HomeMy WebLinkAboutAgreement A-18-564 with CA Dept. of Vet. Affairs Cert. of Compliance, Medi-Cal.pdfAgreement No. 18-564
CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
Annual Medi-Cal Cost Avoidance Program Certificate of Compliance
Fiscal Year 2018/2019
I certify that Fresno County has appointed a County Veterans Service Officer (CVSO)
in compliance with California Code of Regulations, Title 12, Subchapter 4. Please consider this
as our application to participate in the Medi-Cal Cost Avoidance Program authorized by Military
and Veterans Code Section 972.5.
I understand and will comply with the following:
1. All activities of the CVSO for which payment is made by the Cal Vet under this
agreement will reasonably benefit the Department of Health Care Services
(DHCS) or realize cost avoidance to the Medi-Cal program. All State and
County Medi-Cal Eligibility Workers who generate a Form CW-5 (Veterans
Benefits Referral) and/or MC 05 (Military Verification and Referral form) will be
instructed to indicate the applicant's Aid Code on the face of the form.
2. All monies received under this agreement shall be allocated to and spent on
the salaries and expenses of the CVSO.
3. This agreement is binding only if federal funds are available to the CDVA from the
DHCS.
4. The CVSO is responsible for administering this program in accordance with
California Code of Regulations, Title 12, Subchapter 4 and the Ca/Vet Procedure
Manual for Subvention and Medi-Cal Cost Avoidance dated October 1, 2016.
(Rev 5/18)
SCAN AND UPLOAD THIS COMPLETED FORM VIA THE
AGENCY ATTACHMENTS IN VETPRO
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno, State of California
By tf ~ ~ Deputy