HomeMy WebLinkAboutAgreement A-12-184-4 with Turning Point of Central California.pdfCOUNTY OF FRESNO
Fresno, CA
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AMENDMENT IV TO AGREEMENT
THIS AMENDMENT, hereinafter referred to as “Amendment IV”, is made and entered into
this ____ day of __________, 2016, by and between the COUNTY OF FRESNO, a Political
Subdivision of the State of California, hereinafter referred to as “COUNTY”, and TURNING POINT
OF CENTRAL CALIFORNIA, INC., a private non-profit, 501 (c)(3) Corporation, whose address is
P.O. Box 7447, Visalia, California 93290, hereinafter referred to as “CONTRACTOR” (collectively
as the “parties).
WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
No. 12-184, effective April 24, 2012, COUNTY Amendment No. 12-184-1, effective September 11,
2012, COUNTY Amendment No. 12-184-2, effective April 22, 2014, and COUNTY Amendment No.
12-184-3, effective July 1, 2015 (hereinafter collectively referred to as COUNTY Agreement No. 12-
184), whereby CONTRACTOR agreed to provide outpatient mental health treatment services,
outpatient substance use disorder treatment services, and Full-Service Partnership (FSP) treatment
services as required by AB109 Public Safety Realignment and the Postrelease Community
Supervision Act of 2011; and
WHEREAS, CONTRACTOR has requested greater access to the COUNTY’s Department of
Behavioral Health (DBH) electronic health record system (Avatar); and
WHEREAS, COUNTY, through DBH, is willing to provide CONTRACTOR with greater
access to its electronic health record system; and
WHEREAS the parties desire to amend COUNTY Agreement No. 12-184, regarding changes as
stated below and restate the Agreement in its entirety.
NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby acknowledged, the parties agree to amend the Agreement as follows:
1. CONTRACTOR may maintain its records in COUNTY’s Electronic Health Record
(EHR) s ystem (Avatar) in accordance with Exhibit E, “Documentation Standards for Client Records,”
beginning February 1, 2016. The client record shall begin with registration and intake and include
client authorizations, assessments, plans of care, and progress notes, as well as other documents as
approved by the County’s DBH. COUNTY shall be allowed to review records of services provided,
COUNTY OF FRESNO
Fresno, CA
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including the goals and objectives of the treatment plan, and how the therapy provided is achieving the
goals and objectives. If CONTRACTOR determines to maintain its records in AVATAR, it shall
provide COUNTY’s DBH Director, or designee, with a 30-day notice. If at any time CONTRACTOR
chooses not to maintain its records in AVATAR, it shall provide COUNTY’S DBH Director, or
designee, with a 30-day notice and CONTRACTOR will be responsible for obtaining its own system,
at its own cost, for Electronic Health Records management.
A. Disclaimer
COUNTY makes no warranty or representation that information entered into the COUNTY’s
EHR system by CONTRACTOR will be accurate, adequate or satisfactory for CONTRACTOR’s own
purposes or that any information in CONTRACTOR’s possession or control, or transmitted or
received by CONTRACTOR, is or will be secure from unauthorized access, viewing, use, disclosure,
or breach. CONTRACTOR is solely responsible for client information entered by CONTRACTOR
into the COUNTY’s EHR system. CONTRACTOR agrees that all Private Health Information (PHI)
maintained by CONTRACTOR in COUNTY’s EHR system will be maintained in conformance with
all HIPAA laws, as stated in Section Fourteen (14), “Health Insurance Portability and Accountability
Act.”
2. COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of each
month for the prior months hosting fee for access to Avatar in accordance with the fee schedule as set
forth in Exhibit K, “Electronic Health Records Software Charges” attached hereto and incorporated
herein by reference. COUNTY shall invoice CONTRACTOR annually for the annual maintenance
and licensing fee for access to AVATAR in accordance with the fee schedule as set forth in Exhibit K.
COUNTY shall invoice CONTRACTOR annually for the Reaching Recovery fee for access to
AVATAR in accordance with the fee schedule as set forth in Exhibit K. CONTRACTOR shall
provide payment for these expenditures to COUNTY’s Fresno County Department of Behavioral
Health, Accounts Receivable, P.O. Box 712, Fresno, Ca. 93717-0712, Attention: Business Office,
within forty-five (45) days after the date of receipt by CONTRACTOR of the invoicing provided by
COUNTY.”
3. That a new “Exhibit K” is attached hereto and incorporated herein by this reference.
COUNTY OF FRESNO
Fresno, CA
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4. That the existing COUNTY Agreement No. 12-184, Page Twenty-Six (26), beginning
with Line Seventeen (17), with the word “CONTRACTOR” and ending on Page Twenty-Seven, Line
Four (4) with the word “years.” be deleted and the following inserted in its place:
“CONTRACTOR shall submit, if applicable, a copy of its single audit report and
management letter, performed in accordance to the Single Audit Act of 1984 (31 USC section 7502)
and subject to the terms of OMB A-133 to the County of Fresno. A single audit report is not
applicable if all of CONTRACTOR’s federal contracts do not exceed Seven Hundred Thousand and
No/100 Dollars ($750,000.00) or CONTRACTOR’s only funding is through Drug related Medi-Cal. If
a single audit is not applicable, a program audit must be performed and a program audit report with
management letter shall be submitted. Such audit report shall be delivered to COUNTY’s DBH-SAS
for review no later than six (6) months after the close of the subrecipient’s fiscal year in which the
funds supplied through this Agreement are expended. Failure to comply with this Act may result in
COUNTY performing the necessary audit tasks or contracting with a qualified accountant to perform
the audit. All audit cost related to this Agreement are the sole responsibility of CONTRACTOR who
agrees to take corrective action to eliminate any material noncompliance or weakness found as a result
of such audit. Audit work performed by COUNTY under this paragraph shall be billed to
CONTRACTOR at COUNTY’s cost as determined by COUNTY’s Auditor-Controller/Treasurer-Tax
Collector. To maintain the integrity of the audits, CONTRACTOR is required to change its auditor
(Certified Public Accountant) at least every three (3) years.”
5. That the existing COUNTY Agreement No. 12-184, Page Eight (8), Line Four (4),
beginning with the letter “L” and ending on Page Eight (8), Line Nine (9), with the word “Health” be
deleted and the following sections shall be re-numbered sequentially to read as Sections L through V.
6. That the existing COUNTY Agreement No. 12-184, Page Thirteen (13), Line Twenty
(20), beginning with the word “However” and ending on Page Thirteen (13), Line Twenty-Four with
the word, “Agreement” be deleted and the following inserted in its place:
“Notwithstanding the above, changes to services as needed to accommodate changes in
the law relating to mental health and substance use disorder treatment, as set forth in Exhibit A, may
be made with the signed written approval of COUNTY’s DBH Director, or designee, and
COUNTY OF FRESNO
Fresno, CA
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CONTRACTOR through an amendment approved by County Counsel and Auditor. Changes to line
items in the budget, as set forth in Revised Exhibit C, that do not exceed 10% of the maximum
compensation payable to the CONTRACTOR, may be made with the written approval of COUNTY’s
DBH Director, or designee, and CONTRACTOR. Changes to the line items in the budget that exceed
10% of the maximum compensation payable to the CONTRACTOR, may be made with the signed
written approval of COUNTY’s DBH Director, or designee, and CONTRACTOR through an
amendment approved by County Counsel and Auditor. Said budget line item changes shall not result
in any change to the annual maximum compensation amount payable to CONTRACTOR, as stated in
this Agreement.”
7. That all references in existing COUNTY Agreement No. 12-184 to “Exhibit J” regarding
the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and
Health Care shall be changed to read “Exhibit L” where appropriate, attached hereto and incorporated
herein by reference.
8. COUNTY and CONTRACTOR agree that this Amendment IV is sufficient to amend the
Agreement; and that upon execution of this Amendment IV , Agreement 12-184, Amendment I,
Amendment II, Amendment III, and this Amendment IV together shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement, and not amended herein, shall remain
in full force and effect. This Amendment IV shall become effective upon execution by all parties.
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IN WITNESS WHEREOF, the parties hereto have executed this Amendment IV to Agreement No.
12-184 as ofthe day and year first hereinabove written.
3
4 ATTEST:
5
6 CONTRACTOR:
TURNING POINT OF
7 CENTRAL CALIFORNIA, INC.
8
9 By ______________________ ___
10 Print Name: ________________ __
11 Title: ______________________ _
12 Chairman ofBoard, or
President, or any Vice President
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By ______________________ ___
Print Name: _________ _
Title: -------.,---------::-----::-------
Secretary (of Corporation), or
any Assistant Secretary, or
ChiefFinancial Officer, or
any Assistant Treasurer
Mailing Address:
P.O. Box 7447
Visalia, CA 93290-7447
Phone No.: (559) 732-8086 Ext. 140
Contact: ChiefExecutive Officer
COUNTY OF FRESNO
ByE--...r~~
Chairman, Board of Supervisors
Date:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
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COUNTY OF FRESNO
Fresno, CA
1 · APPE.()VEP AS TO LEGAL FORM:
2
DANIEL C. CEDERHORG, COUNTY COUNSEL
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vdt.~.~~I~ By ____________ ~
REVIEWED AND RECOMMENDED FOR APPROVAL:
-~~ ·_:~.:ll.i.•.·.·. ~.· ..... ·.·. By· ~~~ . ·.
Dawan Utecht, Director
Department of.BehavioralHealth
Fimd!Subc.lass:· 0001/lOQOO
Account/Ptowam: 7294·/0
Organization
FY 2011-12
FY2Q}2-13
FY 20)3-14
FY201*·15
FY 2b15-i6
56302070
$250000'
' . '·
$1.;738,246
$1,738;246
,$1 '73 8,246
$1,738,246
56304784
$50,000
$2.50;000
$300000 '., ,, .
$300,000
$300~0bJ)
56304525
$87,500
$46Q,007
$599;262
$744,696
$759,825
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Total Contract
$387;500
$2,448,253
$2,6F,5{J8
$2,782,942
$2;798~071
CO{JNTY 'OF FRESNO
Fresno, CiL
Exhibit K
Page 1 of 1
Electronic Health Records Software Charges
CONTRACTOR understands that COUNTY utilizes Netsmart’s Avatar for its Electronic Health Records management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing Netsmart’s Avatar, as set forth below:
Estimated
Fee
Description Effective Fee Per
User
Est.
Quantity
of Users
FY 15-16
(February 1
– June 30)
NetSmart Avatar Monthly
Hosting Service
(per named user per month)
02/01/2016 $37.00 153 $28,305.00
NetSmart Avatar Annual
Maintenance/License
(per named license per year)
02/01/2016 $249.95 153 $15,934.31
OrderConnect License 1 (per
named license per year) 02/01/2016 $1,278.00 10 $12,780.00
Reaching Recovery Upon first
use of tools $10.00 2,500 $25,000.00
Estimated Total $82,019.31
Should CONTRACTOR choose not to utilize Netsmart’s Avatar for its Electronic Health Records management, CONTRACTOR will
be responsible for obtaining its own system for Electronic Health Records management.
1 Includes 100 faxed pages per month. An additional fee of $0.20 per faxed page will apply, thereafter.
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization’s planning and operations.
10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
— Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization’s ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach, M. C., Cooper, L. A., Robinson, K. A., Price, E. G., Gary, T. L., Jenckes, M. W., Powe, N.R. (2004). Strategies for improving minority healthcare quality. (AHRQ
Publication No. 04-E008-02). Retrieved from the Agency of Healthcare Research and Quality website:
http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf
Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. (Commonwealth Fund Publication No. 962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist, T. A., Gaskin, D. J., & Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities. (2011). National stakeholder strategy for achieving health equity. Retrieved from U.S. Department of Health and
Human Services, Office of Minority Health website: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
U.S. Department of Health and Human Services, Office of Minority Health (2011). National Partnership for Action to End Health Disparities. Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization. (2012). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/