HomeMy WebLinkAboutAgreement A-14-101-3 with Dr. Guzzetta.pdf1
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Agreement No . 14-101-3
AMENDMENT III TO AGREEMENT
THIS AMENDMENTIII to AGREEMENT is made and entered into this 18th day of
-~J=un=e~-' 2019 , by and between the COUNTY OF FRESNO, a political subdivision of the State of
California, hereinafter referred to as "COUNTY", and RICHARD GUZZETTA, M.D., d.b.a.
TOUCHSTONE MEDICAL GROUP , a sole proprietorship, and whose remit to address is 724 Medical
Drive East , Suite I 06 , Clovis, CA 93611 , hereinafter referred to as "CONTRACTOR" (collectively the
"parties").
WHEREAS , the parties entered into that certain Agreement, identified as COUNTY Agreement No.
14-10 I effective July I, 2014 , as amended by Amendment I, effective September 23 , 2014 , and Amendment
II , effective June 20 , 20 I 7, (hereinafter collectively referred to as the Agreement); whereby CONTRACTOR
agreed to provide Physician services for the Department of Behavioral Health (DBH), Substance Use
Disorder (SUD) Services Pathway s to Recovery Program ; and
WHEREAS , the parties desire to amend the Agreement, regarding changes as stated below and
restate the Agreement in its entirety.
NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
hereinafter set forth, the sufficiency of which is acknowledged , the parties agree to as follows:
I . That the portion of Section One (I), SERVICES~ of existing COUNTY Agreement No. 14-
101-2, as set forth in the original Agreement beginning on Page One(!), Line Nineteen (19), with the
number "I " and ending on Page One (I), Line Twenty-Eight (28), with the word "Agreement" be deleted
and the following inserted in its place :
"I. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities
identified in Exhibit A and Exhibit A-1 , Summary of Services, attached hereto and by this reference
24 incorporated herein.
25 B. CONTRACTOR shall provide all services at COUNTY owned and operated
26 facility , located at 515 South Cedar Avenue , Fresno, CA 93702.
27 C . CONTRACTOR shall comply with the requirements stated in the
28 Intergovernmental Agreement as listed in Exhibit B, SAPT Specific Requirements, attached hereto and by
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this reference incorporated herein.
D.CONTRACTOR shall be licensed to practice medicine in the State of
California, be Board Certified in Addiction Medicine and must maintain such licensure and certification
throughout each term of this Agreement, further described in Section Twenty-Two (22) of this Agreement.”
2.That the portion of Section Two (2), TERM, of existing COUNTY Agreement No. 14-101-2,
as set forth in the original Agreement beginning on Page Two (2), Line One (1), with the number “2” and
ending on Page Two (2), Line Six (6), with the word ”term” shall be deleted and the following inserted in its
place:
“2. TERM
This Agreement shall become effective July 1 2014 and shall terminate on June 30,
2017. Thereafter, this Agreement shall renew for a maximum of two (2) additional l2 month periods, unless
written notice of non-renewal is given by either CONTRACTOR or COUNTY or COUNTY's Department of
Behavioral Health Director or her designee, at least 30 days prior to the end of the then current term. The
term of this Agreement shall be extended for one (1) additional twelve (12) month period, commencing on
July 1, 2019 and ending on June 30, 2020.”
3.That the portion of Section Three (3), TERMINATION, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Two (2), Line Seven (7), with the
number “3” and ending on page Two (2), Line Twenty-Eight (8), with the word “terminate” be deleted and
the following inserted in its place:
“3. TERMINATION
A.Non-Allocation of Funds – The terms of this Agreement, and the services to
be provided hereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) 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 COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
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3)A substantially incorrect or incomplete report submitted to COUNTY; or
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 CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach or
default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of any
funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not
expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly refund any such
funds upon demand, or upon COUNTY's option, such repayments shall be deducted from future payments
owing to CONTRACTOR under this Agreement.
C.Without Cause – Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an
intention to terminate to CONTRACTOR.
D.Voluntary Termination of Intergovernmental Agreement - The COUNTY
may terminate its Agreement with DHCS at any time, for any reason, by giving sixty (60) days written notice
to DHCS. In the event the Intergovernmental Agreement is terminated, COUNTY may terminate this
contractor agreement. CONTRACTOR shall be paid for services provided to beneficiaries up to the date of
termination.”
4.That the portion of Section Four (4), COMPENSATION, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Three (3), Line One (1), with the
number “4” and ending on page Four (4), Line Twenty-Three (23), with the word “compensation” be deleted
and the following inserted in its place:
“4. COMPENSATION
A.COMPENSATION – or actual services provided at Pathways, further
described in Revised Exhibit A, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to
receive compensation at the rate of Six Hundred Thirty and No/100 Dollars ($630.00) per half-day (4 hours)
or proration thereof at half-hour intervals. In no event shall the fiscal year compensation paid to
CONTRACTOR by COUNTY exceed Ninety-Eight Thousand Seven Hundred and 00/100 Dollars
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($98,700). In no event shall the maximum compensation paid to CONTRACTOR by COUNTY exceed Four
Hundred Ninety-Three Thousand Five Hundred and 00/100 Dollars ($493,500.00) for the term of this
Agreement, July 1, 2014 through June 30, 2017 with two (2) automatic 12-month extensions. The
compensation for the extension term of this contract as described above in Section Two (2) Term shall be at
the same rate as described in this section, ($630.00) per half-day (4 hours) or proration thereof at half-hour
intervals. In no event shall the maximum compensation paid to the CONTRACTOR by COUNTY exceed
Ninety-Eight Thousand Seven Hundred and 00/100 Dollars ($98,700) for the contract extension year of
fiscal year 2019 - 20. CONTRACTOR's invoices, further described in Section Five (5), INVOICING, of the
original Agreement, shall reflect actual services rendered by CONTRACTOR pursuant to the terms and
conditions of this Agreement.
1) The contract maximum amount as identified in this Agreement may
be reduced based upon State, Federal, and local funding availability. In the event of such action, the
COUNTY’s DBH Director or her designee shall notify the CONTRACTOR in writing of the reduction in
the maximum amount within thirty (30) day
In the event that funding for these services is delayed by the State Controller,
COUNTY may defer payment to CONTRACTOR. The amount of the deferred payment shall not exceed the
amount of funding delayed by the State Controller to the COUNTY. 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.
In addition, if the State of California does not allocate funding for services described in the terms and
conditions of this Agreement, DBH-SUD Services shall not be obligated to reimburse CONTRACTOR for
services performed.
B. PAYMENTS – Regardless of the contract maximum, CONTRACTOR shall
be reimbursed only for hours worked up to but not exceeding the contract maximum for each fiscal year.
1) Payments by COUNTY shall be in arrears, based on
CONTRACTOR’s monthly signed timesheet, showing the dates and the hours worked, submitted for
services provided during the preceding month, within forty-five (45) days after receipt and verification of
CONTRACTOR’s monthly invoices by COUNTY’s DBH, Contracts Division – SUD Services. Any
compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
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Agreement and Amendments shall automatically revert to COUNTY.
2)CONTRACTOR must accept, as payment in full, the amounts paid by
County. CONTRACTOR may not demand any additional payment from DHCS, client, or other third party
payers.
C.COMPLIANCE – If CONTRACTOR should fail to comply with any
provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
CONTRACTOR’s and COUNTY’s obligations under this section shall survive the termination of this
Agreement with respect to services provided during the term of this Agreement without regard to the cause
of termination of this Agreement.
D.PUBLIC INFORMATION – CONTRACTOR shall disclose its funding
source in all public information; however, this requirement of disclosure of funding source shall not be
required in spot radio or television advertising.
E.LOBBYING ACTIVITY – CONTRACTOR shall not directly or indirectly
use any of the funds provided under this Agreement for publicity, lobbying, or propaganda purposes
designed to support or defeat legislation pending before the Congress of the United States or the Legislature
of the State of California.
F.POLITICAL ACTIVITY - CONTRACTOR shall not directly or indirectly
use any of the funds under this Agreement for any political activity or to further the election or defeat of any
candidate for public office.”
5.That the portion of Section Five (5), INVOICING, of existing COUNTY Agreement No. 14-
101-2, as set forth in the original Agreement beginning on page Four (4), Line Twenty-Four (24), with the
number “5” and ending on page Five (5), Line Eighteen (18), with the word “received” be deleted and the
following inserted in its place:
“5. INVOICING
A.CONTRACTOR shall invoice COUNTY by the twentieth (20th) of each
month for actual services rendered in the previous month in accordance with the established rates in
Amendment III, Section 4(A), COMPENSATION, above. Invoices shall be submitted via e-mail to the
assigned staff analyst and to SAS@fresnocountyca.gov.
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If an invoice is incorrect or is otherwise not in proper form or substance,
COUNTY's DBH Director or her designee shall have the right to withhold payment as to only that portion of
the invoice that is incorrect or improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR
agrees to continue to provide services for a period of ninety (90) days after notification of an incorrect or
improper invoice. If after said ninety (90) day period said invoice(s) is still not corrected to COUNTY'S
DBH Director's or her designee's satisfaction, COUNTY'S DBH, Director or her designee may elect to
terminate this Agreement, pursuant to the termination provisions stated in Section Three (3),
TERMINATION, of this Agreement. In addition, CONTRACTOR shall submit all invoices to COUNTY's
DBH Director or her designee for services provided within ninety (90) days after eac h twelve (12) month
period expires or this Agreement is terminated. If invoices are not submitted within ninety (90) days after
each twelve (12) month period expires or this Agreement is terminated, COUNTY's DBH Director or her
designee shall have the right to deny payment on such invoices.”
6.That the portion of Section Seven (7), MODIFICATION, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Six (6), Line Eleven (11), with the
number “7” and ending on page Six (6), Line Twenty-Six (26), with the word “compensation” be deleted and
the following inserted in its place:
“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 Section One (1), SERVICES, as needed to
accommodate changes in State and Federal Law relating to SUD treatment may be made with the signed
written approval of COUNTY’s DBH Director or her designee and respective CONTRACTOR(S) through
an amendment approved by County Counsel and Auditor.”
7.That the portion of Section Eight (8), NON-ASSIGNMENT, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Six (6), Line Twenty-
Seven (27), with the number “8” and ending on page Seven (7), Line One (1), with the word “party” be
deleted and the following inserted in its place:
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“8. NON-ASSIGNMENT / SUBCONTRACTS
Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
CONTRACTOR shall be required to assume full responsibility for all services and
activities covered by this Agreement, whether or not CONTRACTOR is providing services directly. Further,
CONTRACTOR shall be the sole point of contact with regard to contractual matters, including payment of
any and all charges resulting from this Agreement.
If CONTRACTOR should propose to subcontract with one or more third parties to
carry out a portion of services covered by this Agreement, any such subcontract shall be in writing and
approved as to form and content by COUNTY’s DBH Director or her designee prior to execution and
implementation. COUNTY’s DBH Director or her designee shall have the right to reject any such proposed
subcontract. Any such subcontract together with all activities by or caused by CONTRACTOR shall not
require compensation greater than the total budget contained herein. An executed copy of any such
subcontract shall be received by COUNTY before any implementation and shall be retained by COUNTY.
CONTRACTOR shall be responsible to COUNTY for the proper performance of any subcontract. Any
subcontractor shall be subject to the same terms and conditions that CONTRACTOR is subject to under this
Agreement.
If CONTRACTOR hires an independent contract physician, CONTRACTOR shall
require and ensure that such independent contract physician carries Professional Liability (Medical
Malpractice) Insurance, with limits of not less than One Million Dollars ($1,000,000.00) per occurrence,
Three Million Dollars ($3,000,000.00) annual aggregate.”
8.That the portion of Section Nine (9), HOLD-HARMLESS, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Seven (7), Line Two (2), with the
number “9” and ending on page Seven (7), Line Nine (9), with the word “Agreement” be deleted and the
following inserted in its place:
“9. HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S
request, defend the COUNTY, its officers, agents, and employees from any and all costs an d expenses
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(including attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
agents, or employees under this Agreement, and from any and all costs and expenses (including attorney’s
fees and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance, or failure to perform, of CONTRACTOR,
its officers, agents, or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal, and State of California
audit exceptions resulting from noncompliance herein on the part of the CONTRACTOR.”
9.That the portion of Section Ten (10), INSURANCE, of existing COUNTY Agreement No.
14-101-2, as set forth in the original Agreement beginning on page Seven (7), Line Ten (10), with the
number “10” and ending on page Nine (9), Line Four (4) with the word “better” be deleted and the following
inserted in its place:
“10. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from
CONTRACTOR or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and
effect, the following insurance policies or a program of self-insurance, including but not limited to, an
insurance pooling arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two
Million Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars
($4,000,000.00). This policy shall be issued on a per occurrence basis. COUNTY may require specific
coverages including completed operations, products liability, contractual liability, Explosion-Collapse-
Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of this
contract.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
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C.Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D.Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the
California Labor Code.
E.Molestation
Sexual abuse / molestation liability insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This
policy shall be issued on a per occurrence basis.
F.Cyber Liability
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is
undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims involving
infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade
dress, invasion of privacy violations, information theft, damage to or destruction of electronic information,
release of private information, alteration of electronic information, extortion and network security. The policy
shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit
monitoring expenses with limits sufficient to respond to these obligations.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage for
additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by
COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance provided
under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without a minimum
of thirty (30) days advance written notice given to COUNTY.
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CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents,
and employees any amounts paid by the policy of worker’s compensation insurance required by this Agreement.
CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be necessary to
accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under this paragraph is
effective whether or not CONTRACTOR obtains such an endorsement.
Within thirty (30) days from the date CONTRACTOR signs and executes this
Agreement, CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of
the foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of
Behavioral Health, Contracts Division – SUD Services at 3133 N Millbrook Avenue, Fresno, California, 93703,
stating that such insurance coverages have been obtained and are in full force; that the County of Fresno, its
officers, agents and employees will not be responsible for any premiums on the policies; that for such worker’s
compensation insurance the CONTRACTOR has waived its right to recover from the COUNTY, its officers,
agents, and employees any amounts paid under the insurance policy and that waiver does not invalidate the
insurance policy; 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 fails to keep in effect at all times insurance coverage as
herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of
California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of
A FSC VII or better.”
10. That the portion of Section Eleven (11), HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT, of existing COUNTY Agreement No. 14-101-2, as set forth in the original
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Agreement beginning on page Nine (9), Line Five (5), with the number “11” and ending on page Seventeen
(17), Line Four (4), with the word “occasion” be deleted and the following inserted in its place:
“11. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of protected health
information between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the
security of Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the
Health Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI, as
set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of
Federal Regulations (CFR).
Additionally, CONTRACTOR shall comply with the HIPAA requirements stated in
Exhibit C, “SAPT Specific Requirements”.”
11.That the portion of Section Twelve (12), DATA SECURITY, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Seventeen (17), Line Five
(5), with the number “12” and ending on page Seventeen (17), Line Twenty-Seven (27), with the word
“drive” be deleted and the following inserted in its place:
“12. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent
access, viewing, use or disclosure of COUNTY data including sensitive or personal beneficiary information;
abuse of COUNTY resources; and/or disruption to county operations, individuals and/or agencies that enter
into a contractual relationship with the COUNTY for the purpose of providing services under this agreement
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must employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by the COUNTY, including but not limited to the following:
A.CONTRACTOR-OWNED MOBILE, WIRELESS, OR HANDHELD
DEVICES
CONTRACTOR may not connect to COUNTY networks via personally
owned mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled; and
4)A secure connection is used.
B.CONTRACTOR-OWNED COMPUTERS OR COMPUTER PERIPHERALS
CONTRACTOR may not bring CONTRACTOR-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and transferred
by means of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data
must be encrypted.
C.COUNTY-OWNED COMPUTER EQUIPMENT
CONTRACTOR or anyone having an employment relationship with the
COUNTY may not use COUNTY computers or computer peripherals on non-COUNTY premises without
prior authorization from the COUNTY’s Chief Information Officer, and/or designee(s).
D.CONTRACTOR may not store COUNTY’s private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access, viewing,
use or disclosure of data maintained in computer files, program documentation, data processing systems, data
files and data processing equipment which stores or processes COUNTY data internally and externally.
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F.Confidential beneficiary information transmitted to one party by the other by
means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G.CONTRACTOR is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information, data
maintained in computer files, program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to CONTRACTOR’s response to all
incidents arising from a possible breach of security related to COUNTY’s confidential beneficiary
information provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to
affected individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR will be responsible for all costs incurred as a result of providing the required notification.”
12.That the portion of Section Fourteen (14), COMPLAINTS, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Eighteen (18), Line Twenty-Three
(23), with the number “14” and ending on page Nineteen (19), Line Six (6), with the word “complaint” be
deleted and the following inserted in its place:
“14. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a
beneficiary or a beneficiary's family. CONTRACTOR shall provide a summary of the complaint log entries
concerning COUNTY-sponsored beneficiaries to COUNTY at monthly intervals by the fifteenth (15th) day
of the following month, in a format that is mutually agreed upon. CONTRACTOR shall post signs informing
beneficiary of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all
incidents reportable to state licensing bodies that affect COUNTY beneficiaries within twenty-four (24)
hours of receipt of a complaint.
Within fifteen (15) days after each incident or complaint affecting COUNTY-
sponsored beneficiaries, CONTRACTOR 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.”
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13.That the portion of Section Sixteen (16), COMPLIANCE WITH LAWS AND POLICIES, of
existing COUNTY Agreement No. 14-101-2, as set forth in Amendment II beginning on page One (1), Line
Nineteen (19), with the number “16” and ending on page Two (2), Line Twelve (12), with the word
“Agreement” be deleted and the following inserted in its place:
“16. COMPLIANCE WITH LAWS, POLICIES AND RULES
CONTRACTOR shall comply with all applicable rules and regulations set forth in
CCR Titles 9 and 22, and California Health and Safety Code § 11750 et seq., with the exception of
regulations waived by the Centers for Medicare and Medicaid Services and DHCS, as stated w ithin the
DMC-Organized Delivery System (ODS) Special Terms and Conditions (STCs) and the DMC
Intergovernmental Agreement. CONTRACTOR shall comply with any other Federal and State laws or
guidelines applicable to CONTRACTOR’s performance under this Agreement or any local ordinances,
regulations, or policies applicable. Such provisions include, but are not restricted to:
A.CONTRACTOR shall comply with 42 CFR Part 438.
B.CONTRACTOR shall comply with Early and Periodic Screening, Diagnostic
and Treatment (EPSDT) statutes and regulations.
C.CONTRACTOR shall furnish beneficiary records in accordance with the
applicable Federal, State and local regulations and requirements, including in such records a treatment plan
for each beneficiary, and evidence of each service rendered.
D.CONTRACTOR shall submit accurate, complete and timely claims and cost
reports, reporting only allowable costs.
E.CONTRACTOR shall comply with statistical reporting and program
evaluation systems as provided in State of California regulations and in this Agreement.
F.CONTRACTOR shall comply with requirements contained in the
Intergovernmental Agreement as listed in Exhibit B, SAPT Specific Requirements, attached hereto and by
this reference incorporated herein, until such time that a new Intergovernmental Agreement is established.
Upon amendment of the Intergovernmental Agreement, the terms of the amended Contract shall
automatically be incorporated into this Agreement.
G.CONTRACTOR shall inform every beneficiary of their rights regarding
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Grievance and Appeals as described in the Provider Manual, attached hereto and by this reference
incorporated.
H.In the event any law, regulation, or policy referred to in this Agreement is
amended during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment. Exhibits will be updated as needed and no formal amendment of this
contract is required for new rules to apply.”
14.That the portion of Section Eighteen (18), DRUG-FREE WORKPLACE, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty (20),
Line Twenty-One (21), with the number “18” and ending on page Twenty (20), Line Twenty-Three (23),
with the number “8350” be deleted and the following inserted in its place:
“18. [RESERVED]”
15.That the portion of Section Nineteen (19), FEDERAL CERTIFICATION, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty (20),
Line Twenty-Four (24), with the number “19” and ending on page Twenty-One (21), Line Twenty-Six (26),
with the word “into” be deleted and the following inserted in its place:
“19. [RESERVED]”
16.That the portion of Section Twenty (20), ENERGY EFFICIENCY, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-One (21), Line
Twenty-Seven (27), with the number “20” and ending on page Twenty-Two (22), Line Two (2), with the
number “163” be deleted and the following inserted in its place:
“20. [RESERVED]”
17.That the portion of Section Twenty-One (21), REFERENCES TO LAWS AND RULES, of
existing COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page
Twenty-Two (22), Line Three (3), with the number “21” and ending on page Twenty-Two (22), Line Six
(6), with the word “amendment” be deleted and the following inserted in its place:
“21. [RESERVED]”
18.That the portion of Section Twenty-Two (22), LICENSING/CERTIFICATES, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Two
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(22), Line Seven (7), with the number “22” and ending on page Twenty-Two (22), Line Eighteen (18), with
the word “changed” be deleted and the following inserted in its place:
“22. LICENSING-CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s
staff shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
for the provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any appeal
related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all applicable
laws, rules or regulations, as may now exist or be hereafter changed.”
19.That the portion of Section Twenty-Three (23), CHILD ABUSE REPORTING, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Two
(22), Line Nineteen (19), with the number “23” and ending on page Twenty-Two (22), Line Twenty-Seven
(27), with the word “herein” be deleted and the following inserted in its place:
“23. CHILD ABUSE REPORTING
CONTRACTOR shall utilize a procedure acceptable to the COUNTY to ensure that
all of CONTRACTOR’s employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement shall report all known or suspected child abuse or neglect to one or more of the
agencies set forth in Penal Code §11165.9. This procedure shall include having all of CONTRACTOR’s
employees, volunteers, consultants, subcontractors or agents performing services under this Agreement sign
a statement that he or she knows of and will comply with the reporting requirements set forth in Penal Code
§11166. The statement to be utilized by CONTRACTOR for reporting is set forth in Exhibit B, “Notice of
Child Abuse Reporting,” attached hereto and by this reference incorporated herein.”
20.That the portion of Section Twenty-Four (24), CHARITABLE CHOICE, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Three
(23), Line One (1), with the number “24” and ending on page Twenty-Three (23), Line Fifteen (15) with the
word “objection” be deleted and the following inserted in its place:
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“24. [RESERVED]”
21.That the portion of Section Twenty-Five (25), EVALUATION AND MONITORING, of
existing COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page
Twenty-Three (23), Line Sixteen (16), with the number “25” and ending on page Twenty-Three (23), Line
Twenty-Six (26), with the word “review” be deleted and the following inserted in its place:
“25. EVALUATION – MONITORING
CONTRACTOR shall participate in a review of the program at least yearly or more
frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
information requested by the COUNTY, DHCS, and/or the subcontractor during the progra m evaluation,
monitoring, and/or review.
COUNTY’s DBH Director, or her designee, and DHCS or their designees shall
monitor and evaluate the performance of CONTRACTOR under this Agreement to determine to the best
possible degree the success or failure of the services provided under this Agreement. At the discretion of the
COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and monitor the
performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of the program as
needed, at the discretion of COUNTY.
COUNTY shall recapture from CONTRACTOR the value of any services or other
expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the discretion
of the COUNTY, CONTRACTOR shall enter into a repayment agreement with the COUNTY, with total
monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to recover
the amount of funds to be recouped. The monthly repayment amounts shall be netted against th e
CONTRACTOR’s monthly billing for services rendered during the month. COUNTY reserves the right to
forgo a repayment agreement and recoup all funds immediately.”
22.That the portion of Section Twenty-Six (26), CULTURAL COMPETENCY, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Three
(23), Line Twenty-Seven (27), with the number “26” and ending on page Twenty-Five (25), Line Five (5),
with the word “accordingly” be deleted and the following inserted in its place:
///
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“26. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply
with:
A.Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d,
and 45 CFR Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to e qual
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 beneficiaries, including, but not limited to, assessing
the cultural and linguistic needs of its beneficiaries, training of staff on the policies and procedures, and
monitoring its language assistance program. The CONTRACTOR’s procedures must include ensuring
compliance of any sub-contracted providers with these requirements.
C.CONTRACTOR assurances that minors shall not be used as interpreters.
D.CONTRACTOR shall provide and pay for interpreting and translation
services to persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services shall be
provided as necessary to allow such participants meaningful access to the programs, services and benefits
provided by CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR’s
“vital documents” (those documents that contain information that is critical for accessing CONTRACTOR’s
services or are required by law) shall be provided to participants at no cost to the participant.
CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
translate for a program participant, or who directly communicate with a program participa nt in a language
other than English, demonstrate proficiency in the participant's language and can effectively communicate
any specialized terms and concepts peculiar to CONTRACTOR’s services.
E.In compliance with the State mandated Culturally and Linguistically
Appropriate Services standards as published by the Office of Minority Health, CONTRACTOR must submit
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to COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR’s plan to address
all fifteen national cultural competency standards as set forth in the “National Standards on Culturally and
Linguistically Appropriate Services” (CLAS), attached hereto as Exhibit N, and incorporated herein by this
reference. County’s annual on-site review of CONTRACTOR shall include collection of documentation to
ensure all national standards are implemented. As the national competency standards are updated,
CONTRACTOR’s plan must be updated accordingly.”
23.That the portion of Section Twenty-Seven (27), NON-DISCRIMINATION, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Five
(25), Line Six (6), with the number “27” and ending on page Twenty-Six (26), Line Seventeen (17), with the
word “disabled” be deleted and the following inserted in its place:
“27. NON-DISCRIMINATION PROVISION
ELIGIBILITY FOR SERVICES – CONTRACTOR shall prepare, prominently post
in its facility, and make available to the DBH Director or her designee and to the public all eligibility
requirements to participate in the program funded under this Agreement. CONTRACTOR shall not
unlawfully discriminate in the provision of services because of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical conditi on, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military or veteran status as provided
by State of California and Federal law in accordance with Title VI of the Civil Rights Act of 1964 (42 USC §
2000(d)); Age Discrimination Act of 1975 (42 USC §1681); Rehabilitation Act of 1973 (29 USC §794);
Education Amendments of 1972 (20 USC §1681); Americans with Disabilities Act of 1990 (42 USC §
12132); 45 CFR, Part 84; provisions of the Fair Employment and Housing Act (California Government Code
§12900); and regulations promulgated thereunder (CCR Title 2, §7285.0); Title 2, Division 3, Article 9.5 of
the California Government Code commencing with section 11135; and CCR Title 9, Division 4, Chapter 6
commencing with section 10800.
A.EQUAL OPPORTUNITY – CONTRACTOR shall comply with California
Government Code, §2990 and CCR Title 2, Division 4, Chapter 5, in matters related to the development,
implementation, and maintenance of a nondiscrimination program. CONTRACTOR shall not discriminate
against any employee or applicant for employment because race, religious creed, color, national origin,
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ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military or veteran status. Such
practices include retirement, recruitment, advertising, hiring, layoff, termination, upgrading, demotion,
transfer, rates of pay or other forms of compensation, use of facilities, and other terms and conditions of
employment. CONTRACTOR agrees to post in conspicuous places, notices available to all employees and
applicants for employment setting forth the provisions of the Equal Opportunity Act (42 USC §2000(e)) in
conformance with Federal Executive Order No. 11246. CONTRACTOR agrees to comply with the
provisions of the Rehabilitation Act of 1973 (29 USC §794).
B.SUSPENSION OF COMPENSATION – If an allegation of discrimination
occurs, DBH may withhold all further funds, until CONTRACTOR can show by clear and convincing
evidence to the satisfaction of DBH that funds provided under this Agreement were not used in connection
with the alleged discrimination.
C.NEPOTISM – Except by consent of the DBH Director or her 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.
D.NEW FACILITIES AND DISABILITY ACCESS – New facilities shall be
wheelchair accessible and provide access to the disabled, consistent with CCR Title 9, §10820. If a new
facility will be utilized, a plan ensuring accessibility to the disabled must be developed. DBH shall assess,
monitor, and document CONTRACTOR’s compliance with the Rehabilitation Act of 1973 and Americans
with Disabilities Act of 1990 to ensure that recipients/beneficiaries and intended recipients/beneficiaries of
services are provided services without regard to physical or mental disability and that CONTRACTOR has
provided a facility accessible to the physically disabled.”
24.That the portion of Section Twenty-Eight (28), TAX EQUITY AND FISCAL
RESPONSIBILITY ACT, of existing COUNTY Agreement No. 14-101-2, as set forth in the original
Agreement beginning on page Twenty-Six (26), Line Eighteen (18), with the number“28” and ending on
page Twenty-Seven (27), Line Seven (7), with the word “costs” be deleted and the following inserted in its
place:
///
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“28. [RESERVED]”
25.That the portion of Section Twenty-Nine (29), RECORDS, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Seven (27), Line Eight (8),
with the number “29” and ending on page Twenty-Eight (28), Line Sixteen (16), with the number “51009”
be deleted and the following inserted in its place:
“29. RECORDS
A.RECORD ESTABLISHMENT AND MAINTENANCE – CONTRACTOR
shall establish and maintain records in accordance with State and Federal rules and regulations in addition to
those requirements prescribed by COUNTY with respect to all matters covered by this Agreement. Except as
otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period of ten (10)
years from the finalized cost settlement process, or from the date of completion of any audit, whichever is
later.
B.DOCUMENTATION – CONTRACTOR shall maintain adequate records in
sufficient detail to make possible an evaluation of services, and contain all the data necessary in reporting to
the State of California and/or Federal agency. All client records shall be maintained pursuant to applicable
State of California and Federal requirements concerning confidentiality.
C.REPORTS – CONTRACTOR shall submit to COUNTY monthly fiscal and
all program reports as further described in Section Thirty (30), REPORTS. CONTRACTOR shall submit a
complete and accurate year-end cost report for each fiscal year affected by this Agreement, following the end
of each fiscal year affected by this Agreement. CONTRACTOR shall also furnish to COUNTY such
statements, records, reports, data, and information as COUNTY may request pertaining to matters covered by
this Agreement. All reports submitted by CONTRACTOR to COUNTY must be typewritten.
D.SUSPENSION OF COMPENSATION – In the event that CONTRACTOR
fails to provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to
withhold payments until there is compliance.
E.CLIENT CONFIDENTIALITY – CONTRACTOR shall conform to and
COUNTY shall monitor compliance with all State and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information requirements of 42 CFR §2.1 et
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seq., Welfare and Institutions Code §§5328, 10850 and 14100.2, Health and Safety Code §§11977 and
11812, Civil Code, Division 1, Part 2.6, and CCR Title 22 §51009.”
26.That the portion of Section Thirty-One (31), PROPERTY OF COUNTY, of existing
COUNTY Agreement No. 14-101-2, as set forth in the Amendment I beginning on page Two (2), Line
Seven (7), with the number “31” and ending on page Three (3), Line Thirteen (13), with the number “(45)”
be deleted and the following inserted in its place:
“31. PROPERTY OF COUNTY
A.CONTRACTOR shall submit purchase invoices for the purchase of any fixed
assets with their monthly invoices. All purchases over Five Thousand and No/100 Dollars ($5,000.00), and
certain purchases under Five Thousand and No/100 Dollars ($5,000.00) such as fans, calculators, cameras,
VCRs, DVDs and other sensitive items as determined by COUNTY’s DBH Director, or her designee, made
during the life of this Agreement shall be identified as assets that can be inventoried and maintained in
COUNTY’s DBH Asset Inventory System. These assets shall be retained by COUNTY, as COUNTY
property, in the event this Agreement is terminated or upon expiration of this Agreement. CONTRACTOR
agrees to participate in an annual inventory of all COUNTY fixed assets and shall be physically present
when fixed assets are returned to COUNTY’s possession at the termination or expiration of this Agreement.
CONTRACTOR is responsible for returning to COUNTY all COUNTY owned fixed assets, or the monetary
value of said fixed assets if unable to produce the fixed assets at the expiration or termination of this
Agreement.
B.The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH Director or her designee, 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 Director or her designee may refuse
reimbursement for any costs resulting from equipment purchased, which are incurred by CONTRACTOR, if
prior written approval has not been obtained from COUNTY.
C.The terms and conditions described in this Section are not applicable to the
leasing of vehicles by CONTRACTOR with the funds provided under this Agreement.”
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27.That the portion of Section Thirty-Two (32), PROHIBITION ON PUBLICITY, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Nine
(29), Line Eleven (11), with the number “32” and ending on page Twenty-Nine (29), Line Nineteen (19),
with the word “expense(s)” be deleted and the following inserted in its place:
“32. PROHIBITION ON PUBLICITY
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), SERVICES, of this
Agreement shall be allowed as necessary to raise public awareness about the availability of such specific
services when approved in advance by the DBH Director or her designee, and at a cost to be provided for
such items as written/printed materials, the use of media (i.e., radio, television, newspapers) and any other
related expense(s).”
28.That the portion of Section Thirty-Three (33), AUDITS AND INSPECTIONS, of existing
COUNTY Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Twenty-Nine
(29), Line Twenty (20), with the number “33” and ending on page Thirty (30), Line Eight (8), with the word
“penalties” be deleted and the following inserted in its place:
“33. AUDITS AND INSPECTIONS
The CONTRACTOR 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. The CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all of electronic or print books and records as well as
inspection of the premises, physical facilities and equipment where Medicaid -related activities are conducted
to ensure CONTRACTOR'S compliance with the terms of this Agreement.
The refusal of CONTRACTOR to permit access to, and inspection of, electronic or
print books and records, physical facilities, and/or refusal to permit interviews with employees, as described
in this part, constitutes an express and immediate material breach of this Agreement a nd will be sufficient
basis to terminate the Agreement for cause or default.
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The right to audit under this section exists for ten (10) years from the final date of the
agreement period or from the date of completion of any audit, whichever is later.
Notwithstanding the provisions stated in Section Two (2), TERM, of this Agreement,
it is acknowledged by the parties hereto that this Agreement shall continue in full force and effect until all
audit procedures and requirements as stated in this Agreement have b een completed to the review and
satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or resulting from any audit
and/or inspections including, but not limited to, actual costs incurred and the payment of any expenditures
disallowed by either COUNTY, State, or Federal governmental entities, including any assessed interest and
penalties.
If CONTRACTOR, through an audit by the STATE or COUNTY, is found to be in
violation of this contract which results in the recoupment of funds paid to CO NTRACTOR, COUNTY may,
upon mutual consent between CONTRACTOR and COUNTY, enter into a repayment agreement with the
CONTRACTOR, with total monthly payments not to exceed twelve (12) months from the date of the
repayment agreement, to recover the amount of funds to be recouped. The monthly repayment amounts shall
be netted against the CONTRACTOR’s monthly billing for services rendered during the month. COUNTY
reserves the right to forgo a repayment agreement and recoup all funds immediately.”
29.That the portion of Section Thirty-Four (34), NOTICES, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Thirty (30), Line Nine (9), with the
number “34” and ending on page Thirty (30), Line Nineteen (19), with the word “party” be deleted and the
following inserted in its place:
“34. NOTICES
The persons and their addresses having authority to give and receive notices under
this Agreement include the following:
COUNTY
Director, Fresno County
Department of Behavioral Health
4441 East Kings Canyon
Fresno, CA 93702
CONTRACTOR
Richard Guzzetta, M.D.
Touchstone Medical Group
724 Medical Drive East, Suite 106
Clovis, CA 93611
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All notices between the COUNTY and CONTRACTOR provided for or permitted
under this Agreement must be in writing and delivered either by personal service, by first -class United States
mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered
by personal service is effective upon service to the recipient. A notice delivered by first -class United States
mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
COUNTY business day after deposit with the overnight commercial courier service, delivery fe es 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).”
30.That the portion of Section Thirty-Five (35), CHANGE OF LEADERSHIP /
MANAGEMENT, of existing COUNTY Agreement No. 14-101-2, as set forth in the original Agreement
beginning on page Thirty (30), Line Twenty (20), with the number “35” and ending on page Thirty (30),
Line Twenty-Six (26), with the word “finances” be deleted and the following inserted in its place:
“35. CHANGE OF LEADERSHIP/MANAGEMENT
Any and all notices between COUNTY and CONTRACTOR(S) provided for or
permitted under this Agreement or by law, shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the United
States Mail, postage prepaid, addressed to such party.
In the event of any change in the status of CONTRACTOR’s leadership or
management, CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the
date of change. Such notification shall include any new leader or manager’s name, address and
qualifications. “Leadership or management” shall include any employee, member, or owner of
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CONTRACTOR who either a) directs individuals providing services pursuant to this Agreement; b)
exercises control over the manner in which services are provided; or c) has authority over CONTRACTOR’s
finances.”
31. That the portion of Section Thirty-Six (36), GOVERNING LAW, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Thirty (30), Line Twenty-
Seven (27), with the number “36” and ending on page Thirty-One (31), Line Three (3), with the word
“California” be deleted and the following inserted in its place:
“36. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in
Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.”
32. That the portion of Section Thirty-Seven (37), DISCLOSURE OF SELF-DEALING
TRANSACTIONS, of existing COUNTY Agreement No. 14-101-2, as set forth in the original Agreement
beginning on page Thirty-One (31), Line Four (4), with the number “37” and ending on page Thirty-One
(31), Line Fourteen (14), with the word “thereafter” be deleted and the following inserted in its place:
“37. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation
(a for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes
its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services under
this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party
and in which one or more of its directors has a material financial interest . Members of the Board of Directors
shall disclose any self-dealing transactions that they are a party to by completing and signing a Self-Dealing
Transaction Disclosure Form, attached hereto as Exhibit D and incorporated herein by reference, and
submitting it to the COUNTY prior to commencing with the self-dealing transaction or immediately
thereafter.”
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33.That the portion of Section Thirty-Eight (38), SUBCONTRACTS, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Thirty-One (31), Line
Fifteen (15), with the number “38” and ending on page Thirty-Two (32), Line Nine (9), with the word
“aggregate” be deleted and the following inserted in its place:
“38. NON-ASSIGNMENT / SUBCONTRACTS
Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
CONTRACTOR shall be required to assume full responsibility for all services and
activities covered by this Agreement, whether or not CONTRACTOR is providing services directly. Further,
CONTRACTOR shall be the sole point of contact with regard to contractual matters, including payment of
any and all charges resulting from this Agreement.
If CONTRACTOR should propose to subcontract with one or more third parties to
carry out a portion of services covered by this Agreement, any such subcontract shall be in writing and
approved as to form and content by COUNTY’s DBH Director or her designee prior to execution and
implementation. COUNTY’s DBH Director or her designee shall have the right to reject any such proposed
subcontract. Any such subcontract together with all activities by or caused by CONTRACTOR shall not
require compensation greater than the total budget contained herein. An executed copy of any such
subcontract shall be received by COUNTY before any implementation and shall be retained by COUNTY.
CONTRACTOR shall be responsible to COUNTY for the proper performance of any subcontract. Any
subcontractor shall be subject to the same terms and conditions that CONTRACTOR is subject to under this
Agreement.
It is expressly recognized that CONTRACTOR cannot engage in the practice of
physical health medicine. If any medical services outside of the scope of the CONTRACTOR’s medical
director are provided in connection with the services under this Agreement, such medical services shall be
performed by an independent contract physician. In this instance, the requirements o f the Confidential
Medical Information Act (Civil Code 56 et seq.) shall be met.
If CONTRACTOR hires an independent contract physician, CONTRACTOR shall
require and ensure that such independent contract physician carries Professional Liability (Medical
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Malpractice) Insurance, with limits of not less than One Million Dollars ($1,000,000.00) per occurrence,
Three Million Dollars ($3,000,000.00) annual aggregate.”
34. That the portion of Section Thirty-Nine (39), STATE ALCOHOL AND DRUG
REQUIREMENTS, of existing COUNTY Agreement No. 14-101-2, as set forth in the original Agreement
beginning on page Thirty-Two (32), Line Ten (10), with the number “39” and ending on page Thirty-Five
(35), Line Four (4), with the word “Agreement” be deleted and the following inserted in its place:
“39. [RESERVED]”
35. That the portion of Section Forty (40), SINGLE AUDIT, of existing COUNTY Agreement
No. 14-101-2, as set forth in the original Agreement beginning on page Thirty-Five (35), Line Five (5), with
the number “40” and ending on page Thirty-Five (35), Line Eighteen (18), with the word “Collector” be
deleted and the following inserted in its place:
“40. SINGLE AUDIT”
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars
($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an
annual audit in accordance with the requirements of the Single Audit Standards as set forth in 2 Code of
Federal Regulations (CFR) Part 200. CONTRACTOR 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 must include a corrective action plan signed by an authorized
individual. CONTRACTOR agrees to take action to correct any mate rial non-compliance or weakness found
as a result of such audit. Such audit shall be delivered to COUNTY’s Department of Behavioral Health,
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. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts
do not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s
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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 to
COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall be
delivered to COUNTY’s Department of Behavioral Health, Business Office for review, no later 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 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 at COUNTY’s cost, as determined by COUNTY’s Auditor-
Controller/Treasurer-Tax Collector.
C.CONTRACTOR shall make available all records and accounts for inspection
by COUNTY, the State of California, if applicable, the Comptroller General of th e United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a minimum of ten
(10) years, in accordance with 42 CFR Part 438.3(h), from the finalized cost settlement process or, if an audit
by the Federal government or DHCS has been started before the expiration of the ten (10) year period,
records shall be maintained until completion of the audit and final resolution of all findings.”
36.That the portion of Section Forty-One (41), ASSURANCES, of existing COUNTY
Agreement No. 14-101-2, as set forth in the original Agreement beginning on page Thirty-Five (35), Line
Nineteen (19), with the number “41” and ending on page Thirty-Eight (38), Line One (1), with the word
“Agreement” be deleted and the following inserted in its place:
“41. ASSURANCES”
In entering into this Agreement, CONTRACTOR certifies that it is not currently
excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs;
that it has not been convicted of a criminal offense related to the provision of health care items or services;
nor has it been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
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for, or involvement with, COUNTY’s business operations related to the Federal Health Care Programs and
shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or the
items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly
or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time as
CONTRACTOR is reinstated into participation in the Federal Health Care Programs. Further the
CONTRACTOR agrees to the Disclosure of Criminal History and Civil Actions and Certification regarding
debarment suspension and other responsibility matters primary covered transactions; CONTRACTOR must
sign an appropriate Certification regarding debarment, suspension, and other responsibility matters, attached
hereto as Exhibit K, incorporated herein by reference and made part of this Agreement.
A.If COUNTY has notice that CONTRACTOR has been charged with a
criminal offense related to any Federal Health Care Program, or is proposed for exclusion during the term on
any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
claims submitted to any Federal Health Care Program. At its discretion given such circumstances, COUNTY
may request that CONTRACTOR cease providing services until resolution of the charges or the proposed
exclusion.
B.CONTRACTOR agrees that all potential new employees of CONTRACTOR
or subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
this Agreement, will be queried as to whether (1) they are now or ever have been excluded, suspe nded,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they have been
convicted of a criminal offense related to the provision of health care items or services; and or (3) they have
been reinstated to participation in the Federal Health Care Programs after a period of exclusion, suspension,
debarment, or ineligibility.
1)In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires or
engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
2)Notwithstanding the above, COUNTY at its discretion may terminate
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this Agreement in accordance with Section Three (3), TERMINATION, of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee
or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to services
provided to COUNTY. Such demand for adequate assurance shall be effective upon a time frame t o be
determined by COUNTY to protect the interests of COUNTY beneficiaries.
C.CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement (1) are not currently excluded, suspended, debarred, or
otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
criminal offense related to the provision of health care items or services; and (3) have not been reinstated to
participation in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs, or
has been convicted of a criminal offense relating to the provision of health care services, CONTRACTOR
will ensure that said employee or subcontractor does no work, either direct or indirect, relating to services
provided to COUNTY.
1)CONTRACTOR agrees to notify COUNTY immediately during the
term of this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
case, is providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating to
the provision of health care services.
2)Notwithstanding the above, COUNTY at its discretion may terminate
this Agreement in accordance with the Section Three (3), TERMINATION, of this Agreement, or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee
or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to services
provided to COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
determined by COUNTY to protect the interests of COUNTY beneficiaries.
D.CONTRACTOR agrees to cooperate fully with any reasonable requests for
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information from COUNTY which may be necessary to complete any internal or external audits relating to
this Agreement.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any
penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
the terms of this Agreement.”
37. That the portion of Section Forty-Two (42), DISCLOSURE OF OWNERSHIP AND/OR
CONTROL INTEREST INFORMATION, of existing COUNTY Agreement No. 14-101-2, as set forth in
the Amendment I beginning on page Three (3), Line Fourteen (14), with the number “42” and ending on
page Three (3), Line Twenty-Five (25), with the word “Administration” be deleted and the following
inserted in its place:
“42. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal
agent, or managed care entity as defined in 42 CFR §455.101 455.104, and 455.106(a)(1),(2).
In accordance with 42 CFR §§455.101, 455.104, 455.105 and 455.106(a)(1),(2), the
following information must be disclosed by CONTRACTOR by completing Exhibit F “Disclosure of
Ownership and Control Interest Statement,” attached hereto and by this reference incorporated herein.
CONTRACTOR shall submit this form to the Department of Behavioral Health within thirty (30) days of the
effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via email to
DBHAdministration@fresnocountyca.gov attention: Contracts Administration.
A. Name and address of any person(s) whether it be an individual or corporation
with an ownership or controlling interest in the disclosing entity or managed care entity.
1) Address must include the primary business address, every business
location and P.O. Box address(es).
2) 2) Date of birth and Social Security Number for individuals.
3) 3) Tax identification number for other corporations or entities with
ownership or controlling interest in the disclosing entity.
B. Any subcontractor(s) in which the disclosing entity has five (5) percent or
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more interest.
C.Whether the person(s) with an ownership or controlling interest of the
disclosing entity is related to another person having ownership or controlling interest as a parent, spouse,
sibling or child. Including whether the person(s) with ownership or controlling interest of the disclosing
entity is related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
interest in any of its subcontractors.
D.Name of any other disclosing entity in which an owner of the disclosing
entity has an ownership or control interest.
E.The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month period
ending on the date of the request; and
F.Any significant business transactions between CONTRACTOR and any
wholly owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
ending on the date of the request.
G.Any person(s) with an ownership or control interest in CONTRACTOR, or
agent or managing employee of CONTRACTOR; and
1)Has been convicted of a criminal offense related to that person's
involvement in any program under Medicare, Medicaid, or the title XX services program since the inception
of those programs.
H.The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month period
ending on the date of the request; and
I.Any significant business transactions between CONTRACTOR and any
wholly owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
ending on the date of the request.”
38.That the portion of Section Forty-Three (43), REPORTING REQUIREMENTS,
COPYRIGHT AND PATENTS, of existing COUNTY Agreement No. 14-101-2, as set forth in the
Amendment I beginning on page Three (3), Line Twenty-Six (26), with the number “43” and ending on page
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Four (4), Line Two (2), with the word “Agreement” be deleted and the following inserted in its place:
“43. [RESERVED]”
39.That the portion of Section Forty-Four (44), SMOKING PROHIBITION REQUIREMENTS,
of existing COUNTY Agreement No. 14-101-2, as set forth in the Amendment I beginning on page Four (4),
Line Three (3), with the number “44” and ending on page Four (4), Line Twelve (12), with the number
“2014” be deleted and the following inserted in its place:
“44. [RESERVED]”
40.That the portion of Section Forty-Five (45), UNLAWFUL USE OF DRUGS AND
ALCOHOL, of existing COUNTY Agreement No. 14-101-2, as set forth in the Amendment II beginning on
page Two (2), Line Eighteen (18), with the number“45” and ending on page Three (3), Line Five (5), with
the word “message” be deleted and the following inserted in its place:
“45. [RESERVED]”
41.That the portion of Section Forty-Six (46), RESTRICTION ON THE DISTRIBUTION OF
STERILE NEEDLES, of existing COUNTY Agreement No. 14-101-2, as set forth in the Amendment II
beginning on page Three (3), Line Six (6), with the number “46” and ending on page Three (3), Line Ten
(10), with the word “users” be deleted and the following inserted in its place:
“46. RESTRICTION ON THE DISTRIBUTION OF STERILE NEEDLES
CONTRACTOR shall adhere to the requirement that no funds shall be used to carry
out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug
unless the DHCS chooses to implement a demonstration syringe services program for intravenous drug
users.”
42.That the portion of Section Forty-Seven (47), TRAFFICKING IN PERSONS PROVISIONS
–PRIVATE ENTITY, of existing COUNTY Agreement No. 14-101-2, as set forth in the Amendment II
beginning on page Three (3), Line Eleven (11), with the number “47” and ending on page Four (4), Line
Seven (7), with the word “traning” be deleted and the following inserted in its place:
“47. [RESERVED]”
43.That the portion of Section Forty-Eight (48), CONFIDENTIALITY OATH, of existing
COUNTY Agreement No. 14-101-2, as set forth in the Amendment II beginning on page Four (4), Line
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Eight (8), with the number “48” and ending on page Four (4), Line Thirteen (13), with the word “agreement”
be deleted and the following inserted in its place:
“48. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any one
provision in the Agreement shall not affect the other provisions.”
44.That effective July 1, 2019, all references in existing COUNTY Agreement No. 14-101-2 to
“Exhibit A” shall be changed to read “Exhibits A and A-1” attached hereto and incorporated herein by
reference.
45.COUNTY and CONTRACTOR agree that this Amendment III is sufficient to amend the
Agreement #14-101, Amendment I, and Amendment II, and, that upon execution of this Amendment, the
Agreement, Amendment I, Amendment II, Amendment III, and all Exhibits and Attachments together shall
be considered the Agreement.
46.The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement and not amended herein shall remain in full
force and effect.
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1 IN WITNESS WHEREOF, the parties hereto h ave executed this Agreement as of the day and year first
2 hereinabove w1itten .
3 ATTEST:
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CONTRACTOR:
To{J ch~tone Medical Grf o
(Au~i~tdi===
e_\ c .-\tf\Q,~ · , J 2::;·:::~"TrA --/\
Print Name & Title
'?J.Jf tA~f> CT'L~~Jf .c «tO b
C Lu J l /4 ( ~ ti-? 6 / <
Mailing Address
FOR ACCOUNTING USE ONLY :
Fund/Subclass: 0001 /10000
ORG No .: 56302096
Account No.: 7295
Requisition No.:
COUNTY OF FRESNO
~ 5<'4:__;>
Nathan Magsig
Chairman of the Board of Supervisors
of the County of Fresno
ATTEST:
Bernice E . Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
36
Exhibit A-1
1
SUMMARY OF SERVICES
CONTRACTOR: Richard Guzzetta, M.D., d.b.a. TOUCHSTONE MEDICAL GROUP
ADDRESS: 724 Medical Center Drive East, Suite 106
SERVICE ADDRESS: 515 South Cedar Avenue, Fresno, CA 93702
SERVICES: Pathways to Recovery Medical Director Services
TERM: July 1, 2019 – June 30, 2020
TERM AMOUNT: $98,700
SUMMARY OF MEDICAL DIRECTOR SERVICES:
The Fresno County Department of Behavioral Health’s Pathways to Recovery Program
(Pathways), is an outpatient drug and alcohol treatment program that is certified to provide
Drug Medi-Cal Perinatal and Non-Perinatal Outpatient Drug Free and intensive outpatient
substance use disorder (SUD) treatment services for women. Pathways also provides mental
health services for both men and women and intensive treatment service for those clients that
have both an SUD and mental health diagnosis.
Services are provided by professional staff, including licensed and unlicensed mental health
clinicians, substance abuse specialists and community mental health specialists. All SUD
medical services provided at the Pathways program are under the direction of CONTRACTOR.
CONTRACTOR will provide regularly scheduled hours and will otherwise be available on-call
during Pathways business hours, further described herein.
Pathways provides the following SUD services:
Substance Use Disorder Treatment: Outpatient and intensive outpatient substance use
disorder treatment program that specializes in the treatment of individuals with substance use
and co-occurring disorders. The program provides a variety of individual and group sessions,
case management, and recovery services.
Pathways is open Monday through Friday 8:00AM to 5:00 PM, with the exception of County-
approved holidays.
For a complete list of County observed holidays, please click the following link:
https://www.co.fresno.ca.us/departments/district-attorney/contacting-district-attorney-s-
office/county-holidays
Exhibit A-1
2
CONTRACTOR DUTIES AND REQUIREMENTS:
CONTRACTOR, as the Pathways Medical Director, shall:
1. Be a physician who is licensed by the Medical Board of California or the Osteopathic
Medical Board of California as described in California Code of Regulations (CCR) Title 22,
Section 51341.1(b)(28) and meet the requirements of the CCR Title 22, Section 51000.70,
be Board-Certified in Addiction Medicine, and maintain such licensure and certification
throughout each term of the Agreement.
a. CCR Title 22, Section 51000.70: Each Substance use disorder clinic shall have
a licensed physician designated as the substance use disorder medical director,
who is an agent of the substance use disorder clinic. The substance use
disorder medical director shall meet the following requirements: (a) Not be
excluded from participation in any State or Federal Medicare or Medicaid
program; (b) Be enrolled in Medi-Cal as a substance use disorder medical
director; and (c) Be acting in compliance with all laws and requirements of the
Medi-Cal program.
2. Assume the responsibility for Pathways SUD and co-occurring clients. This includes (1)
establishing, reviewing and maintaining medical policies and standards; (2) assuring the
quality of medical services given to all patients; (3) performing duties in accordance with all
State of California and Federal rules and regulations, including, but not limited to, CCR Title
22, Section 51341.1: Drug Medi-Cal Substance Abuse Services.
3. Receive a minimum of five (5) hours of continuing medical education in addiction medicine
each year.
4. Be enrolled with the State Department of Health Care Services (DHCS) under applicable
State regulations, screened in accordance with 42 CFR 455.450(a) as a "limited" categorical
risk within a year prior to serving as a Medical Director under this Agreement, and have
signed a Medicaid provider agreement with DHCS as required by 42 CFR 431.107.
5. Follow Pathways Medical Director Code of Conduct.
6. Operate within CONTRACTOR's scope of practice and according to the ethical
standards of his profession.
7. Attend annual DBH Compliance Training.
8. Attend weekly combined SUD and mental health clinical staff meetings to offer consultation
and support Pathways staff.
9. Attend monthly prescribers meetings.
10. Adhere to COUNTY policies, procedures and protocols with regard to the use of equipment
and resources, to include e-mail accounts and internet resources. CONTRACTOR's
use of these, or any other COUNTY resources, shall be strictly limited to the services
contemplated in the entire Agreement.
11. Support and subscribe to DHCS bulletins or guidelines as well as other regulations or
documents that govern the provision of services under the auspices of Pathways
program.
Exhibit A-1
3
12. Maintain regularly scheduled hours and on-call hours during Pathways business hours
(M-F, 8:00AM-5:00 PM excluding County's holidays). Schedule a minimum of two (2) half
days (defined as 4-5 hour per day segments) in the office per week. Participate in Pathways’
activities that include, but are not limited to, medical oversight; clinical staff meetings; and
continuous quality improvement. The regularly scheduled hours may be subject to change
upon mutual agreement between CONTRACTOR and COUNTY's DBH Adult System of
Care Division.
13. Notify Pathways Clinical Supervisors at least 90 days in advance for absences due to
vacation, conferences, etc. so that the Clinical Supervisors can arrange physician coverage.
14. Be available on-call by telephone during business hours for consultations or client care.
15. Consult with the Fresno County Department of Behavioral Health Medical Director as
needed on issues pertaining to County operations.
16. Administer physical examinations or sign waivers based on a review of health
questionnaires and SUD histories for all clients within thirty (30) days of admission to
Pathways as medically necessary.
17. Maintain client records and comply with all State of California and Federal confidentiality
laws.
18. Meet with clients as needed.
19. Review LPHA/counselor’s justifications for admission, continuation of services or
determination to discharge based on: the medical necessity of treatment as determined by
American Society of Addiction Medicine (ASAM) criteria, the client’s prognosis and the
LPHA/counselor’s recommendation.
20. Refer seriously mentally ill psychiatric cases to mental health programs or psychiatry
staff with DBH Metro for further evaluation.
21. Prescribe medication to Pathways’ SUD clients when medically necessary.
In addition to the services described above, provide DBH - Adult System of Care Division with
specialized consultative services. These specialized consultant services included
CONTRACTOR acting as a consultant for projects and programs that require a physician’s
medical perspective regarding program design and target populations, developing patient
placement criteria consistent with the American Society of Addiction Medicine guidelines, and
developing overall policies on patient placement criteria. Specialized consultative services may
also include input regarding the development of academic curricula for California State
University, Fresno graduate students to facilitate local addiction research.
COUNTY RESPONSIBILITIES:
1. COUNTY shall provide electricity, telephone service restricted to the (559) service area,
alarm system, routine janitorial service and security services. These services shall be
commensurate with the level and quality of such services provided to Pathways program
and facility.
Exhibit A-1
4
2. COUNTY shall provide access to office equipment including, but not limited to, e-mail
access and a COUNTY e-mail account, computer, printer and fax that is associated with
daily operations of CONTRACTOR, as determined by COUNTY.