNTY pupils within twenty-four (24) hours of receipt of a complaint.
16 22. NOTICES
1 7 The persons having authority to give and receive notices under this Agreement and their
18 addresses include the following:
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COUNTY
Director, Fresno County
Department of Behavioral Health
4441 E. Kings Canyon Rd
Fresno, CA 93702
CONTRACTOR
Superintendent
Fresno County Superintendent of Schools
1111 Van Ness A venue
Fresno, CA 93721
2 4 Any and all notices between the COUNTY and the CONTRACTOR provided for or
2 5 permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
2 6 personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
2 7 United States Mail, postage prepaid, addressed to such party.
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1 23. GOVERNING LAW
2 The parties agree, that for the purposes of venue, performance under this Agreement is
3 to be in Fresno County, California.
4 The rights and obligations of the parties and all interpretation and performance of this
5 Agreement shall be governed in all respects by the laws of the State of California.
6 24. ENTIRE AGREEMENT
7 This Agreement, including all Exhibits, constitutes the entire Agreement between the
8 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
9 agreement negotiations, proposals, commitments, writings, advertisements, publications, and
1 0 understandings of any nature whatsoever unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
3 ATTEST:
4 FRESNO COUNTY
5 SUPERINTENDENT OF SCHOOLS
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By~-.w~
Jim Y ovino, Superi11dellt
Fresno County Superintendent of Schools
1 0 Date: 05'" /~ / C S
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16 By~CJdr
17 Print Name: (~Jilt'"' Orro
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Title: SttCu>R. v,~~:t-tt>?, t'lJQt.alfl~~ <$dt.~.
Secretary (of Corporation), or
any Assistant Secretary, or
ChiefFinancial Officer, or
any Assistant Treasurer
Mailing Address:
1111 Van Ness Avenue
Fresno, CA 93721
Contact: Pam Coronado
COUNTY OF FRESNO
Date: % /~ UJ/f
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURES PAGES ATTACHED
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Administrator of Court and Community Schools
Phone No.: (559) 600-4990
Email: pcoronado@fcoe.org
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APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
REVIEWED AND RECOMMENDED
FOR APPROVAL:
Dawan Utecht, Director
Department of Behavioral Health
Fund/Subclass:
Organization:
Account/Program:
0001/10000
56304311
7294/0
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Inter-Agency Agreement-Purpose and Intent
Exhibit A
Page 1 of2
This Agreement formalizes a partnership between Fresno County (County) and Fresno County
Office of Education (FCOE) to increase access to mental health services for students at Violet
Heintz Education Academy (VHEA). The target population is Medi-Cal and uninsured students
who are un-served or underserved through traditional mental health programs. Services are
provided by one clinician and one Community Mental Health Specialist (CMHS) from the
Department of Behavioral Health (DBH).
Responsibilities of FCOENHEA
1. FCOE will provide secure and confidential office space that will:
a. Ensure mental health services can be conducted in the manner that fulfills State
and Federal confidentiality requirements.
b. Not allow the conversation between the student, therapist and/or family to be
heard outside ofthe confidential space.
c. Not be accessed by school staff during therapy sessions.
d. Promote the safety and well-being of each student and be maintained in good
working order.
e. Be large enough to conduct individual and family sessions.
2. In the case that there are windows that are viewable by anyone outside of the confidential
space, then FCOE will provide blinds, curtains or other coverings to protect the
confidentiality of each student in treatment in accordance with FCOE and DBH policies.
3. FCOE will provide a telephone in the confidential space used by the DBH clinician and
CMHS for their day-to-day work, consultations and collaborations regarding their
clients/students. If no phones are available, a hand-held two-way radio will be provided
to the DBH clinician and CMHS with training on how to use it for the clinician's safety
and that of the students.
4. VHEA will designate a staff person to coordinate the referral process. The staff
coordinator shall be responsible for speaking with the parent or legal guardian of the
student (if student is a minor) and the student, that a referral for children's mental health
services has been made. If the parent objects to the mental health referral, the referral
process will not proceed.
5. VHEA Administration will educate school staff regarding referrals for mental health
services by the second week of the fall semester.
6. Once a student completes the referral process, school staffwill work with DBH staff to
communicate whether or not the student is present on the days of their appointment and
to assist with having the student summoned for his/her appointment.
7. Meetings between appropriate school staff and DBH staff will be held as needed to
discuss individual students' stability, well-being and progress toward meeting mental
health treatment goals as well as other supportive services that may be needed.
Responsibilities of County/DBH
Exhibit A
Page 2 of2
I. Upon receipt of a referral, DBH staffwill begin the intake process within five (5)
working days by working with the staff coordinator to obtain parental consent.
a. It is understood that the provision of mental health services is voluntary and the
families may decline services at any point in the treatment process.
2. Upon receipt of parental consent, DBH staff will determine the medical necessity of each
referral as well as the student's insurance eligibility.
a. Each student's access to treatment services will be triaged based on acuity and
urgency to initiate mental health services.
b. The parent/legal guardian will be advised at the conclusion of the assessment
interview whether or not their child's symptoms meet Medi-Cal medical necessity
criteria and when treatment services will begin.
c. If no services are warranted, the rationale will be explained to both the
parent/legal guardian and the StaffCoordinator.
3. Upon completion ofthe intake process, a mental health assessment will be scheduled.
a. Parents/legal guardians are expected to participate in assessment, treatment
planning and ongoing treatment services as determined by DBH staff.
b. Parents who do not keep their scheduled appointment will be contacted and
rescheduled based on scheduling availability and acuity.
c. DBH staff will work collaboratively with school staffto determine an appropriate
schedule for ongoing services that will not negatively impact the student's
educational needs.
4. At the beginning of each day, DBH staff will provide school staff with a list of students
who are scheduled to be seen that day.
5. DBH staff will keep track of each referral and inform the staff coordinator when program
capacity has been reached, when services can be provided, and/or other options that may
be available.
6. DBH staffwill monitor student engagement in mental health services and work with
school staff to determine if any changes in the day-to-day operations are needed.
7. Meetings between appropriate school staff and DBH staffwill be held as needed to
discuss individual students' stability, well-being and progress toward meeting mental
health treatment goals as well as other supportive services that may be needed.
The DBH Director, or designee, or FCOE may request to convene for review and revision of the
program design as policies and regulations change.
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
Exhibit-B
Page 1 of2
The COUNTY and its subCONTRACTOR(S)s shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health Program (directly
or through contract) providing Short-Doyle/Medi-Cal services have met applicable
professional licensure requirements pursuant to Business and Professions and Welfare and
Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR(S)(S) 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 ofFederal
Regulations sections 2.1 et seq; California Welfare and Institutions Code, sections 14100.2,
11977, 11812, 5328; Division 1 0.5 and 10.6 of the California Health and Safety Code; Title
22, California Code of Regulations, section 51 009; and Division 1, Part 2.6, Chapters 1-7 of
the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR(S)(S) shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set forth in Exhibit
B. No person shall, because of ethnic group identification, age, sex, 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(S)(S) 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.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further funds,
until CONTRACTOR(S)(S) can show clear and convincing evidence to the
Exbibit-B
Page 2 of 2
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(S) who is related by blood
or marriage to, or who is a member ofthe Board of Directors or an officer of
CONTRACTOR(S).
5. PATIENTS' RIGHTS
CONTRACTOR(S) shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
Exhibit C
Page I of2
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
Exhibit C
Page 2 of2
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)"
SElf-DEAUNG TRANSACTION DISCLOSURE FORM
Exhibit D
Page I of2
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
(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)
Exhibit D
Page 2 of2
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature: I Date: I