HomeMy WebLinkAboutAgreement A-23-508 Amendment No. 1 to Agreement with DHCS.pdf Agreement No. 23-508
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
This amendment is entered into between the Department of Health Care Services and the County named below.
rCOUNTY NAME Fresno County
PERFORMANCE PERIOD December 14,2022 through End of implementation date June 30,2025 i
CLOSE OUT TERM July 1,2025 through June 30,2026
PRIOR AGREEMENT AMOUNT $ 1,204,000.00 !
AMENDMENT EFFECTIVE DATE Upon DHCS counter-signature,unless otherwise specified
The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the
Allocation Agreement and incorporated herein. All other terms and conditions not specifically revised by this amendment
shall remain the same.
AMENDMENT DETAILS
1. Purpose of amendment: This Amendment shall be used to increase or decrease the approved Allocation Agreement
Budget Plan or to modify the approved Performance Period end date due to approved revisions to the original Work
Plan and/or Goals and Objectives. Revisions may be due to the following: ,
a. The requirement to implement activities relating to Medi-Cal Renewal Events
b. The requirement to implement focused outreach for Medi-Cal Expansions
II. Amended Allocation Agreement Documents:
a. Revised Budget Plan—A 1 —Attachment 1
I b. Revised Work Plan—Al —Attachment 2
;
111. Changes made in this amendment must be made as bold and underline for new additions, while deletions must be
made as a strikethrough text(i.e. str-iko -eug )
i
REVISED ALLOCATION AMOUNT NOT TO ONE MILLION,TWO HUNDRED AND EIGHTY-TWO
EXCEED: $ 1,282,250.00 f THOUSAND,TWO HUNDRED FIFTY DOLLARS
The General and Special Provisions attached are made a part of and incorporated into the Agreement.
FRESNO COUNTY ; DEPARTMENT OF HEALTH CARE SERVICES STATE
OF CALIFORNIA
P.O. BOX 1912 ATTN: HEALTH ENROLLMENT NAVIGATORS SECTION
!
FRESNO,CA 93718-1912 MEDI-CAL ELIGIBILITY DIVISION
PO BOX 997417,MS 4607
SACRAMENTO,CA 95899-7417
BY(AUTHORIZE SIGNATURE): BY(AUTHORIZED SIGNATURE): i
PR NT D AND TITLE OF PERSON SIGNING: PRINTED NAME AND TITLE OF PERSON SIGNING:
Sal mtero,Chairman,Board of Supervisors Yin 'ia Huang,Assistant Deputy Director
DATE SIGNED: DATE SIGNED:
1 Qlig1z.3 I
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By ;c ( ;C1rG Deputy
Page 1
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
TERMS AND CONDITIONS OF ALLOCATION AMOUNT
The County shall be responsible for the performance of the work as set forth herein below and for the
preparation of deliverables and reports as specified in this Agreement. The County Project
Representative shall promptly notify the State of events or proposed changes that could affect the
Work Plan under this Agreement.
Special Provisions
1. County shall complete all work in accordance with an approved Work Plan, which will be
included in this Agreement as Attachment 2.
2. Rights in Data and Reporting: The County agrees that all data and reports produced in the
performance of this Agreement are subject to the rights of the State as set forth in this section.
The State shall have the right to reproduce, publish, and use all such data and reports, or any
part thereof, in any manner and for any purposes whatsoever and to authorize others to do so in
compliance with applicable laws.
3. Project partner agrees to attend monthly meetings with their assigned analyst or designated
Navigators Project staff.
General Provisions
A. Definitions
A. The term "Allocation" as used herein means the Health Navigators Allocation funding
authorized by SB 154 (Chapter 43, Statutes of 2022).
B. The term "Agreement" as used herein means an allocation agreement between the State
and County specifying the payment of Allocation Amount by the State for the
performance of Work Plan(Attachment 2)within the Service Term by the County.
C. The term "County" as used herein means the party described as the County on page one
(1) of this Agreement.
D. The term "Allocation Amount" as used herein means funds awarded to the County by
the State.
E. The term "Service Term" as used herein means the period of time that the partner has to
conduct the approved activities outlined in the work plan (Attachment 2).
F. The term "Project Representative" as used herein means the person authorized by the
County to be responsible for the Allocation Amount and is capable of making daily
management decisions.
Page 2
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
G. The term "State" as used herein means the Department of Health Care Services.
H. Project Partner—A qualified County or Community-Based Organization selected to
enter into an agreement with DHCS to provide services and to comply with the terms
and conditions set forth in the Allocation Agreement.
I. The "Closeout Term" as used herein means administrative activities of this Agreement
to closeout or wind down all administrative Health Navigator Project activities engaged
in after the end of the Service Term Period stated on page one.
J. Regular Office Hours - as used herein means the hours between 8:OOAM and 5:OOPM
on all state business days.
B. Allocation Execution
1. County agrees to complete the corresponding activities in accordance with the time of
the Service Term and Closeout Term, and under the terms and conditions of this
Agreement.
2. County shall comply with the provisions of SB 154.
3. County shall begin implementation once this agreement has been signed by the County
and countersigned by DHCS. Any implementation completed prior to the execution date
will not be reimbursed.
4. County agrees to submit in writing any deviation from the Work Plan (Attachment 2) to
the State for approval prior to implementation of changes.
C. Allocation Costs
Subject to the availability of Allocation Amount, the State hereby grants to the County funding
not to exceed the amount stated on page one (1) of this Agreement in consideration of and on
condition that the sum be expended in carrying out the purpose as set forth in the Work Plan
and under the terms and conditions set forth in this Agreement.
The Allocation Amount to be provided to the County, under this Agreement, may be disbursed
as follows:
1. To County: County shall disperse any amount of the Allocation Amount that the County
deems appropriate. County may subcontract with one or more other community-based
organizations to perform the activities identified in the approved Work Plan,
Attachment 2. The State recommends, but does not require, the County to collaborate
with one or more CBOs to develop, conduct, and implement effective tools and
methods to expand Medi-Cal outreach, increase Medi-Cal enrollment and contribute
efforts to retention of the uninsured, targeted populations. The County is not required to
immediately contract with CBOs in light of the timelines the contracting processes may
Page 3
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
necessitate. However, the County will need to demonstrate its contracting progress with
CBOs through required reporting activities.
2. Indirect administrative costs, including planning, plan documentation, and other
administrative costs shall not exceed the amount approved in the Budget Plan,
Attachment 1 of the Allocation Agreement.
D. Payment Documentation
1. All payment requests must be submitted by the County to the State, on a quarterly basis,
using a completed Navigators Project Quarterly Invoice, Attachment 3. The invoice
and the deliverables noted below must accompany the invoice as outlined in the
Quarterly Invoice and Deliverables Deadline Bulletin(2022-005).
a. Budget Plan, Amendment I (A I)—Attachment 1
b. Work Plan, Amendment 1 (A I)—Attachment 2
c. Navigators Project Quarterly Invoice, Attachment 3
d. Monthly Data Report, Attachment 4
e. Quarterly Progress Report, Attachment 5
In very limited circumstances, DHCS may approve a different submission schedule for
an individual County outside of what is listed in the Quarterly Invoice and Deliverables
Deadline Bulletin (2022-005). In order for this change to be approved for the
submission of the documents listed in Section D, la, lb, and lc (listed above), this
change must be agreed to, in writing, by both County and DHCS prior to enactment of
this change in schedule.
2. County shall submit all documentation to the State for Allocation completion within the
Closeout Term as shown on page one (1).
3. Payments to the County shall be on a costs incurred basis. Expenses on the quarterly
invoice must include activities performed during the billing period.
4. The County must meet the requirements of this Allocation Agreement, including the
terms of all of its referenced Attachments, in order to receive approved Allocation
payments from the State. If the County fails to meet such requirements or exhibit
deficiencies in the performance of this Agreement, the State may withhold partial or full
Allocation payments. See also section F. Loss of Allocation Amount below for more
information.
5. Payment will be issued by the State upon the accurate, complete, and timely
submission, in accordance with the submission schedule outlined in the Quarterly
Invoice and Deliverables Deadline Bulletin(2022-005), of the following documents:
a. Monthly Data Report Attachment 4
b. A complete Navigators Project Invoice Attachment 3
c. A complete Quarterly Progress Report Attachment 5
Page 4
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
Budget Plan Attachment 1
County is required to use the Budget Plan, Attachment 1 to identify all line items of
expenditure for each fiscal year of the project. DHCS provides approval of this initial
Budget Plan upon DHCS countersignature of the Budget Plan. Upon completion of a fiscal
year, County must submit a new proposed Budget Plan by July 31 that identifies estimated
expenditures for the current and subsequent fiscal years.
If the County needs to adjust line-item expenditures, County can unilaterally shift less than
five percent (5%) of funding between one or more line-item amounts within the Non-
Personnel — Direct Costs section and/or the Personnel Staff section. Any adjustment
resulting in a change that exceeds five percent (5%) of any singular line item from the most
recently approved Budget Plan requires DHCS approval prior to enacting this change. Any
proposed revisions to the Budget Plan by County must be submitted to DHCS in writing.
DHCS has up to thirty (30) calendar days to review and provide response of approval or
denial of the request.
Work Plan Attachment 2
County is required to use the Work Plan, Attachment 2. As outlined in the Quarterly
Invoice, a Work Plan must be submitted to, and approved by, DHCS in order to receive the
quarterly payment. The Work Plan shall include strategies and time-frames for outreach,
enrollment, and retention activities completed by the County and its contracted CBOs. Any
proposed revisions to the Work Plan by County must be submitted to DHCS in writing.
DHCS has up to thirty (30) calendar days to provide a response of approval or denial of the
request.
Navigators Proi ect Invoice Attachment 3
County is required to use the Navigators Project Invoice, Attachment 3. Invoices must be
submitted by the County on a quarterly basis as outlined in the Quarterly Invoice and
Deliverables Deadline Bulletin (2022-005). The invoice must be accurate and complete and
include detailed budget activity and expenditures for the specific quarter. The expenditures
identified in the invoice must be supported by all appropriate documents (such as receipts,
proof of payment, time sheets, etc.) to substantiate that payment was made and is eligible
for reimbursement of allowable expenditures. DHCS will issue an Invoice Dispute
Notification form (STD 209) if the County has submitted an invoice for payment, but has
not submitted any or all of the following items:
• Monthly Data Report (for the corresponding quarter being billed)
• Quarterly Progress Report (for the corresponding quarter being billed)
• Budget Plan due to entering a new fiscal year
• Budget Plan for a shift equal to or greater than five percent (5%)
As outlined in Bulletin 2020-003 Instructions for Submitting Quarterly Invoice and
Progress Report an initial payment is permissible. In order for DHCS to consider approval
of an initial payment request, the County is required to have a DHCS-approved Budget
Plan, submit a prospectus invoice (on the Navigators Project Quarterly Invoice, Attachment
3 form) identifying anticipated expenditures, and provide a narrative explaining why these
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ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
funds are needed and the work expected to be performed. Once submitted, DHCS will
provide notice within two (2) weeks if the request has been approved.
All initial payment requests cannot exceed twenty-five percent (25%) of the current fiscal
year's budget. If a subsequent initial payment is requested, the County must provide proof
of funds expenditure via the quarterly invoice process. All subsequent initial payments
require full utilization before another initial payment will be considered for the requested
amount; otherwise, the subsequent initial payment request will be reduced by the
unexpended amount (the difference between what was paid and what expended in the
approved quarterly invoice.).
If an invoice payment is withheld, the County will need to provide the information and/or
report(s) identified by DHCS to remediate the deficiency before DHCS will authorize
payment.
Monthly Data Report Attachment 4
County is required to use the Monthly Data Report, Attachment 4, or other reporting
method as directed by the State. The County is required to submit accurate and complete
monthly updates on a timely basis, for specific data points, as defined on the Monthly Data
Report Template, regarding the Health Navigators Project, which the State will review and
subsequently publish for public consumption. Each Monthly Data Report must include (at a
minimum) the following pieces of data for every individual submitted as either enrolled or
retained on the `Enrollment and Retention Rpt"tab:
• Full name (first and last)
• Date of birth
• Social Security Number and/or Client Identification Number
• Identify status as either enrolled or retained
• At least one or more of the 11 identified Target Populations
Each Monthly Data Report must also include updates to the following self-reported data
points on the "Aggregate Data Reporting"tab:
• DP 1: Enrolled
• DP 2: Retained
• DP 3: Direct Outreach
• DP 4: Media Outreach
• DP 5: Assisted with Application
• DP 6: Assisted with Accessing&Utilizing Health Care Services
• DP 7: Assisted with Troubleshooting
• DP 8: Assisted with Redetermination
Failure to submit complete and accurate reports on a timely basis, in accordance with the
submission schedule outlined in the Quarterly Invoice and Deliverables Deadline Bulletin
(2022-005), may result in withheld payments and an invoice dispute issued to the County.
Payments will be issued once the complete Monthly Data Report is provided to DHCS.
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ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
Ouarterly Progress Report Attachment 5
County is required to submit a Quarterly Progress Report, Attachment 5 according to the
Quarterly Invoice and Deliverables Deadline Bulletin (2022-005). Quarterly Progress
reports will be required starting with the first quarter reporting period. The County must
provide a progress report to measure and document progress-to-date on the work plan
objectives and performance goals. The State reserves the right to require reports more
frequently than on a quarterly basis if necessary, but no more than once a month. Failure to
submit complete and accurate reports on a timely basis, in accordance with the submission
schedule outlined in the Quarterly Invoice and Deliverables Deadline Bulletin (2022-005),
may result in withheld payments and an invoice dispute issued to the County. Payments
will be issued once the complete Quarterly Progress Report is provided to DHCS.
E. Allocation Termination or Withdrawal
1. County may withdraw from the Health Navigators Allocation Funding by notifying the
State in writing at any time of its request to withdraw from further participation. Once
the withdraw request is received, the State will contact the County to complete close out
tasks.
2. County may unilaterally rescind this Agreement at any time prior to the execution of the
Allocation Amount. After the execution of the Allocation Amount, this Agreement may
be rescinded, modified or amended by mutual agreement in writing.
3. Failure by the County to comply with the terms of this Agreement may be cause for
termination of all obligations of the State under this Allocation Agreement and for any
additional Allocation payments.
Upon termination or withdrawal from participation, the County must return all unspent
allocated funds to the State.
F. Loss of Allocation Amount
The County may be subject to partial or full loss of the approved Allocation Amount if any of
the following occurs, including but not limited to:
1. The County fails, without good cause, to return a signed Agreement to DHCS within
sixty(60) days of receipt of the Agreement.
2. The County fails, without good cause, to produce satisfactory invoices and deliverables
as outlined in the Quarterly Invoice and Deliverables Deadline Bulletin (2022-005).
3. The County fails, without good cause, to meet a satisfactory participation rate as
proposed on their work plan.
4. The County withdraws from the Allocation Agreement.
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ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
5. A County fails to submit a timely and satisfactory Corrective Action Plan (CAP), when
applicable. Such an action shall result in a fifty percent (50%) reduction of the total
Allocation Amount.
G. Hold Harmless
1. County agrees to waive all claims and recourse against the State including the right to
contribution for loss or damage to persons or property arising from, growing out of or in
any way connected with or incident to this Agreement, except claims arising from the
concurrent or sole negligence of the State, its officers, agents, and employees.
2. County agrees to indemnify, hold harmless and defend the State, its officers, agents and
employees against any and all claims, demand costs, expenses or liability costs arising
out of legal actions pursuant to items which the County has certified. County
acknowledges that it is solely responsible for compliance with items to which it has
certified.
H. Financial Records
1. County agrees to maintain satisfactory financial accounts, documents and records for
the expenditures of the Allocation Amount and to make them available to the State for
auditing at reasonable times. County also agrees to retain such financial accounts,
documents and records for three (3) years following the termination or completion of
the Allocation Agreement.
2. County and State agree that during Regular Office Hours each of the parties hereto and
their duly authorized representative shall have the right to inspect and make copies of
any books, records or reports of the other party pertaining to this Agreement or matters
related thereto. County agrees to maintain and make available for inspection by the
State accurate records of all of its costs, disbursements and receipts with respect to its
activities under this Agreement.
3. County agrees to use a generally accepted accounting system.
1. Audits
1. Allocations are subject to audits by the State for three (3) years following the final
payment of the Allocation Amount. The purpose of such audits is to verify that
expenditures of the Allocation Amount were properly documented. County will be
contacted at least thirty (30) days in advance of an audit.
2. Audits will include all books, papers, accounts, documents, or other records of the
County as they relate to the Allocation for which the State authorized the Allocation
Amount. The County shall ensure that the Allocation Amount records, including the
sources, documents and cancelled warrants, are readily available to the State.
Page 8
ALLOCATION AGREEMENT AMENDMENT 1 (Al)
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
COUNTY OF FRESNO
State of California—Department of Health Care Services
3. County must also provide an employee having knowledge of the Allocation Amount
and the accounting procedure or system to assist the State's auditor. The County shall
provide a copy of any document,paper, record, or the like requested by the State.
4. All Allocation Amount records must be retained for at least one (1) year following an
audit or final disputed audit findings, whichever is later in time.
J. Nondiscrimination
1. County shall not discriminate against any person on the basis of sex, race, color,
religion, ancestry, national origin, ethnic group identification, age, mental disability,
physical disability, medical condition, genetic information, marital status, gender,
gender identity, or sexual orientation when conducting Health Navigators efforts
pursuant to this Agreement and in compliance with the Americans with Disabilities Act.
2. County shall ensure the security, privacy and confidentiality of each enrollee.
K. Health Insurance Portability and Accountability Act of 1996 ("HIPAA") Attachment 6
1. County shall ensure security of privacy and confidentiality of each consumer
application and comply with HIPAA requirements as set forth by law in accordance
with Attachment 6.
L. Federal Terms & Conditions Attachment 7
1. County shall comply with all requirements and special terms and conditions set forth
within the Federal Terms and Conditions that all individuals receiving Title XIX must
adhere to. Such Federal Terms and Conditions are attached hereto as Attachment 7 and
fully incorporated herein by reference.
Page 9
Department of Health Care Services COUNTY OF FRESNO Attachment 1
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
BUDGET PLAN -AMENDMENT 1
Upon a fully signed and executed Allocation Agreement (Agreement), the county or organization is authorized to use funds for its approved purposes. Any
proposed changes to this approved funding agreement requires written approval by DHCS prior to implementing the changes.
Cumulative transfers among annual budget line items are allowed as long as the amount does not exceed five percent (5%) of the current total approved budget.
Time Base SFY 1 SFY 2 SFY 3 Administrative
Medi-Cal Navigators Project (AB 74) (FTEs) Close-Out
7/01/22 — 6/30/23 7/1/23 — 6/30/24 7/1/24 — 6/30/25 7/1/25 — 6/30/26 Amount
Personnel Staff
Benefits $ -
Total Personnel Expenses - $ - $ - $ - $ - $ -
Non-Personnel — Direct Costs
Office Expenses $ -
Equipment $ 1 ,000.00 $ 1,000.00 $ 1 ,000.00 $ 3,000.00
Travel $ -
Training $ -
Outreach Material $ 1 ,200.00 $ 1,200.00 $ 1,200.00 $ 3,600.00
Media Outreach $ 250.00 $ 250.00 $ 250.00 $ 750.00
Total Budget for All CBOs $ 398,883.00 $ 398,883.00 $ 398,884.00 $ 1,196,650.00
Other Costs [itemize expenses in an attachment] $ -
- Incentives $ -
Total Direct Costs $ 401,333.00 $ 401,333.00 $ 401,334.00 $ - $ 1,204,000.00
Augmentation for Renewals & Expansion
Event Costs $ -
Equipment (Purchase/Rental) $ -
Travel $ -
Training $ -
Outreach Material - Incentives $ 4,368.00 $ 4,368.00
Media Outreach $ -
Other Costs [itemize expenses - list as a subbullet]
- Program Supervisor 20% FTE $ 46,882.00 $ 46,882.00
- Eligibility Worker 20% FTE
New/Augmentation(s) for CBO Assistance (Directly
Related to the Renewals & Expansion Workload) $ 27,000.00 $ 27,000.00
Event Costs
Totals Medi-Cal Renewals & Expansions $ - $ 78,250.00 $ - $ - $ 78,250.00
Budget Plan Page 1 of 4 Approved: 7/06/2023
Department of Health Care Services COUNTY OF FRESNO Attachment 1
MEDI-CAL HEALTH ENROLLMENT NAVIGATORS PROJECT
BUDGET PLAN -AMENDMENT 1
Time Base SFY 1 SFY 2 SFY 3 Administrative
Medi-Cal Navigators Project (AB 74) (FTEs) Close-Out
7/01/22 — 6/30/23 7/1/23 — 6/30/24 7/1/24 — 6/30/25 7/1/25 — 6/30/26 Amount
Non-Personnel — Indirect Costs
-Health Insurance $ - $ - $ - $ -
-Other Costs [itemize expenses in an attachment] $ - $ - $ - $ -
Total Indirect Costs $ - $ - $ - $ - $ -
Total Personnel Expenses $ - $ - $ - $ - $ -
Total Direct Costs $ 401,333.00 $ 401,333.00 $ 401,334.00 $ - $ 1,204,000.00
Total Augmentation Costs $ - $ 78,250.00 $ - $ - $ 78,250.00
Total Indirect Costs @ 15.0% $ - $ - $ - $ - $ -
Grand Total $ 401,333.00 $ 479,583.00 $ 401,334.00 $ - $ 1,282,250.00
Budget Plan Page 2 of 4 Approved: 7/06/2023
Department of Health Care Services DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions - Amendment 1
# Field Name .J�������Descriptiojnd
Tab 3 Budget Plan Line Items For the Personnel section of your budget plan; state the staff, the time spent on the
project, job title, and the role the individual will serve during the Health Navigators Project.
N
For the Direct operating costs, state what your county or organization intends to bill toward
0 each line item.
C�
M Once awarded, If you plan to bill something different then what was previously stated,
i
�-' please notify DHCS for approval before purchasing. If you do not seek approval prior to
N
purchasing and the item(s) is not permissible, DHCS will not reimburse the item(s)
purchased.
FTE Name/Job Title or Position Role Description for the Health Navigators Project
a
a
O
i U)
Equipment Canopy frames. Collapsable utility wagons, poster display A-Frams, tables, chairs, table
cloths and any other item requested by CBO and approved by DSS Admin for use at
outreach events.
v Outreach Material Flyers (in English and Spanish): "How to Apply for Benefits", "Medical Notice"; "Are you
W
i N Covered?", and PHE Unwind. Brochure: Minor Consent (Eng. & Spanish) A-Frame
N Posters: For various Outreach Events and PHE Unwind. Canva Pro: 1-year subscription
O renewal to create flyers and social media posts (County Facebook and Instagram
V accounts).
a Media Outreach Medi-Cal outreach and PHE unwind messaging, with tools such as the Canva application,
Nto be shared with the general public via news and social media outlets (Local TV stations,
Podcasts, Department Youtube account, Instagram, Twitter).
Q Total Budget for All CBOs Master Agreement/Contract with CBOs, NRCs, and FQHCs for the provision of PHE
0 unwind direct messaging, client education, outreach, application assistance - renewals
O and enrollments.
Z
Other Cost:
- Incentives
Budget Plan Description Page 3 of 4 Approved: 7/06/2023
Department of Health Care Services DHCS Health Enrollment Navigators Project Attachment 1
Budget Plan Reporting Instructions - Amendment 1
Field Name AMANELOM Description
Outreach Material Incentives
a
O
Other Costs Program Supervisor
Eligibility Worker
E
CM CBO Assistance Event Costs
a
Budget Plan Description Page 4 of 4 Approved: 7/06/2023
A/H CS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
NavigatorsProgram Planning and Startup Plan
Section 1: Identify specific anticipated completion dates for the activities
identified
PROGRAM PLANNING AND START-UP ACTIVITIES ANTICIPATED ACTUAL
COMPLETION COMPLETION
What strategies/ activities will be used to achieve? DATE DATE
Create social media posts for County Facebook, Instagram, and Twitter accounts to inform public of
pending PHE end and steps current Medi-Cal clients should take to assist in maintaining active 2/28/2023
Medi-Cal.
Create fliers to inform public of pending PHE end and steps current Medi-Cal clients should take to
assist in maintaining active Medi-Cal. 2/28/2023
Create aids for social media posts and fliers to provide tips for maintaining an active Medi-Cal case
and to assist in choosing a Managed Care Plan for those that do not qualify for Medi-Cal. 4/30/2023
Concentrate specific outreach efforts to community centers and senior centers throughout Fresno
County in order to expand messaging of program changes (Medi-Cal Expansion) and pending PHE 2/28/2023
termination.
Provide targeted training to contracted Neighborhood Resource Centers to educate support staff 2/28/2023
regarding upcoming Medi-Cal program changes.
Generate scope of work, amend current NRC contracts, initiate process to contract with interested
CBOs and secure Board of Supervisor approved contracts, conduct initial training sessions with 4/30/2023
partners for the provisions related to PHE messaging and retention as outlined in contracts, and any
other related tasks to intiate CBO activities start-up.
Planning & Start-Up Page 1 of 6 Approved: 7/6/2023
A/H CS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
troubleshooting,al atgiWW"� _�qq
Section 2: Identify specific outreach, application assistance, enrollment, access & utilization to health care,
strategies and activities that meets the core objectives of AB 74 you will conduct to implement this approach. Identify specific target
. . . . . the responsible . will implement . . short
of examples of activities under each task is on . . .
IL
STRATEGIES AND ACTIVITIES TARGET RESPONSIBLE
POPULATIONS ENTITY
What strategies/ activities will be used to achieve the AB74 goals? Refer to Tab 6 Name of county or CBO,or
Task subcontracted entity
Outreach Conduct outreach events (pop-ups or one-off community events) to distribute fliers, 5 6 7g , ,
resource materials, and incentives. Provide general information and/or one-on-one , , ,11, 9 10 CBOs
assistance to attendees/clients.
Application Assist applicants in person with completing Medi-Cal applications and/or collecting
Assistance necessary verifications. Submit client applications to DSS for processing/enrollment. 5, 6, 7, 8, 9, 10,11 CBOs
Retention Provide assistance to clients when completing redetermination packets and/or 5, 6, 7, 8, 9, 10, CBOs
submitting required substantiating documentation. 11
Troubleshooti Assist clients with accessing/contacting DSS eligibility staff to discuss issues; provide 5, 6, 7, 8, 9, 10, CBOs
ng guidance, literacy assistance for client during interactions. 11
Access & Provide information about how to use Medi-Cal, provide information regarding the
Utilization various managed care plans in the area and how to access; assist with accessing 5, 6, 7,11 9, 10, CBOs
services.
Enrollment Provide assistance to clients when completing enrollment packets and/or submitting 5, 6, 7, 8, 9, 10, CBOs
required substantiating documentation. 11
Normal Operations Page 2 of 6 Approved:7/6/2023
A/H CS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
implementPublic Health Emerglyncy (PHE) Plan
Section 3: On this tab, partners should list additional activities that go above and beyond the core AB74 activities as for the following phases
of PHE. 1) Identify activities relating to outreach focus during PHE to encourage beneficiaries to provide their local county social services
agency with any updated contact information such as: name, address, phone number, and email so the county can contact beneficiaries with
important information about keeping their Medi-Cal coverage. Identify specific target population(s) and the responsible entity who will
• • to outreach and retention during the 60 days prior to PHE termination. • - specific
target population(s) and the responsible entity who will implement these activities. 3) Identify activities relating to the PHE unwind which
focuses on retention. Identify specific target population(s) and the responsible entity who will implement these activities.
STRATEGIES AND ACTIVITIES TARGET RESPONSIBLE
Task POPULATIONS ENTITY
What strategies/ activities will be used to achieve this phase? Refer to Tab 6 Name of county or CBO,or
subcontracted entity
During PHE
Outreach Share resources at outreach events informing public of impending changes with PHE and
5, 6, 7 8, 9, 10,
the need for udpated client contact information. Conduct case look-ups onsite, inform 11, DSS
clients of information/verification necessary to maintain an active case.
Media
Outreach Create Medi-Cal outreach and PHE unwind messaging, with tools such as the Canva 5, 6, 7, 8, 9, 10, DSS
application, to be shared with the general public via news and social media outlets (Local 11
TV stations, Podcasts, Department Youtube account, Instagram, Twitter).
Outreach Provide PHE unwind messaging through direct client contact 1-10 CBOs
60 Days Prior to PHE Termination
Outreach Share resources at outreach events informing public of impending changes with PHE and 5, 6, 7, 8, 9, 10, CBOs
the need for updated client contact information. 11
Outreach Provide client education through direct contact regarding actions/documentation 1-10 CBOs
necessary to maintain active case following end of PHE.
12 Month PHE Unwinding Period
Outreach Provide assistance to clients in the field and in office when completing their 5 6 7g
redetermination packets and/or submitting required substantiating documentation. , , 7, 8, 9, 10,
CBOs
PHE Operations Page 3 of 6 Approved:7/6/2023
P,o H CS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
Outreach At outreach events, provide direct information to clients regarding how to maintain their 5 6 7g , ,
ongoing case, update contact information, and provide information on necessary , , ,11, g 10 CBOs
verifications.
Retention Continue client education and PHE messaging. Assist clients with on-site 1-10 CBOs
retention/reenrollment applicatons.
PHE Operations Page 4 of 6 Approved:7/6/2023
END-H CS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
Augmented Funding For Focused Activities (Relop Ms Expansions)
Partners must detail out • approaches that were identified in their April1 • , •rs Project Survey for
Focused Activities related to Medi-Cal Renewals and Medi-Cal Expansion populations that go above and beyond the core SB 154
activities already detailed in Tab 2 and Tab 3 of your approved Work Plan. The following information must be completed for the
two sections below: 1) List and detail activities relating to the end of the Continuous Coverage Requirement unwind phase which
focuses on retention. Identify specific target population(s) and the responsible entity who will implement these activities. 2) List
and detail activities relating to outreach focus regarding the Medi-Cal expansions to educate and encourage individuals to apply
and enroll into Medi-Cal prior to or after the implementation of the expansions. Identify specific target population(s), language(s),
• the responsiblewho will implement
TASK STRATEGIES AND ACTIVITIES TARGET TARGET RESPONSIBLE
POPULATIONS LANGUAGE(S) ENTITY
Renewal Events - End of Continuous Coverage Requirement
Unwinding Period
Select One Did not request funding for this activity.
Medi-Cal Expansions Focused Outreach and Enrollments
Host/attend events within communities in which target populations
reside or gather (shop, worship, work), provide relevant targeted
Outreach information regarding the expansion, distribute fliers, resource 5,6,7,8, 9, 12 Spanish CBO/DSS
materials and incentives. Provide assistance in locating nearest
DSS site when necessary.
Application Assist applicants in person with completing Medi-cal applications
Assistance and/or collecting necessary verifications. Submit client applications 5,6,7,8, 9, 12 Spanish CBO/DSS
to DSS for processing/enrollment.
Track CBO submitted applications for clients from the expansion
Enrollment populations approval/enrollment into Medi-Cal. (While completed 5,6,7,8, 9, 12 Spanish DSS
by DSS staff not funded by the project, data will be tracked and
reported to DHCS).
Addt'I Funding Activities Page 5 of 6 Approved:7/6/2023
&HCS COUNTY OF FRESNO Attachment 2
NAVIGATORS PROJECT WORK PLAN AMENDMENT 1
Normal Operations
024
Media Outreach 1 000 1 000 1 000 Will be conducted b Department staff; NOT funded b project.
( ) ( ) ( ) Y p Yp 1
Direct Outreach 10,000 10,000 10,000
Application Assistanc 1,550 1,550 1,550
Enrollment 1,200 1,200 1,200 CBOs to provide assistance. Processing/determinations do be completed by Department staff; NOT funded by project.
Retention 900 900 900 CBOs to provide assistance. Processing/determinations do be completed by Department staff; NOT funded by project.
Navigation 750 750 750
Troubleshooting 300 300 300
Focused Activities For
Direct Outreach 8,000
Application Assistanc 840
Media Outreach (1,000) Will be conducted by Department staff; NOT funded by project.
Enrollment 24 CBOs to provide assistance. Processing/determinations do be completed by Department staff; NOT funded by project.
Retention 900 1CBOs to provide assistance. Processing/determinations do be completed by Department staff; NOT funded by project.
Navigation 750
Troubleshooting 300
Project Goals Page 6 of 6 Approved: 7/6/2023
County of Fresno
Allocation Agreement SB 154
Page 1 of 7
Attachment 6
Applicability to Allocation Agreement
This Business Associate Addendum (BAA) has been prepared for use solely in connection with the "Allocation
Agreement — Medi-Cal Health Enrollment Navigators Project between County and the Department of Health
Care Services (DHCS). The following conditions apply to the extent that performance of the Allocation
Agreement by County results in County having access to or gathering Protected Health Information or Personal
Information as defined in paragraph 4.1 below:
A. If the county business unit entering into the Allocation Agreement on behalf of County is the same county
business unit that performs Medi-Cal eligibility services on behalf of DHCS, and County has made a
separate Privacy and Security Agreement with DHCS, then this BAA does not apply, and the Allocation
Agreement shall instead be subject to the provisions of the Privacy and Security Agreement.
B. If the county business unit or other entity entering into the Allocation Agreement is not the same county
business unit that performs Medi-Cal eligibility services on behalf of DHCS, or County has not made a
separate Privacy and Security Agreement with DHCS, then the following BAA does apply to the Allocation
Agreement.
Business Associate Addendum
1. This Agreement has been determined to constitute a business associate relationship under the Health
Insurance Portability and Accountability Act (HIPAA) and its implementing privacy and security regulations
at 45 Code of Federal Regulations, Parts 160 and 164 (collectively, and as used in this Agreement)
2. The term "Agreement" as used in this document refers to and includes both this Business Associate
Addendum and the contract to which this Business Associate Agreement is attached as an exhibit, if any.
3. For purposes of this Agreement, the term "Business Associate" shall have the same meaning as set forth in
45 CFR section 160.103.
4. The Department of Health Care Services (DHCS) intends that Business Associate may create, receive,
maintain, transmit or aggregate certain information pursuant to the terms of this Agreement, some of which
information may constitute Protected Health Information (PHI) and/or confidential information protected by
Federal and/or state laws.
4.1 As used in this Agreement and unless otherwise stated, the term "PHI" refers to and includes both "PHI"
as defined at 45 CFR section 160.103 and Personal Information (PI) as defined in the Information
Practices Act (IPA) at California Civil Code section 1798.3(a). PHI includes information in any form,
including paper, oral, and electronic.
4.2 As used in this Agreement, the term "confidential information" refers to information not otherwise defined
as PHI in Section 4.1 of this Agreement, but to which state and/or federal privacy and/or security
protections apply.
5. Contractor (however named elsewhere in this Agreement) is the Business Associate of DHCS acting on
DHCS's behalf and provides services or arranges, performs or assists in the performance of functions or
activities on behalf of DHCS, and may create, receive, maintain, transmit, aggregate, use or disclose PHI
(collectively, "use or disclose PHI") in order to fulfill Business Associate's obligations under this Agreement.
DHCS and Business Associate are each a party to this Agreement and are collectively referred to as the
"parties."
6. The terms used in this Agreement, but not otherwise defined, shall have the same meanings as those terms
in HIPAA and/or the IPA. Any reference to statutory or regulatory language shall be to such language as in
effect or as amended.
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
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Allocation Agreement SB 154
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7. Permitted Uses and Disclosures of PHI by Business Associate. Except as otherwise indicated in this
Agreement, Business Associate may use or disclose PHI, inclusive of de-identified data derived from such
PHI, only to perform functions, activities or services specified in this Agreement on behalf of DHCS, provided
that such use or disclosure would not violate HIPAA or other applicable laws if done by DHCS.
7.1 Specific Use and Disclosure Provisions. Except as otherwise indicated in this Agreement, Business
Associate may use and disclose PHI if necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business Associate. Business
Associate may disclose PHI for this purpose if the disclosure is required by law, or the Business
Associate obtains reasonable assurances from the person to whom the information is disclosed that it
will be held confidentially and used or further disclosed only as required by law or for the purposes for
which it was disclosed to the person. The person shall notify the Business Associate of any instances
of which the person is aware that the confidentiality of the information has been breached, unless such
person is a treatment provider not acting as a business associate of Business Associate.
8. Compliance with Other Applicable Law
8.1 To the extent that other state and/or federal laws provide additional, stricter and/or more protective
(collectively, more protective) privacy and/or security protections to PHI or other confidential information
covered under this Agreement beyond those provided through HIPAA, Business Associate agrees:
8.1.1 To comply with the more protective of the privacy and security standards set forth in applicable state
or federal laws to the extent such standards provide a greater degree of protection and security than
HIPAA or are otherwise more favorable to the individuals whose information is concerned; and
8.1.2 To treat any violation of such additional and/or more protective standards as a breach or security
incident, as appropriate, pursuant to Section 18. of this Agreement.
8.2 Examples of laws that provide additional and/or stricter privacy protections to certain types of PHI
and/or confidential information, as defined in Section 4. of this Agreement, include, but are not limited
to the Information Practices Act, California Civil Code sections 1798-1798.78, Confidentiality of
Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, Welfare and Institutions Code section 5328,
and California Health and Safety Code section 11845.5.
8.3 If Business Associate is a Qualified Service Organization (QSO) as defined in 42 CFR section 2.11,
Business Associate agrees to be bound by and comply with subdivisions (2)(i) and (2)(ii) under the
definition of QSO in 42 CFR section 2.11.
9. Additional Responsibilities of Business Associate
9.1 Nondisclosure. Business Associate shall not use or disclose PHI or other confidential information other
than as permitted or required by this Agreement or as required by law.
9.2 Safeguards and Security.
9.2.1 Business Associate shall use safeguards that reasonably and appropriately protect the
confidentiality, integrity, and availability of PHI and other confidential data and comply, where
applicable, with subpart C of 45 CFR Part 164 with respect to electronic protected health
information, to prevent use or disclosure of the information other than as provided for by this
Agreement. Such safeguards shall be based on applicable Federal Information Processing
Standards (FIPS) Publication 199 protection levels.
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
County of Fresno
Allocation Agreement SB 154
Page 3 of 7
9.2.2 Business Associate shall, at a minimum, utilize a National Institute of Standards and Technology
Special Publication (NIST SP) 800-53 compliant security framework when selecting and
implementing its security controls and shall maintain continuous compliance with NIST SP 800-
53 as it may be updated from time to time. The current version of NIST SP 800-53, Revision 5,
is available online at https://csrc.nist.gov/publications/detail/sp/800-53/rev-5/final; updates will
be available online at https://csrc.nist.gov/publications/sp800.
9.2.3 Business Associate shall employ FIPS 140-2 validated encryption of PHI at rest and in motion
unless Business Associate determines it is not reasonable and appropriate to do so based upon
a risk assessment, and equivalent alternative measures are in place and documented as
such. FIPS 140-2 validation can be determined online at
https://csrc.nist.gov/protects/cryptographic-modu le-validation-program/validated-
modules/search, with information about the Cryptographic Module Validation Program under
FIPS 140-2 available online at https://csrc.nist.gov/Projects/cryptographic-module-validation-
program/figs-140-2. In addition, Business Associate shall maintain, at a minimum, the most
current industry standards for transmission and storage of PHI and other confidential information.
9.2.4 Business Associate shall apply security patches and upgrades, and keep virus software up-to-
date, on all systems on which PHI and other confidential information may be used.
9.2.5 Business Associate shall ensure that all members of its workforce with access to PHI and/or
other confidential information sign a confidentiality statement prior to access to such data. The
statement must be renewed annually.
9.2.6 Business Associate shall identify the security official who is responsible for the development and
implementation of the policies and procedures required by 45 CFR Part 164, Subpart C.
9.3 Business Associate's Agent. Business Associate shall ensure that any agents, subcontractors, sub
awardees, vendors or others (collectively, "agents") that use or disclose PHI and/or confidential
information on behalf of Business Associate agree to the same restrictions and conditions that apply to
Business Associate with respect to such PHI and/or confidential information.
10. Mitigation of Harmful Effects. Business Associate shall mitigate, to the extent practicable, any harmful
effect that is known to Business Associate of a use or disclosure of PHI and other confidential information in
violation of the requirements of this Agreement.
11. Access to PHI. Business Associate shall make PHI available in accordance with 45 CFR section 164.524.
12. Amendment of PHI. Business Associate shall make PHI available for amendment and incorporate any
amendments to protected health information in accordance with 45 CFR section 164.526.
13. Accounting for Disclosures. Business Associate shall make available the information required to provide
an accounting of disclosures in accordance with 45 CFR section 164.528.
14. Compliance with DHCS Obligations. To the extent Business Associate is to carry out an obligation of
DHCS under 45 CFR Part 164, Subpart E, comply with the requirements of the subpart that apply to DHCS
in the performance of such obligation.
15. Access to Practices, Books and Records. Business Associate shall make its internal practices, books,
and records relating to the use and disclosure of PHI on behalf of DHCS available to DHCS upon reasonable
request, and to the federal Secretary of Health and Human Services for purposes of determining DHCS'
compliance with 45 CFR Part 164, Subpart E.
16. Return or Destroy PHI on Termination, Survival. At termination of this Agreement, if feasible, Business
Associate shall return or destroy all PHI and other confidential information received from or created or
received by Business Associate on behalf of, DHCS that Business Associate still maintains in any form and
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
County of Fresno
Allocation Agreement SB 154
Page 4 of 7
retain no copies of such information. If return or destruction is not feasible, Business Associate shall notify
DHCS of the conditions that make the return or destruction infeasible, and DHCS and Business Associate
shall determine the terms and conditions under which Business Associate may retain the PHI. If such return
or destruction is not feasible, Business Associate shall extend the protections of this Agreement to the
information and limit further uses and disclosures to those purposes that make the return or destruction of
the information infeasible.
17. Special Provision for SSA Data. If Business Associate receives data from or on behalf of DHCS that was
verified by or provided by the Social Security Administration (SSA data) and is subject to an agreement
between DHCS and SSA, Business Associate shall provide, upon request by DHCS, a list of all employees
and agents and employees who have access to such data, including employees and agents of its agents, to
DHCS.
18. Breaches and Security Incidents. Business Associate shall implement reasonable systems for the
discovery and prompt reporting of any breach or security incident, and take the following steps:
18.1 Notice to DHCS.
18.1.1 Business Associate shall notify DHCS immediately upon the discovery of a suspected breach
or security incident that involves SSA data. This notification will be provided by email upon
discovery of the breach. If Business Associate is unable to provide notification by email, then
Business Associate shall provide notice by telephone to DHCS.
18.1.2 Business Associate shall notify DHCS within 24 hours by email (or by telephone if Business
Associate is unable to email DHCS) of the discovery of the following, unless attributable to a
treatment provider that is not acting as a business associate of Business Associate:
18.1.2.1 Unsecured PHI if the PHI is reasonably believed to have been accessed or acquired
by an unauthorized person;
18.1.2.2 Any suspected security incident which risks unauthorized access to PHI and/or other
confidential information;
18.1.2.3 Any intrusion or unauthorized access, use or disclosure of PHI in violation of this
Agreement; or
18.1.2.4 Potential loss of confidential information affecting this Agreement.
18.1.3 Notice shall be provided to the DHCS Program Contract Manager (as applicable), the DHCS
Privacy Office, and the DHCS Information Security Office (collectively, "DHCS Contacts")
using the DHCS Contact Information at Section 18.6. below.
Notice shall be made using the current DHCS "Privacy Incident Reporting Form" ("PIR Form";
the initial notice of a security incident or breach that is submitted is referred to as an "Initial
PIR Form") and shall include all information known at the time the incident is reported. The
form is available online at
https://www.dhcs.ca.gov/formsandpubs/laws/priv/Documents/Privacy-Incident-Report-PIR.pdf.
Upon discovery of a breach or suspected security incident, intrusion or unauthorized access,
use or disclosure of PHI, Business Associate shall take:
18.1.3.1 Prompt action to mitigate any risks or damages involved with the security incident or
breach; and
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
County of Fresno
Allocation Agreement SB 154
Page 5 of 7
18.1.3.2 Any action pertaining to such unauthorized disclosure required by applicable Federal
and State law.
18.2 Investigation. Business Associate shall immediately investigate such security incident or breach.
18.3 Complete Report. To provide a complete report of the investigation to the DHCS contacts within ten
(10) working days of the discovery of the security incident or breach. This "Final PIR" must include
any applicable additional information not included in the Initial Form. The Final PIR Form shall include
an assessment of all known factors relevant to a determination of whether a breach occurred under
HIPAA and other applicable federal and state laws. The report shall also include a full, detailed
corrective action plan, including its implementation date and information on mitigation measures
taken to halt and/or contain the improper use or disclosure. If DHCS requests information in addition
to that requested through the PIR form, Business Associate shall make reasonable efforts to provide
DHCS with such information. A "Supplemental PIR" may be used to submit revised or additional
information after the Final PIR is submitted. DHCS will review and approve or disapprove Business
Associate's determination of whether a breach occurred, whether the security incident or breach is
reportable to the appropriate entities, if individual notifications are required, and Business Associate's
corrective action plan.
18.3.1 If Business Associate does not complete a Final PIR within the ten (10) working day
timeframe, Business Associate shall request approval from DHCS within the ten (10)working
day timeframe of a new submission timeframe for the Final PIR.
18.4 Notification of Individuals. If the cause of a breach is attributable to Business Associate or its
agents, other than when attributable to a treatment provider that is not acting as a business associate
of Business Associate, Business Associate shall notify individuals accordingly and shall pay all costs
of such notifications, as well as all costs associated with the breach. The notifications shall comply
with applicable federal and state law. DHCS shall approve the time, manner and content of any such
notifications and their review and approval must be obtained before the notifications are made.
18.5 Responsibility for Reporting of Breaches to Entities Other than DHCS. If the cause of a breach
of PHI is attributable to Business Associate or its agents, other than when attributable to a
treatment provider that is not acting as a business associate of Business Associate, Business
Associate is responsible for all required reporting of the breach as required by applicable federal and
state law.
18.6 DHCS Contact Information. To direct communications to the above referenced DHCS staff, the
Contractor shall initiate contact as indicated here. DHCS reserves the right to make changes to the
contact information below by giving written notice to Business Associate. These changes shall not
require an amendment to this Agreement.
DHCS Program DHCS Privacy Office DHCS Information Security Office
Contract Manager
See the Scope of Work Privacy Office Information Security Office
exhibit for Program c/o: Office of HIPAA Compliance DHCS Information Security Office
Contract Manager Department of Health Care Services P.O. Box 997413, MS 6400
information. If this P.O. Box 997413, MS 4722 Sacramento, CA 95899-7413
Business Associate Sacramento, CA 95899-7413
Agreement is not Email: incidents(cbdhcs.ca.gov
attached as an exhibit to Email: incidents(c�dhcs.ca.gov
a contract, contact the
DHCS signatory to this Telephone: (916)445-4646
Agreement.
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
County of Fresno
Allocation Agreement SB 154
Page 6 of 7
19. Responsibility of DHCS. DHCS agrees to not request the Business Associate to use or disclose PHI in
any manner that would not be permissible under HIPAA and/or other applicable federal and/or state law.
20. Audits, Inspection and Enforcement
20.1 From time to time, DHCS may inspect the facilities, systems, books and records of Business Associate
to monitor compliance with this Agreement. Business Associate shall promptly remedy any violation
of this Agreement and shall certify the same to the DHCS Privacy Officer in writing. Whether or how
DHCS exercises this provision shall not in any respect relieve Business Associate of its responsibility
to comply with this Agreement.
20.2 If Business Associate is the subject of an audit, compliance review, investigation or any proceeding
that is related to the performance of its obligations pursuant to this Agreement or is the subject of any
judicial or administrative proceeding alleging a violation of HIPAA, Business Associate shall promptly
notify DHCS unless it is legally prohibited from doing so.
21. Termination
21.1 Termination for Cause. Upon DHCS' knowledge of a violation of this Agreement by Business
Associate, DHCS may in its discretion:
21.1.1 Provide an opportunity for Business Associate to cure the violation and terminate this
Agreement if Business Associate does not do so within the time specified by DHCS; or
21.1.2 Terminate this Agreement if Business Associate has violated a material term of this
Agreement.
21.2 Judicial or Administrative Proceedings. DHCS may terminate this Agreement if Business
Associate is found to have violated HIPAA, or stipulates or consents to any such conclusion, in any
judicial or administrative proceeding.
22. Miscellaneous Provisions
22.1 Disclaimer. DHCS makes no warranty or representation that compliance by Business Associate with
this Agreement will satisfy Business Associate's business needs or compliance obligations. Business
Associate is solely responsible for all decisions made by Business Associate regarding the
safeguarding of PHI and other confidential information.
22.2. Amendment.
22.2.1 Any provision of this Agreement which is in conflict with current or future applicable Federal or
State laws is hereby amended to conform to the provisions of those laws. Such amendment of
this Agreement shall be effective on the effective date of the laws necessitating it, and shall be
binding on the parties even though such amendment may not have been reduced to writing and
formally agreed upon and executed by the parties.
22.2.2 Failure by Business Associate to take necessary actions required by amendments to this
Agreement under Section 22.2.1 shall constitute a material violation of this Agreement.
22.3 Assistance in Litigation or Administrative Proceedings. Business Associate shall make itself and
its employees and agents available to DHCS at no cost to DHCS to testify as witnesses, or otherwise,
in the event of litigation or administrative proceedings being commenced against DHCS, its directors,
officers and/or employees based upon claimed violation of HIPAA, which involve inactions or actions
by the Business Associate.
22.4 No Third-Party Beneficiaries. Nothing in this Agreement is intended to or shall confer, upon any
third person any rights or remedies whatsoever.
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Allocation Agreement SIB 154
Page 7of7
22.5 Interpretation. The terms and conditions in this Agreement shall be interpreted as broadly as
necessary to implement and comply with HIPAA and other applicable laws.
22.6 No Waiver of Obligations. No change, waiver or discharge of any liability or obligation hereunder
on any one or more occasions shall be deemed a waiver of performance of any continuing or other
obligation, or shall prohibit enforcement of any obligation, on any other occasion.
DHCS HIPAA BAA 09/21 - modified for Allocation Agreement 10012022
Department of Health Care Services Attachment 7
Medi-Cal Health Enrollment Navigators Project
Special Terms and Conditions
(For federally funded service contracts or agreements and grant agreements)
The use of headings or titles throughout this exhibit is for convenience only and shall not
be used to interpret or to govern the meaning of any specific term or condition.
The terms "contract", "Contractor" and "Subcontractor" shall also mean, "agreement",
"grant", "grant agreement", "Grantee" and "Subgrantee" respectively.
The terms "California Department of Health Care Services", "California Department of
Health Services", `Department of Health Care Services", "Department of Health Services",
"CDHCS", "DHCS", "CDHS", and "DHS" shall all have the same meaning and refer to the
California State agency that is a party to this Agreement.
This exhibit contains provisions that require strict adherence to various contracting laws
and policies. Some provisions herein are conditional and only apply if specified conditions
exist(i.e., agreement total exceeds a certain amount; agreement is federally funded, etc.).
The provisions herein apply to this Agreement unless the provisions are removed by
reference on the face of this Agreement, the provisions are superseded by an alternate
provision appearing elsewhere in this Agreement, or the applicable conditions do not
exist.
Page 1 of 39
Department of Health Care Services Attachment 7
Medi-Cal Health Enrollment Navigators Project
Index of Special Terms and Conditions
1. Federal Equal Employment Opportunity 20. Debarment and Suspension
Requirements Certification
2. Travel and Per Diem Reimbursement 21 . Smoke-Free Workplace
3. Procurement Rules Certification
4. Equipment Ownership/ Inventory/ 22. Covenant Against Contingent
Disposition Fees
5. Subcontract Requirements 23. Payment Withholds
6. Income Restrictions 24. Performance Evaluation
7. Audit and Record Retention 25. Officials Not to Benefit
8. Site Inspection 26. Four-Digit Date Compliance
9. Federal Contract Funds 27. Prohibited Use of State Funds
for Software
10. Termination
28. Use of Small, Minority Owned
11. Intellectual Property Rights and Women's Businesses
12. Air or Water Pollution Requirements 29. Alien Ineligibility Certification
13. Prior Approval of Training Seminars, 30. Union Organizing
Workshops or Conferences 31 . Contract Uniformity(Fringe
14. Confidentiality of Information Benefit Allowability)
15. Documents, Publications, and Written 32. Suspension or Stop Work
Reports Notification
16. Dispute Resolution Process 33. Public Communications
17. Financial and Compliance Audit 34. Compliance with Statutes and
Requirements Regulations
18. Human Subjects Use Requirements 35. Lobbying Restrictions and
19. Novation Requirements Disclosure Certification
Page 2 of 39
Department of Health Care Services Attachment 7
Medi-Cal Health Enrollment Navigators Project
1. Federal Equal Opportunity Requirements
(Applicable to all federally funded agreements entered into by the Department of
Health Care Services)
a. The Contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, national origin, physical or
mental handicap, disability, age or status as a disabled veteran or veteran of the
Vietnam era. The Contractor will take affirmative action to ensure that qualified
applicants are employed, and that employees are treated during employment,
without regard to their race, color, religion, sex, national origin, physical or mental
handicap, disability, age or status as a disabled veteran or veteran of the
Vietnam era. Such action shall include, but not be limited to the following:
employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation;
and career development opportunities and selection for training, including
apprenticeship. The Contractor agrees to post in conspicuous places, available
to employees and applicants for employment, notices to be provided by the
Federal Government or DHCS, setting forth the provisions of the Equal
Opportunity clause, Section 503 of the Rehabilitation Act of 1973 and the
affirmative action clause required by the Vietnam Era Veterans' Readjustment
Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the
Contractor's obligation under the law to take affirmative action to employ and
advance in employment qualified applicants without discrimination based on their
race, color, religion, sex, national origin physical or mental handicap, disability,
age or status as a disabled veteran or veteran of the Vietnam era and the rights
of applicants and employees.
b. The Contractor will, in all solicitations or advancements for employees placed by
or on behalf of the Contractor, state that all qualified applicants will receive
consideration for employment without regard to race, color, religion, sex, national
origin physical or mental handicap, disability, age or status as a disabled veteran
or veteran of the Vietnam era.
c. The Contractor will send to each labor union or representative of workers with
which it has a collective bargaining agreement or other contract or understanding
a notice, to be provided by the Federal Government or the State, advising the
labor union or workers' representative of the Contractor's commitments under the
provisions herein and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
d. The Contractor will comply with all provisions of and furnish all information and
reports required by Section 503 of the Rehabilitation Act of 1973, as amended,
the Vietnam Era Veterans' Readjustment Assistance Act of 1974 (38 U.S.C.
4212) and of the Federal Executive Order No. 11246 as amended, including by
Executive Order 11375, `Amending Executive Order 11246 Relating to Equal
Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60,
"Office of the Federal Contract Compliance Programs, Equal Employment
Opportunity, Department of Labor," and of the rules, regulations, and relevant
orders of the Secretary of Labor.
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e. The Contractor will furnish all information and reports required by Federal
Executive Order No. 11246 as amended, including by Executive Order 11375,
'Amending Executive Order 11246 Relating to Equal Employment Opportunity,'
and as supplemented by regulation at 41 CFR part 60, "Office of Federal
Contract Compliance Programs, Equal Employment Opportunity, Department of
Labor," and the Rehabilitation Act of 1973, and by the rules, regulations, and
orders of the Secretary of Labor, or pursuant thereto, and will permit access to its
books, records, and accounts by the State and its designated representatives
and the Secretary of Labor for purposes of investigation to ascertain compliance
with such rules, regulations, and orders.
f. In the event of the Contractor's noncompliance with the requirements of the
provisions herein or with any federal rules, regulations, or orders which are
referenced herein, this Agreement may be cancelled, terminated, or suspended
in whole or in part and the Contractor may be declared ineligible for further
federal and state contracts in accordance with procedures authorized in Federal
Executive Order No. 11246 as amended and such other sanctions may be
imposed and remedies invoked as provided in Federal Executive Order No.
11246 as amended, including by Executive Order 11375, `Amending Executive
Order 11246 Relating to Equal Employment Opportunity,' and as supplemented
by regulation at 41 CFR part 60, "Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor," or by rule,
regulation, or order of the Secretary of Labor, or as otherwise provided by law.
g. The Contractor will include the provisions of Paragraphs a through g in every
subcontract or purchase order unless exempted by rules, regulations, or orders
of the Secretary of Labor issued pursuant to Federal Executive Order No. 11246
as amended, including by Executive Order 11375, `Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by
regulation at 41 CFR part 60, "Office of Federal Contract Compliance Programs,
Equal Employment Opportunity, Department of Labor," or Section 503 of the
Rehabilitation Act of 1973 or (38 U.S.C. 4212) of the Vietnam Era Veteran's
Readjustment Assistance Act, so that such provisions will be binding upon each
subcontractor or vendor. The Contractor will take such action with respect to any
subcontract or purchase order as the Director of the Office of Federal Contract
Compliance Programs or DHCS may direct as a means of enforcing such
provisions including sanctions for noncompliance provided, however, that in the
event the Contractor becomes involved in, or is threatened with litigation by a
subcontractor or vendor as a result of such direction by DHCS, the Contractor
may request in writing to DHCS, who, in turn, may request the United States to
enter into such litigation to protect the interests of the State and of the United
States.
2. Travel and Per Diem Reimbursement
(Applicable if travel and/or per diem expenses are reimbursed with agreement
funds.)
Reimbursement for travel and per diem expenses from DHCS under this Agreement
shall, unless otherwise specified in this Agreement, be at the rates currently in effect,
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as established by the California Department of Human Resources (CaIHR), for
nonrepresented state employees as stipulated in DHCS' Travel Reimbursement
Information Exhibit. If the CaIHR rates change during the term of the Agreement, the
new rates shall apply upon their effective date and no amendment to this Agreement
shall be necessary. Exceptions to CaIHR rates may be approved by DHCS upon the
submission of a statement by the Contractor indicating that such rates are not
available to the Contractor. No travel outside the State of California shall be
reimbursed without prior authorization from DHCS. Verbal authorization should be
confirmed in writing. Written authorization may be in a form including fax or email
confirmation.
3. Procurement Rules
(Applicable to agreements in which equipment/property, commodities and/or
supplies are furnished by DHCS or expenses for said items are reimbursed by
DHCS with state or federal funds provided under the Agreement.)
a. Equipment/Property definitions
Wherever the term equipment and/or property is used, the following definitions
shall apply:
(1) Major equipment/property: A tangible or intangible item having a base unit
cost of $5,000 or more with a life expectancy of one (1) year or more and is
either furnished by DHCS or the cost is reimbursed through this Agreement.
Software and videos are examples of intangible items that meet this
definition.
(2) Minor equipment/property: A tangible item having a base unit cost of less
than $5,000 with a life expectancy of one (1) year or more and is either
furnished by DHCS or the cost is reimbursed through this Agreement.
b. Government and public entities (including state colleges/universities and
auxiliary organizations), whether acting as a contractor and/or subcontractor,
may secure all commodities, supplies, equipment and services related to such
purchases that are required in performance of this Agreement. Said
procurements are subject to Paragraphs d through h of Provision 3. Paragraph c
of Provision 3 shall also apply, if equipment/property purchases are delegated to
subcontractors that are nonprofit organizations or commercial businesses.
c. Nonprofit organizations and commercial businesses, whether acting as a
contractor and/or subcontractor, may secure commodities, supplies,
equipment/property and services related to such purchases for performance
under this Agreement.
(1) Equipment/property purchases shall not exceed $50,000 annually.
To secure equipment/property above the annual maximum limit of$50,000,
the Contractor shall make arrangements through the appropriate DHCS
Program Contract Manager, to have all remaining equipment/property
purchased through DHCS' Purchasing Unit. The cost of equipment/property
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purchased by or through DHCS shall be deducted from the funds available in
this Agreement. Contractor shall submit to the DHCS Program Contract
Manager a list of equipment/property specifications for those items that the
State must procure. DHCS may pay the vendor directly for such arranged
equipment/property purchases and title to the equipment/property will remain
with DHCS. The equipment/property will be delivered to the Contractor's
address, as stated on the face of the Agreement, unless the Contractor
notifies the DHCS Program Contract Manager, in writing, of an alternate
delivery address.
(2) All equipment/property purchases are subject to Paragraphs d through h of
Provision 3. Paragraph b of Provision 3 shall also apply, if equipment/property
purchases are delegated to subcontractors that are either a government or
public entity.
(3) Nonprofit organizations and commercial businesses shall use a procurement
system that meets the following standards:
(a) Maintain a code or standard of conduct that shall govern the performance
of its officers, employees, or agents engaged in awarding procurement
contracts. No employee, officer, or agent shall participate in the selection,
award, or administration of a procurement, or bid contract in which, to his
or her knowledge, he or she has a financial interest.
(b) Procurements shall be conducted in a manner that provides, to the
maximum extent practical, open, and free competition.
(c) Procurements shall be conducted in a manner that provides for all of the
following:
[1] Avoid purchasing unnecessary or duplicate items.
[2] Equipment/property solicitations shall be based upon a clear and
accurate description of the technical requirements of the goods to be
procured.
[3] Take positive steps to utilize small and veteran owned businesses.
d. Unless waived or otherwise stipulated in writing by DHCS, prior written
authorization from the appropriate DHCS Program Contract Manager will be
required before the Contractor will be reimbursed for any purchase of $5,000 or
more for commodities, supplies, equipment/property, and services related to
such purchases. The Contractor must provide in its request for authorization all
particulars necessary, as specified by DHCS, for evaluating the necessity or
desirability of incurring such costs. The term "purchase" excludes the purchase
of services from a subcontractor and public utility services at rates established for
uniform applicability to the general public.
e. In special circumstances, determined by DHCS (e.g., when DHCS has a need to
monitor certain purchases, etc.), DHCS may require prior written authorization
and/or the submission of paid vendor receipts for any purchase, regardless of
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dollar amount. DHCS reserves the right to either deny claims for reimbursement
or to request repayment for any Contractor and/or subcontractor purchase that
DHCS determines to be unnecessary in carrying out performance under this
Agreement.
f. The Contractor and/or subcontractor must maintain a copy or narrative
description of the procurement system, guidelines, rules, or regulations that will
be used to make purchases under this Agreement. The State reserves the right
to request a copy of these documents and to inspect the purchasing practices of
the Contractor and/or subcontractor at any time.
g. For all purchases, the Contractor and/or subcontractor must maintain copies of
all paid vendor invoices, documents, bids and other information used in vendor
selection, for inspection or audit. Justifications supporting the absence of bidding
(i.e., sole source purchases) shall also be maintained on file by the Contractor
and/or subcontractor for inspection or audit.
h. DHCS may, with cause (e.g., with reasonable suspicion of unnecessary
purchases or use of inappropriate purchase practices, etc.), withhold, cancel,
modify, or retract the delegated purchase authority granted under Paragraphs b
and/or c of Provision 3 by giving the Contractor no less than 30 calendar days
written notice.
4. Equipment/Property Ownership / Inventory/ Disposition
(Applicable to agreements in which equipment/property is furnished by DHCS and/or
when said items are purchased or reimbursed by DHCS with state or federal funds
provided under the Agreement.)
a. Wherever the term equipment and/or property is used in Provision 4, the
definitions in Paragraph a of Provision 3 shall apply.
Unless otherwise stipulated in this Agreement, all equipment and/or property that
is purchased/reimbursed with agreement funds or furnished by DHCS under the
terms of this Agreement shall be considered state equipment and the property of
DHCS.
(1) Reporting of Equipment/Property Receipt
DHCS requires the reporting, tagging and annual inventorying of all
equipment and/or property that is furnished by DHCS or
purchased/reimbursed with funds provided through this Agreement.
Upon receipt of equipment and/or property, the Contractor shall report the
receipt to the DHCS Program Contract Manager. To report the receipt of said
items and to receive property tags, Contractor shall use a form or format
designated by DHCS' Asset Management Unit. If the appropriate form (i.e.,
Contractor Equipment Purchased with DHCS Funds) does not accompany
this Agreement, Contractor shall request a copy from the DHCS Program
Contract Manager.
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(2) Annual Equipment/Property Inventory
If the Contractor enters into an agreement with a term of more than twelve
months, the Contractor shall submit an annual inventory of state equipment
and/or property to the DHCS Program Contract Manager using a form or
format designated by DHCS' Asset Management Unit. If an inventory report
form (i.e., Inventory/Disposition of DHCS-Funded Equipment) does not
accompany this Agreement, Contractor shall request a copy from the DHCS
Program Contract Manager. Contractor shall:
(a) Include in the inventory report, equipment and/or property in the
Contractor's possession and/or in the possession of a subcontractor
(including independent consultants).
(b) Submit the inventory report to DHCS according to the instructions
appearing on the inventory form or issued by the DHCS Program Contract
Manager.
(c) Contact the DHCS Program Contract Manager to learn how to remove,
trade-in, sell, transfer or survey off, from the inventory report, expired
equipment and/or property that is no longer wanted, usable or has passed
its life expectancy. Instructions will be supplied by either the DHCS
Program Contract Manager or DHCS' Asset Management Unit.
b. Title to state equipment and/or property shall not be affected by its incorporation
or attachment to any property not owned by the State.
c. Unless otherwise stipulated, DHCS shall be under no obligation to pay the cost of
restoration, or rehabilitation of the Contractor's and/or Subcontractor's facility
which may be affected by the removal of any state equipment and/or property.
d. The Contractor and/or Subcontractor shall maintain and administer a sound
business program for ensuring the proper use, maintenance, repair, protection,
insurance and preservation of state equipment and/or property.
(1) In administering this provision, DHCS may require the Contractor and/or
Subcontractor to repair or replace, to DHCS' satisfaction, any damaged, lost
or stolen state equipment and/or property. In the event of state equipment
and/or miscellaneous property theft, Contractor and/or Subcontractor shall
immediately file a theft report with the appropriate police agency or the
California Highway Patrol and Contractor shall promptly submit one copy of
the theft report to the DHCS Program Contract Manager.
e. Unless otherwise stipulated by the Program funding this Agreement, equipment
and/or property purchased/reimbursed with agreement funds or furnished by
DHCS under the terms of this Agreement, shall only be used for performance of
this Agreement or another DHCS agreement.
f. Within sixty (60) calendar days prior to the termination or end of this Agreement,
the Contractor shall provide a final inventory report of equipment and/or property
to the DHCS Program Contract Manager and shall, at that time, query DHCS as
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to the requirements, including the manner and method, of returning state
equipment and/or property to DHCS. Final disposition of equipment and/or
property shall be at DHCS expense and according to DHCS instructions.
Equipment and/or property disposition instructions shall be issued by DHCS
immediately after receipt of the final inventory report. At the termination or
conclusion of this Agreement, DHCS may at its discretion, authorize the
continued use of state equipment and/or property for performance of work under
a different DHCS agreement.
g. Motor Vehicles
(Applicable only if motor vehicles are purchased/reimbursed with agreement
funds or furnished by DHCS under this Agreement.)
(1) If motor vehicles are purchased/reimbursed with agreement funds or
furnished by DHCS under the terms of this Agreement, within thirty (30)
calendar days prior to the termination or end of this Agreement, the
Contractor and/or Subcontractor shall return such vehicles to DHCS and shall
deliver all necessary documents of title or registration to enable the proper
transfer of a marketable title to DHCS.
(2) If motor vehicles are purchased/reimbursed with agreement funds or
furnished by DHCS under the terms of this Agreement, the State of California
shall be the legal owner of said motor vehicles and the Contractor shall be the
registered owner. The Contractor and/or a subcontractor may only use said
vehicles for performance and under the terms of this Agreement.
(3) The Contractor and/or Subcontractor agree that all operators of motor
vehicles, purchased/reimbursed with agreement funds or furnished by DHCS
under the terms of this Agreement, shall hold a valid State of California
driver's license. In the event that ten or more passengers are to be
transported in any one vehicle, the operator shall also hold a State of
California Class B driver's license.
(4) If any motor vehicle is purchased/reimbursed with agreement funds or
furnished by DHCS under the terms of this Agreement, the Contractor and/or
Subcontractor, as applicable, shall provide, maintain, and certify that, at a
minimum, the following type and amount of automobile liability insurance is in
effect during the term of this Agreement or any extension period during which
any vehicle remains in the Contractor's and/or Subcontractor's possession:
Automobile Liability Insurance
(a) The Contractor, by signing this Agreement, hereby certifies that it
possesses or will obtain automobile liability insurance in the amount of
$1,000,000 per occurrence for bodily injury and property damage
combined. Said insurance must be obtained and made effective upon the
delivery date of any motor vehicle, purchased/reimbursed with agreement
funds or furnished by DHCS under the terms of this Agreement, to the
Contractor and/or Subcontractor.
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(b) The Contractor and/or Subcontractor shall, as soon as practical, furnish a
copy of the certificate of insurance to the DHCS Program Contract
Manager. The certificate of insurance shall identify the DHCS contract or
agreement number for which the insurance applies.
(c) The Contractor and/or Subcontractor agree that bodily injury and property
damage liability insurance, as required herein, shall remain in effect at all
times during the term of this Agreement or until such time as the motor
vehicle is returned to DHCS.
(d) The Contractor and/or Subcontractor agree to provide, at least thirty (30)
days prior to the expiration date of said insurance coverage, a copy of a
new certificate of insurance evidencing continued coverage, as indicated
herein, for not less than the remainder of the term of this Agreement, the
term of any extension or continuation thereof, or for a period of not less
than one (1) year.
(e) The Contractor and/or Subcontractor, if not a self-insured government
and/or public entity, must provide evidence, that any required certificates
of insurance contain the following provisions:
[1] The insurer will not cancel the insured's coverage without giving thirty
(30) calendar days prior written notice to the State (California
Department of Health Care Services).
[2] The State of California, its officers, agents, employees, and servants
are included as additional insureds, but only with respect to work
performed for the State under this Agreement and any extension or
continuation of this Agreement.
[3] The insurance carrier shall notify the California Department of Health
Care Services (DHCS), in writing, of the Contractor's failure to pay
premiums; its cancellation of such policies; or any other substantial
change, including, but not limited to, the status, coverage, or scope of
the required insurance. Such notices shall contain a reference to each
agreement number for which the insurance was obtained.
(f) The Contractor and/or Subcontractor is hereby advised that copies of
certificates of insurance may be subject to review and approval by the
Department of General Services (DGS), Office of Risk and Insurance
Management. The Contractor shall be notified by DHCS, in writing, if this
provision is applicable to this Agreement. If DGS approval of the certificate
of insurance is required, the Contractor agrees that no work or services
shall be performed prior to obtaining said approval.
(g) In the event the Contractor and/or Subcontractor fails to keep insurance
coverage, as required herein, in effect at all times during vehicle
possession, DHCS may, in addition to any other remedies it may have,
terminate this Agreement upon the occurrence of such event.
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5. Subcontract Requirements
(Applicable to agreements under which services are to be performed by
subcontractors including independent consultants.)
a. Prior written authorization will be required before the Contractor enters into or is
reimbursed for any subcontract for services costing $5,000 or more. Except as
indicated in Paragraph a(3) herein, when securing subcontracts for services
exceeding $5,000, the Contractor shall obtain at least three bids or justify a sole
source award.
(1) The Contractor must provide in its request for authorization, all information
necessary for evaluating the necessity or desirability of incurring such cost.
(2) DHCS may identify the information needed to fulfill this requirement.
(3) Subcontracts performed by the following entities or for the service types listed
below are exempt from the bidding and sole source justification requirements:
(a) A local governmental entity or the federal government,
(b) A State college or State university from any State,
(c) A Joint Powers Authority,
(d) An auxiliary organization of a California State University or a California
community college,
(e) A foundation organized to support the Board of Governors of the California
Community Colleges,
(f) An auxiliary organization of the Student Aid Commission established
under Education Code § 69522,
(g) Firms or individuals proposed for use and approved by DHCS' funding
Program via acceptance of an application or proposal for funding or
pre/post contract award negotiations,
(h) Entities and/or service types identified as exempt from advertising and
competitive bidding in State Contracting Manual Chapter 5 Section 5.80
Subsection B.2.
b. DHCS reserves the right to approve or disapprove the selection of
subcontractors and with advance written notice, require the substitution of
subcontractors and require the Contractor to terminate subcontracts entered into
in support of this Agreement.
(1) Upon receipt of a written notice from DHCS requiring the substitution and/or
termination of a subcontract, the Contractor shall take steps to ensure the
completion of any work in progress and select a replacement, if applicable,
within 30 calendar days, unless a longer period is agreed to by DHCS.
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c. Actual subcontracts (i.e., written agreement between the Contractor and a
subcontractor) of$5,000 or more are subject to the prior review and written
approval of DHCS. DHCS may, at its discretion, elect to waive this right. All such
waivers shall be confirmed in writing by DHCS.
d. Contractor shall maintain a copy of each subcontract entered into in support of
this Agreement and shall, upon request by DHCS, make copies available for
approval, inspection, or audit.
e. DHCS assumes no responsibility for the payment of subcontractors used in the
performance of this Agreement. Contractor accepts sole responsibility for the
payment of subcontractors used in the performance of this Agreement.
f. The Contractor is responsible for all performance requirements under this
Agreement even though performance may be carried out through a subcontract.
g. The Contractor shall ensure that all subcontracts for services include provision(s)
requiring compliance with applicable terms and conditions specified in this
Agreement.
h. The Contractor agrees to include the following clause, relevant to record
retention, in all subcontracts for services:
"(Subcontractor Name) agrees to maintain and preserve, until three years after
termination of (Agreement Number) and final payment from DHCS to the
Contractor, to permit DHCS or any duly authorized representative, to have
access to, examine or audit any pertinent books, documents, papers and records
related to this subcontract and to allow interviews of any employees who might
reasonably have information related to such records."
i. Unless otherwise stipulated in writing by DHCS, the Contractor shall be the
subcontractor's sole point of contact for all matters related to performance and
payment under this Agreement.
j. Contractor shall, as applicable, advise all subcontractors of their obligations
pursuant to the following numbered provisions of this Exhibit: 1, 2, 3, 4, 5, 6, 7, 8,
10, 11, 12, 13, 14, 17, 19, 20, 24, 32 and/or other numbered provisions herein
that are deemed applicable.
6. Income Restrictions
Unless otherwise stipulated in this Agreement, the Contractor agrees that any
refunds, rebates, credits, or other amounts (including any interest thereon) accruing
to or received by the Contractor under this Agreement shall be paid by the
Contractor to DHCS, to the extent that they are properly allocable to costs for which
the Contractor has been reimbursed by DHCS under this Agreement.
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7. Audit and Record Retention
(Applicable to agreements in excess of$10,000.)
a. The Contractor and/or Subcontractor shall maintain books, records, documents,
and other evidence, accounting procedures and practices, sufficient to properly
reflect all direct and indirect costs of whatever nature claimed to have been
incurred in the performance of this Agreement, including any matching costs and
expenses. The foregoing constitutes "records" for the purpose of this provision.
b. The Contractor's and/or subcontractor's facility or office or such part thereof as
may be engaged in the performance of this Agreement and his/her records shall
be subject at all reasonable times to inspection, audit, and reproduction.
c. Contractor agrees that DHCS, the Department of General Services, the Bureau
of State Audits, or their designated representatives including the Comptroller
General of the United States shall have the right to review and to copy any
records and supporting documentation pertaining to the performance of this
Agreement. Contractor agrees to allow the auditor(s) access to such records
during normal business hours and to allow interviews of any employees who
might reasonably have information related to such records. Further, the
Contractor agrees to include a similar right of the State to audit records and
interview staff in any subcontract related to performance of this Agreement. (GC
8546.7, CCR Title 2, Section 1896.77)
d. The Contractor and/or Subcontractor shall preserve and make available his/her
records (1) for a period of three years from the date of final payment under this
Agreement, and (2) for such longer period, if any, as is required by applicable
statute, by any other provision of this Agreement, or by subparagraphs (1) or (2)
below.
(1) If this Agreement is completely or partially terminated, the records relating to
the work terminated shall be preserved and made available for a period of
three years from the date of any resulting final settlement.
(2) If any litigation, claim, negotiation, audit, or other action involving the records
has been started before the expiration of the three-year period, the records
shall be retained until completion of the action and resolution of all issues
which arise from it, or until the end of the regular three-year period, whichever
is later.
e. The Contractor and/or Subcontractor may, at its discretion, following receipt of
final payment under this Agreement, reduce its accounts, books and records
related to this Agreement to microfilm, computer disk, CD ROM, DVD, or other
data storage medium. Upon request by an authorized representative to inspect,
audit or obtain copies of said records, the Contractor and/or Subcontractor must
supply or make available applicable devices, hardware, and/or software
necessary to view, copy and/or print said records. Applicable devices may
include, but are not limited to, microfilm readers and microfilm printers, etc.
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f. The Contractor shall, if applicable, comply with the Single Audit Act and the audit
requirements set forth in 2 C.F.R. § 200.501 (2014).
8. Site Inspection
The State, through any authorized representatives, has the right at all reasonable
times to inspect or otherwise evaluate the work performed or being performed
hereunder including subcontract supported activities and the premises in which it is
being performed. If any inspection or evaluation is made of the premises of the
Contractor or Subcontractor, the Contractor shall provide and shall require
Subcontractors to provide all reasonable facilities and assistance for the safety and
convenience of the authorized representatives in the performance of their duties. All
inspections and evaluations shall be performed in such a manner as will not unduly
delay the work.
9. Federal Contract Funds
(Applicable only to that portion of an agreement funded in part or whole with federal
funds.)
a. It is mutually understood between the parties that this Agreement may have been
written before ascertaining the availability of congressional appropriation of
funds, for the mutual benefit of both parties, in order to avoid program and fiscal
delays which would occur if the Agreement were executed after that
determination was made.
b. This agreement is valid and enforceable only if sufficient funds are made
available to the State by the United States Government for the fiscal years
covered by the term of this Agreement. In addition, this Agreement is subject to
any additional restrictions, limitations, or conditions enacted by the Congress or
any statute enacted by the Congress which may affect the provisions, terms or
funding of this Agreement in any manner.
c. It is mutually agreed that if the Congress does not appropriate sufficient funds for
the program, this Agreement shall be amended to reflect any reduction in funds.
d. DHCS has the option to invalidate or cancel the Agreement with 30-days
advance written notice or to amend the Agreement to reflect any reduction in
funds.
10.Termination
a. For Cause
The State may terminate this Agreement, in whole or in part, and be relieved of
any payments should the Contractor fail to perform the requirements of this
Agreement at the time and in the manner herein provided. In the event of such
termination, the State may proceed with the work in any manner deemed proper
by the State. All costs to the State shall be deducted from any sum due the
Contractor under this Agreement and the balance, if any, shall be paid to the
Contractor upon demand. If this Agreement is terminated, in whole or in part, the
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State may require the Contractor to transfer title, or in the case of licensed
software, license, and deliver to the State any completed deliverables, partially
completed deliverables, and any other materials, related to the terminated portion
of the Contract, including but not limited to, computer programs, data files, user
and operations manuals, system and program documentation, training programs
related to the operation and maintenance of the system, and all information
necessary for the reimbursement of any outstanding Medicaid claims. The State
shall pay contract price for completed deliverables delivered and accepted and
items the State requires the Contractor to transfer as described in this paragraph
above.
b. For Convenience
The State retains the option to terminate this Agreement, in whole or in part,
without cause, at the State's convenience, without penalty, provided that written
notice has been delivered to the Contractor at least ninety (90) calendar days
prior to such termination date. In the event of termination, in whole or in part,
under this paragraph, the State may require the Contractor to transfer title, or in
the case of licensed software, license, and deliver to the State any completed
deliverables, partially completed deliverables, and any other materials related to
the terminated portion of the contract including but not limited to, computer
programs, data files, user and operations manuals, system and program
documentation, training programs related to the operation and maintenance of
the system, and all information necessary for the reimbursement of any
outstanding Medicaid claims. The Contractor will be entitled to compensation
upon submission of an invoice and proper proof of claim for the services and
products satisfactorily rendered, subject to all payment provisions of the
Agreement. Payment is limited to expenses necessarily incurred pursuant to this
Agreement up to the date of termination.
11.Intellectual Property Rights
a. Ownership
(1) Except where DHCS has agreed in a signed writing to accept a license,
DHCS shall be and remain, without additional compensation, the sole owner
of any and all rights, title and interest in all Intellectual Property, from the
moment of creation, whether or not jointly conceived, that are made,
conceived, derived from, or reduced to practice by Contractor or DHCS and
which result directly or indirectly from this Agreement.
(2) For the purposes of this Agreement, Intellectual Property means recognized
protectable rights and interest such as: patents, (whether or not issued)
copyrights, trademarks, service marks, applications for any of the foregoing,
inventions, trade secrets, trade dress, logos, insignia, color combinations,
slogans, moral rights, right of publicity, author's rights, contract and licensing
rights, works, mask works, industrial design rights, rights of priority, know
how, design flows, methodologies, devices, business processes,
developments, innovations, good will and all other legal rights protecting
intangible proprietary information as may exist now and/or here after come
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into existence, and all renewals and extensions, regardless of whether those
rights arise under the laws of the United States, or any other state, country or
jurisdiction.
(a) For the purposes of the definition of Intellectual Property, "works" means
all literary works, writings and printed matter including the medium by
which they are recorded or reproduced, photographs, art work, pictorial
and graphic representations and works of a similar nature, film, motion
pictures, digital images, animation cells, and other audiovisual works
including positives and negatives thereof, sound recordings, tapes,
educational materials, interactive videos and any other materials or
products created, produced, conceptualized and fixed in a tangible
medium of expression. It includes preliminary and final products and any
materials and information developed for the purposes of producing those
final products. Works does not include articles submitted to peer review or
reference journals or independent research projects.
(3) In the performance of this Agreement, Contractor will exercise and utilize
certain of its Intellectual Property in existence prior to the effective date of this
Agreement. In addition, under this Agreement, Contractor may access and
utilize certain of DHCS' Intellectual Property in existence prior to the effective
date of this Agreement. Except as otherwise set forth herein, Contractor shall
not use any of DHCS' Intellectual Property now existing or hereafter existing
for any purposes without the prior written permission of DHCS. Except as
otherwise set forth herein, neither the Contractor nor DHCS shall give any
ownership interest in or rights to its Intellectual Property to the other Party. If
during the term of this Agreement, Contractor accesses any third-party
Intellectual Property that is licensed to DHCS, Contractor agrees to abide by
all license and confidentiality restrictions applicable to DHCS in the third-
party's license agreement.
(4) Contractor agrees to cooperate with DHCS in establishing or maintaining
DHCS' exclusive rights in the Intellectual Property, and in assuring DHCS'
sole rights against third parties with respect to the Intellectual Property. If the
Contractor enters into any agreements or subcontracts with other parties in
order to perform this Agreement, Contractor shall require the terms of the
Agreement(s) to include all Intellectual Property provisions. Such terms must
include, but are not limited to, the subcontractor assigning and agreeing to
assign to DHCS all rights, title and interest in Intellectual Property made,
conceived, derived from, or reduced to practice by the subcontractor,
Contractor or DHCS and which result directly or indirectly from this
Agreement or any subcontract.
(5) Contractor further agrees to assist and cooperate with DHCS in all
reasonable respects, and execute all documents and, subject to reasonable
availability, give testimony and take all further acts reasonably necessary to
acquire, transfer, maintain, and enforce DHCS' Intellectual Property rights
and interests.
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b. Retained Rights / License Rights
(1) Except for Intellectual Property made, conceived, derived from, or reduced to
practice by Contractor or DHCS and which result directly or indirectly from
this Agreement, Contractor shall retain title to all of its Intellectual Property to
the extent such Intellectual Property is in existence prior to the effective date
of this Agreement. Contractor hereby grants to DHCS, without additional
compensation, a permanent, non-exclusive, royalty free, paid-up, worldwide,
irrevocable, perpetual, non-terminable license to use, reproduce,
manufacture, sell, offer to sell, import, export, modify, publicly and privately
display/perform, distribute, and dispose Contractor's Intellectual Property with
the right to sublicense through multiple layers, for any purpose whatsoever, to
the extent it is incorporated in the Intellectual Property resulting from this
Agreement, unless Contractor assigns all rights, title and interest in the
Intellectual Property as set forth herein.
(2) Nothing in this provision shall restrict, limit, or otherwise prevent Contractor
from using any ideas, concepts, know-how, methodology or techniques
related to its performance under this Agreement, provided that Contractor's
use does not infringe the patent, copyright, trademark rights, license or other
Intellectual Property rights of DHCS or third party, or result in a breach or
default of any provisions of this Exhibit or result in a breach of any provisions
of law relating to confidentiality.
c. Copyright
(1) Contractor agrees that for purposes of copyright law, all works [as defined in
Paragraph a, subparagraph (2)(a) of this provision] of authorship made by or
on behalf of Contractor in connection with Contractor's performance of this
Agreement shall be deemed "works made for hire". Contractor further agrees
that the work of each person utilized by Contractor in connection with the
performance of this Agreement will be a "work made for hire," whether that
person is an employee of Contractor or that person has entered into an
agreement with Contractor to perform the work. Contractor shall enter into a
written agreement with any such person that: (i) all work performed for
Contractor shall be deemed a "work made for hire" under the Copyright Act
and (ii) that person shall assign all right, title, and interest to DHCS to any
work product made, conceived, derived from, or reduced to practice by
Contractor or DHCS and which result directly or indirectly from this
Agreement.
(2) All materials, including, but not limited to, visual works or text, reproduced or
distributed pursuant to this Agreement that include Intellectual Property made,
conceived, derived from, or reduced to practice by Contractor or DHCS and
which result directly or indirectly from this Agreement, shall include DHCS'
notice of copyright, which shall read in 3mm or larger typeface: V [Enter
Current Year e.g., 2010, etc.], California Department of Health Care Services.
This material may not be reproduced or disseminated without prior written
permission from the California Department of Health Care Services." This
notice should be placed prominently on the materials and set apart from other
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matter on the page where it appears. Audio productions shall contain a similar
audio notice of copyright.
d. Patent Rights
With respect to inventions made by Contractor in the performance of this
Agreement, which did not result from research and development specifically
included in the Agreement's scope of work, Contractor hereby grants to DHCS a
license as described under Section b of this provision for devices or material
incorporating, or made through the use of such inventions. If such inventions
result from research and development work specifically included within the
Agreement's scope of work, then Contractor agrees to assign to DHCS, without
additional compensation, all its right, title and interest in and to such inventions
and to assist DHCS in securing United States and foreign patents with respect
thereto.
e. Third-Party Intellectual Property
Except as provided herein, Contractor agrees that its performance of this
Agreement shall not be dependent upon or include any Intellectual Property of
Contractor or third party without first: (i) obtaining DHCS' prior written approval;
and (ii) granting to or obtaining for DHCS, without additional compensation, a
license, as described in Section b of this provision, for any of Contractor's or
third-party's Intellectual Property in existence prior to the effective date of this
Agreement. If such a license upon the these terms is unattainable, and DHCS
determines that the Intellectual Property should be included in or is required for
Contractor's performance of this Agreement, Contractor shall obtain a license
under terms acceptable to DHCS.
f. Warranties
(1) Contractor represents and warrants that:
(a) It is free to enter into and fully perform this Agreement.
(b) It has secured and will secure all rights and licenses necessary for its
performance of this Agreement.
(c) Neither Contractor's performance of this Agreement, nor the exercise by
either Party of the rights granted in this Agreement, nor any use,
reproduction, manufacture, sale, offer to sell, import, export, modification,
public and private display/performance, distribution, and disposition of the
Intellectual Property made, conceived, derived from, or reduced to
practice by Contractor or DHCS and which result directly or indirectly from
this Agreement will infringe upon or violate any Intellectual Property right,
non-disclosure obligation, or other proprietary right or interest of any third-
party or entity now existing under the laws of, or hereafter existing or
issued by, any state, the United States, or any foreign country. There is
currently no actual or threatened claim by any such third party based on
an alleged violation of any such right by Contractor.
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(d) Neither Contractor's performance nor any part of its performance will
violate the right of privacy of, or constitute a libel or slander against any
person or entity.
(e) It has secured and will secure all rights and licenses necessary for
Intellectual Property including, but not limited to, consents, waivers or
releases from all authors of music or performances used, and talent
(radio, television and motion picture talent), owners of any interest in and
to real estate, sites, locations, property or props that may be used or
shown.
(f) It has not granted and shall not grant to any person or entity any right that
would or might derogate, encumber, or interfere with any of the rights
granted to DHCS in this Agreement.
(g) It has appropriate systems and controls in place to ensure that state funds
will not be used in the performance of this Agreement for the acquisition,
operation or maintenance of computer software in violation of copyright
laws.
(h) It has no knowledge of any outstanding claims, licenses or other charges,
liens, or encumbrances of any kind or nature whatsoever that could affect
in any way Contractor's performance of this Agreement.
(2) DHCS makes no warranty that the intellectual property resulting from this
agreement does not infringe upon any patent, trademark, copyright or the like,
now existing or subsequently issued.
g. Intellectual Property Indemnity
(1) Contractor shall indemnify, defend and hold harmless DHCS and its licensees
and assignees, and its officers, directors, employees, agents, representatives,
successors, and users of its products, ("Indemnitees") from and against all
claims, actions, damages, losses, liabilities (or actions or proceedings with
respect to any thereof), whether or not rightful, arising from any and all
actions or claims by any third party or expenses related thereto (including, but
not limited to, all legal expenses, court costs, and attorney's fees incurred in
investigating, preparing, serving as a witness in, or defending against, any
such claim, action, or proceeding, commenced or threatened) to which any of
the Indemnitees may be subject, whether or not Contractor is a party to any
pending or threatened litigation, which arise out of or are related to (i) the
incorrectness or breach of any of the representations, warranties, covenants
or agreements of Contractor pertaining to Intellectual Property; or (ii) any
Intellectual Property infringement, or any other type of actual or alleged
infringement claim, arising out of DHCS' use, reproduction, manufacture,
sale, offer to sell, distribution, import, export, modification, public and private
performance/display, license, and disposition of the Intellectual Property
made, conceived, derived from, or reduced to practice by Contractor or DHCS
and which result directly or indirectly from this Agreement. This indemnity
obligation shall apply irrespective of whether the infringement claim is based
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on a patent, trademark or copyright registration that issued after the effective
date of this Agreement. DHCS reserves the right to participate in and/or
control, at Contractor's expense, any such infringement action brought
against DHCS.
(2) Should any Intellectual Property licensed by the Contractor to DHCS under
this Agreement become the subject of an Intellectual Property infringement
claim, Contractor will exercise its authority reasonably and in good faith to
preserve DHCS' right to use the licensed Intellectual Property in accordance
with this Agreement at no expense to DHCS. DHCS shall have the right to
monitor and appear through its own counsel (at Contractor's expense) in any
such claim or action. In the defense or settlement of the claim, Contractor
may obtain the right for DHCS to continue using the licensed Intellectual
Property; or, replace or modify the licensed Intellectual Property so that the
replaced or modified Intellectual Property becomes non-infringing provided
that such replacement or modification is functionally equivalent to the original
licensed Intellectual Property. If such remedies are not reasonably available,
DHCS shall be entitled to a refund of all monies paid under this Agreement,
without restriction or limitation of any other rights and remedies available at
law or in equity.
(3) Contractor agrees that damages alone would be inadequate to compensate
DHCS for breach of any term of this Intellectual Property Exhibit by
Contractor. Contractor acknowledges DHCS would suffer irreparable harm in
the event of such breach and agrees DHCS shall be entitled to obtain
equitable relief, including without limitation an injunction, from a court of
competent jurisdiction, without restriction or limitation of any other rights and
remedies available at law or in equity.
h. Federal Funding
In any agreement funded in whole or in part by the federal government, DHCS
may acquire and maintain the Intellectual Property rights, title, and ownership,
which results directly or indirectly from the Agreement; except as provided in 37
Code of Federal Regulations part 401.14; however, the federal government shall
have a non-exclusive, nontransferable, irrevocable, paid-up license throughout
the world to use, duplicate, or dispose of such Intellectual Property throughout
the world in any manner for governmental purposes and to have and permit
others to do so.
i. Survival
The provisions set forth herein shall survive any termination or expiration of this
Agreement or any project schedule.
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12.Air or Water Pollution Requirements
Any federally funded agreement and/or subcontract in excess of$100,000 must
comply with the following provisions unless said agreement is exempt by law.
a. Government contractors agree to comply with all applicable standards, orders, or
requirements issued under section 306 of the Clean Air Act (42 USC 7606)
section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738,
and Environmental Protection Agency regulations.
b. Institutions of higher education, hospitals, nonprofit organizations and
commercial businesses agree to comply with all applicable standards, orders, or
requirements issued under the Clean Air Act (42 U.S.C. 7401 et seq.), as
amended, and the Clean Water Act (33 U.S.C. 1251 et seq.), as amended.
13.Prior Approval of Training Seminars, Workshops or Conferences
Contractor shall obtain prior DHCS approval of the location, costs, dates, agenda,
instructors, instructional materials, and attendees at any reimbursable training
seminar, workshop, or conference conducted pursuant to this Agreement and of any
reimbursable publicity or educational materials to be made available for distribution.
The Contractor shall acknowledge the support of the State whenever publicizing the
work under this Agreement in any media. This provision does not apply to necessary
staff meetings or training sessions held for the staff of the Contractor or
Subcontractor to conduct routine business matters.
14.Confidentiality of Information
a. The Contractor and its employees, agents, or subcontractors shall protect from
unauthorized disclosure names and other identifying information concerning
persons either receiving services pursuant to this Agreement or persons whose
names or identifying information become available or are disclosed to the
Contractor, its employees, agents, or subcontractors as a result of services
performed under this Agreement, except for statistical information not identifying
any such person.
b. The Contractor and its employees, agents, or subcontractors shall not use such
identifying information for any purpose other than carrying out the Contractor's
obligations under this Agreement.
c. The Contractor and its employees, agents, or subcontractors shall promptly
transmit to the DHCS Program Contract Manager all requests for disclosure of
such identifying information not emanating from the client or person.
d. The Contractor shall not disclose, except as otherwise specifically permitted by
this Agreement or authorized by the client, any such identifying information to
anyone other than DHCS without prior written authorization from the DHCS
Program Contract Manager, except if disclosure is required by State or Federal
law.
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e. For purposes of this provision, identity shall include, but not be limited to name,
identifying number, symbol, or other identifying particular assigned to the
individual, such as finger or voice print or a photograph.
f. As deemed applicable by DHCS, this provision may be supplemented by
additional terms and conditions covering personal health information (PHI) or
personal, sensitive, and/or confidential information (PSCI). Said terms and
conditions will be outlined in one or more exhibits that will either be attached to
this Agreement or incorporated into this Agreement by reference.
15.Documents, Publications and Written Reports
(Applicable to agreements over $5,000 under which publications, written reports and
documents are developed or produced. Government Code Section 7550.)
Any document, publication or written report (excluding progress reports, financial
reports and normal contractual communications) prepared as a requirement of this
Agreement shall contain, in a separate section preceding the main body of the
document, the number and dollar amounts of all contracts or agreements and
subcontracts relating to the preparation of such document or report, if the total cost
for work by nonemployees of the State exceeds $5,000.
16.Dispute Resolution Process
a. A Contractor grievance exists whenever there is a dispute arising from DHCS'
action in the administration of an agreement. If there is a dispute or grievance
between the Contractor and DHCS, the Contractor must seek resolution using
the procedure outlined below.
(1) The Contractor should first informally discuss the problem with the DHCS
Program Contract Manager. If the problem cannot be resolved informally, the
Contractor shall direct its grievance together with any evidence, in writing, to
the program Branch Chief. The grievance shall state the issues in dispute, the
legal authority or other basis for the Contractor's position and the remedy
sought. The Branch Chief shall render a decision within ten (10) working days
after receipt of the written grievance from the Contractor. The Branch Chief
shall respond in writing to the Contractor indicating the decision and reasons
therefore. If the Contractor disagrees with the Branch Chief's decision, the
Contractor may appeal to the second level.
(2) When appealing to the second level, the Contractor must prepare an appeal
indicating the reasons for disagreement with Branch Chief's decision. The
Contractor shall include with the appeal a copy of the Contractor's original
statement of dispute along with any supporting evidence and a copy of the
Branch Chief's decision. The appeal shall be addressed to the Deputy
Director of the division in which the branch is organized within ten (10)
working days from receipt of the Branch Chief's decision. The Deputy Director
of the division in which the branch is organized or his/her designee shall meet
with the Contractor to review the issues raised. A written decision signed by
the Deputy Director of the division in which the branch is organized or his/her
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designee shall be directed to the Contractor within twenty (20) working days
of receipt of the Contractor's second level appeal.
b. If the Contractor wishes to appeal the decision of the Deputy Director of the
division in which the branch is organized or his/her designee, the Contractor shall
follow the procedures set forth in Health and Safety Code Section 100171.
c. Unless otherwise stipulated in writing by DHCS, all dispute, grievance and/or
appeal correspondence shall be directed to the DHCS Program Contract
Manager.
d. There are organizational differences within DHCS' funding programs and the
management levels identified in this dispute resolution provision may not apply in
every contractual situation. When a grievance is received and organizational
differences exist, the Contractor shall be notified in writing by the DHCS Program
Contract Manager of the level, name, and/or title of the appropriate management
official that is responsible for issuing a decision at a given level.
17.Financial and Compliance Audit Requirements
a. The definitions used in this provision are contained in Section 38040 of the
Health and Safety Code, which by this reference is made a part hereof.
b. Direct service contract means a contract or agreement for services contained in
local assistance or subvention programs or both (see Health and Safety [H&S]
Code Section 38020). Direct service contracts shall not include contracts,
agreements, grants, or subventions to other governmental agencies or units of
government nor contracts or agreements with regional centers or area agencies
on aging (H&S Code Section 38030).
c. The Contractor, as indicated below, agrees to obtain one of the following audits:
(1) If the Contractor is a nonprofit organization (as defined in H&S Code
Section 38040) and receives $25,000 or more from any State agency under
a direct service contract or agreement; the Contractor agrees to obtain an
annual single, organization wide, financial and compliance audit. Said audit
shall be conducted according to Generally Accepted Auditing Standards. This
audit does not fulfill the audit requirements of Paragraph c(3) below. The audit
shall be completed by the 15th day of the fifth month following the end of the
Contractor's fiscal year, and/or
(2) If the Contractor is a nonprofit organization (as defined in H&S Code
Section 38040) and receives less than $25,000 per year from any State
agency under a direct service contract or agreement, the Contractor agrees to
obtain a biennial single, organization wide financial and compliance audit,
unless there is evidence of fraud or other violation of state law in connection
with this Agreement. This audit does not fulfill the audit requirements of
Paragraph c(3) below. The audit shall be completed by the 15th day of the
fifth month following the end of the Contractor's fiscal year, and/or
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(3) If the Contractor is a State or Local Government entity or Nonprofit
organization (as defined by 2 C.F.R. §§ 200.64, 200.70, and 200.90) and
expends $750,000 or more in Federal awards, the Contractor agrees to
obtain an annual single, organization wide, financial and compliance audit
according to the requirements specified in 2 C.F.R. 200.501 entitled "Audit
Requirements". An audit conducted pursuant to this provision will fulfill the
audit requirements outlined in Paragraphs c(1) and c(2) above. The audit
shall be completed by the end of the ninth month following the end of the
audit period. The requirements of this provision apply if:
(a) The Contractor is a recipient expending Federal awards received directly
from Federal awarding agencies, or
(b) The Contractor is a subrecipient expending Federal awards received from
a pass-through entity such as the State, County or community based
organization.
(4) If the Contractor submits to DHCS a report of an audit other than a 2 C.F.R.
200.501audit, the Contractor must also submit a certification indicating the
Contractor has not expended $750,000 or more in federal funds for the year
covered by the audit report.
d. Two copies of the audit report shall be delivered to the DHCS program funding
this Agreement. The audit report must identify the Contractor's legal name and
the number assigned to this Agreement. The audit report shall be due within 30
days after the completion of the audit. Upon receipt of said audit report, the
DHCS Program Contract Manager shall forward the audit report to DHCS' Audits
and Investigations Unit if the audit report was submitted under Section 16.c(3),
unless the audit report is from a City, County, or Special District within the State
of California whereby the report will be retained by the funding program.
e. The cost of the audits described herein may be included in the funding for this
Agreement up to the proportionate amount this Agreement represents of the
Contractor's total revenue. The DHCS program funding this Agreement must
provide advance written approval of the specific amount allowed for said audit
expenses.
f. The State or its authorized designee, including the Bureau of State Audits, is
responsible for conducting agreement performance audits which are not financial
and compliance audits. Performance audits are defined by Generally Accepted
Government Auditing Standards.
g. Nothing in this Agreement limits the State's responsibility or authority to enforce
State law or regulations, procedures, or reporting requirements arising thereto.
h. Nothing in this provision limits the authority of the State to make audits of this
Agreement, provided however, that if independent audits arranged for by the
Contractor meet Generally Accepted Governmental Auditing Standards, the
State shall rely on those audits and any additional audit work and shall build
upon the work already done.
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i. The State may, at its option, direct its own auditors to perform either of the audits
described above. The Contractor will be given advance written notification, if the
State chooses to exercise its option to perform said audits.
j. The Contractor shall include a clause in any agreement the Contractor enters
into with the audit firm doing the single organization wide audit to provide access
by the State or Federal Government to the working papers of the independent
auditor who prepares the single organization wide audit for the Contractor.
k. Federal or state auditors shall have "expanded scope auditing" authority to
conduct specific program audits during the same period in which a single
organization wide audit is being performed, but the audit report has not been
issued. The federal or state auditors shall review and have access to the current
audit work being conducted and will not apply any testing or review procedures
which have not been satisfied by previous audit work that has been completed.
The term "expanded scope auditing" is applied and defined in the U.S. General
Accounting Office (GAO) issued Standards for Audit of Government
Organizations, Programs, Activities and Functions, better known as the "yellow
book".
18.Human Subjects Use Requirements
(Applicable only to federally funded agreements/grants in which performance,
directly or through a subcontract/subaward, includes any tests or examination of
materials derived from the human body.)
By signing this Agreement, Contractor agrees that if any performance under this
Agreement or any subcontract or subagreement includes any tests or examination of
materials derived from the human body for the purpose of providing information,
diagnosis, prevention, treatment or assessment of disease, impairment, or health of
a human being, all locations at which such examinations are performed shall meet
the requirements of 42 U.S.C. Section 263a (CLIA) and the regulations thereunder.
19.Novation Requirements
If the Contractor proposes any novation agreement, DHCS shall act upon the
proposal within 60 days after receipt of the written proposal. DHCS may review and
consider the proposal, consult and negotiate with the Contractor, and accept or
reject all or part of the proposal. Acceptance or rejection of the proposal may be
made orally within the 60-day period and confirmed in writing within five days of said
decision. Upon written acceptance of the proposal, DHCS will initiate an amendment
to this Agreement to formally implement the approved proposal.
20.Debarment and Suspension Certification
(Applicable to all agreements funded in part or whole with federal funds.)
a. By signing this Agreement, the Contractor/Grantee agrees to comply with
applicable federal suspension and debarment regulations including, but not
limited to 2 CFR 180, 2 CFR 376
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b. By signing this Agreement, the Contractor certifies to the best of its knowledge
and belief, that it and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any federal department or agency;
(2) Have not within a three-year period preceding this
application/proposal/agreement 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) violation of Federal or State antitrust statutes; or
commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, tax evasion, receiving stolen
property, making false claims, obstruction of justice, or the commission of any
other offense indicating a lack of business integrity or business honesty that
seriously affects its business honesty;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State or local) with commission of any of the
offenses enumerated in Paragraph b(2) herein; and
(4) Have not within a three-year period preceding this
application/proposal/agreement had one or more public transactions (Federal,
State or local) terminated for cause or default.
(5) Have not, within a three-year period preceding this
application/proposal/agreement, engaged in any of the violations listed under
2 CFR Part 180, Subpart C as supplemented by 2 CFR Part 376.
(6) Shall not knowingly enter into any lower tier covered transaction with a person
who is proposed for debarment under federal regulations (i.e., 48 CFR part 9,
subpart 9.4), debarred, suspended, declared ineligible, or voluntarily excluded
from participation in such transaction, unless authorized by the State.
(7) Will include a clause entitled, "Debarment and Suspension Certification" that
essentially sets forth the provisions herein, in all lower tier covered
transactions and in all solicitations for lower tier covered transactions.
c. If the Contractor is unable to certify to any of the statements in this certification,
the Contractor shall submit an explanation to the DHCS Program Contract
Manager.
d. The terms and definitions herein have the meanings set out in 2 CFR Part 180 as
supplemented by 2 CFR Part 376.
e. If the Contractor knowingly violates this certification, in addition to other remedies
available to the Federal Government, the DHCS may terminate this Agreement
for cause or default.
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21.Smoke-Free Workplace Certification
(Applicable to federally funded agreements/grants and subcontracts/subawards, that
provide health, day care, early childhood development services, education or library
services to children under 18 directly or through local governments.)
a. Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires
that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the
provision of health, day care, early childhood development services, education or
library services to children under the age of 18, if the services are funded by
federal programs either directly or through state or local governments, by federal
grant, contract, loan, or loan guarantee. The law also applies to children's
services that are provided in indoor facilities that are constructed, operated, or
maintained with such federal funds. The law does not apply to children's services
provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable federal
funds is Medicare or Medicaid; or facilities where WIC coupons are redeemed.
b. Failure to comply with the provisions of the law may result in the imposition of a
civil monetary penalty of up to $1,000 for each violation and/or the imposition of
an administrative compliance order on the responsible party.
c. By signing this Agreement, Contractor or Grantee certifies that it will comply with
the requirements of the Act and will not allow smoking within any portion of any
indoor facility used for the provision of services for children as defined by the Act.
The prohibitions herein are effective December 26, 1994.
d. Contractor or Grantee further agrees that it will insert this certification into any
subawards (subcontracts or subgrants) entered into that provide for children's
services as described in the Act.
22.Covenant Against Contingent Fees
(Applicable only to federally funded agreements.)
The Contractor warrants that no person or selling agency has been employed or
retained to solicit/secure this Agreement upon an agreement of understanding for a
commission, percentage, brokerage, or contingent fee, except bona fide employees
or bona fide established commercial or selling agencies retained by the Contractor
for the purpose of securing business. For breach or violation of this warranty, DHCS
shall have the right to annul this Agreement without liability or in its discretion to
deduct from the Agreement price or consideration, or otherwise recover, the full
amount of such commission, percentage, and brokerage or contingent fee.
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23.Payment Withholds
(Applicable only if a final report is required by this Agreement. Not applicable to
government entities.)
Unless waived or otherwise stipulated in this Agreement, DHCS may, at its
discretion, withhold 10 percent (10%) of the face amount of the Agreement, 50
percent (50%) of the final invoice, or $3,000 whichever is greater, until DHCS
receives a final report that meets the terms, conditions and/or scope of work
requirements of this Agreement.
24.Performance Evaluation
(Not applicable to grant agreements.)
DHCS may, at its discretion, evaluate the performance of the Contractor at the
conclusion of this Agreement. If performance is evaluated, the evaluation shall not
be a public record and shall remain on file with DHCS. Negative performance
evaluations may be considered by DHCS prior to making future contract awards.
25.Officials Not to Benefit
No members of or delegate of Congress or the State Legislature shall be admitted to
any share or part of this Agreement, or to any benefit that may arise therefrom. This
provision shall not be construed to extend to this Agreement if made with a
corporation for its general benefits.
26.Four-Digit Date Compliance
(Applicable to agreements in which Information Technology (IT) services are
provided to DHCS or if IT equipment is procured.)
Contractor warrants that it will provide only Four-Digit Date Compliant (as defined
below) Deliverables and/or services to the State. "Four Digit Date compliant"
Deliverables and services can accurately process, calculate, compare, and
sequence date data, including without limitation date data arising out of or relating to
leap years and changes in centuries. This warranty and representation is subject to
the warranty terms and conditions of this Contract and does not limit the generality
of warranty obligations set forth elsewhere herein.
27.Prohibited Use of State Funds for Software
(Applicable to agreements in which computer software is used in performance of the
work.)
Contractor certifies that it has appropriate systems and controls in place to ensure
that state funds will not be used in the performance of this Agreement for the
acquisition, operation or maintenance of computer software in violation of copyright
laws.
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28.Use of Small, Minority Owned and Women's Businesses
(Applicable to that portion of an agreement that is federally funded and entered into
with institutions of higher education, hospitals, nonprofit organizations or commercial
businesses.)
Positive efforts shall be made to use small businesses, minority-owned firms and
women's business enterprises, whenever possible (i.e., procurement of goods
and/or services). Contractors shall take all of the following steps to further this goal.
a. Ensure that small businesses, minority-owned firms, and women's business
enterprises are used to the fullest extent practicable.
b. Make information on forthcoming purchasing and contracting opportunities
available and arrange time frames for purchases and contracts to encourage and
facilitate participation by small businesses, minority-owned firms, and women's
business enterprises.
c. Consider in the contract process whether firms competing for larger contracts
intend to subcontract with small businesses, minority-owned firms, and women's
business enterprises.
d. Encourage contracting with consortiums of small businesses, minority-owned
firms and women's business enterprises when a contract is too large for one of
these firms to handle individually.
e. Use the services and assistance, as appropriate, of such organizations as the
Federal Small Business Administration and the U.S. Department of Commerce's
Minority Business Development Agency in the solicitation and utilization of small
businesses, minority-owned firms and women's business enterprises.
29.Alien Ineligibility Certification
(Applicable to sole proprietors entering federally funded agreements.)
By signing this Agreement, the Contractor certifies that he/she is not an alien that is
ineligible for state and local benefits, as defined in Subtitle B of the Personal
Responsibility and Work Opportunity Act. (8 U.S.C. 1601, et seq.)
30.Union Organizing
(Applicable only to grant agreements.)
Grantee, by signing this Agreement, hereby acknowledges the applicability of
Government Code Sections 16645 through 16649 to this Agreement. Furthermore,
Grantee, by signing this Agreement, hereby certifies that:
a. No state funds disbursed by this grant will be used to assist, promote or deter
union organizing.
b. Grantee shall account for state funds disbursed for a specific expenditure by this
grant, to show those funds were allocated to that expenditure.
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c. Grantee shall, where state funds are not designated as described in b herein,
allocate, on a pro-rata basis, all disbursements that support the grant program.
d. If Grantee makes expenditures to assist, promote or deter union organizing,
Grantee will maintain records sufficient to show that no state funds were used for
those expenditures, and that Grantee shall provide those records to the Attorney
General upon request.
31.Contract Uniformity (Fringe Benefit Allowability)
(Applicable only to nonprofit organizations.)
Pursuant to the provisions of Article 7 (commencing with Section 100525) of Chapter
3 of Part 1 of Division 101 of the Health and Safety Code, DHCS sets forth the
following policies, procedures, and guidelines regarding the reimbursement of fringe
benefits.
a. As used herein fringe benefits shall mean an employment benefit given by one's
employer to an employee in addition to one's regular or normal wages or salary.
b. As used herein, fringe benefits do not include:
(1) Compensation for personal services paid currently or accrued by the
Contractor for services of employees rendered during the term of this
Agreement, which is identified as regular or normal salaries and wages,
annual leave, vacation, sick leave, holidays, jury duty and/or military
leave/training.
(2) Director's and executive committee member's fees.
(3) Incentive awards and/or bonus incentive pay.
(4) Allowances for off-site pay.
(5) Location allowances.
(6) Hardship pay.
(7) Cost-of-living differentials
c. Specific allowable fringe benefits include:
(1) Fringe benefits in the form of employer contributions for the employer's
portion of payroll taxes (i.e., FICA, SUI, SDI), employee health plans (i.e.,
health, dental and vision), unemployment insurance, worker's compensation
insurance, and the employer's share of pension/retirement plans, provided
they are granted in accordance with established written organization policies
and meet all legal and Internal Revenue Service requirements.
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d. To be an allowable fringe benefit, the cost must meet the following criteria:
(1) Be necessary and reasonable for the performance of the Agreement.
(2) Be determined in accordance with generally accepted accounting principles.
(3) Be consistent with policies that apply uniformly to all activities of the
Contractor.
e. Contractor agrees that all fringe benefits shall be at actual cost.
f. Earned/Accrued Compensation
(1) Compensation for vacation, sick leave and holidays is limited to that amount
earned/accrued within the agreement term. Unused vacation, sick leave and
holidays earned from periods prior to the agreement term cannot be claimed
as allowable costs. See Provision f (3)(a) for an example.
(2) For multiple year agreements, vacation and sick leave compensation, which
is earned/accrued but not paid, due to employee(s) not taking time off may be
carried over and claimed within the overall term of the multiple years of the
Agreement. Holidays cannot be carried over from one agreement year to the
next. See Provision f (3)(b) for an example.
(3) For single year agreements, vacation, sick leave and holiday compensation
that is earned/accrued but not paid, due to employee(s) not taking time off
within the term of the Agreement, cannot be claimed as an allowable cost.
See Provision f (3)(c) for an example.
(a) Example No. 1:
If an employee, John Doe, earns/accrues three weeks of vacation and
twelve days of sick leave each year, then that is the maximum amount that
may be claimed during a one year agreement. If John Doe has five weeks
of vacation and eighteen days of sick leave at the beginning of an
agreement, the Contractor during a one-year budget period may only
claim up to three weeks of vacation and twelve days of sick leave as
actually used by the employee. Amounts earned/accrued in periods prior
to the beginning of the Agreement are not an allowable cost.
(b) Example No. 2:
If during a three-year (multiple year) agreement, John Doe does not use
his three weeks of vacation in year one, or his three weeks in year two,
but he does actually use nine weeks in year three; the Contractor would
be allowed to claim all nine weeks paid for in year three. The total
compensation over the three-year period cannot exceed 156 weeks (3 x
52 weeks).
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(c) Example No. 3:
If during a single year agreement, John Doe works fifty weeks and used
one week of vacation and one week of sick leave and all fifty-two weeks
have been billed to DHCS, the remaining unused two weeks of vacation
and seven days of sick leave may not be claimed as an allowable cost.
32.Suspension or Stop Work Notification
a. DHCS may, at any time, issue a notice to suspend performance or stop work
under this Agreement. The initial notification may be a verbal or written directive
issued by the funding Program's Contract Manager. Upon receipt of said notice,
the Contractor is to suspend and/or stop all, or any part, of the work called for by
this Agreement.
b. Written confirmation of the suspension or stop work notification with directions as
to what work (if not all) is to be suspended and how to proceed will be provided
within 30 working days of the verbal notification. The suspension or stop work
notification shall remain in effect until further written notice is received from
DHCS. The resumption of work (in whole or part) will be at DHCS' discretion and
upon receipt of written confirmation.
(1) Upon receipt of a suspension or stop work notification, the Contractor shall
immediately comply with its terms and take all reasonable steps to minimize
or halt the incurrence of costs allocable to the performance covered by the
notification during the period of work suspension or stoppage.
(2) Within 90 days of the issuance of a suspension or stop work notification,
DHCS shall either:
(a) Cancel, extend, or modify the suspension or stop work notification; or
(b) Terminate the Agreement as provided for in the Cancellation /Termination
clause of the Agreement.
c. If a suspension or stop work notification issued under this clause is canceled or
the period of suspension or any extension thereof is modified or expires, the
Contractor may resume work only upon written concurrence of funding Program's
Contract Manager.
d. If the suspension or stop work notification is cancelled and the Agreement
resumes, changes to the services, deliverables, performance dates, and/or
contract terms resulting from the suspension or stop work notification shall
require an amendment to the Agreement.
e. If a suspension or stop work notification is not canceled and the Agreement is
cancelled or terminated pursuant to the provision entitled Cancellation /
Termination, DHCS shall allow reasonable costs resulting from the suspension or
stop work notification in arriving at the settlement costs.
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f. DHCS shall not be liable to the Contractor for loss of profits because of any
suspension or stop work notification issued under this clause.
33.Public Communications
"Electronic and printed documents developed and produced, for public
communications shall follow the following requirements to comply with Section 508
of the Rehabilitation Act and the American with Disabilities Act:
a. Ensure visual-impaired, hearing-impaired and other special needs audiences are
provided material information in formats that provide the most assistance in
making informed choices."
34.Compliance with Statutes and Regulations
a. The Contractor shall comply with all California and federal law, regulations, and
published guidelines, to the extent that these authorities contain requirements
applicable to Contractor's performance under the Agreement.
b. These authorities include, but are not limited to, Title 2, Code of Federal
Regulations (CFR) Part 200, subpart F, Appendix II; Title 42 CFR Part 431,
subpart F; Title 42 CFR Part 433, subpart D; Title 42 CFR Part 434; Title 45 CFR
Part 75, subpart D; and Title 45 CFR Part 95, subpart F. To the extent applicable
under federal law, this Agreement shall incorporate the contractual provisions in
these federal regulations and they shall supersede any conflicting provisions in
this Agreement.
35.Lobbying Restrictions and Disclosure Certification
(Applicable to federally funded agreements in excess of$100,000 per Section 1352
of the 31, U.S.C.)
a. Certification and Disclosure Requirements
(1) Each person (or recipient) who requests or receives a contract or agreement,
subcontract, grant, or subgrant, which is subject to Section 1352 of the 31,
U.S.C., and which exceeds $100,000 at any tier, shall file a certification (in
the form set forth in Attachment 1, consisting of one page, entitled
"Certification Regarding Lobbying") that the recipient has not made, and will
not make, any payment prohibited by Paragraph b of this provision.
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2,
entitled "Standard Form-LLL `disclosure of Lobbying Activities"') if such
recipient has made or has agreed to make any payment using
nonappropriated funds (to include profits from any covered federal action) in
connection with a contract, or grant or any extension or amendment of that
contract, or grant, which would be prohibited under Paragraph b of this
provision if paid for with appropriated funds.
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(3) Each recipient shall file a disclosure form at the end of each calendar quarter
in which there occurs any event that requires disclosure or that materially
affect the accuracy of the information contained in any disclosure form
previously filed by such person under Paragraph a(2) herein. An event that
materially affects the accuracy of the information reported includes:
(a) A cumulative increase of$25,000 or more in the amount paid or expected
to be paid for influencing or attempting to influence a covered federal
action;
(b) A change in the person(s) or individuals(s) influencing or attempting to
influence a covered federal action; or
(c) A change in the officer(s), employee(s), or member(s) contacted for the
purpose of influencing or attempting to influence a covered federal action.
(4) Each person (or recipient) who requests or receives from a person referred to
in Paragraph a(1) of this provision a contract or agreement, subcontract, grant
or subgrant exceeding $100,000 at any tier under a contract or agreement, or
grant shall file a certification, and a disclosure form, if required, to the next tier
above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier
until received by the person referred to in Paragraph a(1) of this provision.
That person shall forward all disclosure forms to DHCS Program Contract
Manager.
b. Prohibition
Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may
be expended by the recipient of a federal contract or agreement, grant, loan, or
cooperative agreement to pay any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in
connection with any of the following covered federal actions: the awarding of any
federal contract or agreement, the making of any federal grant, the making of any
federal loan, entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any federal contract or
agreement, grant, loan, or cooperative agreement.
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Attachment 1
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the making, awarding or
entering into of this Federal contract, Federal grant, or cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of this Federal
contract, grant, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency of the United States Government, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with
this Federal contract, grant, or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL, "Disclosure of Lobbying Activities" in
accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontractors, subgrants,
and contracts under grants and cooperative agreements) of $100,000 or more, and
that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any
person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
Name of Contractor Printed Name of Person Signing for Contractor
County of Fresno Sal Quintero
Contract/Grant Number Signature of Person Signing for Contractor
Date Ti e
R�(q/Z3 Chairman, Fresno County Board of Supervisors
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
Deputy
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After execution by or on behalf of Contractor, please return to:
California Department of Health Care Services
DHCS reserves the right to notify the contractor in writing of an alternate submission
address.
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Attachment 2
CERTIFICATION REGARDING LOBBYING
Approved by OMB (0348-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract _ a. bid/offer/application _ a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan
e. loan guarantee Year quarter
f. loan insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:
O Prime O Subawardee
Tier , if known:
Congressional District, If known: Congressional District, If known:
6. Federal Department/Agency 7. Federal Program Name/Description:
CDFA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying Registrant b. Individuals Performing Services
(If individual, last name, first name, Ml): (including address if different from 10a.
(Last name, First name, MI):
11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This
disclosure of lobbying activities is a material representation of fact upon which reliance was
placed by the tier above when this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available for public inspection. Any
person that fails to file the required disclosure shall be subject to a not more than $100,000 for
each such failure.
Signature:
Print Name:
Title:
Telephone Number:
Date:
Federal Use Only Authorized for Local Reproduction
Standard Form-LLL (Rev. 7-97)
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INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING
ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or
prime Federal recipient, at the initiation or receipt of a covered Federal action, or a
material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of
a form is required for each payment or agreement to make payment to any lobbying entity
for influencing or attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with a covered Federal action. Complete all items that apply for
both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has
been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused
by a material change to the information previously reported, enter the year and quarter
in which the change occurred. Enter the date of the last previously submitted report
by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include
Congressional District, if known. Check the appropriate classification of the reporting
entity that designates if itis, or expects to be, a prime or subaward recipient. Identify
the tier of the subawardee, e.g., the first subawardee of the prime is the 1 st tier.
Subawards include but are not limited to subcontracts, subgrants and contract awards
under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full
name, address, city, State and zip code of the prime Federal recipient. Include
Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include
at least one organizational level below agency name, if known. For example,
Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item
1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number
for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action
identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB)
number; grant announcement number; the contract, grant, or loan award number; the
application/proposal control number assigned by the Federal agency). Include
prefixes, e.g., "RFP-DE-90-001".
9. For a covered Federal action where there has been an award or loan commitment by
the Federal agency, enter the Federal amount of the award/loan commitment for the
prime entity identified in item 4 or 5.
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10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant
under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified
in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full
address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and
telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to
respond to a collection of information unless it displays a valid OMB Control Number.
The valid OMB control number for this information collection is OMB No. 0348-0046.
Public reporting burden for this collection of information is estimated to average 10
minutes per response, including time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to
the Office of Management and Budget, Paperwork Reduction Project (0348-0046),
Washington, DC 20503.
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