HomeMy WebLinkAboutAgreement A-17-265-1 with Turning Point of Central California.pdfAgreement No. 17-265-1
AMENDMENT I TO AGREEMENT
2 THIS AMENDMENT is made and entered into this 11b... day of __ --'M=ay'------' 2019,
3 by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
4 hereinafter referred to as "COUNTY", and TURNING POINT OF CENTRAL CALIFORNIA, INC., a
5 California Private Non-Profit Corporation, whose service address is 3636 N FIRST ST. FRESNO, CA
6 93726 SUITE 135 and remit to address is P.O. BOX 7447 VISALIA, CA 93290, hereinafter referred to
7 as "CONTRACTOR." Reference in this Agreement to "party" or "parties" shall be understood to refer to
8 COUNTY and CONTRACTOR, unless otherwise specified.
9 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
10 No. A-17-265, effective July 1, 2017, hereinafter referred to as the Agreement; and
11 WHEREAS the parties desire to amend the Agreement, regarding changes as stated below and
12 restate the Agreement in its entirety.
13 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
14 contained , the parties hereto agree as follows :
15 1. That the existing COUNTY agreement No . 17-265, Paragraph Four (4)-
16 COMPENSATION -in the Agreement on Page Four (4), beginning on Line Ten (10) and ending on
17 Page Four (4), Line Twenty-Eight (28) be deleted and the following inserted in its place:
18 "4. COMPENSATION
19 A. COMPENSATION -COUNTY agrees to pay CONTRACTOR and
20 CONTRACTOR agrees to receive compensation in accordance with the budget attached hereto and
21 referenced herein in as Exhibit 8 -1, "Budget."
22 1) The maximum amount for the period of July 1, 2017 through June 30 ,
23 2018 shall not exceed Two Million Seven Hundred Twenty-Four Thousand Nine Hundred E ighty-One
24 and No/100 Dollars ($2,724 ,981 .00).
25 2) The maximum amount for the period of July 1, 2018 through June 30 ,
26 2019 shall not exceed Two Million Four Hundred Twenty Seven Thousand Two Hundred Four and
27 No/100 Dollars ($2,427,204 .00).
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3)The maximum amount for the period of July 1, 2019 through June 30,
2020 shall not exceed Two Million Four Hundred Twenty Seven Thousand Two Hundred Four and
No/100 Dollars ($2,427,204.00).
4)The maximum amount for the period of July 1, 2020 through June 30,
2021 shall not exceed Two Million Four Hundred Twenty Seven Thousand Two Hundred Four and
No/100 Dollars ($2,427,204.00).
5)The maximum amount for the period of July 1, 2021 through June 30,
2022 shall not exceed Two Million Four Hundred Twenty Seven Thousand Two Hundred Four and
No/100 Dollars ($2,427,204.00).”
2.That Exhibit B to the existing COUNTY agreement No. 17-265 shall be replaced with
“Exhibit B-1,” which is attached hereto and incorporated herein by reference.
3.That all references in existing COUNTY Agreement No. 17-265 to “Exhibit B” shall be
changed to read “Exhibit B-1.”
4.That Exhibit K to the existing COUNTY agreement No. 17-265 shall be replaced with
“Exhibit K-1,” which is attached hereto and incorporated herein by reference.
5.That all references in existing COUNTY Agreement No. 17-265 to “Exhibit K” shall be
changed to read “Exhibit K-1.”
6.That “Exhibit Q,” and “Exhibit R” of existing COUNTY agreement No. 17-265 shall be
deleted in their entirety.
7.That the existing COUNTY agreement No. 17-265 Section One (1) be amended starting
at Page Two (2), line three (3) after the word “herein.” by inserting the following line:
“CONTRACTOR shall also comply with all of the provisions set forth in Exhibit P-1, “Drug Medi-
Cal Intergovernmental Agreement Requirements”, which is attached hereto and incorporated herein by
this reference.”
8.That Exhibit P to the existing COUNTY agreement No. 17-265 shall be replaced with a
new “Exhibit P-1,” which is attached hereto and incorporated herein by this reference.
9.That the existing COUNTY agreement No. 17-265, beginning on Line Twenty Four (24)
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with the word “CONTRACTOR” and ending on Page Fifty Three (53), Line Twenty six (26) with the
number “-11999.3.” be deleted and the following inserted in its place:
“CONTRACTOR must sign the “Unlawful Use of Drugs and Alcohol Certification,” attached
hereto as Exhibit P-1 Attachment B, incorporated herein by reference and made part of the Agreement
agreeing to uphold the obligations of HSC 11999-11999.3."
10.That the existing COUNTY agreement No. 17-265, beginning on Line Twelve (12) with
the word “CONTRACTOR” and ending at Page Fifty-Four (54), Line Fourteen (14) with the word
“thereafter” be deleted and the following inserted in its place:
“CONTRACTOR shall ensure that all of its employees sign a written confidentiality oath,
attached hereto as Exhibit P-1 Attachment C, before they begin employment with CONTRACTOR and
shall renew said document annually thereafter.”
11.That the existing COUNTY agreement No. 17-265, beginning on Page Fifty-five (55),
Line Twenty-Two (22) and ending on Page Fifty-Five (55), Line Twenty-Five (25) be deleted and the
following inserted in its place:
“CONTRACTOR must sign a certification annually acknowledging the Trafficking Victims
Protection Act of 2000 requirements (TVPA Certification), attached hereto as Exhibit P-1 Attachment A,
incorporated herein by reference and made part of this Agreement and must require all employees to
complete annual TVPA training.”
12.COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend
Agreement No. A-17-265 and Amendment I together with the Agreement shall be considered the
Agreement.
13.The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions, and promises contained in the Agreement and not amended herein shall remain
in full force and effect. This Amendment I shall be effective upon execution.
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EXECUTED AND EFFECTIVE as of the date first above set forth .
TURNING POINT OF CENTRAL COUNTY OF FRESNO
c~.
(A~~ --2-5 5:~ Nathan Magslg, Chairmanbeaoard
of Supervisors of the County of Fresno
dief /;;)(.ee.t.,117,-(5' ~a;/<..
V?t;A ~.J4 . CA · . f' Z-6 ~ -7'!¥-7
Mailing Address 7 ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By: __')u ~ ~Sbo--f)
Deputy
FOR ACCOUNTING USE ONLY:
Funding/Subclass: 0001/10000
ORG No.:56302081
19 56302070
56304784
20
Account No.:7295
21 Requisition No.:
22
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24
25
26
27
28
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Substance Abuse Counselor 6.00 $269,513 $269,513
0002 Case Manager 1.00 $37,378 $37,378
0003 MH Professional/Team Leader 2.00 $145,205 $145,205
0004 Program Director 1.00 $71,399 $71,399
0005 Nurse 0.25 $12,839 $12,839
0006 Billing Clerk 0.75 $26,685 $26,685
0007 Administrative Technician 1.00 $37,009 $37,009
0008 PSC C 1.00 $43,778 $43,778
0009 Intake Specialist/Transportation 1.00 $34,928 $34,928
0010 Secretary 1.00 $35,932 $35,932
0011 Intake Specialist 1.00 $48,908 $48,908
0012 Bookkeeper 0.75 $26,002 $26,002
SALARY TOTAL 16.75 $0 $789,576 $789,576
PAYROLL TAXES:
0031 OASDI/FICA/MEDICARE $62,919 $62,919
0032 SUI $15,301 $15,301
PAYROLL TAX TOTAL $0 $78,220 $78,220
EMPLOYEE BENEFITS:
0040 Retirement $12,172 $12,172
0041 Workers Compensation $7,876 $7,876
0042 Health Insurance (medical, vision, life, dental)$193,228 $193,228
0043 Accrued Paid Leave $32,899 $32,899
EMPLOYEE BENEFITS TOTAL $0 $246,175 $246,175
SALARY & BENEFITS GRAND TOTAL $1,113,971
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $69,362
1011 Rent/Lease Equipment $0
1012 Utilities $20,400
1013 Building Maintenance $6,257
1014 Equipment purchase $2,214
FACILITY/EQUIPMENT TOTAL $98,233
Line Item Description (Must be itemized)
AB 109 - SUD & MH OP
Turning Point of Central California, Inc.
July 1, 2017 - June 30, 2018
Budget Categories -Total Proposed Budget
Exhibit B-1
Page 1 of 8
OPERATING EXPENSES:
1060 Telephone $6,500
1061 Answering Service $0
1062 Postage $500
1063 Printing/Reproduction $1,251
1064 Publications $481
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $19,000
1067 Household Supplies $2,251
1068 Food $0
1069 Program Supplies - Therapeutic $11,650
1070 Program Supplies - Medical $13,213
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $8,974
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $6,650
1075 Lodging $1,000
1076 Other-Vehicle Insurance $6,981
1077 Other- $0
1078 Other - Depreciation $1,395
1079 Other - Recruitment $816
1080 Licenses $34,000
OPERATING EXPENSES TOTAL $114,662
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $500
1082 Liability Insurance $3,150
1083 Administrative Overhead $218,641
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $222,291
SPECIAL EXPENSES (Consultant/Etc.):
1090 O/S Psychiatrist $65,280
1091 O/S Labor Clinical - Therapist $5,000
1092 Translation Services $5,976
1093 Medication Supports $21,810
SPECIAL EXPENSES TOTAL $98,066
FIXED ASSETS:
1190 Computers & Software $5,000
1191 Furniture & Fixtures $2,000
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $7,000
Exhibit B-1
Page 2 of 8
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Intensive Substance Use Disorder Services $200,000
2001 Residential Services $848,625
2002.1 Clothing, Food & Hygiene $2,400
2002.2 Client Transportation & Support $8,813
2002.3 Education Support $4,420
2002.4 Employment Support $6,500
2002.5 Respite Care $0
2002.6 Household Items $0
2002.7 Utility Vouchers $0
2002.8 Child Care $0
NON MEDI-CAL CLIENT SUPPORT TOTAL $1,070,758
TOTAL PROGRAM EXPENSES $2,724,981
DRUG MEDI-CAL REVENUE:Units of Service Rate $ Amount
0.00 $0.00 $0
Group Contacts 9576 $26.23 $251,178
0.00 $0.00 $0
Individual Contacts 1451 $67.38 $97,768
0.00 $0.00 $0
11027 $348,947
0.00%$0
0 $0
$348,947
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)55,498 $2.40 $133,195
3100 Case Management 18,000 $1.80 $32,400
3200 Crisis Services 3,312 $2.95 $9,770
3300 Medication Support 45,000 $3.75 $168,750
3400 Collateral 8,149 $2.40 $19,558
3500 Plan Development 34,000 $2.40 $81,600
3600 Assessment 5,000 $2.40 $12,000
3700 Rehabilitation 26,000 $2.40 $62,400
Estimated Medi-Cal Billing Totals 194,959 $519,673
Estimated % of Federal Financial Participation Reimbursement $181,886
Estimated % of MAGI Federal Financial Participation Reimbursement $155,902
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL $337,788
MEDI-CAL REVENUE TOTAL
Estimated Medi-Cal Billing Totals
Estimated % of Federal Financial Participation Reimbursement
Estimated % of Clients Served that will be Medi-Cal Eligible
Exhibit B-1
Page 3 of 8
OTHER REVENUE (SUDS):
4000 Other - (AB 109)$1,538,246
4100 Other - (SAPT)$200,000
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $1,738,246
OTHER REVENUE (MH):
4000 Other - (Mental Health Realignment)$300,000
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $300,000
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education & Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUE $2,724,981
Exhibit B-1
Page 4 of 8
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Substance Abuse Counselor 6.00 $291,074 $291,074
0002 Case Manager 2.00 $84,530 $84,530
0003 MH Professional/Team Leader 3.00 $225,982 $225,982
0004 Program Director 1.00 $71,399 $71,399
0005 Nurse 0.25 $12,839 $12,839
0006 Billing Clerk 0.75 $26,685 $0 $26,685
0007 Administrative Technician 1.00 $37,009 $0 $37,009
0008 PSC C 1.00 $43,778 $43,778
0009 Intake Specialist/Transportation 1.00 $34,928 $34,928
0010 Secretary 1.00 $35,932 $0 $35,932
0011 Intake Specialist 1.00 $48,908 $48,908
0012 Bookkeeper 0.75 $26,002 $0 $26,002
SALARY TOTAL 18.75 $125,628 $813,438 $939,066
PAYROLL TAXES:
0031 OASDI/FICA/MEDICARE $10,090 $65,333 $75,423
0032 SUI $2,100 $13,600 $15,700
PAYROLL TAX TOTAL $12,190 $78,933 $91,123
EMPLOYEE BENEFITS:
0040 Retirement 1955 $12,660 $14,615
0041 Workers Compensation 1521 $9,854 $11,375
0042 Health Insurance (medical, vision, life, dental)$28,337 $183,484 $211,821
0043 Accrued Paid Leave $7,203 $46,640 $53,843
EMPLOYEE BENEFITS TOTAL $39,016 $252,638 $291,654
SALARY & BENEFITS GRAND TOTAL $1,321,843
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $69,362
1011 Rent/Lease Equipment $2,292
1012 Utilities $20,400
1013 Building Maintenance $6,257
1014 Equipment purchase $2,214
FACILITY/EQUIPMENT TOTAL $100,525
AB 109 - SUD & MH OP
Turning Point of Central California, Inc.
FY 2018-19, FY 2019-20, FY 2020-21, FY 2021-22
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized)
Exhibit B-1
Page 5 of 8
OPERATING EXPENSES:
1060 Telephone $7,000
1061 Answering Service $0
1062 Postage $500
1063 Printing/Reproduction $1,251
1064 Publications $481
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $19,500
1067 Household Supplies $3,400
1068 Food $0
1069 Program Supplies - Therapeutic $11,650
1070 Program Supplies - Medical $13,213
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $17,374
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $6,900
1075 Lodging $1,500
1076 Other-Vehicle Insurance $8,881
1077 Other- $0
1078 Other - Depreciation $1,395
1079 Other - Recruitment $816
1080 Licenses $36,000
OPERATING EXPENSES TOTAL $129,861
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $500
1082 Liability Insurance $3,150
1083 Administrative Overhead $297,446
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $301,096
SPECIAL EXPENSES (Consultant/Etc.):
1090 O/S Psychiatrist $65,280
1091 O/S Labor Clinical - Therapist $10,000
1092 Translation Services $5,976
1093 Medication Supports $21,810
SPECIAL EXPENSES TOTAL $103,066
FIXED ASSETS:
1190 Computers & Software $5,000
1191 Furniture & Fixtures $2,000
1192 Other - (Identify)$0
1193 Other - (Identify)$0
Exhibit B-1
Page 6 of 8
FIXED ASSETS TOTAL $7,000
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Intensive Substance Use Disorder Services $0
2001 Residential Services $441,000
2002.1 Clothing, Food & Hygiene $3,000
2002.2 Client Transportation & Support $8,813
2002.3 Education Support $4,500
2002.4 Employment Support $6,500
2002.5 Respite Care $0
2002.6 Household Items $0
2002.7 Utility Vouchers $0
2002.8 Child Care $0
NON MEDI-CAL CLIENT SUPPORT TOTAL $463,813
TOTAL PROGRAM EXPENSES $2,427,204
DRUG MEDI-CAL REVENUE:Units of Service Rate $ Amount
0.00 $0.00 $0
Groups 150350.00 $2.08 $312,728
Case Management 15600.00 $1.99 $31,044
Individual Contacts 85696.00 $2.08 $178,248
0.00 $0.00 $0
251646 $522,020
79%$412,396
$0
$412,396
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)50,680 $2.40 $121,632
3100 Case Management 50 $1.80 $90
3200 Crisis Services 200 $2.95 $590
3300 Medication Support 11,160 $3.75 $41,850
3400 Collateral 0 $2.40 $0
3500 Plan Development 3,840 $2.40 $9,216
3600 Assessment 20,883 $2.40 $50,119
3700 Rehabilitation 0 $2.40 $0
Estimated Medi-Cal Billing Totals 86,813 $223,497
Estimated % of Federal Financial Participation Reimbursement 79.00%$176,563
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL $176,563
Estimated Medi-Cal Billing Totals
Estimated % of Federal Financial Participation Reimbursement
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL
Exhibit B-1
Page 7 of 8
OTHER REVENUE (SUDS):
4000 Other - (AB 109)$1,538,246
4100 Other - (SAPT)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $1,538,246
OTHER REVENUE (MH):
4000 Other - (MHSA CSS)$0
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $300,000
5200 Innovation Funds $0
5300 Workforce Education & Training Funds $0
MHSA FUNDS TOTAL $300,000
TOTAL PROGRAM REVENUE $2,427,204
Exhibit B-1
Page 8 of 8
EXHIBIT K-1
Page 1 of 1
INTENSIVE/RESIDENTIAL SUBSTANCE USE DISORDER SERVICES
Line item “Residential Services” included in Exhibit B-1 shall be defined as:
• Medication-Assisted Treatment (MAT) at a Licensed Narcotic Treatment Program
• Residential Detoxification/Stabilization
• Residential Services for Males/Females
• Residential Perinatal
• Sober Living Environment
• Monolingual Male Residential Services
These services may be performed by CONTRACTOR, or they may be outsourced to any
County-Contracted provider at the County DBH’s current contract rates. AB 109 contractor must
have a signed MOU in place with the County contracted provider and the MOU’s must be
approved by the County Alcohol and Drug Program Administrator and on file with Fresno
County DBH Contracts Division – Substance Use Disorders. Maximum compensation for these
services is detailed in the approved budget under line item “Residential Services”
Exhibit P-1
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 P-1
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 P-1
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 P-1
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 P-1
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. CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written
confidentiality oath, attached hereto as Attachment C, before they begin employment
with CONTRACTOR and shall renew said document annually thereafter.
CONTRACTOR shall retain each employee’s written confidentiality oath for COUNTY
and DHCS inspection for a period of six (6) years following the termination of this
agreement.
7. 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
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
Exhibit P-1
6
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.
9. ADA CONSIDERATIONS
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
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
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
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
Exhibit P-1
7
hereof as if set forth in full, CONTRACTOR shall not unlawfully discriminate against
any person.
15. FEDERAL LAW REQUIREMENTS
CONTRACTOR shall comply with the following Federal law requirements:
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
Exhibit P-1
8
amended, relating to nondiscrimination on the basis of alcohol
abuse or alcoholism.
16. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
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
CONTRACTOR shall ensure that any counselor or registrant providing
intake, assessment of need for services, treatment or recovery planning, individual or
Exhibit P-1
9
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. ADMISSION DISCRIMINATION
CONTRACTOR shall accept individuals eligible for admission in the order
in which they apply without restriction, up to the limits set under the State-County
Intergovernmental Agreement. CONTRACTOR shall not, based on health status or
need for health care services, discriminate against individuals eligible for admission.
CONTRACTOR shall not discriminate against individuals eligible for admission based
on race, color, national origin, ancestry, religion, sex, marital status, sexual orientation,
gender, gender identity, age, or disability and will not use any policy or practice that
has the effect of discriminating on the basis of race, color, or national origin, ancestry,
religion, sex, marital status, sexual orientation, gender, gender identity, age, or
disability. CONTRACTOR shall ensure that beneficiaries that meet medical necessity
for Medication Assisted Treatment (MAT) receive the same access to care as non-MAT
beneficiaries.
CONTRACTOR shall provide information on how to file a discrimination
complaint with the United States Department of Health and Human Services Office of
Civil Rights if there is a concern of discrimination based on race, color, national origin,
age, disability or sex.
20. SUBCONTRACTUAL REQUIREMENTS
CONTRACTOR shall fulfill contractual requirements of delegated services
or activities in accordance with 42 CFR §438.230 and shall perform the delegated
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)).
21. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO
FACILITIES
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
Exhibit P-1
10
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.
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.
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
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
CONTRACTOR shall make written and verbal information available to
beneficiaries in their language of choice.
Exhibit P-1
11
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) and services
including qualified interpreters for individuals with disabilities. Oral interpretation
requirements apply to all non–English languages, not just those that DHCS identifies
as prevalent. Pursuant to WIC 14029.91(a)(1)(B), Oral interpretation services shall be
provided by an interpreter that, at a minimum, meets all of the following qualifications:
A. Demonstrated proficiency in both English and the target language;
B. Knowledge in both English and the target language of health care
terminology and concepts relevant to health care delivery systems; and
C. Adheres to generally accepted interpreter ethics principle, including
client confidentiality.
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, at no cost and in a
timely manner for non-English speaking/reading/writing beneficiaries and beneficiaries
with disabilities.
Pursuant to 14029.91(a)(1)(C), CONTRACTOR shall not require a
beneficiary with limited English proficiency to provide his or her own interpreter or rely
on a staff member who does not meet the qualifications described above.
CONTRACTOR shall not rely on an adult or minor child accompanying the
limited-English-proficient beneficiary to interpret or facilitate communication except
under the circumstances described in WIC Section 14029.91(a)(1)(D) for emergencies
and upon request that the accompanying adult provide assistance.
Exhibit P-1
12
Pursuant to 45 CFR 92.201, CONTRACTOR shall not require a
beneficiary with limited English proficiency to accept language assistance services.
25. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and
issue to beneficiaries at intake. Member handbooks can also be made available by
mailing a printed copy of the information to the beneficiary’s mailing address, emailing
after obtaining the beneficiary’s agreement to receive information by email, providing
direction in paper or electronic form to the COUNTY website or any other method that
can reasonably be expected to result in the beneficiary receiving that information.
26. TIMELY ACCESS REQUIREMENTS
CONTRACTOR shall meet DHCS and COUNTY standards for timely
access to care and services, taking into account the urgency of the need for services.
CONTRACTORs must offer hours of operation that are no less than the hours of
operation offered to commercial beneficiaries or comparable to Medicaid FFS, if
CONTRACTOR services only Medicaid beneficiaries. Timeliness standards include,
but are not limited to:
A. Initial contact to first face-to-face appointment – 10 business days
B. Initial contact to first dose of NTP – 3 business days
C. Timeliness of services for Urgent Conditions – 1 business day
CONTRACTOR shall ensure that medical attention for emergency and
crisis medical conditions are provided immediately.
27. CARE COORDINATION
CONTRACTOR and COUNTY shall comply with the care and coordination
requirements of the State-County Intergovernmental Agreement, Exhibit A, Attachment
I, II.E.3. CONTRACTOR shall ensure that each beneficiary has an ongoing source of
care appropriate to his or her needs and shall ensure a person or entity within their
organization is formally designated as primarily responsible for coordinating the
services accessed by the beneficiary. The beneficiary shall be provided information on
how to contact their case manager. CONTRACTOR shall coordinate services between
levels of care, with services the beneficiary receives from any other managed care
organization and the services the beneficiary receives from community and social
support providers. Care coordination efforts shall be accurately documented in
beneficiary’s chart to be verified during COUNTY chart audits conducted at least
annually.
CONTRACTOR shall make a best effort to conduct an initial screening of
each beneficiary’s ancillary needs, within thirty (30) calendar days of the effective date
of admission for all new beneficiaries, including subsequent attempts if the initial
attempt to contact the beneficiary is unsuccessful.
Exhibit P-1
13
CONTRACTOR shall ensure that it maintains and shares, as appropriate,
a beneficiary health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each
beneficiary’s privacy is protected in accordance with the privacy requirements in 45
CFR parts 160 and 164 subparts A and E and 42 CFR Part 2, to the extent that they
are applicable.
CONTRACTOR shall ensure that beneficiaries are aware of and are
referred to, when appropriate, recovery supports and services immediately after
discharge or upon completion of an acute care stay.
28. AUTHORIZATION OF SERVICES
CONTRACTOR shall adhere to COUNTY’s written policies and
procedures, outlined in the Provider Manual, for authorization of services.
29. PERFORMANCE IMPROVEMENT PROJECTS
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.
30. CONTRACTOR DMC CERTIFICATION
DMC certified contractors must revalidate DMC certification with DHCS
every five (5) years. Failure to revalidate DMC certification within 120 days following
the expiration of every five (5) year period will result in contract termination. COUNTY
shall terminate CONTRACTOR immediately upon notification from DHCS that the
CONTRACTOR cannot be enrolled, or the expiration of one 120-day period without
enrollment of CONTRACTOR, and shall notify affected beneficiaries. CONTRACTOR
shall ensure enrollment with DHCS as a Medicaid provider consistent with the provider
disclosure, screening and enrollment requirements.
DMC certified CONTRACTORs shall be subject to continuing certification
requirements at least once every five years. DHCS may allow the CONTRACTOR to
continue delivering covered services to beneficiaries at a site subject to on-site review
by DHCS as part of the recertification process prior to the date of the on-site review,
provided the site is operational, the certification remains valid, and has all required fire
clearances. DHCS shall conduct unannounced certification and recertification site visits
at clinics pursuant to W&I Code, Section 14043.7.
Exhibit P-1
14
31. PROGRAM INTEGRITY REQUIREMENTS
CONTRACTOR shall implement and maintain arrangements or procedures
that are designed to detect and prevent fraud, waste, and abuse. CONTRACTOR shall
maintain written policies, procedures, and standards of conduct that articulate
CONTRACTORs commitment to comply with all applicable requirements and
standards under the State-County Intergovernmental Agreement, and all applicable
Federal and State requirements. CONTRACTOR shall establish and implement
procedures and a system with dedicated staff for routine internal monitoring and
auditing of compliance risks, prompt response to compliance issues as they are raised,
investigation of potential compliance problems as identified in the course of self-
evaluation and audits, correction of such problems promptly and thoroughly (or
coordination of suspected criminal acts with law enforcement agencies) to reduce the
potential for recurrence, and ongoing compliance.
CONTRACTOR shall provide reports to COUNTY within 60 calendar days
when it has identified an overpayment. COUNTY shall provide a mechanism for
reporting and collecting overpayment.
CONTRACTOR shall retain information regarding data, information, and
documentation for beneficiary encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years. (INTERGOVERNMENTAL
AGREEMENT P.5)
CONTRACTOR shall not knowingly have a relationship with a director,
officer or partner of CONTRACTOR, a subcontractor of CONTRACTOR, a person with
beneficial ownership of five (5) percent or more of CONTRACTOR’s equity or a
network provider or person with an employment, consulting or other arrangement with
the CONTRACTOR for the provision of items and services that are significant and
material to the CONTRACTOR’s obligations under this Agreement with the following:
A. An individual or entity that is debarred, suspended, or otherwise
excluded from participating in procurement activities under the
Federal Acquisition Regulation or from participating in non-
procurement activities under regulations issued under Executive
Order No. 12549 or under guidelines implementing Executive Order
No. 12549.
B. An individual or entity who is an affiliate, as defined in the Federal
Acquisition Regulation at 48 CFR 2, Section 101, of a person
described above.
CONTRACTOR shall not have a relationship with an individual or entity
that is excluded from participation in any Federal Health Care Program under section
1128 or 1128A of the Act.
Exhibit P-1
15
32. CONTRACTOR SPECIFICATIONS
CONTRACTOR shall ensure that professional staff shall be licensed,
registered, certified or recognized under California scope of practice statutes.
Professional staff shall provide services within their individual scope of practice and
receive supervision required under their scope of practice laws. CONTRACTOR shall
ensure that professional staff (LPHAs) receive a minimum of five (5) hours of
continuing education related to addiction medicine each year. Copies of these
certifications and licenses shall be maintained in staff’s personnel files and records
shall be made available to COUNTY upon request.
CONTRACTOR shall ensure that non-professional staff receive
appropriate onsite orientation and training prior to performing assigned duties. A
professional and/or administrative staff shall supervise non-professional staff.
Professional and non-professional staff are required to have appropriate experience
and any necessary training at the time of hiring. Documentation of trainings,
certifications and licensure shall be contained in personnel files. Registered and
certified SUD counselors shall adhere to all requirements in Title 9, Chapter 8.
33. CREDENTIALING/RECREDENTIALING
CONTRACTOR shall follow the COUNTY’s established credentialing and
re-credentialing process for all licensed and/or certified staff. Initial credentialing must
be completed prior to providing treatment services. Re-credentialing must be
completed every three (3) years.
34. MEDICAL DIRECTOR REQUIREMENTS
CONTRACTOR’s Medical Director must, prior to the delivery of services
under this Contract, be enrolled with DHCS under applicable state regulations,
screened in accordance with 42 CFR 455.450(a) as a “limited” categorical risk within a
year prior to serving as a Medical Director under this Agreement, and have a signed
Medicaid provider agreement with DHCS as required by 42 CFR 431.107.
Medical Directors shall receive a minimum of five (5) hours of continuing
medical education related to addiction medicine annually.
35. ASAM REQUIREMENTS
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 ensure that, at
minimum, staff conducting assessments complete the two e-Training modules entitled
“ASAM Multidimensional Assessment” and “From Assessment to Service Planning and
Exhibit P-1
16
Level of Care”. The CIBHS ASAM webinars or in person trainings may be completed
in lieu of the e-Training modules. 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.
36. MEDICAL NECESSITY
CONTRACTOR shall ensure that an initial medical necessity
determination, for an individual to receive a DMC-ODS benefit, is performed through a
face-to-face review or telehealth by a Medical Director or a LPHA. The Medical
Director or LPHA shall evaluate each beneficiary’s assessment and intake information,
if completed by a counselor, through a face-to-face review or telehealth with the
counselor to establish that a beneficiary meets medical necessity criteria. After
establishing a diagnosis and documenting the basis for diagnosis, the ASAM Criteria
shall be applied to determine placement into the level of assessed services.
CONTRACTOR shall ensure that all ADULT beneficiaries receive at a
diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth
Edition for Substance-Related and Addictive Disorders. After establishing a diagnosis
and documenting the basis for diagnosis, the American Society of Addiction Medicine
(ASAM) Placement Criteria shall be applied by the diagnosing individual to for
placement into the correct level of care.
CONTRACTOR shall periodically as directed by COUNTY, and at a
minimum of every six (6) months, reassess for continued medical necessity of an
ongoing treatment. The reassessment determination must be documented by the
Medical Director, licensed physician or LPHA as clinically appropriate.
For Medical Necessity definition and Assessment and Reassessment
timeframes CONTRACTOR shall refer to the Provider Manual.
Individuals under age 21 are eligible to receive Medicaid services
pursuant to the Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate.
Under the EPSDT mandate, beneficiaries under the age 21 are eligible to receive all
appropriate and medically necessary services needed to correct and ameliorate health
conditions that are coverable under section 1905(a) Medicaid authority. Nothing in the
DMC-ODS shall override any EPSDT requirements. Medical necessity for an
adolescent individual (an individual under the age of 21) is determined using the
following criteria:
A. The adolescent individual may be assessed to be at-risk for
developing a SUD based on the following criteria:
Exhibit P-1
17
i. Substance use does NOT meet the minimum diagnosis
criteria per the DSM 5 ; and
ii. Reports of experimental or early-phase substance use,
associated biopsychosocial risk factors, and information
gathered from the full ASAM assessment and the At-Risk
Determination Tool indicate risk of developing an SUD.
B. The adolescent individual must meet the ASAM adolescent
treatment criteria.
37. MEDI-CAL ELIGIBILITY VERIFICATION
CONTRACTOR shall be responsible for verifying the Medi-Cal eligibility of
each beneficiary for each month of service prior to billing for DMC services for that
month. Medi-Cal eligibility verification should be performed prior to rendering service, in
accordance with and as described in the DHCS DMC Provider Billing Manual. Options
for verifying the eligibility of a Medi-Cal beneficiary are described in the DHCS DMC
Provider Billing Manual at the following web address and by this reference incorporated
herein. http://www.dhcs.ca.gov/formsandpubs/Documents/DMC_Billing_Manual_2017-
Final.pdf.
38. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a beneficiary has Other Health Coverage (OHC),
CONTRACTOR shall bill the OHC prior to billing DMC to receive either payment from
the OHC, or a notice of denial from the OHC indicating that either the recipient’s OHC
coverage has been exhausted or that the specific service is not a benefit of the OHC.
39. DMC REIMBURSEMENT RATE SETTING
CONTRACTOR shall submit financial and service data to COUNTY on an
annual basis in a format provide by, and by a deadline set by, COUNTY for
reimbursement rate setting purposes. COUNTY shall approve contractor-specific
reimbursement rates for each modality except NTPs. CONTRACTORs that do not
comply with the requirements of the rate setting process will be considered out of
compliance with contractual requirements and will not receive annual reimbursement
rates CONTRACTORs that are non-compliant are subject to contract termination.
Annual reimbursement rates for NTP services shall be set by DHCS
pursuant to the process set forth in W&I Code, Section 14021.51.
40. DMC CERTIFICATION AND ENROLLMENT
Prior to delivering SUD services CONTRACTOR shall obtain any licenses,
registrations, DMC certifications or approval to operate a SUD program or provide a
covered service in accordance with applicable laws and regulations. CONTRACTOR
shall continuously maintain any licenses, registrations, DMC certifications or approval
Exhibit P-1
18
to operate a SUD program or provide a covered service in accordance with applicable
laws and regulations for the duration of this Contract. CONTRACTOR and any
subcontractors shall comply with the following regulations and guidelines:
A. Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
B. Title 22, Sections 51490.1(a);
C. Exhibit A, Attachment I, Article III.PP – Requirements for Services;
D. Title 9, Division 4, Chapter 4, Subchapter 1, Sections 10000, et
seq.; and
E. Title 22, Division 3, Chapter 3, sections 51000 et. seq.
41. PERINATAL CERTIFICATION REQUIREMENTS
CONTRACTORs of perinatal DMC services shall be properly certified to
provide these services and comply with the applicable requirements below:
A. Perinatal services shall address treatment and recovery issues
specific to pregnant and postpartum women, such as relationships,
sexual and physical abuse, and development of parenting skills.
B. Perinatal services shall include:
1) Mother/child habilitative and rehabilitative services (i.e.,
development of parenting skills, training in child
development, which may include the provision of cooperative
child care pursuant to Health and Safety Code Section
1596.792);
2) Service access (i.e., provision of or arrangement for
transportation to and from medically necessary treatment);
3) Education to reduce harmful effects of alcohol and drugs on
the mother and fetus or the mother and infant; and
4) Coordination of ancillary services (i.e., assistance in
accessing and completing dental services, social services,
community services, educational/vocational training and
other services which are medically necessary to prevent risk
to fetus or infant).
C. Medical documentation that substantiates the beneficiary's
pregnancy and the last day of pregnancy shall be maintained in the
beneficiary file.
42. YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the “Youth Treatment Guidelines,” available at
the DHCS web address at:
http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and by this reference
incorporated herein, in developing and implementing youth treatment programs funded
under this Agreement until such time new Youth Treatment Guidelines are established
Exhibit P-1
19
and adopted. No formal amendment of this contract is required for new guidelines to
apply.
43. CONTRACTOR CHANGE IN SERVICE OR LOCATION
CONTRACTOR shall ensure that any reduction of covered services or
relocations are not implemented until approval is issued by DHCS. CONTRACTOR
must submit a new DMC certification application to the DHCS Provider Enrollment
Division (PED). The DMC certification application shall be submitted to PED 60 days
prior to the desired effective date of the reduction of covered services or relocation.
CONTRACTOR shall notify COUNTY when its license, registration,
certification, or approval to operate a SUD program or provide a covered service is
revoked, suspended, modified, or not renewed by entities other than DHCS.
44. MEDICATION ASSISTED TREATMENT
CONTRACTORs that do not provide medication assisted treatment shall
have procedures for linkage/integration for beneficiaries requiring medication assisted
treatment. CONTRACTOR staff will regularly communicate with physicians of
beneficiaries who are prescribed these medications unless the beneficiary refuses to
consent to sign 42 CFR part 2 Compliant Releases of Information for this purpose.
45. EVIDENCE BASED PRACTICES (EBP)
CONTRACTOR shall implement Motivational Interviewing and at least two
EBPs prescribed by DHCS based on the timeline established by COUNTY as outlined
in the Provider Manual. The two additional required EBPs may be selected from the
following: Cognitive-Behavioral Therapy, Relapse Prevention, Trauma-Informed
Treatment and Psycho-Education. Three EBPs shall be utilized per service modality.
COUNTY and DHCS will monitor the implementation and regular training of EBPs to
staff during reviews. CONTRACTOR shall ensure that staff are internally monitored for
training, quality of delivery and fidelity of Evidence Based Practices.
46. COORDINATION AND CONTINUITY OF CARE WITH MANAGED CARE
PLANS
CONTRACTOR shall coordinate with the Managed Care Plans, Anthem
and CalVIVA Health, when appropriate, for comprehensive physical and behavioral
health screening and collaborative treatment planning. COUNTY shall maintain MOUs
with the managed care plans to facility beneficiary care coordination and will monitor
CONTRACTORs with regard to the effectiveness of physical health care coordination.
47. POSTSERVICE POSTPAYMENT AND POSTSERVICE PREPAYMENT
(PSPP)
DHCS shall conduct Postservice Postpayment and Postservice
Prepayment (PSPP) Utilization Reviews of contracted DMC providers to determine
Exhibit P-1
20
whether the DMC services were provided. DHCS shall issue the PSPP report to the
COUNTY with a copy to CONTRACTOR. CONTRACTOR shall ensure any deficiencies
are remediated and COUNTY shall attest the deficiencies have been remediated.
All CONTRACTOR shall submit a COUNTY-approved corrective action
plan (CAP) to DHCS within 60 days of the date of the PSPP report. CONTRACTOR(S)
that do not comply with the CAP submittal requirements or fail to implement the
approved CAP provisions within the designated timeline are subject to payment
withholding until compliance is determined.
48. DRUG SCREENING
Where drug screening by urinalysis is deemed medically appropriate,
CONTRACTOR shall establish procedures which protect against the falsification and/or
contamination of any urine sample and document urinalysis results in the beneficiary’s
file.
49. TREATMENT RECORDING REQUIREMENTS
CONTRACTOR shall comply with the requirements outlined in the
Intergovernmental Agreement, Exhibit A, Attachment I, Section PP, regarding
admission, assessment, beneficiary record, medical necessity and diagnosis, physical
examination, treatment plan, sign-in sheets, progress notes, continuing services, and
discharge.
50. 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 ensure 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 162915(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)].
Exhibit P-1
21
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.
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.
Exhibit P-1
22
51. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER
BENEFITS
A. General Parity Requirement
CONTRACTOR shall not impose any financial requirements,
Quantitative Treatment Limitations, or Non-Quantitative Treatment Limitations in any
classification of benefit (inpatient, outpatient, emergency care, or prescription drugs)
other than those limitations permitted and outlined in the State-County Contract.
CONTRACTOR shall not apply any financial requirement or
treatment limitation to substance use disorder services in any classification of benefit
that is more restrictive than the predominant financial requirement or treatment limitation
of that type applied to substantially all medical/surgical benefits in the same
classification of benefit furnished to beneficiaries (whether or not the benefits are
furnished by the CONTRACTOR). (42 CFR 438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to
beneficiaries in every classification in which medical/surgical benefits are provided. (42
CFR 438.910(b)(2))
B. Quantitative Limitations
CONTRACTOR shall not apply any cumulative financial
requirement for substance use disorder services in a classification that accumulates
separately from any established for medical/surgical services in the same classification.
(42 CFR 438.910(c)(3))
C. Non-Quantitative Limitations
CONTRACTOR shall not impose a non-quantitative treatment
limitation for substance use disorder benefits in any classification unless, under the
policies and procedures of CONTRACTOR as written and in operation, any processes,
strategies, evidentiary standards, or other factors used in applying the non-quantitative
treatment limitation to substance use disorder benefits in the classification are
comparable to, and are applied no more stringently than, the processes, strategies,
evidentiary standards, or other factors used in applying the limitation for
medical/surgical benefits in the classification. (42 CFR §438.910(d))
CONTRACTOR shall use processes, strategies, evidentiary
standards, or other factors in determining access to out-of-network providers for
substance use disorder services that are comparable to, and applied no more
stringently than, the processes, strategies, evidentiary standards, or other factors in
determining access to out-of-network providers for medical/surgical benefits. (42 CFR
§438.910(d)(3))
Exhibit P-1
23
52. ACCESSIBILITY CONSIDERATIONS
CONTRACTOR shall ensure that their health programs or activities
provided through electronic and information technology are accessible to beneficiaries
with disabilities, unless doing so would result in undue financial and administrative
burdens or a fundamental alteration in the nature of the health programs or activities.
When undue financial and administrative burdens or a fundamental alteration exist,
CONTRACTOR shall provide information in a format other than an electronic format that
would not result in such undue financial and administrative burdens or a fundamental
alteration but would ensure, to the maximum extent possible, that beneficiaries with
disabilities receive the benefits or services of the health program or activity that are
provided through electronic and information technology.
CONTRACTOR shall make reasonable modifications to policies,
practices, or procedures when such modifications are necessary to avoid discrimination
on the basis of disability, unless CONTRACTOR can demonstrate that making the
modifications would fundamentally alter the nature of the health program or activity. For
the purposes of this section, the term ‘‘reasonable modifications’’ shall be interpreted in
a manner consistent with the term as set forth in the ADA Title II regulation at 28 CFR
35.130(b)(7).
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:_________________________________
Exhibit P-1
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 P-1
Attachment C
Page 1 of 1
3133 N Millbrook, Fresno, California 93703
FAX (559) 600-7673 www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer
PRIVACY AND SECURITY AGREEMENT REGARDING AUTHORIZED ACCESS TO
CONFIDENTIAL PROTECTED HEALTH INFORMATION FOR FRESNO COUNTY DEPARTMENT
OF BEHAVIORAL HEALTH (DBH) EMPLOYEES AND/OR NON-DBH SUD SERVICES
WORKFORCE MEMBERS
OATH OF CONFIDENTIALITY
As a condition of obtaining access to any Protected Health Information (PHI) that is necessary to carry
out my function with DBH, I ___________________________, agree to not divulge any PHI to
unauthorized persons. Furthermore, I maintain that I will not publish or otherwise make public any
information regarding persons who receive Substance Use Disorder Services such that the persons who
receive or have received such services are identifiable.
Access to such data shall be limited to Fresno County DBH personnel, subcontractors, and
subcontractors’ personnel who require this information in the performance of their duties and have signed
an Oath of Confidentiality with DBH.
By signing this oath, I agree to uphold the security and confidentiality requirements outlined by the Medi-
Cal Privacy and Security Agreement signed by DBH, surveillance and safeguarding announcements
issued by DHCS, and other applicable terms and stipulations provided by the HIPAA doctrine as well as
other relevant state and federal regulations.
I hereby certify my understanding of the need to:
1. Exercise due care to preserve data integrity and confidentiality.
2. Treat passwords and user accounts as confidential information.
3. Take reasonable precautions to ensure the protection of PHI from unauthorized access.
4. Notify DHCS when there is a possible security violation including unauthorized access to PHI by
completing a “Privacy Incident Report” at:
http://www.dhcs.ca.gov/formsandpubs/laws/priv/Pages/DHCSBusinessAssociatesOnly.aspx and
return the completed form to: privacyofficer@dhcs.ca.gov.
I recognize that unauthorized release of confidential information may make me subject to civil and
criminal sanctions pursuant to the provisions of the Welfare and Institutions Code Section 14100.2,
Welfare and Institutions Code Section 5328 et seq. and the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). I further acknowledge that the unauthorized release of confidential
information as described in this document may result in disciplinary action up to and including
termination of any office of employment or contract.
Agency Name:
Signature:
____________________________________
Date:
____________________________________
Exhibit P-1