HomeMy WebLinkAboutAgreement A-23-303 Agreement with Kings View.pdf Agreement No. 23-303
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between
3 Kings View, a California non-profit corporation ("Contractor"), and the County of Fresno, a
4 political subdivision of the State of California ("County").
5 Recitals
6 A. County, through its Department of Behavioral Health (DBH), is in need of a qualified
7 agency to operate Mental Health Crisis Intervention Services within the Fresno metropolitan
8 (metro) area as specified in this Agreement, to help reduce stigma and discrimination against
9 mental illness and provide mental health crisis intervention services in a working
10 partnership with Fresno metro first responders.
11 B. County entered into Agreement No.18-688 with Contractor on December 11, 2018,
12 amended by Agreement No. 22-421 on September 20, 2022, collectively Agreement No. 22-
13 421.
14 C. Changes to the agreement are necessary due the Department of Health Care Services'
15 implementation of California Advancing and Innovating Medi-Cal (CalAIM), which includes a
16 new billing structure that Contractors must utilize.
17 D. This Agreement shall replace, restate, and supersede Agreement No. 22-421 in its
18 entirety.
19 The parties therefore agree as follows:
20 Article 1
21 Contractor's Services
22 1.1 Scope of Services. The Contractor shall perform all of the services provided in
23 Exhibit A to this Agreement, titled "Scope of Services."
24 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
25 able to perform all of the services provided in this Agreement.
26 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
27 applicable federal, state, and local laws and regulations in the performance of its obligations
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1 under this Agreement, including but not limited to workers compensation, labor, and
2 confidentiality laws and regulations.
3 Contractor shall provide services in conformance with all applicable State and Federal
4 statutes, regulations and subregulatory guidance, as from time to time amended, including but
5 not limited to:
6 (A) California Code of Regulations, Title 9;
7 (B) California Code of Regulations, Title 22;
8 (C) California Welfare and Institutions Code, Division 5;
9 (D) United States Code of Federal Regulations, Title 42, including but not limited to
10 Parts 438 and 455;
11 (E) United States Code of Federal Regulations, Title 45;
12 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable;
13 (G)Balanced Budget Act of 1997;
14 (H) Health Insurance Portability and Accountability Act (HIPAA); and
15 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory
16 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and
17 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of
18 County's, state or federal contracts governing services for persons served.
19 In the event any law, regulation, or guidance referred to in this section 1.3 is amended
20 during the term of this Agreement, the parties agree to comply with the amended authority as of
21 the effective date of such amendment without amending this Agreement.
22 Contractor recognizes that County operates its mental health programs under an
23 agreement with DHCS, and that under said agreement the State imposes certain requirements
24 on County and its subcontractors. Contractor shall adhere to all State requirements, including
25 those identified in Exhibit B, "Behavioral Health Requirements."
26 1.4 Meetings. Contractor shall participate in monthly, or as needed, workgroup meetings
27 consisting of staff from County's DBH to discuss service requirements, data reporting, training,
28 policies and procedures, overall program operations and any problems or foreseeable problems
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1 that may arise. Contractor shall also participate in other County meetings, such as but not
2 limited to quality improvement meetings, provider meetings, Behavioral Health Board meetings,
3 bi-monthly contractor meetings, etc. Schedule for these meetings may change based on the
4 needs of the County.
5 1.5 Organizational Provider. Contractor shall maintain requirements as a Mental Health
6 Plan (MHP) organizational provider throughout the term of this Agreement, as described in
7 Article 17 of this Agreement. If for any reason, this status is not maintained, County may
8 terminate this Agreement pursuant to Article 7 of this Agreement.
9 1.6 Staffing. Contractor agrees that prior to providing services under the terms and
10 conditions of this Agreement, Contractor shall have staff hired and in place for program services
11 and operations or County may, in addition to other remedies it may have, suspend referrals or
12 terminate this Agreement, in accordance with Article 7 of this Agreement.
13 1.7 Credentialing and Recredentialing. Contractor and their respective staff must
14 follow the uniform process for credentialing and recredentialing of service providers established
15 by County, including disciplinary actions such as reducing, suspending, or terminating provider's
16 privileges. Failure to comply with specified requirements can result in suspension or termination
17 of an individual or provider.
18 Upon request, the Contractor must demonstrate to the County that each of its providers
19 are qualified in accordance with current legal, professional, and technical standards, and that
20 they are appropriately licensed, registered, waivered, and/or certified.
21 Contractor must not employ or subcontract with providers debarred, suspended or
22 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in
23 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set
24 forth in 42 C.F.R. §438.610. See Article 12 below.
25 Contractor is required to verify and document at a minimum every three years that each
26 network provider that delivers covered services continues to possess valid credentials, including
27 verification of each of the credentialing requirements as per the County's uniform process for
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1 credentialing and recredentialing. If any of the requirements are not up-to-date, updated
2 information should be obtained from network providers to complete the re-credentialing process.
3 1.8 Criminal Background Check. Contractor shall ensure that all providers and/or
4 subcontracted providers consent to a criminal background check, including fingerprinting to the
5 extent required under state law and 42 C.F.R. § 455.434(a). Contractor shall provide evidence
6 of completed consents when requested by the County, DHCS or the US Department of Health &
7 Human Services (US DHHS).
8 1.9 Guiding Principles. Contractor shall align programs, services, and practices with
9 the vision, mission, and guiding principles of the DBH, as further described in Exhibit C, "Fresno
10 County Department of Behavioral Health Guiding Principles of Care Delivery."
11 1.10 Clinical Leadership. Contractor shall send to County upon execution of this
12 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their
13 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to
14 oversee services based on the level of care and program design presented herein shall be
15 included in this plan. A description and monitoring of this plan shall be provided.
16 1.11 Timely Access. It is the expectation of the County that Contractor provide timely
17 access to services that meet the State of California standards for care. Contractor shall track
18 timeliness of services to persons served and provide a monthly report showing the monitoring or
19 tracking tool that captures this data. County and Contractor shall meet to go over this monitoring
20 tool, as needed but at least on a monthly basis. County shall take corrective action if there is a
21 failure to comply by Contractor with timely access standards. Contractor shall also provide
22 tracking tools and measurements for effectiveness, efficiency, and persons served satisfaction
23 as further detailed in Exhibit A.
24 1.12 Electronic Health Record. Contractor may maintain its records in County's
25 electronic health record (EHR) system in accordance with Exhibit D, "Documentation Standards
26 for Person Served Records", as licenses become available. The person served record shall
27 begin with registration and intake, and include person served authorizations, assessments,
28 plans of care, and progress notes, as well as other documents as approved by County. County
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1 shall be allowed to review records of all and any services provided. If Contractor determines to
2 maintain its records in the County's EHR, it shall provide County's DBH Director, or his or her
3 designee, with a thirty (30) day notice. If at any time Contractor chooses not to maintain its
4 records in the County's EHR, it shall provide County's DBH Director, or designee, with thirty (30)
5 days advance written notice and Contractor will be responsible for obtaining its own system, at
6 its own cost, for electronic health records management.
7 Disclaimer
8 County makes no warranty or representation that information entered into the County's
9 DBH EHR system by Contractor will be accurate, adequate, or satisfactory for Contractor's own
10 purposes or that any information in Contractor's possession or control, or transmitted or
11 received by Contractor, is or will be secure from unauthorized access, viewing, use, disclosure,
12 or breach. Contractor is solely responsible for person served information entered by Contractor
13 into the County's DBH EHR system. Contractor agrees that all Private Health Information (PHI)
14 maintained by Contractor in County's DBH EHR system will be maintained in conformance with
15 all HIPAA laws, as stated in section 18.1, "Health Insurance Portability and Accountability Act."
16 1.13 Records. Contractor shall maintain records in accordance with Exhibit D,
17 "Documentation Standards for Person Served Records". All records shall be maintained for a
18 minimum of ten (10) years from the date of the end of this Agreement.
19 1.14 Access to Records. Contractor shall provide County with access to all
20 documentation of services provided under this Agreement for County's use in administering this
21 Agreement. Contractor shall allow County, CMS, the Office of the Inspector General, the
22 Controller General of the United States, and any other authorized Federal and State agencies to
23 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
24 records, documents, and the premises, equipment and facilities maintained by the Contractor
25 pertaining to such services at any time and as otherwise required under this Agreement.
26 1.15 Quality Improvement Activities and Participation. Contractor shall comply with
27 the County's ongoing comprehensive Quality Assessment and Performance Improvement
28 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established
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1 outcomes by following structural and operational processes and activities that are consistent
2 with current practice standards.
3 Contractor shall participate in quality improvement (QI) activities, including clinical and
4 non-clinical performance improvement projects (PIPs), as requested by the County in relation to
5 State and Federal requirements and responsibilities, to improve health outcomes and
6 individuals' satisfaction over time. Other QI activities include quality assurance, collection and
7 submission of performance measures specified by the County, mechanisms to detect both
8 underutilization and overutilization of services, individual and system outcomes, utilization
9 management, utilization review, provider appeals, provider credentialing and re-credentialing,
10 and person served grievances. Contractor shall measure, monitor, and annually report to the
11 County its performance.
12 1.16 Rights of Persons Served. Contractor shall comply with applicable laws and
13 regulations relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal.
14 Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The Contractor shall
15 ensure that its subcontractors comply with all applicable patients' rights laws and regulations.
16 Article 2
17 Reporting
18 2.1 Reports. The Contractor shall submit the following reports:
19 (A) Outcome Reports
20 Contractor shall submit to County clinical program performance outcome reports,
21 as requested.
22 Outcome reports and outcome requirements are subject to change at County's
23 discretion. Contractor shall provide outcomes as stated in Exhibit A and Exhibit E,
24 "Performance Outcome Measures".
25 (B) Staffing Report
26 Contractor shall submit monthly staffing reports due by the 10th of each month
27 that identify all direct service and support staff by first and last name, applicable
28 licensure/certifications, and full-time hours worked to be used as a tracking tool to
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1 determine if Contractor's program is staffed according to the requirements of this
2 Agreement.
3 (C) Mental Health Services Act (MHSA) Reporting
4 Contractor shall adhere to MHSA reporting including but not limited to fiscal,
5 outcomes, and demographics as described in Exhibit A.
6 (D) Crisis Care Mobile Units (CCMU) Grant Reporting
7 Contractor shall submit all CCMU grant reports as requested by County and
8 described in Exhibit A.
9 (E) Additional Reports
10 Contractor shall also furnish to County such statements, records, reports, data,
11 and other information as County may request pertaining to matters covered by this
12 Agreement. In the event that Contractor fails to provide such reports or other
13 information required hereunder, it shall be deemed sufficient cause for County to
14 withhold monthly payments until there is compliance. In addition, Contractor shall
15 provide written notification and explanation to County within five (5) days of any funds
16 received from another source to conduct the same services covered by this Agreement.
17 2.2 Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
18 California Department of Health Care Services (DHCS), or their designees, the right to review
19 and monitor records, programs, or procedures, at any time, in regard to persons served, as well
20 as the overall operation of Contractor's programs, in order to ensure compliance with the terms
21 and conditions of this Agreement.
22
23 Article 3
24 County's Responsibilities
25 3.1 The County shall provide oversight and collaborate with Contractor, other County
26 Departments and community agencies to help achieve program goals and outcomes. In addition
27 to contractor monitoring of program, oversight includes, but not limited to, coordination with
28 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
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1 County shall participate in evaluating the progress of the overall program, levels of
2 care components, and the efficiency of collaboration with the Contractor staff and will be
3 available to Contractor for ongoing consultation.
4 County shall receive and analyze statistical outcome data from Contractor
5 throughout the term of contract on a monthly basis. County shall notify the Contractor when
6 additional participation is required. The performance outcome measurement process will not be
7 limited to survey instruments but will also include, as appropriate, persons served and staff
8 surveys, chart reviews, and other methods of obtaining required information.
9 Article 4
10 Compensation, Invoices, and Payments
11 4.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
12 the performance of its services under this Agreement as described in Exhibit F to this
13 Agreement.
14 4.2 Specialty Mental Health Services Maximum Compensation. The maximum
15 compensation payable to the Contractor under this Agreement for the period of July 1, 2023
16 through June 30, 2024 for Specialty Mental Health Services is Two Hundred Six Thousand,
17 Fourteen and No/100 Dollars ($206,014.00), which is not a guaranteed sum but shall be paid
18 only for services rendered and received. The maximum compensation payable to the Contractor
19 under this Agreement for the period of July 1, 2024 through June 30, 2025 for Specialty Mental
20 Health Services is Three Hundred Five Thousand, Nine Hundred Thirty-Two and No/100 Dollars
21 ($305,932.00), which is not a guaranteed sum but shall be paid only for services rendered and
22 received.
23 4.3 MHSA Prevention and Early Intervention (PEI) Services Maximum
24 Compensation. The maximum compensation payable to the Contractor under this Agreement
25 for the period of July 1, 2023 through June 30, 2024 for MHSA PEI Services is Two Million, One
26 Hundred Ninety Thousand, Seven Hundred Thirty and No/100 Dollars ($2,190,730.00). The
27 maximum compensation payable to the Contractor under this Agreement for the period of July
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1 1, 2024 through June 30, 2025 for MHSA PEI Services is Two Million, One Hundred Ninety
2 Thousand, Seven Hundred Thirty and No/100 Dollars ($2,190,730.00).
3 4.4 Total Maximum Compensation. In no event shall the maximum contract amount for
4 all the services provided by the Contractor to County under the terms and conditions of this
5 Agreement be in excess of Four Million, Eight Hundred Ninety-Three Thousand, Four Hundred
6 Six and No/100 Dollars ($4,893,406.00) during the entire term of this Agreement. The
7 Contractor acknowledges that the County is a local government entity and does so with notice
8 that the County's powers are limited by the California Constitution and by State law, and with
9 notice that the Contractor may receive compensation under this Agreement only for services
10 performed according to the terms of this Agreement and while this Agreement is in effect, and
11 subject to the maximum amount payable under this section.
12 The Contractor will be compensated for performance of its services under this
13 Agreement as provided in this Article. The Contractor is not entitled to any compensation except
14 as expressly provided in this Agreement.
15 4.5 Specialty Mental Health Services Claiming. Contractor shall enter claims data into
16 the County's billing and transactional database system within the timeframes established by
17 County. Contractor shall use Current Procedural Terminology (CPT) or Healthcare Common
18 Procedure Coding System (HCPCS) codes, as provided in the DHCS Billing Manual available at
19 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
20 amended.
21 Claims shall be complete and accurate and must include all required information
22 regarding the claimed services. Claims data entry into the County's electronic health record
23 system shall be the responsibility of Contractor. County shall monitor the volume of services,
24 billing amounts and service types entered into County's electronic health record/information
25 system. Any and all audit exceptions resulting from the provision and reporting of specialty
26 mental health services by Contractor shall be the sole responsibility of Contractor. Contractor
27 will comply with all applicable policies, procedures, directives, and guidelines regarding the use
28 of County's electronic health record/information system.
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1 Contractor must provide all necessary data to allow County to bill Medi-Cal, and any
2 other third-party source, for services and meet State and Federal reporting requirements. The
3 necessary data can be provided by a variety of means, including but not limited to: 1) direct data
4 entry into County's electronic health record/information system; 2) providing an electronic file
5 compatible with County's electronic health record/information system; or 3) integration between
6 County's electronic health record/information system and Contractor's information system(s).
7 Contractor shall maximize the Federal Financial Participation (FFP) reimbursement by claiming
8 all possible Medi-Cal services and correcting denied services for resubmission as needed.
9 4.6 Applicable Fees. Contractor shall not charge any persons served or third-party
10 payers any fee for service unless directed to do so by the County's DBH Director or designee at
11 the time the individual is referred for services. When directed to charge for services, Contractor
12 shall use the uniform billing and collection guidelines prescribed by DHCS.
13 Contractor will perform eligibility and financial determinations, in accordance with DHCS'
14 Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless directed
15 otherwise by the County's DBH Director or designee.
16 Contractor shall not submit a claim to, or demand or otherwise collect reimbursement
17 from, the person served or persons acting on behalf of the person served for any specialty
18 mental health or related administrative services provided under this Contract, except to collect
19 other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9,
20 §1810.365(c).
21 The Contractor must not bill persons served, for covered services, any amount greater
22 than would be owed if the County provided the services directly as per and otherwise not bill
23 persons served as set forth in 42 C.F.R. § 438.106.
24 If a person served has dual coverage, such as other health coverage (OHC) or Federal
25 Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
26 have validation of claiming with no response for ninety (90) days after the claim was mailed
27 before the service can be entered into the County's electronic health record/information system.
28 Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
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1 pay in each month. A copy of explanation of benefits or CMS 1500 form is required as
2 documentation. Contractor must comply with all laws and regulations governing the Federal
3 Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42
4 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers
5 for Medicare and Medicaid Services as they relate to participation, coverage and claiming
6 reimbursement. Contractor will be responsible for compliance as of the effective date of each
7 Federal, State or local law or regulation specified.
8 4.7 Invoices. The Contractor shall submit monthly invoices, in arrears by the fifteenth
9 (15t") day of each month, in the format directed by the County. The Contractor shall submit
10 invoices electronically to: 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh-
11 invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with
12 a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH Director
13 or designee, if an invoice is incorrect or is otherwise not in proper form or substance, County's
14 DBH Director, or designee, shall have the right to withhold payment as to only the portion of the
15 invoice that is incorrect or improper after five (5) days prior notice to Contractor. Contractor
16 agrees to continue to provide services for a period of ninety (90) days after notification of an
17 incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not corrected
18 to County satisfaction, County's DBH Director, or designee, may elect to terminate this
19 Agreement, pursuant to the termination provisions stated in Article 7 of this Agreement.
20 4.8 Cost Reimbursement Based Invoices. Invoices for cost reimbursement services
21 shall be based on actual expenses incurred in the month of service. Contractor shall submit
22 monthly invoices and general ledgers to County that itemize the line item charges for monthly
23 program costs. The invoices and general ledgers will serve as tracking tools to determine if
24 Contractor's costs are in accordance with its budgeted cost. Failure to submit reports and other
25 supporting documentation shall be deemed sufficient cause for County to withhold payments
26 until there is compliance.
27 Contractor must report all revenue collected from a third-party, client-pay or private-pay
28 in each monthly invoice. In addition, Contractor shall submit monthly invoices for reimbursement
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1 that equal the amount due less any revenue collected and/or unallowable cost such as lobbying
2 or political donations from the monthly invoice reimbursements.
3 Travel shall be reimbursed based on actual expenditures and reimbursement shall be at
4 Contractor's adopted rate, not to exceed the Federal Internal Revenue Services (IRS) published
5 rate.
6 4.9 Corrective Action Plans. Contractors shall enter services into the County's billing
7 and transactional database and submit invoices in accordance with the deadlines listed above
8 and information shall be accurate. Failure to meet the requirements set forth will result in a
9 corrective action plan and at the discretion of the County's DBH Director or designee, and may
10 result in financial penalties or termination of Agreement per Article 7.
11 4.10 Payment. Payments shall be made by County to Contractor in arrears, for services
12 provided during the preceding month, within forty-five (45) days after the date of receipt,
13 verification, and approval by County. All final invoices and/or any final budget modification
14 requests shall be submitted by Contractor within sixty (60) days following the final month of
15 service for which payment is claimed. No action shall be taken by County on claims submitted
16 beyond the sixty (60) day closeout period. Any compensation which is not expended by
17 Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to
18 County.
19 4.11 Specialty Mental Health Services Payments. Payment shall be made upon
20 certification and other proof satisfactory to County that services have actually been performed
21 by Contractor as specified in this Agreement and/or after receipt and verification of actual
22 services provided.
23 4.12 Cost Reimbursement Payments. Payment shall be made upon certification or other
24 proof satisfactory to County that services have actually been performed by Contractor as
25 specified in this Agreement and/or after receipt and verification of actual expenditures incurred
26 by Contractor for monthly program costs, as identified in the budget narratives and budgets
27 identified in Exhibit F, in the performance of this Agreement. County shall not be obligated to
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1 make any payments under this Agreement if the request for payment is received by County
2 more than sixty (60) days after this Agreement has terminated or expired.
3 4.13 Recoupments and Audits. County shall recapture from Contractor the value of any
4 services or other expenditures determined to be ineligible based on the County or State
5 monitoring results. The County reserves the right to enter into a repayment agreement with
6 Contractor, with total monthly payments not to exceed twelve (12) months from the date of the
7 repayment agreement, to recover the amount of funds to be recouped. The County has the
8 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of
9 the repayment agreement. The repayment agreement may be made with the signed written
10 approval of County's DBH Director, or designee, and respective Contractor through a
11 repayment agreement. The monthly repayment amounts may be netted against the Contractor's
12 monthly billing for services rendered during the month, or the County may, in its sole discretion,
13 forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
14 and County may seek requital from any other means, including, but not limited to, a separate
15 contract or agreement with Contractor.
16 Contractor shall be held financially liable for any and all future disallowances/audit
17 exceptions due to Contractor's deficiency discovered through the State audit process and
18 County utilization review for services provided during the course of this Agreement. At County's
19 election, the disallowed amount will be remitted within forty-five (45) days to County upon
20 notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
21 receive reimbursement for any units of services rendered that are disallowed or denied by the
22 Fresno County Mental Health Plan (Mental Health Plan) utilization review process or through
23 the State of California DHCS audit and review process, cost report audit settlement if applicable,
24 for Medi-Cal eligible beneficiaries.
25 4.14 Incidental Expenses. The Contractor is solely responsible for all of its costs and
26 expenses that are not specified as payable by the County under this Agreement. If Contractor
27 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for
28 further compensation.
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1 4.15 Restrictions and Limitations. This Agreement shall be subject to any restrictions,
2 limitations, and/or conditions imposed by County or state or federal funding sources that may in
3 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also
4 contingent upon sufficient funds being made available by County, state, or federal funding
5 sources for the term of the Agreement. If the federal or state governments reduce financial
6 participation in the Medi-Cal program, County agrees to meet with Contractor to discuss
7 renegotiating the services required by this Agreement.
8 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
9 over and is not available for services provided in subsequent years.
10 In the event that funding for these services is delayed by the State Controller, County
11 may defer payments to Contractor. The amount of the deferred payment shall not exceed the
12 amount of funding delayed by the State Controller to the County. The period of time of the
13 deferral by County shall not exceed the period of time of the State Controller's delay of payment
14 to County plus forty-five (45) days.
15 4.16 Additional Financial Requirements. County has the right to monitor the
16 performance of this Agreement to ensure the accuracy of claims for reimbursement and
17 compliance with all applicable laws and regulations.
18 Contractor must comply with the False Claims Act employee training and policy
19 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
20 Department of Health and Human Services may specify.
21 Contractor agrees that no part of any federal funds provided under this Agreement shall
22 be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
23 Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as from
24 time to time amended.
25 Federal Financial Participation is not available for any amount furnished to an Excluded
26 individual or entity, or at the direction of a physician during the period of exclusion when the
27 person providing the service knew or had reason to know of the exclusion, or to an individual or
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1 entity when the County failed to suspend payments during an investigation of a credible
2 allegation of fraud [42 U.S.C. section 1396b(i)(2)].
3 Contractor must maintain financial records for a minimum period of ten (10) years or until
4 any dispute, audit or inspection is resolved, whichever is later. Contractor will be responsible for
5 any disallowances related to inadequate documentation.
6 4.17 Contractor Prohibited from Redirection of Contracted Funds. Contractor may
7 not redirect or transfer funds from one funded program to another funded program under which
8 Contractor provides services pursuant to this Agreement except through a duly executed
9 amendment to this Agreement.
10 Contractor may not charge services delivered to an eligible person served under one
11 funded program to another funded program unless the person served is also eligible for services
12 under the second funded program.
13 4.18 Financial Audit Report Requirements for Pass-Through Entities. If County
14 determines that Contractor is a "subrecipient" (also known as a "pass-through entity") as defined
15 in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the applicable cost
16 principles and administrative requirements including claims for payment or reimbursement by
17 County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. Contractor
18 shall observe and comply with all applicable financial audit report requirements and standards.
19 Financial audit reports must contain a separate schedule that identifies all funds included
20 in the audit that are received from or passed through the County. County programs must be
21 identified by Agreement number, Agreement amount, Agreement period, and the amount
22 expended during the fiscal year by funding source.
23 Contractor will provide a financial audit report including all attachments to the report and
24 the management letter and corresponding response within six months of the end of the audit
25 year to the County's DBH Director or designee. The County's Director or designee is
26 responsible for providing the audit report to the County Auditor.
27 Contractor must submit any required corrective action plan to the County simultaneously
28 with the audit report or as soon thereafter as it is available. The County shall monitor
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1 implementation of the corrective action plan as it pertains to services provided pursuant to this
2 Agreement.
3 Article 5
4 Term of Agreement
5 5.1 Term. This Agreement is effective on July 1, 2023, and terminates on June 30, 2024
6 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension,"
7 below.
8 5.2 Extension. The term of this Agreement may be extended for no more than a one-
9 year period only upon written approval of both parties at least thirty (30) days before the first day
10 of the one-year extension period. The County's DBH Director or designee is authorized to sign
11 the written approval on behalf of the County based on the Contractor's satisfactory
12 performance. The extension of this Agreement by the County is not a waiver or compromise of
13 any default or breach of this Agreement by the Contractor existing at the time of the extension
14 whether or not known to the County.
15 Article 6
16 Notices
17 6.1 Contact Information. The persons and their addresses having authority to give and
18 receive notices provided for or permitted under this Agreement include the following:
19
For the County:
20 Director
County of Fresno
21 1925 E. Dakota Avenue
Fresno, CA 93726
22
For the Contractor:
23 Chief Executive Director
Kings View
24 1396 W. Herndon Avenue
Fresno, CA93711
25
6.2 Change of Contact Information. Either party may change the information in section
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6.1 by giving notice as provided in section 6.3.
27
6.3 Method of Delivery. Each notice between the County and the Contractor provided
28
for or permitted under this Agreement must be in writing, state that it is a notice provided under
16
1 this Agreement, and be delivered either by personal service, by first-class United States mail, by
2 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
3 Document Format (PDF) document attached to an email.
4 (A) A notice delivered by personal service is effective upon service to the recipient.
5 (B) A notice delivered by first-class United States mail is effective three (3) County
6 business days after deposit in the United States mail, postage prepaid, addressed to the
7 recipient.
8 (C)A notice delivered by an overnight commercial courier service is effective one (1)
9 County business day after deposit with the overnight commercial courier service,
10 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
11 the recipient.
12 6.4 Claims Presentation. For all claims arising from or related to this Agreement,
13 nothing in this Agreement establishes, waives, or modifies any claims presentation
14 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
15 of Title 1 of the Government Code, beginning with section 810).
16 6.5 Notification of Changes. Contractor shall notify County in writing of any change in
17 organizational name, Head of Service or principal business at least fifteen (15) business days in
18 advance of the change. Contractor shall notify County of a change of service location at least
19 six (6) months in advance to allow County sufficient time to comply with site certification
20 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing
21 by the County, and no further amendment of the Agreement shall be necessary provided that
22 such change of address does not conflict with any other provisions of this Agreement.
23 Contractor must immediately notify County of a change in ownership, organizational
24 status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
25 services in a and in no event more than fifteen (15) days of the change.
26
27
28
17
1 Article 7
2 Termination and Suspension
3 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
4 contingent on the approval of funds by the appropriating government agency. If sufficient funds
5 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
6 Contractor, may:
7 (A) Modify the services provided by the Contractor under this Agreement; or
8 (B) Terminate this Agreement.
9 7.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, the County may give written notice of the breach to the Contractor. The written
12 notice may suspend performance under this Agreement and must provide at least thirty
13 (30) days for the Contractor to cure the breach.
14 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
15 time stated in the written notice, the County may terminate this Agreement immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of the
17 County, the Contractor has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this Agreement;
20 (3) Submitted a substantially incorrect or incomplete report to the County; or
21 (4) Improperly performed any of its obligations under this Agreement.
22 7.3 Termination without Cause. In circumstances other than those set forth above, the
23 County may terminate this Agreement by giving at least thirty (30) days advance written notice
24 to the Contractor.
25 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
26 under this Article 7 is without penalty to or further obligation of the County.
27 7.5 County's Rights upon Termination. Upon termination for breach under this Article
28 7, the County may demand repayment by the Contractor of any monies disbursed to the
18
1 Contractor under this Agreement that, in the County's sole judgment, were not expended in
2 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
3 demand. This section survives the termination of this Agreement.
4 In the event this Agreement is terminated, Contractor shall be entitled to compensation
5 for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
6 and conditions of this Agreement through and including the effective date of termination. This
7 provision shall not limit or reduce any damages owed to the County due to a breach of this
8 Agreement by Contractor.
9 Article 8
10 Informing Materials for Persons Served
11 8.1 Basic Information Requirements. Contractor shall provide information in a manner
12 and format that is easily understood and readily accessible to the persons served (42 C.F.R. §
13 438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
14 understood language, format, and alternative formats that take into consideration the special
15 needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor shall inform the
16 persons served that information is available in alternate formats and how to access those
17 formats in compliance with 42 C.F.R. § 438.10.
18 Contractor shall provide the required information in this section to each individual
19 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental
20 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, §
21 1810.360(e)).
22 Contractor shall utilize the County's website that provides the content required in this
23 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth
24 in 42 C.F.R. § 438.10.
25 Contractor shall use the DHCS/County-developed beneficiary handbook and persons
26 served notices (42 C.F.R. §§ 438.1 0(c)(4)(ii), 438.62(b)(3)).
27 8.2 Electronic Submission. Persons served information required in this section may
28 only be provided electronically by the Contractor if all of the following conditions are met:
19
1 (A) The format is readily accessible;
2 (B) The information is placed in a location on the Contractor's website that is
3 prominent and readily accessible;
4 (C)The information is provided in an electronic form which can be electronically
5 retained and printed;
6 (D)The information is consistent with the content and language requirements of this
7 Agreement;
8 (E) The individual is informed that the information is available in paper form without
9 charge upon request and the Contractor shall provide it upon request within five (5)
10 business days (42 C.F.R. § 438.10(c)(6)).
11 8.3 Language and Format. Contractor shall provide all written materials, including
12 taglines, for persons served or potential persons served in a font size no smaller than twelve
13 (12) point (42 C.F.R. 438.10(d)(6)(ii)).
14 Contractor shall ensure its written materials that are critical to obtaining services are
15 available in alternative formats, upon request of the person served or potential person served at
16 no cost.
17 Contractor shall make its written materials that are critical to obtaining services,
18 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance
19 notices, denial and termination notices, and the Contractor's mental health education materials,
20 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)).
21 (A) Contractor shall notify persons served, prospective persons served, and
22 members of the public that written translation is available in prevalent languages free of
23 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst.
24 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)).
25 Contractor shall make auxiliary aids and services available upon request and free of
26 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
27
28
20
1 Contractor shall make oral interpretation and auxiliary aids, such as Teletypewriter
2 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free
3 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5).
4 Taglines for written materials critical to obtaining services must be printed in a conspicuously
5 visible font size, no smaller than twelve (12) point font.
6 8.4 Beneficiary Informing Materials. Each person served must receive and have
7 access to the beneficiary informing materials upon request by the individual and when first
8 receiving SMHS from Contractor. Beneficiary informing materials include but are not limited to:
9 (A) Consumer Handbook
10 (B) Provider Directory
11 (C) Grievance form
12 (D)Appeal/Expedited Appeal form
13 (E) Advance Directives brochure
14 (F) Change of Provider form
15 (G)Suggestions brochure
16 (H) Notice of Privacy Practices
17 (1) Notices of Adverse Benefit Determination (NOABDs — Including Denial and
18 Termination notices)
19 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving
20 individuals under the age of twenty-one (21))
21 (K) Contractor shall ensure beneficiary informing material are displayed in the
22 threshold languages of Fresno County at all service sites, including but not limited to the
23 following:
24 (1) Consumer Handbook
25 (2) Provider Directory
26 (3) Grievance form
27 (4) Appeal/Expedited Appeal form
28 (5) Advance Directives brochure
21
1 (6) Change of Provider form
2 (7) Suggestions brochure
3 All beneficiary informing written materials will use easily understood language and
4 format (i.e. material written and formatted at a sixth grade reading level), and will use a font size
5 no smaller than twelve (12) point. All beneficiary informing written materials shall inform
6 beneficiaries of the availability of information in alternative formats and how to make a request
7 for an alternative format. Inventory and maintenance of all beneficiary informing materials will be
8 maintained by the County's DBH Managed Care Division. Contractor will ensure that its written
9 materials include taglines or that an additional taglines document is available.
10 8.5 Beneficiary Handbook. Contractor shall provide each persons served with a
11 beneficiary handbook at the time the individual first accesses services and thereafter upon
12 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
13 business days after receiving notice of enrollment.
14 Contractor shall give each individual notice of any significant change to the information
15 contained in the beneficiary handbook at least thirty (30) days before the intended effective date
16 of change as per BHIN 22-060.
17 8.6 Accessibility. Required informing materials must be electronically available on
18 Contractor's website and must be physically available at the Contractor's facility lobby for
19 individuals' access.
20 Informing materials must be made available upon request, at no cost, in alternate
21 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and
22 American Sign Language) and must be provided to persons served within five (5) business
23 days. Large print materials shall be in a minimum of eighteen (18) point font size.
24 Informing materials will be considered provided to the individual if Contractor does one
25 or more of the following:
26 (A) Mails a printed copy of the information to the persons served's mailing address
27 before the individual receives their first specialty mental health service;
28
22
1 (B) Mails a printed copy of the information upon the individual's request to their
2 mailing address;
3 (C) Provides the information by email after obtaining the persons served's agreement
4 to receive the information by email;
5 (D) Posts the information on the Contractor's website and advises the person served
6 in paper or electronic form that the information is available on the internet and includes
7 applicable internet addresses, provided that individuals with disabilities who cannot
8 access this information online are provided auxiliary aids and services upon request and
9 at no cost; or,
10 (E) Provides the information by any other method that can reasonably be expected
11 to result in the person served receiving that information. If Contractor provides informing
12 materials in person, when the individual first receives specialty mental health services,
13 the date and method of delivery shall be documented in the persons served's file.
14 8.7 Provider Directory. Contractor must follow the County's provider directory policy, in
15 compliance with MHSUDS IN 18-020.
16 Contractor must make available to persons served, in paper form upon request and
17 electronic form, specified information about the County provider network as per 42 C.F.R. §
18 438.10(h). The most current provider directory is electronically available on the County website
19 and is updated by the County no later than thirty (30) calendar days after information is received
20 to update provider information. A paper provider directory must be updated at least monthly as
21 set forth in 42 C.F.R. § 438.10(h)(3)(i).
22 Any changes to information published in the provider directory must be reported to the
23 County within two (2) weeks of the change.
24 Contractor will only need to report changes/updates to the provider directory for
25 licensed, waivered, or registered mental health providers.
26
27
28
23
1 Article 9
2 Independent Contractor
3 9.1 Status. In performing under this Agreement, the Contractor, including its officers,
4 agents, employees, and volunteers, is at all times acting and performing as an independent
5 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint
6 venturer, partner, or associate of the County.
7 9.2 Verifying Performance. The County has no right to control, supervise, or direct the
8 manner or method of the Contractor's performance under this Agreement, but the County may
9 verify that the Contractor is performing according to the terms of this Agreement.
10 9.3 Benefits. Because of its status as an independent contractor, the Contractor has no
11 right to employment rights or benefits available to County employees. The Contractor is solely
12 responsible for providing to its own employees all employee benefits required by law. The
13 Contractor shall save the County harmless from all matters relating to the payment of
14 Contractor's employees, including compliance with Social Security withholding and all related
15 regulations.
16 9.4 Services to Others. The parties acknowledge that, during the term of this
17 Agreement, the Contractor may provide services to others unrelated to the County.
18 9.5 Operating Costs. Contractor shall provide all personnel, supplies, and operating
19 expenses of any kind required for the performance of this Agreement.
20 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this
21 Agreement, the Contractor will be performing hiring, training, and credentialing of staff, and
22 County will be performing additional staff credentialing to ensure compliance with State and
23 Federal regulations.
24 9.7 Subcontracts. Contractor shall obtain written approval from County's Department of
25 Behavioral Health Director, or designee before subcontracting any of the services delivered
26 under this Agreement. County's Department of Behavioral Health Director, or designee retains
27 the right to approve or reject any request for subcontracting services. Any transferee, assignee,
28 or subcontractor will be subject to all applicable provisions of this Agreement, and all applicable
24
1 State and Federal regulations. Contractor shall be held primarily responsible by County for the
2 performance of any transferee, assignee, or subcontractor unless otherwise expressly agreed to
3 in writing by County's Department of Behavioral Health Director, or designee. The use of
4 subcontractors by Contractor shall not entitle Contractor to any additional compensation that is
5 provided for under this Agreement.
6 Contractor shall remain legally responsible for the performance of all terms and
7 conditions of this Agreement, including, without limitation, all SMHS provided by third parties
8 under subcontracts, whether approved by the County or not.
9
10 Article 10
11 Indemnity and Defense
12 10.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
13 County (including its officers, agents, employees, and volunteers) against all claims, demands,
14 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
15 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
16 the performance or failure to perform by the Contractor (or any of its officers, agents,
17 subcontractors, or employees) under this Agreement. The County may conduct or participate in
18 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
19 defend the County.
20 10.2 Survival. This Article 10 survives the termination of this Agreement.
21 Article 11
22 Insurance
23 11.1 The Contractor shall comply with all the insurance requirements in Exhibit G to this
24 Agreement.
25 Article 12
26 Assurances
27 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal
28 Health Care Program.
25
1 (A) In entering into this Agreement, Contractor certifies that it is not excluded from
2 participation in Federal Health Care Programs under either Section 1128 or 1128A of the
3 Social Security Act. Failure to so certify will render all provisions of this Agreement null
4 and void and may result in the immediate termination of this Agreement.
5 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not
6 employ or subcontract with providers or have other relationships with providers excluded
7 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
8 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct initial
9 and monthly exclusion and suspension searches of the following databases and provide
10 evidence of these completed searches when requested by County, DHCS or the US
11 Department of Health and Human Services (DHHS):
12 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
13 Individuals/Entities (LEIE) Federal Exclusions
14 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
15 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
16 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration
17 System (NPPES)
18 (4) any other database required by DHCS or US DHHS.
19 (C) In entering into this Agreement, Contractor certifies, that Contractor does not
20 employ staff or individual contractors/vendors that are on the Social Security
21 Administration's Death Master File. Contractor shall check the database prior to
22 employing staff or individual contractors/vendors and provide evidence of these
23 completed searches when requested by the County, DHCS or the US DHHS.
24 (D) Contractor is required to notify County immediately if Contractor becomes aware
25 of any information that may indicate their (including employees/staff and individual
26 contractors/vendors) potential placement on an exclusions list.
27 (E) Contractor shall screen and periodically revalidate all network providers in
28 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
26
1 (F) Contractor must confirm the identity and determine the exclusion status of all its
2 providers, as well as any person with an ownership or control interest, or who is an
3 agent or managing employee of the contracted agency through routine checks of federal
4 and state databases. This includes the Social Security Administration's Death Master
5 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and
6 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
7 455.436.
8 (G) If Contractor finds a provider that is excluded, it must promptly notify the County
9 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
10 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded
11 provider as an overpayment, and any such inappropriate payments may be subject to
12 recovery.
13 Article 13
14 Inspections, Audits, and Public Records
15 13.1 Inspection of Documents. The Contractor shall make available to the County, and
16 the County may examine at any time during business hours and as often as the County deems
17 necessary, all of the Contractor's records and data with respect to the matters covered by this
18 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
19 request by the County, permit the County to audit and inspect all of such records and data to
20 ensure the Contractor's compliance with the terms of this Agreement.
21 13.2 State Audit Requirements. If the compensation to be paid by the County under this
22 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
23 California State Auditor, as provided in Government Code section 8546.7, for a period of three
24 years after final payment under this Agreement. This section survives the termination of this
25 Agreement.
26 13.3 Internal Auditing. Contractors of sufficient size as determined by County shall
27 institute and conduct a Quality Assurance Process for all services provided hereunder. Said
28
27
1 process shall include at a minimum a system for verifying that all services provided and claimed
2 for reimbursement shall meet SMHS definitions and be documented accurately.
3 In addition, Contractors with medication prescribing authority shall adhere to County's
4 medication monitoring review practices. Contractor shall provide County with notification and a
5 summary of any internal audit exceptions and the specific corrective actions taken to sufficiently
6 reduce the errors that are discovered through Contractor's internal audit process. Contractor
7 shall provide this notification and summary to County as requested by the County.
8 13.4 Confidentiality in Audit Process. Contractor and County mutually agree to
9 maintain the confidentiality of Contractor's records and information of persons served, in
10 compliance with all applicable State and Federal statutes and regulations, including but not
11 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall
12 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable
13 statutes.
14 Contractor's fiscal records shall contain sufficient data to enable auditors to perform a
15 complete audit and shall be maintained in conformance with standard procedures and
16 accounting principles.
17 Contractor's records shall be maintained as required by DBH and DHCS on forms
18 furnished by DHCS or the County. All statistical data or information requested by the County's
19 DBH Director or designee shall be provided by the Contractor in a complete and timely manner.
20 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor files to
21 ensure appropriate clinical documentation, high quality service provision and compliance with
22 applicable federal, state and county regulations.
23 Such audits may result in requirements for Contractor to reimburse County for services
24 previously paid in the following circumstances:
25 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation
26 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
27 section 14107.11, subdivision (d).
28
28
1 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the Medicare
2 Managed Care Manual available at https://www.cros.gov/Regulations-and-
3 Guidance/Guidance/Manuals
4 (B) Overpayment of Contractor by County due to errors in claiming or
5 documentation.
6 (C) Other reasons specified in the SMHS Reasons for Recoupment document
7 released annually by DHCS and posted on the DHCS BHIN website.
8 Contractor shall reimburse County for all overpayments identified by Contractor, County,
9 and/or state or federal oversight agencies as an audit exception within the timeframes required
10 by law or Country or state or federal agency. Funds owed to County will be due within forty-five
11 (45) days of notification by County, or County shall withhold future payments until all excess
12 funds have been recouped by means of an offset against any payments then or thereafter owing
13 to County under this or any other Agreement between the County and Contractor.
14 13.6 Cooperation with Audits. Contractor shall cooperate with County in any review
15 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This
16 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits.
17 In addition, Contractor shall comply with all requests for any documentation or files
18 including, but not limited to, files for persons served.
19 Contractor shall notify the County of any scheduled or unscheduled external evaluation
20 or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
21 all parts of external review processes.
22 Contractor shall allow inspection, evaluation and audit of its records, documents and
23 facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
24 has been notified that an audit or investigation of this Agreement has been commenced, until
25 such time as the matter under audit or investigation has been resolved, including the exhaustion
26 of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and 438.2301(3)(i-iii).
27 13.7 Single Audit Clause. If Contractor expends Seven Hundred Fifty Thousand and
28 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, Contractor
29
1 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
2 Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. Contractor shall
3 submit said audit and management letter to County. The audit must include a statement of
4 findings or a statement that there were no findings. If there were negative findings, Contractor
5 must include a corrective action plan signed by an authorized individual. Contractor agrees to
6 take action to correct any material non-compliance or weakness found as a result of such audit.
7 Such audit shall be delivered to County's DBH Finance Division for review within nine (9)
8 months of the end of any fiscal year in which funds were expended and/or received for the
9 program. Failure to perform the requisite audit functions as required by this Agreement may
10 result in County performing the necessary audit tasks, or at County's option, contracting with a
11 public accountant to perform said audit, or may result in the inability of County to enter into
12 future agreements with Contractor. All audit costs related to this Agreement are the sole
13 responsibility of Contractor.
14 A single audit report is not applicable if Contractor's Federal contracts do not exceed the
15 Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractor's
16 only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
17 must be performed and a program audit report with management letter shall be submitted by
18 Contractor to County as a minimum requirement to attest to Contractor solvency. Said audit
19 report shall be delivered to County's DBH Finance Division for review no later than nine (9)
20 months after the close of the fiscal year in which the funds supplied through this Agreement are
21 expended. Failure to comply with this Act may result in County performing the necessary audit
22 tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
23 this Agreement are the sole responsibility of Contractor who agrees to take corrective action to
24 eliminate any material noncompliance or weakness found as a result of such audit. Audit work
25 performed by County under this paragraph shall be billed to Contractor at County cost, as
26 determined by County's Auditor-Controller/Treasurer-Tax Collector.
27 Contractor shall make available all records and accounts for inspection by County, the
28 State of California, if applicable, the Controller General of the United States, the Federal Grantor
30
1 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
2 least three (3) years following final payment under this Agreement or the closure of all other
3 pending matters, whichever is later.
4 13.8 Public Records. The County is not limited in any manner with respect to its public
5 disclosure of this Agreement or any record or data that the Contractor may provide to the
6 County. The County's public disclosure of this Agreement or any record or data that the
7 Contractor may provide to the County may include but is not limited to the following:
8 (A) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose this Agreement to the public or such governmental
10 agency.
11 (B) The County may voluntarily, or upon request by any member of the public or
12 governmental agency, disclose to the public or such governmental agency any record or
13 data that the Contractor may provide to the County, unless such disclosure is prohibited
14 by court order.
15 (C)This Agreement, and any record or data that the Contractor may provide to the
16 County, is subject to public disclosure under the Ralph M. Brown Act (California
17 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
18 (D)This Agreement, and any record or data that the Contractor may provide to the
19 County, is subject to public disclosure as a public record under the California Public
20 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
21 with section 6250) ("CPRA").
22 (E) This Agreement, and any record or data that the Contractor may provide to the
23 County, is subject to public disclosure as information concerning the conduct of the
24 people's business of the State of California under California Constitution, Article 1,
25 section 3, subdivision (b).
26 (F) Any marking of confidentiality or restricted access upon or otherwise made with
27 respect to any record or data that the Contractor may provide to the County shall be
28
31
1 disregarded and have no effect on the County's right or duty to disclose to the public or
2 governmental agency any such record or data.
3 13.9 Public Records Act Requests. If the County receives a written or oral request
4 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
5 and which the County has a right, under any provision of this Agreement or applicable law, to
6 possess or control, then the County may demand, in writing, that the Contractor deliver to the
7 County, for purposes of public disclosure, the requested records that may be in the possession
8 or control of the Contractor. Within five business days after the County's demand, the
9 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
10 possession or control, together with a written statement that the Contractor, after conducting a
11 diligent search, has produced all requested records that are in the Contractor's possession or
12 control, or (b) provide to the County a written statement that the Contractor, after conducting a
13 diligent search, does not possess or control any of the requested records. The Contractor shall
14 cooperate with the County with respect to any County demand for such records. If the
15 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
16 CPRA or other applicable law, it must deliver the record or data to the County and assert the
17 exemption by citation to specific legal authority within the written statement that it provides to
18 the County under this section. The Contractor's assertion of any exemption from disclosure is
19 not binding on the County, but the County will give at least 10 days' advance written notice to
20 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
21 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
22 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
23 failure to produce any such records, or failure to cooperate with the County with respect to any
24 County demand for any such records.
25 Article 14
26 Right to Monitor
27 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of
28 California or any subdivision or appointee thereof, including the Auditor General, shall have
32
1 absolute right to review and audit all records, books, papers, documents, corporate minutes,
2 financial records, staff information, records of persons served, other pertinent items as
3 requested, and shall have absolute right to monitor the performance of Contractor in the delivery
4 of services provided under this Agreement. Full cooperation shall be given by the Contractor in
5 any auditing or monitoring conducted, according to this agreement.
6 14.2 Accessibility. Contractor shall make all of its premises, physical facilities,
7 equipment, books, records, documents, agreements, computers, or other electronic systems
8 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished
9 under the terms of this Agreement, or determinations of amounts payable available at any time
10 for inspection, examination, or copying by County, the State of California or any subdivision or
11 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of
12 Inspector General, the United States Controller General or their designees, and other
13 authorized federal and state agencies. This audit right will exist for at least ten years from the
14 final date of the Agreement period or in the event the Contractor has been notified that an audit
15 or investigation of this Agreement has commenced, until such time as the matter under audit or
16 investigation has been resolved, including the exhaustion of all legal remedies, whichever is
17 later (42 CFR §438.230(c)(3)(I)-(ii)).
18 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
19 evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud or
20 similar risk. The Department's inspection shall occur at the Contractor's place of business,
21 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)).
22 14.3 Cooperation. Contractor shall cooperate with County in the implementation,
23 monitoring and evaluation of this Agreement and comply with any and all reporting requirements
24 established by County. Should County identify an issue or receive notification of a complaint or
25 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request
26 information from Contractor to ensure compliance with laws, regulations, and requirements, as
27 applicable.
28
33
1 14.4 Probationary Status. County reserves the right to place Contractor on probationary
2 status, as referenced in the Probationary Status Article, should Contractor fail to meet
3 performance requirements; including, but not limited to violations such as high disallowance
4 rates, failure to report incidents and changes as contractually required, failure to correct issues,
5 inappropriate invoicing, untimely and inaccurate data entry, not meeting performance outcomes
6 expectations, and violations issued directly from the State. Additionally, Contractor may be
7 subject to Probationary Status or termination if agreement monitoring and auditing corrective
8 actions are not resolved within specified timeframes.
9 14.5 Record Retention. Contractor shall retain all records and documents originated or
10 prepared pursuant to Contractor's performance under this Agreement, including grievance and
11 appeal records, and the data, information and documentation specified in 42 C.F.R. parts
12 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term
13 end date of this Agreement or until such time as the matter under audit or investigation has
14 been resolved. Records and documents include but are not limited to all physical and electronic
15 records and documents originated or prepared pursuant to Contractor's or subcontractor's
16 performance under this Agreement including working papers, reports, financial records and
17 documents of account, records of persons served, prescription files, subcontracts, and any
18 other documentation pertaining to covered services and other related services for persons
19 served.
20 14.6 Record Maintenance. Contractor shall maintain all records and management books
21 pertaining to service delivery and demonstrate accountability for agreement performance and
22 maintain all fiscal, statistical, and management books and records pertaining to the program.
23 Records should include, but not be limited to, monthly summary sheets, sign-in sheets, and
24 other primary source documents. Fiscal records shall be kept in accordance with Generally
25 Accepted Accounting Principles and must account for all funds, tangible assets, revenue and
26 expenditures. Fiscal records must also comply with the Code of Federal Regulations (CFR),
27 Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles,
28 and Audit Requirements for Federal Awards.
34
1 All records shall be complete and current and comply with all Agreement requirements.
2 Failure to maintain acceptable records per the preceding requirements shall be considered
3 grounds for withholding of payments for billings submitted and for termination of Agreement.
4 Contractor shall maintain records of persons served and community service in
5 compliance with all regulations set forth by local, state, and federal requirements, laws, and
6 regulations, and provide access to clinical records by County staff.
7 Contractor shall comply with the Article 18 and Article 1 regarding relinquishing or
8 maintaining medical records.
9 Contractor shall agree to maintain and retain all appropriate service and financial
10 records for a period of at least ten (10) years from the date of final payment, the final date of the
11 contract period, final settlement, or until audit findings are resolved, whichever is later.
12 14.7 Financial Reports. Contractor shall submit audited financial reports on an annual
13 basis to the County. The audit shall be conducted in accordance with Generally Accepted
14 Accounting Principles and generally accepted auditing standards.
15 14.8 Agreement Termination. In the event the Agreement is terminated, ends its
16 designated term or Contractor ceases operation of its business, Contractor shall deliver or make
17 available to County all financial records that may have been accumulated by Contractor or
18 subcontractor under this Agreement, whether completed, partially completed or in progress
19 within seven (7) calendar days of said termination/end date.
20 14.9 Facilities and Assistance. Contractor shall provide all reasonable facilities and
21 assistance for the safety and convenience of the County's representatives in the performance of
22 their duties. All inspections and evaluations shall be performed in such a manner that will not
23 unduly delay the work of Contractor.
24 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial
25 provisions of the Agreement, delegated activities or obligations, or application of other remedies
26 permitted by state or federal law when the County or DHCS determines Contractor has not
27 performed satisfactorily.
28
35
1 14.11 Site Inspection. Without limiting any other provision related to inspections or audits
2 otherwise set forth in this Agreement, Contractor shall permit authorized County, state, and/or
3 federal agency(ies), through any authorized representative, the right to inspect or otherwise
4 evaluate the work performed or being performed hereunder including subcontract support
5 activities and the premises which it is being performed. Contractor shall provide all reasonable
6 assistance for the safety and convenience of the authorized representative in the performance
7 of their duties. All inspections and evaluations shall be made in a manner that will not unduly
8 delay the work of the Contractor.
9 Article 15
10 Complaint Logs and Grievances
11 15.1 Documentation. Contractor shall log complaints and the disposition of all complaints
12 from a person served or their family. Contractor shall provide a copy of the detailed complaint
13 log entries concerning County-sponsored persons served to County at monthly intervals by the
14 tenth (10th) day of the following month, in a format that is mutually agreed upon. Contractor
15 shall allow beneficiaries or their representative to file a grievance either orally, or in writing at
16 any time with the Mental Health Plan. In the event Contractor is notified by a beneficiary or their
17 representative of a discrimination grievance, Contractor shall report discrimination grievances to
18 the Mental Health Plan within twenty-four (24) hours. The Contractor shall not require a
19 beneficiary or their representative to file a discrimination grievance with the Mental Health Plan
20 before filing the complaint directly with the DHCS Office of Civil Rights and the U.S. Health and
21 Human Services Office for Civil Rights.
22 15.2 Rights of Persons Served. Contractor shall post signs informing persons served of
23 their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
24 Contractor shall inform every person served of their rights as set forth in Exhibit H.
25 15.3 Incident Reporting. Contractor shall file an incident report for all incidents involving
26 persons served, following the protocol identified in Exhibit I.
27 Article 16
28 Property of County
36
1 16.1 Applicability. Article 16 shall only apply to the program components and services
2 provided under operational costs.
3 16.2 Fixed Assets. County and Contractor recognize that fixed assets are tangible and
4 intangible property obtained or controlled under County for use in operational capacity and will
5 benefit County for a period more than one (1) year.
6 16.3 Agreement Assets. Assets shall be tracked on an agreement by agreement basis.
7 All of these assets shall fall into the "Equipment" category unless funding source allows for
8 additional types of assets. At a minimum, the following types of items are considered to be
9 assets:
10 (A) Computers (desktops and laptops)*
11 (B) Copiers, cell phones, tablets, and other devices with any HIPAA data
12 (C) Modular furniture
13 (D)Any items over $500 or more with a lifespan of at least two (2) years:
14 (1) Televisions
15 (2) Washers/Dryers
16 (3) Printers
17 (4) Digital Cameras
18 (5) Other equipment/furniture
19 (6) Items in total when purchased or used as a group fall into one or more of the
20 above categories
21 (E) Items of sensitive nature shall be purchased and allocated to a single agreement.
22 All items containing HIPAA data are considered sensitive.
23 Contractor shall ensure proper tracking for contact assets that include the following
24 asset attributes at a minimum:
25 (A) Description of the asset;
26 (B) The unique identifier of the asset if applicable, i.e., serial number;
27 (C)The acquisition date;
28 (D)The quantity of the asset;
37
1 (E) The location of the asset or to whom the asset is assigned;
2 (F) The cost of the asset at the time of acquisition;
3 (G)The source of grant funding if applicable;
4 (H)The disposition date, and
5 (1) The method of disposition (surplus, transferred, destroyed, lost)
6 All Contract assets shall be returned to the Department at the end of the agreement
7 period.
8 16.4 Retention and Maintenance. Assets shall be retained by County, as County
9 property, in the event this Agreement is terminated or upon expiration of this Agreement.
10 Contractor agrees to participate in an annual inventory of all County fixed and inventoried
11 assets. Upon termination or expiration of this Agreement, Contractor shall be physically present
12 when fixed and inventoried assets are returned to County possession. Contractor is responsible
13 for returning to County all County owned undepreciated fixed and inventoried assets, or the
14 monetary value of said assets if unable to produce the assets at the expiration or termination of
15 this Agreement. Contractor further agrees to the following:
16 Maintain all items of equipment in good working order and condition, normal wear and
17 tear excepted;
18 Label all items of equipment with County assigned program number, to perform periodic
19 inventories as required by County and to maintain an inventory list showing where and how the
20 equipment is being used in accordance with procedures developed by County. All such lists
21 shall be submitted to County within ten (10) days of any request therefore; and
22 Report in writing to County immediately after discovery, the loss or theft of any items of
23 equipment. For stolen items, the local law enforcement agency must be contacted, and a copy
24 of the police report submitted to County.
25 16.5 Equipment Purchase. The purchase of any equipment by Contractor with funds
26 provided hereunder shall require the prior written approval of County's DBH Director or
27 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly
28 related to Contractor's services or activity under the terms of this Agreement. County may
38
1 refuse reimbursement for any costs resulting from equipment purchased, which are incurred by
2 Contractor, if prior written approval has not been obtained from County.
3 16.6 Modification. Contractor must obtain prior written approval from County's DBH
4 whenever there is any modification or change in the use of any property acquired or improved,
5 in whole or in part, using funds under this Agreement. If any real or personal property acquired
6 or improved with said funds identified herein is sold and/or is utilized by Contractor for a use
7 which does not qualify under this Agreement, Contractor shall reimburse County in an amount
8 equal to the current fair market value of the property, less any portion thereof attributable to
9 expenditures of funds not provided under this Agreement. These requirements shall continue in
10 effect for the life of the property. In the event this Agreement expires, the requirements for this
11 Article shall remain in effect for activities or property funded with said funds, unless action is
12 taken by the State government to relieve County of these obligations.
13 Article 17
14 Compliance
15 17.1 Compliance. Contractor agrees to comply with County's Contractor Code of
16 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit J. Within
17 thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of
18 Contractor's employees, agents, and subcontractors providing services under this Agreement
19 certify in writing, that he or she has received, read, understood, and shall abide by the
20 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of
21 hire, all new employees, agents, and subcontractors providing services under this Agreement
22 shall certify in writing that he or she has received, read, understood, and shall abide by the
23 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and
24 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
25 Contractor and its employees, agents, and subcontractors.
26 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
27 employees, agents, and subcontractors providing services under this Agreement shall complete
28 general compliance training, and appropriate employees, agents, and subcontractors shall
39
1 complete documentation and billing or billing/reimbursement training. All new employees,
2 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
3 Each individual who is required to attend training shall certify in writing that he or she has
4 received the required training. The certification shall specify the type of training received and
5 the date received. The certification shall be provided to County's DBH Compliance Officer at
6 1925 E. Dakota Ave, Fresno, California 93726. Contractor agrees to reimburse County for the
7 entire cost of any penalty imposed upon County by the Federal Government as a result of
8 Contractor's violation of the terms of this Agreement.
9 17.2 Compliance with State Medi-Cal Requirements. Contractor shall be required to
10 maintain Mental Health Plan organizational provider certification by Fresno County. Contractor
11 must meet Medi-Cal organization provider standards as listed in Exhibit K, "Medi-Cal
12 Organizational Provider Standards." It is acknowledged that all references to Organizational
13 Provider and/or Provider in Exhibit K shall refer to Contractor.
14 17.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor will
15 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the
16 effective date of this Agreement through County to provide reimbursable services to Medi-Cal
17 eligible persons served. In addition, Contractor shall work with the County's DBH to execute
18 the process if not currently certified by County for credentialing of staff. During this process, the
19 Contractor will obtain a legal entity number established by the DHCS, a requirement for
20 maintaining Mental Health Plan organizational provider status throughout the term of this
21 Agreement. Contractor will be required to become Medi-Cal certified prior to providing services
22 to Medi-Cal eligible persons served and seeking reimbursement from the County. Contractor
23 will not be reimbursed by County for any services rendered prior to certification.
24 Contractor shall provide direct specialty mental health services in accordance with the
25 Mental Health Plan. Contractor must comply with the "Fresno County Mental Health Plan
26 Compliance Program and Code of Conduct" set forth in Exhibit J.
27 Contractor may provide direct specialty mental health services using unlicensed staff as
28 long as the individual is approved as a provider by the Mental Health Plan, is supervised by
40
1 licensed staff, works within his/her scope and only delivers allowable direct specialty mental
2 health services. It is understood that each service is subject to audit for compliance with
3 Federal and State regulations, and that County may be making payments in advance of said
4 review. In the event that a service is disapproved, County may, at its sole discretion, withhold
5 compensation or set off from other payments due the amount of said disapproved services.
6 Contractor shall be responsible for audit exceptions to ineligible dates of services or incorrect
7 application of utilization review requirements.
8 17.4 Network Adequacy. The Contractor shall ensure that all services covered under this
9 Agreement are available and accessible to persons served in a timely manner and in
10 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206
11 (a), (c)).
12 Contractor shall submit, when requested by County and in a manner and format
13 determined by the County, network adequacy certification information to the County, utilizing a
14 provided template or other designated format.
15 Contractor shall submit updated network adequacy information to the County any time
16 there has been a significant change that would affect the adequacy and capacity of services.
17 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42
18 C.F.R. §438.3 (1), the Contractor shall provide a person served the ability to choose the person
19 providing services to them.
20 17.5 Compliance Program, Including Fraud Prevention and Overpayments.
21 Contractor shall have in place a compliance program designed to detect and prevent fraud,
22 waste and abuse, as per 42 C.F.R. § 438.608(a)(1), that must include:
23 (A) Written policies, procedures, and standards of conduct that articulate the
24 organization's commitment to comply with all applicable requirements and standards
25 under the Agreement, and all applicable federal and state requirements.
26 (B) A Compliance Office (CO) who is responsible for developing and implementing
27 policies, procedures, and practices designed to ensure compliance with the
28
41
1 requirements of this Agreement and who reports directly to the CEO and the Board of
2 Directors.
3 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior
4 management level charged with overseeing the organization's compliance program and
5 its compliance with the requirements under the Agreement.
6 (D)A system for training and education for the Compliance Officer, the organization's
7 senior management, and the organization's employees for the federal and state
8 standards and requirements under the Agreement.
9 (E) Effective lines of communication between the Compliance Officer and the
10 organization's employees.
11 (F) Enforcement of standards through well-publicized disciplinary guidelines.
12 (G)The establishment and implementation of procedures and a system with
13 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt
14 response to compliance issues as they are raised, investigation of potential compliance
15 problems as identified in the course of self-evaluation and audits, corrections of such
16 problems promptly and thoroughly to reduce the potential for recurrence and ongoing
17 compliance with the requirements under the Agreement.
18 (H)The requirement for prompt reporting and repayment of any overpayments
19 identified.
20 17.6 Reporting. Contractor must have administrative and management arrangements or
21 procedures designed to detect and prevent fraud, waste and abuse of federal or state health
22 care funding. Contractor must report fraud and abuse information to the County including but
23 not limited to:
24 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7),
25 (B) All overpayments identified or recovered, specifying the overpayment due to
26 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2),
27
28
42
1 (C) Information about changes in a persons served's circumstances that may affect
2 the person served's eligibility including changes in the their residence or the death of the
3 person served as per 42 C.F.R. § 438.608(a)(3).
4 (D) Information about a change in the Contractor's circumstances that may affect the
5 network provider's eligibility to participate in the managed care program, including the
6 termination of this Agreement with the Contractor as per 42 C.F.R. § 438.608(a)(6).
7 Contractor shall implement written policies that provide detailed information about the
8 False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68) of the
9 Act, including information about rights of employees to be protected as whistleblowers.
10 Contractor shall make prompt referral of any potential fraud, waste or abuse to County or
11 potential fraud directly to the State Medicaid Fraud Control Unit.
12 17.7 Overpayments. County may suspend payments to Contractor if DHCS or County
13 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42
14 C.F.R. §438.608 (a)(8)).
15 Contractor shall report to County all identified overpayments and reason for the
16 overpayment, including overpayments due to potential fraud. Contractor shall return any
17 overpayments to the County within 60 calendar days after the date on which the overpayment
18 was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)).
19 Article 18
20 Federal and State Laws
21 18.1 Health Insurance Portability and Accountability Act. County and Contractor each
22 consider and represent themselves as covered entities as defined by the U.S. Health Insurance
23 Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
24 disclose Protected Health Information (PHI) as required by law.
25 County and Contractor acknowledge that the exchange of PHI between them is only for
26 treatment, payment, and health care operations.
27 County and Contractor intend to protect the privacy and provide for the security of PHI
28 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
43
1 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
2 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and
3 other applicable laws.
4 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
5 Contractor to enter into a agreement containing specific requirements prior to the disclosure of
6 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e)
7 of the Code of Federal Regulations.
8 18.2 Physical Accessibility. In accordance with the accessibility requirements of section
9 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must
10 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
11 beneficiaries with physical or mental disabilities.
12 Article 19
13 Data Security
14 19.1 Data Security Requirements. Contractor shall comply with data security
15 requirements in Exhibit L to this Agreement.
16
17 Article 20
18 Publicity Prohibition
19 20.1 Self-Promotion. None of the funds, materials, property, or services provided directly
20 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
21 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.)for the purpose of self-
22 promotion.
23 20.2 Public Awareness. Notwithstanding the above, publicity of the services described in
24 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
25 availability of such specific services when approved in advance by County's DBH Director or
26 designee and at a cost to be provided in Exhibit F for such items as written/printed materials,
27 the use of media (i.e., radio, television, newspapers), and any other related expense(s).
28 Communication products must follow DBH graphic standards, including typefaces and colors, to
44
1 communicate our authority and project a unified brand. This includes all media types and
2 channels and all materials on and offline that are created as part of DBH's efforts to provide
3 information to the public.
4 Article 21
5 Disclosure of Self-Dealing Transactions
6 21.1 Applicability. This Article 21 applies if the Contractor is operating as a corporation,
7 or changes its status to operate as a corporation.
8 21.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
9 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
10 "Self-Dealing Transaction Disclosure Form" (Exhibit M to this Agreement) and submitting it to
11 the County before commencing the transaction or immediately after.
12 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
13 a party and in which one or more of its directors, as an individual, has a material financial
14 interest.
15 Article 22
16 Disclosure of Ownership and/or Control Interest Information
17 22.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
18 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
19 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
20 22.2 Duty to Disclose. Contractor must disclose the following information as requested in
21 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
22 Exhibit N:
23 (A) Disclosure of Five Percent (5%) or More Ownership Interest:
24 (1) In the case of corporate entities with an ownership or control interest in the
25 disclosing entity, the primary business address as well as every business location
26 and P.O. Box address must be disclosed. In the case of an individual, the date of
27 birth and Social Security number must be disclosed.
28
45
1 (2) In the case of a corporation with ownership or control interest in the
2 disclosing entity or in any subcontractor in which the disclosing entity has a five
3 percent (5%) or more interest, the corporation tax identification number must be
4 disclosed.
5 (3) For individuals or corporations with ownership or control interest in any
6 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
7 the disclosure of familial relationship is required.
8 (4) For individuals with five percent (5%) or more direct or indirect ownership
9 interest of a disclosing entity, the individual shall provide evidence of completion of a
10 criminal background check, including fingerprinting, if required by law, prior to
11 execution of Contract. (42 C.F.R. § 455.434)
12 (B) Disclosures Related to Business Transactions:
13 (1) The ownership of any subcontractor with whom Contractor has had business
14 transactions totaling more than $25,000 during the 12-month period ending on the
15 date of the request.
16 (2) Any significant business transactions between Contractor and any wholly
17 owned supplier, or between Contractor and any subcontractor, during the 5-year
18 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
19 (C) Disclosures Related to Persons Convicted of Crimes:
20 (1) The identity of any person who has an ownership or control interest in the
21 provider or is an agent or managing employee of the provider who has been
22 convicted of a criminal offense related to that person's involvement in any program
23 under the Medicare, Medicaid, or the Title XXI services program since the inception
24 of those programs. (42 C.F.R. § 455.106.)
25 (2) County shall terminate the enrollment of Contractor if any person with five
26 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
27 has been convicted of a criminal offense related to the person's involvement with
28 Medicare, Medicaid, or Title XXI program in the last 10 years.
46
1 22.3 Contractor must provide disclosure upon execution of Contract, extension for
2 renewal, and within 35 days after any change in Contractor ownership or upon request of
3 County. County may refuse to enter into an agreement or terminate an existing agreement with
4 Contractor if Contractor fails to disclose ownership and control interest information, information
5 related to business transactions and information on persons convicted of crimes, or if Contractor
6 did not fully and accurately make the disclosure as required.
7 22.4 Contractor must provide the County with written disclosure of any prohibited
8 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
9 or have other relationships with providers Excluded from participation in Federal Health Care
10 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
11 §438.610.
12 22.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
13 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this
14 Agreement where any person with five (5) percent or greater direct or indirect ownership interest
15 in Contractor has been convicted of a criminal offense related to that person's involvement with
16 the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County may terminate
17 this Agreement where any person with five (5) percent or greater direct or indirect ownership
18 interest in the Contractor did not submit timely and accurate information and cooperate with any
19 screening method required in CFR, Title 42, Section 455.416
20 Article 23
21 Disclosure of Criminal History and Civil Actions
22 23.1 Applicability. Contractor is required to disclose if any of the following conditions
23 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
24 referred to as "Contractor"):
25 (A) Within the three (3) year period preceding the Agreement award, they have been
26 convicted of, or had a civil judgment tendered against them for:
27
28
47
1 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
2 or performing a public (federal, state, or local) transaction or contract under a public
3 transaction;
4 (2) Violation of a federal or state antitrust statute;
5 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
6 or
7 (4) False statements or receipt of stolen property.
8 (B) Within a three (3) year period preceding their Agreement award, they have had a
9 public transaction (federal, state, or local) terminated for cause or default.
10 23.2 Duty to Disclose. Disclosure of the above information will not automatically
11 eliminate Contractor from further business consideration. The information will be considered as
12 part of the determination of whether to continue and/or renew this Agreement and any additional
13 information or explanation that Contractor elects to submit with the disclosed information will be
14 considered. If it is later determined that the Contractor failed to disclose required information,
15 any contract awarded to such Contractor may be immediately voided and terminated for
16 material failure to comply with the terms and conditions of the award.
17 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
18 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit O.
19 Additionally, Contractor must immediately advise the County in writing if, during the term of the
20 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
21 participation in Federal or State funded programs or from receiving federal funds as listed in the
22 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
23 become applicable to Contractor. Contractor shall indemnify, defend, and hold County
24 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility,
25 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
26 Responsibility Matters.
27 Article 24
28 Cultural and Linguistic Competency
48
1 24.1 General.All services, policies and procedures must be culturally and linguistically
2 appropriate. Contractor must participate in the implementation of the most recent Cultural
3 Competency Plan for the County and shall adhere to all cultural competency standards and
4 requirements. Contractor shall participate in the County's efforts to promote the delivery of
5 services in a culturally competent and equitable manner to all individuals, including those with
6 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and
7 regardless of gender, sexual orientation, or gender identity including active participation in the
8 County's Diversity, Equity and Inclusion Committee.
9 24.2 Policies and Procedures. Contractor shall comply with requirements of policies and
10 procedures for ensuring access and appropriate use of trained interpreters and material
11 translation services for all limited and/or no English proficient beneficiaries, including, but not
12 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
13 policies and procedures, and monitoring its language assistance program. Contractor's policies
14 and procedures shall ensure compliance of any subcontracted providers with these
15 requirements.
16 24.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation
17 is available for any language and written translation is available in prevalent languages and that
18 auxiliary aids and services are available upon request, at no cost and in a timely manner for
19 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities.
20 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to
21 interpret or facilitate communication; however, if the beneficiary refuses language assistance
22 services, the Contractor must document the offer, refusal, and justification in the beneficiary's
23 file.
24 24.4 Interpreter Qualifications. Contractor shall ensure that employees, agents,
25 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
26 communicate with a beneficiary in a language other than English (1) have completed annual
27 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the
28 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
49
1 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic
2 principles. As requested by County, Contractor shall identify all who interpret for or provide
3 direct communication to any program beneficiary in a language other than English and identify
4 when the Contractor last monitored the interpreter for language competence.
5 24.5 CLAS Standards. Contractor shall submit to County for approval, within ninety (90)
6 days from date of contract execution, Contractor's plan to address all fifteen (15) National
7 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the
8 Office of Minority Health and as set forth in Exhibit P "National Standards on Culturally and
9 Linguistically Appropriate Services." As the CLAS standards are updated, Contractor's plan
10 must be updated accordingly. As requested by County, Contractor shall be responsible for
11 conducting an annual CLAS self-assessment and providing the results of the self-assessment to
12 the County. The annual CLAS self-assessment instruments shall be reviewed by the County
13 and revised as necessary to meet the approval of the County.
14 24.6 Training Requirements. Cultural competency training for Contractor staff should be
15 substantively integrated into health professions education and training at all levels, both
16 academically and functionally, including core curriculum, professional licensure, and continuing
17 professional development programs. As requested by County, Contractor shall report on the
18 completion of cultural competency trainings to ensure direct service providers are completing a
19 minimum of twelve (12) hours of annual cultural competency training.
20 24.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that
21 includes staff at all agency levels to discuss cultural competence. Contractor shall designate a
22 representative from Contractor's team to attend County's Diversity, Equity and Inclusion
23 Committee.
24 Article 25
25 General Terms
26 25.1 Modification. Except as provided in Article 7, "Termination and Suspension," this
27 Agreement may not be modified, and no waiver is effective, except by written agreement signed
28
50
1 by both parties. The Contractor acknowledges that County employees have no authority to
2 modify this Agreement except as expressly provided in this Agreement.
3 (A) Notwithstanding the above, non-material changes to services, staffing, and
4 responsibilities of the Contractor, as needed, to accommodate changes in the laws
5 relating to service requirements and specialty mental health treatment, may be made
6 with the signed written approval of County's DBH Director, or designee, and Contractor
7 through an amendment approved by County's County Counsel and the County's Auditor-
8 Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in any
9 change to the maximum compensation amount payable to Contractor, as stated herein.
10 (B) In addition, changes to line items and expense category subtotals, as set forth in
11 Exhibit F, that when added together during the term of the agreement do not exceed ten
12 percent (10%) of the total maximum compensation payable to Contractor, may be made
13 with the written approval of Contractor and County's DBH Director or designee. Said
14 modifications shall not result in any change to the maximum compensation amount
15 payable to Contractor, as stated herein.
16 25.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
17 under this Agreement without the prior written consent of the other party.
18 25.3 Governing Law. The laws of the State of California govern all matters arising from
19 or related to this Agreement.
20 25.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
21 County, California. Contractor consents to California jurisdiction for actions arising from or
22 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
23 brought and maintained in Fresno County.
24 25.5 Construction. The final form of this Agreement is the result of the parties' combined
25 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
26 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
27 against either party.
28 25.6 Days. Unless otherwise specified, "days" means calendar days.
51
1 25.7 Headings. The headings and section titles in this Agreement are for convenience
2 only and are not part of this Agreement.
3 25.8 Severability. If anything in this Agreement is found by a court of competent
4 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
5 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
6 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
7 intent.
8 25.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
9 not unlawfully discriminate against any employee or applicant for employment, or recipient of
10 services, because of race, religious creed, color, national origin, ancestry, physical disability,
11 mental disability, medical condition, genetic information, marital status, sex, gender, gender
12 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
13 all applicable State of California and federal statutes and regulation.
14 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
15 beneficiaries are provided without use of any policy or practice that has the effect of
16 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
17 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
18 genetic information, health status or need for health care services, or mental or physical
19 disability.
20 25.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
21 of the Contractor under this Agreement on any one or more occasions is not a waiver of
22 performance of any continuing or other obligation of the Contractor and does not prohibit
23 enforcement by the County of any obligation on any other occasion.
24 25.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
25 between the Contractor and the County with respect to the subject matter of this Agreement,
26 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
27 publications, and understandings of any nature unless those things are expressly included in
28 this Agreement. If there is any inconsistency between the terms of this Agreement without its
52
1 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
2 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
3 exhibits.
4 25.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to
5 create any rights or obligations for any person or entity except for the parties.
6 25.13 Authorized Signature. The Contractor represents and warrants to the County that:
7 (A) The Contractor 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 is duly
10 authorized to do so and his or her signature on this Agreement legally binds the
11 Contractor to the terms of this Agreement.
12 25.14 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),
53
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 25.15 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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DocuSign Envelope ID;99F92FOA-4F76493D-AA5B-F51B9F63EF65
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
KINGS VIEW COUNTY OF FRESNO
3
Docu&gned by:
4 A.,."N14,,z
r
5 Ama a ugent Divine, CEO Sal Quintero, hairman of the Board of
Supervisors of the County of Fresno
6 1396 W. Herndon Ave
Fresno, CA 93711 Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
By:
10 Deputy
11 For accounting use only:
12 Org No.: 56304763
Account No.: 7295
13 Fund No.: 0001
Subclass No.: 10000
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Exhibit A
Fresno Metropolitan (Metro) Crisis Intervention Team (CIT) Services
SCOPE OF SERVICES
I. PROJECT DESCRIPTION
Contractor shall provide the following behavioral health crisis intervention services to
individuals within the Fresno metropolitan (metro) area. Crisis intervention services shall be
provided in collaboration with law enforcement agencies (which includes City of Fresno
Police Department, City of Clovis Police Department and the County's Sheriff's Office) and
other first responders. These services shall be provided out in the field where person served
interaction with law enforcement and emergency services personnel (first responders) typically
occurs, and where crisis intervention services are most beneficial. Crisis intervention services are
community based, incorporate stigma reduction and prevention as a product of the placement of
staff in first responder scenarios.
The Crisis Intervention Team (CIT) Field Clinicians shall serve as active liaisons with law
enforcement to provide training, outreach, and direct field response to persons served actively
experiencing a behavioral health crisis in the community, specifically in the Fresno metro area.
Evaluations for Welfare and Institutions Code 5150 holds and recurrent calls from law
enforcement are a primary focus. A pilot project began in September of 2017 with a small group of
Fresno County Department of Behavioral Health (DBH) field clinicians co-located and providing
co-response with the Fresno Police Department (FPD). Through evaluation of that initial phase of
the pilot, it was determined that the need for CIT services is far greater, requiring increased
staffing levels and hours of operation.
With this Agreement, DBH will be entering into Phase 2 of the Fresno Metro CIT program, which
will include services provided by the Contractor. This CIT program growth will allow for expansion
to include the Fresno County's Sheriff's Office (FSO) and the City of Clovis Police Department
(CPD).
II. TARGET POPULATION
The target population to be served by the Metro CIT shall be individuals within the Fresno metro
area currently experiencing an acute behavioral health crisis, including any behavioral health
signs and symptoms, requiring immediate crisis intervention, de-escalation, and triage services.
There is no stipulation regarding age or severity of mental illness and/or substance use disorder.
III. LOCATION OF SERVICES
Services shall be provided to individuals throughout the greater Fresno metro area and within
the community, as opposed to services being performed at traditional behavioral health
department offices or clinics. Crisis intervention services are intended to be provided in the
field where person served interaction with law enforcement and emergency services personnel
(first responders) typically occurs and where crisis intervention services are most beneficial.
A-1
Exhibit A
Services are not to be provided in any facility that employs staff who have the ability to evaluate
for and write a Welfare and Institutions Code 5150 hold. These facilities include, but are not
limited to: hospitals, emergency departments, the Fresno County jail, inpatient facilities (e.g.,
psychiatric health facilities, crisis stabilization units, crisis residential facilities, skilled nursing
facilities, full-service partnerships, short-term residential treatment programs, etc.), and mental
health treatment facilities (residential or outpatient). Should the Contractor have any questions
about which facilities are not considered part of community response, they must immediately
request such clarification from DBH and approval prior to providing services.
IV. DESCRIPTION OF SERVICES
Contractor shall have the willingness and ability to provide CIT services throughout the Fresno
metro area. Crisis intervention services will be provided within the city limits of Fresno and Clovis,
and within the area under Sheriff Jurisdiction (known as "County Islands"). The types of crisis
intervention services provided should be consistent; however, the location of operation should be
flexible to the needs of each the jurisdictions and law enforcement agencies identified.
Behavioral health crisis intervention services include, but are not limited to: assessment, crisis
intervention, community referrals and linkages and short-term/brief case management. In addition,
time permitting, services shall also include community outreach, engagement, education, and
prevention to those potentially in need of services for mental illness and/or co-occurring
substance use disorders. CIT services shall be provided out in the field and in collaboration with
law enforcement as well as the first responders and the Contractor will be expected to coordinate
and build relationships with community agencies, such as schools, hospitals and churches.
Metro CIT will be a unit consisting of field clinicians and law enforcement officers, providing dual
response to behavioral health crisis calls for service. This collaboration will allow Metro CIT to
respond to calls in which there is a behavioral health need to provide compassionate,
person/family centered crisis interventions to persons served and their support systems that are
experiencing behavioral health signs and symptoms. Metro CIT will assist in 911 calls from the
public and will be dispatched jointly to the scene, which will allow law enforcement patrol officers
to continue on to new incoming 911 calls. Metro CIT will jointly provide the behavioral health
interventions within a secure scene. Metro CIT will be able to respond to and handle the initial
crisis, but shall also provide post-crisis contacts, referrals, and linkages to appropriate services.
The Metro CIT program shall be a partnership between Contractor and DBH. DBH staff shall
oversee program expenditures, outcomes reporting, and contract monitoring. CIT services will be
funded by Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI), and Medi-
Cal Federal Financial Participation (FFP), which also mandate specific reporting requirements of
Contractor.
As this Agreement will initiate Phase 2 of the Fresno Metro CIT pilot program, the Contractor will
be expected to demonstrate a capability to evolve the program along its intended course and
redirect, as needed, upon coordination with the DBH Director, or designee, and input from each of
the law enforcement agencies. The Contractor shall agree to cooperate with DBH and all law
enforcement agencies involved in discussing and evaluating the program and be open to
testing/experimenting with appropriate and effective co-response design(s).
A-2
Exhibit A
Existing DBH field clinicians teamed up with FPD are currently experimenting with a "full co-
response" model, which includes allowing clinicians to ride along to the crisis calls in FPD
vehicles. If this model works effectively, DBH may decide to include said model with these
contracted services. If this occurs, DBH will negotiate with Contractor to amend the existing
contract terms.
With regard to crisis intervention services, the Contractor shall demonstrate the capability
to meet the following service provisions:
1. Crisis intervention services shall be provided in the field during person served interaction
with law enforcement and first responders. Given the nature of crisis intervention services,
Contractor shall include all of the following:
A. Crisis prevention and intervention services, including 5150 holds, as necessary.
B. Determination if the person served who is in need of crisis services, has other health
coverage, no health coverage, or Medi-Cal. Ensure crisis intervention services are
provided regardless of ability to pay.
C. Provide post-crisis follow-up as applicable.
D. Address and minimize recidivism with regards to use of local emergency services.
E. Ensure the crisis response system is monitored and rapidly responsive to changing
needs within the Fresno metro area.
2. The Metro CIT Program is designed to be a co-response model and therefore staffing will be
co-located with each participating law enforcement agency. The Contractor shall collaborate
with participating law enforcement agencies with regard to site location selections. The
County will work with the Contractor and the participating law enforcement agencies to
identify appropriate sites where Metro CIT staff and law enforcement officers shall be co-
located in order to provide co-response for the purpose of providing rapid, effective,
recovery/well-being-oriented crisis services. Available co-location sites may vary by agency
and may be modified during the term of this Agreement.
3. Contractor shall provide data collection and reporting, including but not limited to:
A. Contractor shall submit monthly staffing reports due by the 10th of each month that
identify all direct service and support staff by first and last name, applicable
I ice nsure/certifications, and full-time hours worked to be used as a tracking tool to
determine if Contractor's program is staffed according to the requirements of this
Agreement.
B. Contractor shall submit Crisis Care Mobile Unit (CCMU) grant reports as requested by
County. Data includes, but is not limited to, person served demographic information,
mobile crisis dispatch reason, encounter disposition, encounter location as well as
services and resources provided.
C. Training and resource/community development hours shall be captured and reported by
the 10th of the month, for the preceding reporting period, to the DBH Staff Analyst. This
data will not be billed as revenue.
D. The Contractor shall ensure billable specialty mental health services meet all County,
State, Federal regulations including any utilization review, credentialing, site
certifications, and other quality assurance standards. All pertinent and appropriate
information shall be provided in a timely manner to County in order to bill Medi-Cal for
A-3
Exhibit A
services rendered. The Contractor should also ensure that private insurance and/or
Medi-Care is properly billed prior to submitting Medi-Cal claims to the County. The
necessary data can be provided by a variety of means, including but not limited to: 1)
direct data entry into County's information system; 2) providing an electronic file
compatible with County's information system; or 3) integration between County's
information system and Contractor's information system(s).
E. The Contractor shall maintain ongoing crisis tracking data per individual law
enforcement agency as requested by DBH and/or law enforcement.
4. The Contractor must also use any standardized tools, such as the "Columbia Suicide
Severity Risk," as directed by DBH.
5. The Contractor must adhere to any and all applicable statutes as stated in MHSUDS Notice
18-011, "Federal Network Adequacy Standards for Mental Health Plans (MHPs) and Drug
Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties" as well as any updates to
the notice.
6. Contractor may be asked, at the request of specific law enforcement agencies, to have
clinical personnel participate in hostage negotiation training and make that personnel
available to co-respond with the law enforcement agencies in matters which require that
unique expertise. Each law enforcement agency will determine whether CIT clinicians will
be utilized in this fashion.
7. Case management services are provided by interagency coordination between behavioral
health clinicians, case managers and community-based organizations to link these
individuals to behavioral health services and other supports identified by the behavioral
health clinician during the CIT encounter(s). A case manager must be assigned to each
individual within twenty-four (24) hours of the crisis encounter.
Case management services will be culturally responsive, strengths-based, trauma-
informed and recovery-oriented. These services will be continuously evaluated by the
County and Contractor. The Contractor must adapt to meet the geographically dispersed
needs of those living in rural and metropolitan Fresno County, the communities' needs as
crisis services and demands fluctuate, and as Fresno County identifies more appropriate
CIT models that improve service delivery.
Case management services must be community-based; incorporate stigma reduction and
suicide prevention; and comprehensive of recovery practices and community engagement
during the course of service delivery.
8. Documentation and Billing
A. Contractor will use Fresno County DBH's electronic health record (EHR) and billing
system (currently SmartCare), and business management platform (currently Domo)
to conduct data analysis.
B. Contractor must complete all documentation within 24 hours of service delivery,
including but not limited to: access forms, person served referral forms and progress
A-4
Exhibit A
notes. In addition, all related documents need to be uploaded within the same
timeframe.
C. Contractor must adhere to the documentation standards established in the Fresno
County DBH Clinical Documentation and Billing Manual for Specialty Mental Health
Services,-DBH Policy and Procedure Guides (PPG) 2.1.9 "Assessments" and DBH
PPG 4.4.6 "Documentation Standards for Progress Notes" as well as any future
amendments to these documents.
D. Contractor shall utilize collaborative documentation with the person served whenever
it is clinically indicated. Staff must adhere to DBH's collaborative documentation
standards, which may include training courses offered by DBH.
9. Care Coordination and Community Collaboration
A. Contractor shall participate in care coordination activities with DBH, law enforcement
and other community agencies.
B. Contractor agrees to coordinate with the Family Urgent Response System in Fresno
County and utilize this program as a resource for qualified individuals.
C. Comprehensive knowledge of community resources is essential for case management
staff to refer persons served to appropriate services. Contractor must make all
attempts to ensure program staff are aware of applicable community resources and
how to refer to these programs.
D. If the person served is linked to a DBH program, Contractor will notify the service
provider as soon as practicable.
This Scope of Work provides an outline of desired services and should not be considered all-
inclusive.
V. STAFFING LEVELS
1 . Contractor shall recruit and maintain the identified number of skilled, licensed, culturally
competent and appropriately trained staff dedicated to the Fresno Metro CIT program
throughout the term of this Agreement.
2. All Metro CIT clinicians shall be skilled at engaging persons in crisis in a stabilizing,
therapeutic, recovery/well-being focused manner and be well versed in crisis de-escalation
techniques. All CIT clinicians shall be 5150 trained and certified by County's Managed
Care Division.
3. Every Metro CIT clinician will need to be credentialed via DBH's Managed Care Division.
Training in Compliance, and Documentation and Billing are required and will be provided
by DBH to Contractor staff for all new hires within their first thirty (30) days of being
credentialed, and then annually thereafter.
4. As this Agreement initiates Phase 2 of the pilot program, staffing levels may need to be
modified, as appropriate, based upon need, as agreed upon between County and
Contractor.
5. Specific geographic boundaries will be established for each law enforcement agency;
however, jurisdictional crossover may be required to assist in immediate crisis need.
6. Clinicians are to be directly assigned to each law enforcement agency permanently, not to
be on a rotational basis between agencies. This shall be conducted to encourage rapport-
building between law enforcement staff and clinical staff. Although clinicians will be
A-5
Exhibit A
assigned to one specific agency on a permanent basis, it's expected that all CIT clinicians
are cross-trained in the event there is a urgent need for CIT clinician(s) within another law
enforcement agency's jurisdiction.
7. On call/extra help part-time clinical staff to cover shifts and back up, as needed.
8. A Supervisory Clinician shall provide oversight to all clinicians, work collaboratively with
the Law Enforcement Agencies to build and expand services, and provide additional crisis
response as needed.
9. Designated administrative support shall collect data for tracking and reporting purposes.
VI. HOURS OF OPERATION
Contractor will be required to be available to provide services from 6:00 am — 12:00 am, seven
(7) days per week throughout the year, including telephone and face-to-face
contact as needed.
Staff work schedules shall be responsive to person served needs and shall permit staff to work
evenings and weekends. During off-hour periods (5:00 pm — 8:00 am), Contractor shall
have identified staff that are regularly scheduled to work after regular business hours and/or
on the weekends, if deemed necessary, in order to reduce over-time costs and in order to
provide a more flexible treatment schedule for persons served.
VIIII. PERFORMANCE AND OUTCOME MEASUREMENTS
DBH is dedicated to supporting the wellness of individuals, families and communities in Fresno
County who are affected by, or at the risk of, mental illness and/or substance use disorders
through the cultivation of strengths toward promoting recovery in the least restrictive
environment.
Contractor will be required to submit measurable outcomes on an annual basis, as identified in
the Departments Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures as
well as any updates to this policy. Performance outcomes measures must be approved by DBH
and satisfy all State and local mandates. DBH will provide technical assistance and support in
defining measurable outcomes. All performance indicators will reflect the four (4) domains
identified by the Commission Accreditation of Rehabilitation Facilities (CARF). The domains are
Effectiveness, Efficiency, Access, and Satisfaction. These are defined and listed below.
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 (1) performance indicator will be identified for each of the four (4) CARF domains listed
below.
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.
a. 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.
A-6
Exhibit A
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.
a. 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.
a. 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 persons served,
family, staff, and stakeholders. The degree to which persons served, the 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.
a. Examples of indicators include: opinion of persons served or other key stakeholders
in regards to access, process, or outcome of services received, person served
and/or Treatment Perception Survey.
Contractor must address each of the categories referenced above and any additional
performance and outcome measures that are deemed best to evaluate the services provided
to persons served and/or to evaluate overall program performance. DBH may adjust the
performance and outcome measures periodically throughout the duration of this Agreement, as
needed, to best measure the program as determined by the County. Contractor will be required
to utilize and integrate clinical tools as directed by DBH.
Contractor must utilize a computerized tracking system with which performance and
outcome measures and other relevant data, such as demographics, will be maintained. The
data tracking system may be incorporated into the selected Contractor's Electronic Health
Record (EHR) or be a stand-alone database. DBH must be afforded reasonable access to the
data tracking system, if applicable.
A-7
Exhibit B
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.
B-1
Exhibit B
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.
B-2
Exhibit B
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
B-3
Exhibit B
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.
B-4
Exhibit B
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.
B-5
Exhibit B
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.
B-6
Exhibit B
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:
B-7
Exhibit B
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
B-8
Exhibit B
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
B-9
Exhibit B
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.
B-10
Exhibit B
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,
B-11
Exhibit B
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-
B-12
Exhibit B
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.
B-13
Exhibit B
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.
B-14
Exhibit B
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.
B-15
Exhibit B
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.
B-16
Exhibit B
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
B-17
Exhibit B
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.
B-18
Exhibit C
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
C-1
Exhibit C
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
C-2
Exhibit C
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
C-3
Exhibit C
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
C-4
Exhibit D
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 D-1
Exhibit D
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 D-2
Exhibit D
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 D-3
Exhibit E
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 � age
E-1
Exhibit E
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy 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
E-2
Exhibit E
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 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
E-3
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
Fiscal Year (FY) 2023-24
PROGRAM EXPENSES
1000: DIRECT SALARIES & BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.030 $ 5,788 $ 5,788
1102 Regional Director 0.105 14,333 14,333
1103 Accountant 0.140 13,304 13,304
1104 CIT Program Manager 1.000 114,725 114,725
1105 UR Specialist 1.000 101,920 101,920
1106 Administrative Specialist 1.000 50,014 50,014
1107 Quality Improvement Data Analyst 0.250 20,800 20,800
1108 - -
1109 - -
1110 - -
1111 - -
1112 - -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 3.53 $ 320,884 $ 320,884
Acct# Program Position FTE Admin Program Total
1116 Licensed Field Clinician 2.00 $ 178,229 $ 178,229
1117 Unlicensed Field Clinician 8.00 701,749 701,749
1118 Licensed Lead Field Clinician 2.00 216,347 216,347
1119 Case Manager 2.00 105,269 105,269
1120 Per Diem Field Clinician (Licensed) 1,000 hrs/yr 0.50 44,841 44,841
1121 -
1122 - -
1123 - -
1124 - -
1125 - -
1126 - -
1127 - -
1128 - -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - I -
Direct Personnel Program Salaries Subtotal 14.50 $ 1,246,435 $ 1,246,435
Admin Program Total
Direct Personnel Salaries Subtotal 18.03 I $ 320,884 $ 1,246,435 $ 1,567,319
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,072 $ 15,819 $ 19,891
1202 Worker's Compensation 5,498 21,357 26,855
1203 Health Insurance 21,355 82,951 104,306
1204 Other (specify) - - -
1205 Other (specify) - - -
1206 Other (specify) - - -
Direct Employee Benefits Subtotal:j 30,925 1 $ 120,127 1 $ 151,052
Direct Payroll Taxes& Expenses:
Acct# I Description Admin Program Total
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-1
Exhibit F
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 24,416 94,840 119,256
1303 SUI 990 3,844 4,834
1304 Other (specify) - - -
1305 Other (specify) - - -
1306 Other (specify) - - -
Direct Payroll Taxes& Expenses Subtotal: $ 25,406 $ 98,684 $ 124,090
DIRECT EMPLOYEE SALARIES & BENEFITS TOTAL: Admin Program Total
$ 377,215 $ 1,465,246 $ 1,842,461
DIRECT EMPLOYEE SALARIES & BENEFITS PERCENTAGE: Admin Program
20% 80%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 9,500
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify) -
2012 Other (specify) -
2013 Other (specify) -
2014 Other (specify) -
2015 Other (specify) -
2016 Other (specify) -
DIRECT CLIENT CARE TOTAL $ 9,500
3000: DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 31,950
3002 Printing/Postage 4,600
3003 Office, Household & Program Supplies 5,500
3004 Advertising -
3005 Staff Development &Training 14,000
3006 Staff Mileage 1,000
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance 37,650
3009 10ther -
3010 Other (Staff Uniforms) 4,000
3011 Other (Recruitment & Background Checks) 1,500
3012 Other (specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 100,200
4000: DIRECT FACILITIES& EQUIPMENT
Acct# Line Item Description I Amount
4001 Building Maintenance
4002 Rent/Lease Building 26,299
4003 Rent/Lease Equipment 4,221
4004 Rent/Lease Vehicles 44,000
4005 Security -
4006 Utilities -
4007 Other (specify) -
4008 1 Other (specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-2
Exhibit F
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 74,520
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ 72,727
5002 HMIS (Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,600
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 10ther(specify) -
DIRECT SPECIAL EXPENSES TOTAL:1 $ 75,327
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
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): Auto, Property, General, Professional Liability 20,000
6006 Payroll Services -
6007 Depreciation (Provider-owned Equipment to be Used for Program Purposes) -
6008 Personnel (Indirect Salaries&Benefits) -
6009 Other(Administrative Overhead) 256,736
6010 10ther(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 276,736
INDIRECT COST RATE 13.05%
7000: DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 16,000
7002 Copiers, Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture & Fixtures 2,000
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 10ther(specify) -
FIXED ASSETS EXPENSES TOTAL $ 18,000
TOTAL PROGRAM EXPENSES $ 2,396,744
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Estimated Specialty Mental Health Services Billing Totals: $ 1,373,431
Estimated %of Clients who are Medi-Cal Beneficiaries 30%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 412,029
Federal Financial Participation (FFP) % 1 50% 206,015
MEDI-CAL FFP TOTAL $ 206,014
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-3
Exhibit F
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
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 $ -
8302 PEI - Prevention & Early Intervention Crisis Intervention Team & Rural Triage 2,190,730
8303 INN - Innovations -
8304 WET-Workforce Education &Training -
8305 JCFTN -Capital Facilities &Technology -
MHSA TOTAL $ 2,190,730
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants (Specify) -
8404 Other (Specify) -
8405 1 Other (Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 2,396,744
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-4
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
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
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH STARS 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.03
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
FURS/Fresno 0.03
CVSPH/California State,Tulare, Calaveras, Tuolumi 0.13
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.02
PATH STARS 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.16
Metro CIT/Fresno 0.105
Map Point/Fresno 0.05
FURS/Fresno 0.03
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tulare, Calaveras, Tuolumi 0.29
Madera 0.14
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant
PATH SMHS/Fresno 0.02
F-5
Exhibit F
PATH OEL/Fresno 0.05
PATH STARS 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.15
Metro CIT/Fresno 0.14
Map Point/Fresno 0.07
FURS/Fresno 0.03
Finance Department 0.37
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH STARS 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.25
Map Point/Fresno 0.07
FURS/Fresno 0.03
Shasta 0.04
QI Deparment 0.12
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
F-6
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
Fiscal Year (FY) 2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: DIRECT SALARIES & BENEFITS 1,842,461
Administrative Positions 320,884
1101 Executive Director 5,788 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 14,333 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1103 Accountant 13,304 Prepares and provides budget guidance, monthly invoicing, and other fiscal services.
1104 CIT Program Manager 114,725 Provides supervision of all staff and direct oversight of program management.
1105 UR Specialist 101,920 Provides supervision of all licensed and unlicensed clinical staff.
1106 Administrative Specialist 50,014 Provides administrative support for the program and assist with medical billing and
records.
1107 Quality Improvement Data Analyst 20,800 This position will perform a wide range of duties to support data collection,
management, and reporting needs for all collaborative partnerships.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 10 -
Program Positions 1,246,435
1116 Licensed Field Clinician 178,229 Assist with managing the client's illness and reduce its impact on the client's life, and
referrals to appropriate linkages. Services shall include crisis assessments, suicide risk
assessments,safety plan development, disseminating information regarding, and
linkage to, behavioral health services &community resources, and post-crisis case
management and care coordination activities. Additional services can include
assistance locating stable housing, coordinating care meetings, collaboration with
school staff,foster family agencies, regional center representatives, primary care
physicians, inpatient and residential services, social workers, substance use disorder
services, and parole or probation officers.
1117 Unlicensed Field Clinician 701,749 Assist with managing the client's illness and reduce its impact on the client's life, and
referrals to appropriate linkages. Services shall include crisis assessments, suicide risk
assessments, safety plan development, disseminating information regarding, and
linkage to, behavioral health services&community resources, and post-crisis case
management and care coordination activities. Additional services can include
assistance locating stable housing, coordinating care meetings, collaboration with
school staff,foster family agencies, regional center representatives, primary care
physicians, inpatient and residential services, social workers, substance use disorder
services, and parole or probation officers.
1118 Licensed Lead Field Clinician 216,347 Assist with managing the client's illness and reduce its impact on the client's life, and
referrals to appropriate linkages. Services shall include crisis assessments, suicide risk
assessments,safety plan development, disseminating information regarding, and
linkage to, behavioral health services &community resources, and post-crisis case
management and care coordination activities. Additional services can include
assistance locating stable housing, coordinating care meetings, collaboration with
school staff,foster family agencies, regional center representatives, primary care
physicians, inpatient and residential services, social workers, substance use disorder
services, and parole or probation officers. Provides guidance and support to other
field clinicains
1119 Case Manager 105,269 Provides post-crisis case management and care coordination activites.
1120 Per Diem Field Clinician (Licensed) 1,000 hrs/yr 44,841 Per Diem-Assist with managing the client's illness and reduce its impact on the
client's life, and referrals to appropriate linkages. Services shall include crisis
assessments,suicide risk assessments, safety plan development, disseminating
information regarding, and linkage to, behavioral health services&community
resources, and post-crisis case management and care coordination activities.
Additional services can include assistance locating stable housing, coordinating care
meetings, collaboration with school staff,foster family agencies, regional center
representatives, primary care physicians, inpatient and residential services, social
workers, substance use disorder services, and parole or probation officers.
1121 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-7
Exhibit F
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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 10 -
Direct Employee Benefits 151,052
1201 IRetirement 19,891 Cost of 401K
1202 Worker's Compensation 26,855 Workers' Compensation Insurance
1203 Health Insurance 104,306 Cost of medical,vision, dental, life and long-term disability insurance.
1204 Other(specify) -
1205 Other(specify) -
1206 1 Other(specify) -
Direct Payroll Taxes& Expenses: 124,090
1301 OASDI -
1302 FICA/MEDICARE 119,256 Cost of FICA/Medicare
1303 SUI 4,834 Cost of SUI
1304 Other(specify) -
1305 Other(specify) -
1306 Other (specify) -
2000: DIRECT CLIENT SUPPORT 9,500
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation &Support -
2004 Clothing, Food, & Hygiene 9,500 Expenses that supports clients with clothing,food, water, blankets, and hygiene
supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other (specify) -
3000: DIRECT OPERATING EXPENSES 100,200
3001 1 Telecommunications 31,950 Cost of a cell phone,cell phones service, data connectivity.
3002 Printing/Postage 4,600 Anticipating courier services and postage necessary for program. Business cards,
51/50 forms,and other special printing in bulk that is less cost effective to outsource
rather than utilization of a copier.
3003 Office, Household & Program Supplies 5,500 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 14,000 Cost of continuation of staff development,training, and continuing education
(CEUs). Includes, registration cost,travel transportation, staff meals, and lodging
expenses.
3006 Staff Mileage 1,000 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees,such as parking fees.
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance 371650 Minor auto repairs & maintenance required to maintain 11 leased vehicles for client
transportation and program needs. Includes expenses such as oil changes, car
washes,vehicle tracking service,auto fuel, and DMV fees.
3009 Other -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-8
Exhibit F
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3010 Other (Staff Uniforms) 4,000 Intended for pilot program to provide standardized clothing for team members
traveling with law enforcement. Clothing is intended to cover bullet proof safety
gear with neutral clothing choices to reaffirm that staff are not law enforcement.
3011 Other(Recruitment& Background Checks) 1,500 Thorough background checks,drug testing, and job postings.
3012 Other(specify) -
4000: DIRECT FACILITIES& EQUIPMENT 74,520
4001 1 Building Maintenance -
4002 Rent/Lease Building 26,299 Shared building lease space.
4003 Rent/Lease Equipment 4,221 Shared cost for copier leases and water dispenser rental.
4004 Rent/Lease Vehicles 44,000 Cost of[11] leased vehicles to assist with program and client needs.
4005 Security -
4006 Utilities -
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 1 Other (specify) -
5000: DIRECT SPECIAL EXPENSES 75,327
5001 Consultant (Network& Data Management) 72,727 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management,technology procurement,telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,600 Anticipating need of outsource translation services.
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other (specify) -
6000: INDIRECT EXPENSES 276,736
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Auto, Property, General, 20,000 Direct expense to program for general, professional liability, personal property,
Professional Liability accidental,and auto insurance.
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to be Used -
6008 Personnel (Indirect Salaries& Benefits) -
6009 Other(Administrative Overhead) 256,736 Expense provides corporate management,fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 1 Other (specify) -
7000: DIRECT FIXED ASSETS 18,000
7001 Computer Equipment&Software 16,000 replacement computer equipment and ongoing software licenses
7002 Copiers,Cell Phones,Tablets, Devices to Contain -
7003 Furniture& Fixtures 2,000 Anticipating shared cost or replacement furniture needs.
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: 2,396,744
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,396,744
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-9
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
Fiscal Year (FY) 2024-25
PROGRAM EXPENSES
1000: DIRECT SALARIES & BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.030 $ 5,962 $ 5,962
1102 Regional Director 0.105 14,763 14,763
1103 Accountant 0.140 13,703 13,703
1104 CIT Program Manager 1.000 118,167 118,167
1105 UR Specialist 1.000 104,978 104,978
1106 Administrative Specialist 1.000 51,514 51,514
1107 Quality Improvement Data Analyst 0.250 21,424 21,424
1108 - -
1109 - -
1110 - -
1111 - -
1112 - -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 3.53 $ 330,511 $ 330,511
Acct# Program Position FTE Admin Program Total
1116 Licensed Field Clinician 2.00 $ 183,576 $ 183,576
1117 Unlicensed Field Clinician 8.00 722,801 722,801
1118 Licensed Lead Field Clinician 2.00 222,837 222,837
1119 Case Manager 2.00 108,427 108,427
1120 Per Diem Field Clinician (Licensed) 1,000 hrs/yr 0.50 46,186 46,186
1121 - -
1122 - -
1123 - -
1124 - -
1125 - -
1126 - -
1127 - -
1128 - -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - I -
Direct Personnel Program Salaries Subtotall 14.50 $ 1,283,827 $ 1,283,827
Admin Program Total
Direct Personnel Salaries Subtotal 18.03 $ 330,511 $ 1,283,827 $ 1,614,338
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,194 $ 16,294 $ 20,488
1202 Worker's Compensation 5,663 21,998 27,661
1203 Health Insurance 21,996 85,440 107,436
1204 Other (specify) - - -
1205 Other (specify) - - -
1206 Other (specify) - - -
Direct Employee Benefits Subtotal: $ 31,853 $ 123,732 $ 155,585
Direct Payroll Taxes& Expenses:
Acct# I Description Admin Program Total
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-10
Exhibit F
1301 AASDI $ - $ - $ -
1302 FICA/MEDICARE 25,148 97,685 122,833
1303 SUI 1,020 3,959 4,979
1304 Other(specify) - - -
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes& Expenses Subtotal: $ 26,168 $ 101,644 $ 127,812
DIRECT EMPLOYEE SALARIES& BENEFITS TOTAL: Admin Program Total
$ 388,532 $ 1,509,203 $ 1,897,735
DIRECT EMPLOYEE SALARIES& BENEFITS PERCENTAGE: Admin Program
20% 80%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation &Support -
2004 Clothing, Food, & Hygiene 9,500
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies- Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 9,500
3000: DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 32,909
3002 Printing/Postage 4,690
3003 Office, Household & Program Supplies 5,665
3004 Advertising -
3005 Staff Development &Training 14,000
3006 Staff Mileage 1,000
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance 38,780
3009 10ther
3010 Other(Staff Uniforms) 4,000
3011 Other(Recruitment& Background Checks) 2,000
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 103,044
4000: DIRECT FACILITIES& EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 27,088
4003 Rent/Lease Equipment 4,348
4004 Rent/Lease Vehicles 45,320
4005 Security -
4006 Utilities -
4007 Other(specify) -
4008 1 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-11
Exhibit F
4009 Other(specify) -
4010 1 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 76,756
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant (Network& Data Management) $ 79,795
5002 HMIS (Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,600
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 1 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 82,395
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
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): Auto, Property, General, Professional Liability 22,000
6006 Payroll Services -
6007 Depreciation (Provider-owned Equipment to be Used for Program Purposes) -
6008 Personnel (Indirect Salaries&Benefits) -
6009 Other(Administrative Overhead) 287,232
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 309,232
INDIRECT COST RATE 14.14%
7000: DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 16,000
7002 Copiers, Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture & Fixtures 2,000
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 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 18,000
TOTAL PROGRAM EXPENSES $ 2,496,662
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Estimated Specialty Mental Health Services Billing Totals: $ 2,060,149
Estimated %of Clients who are Medi-Cal Beneficiaries 30%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 611,864
Federal Financial Participation (FFP) % 1 50% 305,932
MEDI-CAL FFP TOTAL $ 305,932
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-12
Exhibit F
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
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 $ -
8302 PEI - Prevention & Early Intervention Crisis Intervention Team & Rural Triage 2,190,730
8303 INN - Innovations -
8304 IWET-Workforce Education &Training -
8305 JCFTN -Capital Facilities &Technology -
MHSA TOTAL $ 2,190,730
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants (Specify) -
8404 Other (Specify) -
8405 1 Other (Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 2,496,662
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
F-13
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
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
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH STARS 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.03
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
FURS/Fresno 0.03
CVSPH/California State,Tulare, Calaveras, Tuolumi 0.13
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.02
PATH STARS 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.16
Metro CIT/Fresno 0.105
Map Point/Fresno 0.05
FURS/Fresno 0.03
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tulare, Calaveras, Tuolumi 0.29
Madera 0.14
Total 1.00
IPosition Contract#/Name/Department/County FTE
F-14
Exhibit F
Accountant PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH STARS 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.15
Metro CIT/Fresno 0.14
Map Point/Fresno 0.07
FURS/Fresno 0.03
Finance Department 0.37
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH STARS 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.25
Map Point/Fresno 0.07
FURS/Fresno 0.03
Shasta 0.04
QI Deparment 0.12
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
F-15
Exhibit F
Fresno Metropolitan Crisis Intervention Team (Metro CIT)
Kings View
Fiscal Year (FY) 2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: DIRECT SALARIES & BENEFITS 1,897,735
Administrative Positions 330,511
1101 Executive Director 5,962 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 14,763 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1103 Accountant 13,703 Prepares and provides budget guidance, monthly invoicing, and other fiscal services.
1104 CIT Program Manager 118,167 Provides supervision of all staff and direct oversight of program management.
1105 UR Specialist 1041978 Provides supervision of all licensed and unlicensed clinical staff.
1106 Administrative Specialist 51,514 Provides administrative support for the program and assist with medical billing and
records.
1107 Quality Improvement Data Analyst 21,424 This position will perform a wide range of duties to support data collection,
management, and reporting needs for all collaborative partnerships.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 10 -
Program Positions 1,283,827
1116 Licensed Field Clinician 183,576 Assist with managing the client's illness and reduce its impact on the client's life, and
referrals to appropriate linkages. Services shall include crisis assessments, suicide risk
assessments, safety plan development, disseminating information regarding, and
linkage to, behavioral health services & community resources, and post-crisis case
management and care coordination activities. Additional services can include
assistance locating stable housing, coordinating care meetings, collaboration with
school staff, foster family agencies, regional center representatives, primary care
physicians, inpatient and residential services, social workers, substance use disorder
services, and parole or probation officers.
1117 Unlicensed Field Clinician 722,801 Assist with managing the client's illness and reduce its impact on the client's life,and
referrals to appropriate linkages. Services shall include crisis assessments,suicide risk
assessments,safety plan development, disseminating information regarding,and
linkage to, behavioral health services&community resources,and post-crisis case
management and care coordination activities.Additional services can include
assistance locating stable housing,coordinating care meetings,collaboration with
school staff,foster family agencies, regional center representatives, primary care
physicians, inpatient and residential services,social workers,substance use disorder
services,and parole or probation officers.
1118 Licensed Lead Field Clinician 222,837 Assist with managing the client's illness and reduce its impact on the client's life,and
1119 Case Manager 108,427 Provides post-crisis case management and care coordination activites.
1120 Per Diem Field Clinician (Licensed) 1,000 hrs/yr 46,186 Per Diem-Assist with managing the client's illness and reduce its impact on the
client's life, and referrals to appropriate linkages. Services shall include crisis
assessments, suicide risk assessments, safety plan development, disseminating
information regarding, and linkage to, behavioral health services &community
resources, and post-crisis case management and care coordination activities.
Additional services can include assistance locating stable housing, coordinating care
meetings, collaboration with school staff, foster family agencies, regional center
representatives, primary care physicians, inpatient and residential services, social
workers, substance use disorder services, and parole or probation officers.
1121 -
1122 0 -
1123 0 -
1124 0 -
1125 0 -
1126 0 -
1127 0 -
1128 0 -
1129 0 -
1130 0 -
1131 0 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-16
Exhibit F
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1132 0 -
1133 0 -
1134 0 -
Direct Employee Benefits 155,585
1201 Retirement 20,488 Cost of 401K
1202 Worker's Compensation 27,661 Workers' Compensation Insurance
1203 Health Insurance 107,436 Cost of medical,vision, dental, life and long-term disability insurance.
1204 Other(specify) -
1205 Other(specify) -
1206 1 Other(specify) -
Direct Payroll Taxes& Expenses: 127,812
1301 OASDI -
1302 FICA/MEDICARE 122,833 Cost of FICA/Medicare
1303 SUI 4,979 Cost of SUI
1304 Other(specify) -
1305 Other(specify) -
1306 Other (specify) -
2000: DIRECT CLIENT SUPPORT 9,500
2001 IChild Care -
2002 Client Housing Support -
2003 Client Transportation &Support -
2004 Clothing, Food,& Hygiene 9,500 Expenses that supports clients with clothing,food,water, blankets,and hygiene
supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies- Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
3000: DIRECT OPERATING EXPENSES 103,044
3001 Telecommunications 32,909 Cost of a cell phone, cell phones service, data connectivity.
3002 Printing/Postage 41690 Anticipating courier services and postage necessary for program. Business cards,
51/50 forms, and other special printing in bulk that is less cost effective to outsource
rather than utilization of a copier.
3003 Office, Household & Program Supplies 5,665 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development &Training 14,000 Cost of continuation of staff development,training, and continuing education
(CEUs). Includes, registration cost,travel transportation, staff meals, and lodging
expenses.
3006 Staff Mileage 1,000 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees,such as parking fees.
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance 38,780 Minor auto repairs& maintenance required to maintain 11 leased vehicles for client
transportation and program needs. Includes expenses such as oil changes, car
washes,vehicle tracking service, auto fuel, and DMV fees.
3009 Other -
3010 Other(Staff Uniforms) 4,000 Intended for pilot program to provide standardized clothing for team members
traveling with law enforcement. Clothing is intended to cover bullet proof safety
gear with neutral clothing choices to reaffirm that staff are not law enforcement.
3011 Other(Recruitment& Background Checks) 2,000 Thorough background checks,drug testing,and job postings.
3012 Other (specify) -
4000: DIRECT FACILITIES& EQUIPMENT 76,756
4001 1 Building Maintenance -
4002 Rent/Lease Building 27,088 Shared building lease space.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-17
Exhibit F
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 4,348 Shared cost for copier leases and water dispenser rental.
4004 Rent/Lease Vehicles 45,320 Cost of[11] leased vehicles to assist with program and client needs.
4005 Security -
4006 Utilities -
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 1 Other(specify) -
5000: DIRECT SPECIAL EXPENSES 82,395
5001 Consultant (Network& Data Management) 79,795 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management,technology procurement,telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,600 Anticipating need of outsource translation services.
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 1 Other(specify) -
6000: INDIRECT EXPENSES 309,232
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Auto, Property,General, 22,000 Direct expense to program for general, professional liability, personal property,
Professional Liability accidental, and auto insurance.
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to be Used -
6008 Personnel (Indirect Salaries& Benefits) -
6009 Other (Administrative Overhead) 287,232 Expense provides corporate management,fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 1 Other(specify) -
7000: DIRECT FIXED ASSETS 18,000
7001 Computer Equipment&Software 16,000 replacement computer equipment and ongoing software licenses
7002 Copiers,Cell Phones,Tablets, Devices to Contain -
7003 Furniture& Fixtures 2,000 Anticipating shared cost or replacement furniture needs.
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 Other (specify) -
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,496,662
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,496,662
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
F-18
Exhibit G
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, 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 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
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
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 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.
G-1
Exhibit G
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 obligations under Article 19
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 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 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 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 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 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 policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
G-2
Exhibit G
(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.
(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 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 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 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 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 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 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 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 is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor 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. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
G-3
Exhibit G
(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.
G-4
Exhibit H
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.
H-1
Exhibit H
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.
H-2
Exhibit I
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.
I-1
Exhibit I
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:
1-2
Exhibit I
E 0 Q Y fresnodbh.IogicmanagecmmAncidents/?t=9&p=l&k=182be0c5cdcd5072bbl864cdee4d3d6e
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'
1-3
Exhibit I
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
1-4
Exhibit I
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 fresrrodbh.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.
1-5
Exhibit I
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:
Notiriwtion To:Mila Arevalo
r7]:=
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.
1-6
Exhibit I
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,Manag,,
1-7
Exhibit I
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
1-8
Exhibit I
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 carontt 30-31-19�
Task ID:313 Sourte:303:null 1c 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
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1-9
Exhibit I
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1-10
Exhibit J
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.
J-1
Exhibit J
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.
J-2
Exhibit J
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:
J-3
Exhibit K
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.
K-1
Exhibit K
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.
K-2
Exhibit L
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 L.
(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 L.
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Exhibit L
(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 L;
(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
L-2
Exhibit L
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 L, 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)
L-3
Exhibit L
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 L. 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
L-4
Exhibit L
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 L, 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,
L-5
Exhibit L
including taking any corrective action under this Exhibit L, 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 L.
(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 L, 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 L.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit L. 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
L-6
Exhibit L
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
L, 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 L 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 L 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 L 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 L 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
L-7
Exhibit L
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 L shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit L
is intended to confer, nor shall anything in this Exhibit L 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.
L-8
Exhibit M
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("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 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).
M-1
Exhibit M
(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:
M-2
Exhibit N
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
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Exhibit N
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
N-2
Exhibit O
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;
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Exhibit O
(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)
O-2
Exhibit P
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 P
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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S(_ U.S.Deportment of https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
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