HomeMy WebLinkAboutAgreement A-18-685 with ValueOptions of California Inc..pdfAgreement No . 18-685
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 11th day of December , 2018 , by and between
3 the COUNTY OF FRESNO , a Political Subdivision of the State of California , hereinafter referred to as
4 "COUNTY", and VALUEOPTIONS OF CALIFORNIA, INC. herein after referred to as
5 "CONTRACTOR." Reference in this Agreement to "party " or "parties " shall be understood to refer to
6 COUNTY and CONTRACTOR , unless otherwise specified .
7 WITNESS ETH
8 WHEREAS , COUNTY is authorized through its Intergovernmental Agreement with the California
9 Department of Health Care Services , hereinafter referred to as State or DHCS , to subcontract for Drug
10 Medi-Cal services in Fresno County ; and
11 WHEREAS , COUNTY is authorized to contract with privately operated agencies for the
12 provision of alcohol and SUD treatment services , pursuant to Title 9 , Division 4 of the California
13 Code of Regulations and Division 10 .5 (commencing with Section 11750) of the California Health
14 and Safety Code; and
15 WHEREAS , COUNTY , through its Department of Behavioral Health , is a Mental Hea lth Plan as
16 defined in Title 9 of the California Code of Regulations section 1810 .226 ; and
17 WHEREAS , CONTRACTOR(S) is licensed by the State of Cal ifornia Department of Managed
18 Health care to provide services required by the County , pursuant to the terms and conditions of this
19 Agreement.
20 NOW, THEREFORE , in consideration of the mutual covenants , terms and conditions herein
21 contained , the parties hereto agree as follows :
22
23
1. SERVICES
A. CONTRACTOR shall perform all serv ices and fulfill all responsib ilities as set forth
24 in Exhibit A , "Scope of Work ," attached hereto and by this reference incorporated herein and made part
25 of this Agreement.
26 B . It is acknowledged by all parties hereto that COUNTY 's DBH Contracted
27 Services Division shall mon itor the services operated by CONTRACTOR , in accordance with Section
28 Eighteen (18), EVALUATION -MONITORING , of th is Agreement.
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C. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH to discuss program requirements, data reporting, training,
policies, procedures, overall program operations and any problems or foreseeable problems that may
arise.
D. CONTRACTOR shall maintain requirements as a Drug Medi-Cal Organized
Delivery System contractor for to the extent applicable for the services described herein throughout the
term of this Agreement. If for any reason this status is not maintained, COUNTY may terminate this
Agreement pursuant to Section Three (3), TERMINATION, of this Agreement.
E. CONTRACTOR agrees that prior to providing services under the terms and
conditions of this Agreement, CONTRACTOR shall have staff hired and in place for program services
and operations or COUNTY may, in addition to other remedies, terminate this Agreement, in
accordance with Section Two (2), TERM, of this Agreement.
F. Upon issuance of final direction from DHCS, CONTRACTOR will work in good
faith with DBH to amend this Agreement to develop and implement a comprehensive scope of work to
meet DHCS requirements for concurrent reviews of inpatient mental health treatment authorizations.
Upon the parties’ final written agreement to terms, the scope of work will become part of this
agreement, with a revised budget accounting for the additional service, through an amendment to this
agreement that is approved by CONTRACTOR and COUNTY.
G. CONTRACTOR will promptly provide copies of policies and procedures for
Administrative Services as reasonably requested by COUNTY. During normal business hours, as
reasonably required, upon reasonable prior notice and with all confidentiality/privacy protections in
place, CONTRACTOR shall provide COUNTY, its duly authorized representatives or applicable
governmental agencies, access to inspect facilities, equipment, documents and records reasonably
relating to Administrative Services provided by CONTRACTOR hereunder. CONTRACTOR shall
cooperate with collecting and sharing with COUNTY data pursuant to those reports listed in this
Agreement and its Exhibits and shall cooperate with such additional reporting that COUNTY is required
to submit to regulators or accreditation entities. COUNTY possesses and retains all right, title, and
interest in and to COUNTY data. COUNTY may access and copy any COUNTY data in
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CONTRACTOR’s possession as reasonably requested. Promptly after COUNTY’S request or at such
regular intervals as reasonably requested by COUNTY, CONTRACTOR shall facilitate access and
copying of COUNTY data in a format that is usable by COUNTY in its day-to-day operations so that
COUNTY can back-up the data as needed and resume performance of critical functions in the case of
termination of this Agreement or disaster.
H. CONTRACTOR may maintain records and data related to the operation of the
services described within this agreement in COUNTY’s electronic health record (EHR) system (Avatar).
COUNTY shall be allowed to review such records and data in the performance and monitoring of this
agreement. 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.
1) 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 will be held harmless for any decision made based on
information obtained by COUNTY’s EHR which may be inaccurate. 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 Twenty Six (26), “Health
Insurance Portability and Accountability Act.”
2. TERM
This Agreement shall become effective upon execution and shall continue through June 30,
2020, unless otherwise terminated pursuant to the terms set forth herein.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
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provided hereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated, at any time by giving the CONTRACTOR sixty (60) days advance written notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY, after it has provided
Contractor written notice of same and no less than 14 days’ opportunity to cure, there remains:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY;
or
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default which may then exist on the part of the CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to the COUNTY with respect to
the breach or default. The COUNTY shall have the right to demand of the CONTRACTOR the
repayment to the COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which
are determined by a court of competent jurisdiction to have not been expended in accordance with the
terms of this Agreement.
C. Without Cause –Under circumstances other than those set forth above, this
Agreement may be terminated by either party upon the giving of thirty (60) days advance written notice
of an intention to terminate to the other party.
D. Voluntary Termination of Intergovernmental Agreement - The COUNTY may
terminate its Agreement with DHCS at any time, for any reason, by giving sixty (60) days written notice
to DHCS. In the event the Intergovernmental Agreement is terminated, COUNTY may terminate this
contractor agreement. CONTRACTOR shall be paid for services provided to beneficiaries up to the
date of termination.
4. COMPENSATION
A. Contingent upon confirmation of funding by the California Department of Health
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Care Services, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with Exhibit B, “Budget” attached hereto and by this reference
incorporated herein, for each term of the Agreement. Monthly invoices shall be submitted in accordance
with Section Five (5), INVOICING, of this Agreement.
The maximum compensation amount under this Agreement for the initial term through
December 31, 2018 shall not exceed Two Hundred Two Thousand and No/100 Dollars ($202,000.00).
The maximum compensation amount under this Agreement for the term January 1, 2019
through June 30, 2019 shall not exceed One Million Three Hundred Thousand and No/100 Dollars
($1,300,000.00).
The maximum compensation amount under this Agreement for the term July 1, 2019 through
June 30, 2020 shall not exceed Two Million Six Hundred Thousand and No/100 Dollars
($2,600,000.00).
B. It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply
with any material provision of this Agreement after written notice to CONTRACTOR of the alleged
failure and CONTRACTOR’s failure to cure after no less than 14 days, COUNTY shall be relieved of its
obligation for further compensation.
C. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided in the preceding month, within forty-five (45) days after the date of receipt and approval by
COUNTY of the monthly invoicing as described in Section Five (5), INVOICING, herein. Payments shall
be documented to COUNTY on a monthly basis by the twentieth (20) day of the month following the
month of said expenditures.
D. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
All final invoices shall be submitted by CONTRACTOR within sixty (60) days following
the final month of service for which payment is claimed. No action shall be taken by COUNTY on
invoices submitted beyond the sixty (60) day closeout period.
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E. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred
payment shall not exceed the amount of funding delayed by the State Controller to COUNTY. The
period of time of the deferral by COUNTY shall not exceed the period of time of the State Controller’s
delay of payment to COUNTY plus forty-five (45) days.
F. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with Drug Medi-Cal Administrative and/or Realignment Funds. It is further understood by
CONTRACTOR and COUNTY that funds shall be used to support appropriate SUD 24/7 Access Line,
Prior Authorizations and concurrent reviews for SUD Residential Services.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY by the twentieth (20th) of each month.
Total reimbursement cannot exceed the maximum annual contract amount. Invoices shall be submitted
via email to the assigned staff analyst and to SAS@fresnocountyca.gov.
B. COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of
the month for the prior month’s hosting fee for access to COUNTY’s electronic information system in
accordance with the fee schedule set forth in Exhibit C, “Electronic Health Records Software Charges,”
attached hereto and incorporated herein by this reference and made part of this Agreement. COUNTY
shall invoice CONTRACTOR(S) annually for the annual maintenance and licensing fee for access to
COUNTY’s electronic information system in accordance with the fee schedule as set forth in Exhibit C.
CONTRACTOR shall provide payment for these expenditures to COUNTY’s 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.
C. At the discretion of COUNTY’s DBH Director or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director or designee shall
have the right to withhold payment as to only that portion of the invoice that is incorrect or improper,
with five (5) days prior notice of intent to withhold funds to CONTRACTOR. CONTRACTOR agrees to
continue to provide services for a period of ninety (90) days after notification of an incorrect or improper
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invoice. If after the ninety (90) day period, the invoice(s) is still not corrected to the satisfaction of
COUNTY DBH, COUNTY’s DBH Director, or designee, may elect to terminate this Agreement,
pursuant to the termination provisions stated in Section Three (3), TERMINATION, of this Agreement.
COUNTY’s DBH, at the discretion of COUNTY’s DBH Director or designee, shall have the right to deny
payment of any additional invoices received ninety (90) days after the expiration of each term of this
Agreement or termination of this Agreement. If invoices are not submitted within ninety (90) days after
each twelve (12) month period expires or this Agreement is terminated, COUNTY’s DBH Director or her
designee shall have the right to deny payment on such invoices.
D. CONTRACTOR shall maintain financial records for a period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR is responsible for
any disallowances related to inadequate documentation.
E. CONTRACTOR is responsible for collection and managing data in a manner to
be determined by DHCS and the Fresno County Drug Medi-Cal Organized Delivery System in
accordance with applicable rules and regulations.
6. LICENSING-CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for
the provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
7. PROHIBITION ON PUBLICITY
Publicity of the services described in Section One (1), SERVICES, of this Agreement shall be
allowed as necessary to raise public awareness about the availability of such specific services when
approved in advance by the DBH Director or her designee, and at a cost to be provided for such items
as written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
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expense(s).
8. NO THIRD PARTY BENEFICIARIES
It is understood and agreed by and between the parties that the services provided by
CONTRACTOR for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
Agreement is intended to confer on any person other than the parties hereto any right under or by
reason of this Agreement.
9. INDEPENDENT CONTRACTOR
In performance of the work, duties and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no
right to control or supervise or direct the manner or method by which CONTRACTOR shall perform its
work and function. However, COUNTY shall retain the right to administer this Agreement so as to verify
that CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules
and regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely no
right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally required
employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY
harmless from all matters relating to payment of CONTRACTOR'S employees, including compliance
with Social Security withholding and all other regulations governing such matters. It is acknowledged
that during the term of this Agreement, CONTRACTOR may be providing services to others unrelated
to the COUNTY or to this Agreement.
10. NON-ASSIGMNMENT / SUBCONTRACTS
Neither party shall assign, transfer or sub contract this Agreement nor their rights or duties
under this Agreement without the prior written consent of the other party; provided, however, that
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CONTRACTOR may rely upon the services of its affiliates to provide services under this Agreement.
CONTRACTOR shall be required to assume full responsibility for all services and activities
covered by this Agreement, whether or not CONTRACTOR is providing services directly. Further,
CONTRACTOR shall be the sole point of contact with regard to contractual matters, including payment
of any and all charges resulting from this Agreement.
If CONTRACTOR should propose to subcontract with one or more third parties other than its
affiliates to carry out a portion of services covered by this Agreement, any such subcontract shall be in
writing and approved as to form and content by COUNTY’s DBH Director or her designee prior to
execution and implementation. COUNTY’s DBH Director or her designee shall have the right to reject
any such proposed subcontract. Any such subcontract together with all activities by or caused by
CONTRACTOR shall not require compensation greater than the total budget contained herein. An
executed copy of any such subcontract shall be received by COUNTY before any implementation and
shall be retained by COUNTY. CONTRACTOR shall be responsible to COUNTY for the proper
performance of any subcontract. Any subcontractor shall be subject to the same terms and conditions
that CONTRACTOR is subject to under this Agreement.
11. CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility for
planning and carrying out the services provided under this Agreement shall have any direct or indirect
personal financial interest in this Agreement. CONTRACTOR shall comply with all Federal, State of
California, and local conflict of interest laws, statutes, and regulations, which shall be applicable to all
parties and beneficiaries under this Agreement and any officer, agent, or employee of COUNTY.
12. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-profit
or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes its status
to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing transactions
that they are a party to while CONTRACTOR is providing goods or performing services under this
agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party
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and in which one or more of its directors has a material financial interest. Members of the Board of
Directors shall disclose any self-dealing transactions that they are a party to by completing and signing
a “Self-Dealing Transaction Disclosure Form,” attached hereto as Exhibit D and incorporated herein by
reference, and submitting it to the COUNTY prior to commencing with the self-dealing transaction or
immediately thereafter.
13. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; that it
has not been convicted of a criminal offense related to the provision of health care items or services;
nor has it been reinstated to participation in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a
contract, that CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR
from responsibility for, or involvement with, COUNTY’s business operations related to the Federal
Health Care Programs and shall remove such CONTRACTOR from any position in which
CONTRACTOR’s compensation, or the items or services rendered, ordered or prescribed by
CONTRACTOR may be paid in whole or part, directly or indirectly, by Federal Health Care Programs or
otherwise with Federal Funds at least until such time as CONTRACTOR is reinstated into participation
in the Federal Health Care Programs. Further the CONTRACTOR agrees to the Disclosure of Criminal
History and Civil Actions and Certification regarding debarment suspension and other responsibility
matters primary covered transactions; CONTRACTOR must sign an appropriate “Certification
Regarding Debarment, Suspension, and Other Responsibility Matters,” attached hereto as Exhibit E,
incorporated herein by reference and made part of this Agreement.
A. If COUNTY has notice that CONTRACTOR has been charged with a criminal
offense related to any Federal Health Care Program, or is proposed for exclusion during the term on
any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of
any claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or
the proposed exclusion.
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B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
they have been convicted of a criminal offense related to the provision of health care items or services;
and or (3) they have been reinstated to participation in the Federal Health Care Programs after a period
of exclusion, suspension, debarment, or ineligibility.
1) In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
hires or engages such potential employee or subcontractor, CONTRACTOR will ensure that said
employee or subcontractor does no work, either directly or indirectly relating to services provided to
COUNTY.
2) Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) TERMINATION of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
frame to be determined by COUNTY to protect the interests of COUNTY beneficiaries.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have not
been reinstated to participation in the Federal Health Care Program after a period of exclusion,
suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision
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of health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1) CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case,
is providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense
relating to the provision of health care services.
2) Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with the Section Three (3) TERMINATION of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
frame to be determined by COUNTY to protect the interests of COUNTY beneficiaries.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating
to this Agreement.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of the
terms of this Agreement.
14. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent through
amendments agreed to by of all of the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR, as needed, to accommodate changes in the laws 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 CONTRACTOR through an amendment
approved by COUNTY’s Counsel and the COUNTY’s Auditor-Controller’s office.
Said modifications shall not result in any change to the annual maximum compensation amount
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payable to CONTRACTOR, as stated in this Agreement.
15. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million Dollars
($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
C. Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D. Worker’s Compensation
A policy of Worker's Compensation insurance as may be required by the California
Labor Code.
E. Cyber Liability
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim,
$2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as
is undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims
involving infringement of intellectual property, including but not limited to infringement of copyright,
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trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
electronic information, release of private information, alteration of electronic information, extortion and
network security. The policy shall provide coverage for breach response costs as well as regulatory
fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these
obligations.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such
coverage for additional insured shall apply as primary insurance and any other insurance, or self
insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
contributing with insurance provided under CONTRACTOR's policies herein. This insurance shall not
be cancelled or changed without a minimum of thirty (30) days advance written notice given to
COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of
Behavioral Health, Contracts Division – SUD Services at 3133 N Millbrook Avenue, Fresno, California,
93703, stating that such insurance coverages have been obtained and are in full force; that the County
of Fresno, its officers, agents and employees will not be responsible for any premiums on the policies;
that such Commercial General Liability insurance names the County of Fresno, its officers, agents and
employees, individually and collectively, as additional insured, but only insofar as the operations under
this Agreement are concerned; that such coverage for additional insured shall apply as primary
insurance and any other insurance, or self insurance, maintained by COUNTY, its officers, agents and
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employees, shall be excess only and not contributing with insurance provided under CONTRACTOR's
policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty
(30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of
California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
rating of A FSC VII or better.
16. HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request, defend
the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
employees under this Agreement, and from any and all costs and expenses (including attorney’s fees
and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, its officers, agents, or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit exceptions
resulting from noncompliance herein on the part of the CONTRACTOR.
17. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours no more than twice per calendar
year, make available to the COUNTY for examination all of its records and data with respect to the
matters covered by this Agreement. The CONTRACTOR shall, upon request by the COUNTY, permit
the COUNTY to audit and inspect all of such records and data as well as inspection of the premises,
physical facilities and equipment where Medicaid-related activities are conducted to ensure
CONTRACTOR'S compliance with the terms of this Agreement.
The right to audit under this section exists for ten (10) years from the final date of the agreement
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period or from the date of completion of any audit, whichever is later.
Notwithstanding the provisions stated in Section Two (2), TERM, of this Agreement, it is
acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all
audit procedures and requirements as stated in this Agreement have been completed to the review and
satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or resulting from any
audit and/or inspections including, but not limited to, actual costs incurred and the payment of any
expenditures disallowed by either COUNTY, State, or Federal governmental entities, including any
assessed interest and penalties.
CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
minimum of ten (10) years, in accordance with 42 CFR Part 438.3(h), from the finalized cost settlement
process or, if an audit by the Federal government or DHCS has been started before the expiration of
the ten (10) year period, records shall be maintained until completion of the audit and final resolution of
all findings.
Notwithstanding any other provision of law, every contract involving the expenditure of
public funds in excess of ten thousand dollars ($10,000) entered into by any state agency, board,
commission, or department or by any other public entity, including a city, county, city and county, or
district, shall be subject to the examination and audit of the California State Auditor, at the request of
the public entity or as part of any audit of the public entity, for a period of three years after final payment
under the contract in accordance with Government Code 8546.7.
18. EVALUATION – MONITORING
CONTRACTOR shall participate in a review of the program at least yearly or more frequently, or
as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all information
reasonably requested by the COUNTY, DHCS, and/or the subcontractor during the program evaluation,
monitoring, and/or review.
COUNTY’s DBH Director, or her designee, and DHCS or their designees shall monitor and
evaluate the performance of CONTRACTOR under this Agreement to determine to the best possible
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degree the success or failure of the services provided under this Agreement. At the discretion of the
COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of the program
as needed, at the discretion of COUNTY.
COUNTY shall recapture from CONTRACTOR the value of any services or other expenditures
determined to be ineligible based on the COUNTY or State monitoring results. At the discretion of the
COUNTY, recoupment can be made through a future invoice reduction or reimbursement by the
CONTRACTOR.
19. REPORTS – SUBSTANCE USE DISORDER SERVICES
CONTRACTOR(S) shall submit all information and data required by State, including, but not
limited to the following:
A. ASAM Level of Care (LOC) – Submit ASAM LOC data in an electronic format, on
a schedule as determined by the COUNTY which complies with State requirements; and
B. Culturally and Linguistically Appropriate Services (CLAS) - Annually, upon
request by DBH, CONTRACTOR(S) shall provide a CLAS program description and evidence of staff
training; and
C. Outcome Reports – CONTRACTOR and COUNTY shall agree to a “Standard
Reporting Package” within 30 days of the execution of this agreement. CONTRACTOR shall deliver the
reports set forth in the “Standard Reporting Package” according to the timeframes agreed to by
CONTRACTOR and COUNTY. Non-standard reports shall be delivered according to a mutually
agreed-to timeline after full specifications are received and confirmed by CONTRACTOR and approved
by COUNTY. In addition to the Standard Reporting Package, Beacon will provide a maximum of eight
(8) hours of time per month to include design, development and production work for modifications to
any report in the Standard Reporting Package or any non-standard additional reports requested by
COUNTY that are not included in the Standard Reporting Package (the “Reporting Customization
Work”); provided, however, that any unused hours in any month shall not be carried into the next
month. For any Reporting Customization Work beyond the eight (8) hours per month required to
accommodate COUNTY reporting requests (“Additional Reporting Customization Work”), Client shall
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reimburse Beacon at the rate of $150 per hour. This rate for Additional Customization Work shall
increase by three percent (3%) on each anniversary of the Effective Date of this Agreement.
The Standard Reporting Package shall be reviewed by both Parties at least annually for
revision to the reports included in the package and content and format of included reports. Mutually
agreed to changes to the Standard Reporting Package will be made at no additional charge to
COUNTY provided the number of reports and production time for reports does not increase materially.
For any changes to the Standard Reporting Package or any agreed upon modifications to the same
that materially increase the number of reports or production time for reports, such mutually-agreed
upon changes shall be added to this Agreement by an amendment signed by both parties.
20. RECORDS
A. RECORD ESTABLISHMENT AND MAINTENANCE –CONTRACTOR shall
establish and maintain records in accordance with State and Federal rules and regulations in addition
to those requirements prescribed by COUNTY with respect to all matters covered by this Agreement.
Except as otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period
of ten (10) years from the finalized cost settlement process, or from the date of completion of any audit,
whichever is later.
B. DOCUMENTATION – CONTRACTOR shall maintain adequate records in
sufficient detail to make possible an evaluation of services, and contain all the data necessary in
reporting to the State of California and/or Federal agency. All client records shall be maintained
pursuant to applicable State of California and Federal requirements concerning confidentiality.
C. REPORTS – CONTRACTOR shall submit to COUNTY monthly fiscal and all
program reports as further described in Section Nineteen (19) REPORTS – Substance Use Disorder
Services. CONTRACTOR shall submit a complete and accurate year-end cost report for each fiscal
year affected by this Agreement, following the end of each fiscal year affected by this Agreement.
CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and information
as COUNTY may request pertaining to matters covered by this Agreement. All reports submitted by
CONTRACTOR to COUNTY must be typewritten.
D. SUSPENSION OF COMPENSATION – In the event that CONTRACTOR fails to
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provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance.
E. CLIENT CONFIDENTIALITY – CONTRACTOR shall conform to and COUNTY
shall monitor compliance with all State and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements of 42 CFR § 2.1 et seq., Welfare
and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety Code §§ 11977 and 11812, Civil
Code, Division 1, Part 2.6, and CCR Title 22 § 51009.
21. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal beneficiary information;
abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies
that enter into a contractual relationship with the COUNTY for the purpose of providing services under
this Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-OWNED MOBILE, WIRELESS, OR HANDHELD DEVICES
CONTRACTOR may not connect to COUNTY networks via personally-owned mobile,
wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-OWNED COMPUTERS OR COMPUTER PERIPHERALS
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to
be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
means of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data
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must be encrypted.
C. COUNTY-OWNED COMPUTER EQUIPMENT
CONTRACTOR or anyone having an employment relationship with the COUNTY may
not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
authorization from the COUNTY’s Chief Information Officer, and/or designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential beneficiary information transmitted to one party by the other by
means of electronic transmissions must be encrypted according to Advanced Encryption Standards
(AES) of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY upon being made
aware of any violations, breaches or potential breaches of security related to COUNTY’s confidential
information, data maintained in computer files, program documentation, data processing systems, data
files and data processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential beneficiary information
provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR will be responsible for all costs incurred as a result of providing the required
notification.
22. COMPLIANCE WITH LAWS, POLICIES, AND RULES
CONTRACTOR shall comply with all applicable rules and regulations set forth in CCR Titles 9
and 22, and California Health and Safety Code § 11750 et seq., with the exception of regulations
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waived by the Centers for Medicare and Medicaid Services and DHCS, as stated within the DMC-
Organized Delivery Service Special Terms and Conditions and the DMC Intergovernmental Agreement.
CONTRACTOR shall comply with any other Federal and State laws or guidelines applicable to
CONTRACTOR’s performance under this Agreement or any local ordinances, regulations, or policies
applicable. Such provisions include, but are not restricted to:
A. CONTRACTOR shall comply with 42 CFR Part 438;
B. CONTRACTOR shall furnish beneficiary records in accordance with the
applicable Federal, State and local regulations and requirements, including in such records a treatment
plan for each beneficiary, and evidence of each service rendered;
C. CONTRACTOR shall comply with statistical reporting and program evaluation
systems as provided in State of California regulations and in this Agreement.
D. CONTRACTOR shall comply with requirements contained in the
Intergovernmental Agreement with DHCS by this reference incorporated herein, until such time that a
new Intergovernmental Agreement is established. Upon amendment of the Intergovernmental
Agreement, the terms of the amended Intergovernmental Agreement shall automatically be
incorporated into this Agreement.
E. CONTRACTOR shall inform every beneficiary of their rights regarding Grievance
and Appeals according to state and federal law.
F. In the event any law, regulation, or policy referred to in this Agreement is
amended during the term thereof, the parties hereto agree to comply with the amended provision as of
the effective date of such amendment. Exhibits will be updated as needed and no formal amendment of
this contract is required for new rules to apply.
23. NON-DISCRIMINATION PROVISION
ELIGIBILITY FOR SERVICES –CONTRACTOR shall not unlawfully discriminate in the provision
of services because of race, religious creed, color, national origin, ancestry, physical disability, mental
disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender
expression, age, sexual orientation, or military or veteran status as provided by State of California and
Federal law in accordance with Title VI of the Civil Rights Act of 1964 (42 USC § 2000(d)); Age
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Discrimination Act of 1975 (42 USC § 1681); Rehabilitation Act of 1973 (29 USC § 794); Education
Amendments of 1972 (20 USC § 1681); Americans with Disabilities Act of 1990 (42 USC § 12132); 45
CFR, Part 84; provisions of the Fair Employment and Housing Act (California Government Code §
12900); and regulations promulgated thereunder (CCR Title 2, § 7285.0); Title 2, Division 3, Article 9.5
of the California Government Code commencing with section 11135; and CCR Title 9, Division 4,
Chapter 6 commencing with section 10800.
A. EQUAL OPPORTUNITY - CONTRACTOR shall comply with California
Government Code, § 2990 and CCR Title 2, Division 4, Chapter 5, in matters related to the
development, implementation, and maintenance of a nondiscrimination program. CONTRACTOR shall
not discriminate against any employee or applicant for employment because race, religious creed,
color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or
military or veteran status. Such practices include retirement, recruitment, advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of compensation, use of
facilities, and other terms and conditions of employment. CONTRACTOR agrees to post in
conspicuous places, notices available to all employees and applicants for employment setting forth the
provisions of the Equal Opportunity Act (42 USC § 2000(e)) in conformance with Federal Executive
Order No. 11246. CONTRACTOR agrees to comply with the provisions of the Rehabilitation Act of
1973 (29 USC § 794).
24. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a beneficiary or a
beneficiary's family. CONTRACTOR shall provide a summary of the complaint log entries concerning
COUNTY-sponsored beneficiaries to COUNTY at monthly intervals by the fifteenth (15th) day of the
following month, in a format that is mutually agreed upon. CONTRACTOR shall post signs informing
beneficiary of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all
incidents reportable to state licensing bodies that affect COUNTY beneficiaries within twenty-four (24)
hours of receipt of a complaint.
After each incident or complaint affecting COUNTY-sponsored beneficiaries, CONTRACTOR
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shall provide COUNTY with information relevant to the complaint, investigative details of the complaint,
the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the complaint in
a timeframe consistent with federal and state regulations, but not later than fifteen days after each
incident or complaint.
25. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A. Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d, and
45 CFR Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal
access and participation in federally funded programs through the provision of comprehensive and
quality bilingual services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all Limited English Proficient (LEP) beneficiaries,
including, but not limited to, assessing the cultural and linguistic needs of its beneficiaries, training of
staff on the policies and procedures, and monitoring its language assistance program. The
CONTRACTOR’s procedures must include ensuring compliance of any sub-contracted providers with
these requirements.
C. CONTRACTOR assurances that minors shall not be used as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
CONTRACTOR’s “vital documents” (those documents that contain information that is critical for
accessing CONTRACTOR’s services or are required by law) shall be provided to participants at no cost
to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or
partners who interpret or translate for a program participant, or who directly communicate with a
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program participant in a language other than English, demonstrate proficiency in the participant's
language and can effectively communicate any specialized terms and concepts peculiar to
CONTRACTOR’s services.
E. CONTRACTOR shall ensure staff complete a CLAS training annually.
CONTRACTOR shall update CLAS program description as necessary.
26. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered entities as
defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of protected health information
between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code
of Federal Regulations (CFR).
Additionally, CONTRACTOR shall comply with the HIPAA requirements stated in Exhibit F,
“Drug Medi-Cal Specific Requirements.”
27. CHILD ABUSE REPORTING
CONTRACTOR shall utilize a procedure acceptable to the COUNTY to ensure that all of
CONTRACTOR’s employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement shall report all known or suspected child abuse or neglect to one or more of the
agencies set forth in Penal Code § 11165.9 of which they become aware as a result of performing the
services specified in this Agreement..
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28. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
CONTRACTOR shall adhere to the requirement that no funds shall be used to carry out any
program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug unless
the DHCS chooses to implement a demonstration syringe services program for intravenous drug users.
29. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in 42 CFR § 455.101 455.104, and 455.106(a)(1),(2).
In accordance with 42 CFR §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2), the following
information must be disclosed by CONTRACTOR by completing Exhibit G “Disclosure of Ownership
and Control Interest Statement,” attached hereto and by this reference incorporated herein.
CONTRACTOR shall submit this form to the Department of Behavioral Health within thirty (30) days of
the effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via
email to DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
A. Name and address of any person(s) whether it be an individual or corporation
with an ownership or controlling interest in the disclosing entity or managed care entity.
1) Address must include the primary business address, every business
location and P.O. Box address(es).
2) Date of birth and Social Security Number for individuals.
3) Tax identification number for other corporations or entities with ownership
or controlling interest in the disclosing entity.
B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
interest.
C. Whether the person(s) with an ownership or controlling interest of the disclosing
entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
interest in any of its subcontractors.
D. Name of any other disclosing entity in which an owner of the disclosing entity has
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an ownership or control interest.
E. The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
period ending on the date of the request; and
F. Any significant business transactions between CONTRACTOR and any wholly
owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
ending on the date of the request.
G. Any person(s) with an ownership or control interest in CONTRACTOR, or agent
or managing employee of CONTRACTOR; and
1) Has been convicted of a criminal offense related to that person's
involvement in any program under Medicare, Medicaid, or the title XX services program since the
inception of those programs.
H. The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
period ending on the date of the request; and
I. Any significant business transactions between CONTRACTOR and any wholly
owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
ending on the date of the request.
30. CHANGE OF LEADERSHIP/MANAGEMENT
Any and all notices between COUNTY and CONTRACTOR(S) provided for or permitted under
this Agreement or by law, shall be in writing and shall be deemed duly served when personally
delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
In the event of any change in the status of CONTRACTOR’s senior executive leadership,
CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of change.
Such notification shall include any new leader or manager’s name, address and qualifications.
“Leadership or management” shall include any senior executive.
31. NOTICES
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The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
COUNTY ValueOptions of CA
Director, Fresno County Chief Executive Officer
Department of Behavioral Health
4441 East Kings Canyon
Fresno, CA 93702
5665 Plaza Dr., Suite 400
Cypress, CA 90630
All notices between the COUNTY and CONTRACTOR provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail,
by an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered
by personal service is effective upon service to the recipient. A notice delivered by first-class United
States mail is effective three COUNTY business days after deposit in the United States mail, postage
prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is
effective one COUNTY business day after deposit with the overnight commercial courier service,
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient.
A notice delivered by telephonic facsimile is effective when transmission to the recipient is completed
(but, if such transmission is completed outside of COUNTY business hours, then such delivery shall be
deemed to be effective at the next beginning of a COUNTY business day), provided that the sender
maintains a machine record of the completed transmission. For all claims arising out of or related to
this Agreement, nothing in this section establishes, waives, or modifies any claims presentation
requirements or procedures provided by law, including but not limited to the Government Claims Act
(Division 3.6 of Title 1 of the Government Code, beginning with section 810).
32. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno County,
California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
33. SEVERABILITY
The provisions of this agreement are severable. The invalidity or unenforceability of any one
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provision in the agreement shall not affect the other provisions.
34. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire Agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written .
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VALUEOPTIONS OF
CALIFORNIA, INC.
J.~zt43 (Autti'Gzeigature)
Daniel M. Risku / EVP & General Counsel
7 Print Name & Title
8 5665 Plaza Dr. Suite 400
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Cypress , CA 90630
Mailing Address
FOR ACCOUNTING USE ONLY :
ORG No .:5630
Account No .:7295
Requisition No .:
COUNTY OF FRESNO
ATTEST:
hairperson of the Board of
the County of Fresno
Bernice E . Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
-29 -
EXHIBIT A
1
Administrative Services Organization
Service Authorizations and Access Line Services
Scope of Work
Organization: ValueOptions of California, Inc.
Service Address: 5665 Plaza Drive, Suite 400 Cypress, CA 90630
Program Director: Neil Collins, Account Partnerships Director
Contract Period: Implementation: Upon contract execution-December 31, 2018
January 1, 2019 – June 30, 2020
1.0 BACKGROUND:
1.1 Access Line (1-800-654-3937)
The Drug Medi-Cal Organized Delivery System (DMC – ODS) Waiver requires the
establishment of a 24/7 Access Line to respond to substance use disorder (SUD) calls from
county beneficiaries. The Access Line is required to log all calls including at a minimum the
following: date of call, caller name, and disposition. The Access line is required to be HIPAA
compliant and provide for language line capabilities to all callers. A database will be developed
and implemented to provide for a written call log and measurable data required by DHCS,
Fresno County DMC-ODS, and External Quality Review Organization (EQRO – Mental
Health/Substance Use Disorders) and local measurable outcomes for system improvements.
1.2 Service Authorizations
The DMC – ODS Waiver requires that counties provide prior authorization for residential
services within 24 hours of the prior authorization request being submitted by providers.
ValueOptions of California, Inc. (“ValueOptions”) will provide this service on behalf of Fresno
County. Prior authorization for services is locally referred to as SUD Treatment Authorization
Requests (STAR). ValueOptions of California will review the Diagnostic and Statistical Manual
of Mental Disorders (DSM -5) and American Society of Addiction Medicine (ASAM) criteria to
ensure that the beneficiary meets the requirements for service. ValueOptions of California shall
have written policies and procedures for processing requests for initial and continuing
authorization of services.
ValueOptions of California must have a mechanism in place to ensure that there is consistent
application of review criteria for authorization decisions and shall consult with the requesting
provider when appropriate. ValueOptions of California is to meet the established timelines for
decisions for service authorizations. Counties are required to track the number, percentage of
denied, and timeliness of requests for authorization for all DMC-ODS services that are
EXHIBIT A
2
submitted, processed, approved, and denied. This prior authorization for residential services is
compliant with the Medicaid-applicable parity requirements established by the Mental Health
Parity and Addiction Equity Act. Non-residential services shall not require prior authorization.
2.0 TARGET POPULATION:
2.1 Access Line
The 24/7 Access Line will be available to all callers seeking information or SUD treatment
services.
2.2 Service Authorizations as initiated by a SUD Service Provider
Service authorizations will be made for Fresno County SUD clients seeking treatment at a Fresno
County DBH– contracted SUD residential treatment program. ValueOptions of California will
receive necessary information from the residential treatment program including but not limited to
ASAM level of care assessment and DSM 5 diagnosis. Upon receipt of all necessary
information, ValueOptions of California, ValueOptions will make a decision as to authorization
for residential treatment services based on a review of the client’s Medi-Cal eligibility, ASAM
level of care, DSM 5 diagnosis, and other criteria as specified by Fresno County DBH, DHCS, or
CMS. An approval or denial of the request will be provided to the SUD contracted provider and
the beneficiary as required by DHCS.
3.0 LOCATION OF SERVICES:
3.1 Access Line
The physical location of the 24/7 Access Line will be in Orange County, CA.
3.2 Service Authorizations
The physical location of the service authorization offices will be in Orange County, CA.
4.0 DESCRIPTION OF SERVICES:
4.1 Access Line
The 24/7 Access Line for DMC-ODS services will be the same toll free number currently used
for mental health access for Fresno County DBH: 1-800-654-3937. ValueOptions of California
will understand the requirements of the Drug Medi-Cal Organized Delivery System 1115 Waiver
as they relate to the operation of the 24/7 Access Line and work with DBH to ensure all
requirements are met. A “phone tree” or other mechanism will be established to route calls to the
appropriate access line operator depending on whether the call is for mental health services or
SUD services.
All counties are required to have a 24/7 toll free number for prospective beneficiaries to call to
access DMC-ODS services. In order to ensure timely access to services, client flow is designed
with a “No Wrong Door” approach. Any member of the community may contact Fresno County
through its 24/7 Access Line. The 24/7 Access Line will be staffed by licensed practitioners of
the healing arts (LPHA) as defined by DHCS/Special Terms and Conditions and/or certified
EXHIBIT A
3
counselors. Clinical staff will utilize a standardized ASAM Criteria screening tool (approved by
DBH) to assist clients in accessing the most appropriate level of care. All Access Line services
will be made available in all languages through the use of telephonic interpreting and for the hard
of hearing through TTY. During the initial screening, immediate clinical needs are determined
following an assessment for potential risk and safety issues. Callers presenting with emergent
conditions or who are in crisis will be connected to emergency services immediately. Licensed or
credentialed Access Line operators will be trained in SUD/ASAM and will use the results of the
standardized ASAM screening tool to make referrals to treatment providers.
When making referrals to providers after ASAM screenings, Access Line staff will consider
distance traveled, (no more than 60 miles for outpatient and 45 miles for Opioid Treatment
Providers), language capability, and client preference. Telehealth options will also be provided
for rural area residents where available and appropriate. Access Line staff will offer to make an
appointment for callers who are determined eligible. Appointments will be scheduled according
to timeliness to service standards. Appointments must be made using DBH’s electronic health
record (EHR). Initial appointments available to clients in need of urgent services will be made
within 48 hours. Priority populations, such as pregnant IV users, pregnant or parenting users, and
IV drug users, will be considered to have an urgent need for treatment. First service
appointments for non-urgent services will be offered within 10 days.
The Access Line will provide afterhours (Monday through Sunday 5pm-8am) care to community
members by triaging calls and determining if emergency services are necessary or referring to
available SUD services as necessary.
All calls will be logged within 24 hours within a DBH approved database. The log will record
information of all calls made to the access line. The database will be reviewed by DBH to ensure
compliance with all local, state, and federal requirements. DBH may also use the database to
follow up on calls requesting additional information, grievances, or other requests which could
not be immediately resolved at the access line.
Access line staff will screen callers for Medi-Cal eligibility. Should a caller not have Medi-Cal
or out-of-county Medi-Cal and request services they will be directed as follows:
• To the Urgent Care Wellness Center, Youth Wellness Center, or an SUD contracted
provider for SUD services;
• To emergency services if they have an emergent condition;
• To the Fresno County Department of Social Services (DSS) if they would like to address
their Medi-Cal eligibility;
• Should a caller have out-of-county Medi-Cal, the caller will be directed to either DSS to
transfer their Medi-Cal to Fresno County or be connected to the client’s county-of-
residence access line.
EXHIBIT A
4
ValueOptions of California will maintain a resource guide available to callers seeking mental
health, substance use disorders, and other community resources.
ValueOptions of California will be granted access to DBH’s EHR and database. ValueOptions of
California will be required to establish a “tickler” or process approved by DBH that will identify
calls that need a call back by either DBH staff or ValueOptions of California. ValueOptions of
California must use a system that allows for multiple users simultaneously. Scripts will be
developed by ValueOptions of California and DBH and approved by DBH and will address
substance use disorders, mental health, psychiatric crises, and Multi Agency Access Points.
ValueOptions of California must ensure that their phone system is capable of connecting to
emergency services. ValueOptions of California will categorize the types of calls received.
ValueOptions of California will record all necessary demographic information.
Information on the grievance, appeal, expedited appeal will be provided through the Access
Line. Beneficiaries will be informed of their right to access Patient’s Rights Advocacy services
for assistance and representation in the appeals process. Access Line staff will log the grievance,
appeal, and expedited appeal to be tracked and appropriately triaged. The caller may choose to
be connected to DBH’s Managed Care division to file grievances, appeals, expedited appeals,
and state fair hearings or they may choose to receive the contact information to DBH’s Managed
Care division.
Data collected for DMC-ODS requests for service will be determined by DBH, DHCS, and CMS
on an on-going basis. Periodic surveys referred to as “test calls” are conducted by DBH staff and
designated beneficiaries posing as service seekers to determine timeliness of response, language
accessibility, and satisfaction with service quality. A minimum of seven test calls will be made
by DBH per month with at least two calls in threshold languages. Summaries of the test calls will
be reported at the Quality Improvement Committee and Access Committee monthly meetings to
help initiate necessary training and correct deficiencies. These test calls will be monitored for the
following:
• Accurate name, date, phone number logged;
• Whether the caller was assessed for crisis;
• Whether the appropriate information was given on how to access SUD services;
• Whether free language assistance was offered.
A report of all findings related to the test calls will be provided to ValueOptions of California to
complete and return a corrective action plan to DBH for approval. The corrective action plan will
detail steps ValueOptions of California will take to remedy any issues related to service delivery.
The Access Line will also participate in any Performance Improvement Project (PIP) that affects
access to behavioral health services as determined by DBH. Additional information to be tracked
is included in the “Program Objectives and Outcomes Section” of this scope of work. All calls
EXHIBIT A
5
will be logged in DBH’s Electronic Health Record or in a DBH-approved system in a form
determined by DBH. The phone system utilized to field calls will have the capability to capture
and record all data required by County DBH, DHCS, and CMS.
Fresno County’s Quality Improvement Committee (QIC) will set standards, review performance,
and monitor phone response and waiting times to ensure that the Access Line is appropriately
meeting the needs of the community. ValueOptions of California representatives will participate
in the monthly QIC meetings and its subcommittees, including the Access committee, in-person,
by phone, or by teleconference. ValueOptions of California will attend the QIC meetings in-
person on a quarterly basis with exact dates determined by DBH.
Data collected and maintained by ValueOptions of California related to the services described
herein will be provided to DBH in a form approved by DBH on a monthly basis during the term
of this agreement or as needed to ensure compliance with reporting requirements. The process by
which data is provided will be approved by DBH to help facilitate reporting requirements.
4.2 Service Authorizations
DBH SUD – contracted providers will be required to submit service authorizations for residential
services electronically or in a form specified and approved by DBH, including appropriate
documentation/information supporting medical necessity for the recommended ASAM level of
care. Residential services consist of ASAM levels 3.1, 3.3, 3.5 and 3.2-WM. Should County add
ASAM levels 3.7 and 4.0, ValueOptions of California will also process those service requests.
Service authorizations for residential services will be processed within 24 hours of a complete
request being submitted. A complete request will consist of a completed assessment and initial
determination of diagnosis form and STAR form. ValueOptions of California will review each
service request for accuracy, client eligibility, eligible diagnosis, and ensure ASAM criteria and
medical necessity is met. ValueOptions of California will be responsible for notifying providers
and DBH of approval/denial electronically. ValueOptions of California will be responsible for
developing and implementing an appeals process for denied service authorizations. The appeals
process will consist of the service request being reviewed by a licensed clinician (different from
the original reviewer) or medical director who may communicate directly with the provider
and/or client to gather more information if necessary.
If a service authorization request is denied, ValueOptions of California will be responsible for
sending all required Notice of Adverse Benefit Determination (NOABD) forms to the
beneficiary requesting services and to the treatment provider. The beneficiary (or treatment
provider on behalf of the beneficiary) may appeal the denial. ValueOptions of California will
submit documentation of the appeals process for review to DBH for approval prior to
implementation. The appeals process may be modified, with DBH approval, from time to time to
meet local, state, or federal requirements, or for improvements. A log of all appeals including
provider information, beneficiary information, and disposition will be provided to DBH on a
monthly basis for review.
EXHIBIT A
6
DBH will monitor the number, percentage and time period of treatment service authorization
requests approved or denied by ValueOptions of California.
County DBH will conduct reviews of service authorization functions, either in-person or
remotely, on a quarterly basis the first year and semiannually thereafter. The reviews will
encompass the following to ensure compliance with DBH, DHCS, and CMS requirements:
• Staff qualifications and trainings
• Procedures for approval/denials of service requests
• Confidentiality and privacy of beneficiary information
• Adherence to rules and regulations to DBH, DHCS, and CMS requirements
• Timeliness
• Contract compliance
• Correct placement in ASAM level of care
Data collected and maintained by ValueOptions of California related to the services described
herein will be provided to DBH in a form approved by DBH on a monthly basis during the term
of this agreement or as needed to ensure compliance with reporting requirements. The process by
which data is provided will be approved by DBH to help facilitate reporting requirements.
4.3 Concurrent Reviews of Mental Health Inpatient Treatment Authorizations
Upon the issuance of final direction from DHCS, ValueOptions of California will work in good
faith with DBH to develop and implement a comprehensive scope of work to meet DHCS
requirements for concurrent reviews on inpatient mental health treatment authorizations. Upon
final written agreement to terms, the scope of work will become part of this agreement, with a
revised budget accounting for the additional service, through an amendment to this agreement
that is approved by ValueOptions of California and the County of Fresno.
5.0 STAFFING:
5.1 Access Line
The 24/7 Access Line will be staffed by licensed practitioners of the healing arts (LPHA) as
defined by DHCS/Special Terms and Conditions and/or certified AOD counselors. Staff will be
trained in ASAM and utilize a standardized ASAM criteria screening tool (approved by Fresno
DBH) to assist beneficiaries in accessing the most appropriate level of service. Non-clinical staff
may be utilized to support clinical staff with administrative duties such as data entering, Medi-
Cal eligibility determination, and other general clerical functions.
Staff will be trained with a client-centered approach. Ongoing training will include topics such
as:
• Administrative, operational, human resource, and information technology areas
• Cultural competency, including cultural awareness and responsiveness
EXHIBIT A
7
• Motivational interviewing
• One of the following four evidence-based practices (EBP): Psycho-education, trauma
informed treatment, cognitive behavioral therapy, relapse prevention
• Specialized clinical training (ASAM training must be provided)
• Health and wellness promotion, illness and harm prevention, and stigma reduction
• Staff will be trained to become familiar with County DBH’s EHR
A training plan for each staff member shall be submitted to DBH annually listing all trainings
completed and pending/planned for each fiscal year.
Job descriptions for each staff position will be provided to DBH for review prior to project
implementation..
5.2 Service Authorizations
The service authorization function will be staffed by licensed practitioners of the healing arts as
defined by DHCS/Special Terms and Conditions. Staff will be trained in ASAM and will review
a standardized ASAM assessment and medical diagnosis form (approved by DBH) for
approval/denial of service authorization requests. Non-clinical staff may be utilized to support
clinical staff with administrative duties such as data entering, Medi-Cal eligibility determination,
and other general administrative functions.
Staff will be trained with a client-centered approach. Ongoing training will include topics such
as:
• Administrative, operational, human resource, and information technology areas
• Cultural competency, including cultural awareness and responsiveness
• Motivational interviewing
• One of the following four evidence-based practices (EBP): Psycho-education, trauma
informed treatment, cognitive behavioral therapy, relapse prevention
• Specialized clinical training such as ASAM
• Health and wellness promotion, illness and harm prevention, and stigma reduction
• Staff will be trained to become familiar with County DBH’s EHR
A training plan for each staff member shall be submitted to DBH annually listing all trainings
completed and pending/planned for each fiscal year.
Job descriptions for each staff position will be provided to DBH for review prior to project
implementation.
6.0 HOURS OF OPERATION:
6.1 Access Line
ValueOptions of California will operate a state-mandated toll-free access line twenty-four (24)
hours per day, seven (7) days per week.
EXHIBIT A
8
6.2 Service Authorizations
Monday – Sunday: 8:00AM – 5:00PM. Hours may change to accommodate the volume of
service authorizations being requested by DBH SUD contracted providers with DBH approval.
Service authorizations will be provided on a schedule that allows ValueOptions of California to
process all requests for SUD residential services within County, DHCS, and CMS timeliness
requirements. Requests for SUD residential services must be approved/denied within 24 hours of
the request being made. Additionally, ValueOptions of California may temporarily extend office
hours in order to accommodate the volume of service authorizations received.
7.0 AVERAGE CLIENT LENGTH OF STAY:
7.1 Access Line
Call length may vary depending on beneficiary need. Peak hours are expected to be from
8:00AM-5:00PM, but are subject to change.
7.2 Service Authorizations
N/A
8.0 COUNTY RESPONSIBILITIES:
County Shall:
1. Provide oversight (through the County Department of Behavioral Health (DBH), Adult
System of Care, Division Managers or designees) of the CONTRACTOR’s
Administrative Services Organization. In addition to contract monitoring of services,
oversight includes, but is not limited to, coordination with the California Department of
Health Care Services and the Center for Medicaid and Medicare Services in regard to
program administration and outcomes.
2. Assist the CONTRACTOR in making linkages with the total behavioral health system;
this will be accomplished through regularly scheduled meetings as well as formal and
informal consultation.
3. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the vendor staff and will be available to the CONTRACTOR for
ongoing consultation.
4. Receive and analyze statistical data outcome information from vendor throughout the
term of contract on a monthly basis. DBH will notify the vendor when additional
participation is required. The performance outcome measurement process will not be
limited to survey instruments but will also include, as appropriate, client and staff
interviews, chart reviews, and other methods of obtaining required information.
5. Recognize that cultural competence is a goal toward which professionals, agencies, and
systems should strive. Becoming culturally competent is a developmental process and
incorporates at all levels the importance of culture, the assessment of cross-cultural
relations, vigilance towards the dynamics that result from cultural differences, the
EXHIBIT A
9
expansion of cultural knowledge, and the adaptation of services to meet culturally-unique
needs. Offering those services in a manner that fails to achieve its intended result due to
cultural and linguistic barriers is not cost effective. To assist the vendor’s efforts towards
cultural and linguistic competency, DBH shall provide the following at no cost to
vendor(s):
A. Technical assistance to vendor regarding cultural competency requirements and sexual
orientation training.
B. Technical assistance for vendor in translating behavioral health and substance use
disorder services information into DBH’s threshold languages (Spanish and Hmong).
Translation services and costs associated will be the responsibility of the vendor.
9.0 PROGRAM OBJECTIVES AND OUTCOMES:
ValueOptions of California shall utilize a computerized tracking system with which performance
and outcome measures and other relevant client data, such as demographics, will be maintained.
The data tracking system may be incorporated into ValueOptions of California’ electronic health
records (EHR) system or be a stand-alone database. DBH must be afforded read-only access to
the EHR or stand-alone database. Data will be transferred to DBH on a monthly basis or as
determined by DBH. DBH may adjust the outcome measurements needed under these programs
periodically, to best measure the success of clients and programs as determined by the County.
The following items listed below represent program goals to be tracked and achieved by the
vendor during contract terms.
9.1 24/7 Access Line
The 24/7 Access Line will track all outcomes and data as required by the DMC-ODS 1115
Waiver. DBH may require additional outcomes and data to be tracked and reported. Measures
are based on DBH’s three “Value Driven” philosophies: engagement, timeliness, and matching
client needs to appropriate services. DBH reflects the Commission on Accreditation of
Rehabilitation Facilities (CARF) domains comprising of Effectiveness, Efficiency, Access,
Satisfaction & Feedback of Persons Served & Stakeholders. The Access Line will record at least
the following information:
• Number of calls received
• Hold/wait times
• Number of dropped calls
• Length of calls
• Call abandonment
• Name of caller/date/initial disposition
EXHIBIT A
10
• Time to answer calls
• Referrals to services
• Non-English calls
• Foreign language line request by language
• Time from 1st request for service to 1st service
• ValueOptions of California will assess client satisfaction (in the form of a survey)
• Reason for call (to be logged in database)
• Other requested performance indicators as specified by DBH, local, state, federal
requirements
The core concept, Integrated Service Experience, is embedded within the Access Line. The
Access Line allows for consumers and callers to connect with mental health and/or substance use
disorder services based on consumer needs.
Measurable Performance Outcomes, CARF Domains (baseline performance based on 2017)
EFFECTIVENESS:
# Performance Indicator Numerator Denominator Baseline
Performance
Goal
1 Foreign Language Line
Connection
# of Callers successfully
connected to language
line
Total # of Test
Calls
97% 100
%
2 Information on how to
access Services
# of Callers informed
how to access services
Total # of Test
Calls
98% 100
%
3 Information about services
needed to treat a
beneficiary ‘Urgent
Condition’
# of Test Callers
assessed for Crisis
Total # of Test
Calls
97% 100
%
4 Information about how to
use the beneficiary
problem resolution and
Fair Hearing process
# of Callers informed
how to access services
Total # of Test
Calls
98% 100
%
EFFICIENCY:
# Performance Indicator Numerator Denominator Baseline
Performance
Goal
1 Name of beneficiary # of accurate Names
recorded
Total # of Test
Calls
91% 100
%
2 Date of Request # of accurate Dates
recorded
Total # of Test
Calls
96% 100
%
3 Initial Disposition Request # of accurate Disposition
recorded
Total # of Test
Calls
95% 100
%
4 Phone Number # of accurate Phone
Number recorded
Total # of Test
Calls
91% 100
%
EXHIBIT A
11
5 Assessed for Crisis # of Test Callers
assessed for Crisis
Total # of Test
Calls
97% 100
%
6 # of Calls recorded on Call
Log
Total # of Test
Calls
96% 100
%
7 Length of calls Total # of Minutes/sec
of all calls
Total # of Calls - Five
(5)
minu
tes
8 # of Dropped Calls # of Calls Dropped Total # of Calls - 0%
ACCESS:
# Performance Indicator Numerator Denominator Baseline
Performance
Goal
1 Name of beneficiary # of Test Calls with
Accurate Names
Total # of Test
Calls
91% 100
%
2 Linked to Services # of Callers Linked to
Services
Total # of
Callers via
Access Line
- 70%
3 Referred to Services # of Callers Referred to
Services
Total # of
Callers via
Access Line
- 100
%
4 Request to 1st Service Total # of Days to 1st
Service
Total # of
Callers, via the
Access Line
who received
any Service
8 days 10
Days
SATISFACTION:
# Performance Indicator Numerator Denominator Baseline
Performance
Goal
1 Survey Call Respondents Total # of
caller
participated
Total # of calls 51% 40%
2 Consumer Satisfaction # of
respondents
who Strongly
Agreed or
Agreed to
Satisfaction
Total # of
respondents to
satisfaction
question
73% 70%
3 Consumer Resources provided to
Caller
# of
respondents
who Strongly
Agree or
Agree to
receiving
Total # of
respondents to
question
77% 70%
EXHIBIT A
12
appropriate
resources
9.2 Service Authorizations
ValueOptions of California will track all outcomes and data as required by the DMC-ODS 1115
Waiver. DBH may require additional outcomes and data to be tracked and reported. Measures
are based on DBH’s three “Value Driven” philosophies: engagement, timeliness, and matching
client’s needs to appropriate services. DBH reflects the Commission of Accreditation of
Rehabilitation Facilities (CARF) domains comprising of Effectiveness, Efficiency, Access,
Satisfaction & Feedback of Persons Served and Stakeholders. ValueOptions of California will
record at least the following:
• Number of service authorizations received, approved, and denied
o By provider, modality, and priority
• Service authorization processing times
• Number of appeals related to denials of service authorizations, including timeliness of
responses
List of Reports
Within 30 days of executing this agreement, DBH and ValueOptions of CA will mutually agree
to a list a reports to be provided to DBH. The report list will specify data elements, frequency of
reports and due dates.
Exhibit B
ValueOptions of California, Inc.
Budget
24/7 SUD Access Line and Prior/Concurrent Authorizations of SUD Residential Services
$200,002
Cost
$164,688
$28.80 /call
$61.50/authorization
See Exhibit D for rates
$202,000
$1,300,000
$2,600,000
$4,102,000
*Includes up to 700 calls made to the 24/7 SUD Access Line and up to 400 authorizations processed
**Per call received after initial 700 call volume has been reached
***Per authorization processed after initial 400 authorization has been reached
****Electronic Health Record charges are to be charged to COUNTY according to the rates set forth in Exhibit D
January 1, 2019 - June 30, 2019
July 1, 2019 - June 30, 2020
Annual maximums not to exceed:
CONTRACTOR is to invoice COUNTY according to the COMPENSATION and INVOICING sections of
this agreement based on the monthly charges included in this Exhibit B
Total Agreement Maximum
Implementation Costs (Upon execution through December 31, 2018)
Electronic Health Record Charges****
Implementation Costs (Agreement Execution through December 31, 2018)
Monthly
Base Charge*
24/7 SUD Access Line**
Prior/Concurrent Authorizations***
Exhibit C
Page 1 of 1
ELECTRONIC HEALTH RECORD SOFTWARE CHARGES
CONTRACTOR(S) understand that COUNTY utilizes NetSmart’s Avatar for its Electronic Health Records Management.
CONTRACTOR(S) agree to reimburse COUNTY for all user license fees for accessing NetSmart’s Avatar, as set forth below.
Description FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22 FY 2022-23
General Users
Avatar Named User Hosting
(per active user per month; every Avatar “active” log on
ID is a named user) $37.00 $37.00 $37.00 $37.00 $37.00
Avatar Named User Maintenance*
(per active user per month) $14.00 $14.00 $14.00 $14.00 $14.00
Cloud Hosting- Perceptive Disaster Recovery
(per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66
eRx Users
Full Suite Prescriber
(per active user per month; applicable to an active
Prescriber user)
$104.00 $104.00 $104.00 $104.00 $104.00
ePrescribing Controlled Substances Tokens
(per active user per month; applicable to an active
Prescriber user of Controlled Substances)
$8.00 $8.00 $8.00 $8.00 $8.00
Non-Prescribing User
(per active user per month; applicable to an active Non-
Prescriber user)
$13.00 $13.00 $13.00 $13.00 $13.00
Reaching Recovery Users
Reaching Recovery
(per adult client/person served per year; applicable to
adult treatment programs except contracted triage/CI,
CSU or PHF)
$10.00 $10.00 $10.00 $10.00 $10.00
ProviderConnect Users
Individual Subscription1
(per user per month; applicable to provider-user whose
claims are reviewed and posted by Managed Care)
$41.25 $41.25 $41.25 $41.25 $41.25
Should CONTRACTOR(S) choose not to utilize NetSmart’s Avatar for its Electronic Health Records management, CONTRACTOR(S)
will be responsible for obtaining its own system for Electronic Health Records management.
______________________________________________________________________________________________________________________
*Annual Maintenance increases by 3% each FY on July 1st.
Exhibit D
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the transaction; and
b.The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit D
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5)Authorized Signature
Signature: Date:
Exhibit E
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2.The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4.The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6.Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit E
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c)(d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit F
1
DRUG MEDI-CAL INTERGOVERNMENTAL AGREEMENT
REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes substance
use disorder treatment services available throughout the county to Medi-Cal
eligible beneficiaries through funds provided under an Intergovernmental
Agreement with the California Department of Health Care Services. The County,
and all contracted providers, must comply with the terms of the Intergovernmental
Agreement, and any amendments thereto, including but not limited to the
following:
1. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless
the State, its officers, agents and employees from any and all claims and losses accruing
or resulting to any and all contractors, subcontractors, materialmen, laborers and any
other person, firm or corporation furnishing or supplying work, services, materials or
supplies in connection with the performance of this Agreement and from any and all
claims and losses accruing or resulting to any person, firm or corporation who may be
injured or damaged by the CONTRACTOR in the performance of this Agreement.
B. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of
CONTRACTOR, in the performance of this Agreement, shall act in an independent
capacity and not as officers or employees or agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws,
regulations and standards. CONTRACTOR(S) shall establish written procedures
consistent with State-County Contract requirements. The provisions of this Agreement
are not intended to abrogate any provisions of law or regulation existing or enacted during
the term of this Agreement.
D. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor
compliance with all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information requirements at
Part 2, Title 42, Code of Federal Regulations; California Welfare and Institutions Code,
sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the California Health
and Safety Code; Title 22, California Code of Regulations, section 51009; and Division 1,
Part 2.6, Chapters 1-7 of the California Civil Code.
E. REVENUE COLLECTION POLICY
Exhibit F
2
CONTRACTOR shall conform to all policies and procedures
regarding revenue collection issued by the State under the provisions of the Health and
Safety Code, Division 10.5.
F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be
used exclusively for providing alcohol and/or drug program services, administrative costs,
and allowable overhead.
G. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H. REPORTS
CONTRACTOR agrees to participate in surveys related to the
performance of this Agreement and expenditure of funds and agrees to provide any such
information in a mutually agreed upon format.
I. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S)
pursuant to this Agreement along with related patient fees, third party payments, or other
related revenues and funds commingled with the foregoing funds are subject to audit by
the State. The State may audit all alcohol and drug program revenue and expenditures
contained in this Agreement for the purpose of establishing the basis for the subsequent
year's negotiation.
J. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents,
and other evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal
records relating to individuals served under the terms of this Agreement, as required, to
meet the needs of the State in monitoring quality, quantity, fiscal accountability, and
accessibility of services. Information on each individual shall include, but not be limited
to, admission records, patient and participant interviews and progress notes, and records
of service provided by various service locations, in sufficient detail to make possible an
evaluation of services provided and compliance with this Agreement.
2. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED
TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds
Exhibit F
3
will be used under the terms of this Agreement. For purposes of this section, DBH will be
referred to as the "prospective recipient".
B. This certification is required by the regulations implementing
Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, section 98.510,
Participants' responsibilities. The regulations were published as Part VII of the May 26,
1988 Federal Register (pages 19160-19211).
1) The prospective recipient of Federal assistance funds certifies
by entering this Agreement, that neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a
person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the Federal department or
agency with which this transaction originated.
3) Where the prospective recipient of Federal assistance funds is
unable to certify to any of the statements in this certification, such prospective participant
shall attach an explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to
DBH if at any time CONTRACTOR learns that its certification in this clause of this
Agreement was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5) The prospective recipient further agrees that by entering into
this Agreement, it will include a clause identical to this clause of this Agreement, and titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions", in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction
was entered into.
3. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR shall comply with Public Law 103-227, also known as the
Pro-Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code
Section 6404.5, the California Smoke-Free Workplace Law.
4. TRAFFICKING IN PERSONS PROVISIONS – PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations
prohibiting trafficking in persons, as well as trafficking-related activities, including, but
Exhibit F
4
not limited to the trafficking of persons provisions in Section 106(g) of the Trafficking
Victims Protection Act of 2000 (TVPA) as amended by Section 1702.
CONTRACTOR, CONTRACTOR’s employees, subrecipients, and
subrecipients’ employees may not:
A) Engage in severe forms of trafficking in persons during the period
of time that the award is in effect;
B) Procure a commercial sex act during the period of time that the
award is in effect; or
C) Use forced labor in the performance of the award or subawards
under the award.
This agreement may be unilaterally terminated, without penalty, if
CONTRACTOR or a subrecipient that is a private entity is determined to have violated
a prohibition of the TVPA or has an employee who is determined by the DBH Director
or her designee to have violated a prohibition of the TVPA through conduct that is
either associated with performance under the award or imputed to the CONTRACTOR
or their subrecipient using the standards and due process for imputing the conduct of
an individual to an organization that are provided in 2 C.F.R. Part 180, “OMB
Guidelines to Agencies on Government-wide Debarment and Suspension
(Nonprocurement).
CONTRACTOR must inform the DBH Director or her designee
immediately of any information received from any source alleging a violation of a
prohibition of the TVPA.
CONTRACTOR must sign a certification annually acknowledging the
Trafficking Victims Protection Act of 2000 requirements (TVPA Certification), attached
hereto as Attachment A, incorporated herein by reference and made part of this
Agreement and must require all employees to complete annual TVPA training.
5. UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE
MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds
pertaining to drug and alcohol related programs contains a clearly written statement that
there shall be no unlawful use of drugs or alcohol associated with the program.
Additionally, CONTRACTOR shall ensure that no aspect of the program includes any
message in materials, curricula, teachings, or promotion of the responsible use, if the use
is unlawful, of drugs or alcohol pursuant to Health and Safety Code (HSC) 11999-
11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol
Certification, attached hereto as Attachment B, incorporated herein by reference and
made part of this Agreement agreeing to uphold the obligations of HSC 11999 – 11999.3.
Exhibit F
5
This agreement may be unilaterally terminated, without penalty, if
CONTRACTOR or a subcontractor that is a private entity is determined to have violated a
prohibition of the Unlawful Use of Drugs and Alcohol message or has an employee who is
determined by the DBH Director or her designee to have violated a prohibition of the
Unlawful Use of Drugs and Alcohol message.
6. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and
State laws, regulations and standards. In accepting the State drug and alcohol
combined program allocation pursuant to California Health and Safety Code section
11757, CONTRACTOR shall establish written accounting procedures consistent with
applicable Federal and State laws, regulations and standards, and shall be held
accountable for audit exceptions taken by the State or COUNTY for failure to comply
with these requirements. These requirements include, but may not be limited to, those
set forth in this Agreement, and:
A. Division 10.5 of the California Health and Safety Code;
B. California Government Code sections 16366.1 through 16367.9
and 53130 through 53138;
C. Title 9, Division 4 of the California Code of Regulations;
D. 42 United States Code (U.S.C.) section 300x-5;
E. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single
Audit Act Amendments of 1996);
F. 2CFR Part 200 (Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards); and
G. Title 45, Part 96, Subparts B, C and L of the Code of Federal
Regulations (Block Grants).
8. CULTURALLY COMPETENT SERVICES (INTERGOVERNMENTAL
AGREEMENT P.72 AND 76)
CONTRACTOR shall ensure equal access to quality care by diverse
populations by adopting the federal Office of Minority Health Culturally and
Linguistically Appropriate Service (CLAS) national standards and complying with 42
CFR 438.206(c)(2). CONTRACTOR’s policies, procedures, and practices must be
consistent with the principles outlined and are embedded in the organizational
structure, as well as being upheld in day-to-day operations. CONTRACTOR shall
promote the delivery of services in a culturally competent manner to all beneficiaries,
including those with limited English proficiency and diverse cultural and ethnic
backgrounds, disabilities, and regardless of gender, sexual orientation or gender
identity.
Exhibit F
6
9. ADA CONSIDERATIONS (INTERGOVERNMENTAL AGREEMENT P.20)
For those services that CONTRACTOR provides, CONTRACTOR shall
ensure that physical access, reasonable accommodations, and accessible equipment
are available for Medicaid beneficiaries with physical or mental disabilities.
10. ADDITIONAL INTERGOVERNMENTAL AGREEMENT RESTRICTIONS
This Agreement is subject to any additional restrictions, limitations,
conditions, or statutes enacted or amended by the federal or state governments, which
may affect the provisions, terms, or funding of this Agreement in any manner.
11. NULLIFICATION OF DMC-ODS SERVICES
The parties agree that failure of COUNTY, or CONTRACTOR, to comply
with W&I section 14124.24, the Special Terms and Conditions, and this Agreement,
shall be deemed a breach that results in the termination of the State-County
Intergovernmental Agreement for cause. In the event of a breach, the DMC-ODS
services shall terminate. The COUNTY shall immediately begin providing DMC services
to the beneficiaries in accordance with the State Plan.
12. HATCH ACT (INTERGOVERNMENTAL AGREEMENT P.69)
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5
USC, Sections 1501-1508), which limit the political activities of employees whose
principal employment activities are funded in whole or in part with federal funds.
13. LIMITATION ON USE OF FUNDS FOR PROMOTION OF
LEGALIZATION OF CONTROLLED SUBSTANCES (INTERGOVERNMENTAL
AGREEMENT P.69)
CONTRACTOR is prohibited from using funds made available through this
Agreement for any activity that promotes the legalization of any drug or other
substance included in Schedule I of Section 202 of the Controlled Substances Act (21
USC 812).
14. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
(INTERGOVERNMENTAL AGREEMENT P.72)
CONTRACTOR certifies that under the laws of the United States and the
State of California, incorporated into this Agreement by reference and made a part
hereof as if set forth in full, CONTRACTOR shall not unlawfully discriminate against
any person.
15. FEDERAL LAW REQUIREMENTS (INTERGOVERNMENTAL
AGREEMENT P.73)
CONTRACTOR shall comply with the following Federal law requirements:
Exhibit F
7
A. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in
federally funded programs.
B. Title IX of the education amendments of 1972 (regarding education
and programs and activities), if applicable.
C. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
prohibiting discrimination on the basis of race, color, religion, sex,
handicap, familial status or national origin in the sale or rental of
housing.
D. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42
USC Sections 6101 – 6107), which prohibits discrimination on the
basis of age.
E. Age Discrimination in Employment Act (29 CFR Part 1625).
F. Title I of the Americans with Disabilities Act (29 CFR Part 1630)
prohibiting discrimination against the disabled in employment.
G. Americans with Disabilities Act (28 CFR Part 35) prohibiting
discrimination against the disabled by public entities.
H. Title III of the Americans with Disabilities Act (28 CFR Part 36)
regarding access.
I. Rehabilitation Act of 1973, as amended (29 USC Section 794),
prohibiting discrimination on the basis of individuals with disabilities.
J. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part
60) regarding nondiscrimination in employment under federal
contracts and construction contracts greater than $10,000 funded
by federal financial assistance.
K. Executive Order 13166 (67 FR 41455) to improve access to federal
services for those with limited English proficiency.
L. The Drug Abuse Office and Treatment Act of 1972, as amended,
relating to nondiscrimination on the basis of drug abuse.
M. The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
amended, relating to nondiscrimination on the basis of alcohol
abuse or alcoholism.
16. STATE LAW REQUIREMENTS (INTERGOVERNMENTAL AGREEMENT
P.73)
CONTRACTOR shall comply with the following State law requirements:
Exhibit F
8
A. Fair Employment and Housing Act (Government Code Section
12900 et seq.) and the applicable regulations promulgated
thereunder (California Administrative Code, Title 2, Section 7285.0
et seq.).
B. Title 2, Division 3, Article 9.5 of the Government Code,
commencing with Section 11135.
C. Title 9, Division 4, Chapter 8, commencing with Section 10800.
D. No state or Federal funds shall be used by COUNTY, or
CONTRACTOR, for sectarian worship, instruction, and/or
proselytization. No state funds shall be used by CONTRACTOR, or
CONTRACTOR, to provide direct, immediate, or substantial
support to any religious activity.
E. Noncompliance with the requirements of nondiscrimination in
services shall constitute grounds for state to withhold payments
under this Agreement or terminate all, or any type, of funding
provided hereunder.
17. INVESTIGATIONS AND CONFIDENTIALITY OF ADMINISTRATIVE
ACTIONS
COUNTY acknowledges that if a DMC provider is under investigation by
DHCS or any other state, local or federal law enforcement agency for fraud or abuse,
DHCS may temporarily suspend CONTRACTOR from the DMC program, pursuant to
W&I Code, Section 14043.36(a). Information about CONTRACTOR’s administrative
sanction status is confidential until such time as the action is either completed or
resolved. The DHCS may also issue a Payment Suspension to a provider pursuant to
W&I Code, Section 14107.11 and Code of Federal Regulations, Title 42, section
455.23. The COUNTY is to withhold payments from a DMC provider during the time a
Payment Suspension is in effect. COUNTY has executed a Confidentiality Agreement
that permits DHCS to communicate with COUNTY concerning CONTRACTOR(S) that
are subject to administrative sanctions.
18. COUNSELOR CERTIFICATION (IA page 71)
CONTRACTOR shall ensure that any counselor or registrant providing
intake, assessment of need for services, treatment or recovery planning, individual or
group counseling to participants, patients, or residents in a DHCS licensed or certified
program is required to be certified as defined in Title 9, Division 4, Chapter 8.
19. SUBCONTRACTUAL REQUIREMENTS (INTERGOVERNMENTAL
AGREEMENT P.4 AND 42 CFR 438.230)
CONTRACTOR shall fulfill contractual requirements of delegated services
or activities in accordance with 42 CFR §438.230 and shall perform the delegated
Exhibit F
9
activities and reporting responsibilities in compliance with COUNTYs State-County
Intergovernmental Agreement obligations. CONTRACTOR shall comply with all
applicable Medicaid laws and regulations, including applicable sub-regulatory guidance
and contract provisions.
CONTRACTOR shall not bill beneficiaries for covered services under this
agreement in excess of the amount that would be owed by the individual if the
COUNTY had directly provided the services (42 U.S.C. 1396u-2(b)(6)(C)).
20. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO
FACILITIES (IA P. 4)
CONTRACTOR agrees that COUNTY, DHCS, CMS, the HHS Inspector
General, the Comptroller General, or their designees have the right to audit, evaluate,
and inspect any books, records, contracts, computer or other electronic systems of
CONTRACTOR, or of the CONTRACTOR’s sub-contractor, that pertain to any aspect of
services and activities performed, or determination of amounts payable under
COUNTY’s contract with DHCS. CONTRACTOR shall make available, at any time, for
purposes of an audit, evaluation, or inspection, its premises, physical facilities,
equipment, books, records, contracts, computer or other electronic systems relating to
its Medicaid enrollees. The right to audit will exist through 10 years from the final date of
the contract period or from the date of completion of any audit, whichever is later.
22. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the
State-County Intergovernmental Agreement, the Provider Manual and the Consumer
Handbook.
(INTERGOVERNMENTAL AGREEMENT P.74)
CONTRACTOR shall make the following grievance information available
to all beneficiaries:
A. Beneficiary’s right to a State Fair Hearing and how to obtain a
hearing as well as representation rules.
B. Beneficiary’s right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Beneficiary’s right to give written consent to allow CONTRACTOR
or legal representative, acting on behalf of the beneficiary, to file an appeal.
D. Beneficiary may file a grievance orally or in writing to DHCS or
COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
Exhibit F
10
G. Beneficiary’s right to request continuation of benefits during an
appeal or state fair hearing filing although the beneficiary may be liable for the cost of
any continued benefits if the action is upheld.
H. Any state determined contractor’s appeal rights to challenge the
failure of the COUNTY to cover a service.
23. GREIVANCE AND APPEALS RECORDKEEPING REQUIREMENTS (IA
P.5)
CONTRACTOR shall retain beneficiary grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Beneficiary
grievance and appeal data shall include a general description of the reason for the
grievance or appeal, the date the grievance or appeal was received, the date of each
review or, if applicable, review meeting, the resolution and date of resolution at each
level of the grievance or appeal and the name of the covered person for whom the
grievance or appeal was filed. The record must be accurately maintained in a manner
accessible to DHCS and available upon request to CMS.
24. BENEFICIARY INFORMING AND TRANSLATION SERVICES
(INTERGOVERNMENTAL AGREEMENT P.7)
CONTRACTOR shall make written and verbal information available to
beneficiaries in their language of choice.
Written material: CONTRACTOR shall use COUNTY’s written/translated
materials that are critical to obtaining services, including the provider directory,
beneficiary handbook, appeal and grievance notices, and denial and termination
notices, available in the prevalent non–English languages. All other CONTRACTOR
specific written materials must be made available in the prevalent non-English
languages. CONTRACTOR shall ensure that written materials are made available in
alternative formats upon request of the potential beneficiary or beneficiary at no cost.
Written materials shall include taglines in the prevalent non-English languages, as well
as large print, explaining the availability of written translation or oral interpretation to
understand the information provided.
Auxiliary aids: CONTRACTOR shall ensure auxiliary aids and services
shall also be made available upon request of the potential beneficiary or beneficiary at
no cost.
Interpretation services: CONTRACTOR shall make interpretation services
available free of charge to each beneficiary. This includes oral interpretation and the
use of auxiliary aids such as TTY/TDY and American Sign Language. Oral
interpretation requirements apply to all non– English languages, not just those that
DHCS identifies as prevalent.
Exhibit F
11
CONTRACTOR shall notify its beneficiaries that oral interpretation is
available for any language and written translation is available in prevalent languages
and that auxiliary aids and services are available upon request and at no cost for non-
English speaking/reading/writing beneficiaries and beneficiaries with disabilities.
25. AUTHORIZATION OF SERVICES (INTERGOVERNMENTAL
AGREEMENT P.24)
CONTRACTOR shall adhere to COUNTY’s written policies and
procedures, outlined in the Provider Manual, for authorization of services.
26. PERFORMANCE IMPROVEMENT PROJECTS
(INTERGOVERNMENTAL AGREEMENT P.29)
CONTRACTOR shall assist, when requested by COUNTY, in developing
and reviewing annual Performance Improvement Projects including but not limited to
identifying a clinical and a non-clinical problem, brainstorming causes and barriers,
implementation of interventions for the identified problems, and analysis of
interventions. CONTRACTOR shall assist in planning and initiation of activities for
increasing or sustaining improvement.
27. CONTRACTOR SPECIFICATIONS (INTERGOVERNMENTAL
AGREEMENT P.50)
A. Ensure Staffing Standards as follows:
(1) Ensure that all decision-making and authorization for services are
made only by appropriately licensed mental health or waivered/registered professionals
as set forth in CCR 1820.220 and Welfare and Institutions Code (WIC) Division 5, Part
2, section 5751.2.
(2) Ensure that all decisions to modify or deny an authorization request
based on medical necessity criteria or the criteria for emergency admission are
reviewed and approved by a physician as set forth in CCR Title 9 section 1820.220.
(3) Ensure that medical necessity decisions are made only by licensed
mental health or waivered/registered professionals unhindered by fiscal or
administrative management.
(4) Provide peer to peer consultation from board certified physicians to
facilities as clinically appropriate for each Client.
(5) Ensure all personnel providing services under this agreement
understand and comply with the standard that incentives are not utilized that have the
effect of denying medically necessary services.
28. ASAM REQUIREMENTS (INTERGOVERNMENTAL AGREEMENT P.90)
Exhibit F
12
CONTRACTOR shall use COUNTY’s American Society of Addiction
Medicine (ASAM) criteria assessment and re-assessment tools to determine the
beneficiary’s level of care. CONTRACTOR shall ensure that assessment of services for
adolescents will follow the ASAM adolescent treatment criteria.
CONTRACTOR and CONTRACTOR’s staff shall comply with obtaining
ASAM Criteria training prior to providing services. CONTRACTOR shall maintain
records of ASAM trainings in personnel files and will make these records available to
COUNTY upon request.
Residential care CONTRACTORs must meet the established ASAM
criteria for each level of residential care provided and receive an ASAM Designation
prior to providing DMC-ODS services.
29. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
OF 1996
If any of the work performed under this Agreement is subject to the
HIPAA, CONTRACTOR shall perform the work in compliance with all applicable
provisions of HIPAA. As identified in Exhibit F of the State County Intergovernmental
Agreement, DHCS, COUNTY and CONTRACTOR shall cooperate to assure mutual
agreement as to those transactions between them, to which this Provision applies.
Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the
personal health information (PHI), it shall not change any definition, data condition or
use of a data element or segment as proscribed in the federal Health and Human
Services Transaction Standard Regulation [45 CFR Part 162.915(a)].
2) No Additions: CONTRACTOR hereby agrees that for PHI, it
shall not add any data elements or segments to the maximum data set as proscribed in
the HHS Transaction Standard Regulation [45CFR Part 162.915 (b)].
3) No Unauthorized Uses: CONTRACTOR hereby agrees that
for PHI, it shall not use any code or data elements that are marked ‘not used” in the in
the HHS Transactions Implementation specification or are not in the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (c)].
4) No Changes to Meaning or Intent: CONTRACTOR hereby
agrees that for PHI, it shall not change the meaning or intent of the HHS Transaction
Standard’s implementation specification [45CFR Part 162.915 (d)].
B. Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility
that DHCS or others may request an extension from the uses of a standard in the HHS
Transaction Standards. If this occurs, CONTRACTOR agrees that it shall participate in
such test modifications.
Exhibit F
13
C. Adequate Testing
CONTRACTOR is responsible to adequately test all business rules
appropriate to their types and specialties. If the CONTRACTOR is acting as a
clearinghouse for enrolled providers, CONTRACTOR has obligations to adequately test
all business rules appropriate to each and every provider type and specialty for which
they provide clearinghouse services.
D. Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies
identified by DHCS, and transactions errors or deficiencies identified by an enrolled
CONTRACTOR if the COUNTY is acting as a clearinghouse for that CONTRACTOR. If
the CONTRACTOR is a clearinghouse, the CONTRACTOR agrees to properly
communicate deficiencies and other pertinent information regarding electronic
transactions to enrolled CONTRACTORS for which they provide clearinghouse
services.
E. Code Set Retention
Both Parties understand and agree to keep open code sets being
processed or used in this Agreement for a least the current billing period or any appeal
period, whichever is longer.
F. Data Transmission Log
Both Parties shall establish and maintain a Data Transmission Log, which
shall record any and all data transmissions taking place between the Parties during the
term of this Agreement. Each Party shall take necessary and reasonable steps to
ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be
retained by each Party for no less than twenty-four (24) months following the date of
the Data Transmission. The Data Transmission Log may be maintained on computer
media or other suitable means provided that, if necessary to do so, the information
contained in the Data Transmission Log may be retrieved in a timely manner and
presented in readable form.
Attachment A
Page 1 of 1
TRAFFICKING VICTIMS PROTECTION ACT OF 2000
CERTIFICATION
I, ______________________________________, as an authorized agent of (Print Name)
________________________________________, acknowledge the requirement to (Organization Name)
comply with the Trafficking Victims Protection Act of 2000 (TVPA), specifically Section
106(g), which authorizes the County of Fresno to terminate a contract, without penalty,
if this organization or its employees, or a subcontractor or its employees:
• Engages in severe forms of trafficking in persons during the period of time that
the award is in effect;
• Procures a commercial sex act during the period of time that the award in in
effect; or
• Uses forced labor in the performance of the award or subawards under the
award.
I understand that the TVPA establishes human trafficking and related offenses
as federal crimes and attaches severe penalties to them. I will immediately inform the
County of Fresno, Department of Behavioral Health, Contracts Division – Substance
Use Disorder (SUD) Services immediately of any information received from any
source alleging a violation of the TVPA by either this organization or its employees, or
a subcontractor or its employees during the term of this contract.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of the TVPA and, if found in violation, will be immediately
terminated. I agree to submit this signed certification annually on behalf of the
organization acknowledging requirements under the TVPA and attesting that all
employees will receive annual TVPA training, and that documentation of training will
be placed in personnel files.
Signature:_____________________________ Date:______________________
Title:_________________________________
Attachment B
Page 1 of 1
UNLAWFUL USE OF DRUGS AND ALCOHOL
CERTIFICATION
I, ______________________________________, as an authorized agent of
(Print Name)
________________________________________, acknowledge the requirement to
(Organization Name)
comply with California HSC 11999-11999.3, which authorizes the County of Fresno to
terminate a contract, without penalty, if this organization or its employees, or a
subcontractor or its employees fail to ensure that:
• The program contains a component that clearly explains in written materials
that there shall be no unlawful use of drugs or alcohol. No aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if
the use is unlawful, of drugs or alcohol;
• All aspects of a drug- or alcohol-related program are consistent with the “no
unlawful use” message, including, but not limited to, program standards,
curricula, materials, and teachings; and
• The “no unlawful use” of drugs and alcohol message contained in drug- or
alcohol-related programs applies to the use of drugs and alcohol prohibited by
law.
I understand that the State of California enforces an Unlawful Use policy in
which there is zero tolerance for promoting the unlawful use of and drugs or alcohol in
an AOD treatment facility. If this organization fails to satisfy the guidelines adopted by
the State of California, the drug or alcohol program shall not receive state funds and
their contract with Fresno County will be terminated.
I understand that this organization is obligated to ensure any subcontractors are
informed of the requirements of HSC 11999-11999.3 and, if found in violation, will be
immediately terminated.
Signature:_____________________________ Date:______________________
Title:_________________________________
Exhibit G
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address (number, street) City State ZIP Code
CLIA Number Taxpayer ID Number (EIN) / Social Security Number Telephone Number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list all names
and addresses (primary, every business location, and P.O. Box address) of individuals or corporations under “Remarks” on
page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses (primary, every business location, and P.O. Box address) u nder “Remarks” on page 2. If more than
one individual is reported and any of these persons are related to each other, this must be reported under “Remarks.”
NAME DOB ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. ..........................................................................................................
❒ ❒
NAME DOB ADDRESS PROVIDER
Exhibit G
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date Remarks