HomeMy WebLinkAboutAgreement A-19-371 for Youth Empowerment Center Services.pdf
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health facility; the locations of services cannot be changed without prior approval of the DBH Director or
designee.
B. CONTRACTOR(S) shall align programs, services, and practices with the vision,
mission, and guiding principles of the DBH, as further described in Exhibit I, “Fresno County
Department of Behavioral Health Guiding Principles of Care Delivery”, attached hereto and by this
reference incorporated herein and made part of this Agreement.
C. It is acknowledged that upon execution of this Agreement, CONTRACTOR(S)’
service site for the delivery of Youth Empowerment Center program will be located as stated in Exhibit
A. Any change to CONTRACTOR(S)’ location of the service site may be made only upon thirty (30)
days advance written notification to COUNTY’s DBH Director and upon written approval from
COUNTY’s DBH Director, or designee, with notice to the County.
D. CONTRACTOR(S) shall maintain requirements as an Organizational Provider
throughout this Agreement, as described in Section Seventeen (17) of this Agreement. If for any
reason this status is not maintained, the COUNTY may terminate this Agreement pursuant to Section
Three (3) of this Agreement.
E. CONTRACTOR(S) agrees that prior to providing services under the terms and
conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
operations, or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
this Agreement, in accordance with Section Three (3) of this Agreement.
F. CONTRACTOR(S) shall participate in monthly, or as needed, workgroup
meetings consisting of staff from COUNTY’s DBH to discuss requirements, data reporting, training,
policies and procedures, overall program operations and any problems or foreseeable problems that
may arise.
G. It is acknowledged by all parties hereto that COUNTY’s DBH Contracts Division
shall monitor said Youth Empowerment Center program in accordance with Section Fourteen (14) of
this Agreement.
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2. TERM
The term of this Agreement shall become effective on execution through and including
June 30, 2021.
CONTRACTOR(S) added to this Agreement after the execution date shall become part
of the Agreement effective upon the date the executed signature page is received and approved by the
COUNTY’s DBH Director, or designee, as set forth in Section Eleven (11) of this Agreement.
The June 30th termination date specified herein shall be the termination date for all
CONTRACTOR(S), regardless of when CONTRACTOR is added to this Agreement.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, 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(S) sixty (60) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
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; and
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of the CONTRACTOR(S).
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. The COUNTY shall have the right to demand of each CONTRACTOR the repayment
to the COUNTY of any funds disbursed to that CONTRACTOR under this Agreement, which in the
judgment of COUNTY were not expended in accordance with the terms of this Agreement. Each
CONTRACTOR shall promptly refund any funds upon demand or, at COUNTY’s option, such
repayment shall be deducted from future payments owing to that CONTRACTOR under this
Agreement.
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C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY or COUNTY’s DBH Director, or designee, or one (1) or
more CONTRACTOR(S) upon the giving of sixty (60) days advance written notice of an intention to
terminate, with notice to the County.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive
compensation for actual expenditures incurred in accordance with the individual CONTRACTOR’s
“budget” documents approved by the COUNTY’s DBH Director, or designee, and attached hereto as
Exhibits C-1 et seq. and incorporated herein by this reference.
A. Annual Compensation Amounts
For July 1, 2019 through June 30, 2020, in no event shall the maximum
compensation amount under this Agreement exceed Eight Hundred Forty-Six Thousand, Eight Hundred
Sixty-Eight and No/100 Dollars ($846,868.00) for all CONTRACTOR(S) combined.
For July 1, 2020 through June 30, 2021, in no event shall the maximum
compensation amount under this Agreement exceed Eight Hundred Eighty-Nine Thousand, Six
Hundred Thirty-Two and No/100 Dollars ($889,632.00) for all CONTRACTOR(S) combined.
The maximum amounts paid to each CONTRACTOR identified in this Agreement
shall be as stated in the CONTRACTOR(S)’ “Summary of Services” document approved by the
COUNTY’s DBH Director, or designee.
B. Total Maximum Compensation Amounts
In no event shall the total maximum compensation amount under this Agreement
for July 1, 2019 through June 30, 2021 exceed One Million, Seven Hundred Thirty-Six Thousand, Five
Hundred and No/100 Dollars ($1,736,500.00) for all CONTRACTOR(S) combined.
C. Prior to March 1st of each contract year, CONTRACTOR(S) may provide to
COUNTY’s DBH an updated budget and budget narrative in the format identified in Exhibits C-1 et seq.
for the upcoming twelve (12) month period. Each budget shall require justification by the
CONTRACTOR(S), and approval of COUNTY’s DBH Director, or designee, prior to April 1st for the
upcoming twelve (12) month period covered by said budget. If said budget is not received by the
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March 1st due date, the budget for the upcoming twelve (12) month period will remain at the prior
year’s funding level. The amount of said approved budget shall not exceed the maximum
compensation for the current Agreement period.
D. Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR(S)’ adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate.
E. It is understood that all expenses incidental to CONTRACTOR(S)’ performance
of services under this Agreement shall be borne by CONTRACTOR(S). If CONTRACTOR(S) fail to
comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
F. Payments shall be made by COUNTY to CONTRACTOR(S) in arrears for
services provided during 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) herein. Payments shall
be made after receipt and verification of services provided in the performance of this Agreement, in
accordance with the “Summary of Services” as provided for in Exhibit B, and shall be documented to
COUNTY on a monthly basis by the tenth (10th) of the month following the month of said service
provision.
G. 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.
H. All final invoices and/or any final budget modification requests shall be submitted
by CONTRACTOR(S) 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. Any compensation which is not expended by CONTRACTOR(S) pursuant to the terms
and conditions of this Agreement shall automatically revert to COUNTY.
I. The services provided by CONTRACTOR(S) 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(S). The amount of the deferred
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payment shall not exceed the amount of funding delayed by the State Controller to the 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.
J. CONTRACTOR(S) shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR(S)’ deficiency discovered through the applicable
State’s audit process and MHP’s utilization review process during the course of the Agreement. At
COUNTY’s election, the disallowed amount will be remitted within forty-five (45) days to COUNTY upon
notification or shall be withheld from subsequent payments to CONTRACTOR(S). CONTRACTOR(S)
shall not receive reimbursement for any units of services rendered that are disallowed or denied by the
applicable MHP utilization review process or through the State Department of Health Care Services
(DHCS) cost report audit settlement process for Medi-Cal eligible clients.
K. It is understood by CONTRACTOR(S) and COUNTY that this Agreement is
funded with mental health funds to serve adolescents and transition age youth.
5. INVOICING
A. CONTRACTOR(S) shall invoice COUNTY in arrears by the tenth (10th) of each
month for actual services provided during the prior month to DBH-Invoices@fresnocountyca.gov and a
carbon copy to the assigned DBH Mental Health Contracts Staff Analyst. Invoices and reports shall be
in such detail as acceptable to COUNTY’s DBH, as described in this section herein and in Section
Fourteen (14) of this Agreement.
B. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
the line item charges for monthly program costs (per applicable budget, as identified in Exhibit C-1 et
seq.). Unallowable costs such as lobbying or political donations must be deducted from the monthly
invoice reimbursements. The invoices and general ledgers will serve as tracking tools to determine if
CONTRACTOR’s program costs are in accordance with its budgeted cost, as set forth in Exhibit C-1 et
seq.
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
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after five (5) days prior notice to CONTRACTOR(S). CONTRACTOR(S) agrees to continue to provide
services for a period of ninety (90) days after notification of an incorrect or improper invoice. If after the
ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH’s satisfaction, COUNTY’s
DBH Director, or designee, may elect to terminate this Agreement, pursuant to the termination
provisions stated in Section Three (3) of this Agreement. In addition, for invoices received ninety (90)
days after the expiration of each term of this Agreement or termination of this Agreement, at the
discretion of COUNTY’s DBH Director, or designee, COUNTY’s DBH shall have the right to deny
payment of any additional invoices received.
D. CONTRACTOR(S) must report all third party collections from other funding
sources such as private insurance, client private pay or any other third party. COUNTY expects the
invoice for reimbursement to equal the amount due CONTRACTOR less any funding sources not
eligible for Federal reimbursement and any other revenues generated by CONTRACTOR (i.e., private
insurance, etc).
E. CONTRACTOR(S) shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as a
tracking tool to determine if CONTRACTOR(S)’s program is staffed according to the services provided
under this Agreement.
F. CONTRACTOR(S) must maintain such financial records for a period of seven (7)
years, or if there a dispute, audit or inspection, until it is resolved, whichever is later. CONTRACTOR(S)
will be responsible for any disallowances related to inadequate documentation.
G. CONTRACTOR(S) is responsible for collection and managing data in a manner
to be determined by DHCS and the DBH MHP in accordance with applicable rules and regulations.
CONTRACTOR(S) must attend the COUNTY DBH’s Business Office training on documentation and
billing and related cost reporting.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any and
all of CONTRACTOR(S)’ officers, agents, and employees will at all times be acting and performing as
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independent contractors, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venture, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which each CONTRACTOR shall perform its
work and function. However, COUNTY shall retain the right to administer this Agreement so as to
verify that each CONTRACTOR is performing their obligations in accordance with the terms and
conditions thereof. CONTRACTOR(S) and COUNTY shall comply with all applicable provisions of law
and the rules and regulations, if any, of governmental authorities having jurisdiction over matters which
are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR(S) shall have
absolutely no right to employment rights and benefits available to COUNTY employees. Each
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees all
legally-required employee benefits. In addition, CONTRACTOR(S) 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(S) may be
providing services to others unrelated to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR(S), as set forth in Exhibits C-1 et seq., as needed to accommodate changes in the law
relating to mental health and substance use disorder treatment, may be made with the signed written
approval of COUNTY’s DBH Director, or designee, and CONTRACTOR(S) through an amendment
approved by COUNTY’s Counsel and the COUNTY’s Auditor-Controller/Treasurer-Tax Collector’s
Office.
In addition, changes to line items in the budget, and changes to the volume of units of
services/types of service units to be provided attached as set forth in Exhibit C-1 et seq., that do
exceed 10% of maximum compensation payable to each CONTRACTOR may be made with the written
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approval of COUNTY’s DBH Director or designee, with notice to the County. Said budget line item
changes shall not result in any change to the maximum compensation amount payable to each
CONTRACTOR, as stated herein.
Said modifications shall not result in any change to the annual maximum compensation
amount payable to CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
COUNTY and CONTRACTOR(S) shall not assign, transfer or subcontract this
Agreement nor their rights or duties under this Agreement without the prior written consent of COUNTY
and the individual CONTRACTOR seeking to make such assignment.
9. HOLD-HARMLESS
Each 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 fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by each CONTRACTOR, its
officers, agents or employees under this Agreement, and from any and all costs and expenses,
including attorney fees and court 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(S), its officers, agents or employees under this Agreement.
Each CONTRACTOR agrees to indemnify COUNTY for Federal, State of California
and/or local audit exceptions resulting from noncompliance herein on the part of the
CONTRACTOR(S).
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR(S) or any
third parties, each CONTRACTOR, at its sole expense, shall maintain in full force and effect the
following insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations,
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product liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature
of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits no less than One
Million Dollars ($1,000,000) per accident for bodily injury and property damage.
Coverage should include any automobile used in connection with this
Agreement. If CONTRACTOR(S) employees are not covered by
CONTRACTOR(S) automobile liability insurance policy, CONTRACTOR(S) shall
ensure that each employee as part of this Agreement procures and maintains
their own private automobile coverage in force during the term of this Agreement,
at the employee’s sole cost and expense.
C. Professional Liability
If CONTRACTOR(S) employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T., etc.) in providing services, Professional Liability Insurance
with limits of not less than One Million Dollars ($1,000,000) per occurrence,
Three Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees
that it shall maintain, at its sole expense, in full force and effect for a period of
five (5) years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
D. Real and Property Insurance
CONTRACTOR(S) shall maintain a policy of insurance for all risk personal
property coverage which shall be endorsed naming the County of Fresno as an
additional loss payee. The personal property coverage shall be in an amount
that will cover the total of the COUNTY purchase and owned property, at a
minimum, as discussed in Section Twenty One (21) of this Agreement.
All Risk Property Insurance
As applicable, CONTRACTOR(S) will provide property coverage for the full
replacement value of the COUNTY’S personal property in possession of
CONTRACTOR(S) and/or used in the execution of this Agreement. COUNTY
will be identified on an appropriate certificate of insurance as the certificate
holder and will be named as an Additional Loss Payee on the Property Insurance
Policy.
E. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
F. Child Abuse/Molestation and Social Services Coverage
Each CONTRACTOR shall have either separate policies or an umbrella policy
with endorsements covering Child Abuse/Molestation and Social Services
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Liability coverage or have a specific endorsement on their General Commercial
liability policy covering Child Abuse/Molestation and Social Services Liability.
The policy limits for these policies shall be One Million Dollars ($1,000,000) per
occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
policies are to be on a per occurrence basis.
G. Cyber Liability
Cyber Liability Insurance, with limits not less than Two Million Dollars
($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000)
aggregate. Coverage shall be sufficiently broad to respond to the duties and
obligations as is undertaken by CONTRACTOR(S) 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, 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.
H. Waiver of Subrogation
CONTRACTOR(S) hereby grants to COUNTY a waiver of any right to
subrogation which any insurer of said CONTRACTOR(S) may acquire against
the COUNTY by virtue of the payment of any loss under such insurance.
CONTRACTOR(S) agrees to obtain any endorsement that may be necessary to
affect this waiver of subrogation, but this provision applies regardless of whether
or not the COUNTY has received a waiver of subrogation endorsement from the
insurer.
Each 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.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement, said
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
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Contract Services Division, 3133 N. Millbrook Ave, Fresno, California, 93703, Attention: Cultural
Specific Services Mental Health Contract Staff Analyst, 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 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(S) fails to keep in effect at all times insurance coverage as
herein provided, 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 with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
A FSC VII or better.
11. ADDITIONS/DELETIONS OF CONTRACTORS
COUNTY’s DBH Director, or designee, reserves the right at any time during the term of
this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A with oversight and approval
by Internal Services Department – Purchasing Division, with notice to the County. It is understood any
such additions will not affect compensation paid to any other CONTRACTOR, and therefore such
additions may be made by COUNTY without notice to or approval of the other CONTRACTOR(S)
under this Agreement. These same provisions shall apply to the deletion of any CONTRACTOR(S)
contained in Exhibit A, except that deletions shall be by written mutual agreement between the
COUNTY and the particular CONTRACTOR to be deleted, or shall be in accordance with the
provisions of Section Three (3) of this Agreement.
12. LICENSES/CERTIFICATES
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Throughout the term of this Agreement, CONTRACTOR(S) 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(S) 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(S) and
CONTRACTOR(S)’ staff shall comply with all applicable laws, rules or regulations, as may now exist or
be hereafter changed.
13. REPORTS
A. Outcome Reports
CONTRACTOR(S) shall submit to COUNTY’s DBH service outcome reports, as
requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to change at
COUNTY’s DBH discretion.
B. Additional Reports
CONTRACTOR(S) shall also furnish to COUNTY such statements, records,
reports, data, and other information as COUNTY may request pertaining to matters covered by this
Agreement. In the event that CONTRACTOR(S) fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
until there is compliance. In addition, CONTRACTOR(S) shall provide written notification and
explanation to COUNTY within five (5) days of any funds received from another source to conduct the
same services covered by this Agreement.
14. MONITORING
CONTRACTOR(S) agrees to extend to COUNTY’s staff, COUNTY’s DBH Director, or
designee, and DHCS, or their designees, the right to review and monitor records, program or
procedures, at any time, in regard to clients, as well as the overall operation of CONTRACTOR(S)’
program, in order to ensure compliance with the terms and conditions of this Agreement.
15. REFERENCES TO LAWS AND RULES
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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.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR(S) recognizes that COUNTY operates its mental health programs under
an agreement with DHCS, and that under said agreement the State imposes certain requirements on
COUNTY and its subcontractors. CONTRACTOR(S) shall adhere to all State Requirements, including
those identified in Exhibit E, “State Mental Health Requirements”, attached hereto and by this reference
incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR(S) shall be required to maintain organizational provider certification by
Fresno County. It is acknowledged that all references to Organizational Provider and/or Provider in
Exhibit D shall refer to CONTRACTOR(S). In addition, CONTRACTOR(S) shall inform every client of
their rights under the COUNTY’s MHP as described in Exhibit F, “Fresno County Mental Health Plan
Grievances and Appeals Process,” attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTOR(S) shall also file an incident report for all incidents
involving clients, following the DBH’s “Incident Reporting and Intensive Analysis” policy and procedure
guide and using the “Incident Report” worksheet identified in Exhibit L, attached hereto and by this
reference incorporated herein and made part of this Agreement, or a protocol and worksheet presented
by CONTRACTOR(S) that is accepted by COUNTY’s DBH Director, or designee.
18. CONFIDENTIALITY
All services performed by CONTRACTOR(S) under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR(S) 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 (PHI) as required by law.
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COUNTY and CONTRACTOR(S) acknowledge that the exchange of PHI between them
is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
security of 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(S) 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).
20. 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 client 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(S) by the COUNTY, including but not limited to the following:
A. CONTRACTOR(S)-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR(S) may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR(S) 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(S)-Owned Computers or Computer Peripherals
CONTRACTOR(S) may not bring CONTRACTOR(S)-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
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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 must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR(S) 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(S) 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(S) 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 client 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(S) is responsible to immediately notify COUNTY 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)’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided
to CONTRACTOR(S). CONTRACTOR(S) 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(S) will be responsible for all costs incurred as a result of providing the required
notification.
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21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR(S) recognizes that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s MHP for use in operational capacity and
will benefit COUNTY for a period more than one year. Depreciation of the qualified items will be on a
straight-line basis.
For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
1. Asset must have life span of over one (1) year.
2. The asset is not a repair part.
3. The asset must be valued at or greater than the capitalization thresholds
for the asset type.
Asset type Threshold
• land $0
• buildings and improvements $100,000
• infrastructure $100,000
• tangible $5,000
o equipment
o vehicles
• intangible asset $100,000
o internally generated software
o purchased software
o easements
o patents
• and capital lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it
is approved and identified as an asset, it will be tagged with a COUNTY program number. A “Fixed
Asset Log” will be maintained by COUNTY’s Asset Management System and annual inventoried until
the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR(S)’ fixed assets
may be inventoried in comparison to COUNTY’s DBH Asset Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than $1,000, with over one (1) year life span, and/or are mobile and high risk of theft or loss are
sensitive assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and
other sensitive items as determined by COUNTY’s DBH Director, or designee. CONTRACTOR(S)
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maintains a tracking system on the items and are not required to be capitalize or depreciated. The
items are subject to annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR(S) agrees to
participate in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or
expiration of this Agreement, CONTRACTOR(S) shall be physically present when fixed and inventoried
assets are returned to COUNTY possession. CONTRACTOR(S) is responsible for returning to
COUNTY all COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of
said assets if unable to produce the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2. To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
where and how the equipment is being used, in accordance with procedures developed by
COUNTY. All such lists shall be submitted to COUNTY within ten (10) days of any request therefore;
and
3. To report in writing to COUNTY immediately after discovery, the loss or
theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
and a copy of the police report submitted to COUNTY.
D. The purchase of any equipment by CONTRACTOR(S) with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR(S)’ services or activity under
the terms of this Agreement. COUNTY’s DBH may refuse reimbursement for any costs resulting from
equipment purchased, which are incurred by CONTRACTOR(S), if prior written approval has not been
obtained from COUNTY.
E. CONTRACTOR(S) must obtain prior written approval from COUNTY’s DBH
whenever there is any modification or change in the use of any property acquired or improved, in whole
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or in part, using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by CONTRACTOR(S) for a use which does not
qualify under this Agreement, CONTRACTOR(S) shall reimburse COUNTY in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of funds
not provided under this Agreement. These requirements shall continue in effect for the life of the
property. In the event this Agreement expires, or terminates, the requirements for this Section shall
remain in effect for activities or property funded with said funds, unless action is taken by the State
government to relieve COUNTY of these obligations.
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR(S) and its subcontractors
shall not deny the contract’s benefits to any person on the basis 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 and veteran
status, nor shall they discriminate unlawfully against any employee or applicant for employment
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. CONTRACTOR(S) shall insure that the evaluation
and treatment of employees and applicants for employment are free of such discrimination.
CONTRACTOR(S) and subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Gov. Code §12800 et seq.), the regulations promulgated thereunder
(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title
2 of the Government Code (Gov. Code §11135-11139.5), and the regulations or standards adopted by
the awarding state agency to implement such article. CONTRACTOR(S) shall permit access by
representatives of the Department of Fair Employment and Housing and the awarding state agency
upon reasonable notice at any time during the normal business hours, but in no case less than twenty-
four (24) hours notice, to such of its books, records, accounts, and all other sources of information and
its facilities as said Department or Agency shall require to ascertain compliance with this clause.
CONTRACTOR(S) and its subcontractors shall give written notice of their obligations under this clause
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to labor organizations with which they have a collective bargaining or other agreement. (See Cal. Code
Regs., tit. 2, §11105) CONTRACTOR(S) shall include the Non-Discrimination and compliance
provisions of this clause in all subcontracts to perform work under this Agreement.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR(S) shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R
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 LEP consumers, including, but not limited to,
assessing the cultural and linguistic needs of its consumers, 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(S) shall not use minors as interpreters.
D. CONTRACTOR(S) 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(S). 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(S) shall ensure that any employees, agents, subcontractors,
or partners who interpret or translate for a program participant, or who directly communicate with a
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
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CONTRACTOR(S) services.
E. CONTRACTOR(S) shall be responsible for conducting an annual cultural
competency self-assessment and provide the results of said self-assessment to the COUNTY”S
DBH. The annual cultural competency self -assessment instruments shall be reviewed by the COUNTY
and revised as necessary to meet the approval of the COUNTY.
F. Cultural competency training for CONTRACTOR(S) staff should be substantively
integrated into health professions education and training at all levels, both academic and
functional, including core curriculum, professional licensure, and continuing professional development
programs. On an annual basis, CONTRACTOR’s direct service providers shall complete eight (8)
hours of cultural competency training. CONTRACTOR(S) on a monthly basis shall provide COUNTY
DBH a monthly monitoring tool/report that shows cultural competency trainings completed.
G. CONTRACTOR(S) shall attend the COUNTY’s Cultural Competency Committee
monthly meetings, maintain its own cultural competence oversight committee, and develop a cultural
competency plan to address and evaluate cultural competency issues.
24. AMERICANS WITH DISABILITIES ACT
CONTRACTOR(S) agrees to ensure that deliverables developed and produced,
pursuant to this Agreement shall comply with the accessibility requirements of Section 508 of the
Rehabilitation Act and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. §794 (d)),
and regulations implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal
Regulations. In 1998, Congress amended the Rehabilitation Act of 1973 to require Federal agencies to
make their electronic and information technology (EIT) accessible to people with disabilities. California
Government Code Section 11135 codifies section 508 of the Act requiring accessibility of electronic and
information technology.
25. 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. In addition, no employee of COUNTY shall be
employed by CONTRACTOR(S) to fulfill any contractual obligations with COUNTY.
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CONTRACTOR(S) shall also 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.
26. CHARITABLE CHOICE
CONTRACTOR(S) may not discriminate in its program delivery against a client or
potential client on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal
to actively participate in a religious practice. Any specifically religious activity or service made available
to individuals by CONTRACTOR(S) must be voluntary as well as separate in time and location from
COUNTY-funded activities and services. CONTRACTOR(S) shall inform COUNTY as to whether it is
faith-based. If CONTRACTOR(S) identifies as faith-based, it must submit to COUNTY’s DBH a copy of
its policy on referring individuals to an alternate treatment provider, and include a copy of this policy in
its client admission forms. The policy must inform individuals that they may be referred to an
alternative provider if they object to the religious nature of the program, and include a notice to
COUNTY’s DBH. Adherence to this policy will be monitored during annual site reviews and reviews of
client files. If CONTRACTOR(S) identifies as faith-based, by July 1st of each year CONTRACTOR will
be required to report to COUNTY’s DBH the number of individuals who requested referrals to alternate
providers based on religious objection.
27. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v) (1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four
(4) years after the furnishing of services under this Agreement, CONTRACTOR(S) shall make
available, upon written request to the Secretary of the United States Department of Health and Human
Services, or upon request to the Comptroller General of the United States General Accounting Office,
or any of their duly authorized representatives, a copy of this Agreement and such books, documents,
and records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR(S) under this Agreement. CONTRACTOR(S) further agrees that in the event
CONTRACTOR(S) carries out any of its duties under this Agreement through a subcontract, with a
value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month
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period, with a related organization, such Agreement shall contain a clause to the effect that until the
expiration of four (4) years after the furnishing of such services pursuant to such subcontract, the
related organizations shall make available, upon written request to the Secretary of the United States
Department of Health and Human Services, or upon request to the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify
the nature and extent of such costs.
28. SINGLE AUDIT CLAUSE
A. If CONTRACTOR(S) expends Seven Hundred Fifty Thousand Dollars and
No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR(S)
agrees to conduct an annual audit in accordance with the requirements of the Single Audit Standards
as set forth in Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR(S) shall submit
said audit and management letter to COUNTY. The audit must include a statement of findings or a
statement that there were no findings. If there were negative findings, CONTRACTOR(S) must include
a corrective action plan signed by an authorized individual. CONTRACTOR(S) agrees to take action to
correct any material non-compliance or weakness found as a result of such audit. Such audit shall be
delivered to COUNTY’s DBH Business Office for review within nine (9) months of the end of any fiscal
year in which funds were expended and/or received for the program. Failure to perform the requisite
audit functions as required by this Agreement may result in COUNTY performing the necessary audit
tasks, or at COUNTY’s option, contracting with a public accountant to perform said audit, or, may result
in the inability of COUNTY to enter into future agreements with CONTRACTOR(S). All audit costs
related to this Agreement are the sole responsibility of CONTRACTOR(S).
B. A single audit report is not applicable if CONTRACTOR(S)’s Federal contracts do
not exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
CONTRACTOR(S)’ only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
program audit must be performed and a program audit report with management letter shall be
submitted by CONTRACTOR(S) to COUNTY as a minimum requirement to attest to CONTRACTOR’s
solvency. Said audit report shall be delivered to COUNTY’s DBH Business Office for review, no later
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than nine (9) months after the close of the fiscal year in which the funds supplied through this
Agreement are expended. Failure to comply with this Act may result in COUNTY performing the
necessary audit tasks or contracting with a qualified accountant to perform said audit. All audit costs
related to this Agreement are the sole responsibility of CONTRACTOR(S) who agrees to take
corrective action to eliminate any material noncompliance or weakness found as a result of such audit.
Audit work performed by COUNTY under this section shall be billed to the CONTRACTOR(S) at
COUNTY’s cost, as determined by COUNTY’s Auditor-Controller/Treasurer-Tax Collector.
C.CONTRACTOR(S) 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
period of at least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
29.COMPLIANCE
CONTRACTOR(S) agrees to comply with the COUNTY’s “Contractor Code of Conduct
and Ethics” and the COUNTY’s Compliance Program in accordance with Exhibit D. Within thirty (30)
days of entering into this Agreement with the COUNTY, CONTRACTOR(S) shall have all of
CONTRACTOR(S)’ employees, agents and subcontractors providing services under this Agreement
certify in writing, that he or she has received, read, understood, and shall abide by the Contractor Code
of Conduct and Ethics. CONTRACTOR(S) shall ensure that within thirty (30) days of hire, all new
employees, agents and subcontractors providing services under this Agreement shall certify in writing
that he or she has received, read, understood, and shall abide by the Contractor Code of Conduct and
Ethics. CONTRACTOR(S) understands that the promotion of and adherence to the Code of Conduct is
an element in evaluating the performance of CONTRACTOR(S) and its employees, agents and
subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
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subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who
is required to attend training shall certify in writing that he or she has received the required training.
The certification shall specify the type of training received and the date received. The certification shall
be provided to the COUNTY’s Compliance Officer at 3133 N. Millbrook Ave, Fresno, California 93703.
CONTRACTOR(S) 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.
30. ASSURANCES
In entering into this Agreement, CONTRACTOR(S) 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(S) is ineligible on these grounds, COUNTY will remove
CONTRACTOR(S) from responsibility for, or involvement with, COUNTY’s business operations related
to the Federal Health Care Programs and shall remove such CONTRACTOR(S) from any position in
which CONTRACTOR(S)’ compensation, or the items or services rendered, ordered or prescribed by
CONTRACTOR(S) 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(S) is reinstated
into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR(S) has been charged with a criminal
offense related to any Federal Health Care Program, or is proposed for exclusion during the term of any
contract, CONTRACTOR(S) 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(S) cease providing services until resolution of the charges
or the proposed exclusion.
B. CONTRACTOR(S) agrees that all potential new employees of
CONTRACTOR(S) or subcontractors of CONTRACTOR(S) who, in each case, are expected to perform
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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(S) 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(S)
hires or engages such potential employee or subcontractor, CONTRACTOR(S) 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 Two (2) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to be determined
by COUNTY to protect the interests of COUNTY consumers.
C. CONTRACTOR(S) 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(S) 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 of health care services, CONTRACTOR(S) will ensure that said employee or
subcontractor does no work, either direct or indirect, relating to services provided to COUNTY.
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1) CONTRACTOR(S) agrees to notify COUNTY immediately during the term
of this Agreement whenever CONTRACTOR(S) 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 Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to be determined
by COUNTY to protect the interests of COUNTY clients.
D. CONTRACTOR(S) 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 CONTRACTOR(S)’s compliance with the provisions of this Section.
E. CONTRACTOR(S) 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 CONTRACTOR(S)’ obligations as described in this Section.
31. PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR(S)’ advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement
shall be allowed as necessary to raise public awareness about the availability of such specific services
when approved in advance by COUNTY’s DBH Director, or designee, and at a cost to be provided in
Exhibits C-1 et seq. for such items as written/printed materials, the use of media (i.e., radio, television,
newspapers) and any other related expense(s).
32. COMPLAINTS
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CONTRACTOR(S) shall log complaints and the disposition of all complaints from a client
or a client’s family. CONTRACTOR(S) shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of the
following month, in a format that is mutually agreed upon. In addition, CONTRACTOR(S) shall provide
details and attach documentation of each complaint with the log. CONTRACTOR(S) shall post signs
informing clients of their right to file a complaint or grievance. CONTRACTOR(S) shall notify COUNTY
of all incidents reportable to State licensing bodies that affect COUNTY clients within twenty-four (24)
hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR(S) 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 addition, CONTRACTOR(S) shall inform every client of their
rights as set forth in Exhibit F and Exhibit G regarding grievances and incident reporting.
33. CHILD ABUSE REPORTING ACT
CONTRACTOR(S) shall establish a procedure acceptable to the COUNTY’s DBH
Director, or designee, to ensure that all of the CONTRACTOR(S)’ employees, consultants,
subcontractors or agents described in the Child Abuse Reporting Act, section 1116 et seq. of the Penal
Code, and performing services under this Agreement shall report all known or suspected child abuse or
neglect to a child protective agency as defined in Penal Code section 11165.9. This procedure shall
include:
A. A requirement that all CONTRACTOR(S)’ employees, consultants,
subcontractors or agents performing services shall sign a statement that he or she knows of and will
comply with the reporting requirements as defined in Penal Code section 11166(a), identified in Exhibit
K, attached hereto and incorporated herein by reference and made part of this Agreement.
B. Establishing procedures to ensure reporting even when employees, consultants,
subcontractors, or agents who are not required to report child abuse under Penal Code section
11166(a), gain knowledge of or reasonably suspect that a child has been a victim of abuse or neglect.
34. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
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INFORMATION
This provision is only applicable if CONTRACTOR(S) is a disclosing entity, fiscal agent,
or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR(S) by completing Exhibit J, “Disclosure
of Ownership and Control Interest Statement”, attached hereto and by this reference incorporated
herein and made part of this Agreement. CONTRACTOR(S) shall submit this form to COUNTY’s DBH
within thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR(S) shall
report any changes to this information within thirty-five (35) days of occurrence by completing Exhibit J.
CONTRACTOR(S) is required to submit a set of fingerprints for any person with a five (5) percent or
greater direct or indirect ownership interest in CONTRACTOR(S). COUNTY may terminate this
Agreement where any person with a five (5) percent or greater direct or indirect ownership interest in
the CONTRACTOR(S) did not submit timely and accurate information and cooperate with any
screening method required in CFR, Title 42, Section 455.416. Submissions shall be scanned portable
document format (pdf) copies and are to be sent via email to DBHAdministration@fresnocountyca.gov,
Attention: Contracts Administration. COUNTY may deny enrollment or terminate this Agreement where
any person with a five (5) percent or greater direct or indirect ownership interest in CONTRACTOR(S)
has been convicted of a criminal offense related to that person’s involvement with the Medicare,
Medicaid, or Title XXI program in the last ten (10) years.
35. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR(S) is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR(S)”):
A. Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1) Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or
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contract under a public transaction;
2) Violation of a federal or state antitrust statute;
3) Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4) False statements or receipt of stolen property.
B. Within a three (3) year period preceding their Agreement award, they have had
a public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR(S)
from further business consideration. The information will be considered as part of the determination
of whether to continue and/or renew the Agreement and any additional information or explanation
that a CONTRACTOR(S) elects to submit with the disclosed information will be considered. If it is
later determined that the CONTRACTOR(S) failed to disclose required information, any contract
awarded to such CONTRACTOR(S) may be immediately voided and terminated for material failure to
comply with the terms and conditions of the award.
CONTRACTOR(S) must sign a “Certification Regarding Debarment, Suspension, and
Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit L, attached
hereto and by this reference incorporated herein and made part of this Agreement. Additionally,
CONTRACTOR(S) must immediately advise the COUNTY in writing if, during the term of this
Agreement: (1) CONTRACTOR(S) becomes suspended, debarred, excluded or ineligible for
participation in federal or state funded programs or from receiving Federal funds as listed in the
excluded parties’ list system (http://www.epls.gov); or (2) any of the above listed conditions become
applicable to CONTRACTOR(S). CONTRACTOR(S) shall indemnify, defend and hold the COUNTY
harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other
matter listed in the signed Certification Regarding Debarment, Suspension, and Other Responsibility
Matters.
36. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR(S) is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR(S)
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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(S) is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR(S) is a party 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 M
and incorporated herein by reference and made part of this Agreement, and submitting it to the
COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
37.AUDITS AND INSPECTIONS
CONTRACTOR(S) shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. CONTRACTOR(S) shall, upon request by
the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR(S)’ compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor General for a
period of three (3) years after final payment under contract (California Government Code section
8546.7).
38.NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR(S)
Director, Fresno County SEE EXHIBIT A
Department of Behavioral Health
3133 N. Millbrook Ave.
Fresno, CA 93703
All notices between the COUNTY and CONTRACTOR(S) 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
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notice delivered by personal service is effective upon service to the recipient. A notice delivered by
first-class United States mail is effective three (3) 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 (1) 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).
39.SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by a
court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions shall
remain in full force and effect, and shall in no way be affected, impaired or invalidated.
40.SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among the individual CONTRACTORS. By execution of this Agreement,
CONTRACTOR(S) understand that a separate Agreement is formed between each individual
CONTRACTOR and COUNTY.
41.GOVERNING LAW
The parties agree that for the purpose of venue, performance under this Agreement is 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.
42.ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between
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CONTRACTOR(S) 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.
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CONTRACTOR
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21 Fresno, CA 9720
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Phone No.: (559) 256-0100
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COUNTY OF FRESNO
Fresno, CA
Exhibit A
YOUTH EMPOWERMENT CENTER SERVICES
LIST OF CONTRACTOR(S)
1.Kings View Behavioral Health
7170 N. Financial Drive, Suite 110
Fresno, CA 93720
(559)256-4474
Contact: Mayra Fuentes, Program Coordinator
2.Live Again Fresno
916 E. Belmont Avenue
Fresno, CA 93701
(559)294-1390
Contact: Richard Burrell, Executive Director
EXHIBIT B
Page 1 of 7
Mental Health Services Act (MHSA)
Youth Empowerment Centers
SUMMARY OF SERVICES
PROVIDERS: Kings View Behavioral Health
7170 N. Financial Drive, Suite 110
Fresno, CA 93720
Live Again Fresno
916 E Belmont Avenue
Fresno, CA 93701
CONTRACT TERM: FY 2019 – 2020
FY 2020 – 2021
BACKGROUND:
The Youth Empowerment Centers Program will provide wellness and recovery support services
to children and youth with mental illness and their family members and support system.
CONTRACTOR will provide services to youth and transitional-age youth (TAY) at least three (3)
days a week, with a minimum of two (2) hours per meeting of direct services to provide support
groups to this population.
TARGET POPULATION:
The target population is children and youth (ages 10-13), and adolescents (ages 14-17)
attending school in Fresno County including the unserved and underserved cultural, ethnic, and
linguistic communities. Children and adolescents will participate in peer support driven wellness
and recovery activities through education, socialization, life-skills building, and recreational
activities.
The Program will also serve the transition age youth (TAY) population (ages 16-24) through
mentorship, teaching useful life skills as well as resiliency strategies, and preparation for
sustained employment. CONTRACTORS will collaborate with foster agencies’ aging out youth
to provide outreach and engagement in services. In addition, CONTRACTOR will reduce
barriers to success for TAY individuals by linkage to age appropriate housing, access to
transportation, and provide for basic other needs so that youth can focus on education and job
readiness.
EXHIBIT B
Page 2 of 7
LOCATION OF SERVICES:
Youth Empowerment Centers (YEC) may be co-located with other agencies and organizations
targeted to reach the unserved and underserved children, youth, and adolescent populations in
Fresno County. The services provided to this population offer wellness and recovery activities
that include, but are not limited to education, socialization, life-skills training, and other peer
support activities.
Youth Empowerment Centers will take place at off-site locations that are approved by the
County that may be a school or appropriate natural community setting and not necessarily a
mental health facility. Sites will be determined based on community need, availability of the
meeting space, and willingness of the school or community center to allow youth to participate.
Mobile services, such as a food delivery service to homeless youth, may be utilized in order to
reach youth in various settings that may not have immediate access to resources. Operators of
services shall be trained appropriately to communicate with and serve the youth and TAY
populations.
DESCRIPTION OF SERVICES:
Peer Support Groups
Activities at each Center will consist of the following, but not limited to:
• Facilitated peer directed groups, with mental health themes like depression, self-esteem,
anger management, healthy life styles etc.
• Curriculum classes to both youth and families such as parenting classes, anger
management, self-esteem etc.
• One-to-one support to youth
• If necessary, referrals to mental health resources for critical, Serious Emotional
Disturbance (SED) or Serious Mental Illness (SMI) children and youth
• Develop and foster mentor relationships between older teens and younger individuals
• Develop sports, arts/crafts, music, and other appropriate activities at all sites to draw
youth in, particularly high school teenagers
• Ensure that culturally specific approaches and activities are incorporated into the Youth
Empowerment Center
• Collaboration with other community groups to provide specialized activities at the
centers aimed at increasing participation and penetration
• Explore need for youth literacy classes at each center, implement as appropriate
Services at these sites may also include topics such as: bullying, interpersonal skills, anger
management, self-esteem, relationships, Wellness Recovery Action Plan (WRAP),
accountability, positive behavior, dealing with pressure, peer pressure, leadership, eating
EXHIBIT B
Page 3 of 7
disorders, empowerment, suicide prevention, outreach and engagement, stigma reduction, etc.;
encouraged by positive self-reporting, client satisfaction report, engagement and participation,
and other relevant youth topics. The Strengthening Families Program educational groups shall
be available for family members of children and adolescents in the Youth Empowerment
Centers.
Youth Council
Youth Empowerment Centers will design and implement a Youth Council representative of the
populations served that will serve to provide input and direction to YEC programming and
outcomes. The Youth Council will meet quarterly or more frequently as necessary. Sign-in
sheets and meeting minutes shall be available to COUNTY upon request. This will give youth
participants a voice in the decision-making process and operations at YEC, such as the types of
activities and groups.
Transition Age Youth (16-24) Service Provision
The YEC Program shall include a wellness and recovery program plan to specifically address
transition age youth (ages 16-24.) A minimum of 200 TAY individuals will participate in
prevention/wellness and recovery activities.
STAFFING
The staffing plan for Youth Empowerment Centers should be clear and concise and allow for full
implementation of all program components. Program components of Youth Empowerment
Centers require the consultation or staffing of a Licensed Mental Health Clinician to provide
oversight to the program. Any changes in staffing volume must be requested in writing and
approved by DBH Director or designee before implementation.
Position titles do not fully define lived experienced as peer or family; a "peer position" is
reflective of lived experience. It is expected that services shall be provided by peer support
specialists and volunteers. All volunteers will participate in a volunteer training program prior to
volunteer service commencing. Staffing patterns should allow for staff specialization in services
to the different age groups and families to be served.
EXPECTED OUTCOMES:
Performance Measurements/Outcomes Reports shall be completed and submitted to the
designated DBH staff member as requested and shall be approved by DBH. The performance
measurement/ outcome process will not be limited to survey instruments but will also include, as
appropriate, client and staff interviews, and other methods of obtaining needed information.
Monthly outcomes to be tracked for annual report include but are not limited to:
EXHIBIT B
Page 4 of 7
• Effectiveness of program
• Efficiency
• Access and timeliness
• Satisfaction of services from individuals served
Youth Empowerment Reporting/Outcomes
• A minimum of 2,400 (duplicated) youth will participate per year
• A minimum of 300 completed satisfaction surveys per quarter will be collected with
350 surveys being distributed
• A minimum of 20 mental health presentations, servicing 150 youth
• Involvement/participation in YEC activities will improve by 50% based on the pre/post
involvement survey
• 350 unique youth and families will be served
• 350 one to one contacts will be made
• 400 peer support groups will be provided
PROGRAM GOALS
Prevention
• Increase access to care
• Increase access to linkages for services
• Reduce Stress/Anxiety and other systems
• Improvement in participant wellness and recovery
• Reduce ED utilization/visits for mental health services
• Reduce the number of individuals in crisis
• Reduce the number of hospitalization
• Reduce criminal justice involvement
• Reduce new criminal justice involvement
• Reduce the loss of placement/removal from the home
• Increase opportunities for peers to provide services/Increase Peer involvement
• To provide services in culturally responsive manner
Outreach for Recognition of Early Signs of Mental Illness
• Increase awareness of mental health, wellness and recovery
• Increase opportunities for peers to provide services/Increase Peer involvement
• Increase opportunities for those with lived experience to provide services.
• Increase recognition of early signs of a serious mental illness
• Reduce stigma
• Improve understanding of mental illness
EXHIBIT B
Page 5 of 7
• Improve attitudes towards mental illness
• To provide services in culturally responsive manner
• Increase access to early mental health services
Youth and Adolescents
• Seventy percent (70%) of youth and adolescents 10-18 years will report feeling more
hopeful and happier due to interaction with YEC staff and peers at the time quarterly
satisfaction surveys are completed.
• Fifty (50%) of youth and adolescents 10-18 years will demonstrate an understanding
of the Wellness and Recovery Action Plan (WRAP) model within 3 months of joining
YEC by indicating so on the quarterly satisfaction survey.
Transitional Age Youth (TAY)
• Seventy-five (75%) of TAY consumers will be engaged in learning job readiness
skills at Centers and at collaborating agencies in the community to be measured in a
quarterly satisfaction survey.
• Seventy-five percent (75%) of TAY will verbalize an understanding and utilization of
WRAP skills in their own life and be able to mentor others to be measured in a
quarterly satisfaction survey.
COUNTY RESPONSIBILITIES
1. DBH MHSA Coordinator or designee shall assist the contractor in making linkages
with the total mental health system. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
2. DBH MHSA Coordinator or designee shall participate in evaluating the progress of
the overall program and the efficiency and will be available to the contractor for
ongoing consultation.
3. DBH MHSA Coordinator or designee will gather outcome information from target
consumer groups and CONTRACTOR throughout the term of contract. DBH MHSA
Coordinator or designee will notify CONTRACTOR when its participation is required.
The performance outcome measurement process will not be limited to survey
instruments but will also include, as appropriate, consumer and staff interviews, chart
reviews, and other methods of obtaining required information.
4. The County Department of Behavioral Health (DBH), Mental Health Services Act
Coordinator or designee will provide oversight of services funded through MHSA
Prevention and Early Intervention (PEI) funding and collaborate with contactor(s) and
other County Departments and community agencies to help achieve State program
EXHIBIT B
Page 6 of 7
goals and outcomes. In addition to contract monitoring of program(s), oversight
includes, but is not limited to, coordination with the State Department of Mental
Health in regard to program administration and outcomes.
CONTRACTOR RESPONSIBILITIES
1. CONTRACTOR will maintain facilities and equipment, and operate continuously with
the number and classification of staff required for the provision of services.
2. CONTRACTOR must have a location that is accessible by public transportation and
approved by COUNTY.
3. CONTRACTOR will be required to comply with all State regulations regarding State
Performance Outcomes measurement requirements, and participate in the outcomes
measurement process as required by the County and applicable funding sources.
4. CONTRACTOR will participate in performance outcomes throughout the term of the
contract. DBH MHSA Coordinator or designee will notify CONTRACTOR when its
participation is required. The performance outcome measurement process will not
be limited to survey instruments but will also include, as appropriate, consumer and
staff interviews, chart reviews, and other methods of obtaining needed information,
as outlined in the Mental Health Services Act (MHSA) Prevention and Early
Intervention (PEI) Plan.
5. CONTRACTOR’s staff will possess appropriate licenses and certificates and be
qualified in accordance with applicable statutes and regulations. CONTRACTOR will
obtain, maintain and comply with all necessary government authorizations, permits
and licenses required to conduct its operations. In addition, the CONTRACTOR’s
will comply with all applicable Federal, State and local laws, rules, regulations and
orders in its operations including compliance with all applicable safety and health
requirements as to the CONTRACTOR’s employees.
6. CONTRACTOR shall log all complaints and the disposition of all complaints from a
consumer or a consumer’s family. CONTRACTOR shall provide a summary of the
complaint log entries concerning County-sponsored consumers to County at monthly
intervals, by the tenth (10th) fifteenth (15th) day of the following month, in a format
that is mutually agreed upon. CONTRACTOR shall post signs, provided by the
County, informing consumers of their right to file a grievance and appeal.
CONTRACTOR will abide by the Fresno County Mental Health Plan (MHP)
grievance process (Exhibit F) and notify County of all incidents reportable to state
licensing bodies that affect County consumers within twenty-four (24) hours of
receipt of a complaint. CONTRACTOR shall use existing County Department
Incident Report form (Exhibit G) and submit to County a copy of the Incident Report
EXHIBIT B
Page 7 of 7
within 24 hours. Within fifteen (15) days after each incident or complaint affecting
County-sponsored consumers, CONTRACTOR shall provide County with the
complaint and CONTRACTOR’s disposition of, or corrective action taken to resolve
the complaint or incident.
7. CONTRACTOR shall provide a monthly staff work schedule to DBH MHSA
Coordinator or designee.
8. CONTRACTOR shall maintain a service log in collaboration with DBH staff that
reports type of activity/services attended, number of one-to-one peer support
contacts, and number of crisis contacts per month by consumer. This information will
be provided to the DBH Director or designee in a monthly report submitted with the
monthly invoice or as requested by DBH.
9. CONTRACTOR shall provide work schedules, cultural competency training, and
demographic ethnic information as required by the COUNTY.
10. CONTRACTOR shall arrange activities for consumers and provide supplies for such
activities. A schedule of activities and the number of participants will be included in
the monthly reports and submitted to the COUNTY.
11. CONTRACTOR shall attend a provider meeting hosted by DBH monthly or at
intervals determined by DBH.
Page 1 of 6
T&Y
FTE %
TAY & YEC
Admin TAY & YEC Total
PERSONNEL SALARIES:
0001 Executive Director/Regional Director 0.01 3,345 3,345 $6,690
0002 Clinical Supervisor 0.01 3,510 $3,510
0003 Program Manager 0.25 18,274 $18,274
0004 Program Coordinator 1.00 60,829 $60,829
0005 Intake & Support Coordinator
0006 Actvities Coordinator
0007 Volunteer Coordinator
0008 Case Manager I
0009 Vocational Services Coordinator
0010 Parent Partners (TAY/YEC)1.80 78,362 $78,362
0011 Parent Partners (TAY/YEC)3.88 152,589 $152,589
0012 Peer Support Specialists (Blue Sky)
0013 Administrative Specialist II 0.25 $10,950 $10,950
SALARY TOTAL 7.20 $331,204
PAYROLL TAXES:
0031 FICA/MEDICARE 1,094 24,244 $25,338
0032 SUI 172 3,803 $3,975
0033 Workers Compensation 286 6,338 $6,624
PAYROLL TAX TOTAL $35,937
EMPLOYEE BENEFITS:
0041 Retirement 143 3,169 $3,312
0042 Health Insurance (medical, vision, life, dental)2,144 47,536 $49,680
EMPLOYEE BENEFITS TOTAL $52,992
SALARY & BENEFITS GRAND TOTAL $420,133
$331,204
$35,937
$52,992
$420,133
TAY & YEC RFP #962-5377
Kings View Corporation
FISCAL YEAR 2019 - 2020
Budget Categories -
Line Item Description (Must be itemized)
Page 2 of 6
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building 29,540 $29,540
1030 Rent/Lease Equipment 1,936 $1,936
1050 Utilities 3,000 $3,000
1051 Janitorial/Building & Grounds Maintenance 2,629 $2,629
FACILITY/EQUIPMENT TOTAL $37,105 $37,105
OPERATING EXPENSES:
1060 Telephone 600 $600
1062 Postage 20 $20
1063 Printing & Reproduction 500 $500
1066 Office Supplies & Equipment 2,450 $2,450
1067 Household Supplies 200 $200
1068 Food 3,400 $3,400
1069 Program Supplies - Support Groups $0
1069.1Program Supplies - Activities 2,400 $2,400
1069.2Program Supplies - Vocational 250 $250
1069.3Program Supplies - TAY/YEC 5,000 $5,000
1072 Staff Mileage/vehicle maintenance 4,000 $4,000
1074 Staff Training/Registration 2,000 $2,000
1076 Other - Vehicle Leasing 10,092 $10,092
1077 Other - Miscellaneous 500 $500
1078 Staff Recruitment 500 $500
1079 Communication: cell phone, data lines 4,340 $4,340
OPERATING EXPENSES TOTAL $36,252 $36,252
TotalTAY/YEC
Page 3 of 6
FINANCIAL SERVICES EXPENSES:
1082 Liability Insurance 7,925 $7,925
1083 Other - Professional Liability 3,700 $3,700
1084 Other - Administrative Overhead 36,288 $36,288
FINANCIAL SERVICES TOTAL $47,913 $47,913
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant - Network & Data Management 7,843 $7,843
1091 Translation Services 500 $500
SPECIAL EXPENSES TOTAL $8,343 $8,343
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
1192.4Transportation Assistance $0
1192.7Client Vouchers $0
NON MEDI-CAL CLIENT SUPPORT TOTAL $0 $0
FIXED ASSETS:
2000 Computers & Software 3,218 $3,218
2001 Furniture & Fixtures 500 $500
2002 Equipment 1,000 $1,000
FIXED ASSETS TOTAL $4,718 $4,718
$554,464 $554,464
100.00%
MHSA FUNDS:
5100 MHSA PEI Funds 554,464 $554,464
$554,464 $554,464
#REF!
TAY/YEC Total
Page 4 of 6
T&Y
FTE %
TAY & YEC
Admin TAY & YEC Total
PERSONNEL SALARIES:
0001 Executive Director/Regional Director 0.01 3,480 3,480 $6,960
0002 Clinical Supervisor 0.01 3,650 $3,650
0003 Program Manager 0.25 19,005 $19,005
0004 Program Coordinator 1.00 63,252 $63,252
0005 Intake & Support Coordinator
0006 Actvities Coordinator
0007 Volunteer Coordinator
0008 Case Manager I
0009 Vocational Services Coordinator
0010 Parent Partners (TAY/YEC)1.80 80,430 $80,430
0011 Parent Partners (TAY/YEC)3.88 152,589 $152,589
0012 Peer Support Specialists (Blue Sky)
0013 Administrative Specialist II 0.25 $11,387 $11,387
SALARY TOTAL 7.20 $337,273
PAYROLL TAXES:
0031 FICA/MEDICARE 1,137 24,664 $25,801
0032 SUI 178 3,869 $4,047
0033 Workers Compensation 297 6,448 $6,745
PAYROLL TAX TOTAL $36,593
EMPLOYEE BENEFITS:
0041 Retirement 149 3,224 $3,373
0042 Health Insurance (medical, vision, life, dental)2,230 48,361 $50,591
EMPLOYEE BENEFITS TOTAL $53,964
SALARY & BENEFITS GRAND TOTAL $427,830
$337,273
$36,593
$53,964
$427,830
TAY & YEC RFP #962-5377
Kings View Corporation
Fiscal Year 2020 - 2021
Budget Categories -
Line Item Description (Must be itemized)
Page 5 of 6
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building 30,417 $30,417
1030 Rent/Lease Equipment 2,500 $2,500
1050 Utilities 5,000 $5,000
1051 Janitorial/Building & Grounds Maintenance 4,000 $4,000
FACILITY/EQUIPMENT TOTAL $41,917 $41,917
OPERATING EXPENSES:
1060 Telephone 800 $800
1062 Postage 100 $100
1063 Printing & Reproduction 500 $500
1066 Office Supplies & Equipment 3,600 $3,600
1067 Household Supplies 400 $400
1068 Food 3,600 $3,600
1069 Program Supplies - Support Groups $0
1069.1Program Supplies - Activities 2,600 $2,600
1069.2Program Supplies - Vocational 350 $350
1069.3Program Supplies - TAY/YEC 5,500 $5,500
1072 Staff Mileage/vehicle maintenance 4,300 $4,300
1074 Staff Training/Registration 2,500 $2,500
1076 Other - Vehicle Leasing 11,500 $11,500
1077 Other - Miscellaneous 600 $600
1078 Staff Recruitment 600 $600
1079 Communication: cell phone, data lines 4,600 $4,600
OPERATING EXPENSES TOTAL $41,550 $41,550
TotalTAY/YEC
Page 6 of 6
FINANCIAL SERVICES EXPENSES:
1082 Liability Insurance 8,500 $8,500
1083 Other - Professional Liability 3,800 $3,800
1084 Other - Administrative Overhead 38,469 $38,469
FINANCIAL SERVICES TOTAL $50,769 $50,769
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant - Network & Data Management 8,162 $8,162
1091 Translation Services 600 $600
SPECIAL EXPENSES TOTAL $8,762 $8,762
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
1192.4Transportation Assistance $0
1192.7Client Vouchers $0
NON MEDI-CAL CLIENT SUPPORT TOTAL $0 $0
FIXED ASSETS:
2000 Computers & Software 4,400 $4,400
2001 Furniture & Fixtures 500 $500
2002 Equipment 1,500 $1,500
FIXED ASSETS TOTAL $6,400 $6,400
$577,228 $577,228
100.00%
MHSA FUNDS:
5100 MHSA PEI Funds 577,228 $577,228
$577,228 $577,228
#REF!
TAY/YEC Total
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
($xxx,xxx.xx)
Facilities/Equipment Expenses – Line Items 1010-1014
($xxx,xxx.xx)
Operating Expenses - Line Items 1060-1077
($xxx,xxx.xx)
Financial Services Expenses – Line Items 1080-1085
($xxx,xxx.xx)
Special Expenses – Line Items 1090-1092
($xxx,xxx.xx)
Fixed Assets – Line Items 1190-1193
($xxx,xxx.xx)
Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
($xxx,xxx.xx)
TOTAL PROGRAM EXPENSE:($X,XXX,XXX.XX)
YOUTH EMPOWERMENT CENTERS (YEC) PROGRAM
LIVE AGAIN FRESNO
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are
administrative or direct service. Employee benefits should be limited to a maximum of 20% of total
salaries.
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach copy of
lease agreements if available.
Identify and detail the expenses for each item utilized for program.
Local and corporate administrative costs are limited to 15% of the total program budget. Copies of
insurance policies are required.
Detail each line item in Special Expenses.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain
purchases under said amount such as camera, televisions, VCRs/DVDs and other sensitive items,
made during the life of the Agreement resulting from this Request for Proposal, with funds paid
pursuant to this Agreement and that will outlive the life of this Agreement.
Detail any anticipated expenditures for clients.
Exhibit C-2
1
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Director of Development 0.50 $30,000
0002 Program Manager 100.00 $48,000
0003 Parent Partner ($15/hr)0.50 $74,304
0004 Executive Director 0.25 $15,000
0005 Youth Mentors (Volunteer)0.00 $0
0006 Parent Partner Mentor (Volunteer)0.00 $0
0007 Activity Leaders (Volunteer)0.00 $0
0008 Consultation with LCSW 0.03 $300
0009 Title 0.00 $0
0010 Title 0.00 $0
0011 Title 0.00 $0
0012 Title 0.00 $0
SALARY TOTAL 101.28 $0 $0 $167,604
PAYROLL TAXES:
0030 OASDI $14,700
0031 FICA/MEDICARE $3,400
0032 SUI $4,500
PAYROLL TAX TOTAL $0 $0 $22,600
EMPLOYEE BENEFITS:
0040 Retirement $0
0041 Workers Compensation $5,000
0042 Health Insurance (medical, vision, life, dental)$0
EMPLOYEE BENEFITS TOTAL $0 $0 $5,000
SALARY & BENEFITS GRAND TOTAL $195,204
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $30,000
1011 Rent/Lease Equipment $0
1012 Utilities $7,200
1013 Building Maintenance $2,400
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $39,600
OPERATING EXPENSES:
1060 Telephone $1,800
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
YOUTH EMPOWERMENT CENTERS (YEC) PROGRAM
LIVE AGAIN FRESNO
FY 2019-2020 (JULY 1, 2019 - JUNE 30, 2020)
Budget Categories - Total Proposed Budget
Exhibit C-2
2
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $3,000
1067 Household Supplies $1,200
1068 Food $0
1069 Program Supplies - Therapeutic $12,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $9,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $12,000
1075 Lodging $0
1076 Other - (Identify)$0
1077 Other - (Identify)$0
OPERATING EXPENSES TOTAL $39,000
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $3,600
1083 Administrative Overhead $0
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $3,600
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$15,000
1091 Translation Services $0
1092 Medication Supports $0
SPECIAL EXPENSES TOTAL $15,000
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$0
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$0
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
Exhibit C-2
3
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $0
TOTAL PROGRAM EXPENSES $292,404
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Collateral 0 $0.00 $0
3500 Plan Development 0 $0.00 $0
3600 Assessment 0 $0.00 $0
3700 Rehabilitation 0 $0.00 $0
Estimated Specialty Mental Health Services Billing Totals 0 $0
Estimated % of Clients that are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $0
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 0.00%$0
State M/Cal Share of Cost % (BH Realignment/EPSDT) 0.00%$0
MEDI-CAL REVENUE TOTAL $0
OTHER REVENUE:
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $292,404
5100 Community Services & Supports (CSS) Funds $0
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $292,404
TOTAL PROGRAM REVENUE $292,404
Budget Check $584,808
Exhibit C-2
4
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Director of Development 0.50 $30,000
0002 Program Manager 1.00 $48,000
0003 Executive Director 0.25 $15,000
0004 Parent Partner ($15/hr)0.50 $84,304
0005 Activity Leaders (Volunteer)0.00 $0
0006 Youth Mentors (Volunteer)0.00 $0
0007 Parent Partner Mentor (Volunteer)0.00 $0
0008 Consultant with LCSW 0.03 $300
0009 Title 0.00 $0
0010 Title 0.00 $0
0011 Title 0.00 $0
0012 Title 0.00 $0
SALARY TOTAL 2.28 $0 $0 $177,604
PAYROLL TAXES:
0030 OASDI $14,700
0031 FICA/MEDICARE $3,400
0032 SUI $4,500
PAYROLL TAX TOTAL $0 $0 $22,600
EMPLOYEE BENEFITS:
0040 Retirement $0
0041 Workers Compensation $5,000
0042 Health Insurance (medical, vision, life, dental)$0
EMPLOYEE BENEFITS TOTAL $0 $0 $5,000
SALARY & BENEFITS GRAND TOTAL $205,204
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $37,200
1011 Rent/Lease Equipment $0
1012 Utilities $9,500
1013 Building Maintenance $2,900
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $49,600
Line Item Description (Must be itemized)
YOUTH EMPOWERMENT CENTERS (YEC) PROGRAM
LIVE AGAIN FRESNO
FY 2020-2021 (JULY 1, 2020 - JUNE 30, 2021)
Budget Categories - Total Proposed Budget
Exhibit C-2
5
OPERATING EXPENSES:
1060 Telephone $1,800
1061 Answering Service $0
1062 Postage $0
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $3,000
1067 Household Supplies $1,200
1068 Food $0
1069 Program Supplies - Therapeutic $12,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $9,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $12,000
1075 Lodging $0
1076 Other - (Identify)$0
1077 Other - (Identify)$0
OPERATING EXPENSES TOTAL $39,000
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $3,600
1083 Administrative Overhead $0
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $3,600
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$15,000
1091 Translation Services $0
1092 Medication Supports $0
SPECIAL EXPENSES TOTAL $15,000
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
Exhibit C-2
6
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$0
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$0
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $0
TOTAL PROGRAM EXPENSES $312,404
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Collateral 0 $0.00 $0
3500 Plan Development 0 $0.00 $0
3600 Assessment 0 $0.00 $0
3700 Rehabilitation 0 $0.00 $0
Estimated Specialty Mental Health Services Billing Totals 0 $0
Estimated % of Clients that are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $0
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 0.00%$0
State M/Cal Share of Cost % (BH Realignment/EPSDT) 0.00%$0
MEDI-CAL REVENUE TOTAL $0
OTHER REVENUE:
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $312,404
5100 Community Services & Supports (CSS) Funds $0
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $312,404
TOTAL PROGRAM REVENUE $312,404
Exhibit D
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor’s employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County’s Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit D
Page 2 of 3
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person
making a report. Any person engaging in any form of retaliation will be subject to disciplinary
or other appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit D
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
EXHIBIT E
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. 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 42, Code
of Federal Regulations sections 2.1 et seq; 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.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. 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.
EXHIBIT E
Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
c. Every employee who works on this Agreement will:
1) receive a copy of the company's drug -free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
EXHIBIT E
Page 3 of 6
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and CONTRACTOR may be
ineligible for award of any future State agreements if the department determines that any
of the following has occurred: the CONTRACTOR has made false certification, or
violated the certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR’s failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm’s offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
EXHIBIT E
Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
Industrial Relations, or the Department of Justice to determine the contractor’s
compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
EXHIBIT E
Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3) finally determined to be in violation of provisions of federal law
relating to air or water pollution.
EXHIBIT E
Page 6 of 6
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
Exhibit F
Page 1 of 2
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers’ offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit F
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process – the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider’s claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints – if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
Exhibit G
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit G
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
Exhibit H
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
Exhibit I
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
Exhibit I
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
Exhibit I
6. Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
Exhibit I
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit J
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) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses 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 under “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 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 ADDRESS PROVIDER NUMBER
Exhibit J
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
Exhibit K
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and CONTRACTOR
related to the provision of Family Advocacy Services, require that the undersigned report
all known or suspected child abuse or neglect to one or more of the agencies set forth in
Penal Code (PC) section (§) 11165.9.
For purposes of the undersigned’s child abuse reporting requirements, “child
abuse or neglect” includes physical injury inflicted by other than accidental means upon
a child by another person, sexual abuse as defined in PC §11165.1, neglect as defined
in PC §11165.2, willful cruelty or unjustifiable punishment as defined in PC §11165.3,
and unlawful corporal punishment or injury as defined in PC §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the
victim of child abuse or neglect. (PC §11166.) The child abuse report shall be made to
any police department or sheriff’s department (not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Social Services’ 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a “reasonable suspicion” means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child
does not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse.
(PC §11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
SIGNATURE _____________________________ DATE ______________________
Exhibit K
Page 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 K
Page 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 L
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 L
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: