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Home My WebLink AboutAgreement A-23-512 Certificate of Compliance Medi-Cal.pdf Agreement No. 23-512 STATE OF CALIF'ORNSL GAIN lvL L G��etnat DEPARTNI M-NT OF VETERANS A.FF-URS 1, ;Cl Street SACRAMENT©,CALiFORNLi P5814 °' } Telephone. (800)952-5626 Annual Medi-Cal Cost Avoidance Certificate of Compliance Fiscal Year 2023/2024 I certify that Fresno County has appointed a County Veterans Service Officer(CVSO) in compliance with California Code of Regulations,Title 12, Subchapter 4. Please consider this as our application to participate in the Medi-cal Cost Avoidance Program authorized by Military and Veterans Code Section 972.5 I understand and will comply with the following: 1. All activities of the CVSO for which payment is made by the Ca1Vet under this agreement will reasonably benefit the Department of Health Care Services (DHCS)or realize cost avoidance to the Medi-Cal program. All State and County Medi-Cal Eligibility Workers who generate a Form MC 05 (Military Verification and Referral form)will be instructed to indicate the applicant's Aid Code on the face of the form. 2. All monies received under this agreement shall be allocated to and spent on the salaries and expenses of the CVSO. 3.This agreement is binding only if federal funds are available to CalVet from the DHCS. 4. The CVSO is responsible for administering this program in accordance with California Code of Regulations,Title 12, Subchapter 4 and the Cal Vet Procedure Manual for Subvention and Medi-Cal Cost Avoidance for the current state fiscal year. R/i4/z 3 Sal in rVCChirman of the Date Boar Suors of the County of Fresno SCAN AND UPLOAD TH.:IS COMPLETED FORM VIA AGENCY &TTACHME:NTS IN VETPRO ATTEST: Rev.06/23 BERNICE E.SEIDEL Clerk of the Board of Supervisors County �'off Fresno,State of California By *40, k- 0'6te— Deputy Agreement California Department of Veterans Affairs: Medi-Cal Certificate of Compliance (FY 2023-24), and Subvention Certificate of Compliance (FY 2023-24) County of Fresno Fund/Subclass: 0001/10000 Organization: 7110 Account/Program: 3560/0