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HomeMy WebLinkAboutAgreement A-24-264 - Amendment I to Master Agreement No. 23-294.pdf Agreement No. 24-264 1 AMENDMENT NO. 1 TO SERVICE AGREEMENT 2 This Amendment No. 1 to Service Agreement ("Amendment No. 1") is dated 3 June 4, 2024 and is between each Contractor listed in Exhibit A-1 "Non-DMC 4 Outpatient Treatment Vendor List,"(each a "Contractor" and collectively as "Contractors"), and 5 the County of Fresno, a political subdivision of the State of California ("County"). 6 Recitals 7 A. County is authorized through its Substance Use Prevention, Treatment and Recovery 8 Services Block Grant (SUBG) Application with the California Department of Health Care 9 Services ("DHCS" or"State") to subcontract for the provision of Outpatient Substance Use 10 Disorder (SUD) treatment services in Fresno County. 11 B. County is authorized to contract with privately operated agencies for the provision of 12 alcohol and other drug treatment services, pursuant to Title 9, Division 4 of the California Code 13 of Regulations and Division 10.5 (commencing with Section 11750) of the California Health and 14 Safety Code. 15 C. Contractors are certified by the State to provide services required by the County. 16 D. On June 20, 2023, the County and the Contractor entered into Non-Drug Medi-Cal 17 (DMC) Outpatient Master Agreement, which is County Agreement No. 23-294 ("Agreement") for 18 the provision of Non- DMC Outpatient Substance Use Disorder treatment services in Fresno 19 County. 20 E. The County and Contractors now desire to amend various subsections of the Agreement 21 to update provider reporting requirements to align with California Advancing and Innovating 22 Medi-Cal (CaIAIM) initiatives and the new Electronic Health Records system; and add 23 Contractor participation requirements for State efforts to improve culturally responsive care 24 delivery. 25 F. The County and Contractors now desire to revise various exhibits, including Exhibit B, to 26 include clarifying language regarding Peer Support training requirements; Exhibit C to include 27 the current Guiding Principles of Care Delivery; and Exhibit J, SUD Non-Drug Medi-Cal 28 1 1 Outpatient Services Rates, to include flat fee rates previously added to the fee schedule through 2 a Department-issued letter dated October 20, 2023. 3 The parties therefore agree as follows: 4 1. All references in the Agreement to "Exhibit A" shall be deemed references to Exhibit A-1. 5 Exhibit A-1 is attached and incorporated by this reference. 6 2. All references in the Agreement to "Exhibit B" shall be deemed references to Exhibit B-1. 7 Exhibit B-I is attached and incorporated by this reference. 8 3. All references in the Agreement to "Exhibit U shall be deemed references to Exhibit C-1. 9 Exhibit C-1 is attached and incorporated by this reference. 10 4. All references in the Agreement to "Exhibit H" shall be deemed references to Exhibit H-I. 11 Exhibit H-1 is attached and incorporated by this reference. 12 5. All references in the Agreement to "Exhibit X shall be deemed references to Exhibit J-1. 13 Exhibit J-1 is attached and incorporated by this reference. 14 6. That a new Section 1.2.1 shall be added to the agreement, located on page 2 beginning 15 on line 1 as follows: 16 "1.2.1 Medi-Cal Eligibility Verification and Enrollment Requirements. Effective July 17 1, 2024, the Contractor shall, prior to admission, verify Medi-Cal eligibility for Persons Served. 18 Persons served who are not enrolled in Medi-Cal must be referred to the Department of Social 19 Services (DSS)for eligibility determination. Person Served must provide the Medi-Cal Notice of 20 Action, or other supporting documentation as approved by DBH, confirming not eligible for 21 Medi-Cal before services can be claimed under this Agreement. If Person Served is determined 22 to be eligible for Medi-Cal then services are provided under the Medi-Cal Agreement. The 23 Contractor must submit the Notice of Action, or other supporting documentation as approved by 24 DBH, to DBH for invoice processing. 25 Contractors that do not follow this requirement will be denied payment for services 26 provided when no Notice of Action is provided." 27 7. That a new Section 1.8.1 shall be added to the agreement, located on page 4, beginning 28 on line 8 as follows: 2 1 1.8.1 Alcohol and Other Drug Certification. County requires Contractors of SUD 2 outpatient treatment programs that offer treatment, recovery, detoxification, or medication for 3 addiction treatment (MAT) services to obtain the California DHCS Alcohol and Other Drug 4 (AOD) Program Certification prior to offering treatment services. In accordance with BHIN 23- 5 058, existing Contractors must submit an Initial Application for Certification by January 1, 2024 6 and obtain certification by January 1, 2025. Contractor shall maintain a current AOD 7 Certification during the term of this Agreement. County shall terminate a Contractor from this 8 Agreement immediately in the event any of the following occurs: 9 A. Contractor fails to submit to the County a copy of the AOD Certification within 10 thirty (30) days after being approved by DHCS, or 11 B. Certification is not maintained throughout the Agreement term." 12 8. That Article 1, Section 1.27 of the Agreement located at Page 11 beginning on line 25 13 through page 15, line 2 is deleted in its entirety and replaced with the following: 14 1.27 Reports. Contractors shall submit all information and data required by County 15 and State in accordance with Exhibit H-1 — Provider Reporting Requirements, incorporated in 16 this Agreement and also available on the DBH webpage at: 17 https://www.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-Provider- 18 Resources/Substance-Use-Disorder-Provider-. Reporting requirements may be revised 19 periodically to reflect changes to State-mandated reporting. Contractors that are not in 20 compliance with reporting deadlines are subject to payment withholding until reporting 21 compliance is achieved. Reporting requirements include, but are not limited to, the following: 22 (A) Drug and Alcohol Treatment Access Report (DATAR) in an electronic format 23 provided by the State and due no later than five (5) days after the preceding month; 24 (B) Ca1OMS Treatment— Submit Ca1OMS treatment admission, discharge, annual 25 update, and "provider activity report" record in an electronic format through County's EHR, and 26 on a schedule as determined by the County which complies with State requirements for data 27 content, data quality, reporting frequency, reporting deadlines, and report method and due no 28 later than five (5) days after the preceding month. All CalOMS admissions, discharges and 3 1 annual updates must be entered into the County's CalOMS system within twenty-four (24) hours 2 of occurrence; 3 (C)ASAM Level of Care (LOC) — Submit ASAM LOC data in a format determined by 4 DBH, on a schedule as determined by the County which complies with State requirements; 5 (D) DMC Outpatient Timeliness and/or DMC Opioid Timeliness— Contractor shall 6 enter access information into County's EHR at time of first contact with person served; 7 (E) Ineligible Person Screening Report— Format provided by County DBH and due 8 by the fifteenth (151h) day of each month to comply with State requirements; 9 (F) LogicManager Incident Reporting —As needed, when incidents occur and as 10 instructed in Exhibit I, Protocol for Completion of Incident Report. 11 (G)Monthly Status Report— Format provided by County DBH and due by the fifteen 12 (15th) day of each month; 13 (H)Wait list— Required by residential providers only and due by the fifteen (15th) day 14 of each month; 15 (1) Grievance Log — Due by the fifteen (151h) day of each month; 16 (J) Missed Appointments —Contractor shall maintain missed appointment 17 information until such time that DBH is able to collect that information in its Electronic Health 18 Record or other database; 19 (K) Cultural Competency Survey— Completed semi-annually in a format to be 20 determined by DBH; 21 (L) Americans with Disabilities (ADA)—Annually, upon request by County DBH, 22 Contractor shall complete an ADA Accessibility Certification and Self-Assessment, including 23 Implementation Plan, for each service location; 24 (M)Culturally and Linguistically Appropriate Services (CLAS) —Annually, upon 25 request by County DBH, Contractor shall complete an agency CLAS survey in a format 26 determined by County DBH and shall submit a CLAS Self-Assessment, including an 27 Implementation Plan; 28 4 1 (N) Risk Assessment—Annually, upon request by County DBH, Contractor shall 2 submit a Risk Assessment on a form and in a format to be provided by DBH. The Assessment 3 must be submitted to the County in hard copy as well as electronically by the due date set by 4 County; 5 (0)Network Adequacy Certification Tool (NACT)—Annually, upon request, 6 Contractor shall submit NACT data as requested by County DBH; 7 (P) DMC ODS 274 Provider Network Data Reporting — Due monthly by the twenty- 8 fifth (2511) day of each month and in a format provided by County DBH. Additionally, Contractors 9 are required to participate in 274 workgroup meetings with potential corrective actions or 10 sanctions, including withholding payment, for non-compliance. 11 (Q)Cost Reports—On an annual basis for each fiscal year ending June 3011 non- 12 DMC Contractor shall submit a complete and accurate detailed cost report. Cost reports must 13 be submitted to the County as a hard copy with a signed cover letter and an electronic copy by 14 the due date. Submittal must also include any requested support documents such as general 15 ledgers and detailed electronic (e.g. Excel) schedules demonstrating how costs were allocated 16 both within programs, if provider has multiple funding sources (e.g. DMC and SUBG), and 17 between programs, if Contractor provides multiple SUD treatment modalities. 18 Contractor shall maintain general ledgers that reflect the original transaction 19 amounts where each entry in their accounting records represents one-hundred percent (100%) 20 of the total transaction cost and can be supported with the original source documentation (i.e. 21 receipts, bills, invoices, payroll registers, etc.). Bank statements reflecting purchases are not 22 original source documents and will not be accepted as such. All costs found to not be supported 23 by original source documentation will be disallowed. Total unallowable costs shall be allocated 24 their percentage share of the indirect Costs along with the Contractor's direct costs. All reports 25 submitted by Contractor to County must be typewritten. 26 County will issue instructions for completion and submittal of the annual cost 27 report, including the relevant cost report template(s) and due dates within forty-five (45) days of 28 each fiscal year end. All cost reports must be prepared in accordance with Generally Accepted 5 1 Accounting Principles. Unallowable costs such as those denoted in 2 CFR 200 Subpart E, Cost 2 Principles, 41 U.S.C. 4304, and the Center for Medicare and Medicaid Studies (CMS) Provider 3 Reimbursement Manual (PRM) 15-1, must not be included as an allowable cost on the cost 4 report and all invoices. Unallowable costs must be kept in the provider's General Ledger in 5 accounts entitled Unallowable followed by name of the account (e.g. Unallowable — Food) or in 6 some other appropriate form of segregation in the provider's accounting records. For further 7 information on unallowable costs refer to regulations provided above. Once the cost reports 8 have been approved by the County, originally-executed signed certification pages attesting to 9 the accuracy of the information contained in cost reports shall be submitted to the County. 10 Contractors with multiple agreements for the same service provided at the same 11 location where at least one of the Agreements is funded through DMC and the other funding is 12 other federal or county realignment funding will be required to complete cost reports for the non- 13 DMC agreement. Such Agreements will be settled for actual allowable costs in accordance with 14 Medicaid reimbursement requirements as specified in Title XIX or Title XXI of the Social 15 Security Act; Title 22, and the State's Medicaid Plan not to exceed the lesser of actual costs or 16 contract maximum. Within forty-five (45) days of the reconciliation by County, Contractor shall 17 make payment to County or County shall reimburse Contractor as appropriate. 18 During the term of this Agreement and thereafter, County and Contractor agree 19 to settle dollar amounts disallowed or settled in accordance with DHCS and County audit 20 settlement findings. 21 In the event that Contractor fails to provide such reports or other information 22 required hereunder, it shall be deemed sufficient cause for the County to withhold monthly 23 payments until there is compliance. In addition, the Contractor shall provide written notification 24 and explanation to the County within fifteen (15) days of any funds received from another 25 source to conduct the same services covered by this Agreement. 26 9. That the following language shall be added to the agreement, located on page 17, 27 beginning on line 14 as follows: 28 6 1 "Contractor must include Notices of Action for all Persons Served claimed under this 2 Non-DMC Agreement. Notices of Action, or other documentation as approved by DBH, must 3 indicate that Person Served does not meet eligibility requirements for Medi-Cal. Contractor will 4 not be reimbursed for services that cannot be supported with documentation of Medi-Cal 5 denial." 6 10. That a new Section 9.1.1 shall be added to the agreement, located on page 32, 7 beginning on line 18 as follows: 8 "9.1.1 Participation Requirements. The Contractor shall participate in the State's 9 efforts to promote the delivery of services in a culturally competent manner to all persons 10 served, including those with limited English proficiency and diverse cultural and ethnic 11 backgrounds, disabilities, and regardless of gender, sexual orientation or gender identity. (42 12 CFR §438.206(c)(2).)" 13 11. When both parties have signed this Amendment No.1, the Agreement, and this 14 Amendment No. 1 together constitute the Agreement. 15 12. The Contractor represents and warrants to the County that: 16 a. The Contractor is duly authorized and empowered to sign and perform its obligations 17 under this Amendment. 18 b. The individual signing this Amendment on behalf of the Contractor is duly authorized 19 to do so and his or her signature on this Amendment legally binds the Contractor to 20 the terms of this Amendment. 21 13. The parties agree that this Amendment may be executed by electronic signature as 22 provided in this section. 23 a. An "electronic signature" means any symbol or process intended by an individual 24 signing this Amendment to represent their signature, including but not limited to (1) a 25 digital signature; (2) a faxed version of an original handwritten signature; or (3) an 26 electronically scanned and transmitted (for example by PDF document) version of an 27 original handwritten signature. 28 7 1 b. Each electronic signature affixed or attached to this Amendment (1) is deemed 2 equivalent to a valid original handwritten signature of the person signing this 3 Amendment for all purposes, including but not limited to evidentiary proof in any 4 administrative or judicial proceeding, and (2) has the same force and effect as the 5 valid original handwritten signature of that person. 6 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5, 7 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 8 2, Title 2.5, beginning with section 1633.1). 9 d. Each party using a digital signature represents that it has undertaken and satisfied 10 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1) 11 through (5), and agrees that each other party may rely upon that representation. 12 e. This Amendment is not conditioned upon the parties conducting the transactions 13 under it by electronic means and either party may sign this Amendment with an 14 original handwritten signature. 15 14. This Amendment may be signed in counterparts, each of which is an original, and all of 16 which together constitute this Amendment. 17 15. The Agreement as amended by this Amendment No. 1 is ratified and continued. All 18 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and 19 effect. 20 [SIGNATURE PAGE FOLLOWS] 21 22 23 24 25 26 27 28 8 1 The parties are signing this Amendment No. [11 on the date stated in the introductory 2 clause. 3 CONTRACTOR COUNTY OFFRESNO 4 SEE FOLLOWING SIGNATURE PAGES 5 � - - 6 Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno 7 Attest: 8 Bernice E. Seidel, Clerk of the Board of Supervisors 9 County of Fresno, State of California 10 By: _ 11 Deputy 12 For accounting use only: 13 Org No.:56302081 Account No.:7295 14 Fund No.:0001 Subclass No.:10000 15 16 17 18 19 20 21 22 23 24 25 26 27 28 9 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: CENTRAL CALIFORNIA RECOVERY, INC. 5 6 Bye{ `�� 7 8 Print Name: C 9 SS 10 Title: Ch rman of the Board, resident, or Vice President 11 12 Date: 13 14 15 B Y_ 16 .-- Print Name: ZItAfz 17 18 Title: .Q /Z 19 Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: �S/ U; 22 23 24 25 26 27 28 10 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: DELTA CARE, INC. 5 6By IFZ� �- 7 8 Print Name: Rk itk 9 10 Title: Chairman of the Board, President, or Vice President 11 12 Date: M 13 14 --- 15 By 16 _ 17 Print Name: 18 Title: �V\ 19 Secretary (ofCorporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: 22 23 24 25 26 27 28 11 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: FRESNO NEW CONNECTION, INC. 5 6 B 7 8 Print Name: �c�Zc in�� K�ti !/c���; 9 10 Title: Chairman of the Board, President, or Vice President 11 12 Date: i 13 14 4-� 15 BY 16 c 17 Print Name 18 Title: �i�'�L� - 19 Secretary Secretary, (of Corporation), Assist nt Sreta , Chief Financial Officer, or Assistant Treasurer 20 21 Date: 22 23 24 25 26 27 28 12 I DocuSign Envelope ID:96CO3AD9-OF3B-4E47-AOAF-7EO6398764DE 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: KINGS VIEW 5 FDocuSigned by: By 7 8 Amanda Nugent Print Name: of vi nP, PhD 9 CEO 10 Title: Chairman of the Board, President, or Vice President 11 12 Date: 5/2/2024 13 14 DocuSigned by: 15 By 16 Michael 17 Print Name: Kag reff 18 CFO Title: 19 Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: 5/2/2024 22 23 24 25 26 27 28 13 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: MENTAL HEALTH SYSTEMS, INC. 5 6 By 241L L Cq11q#hah 7 8 Print Name: James C. Callaghan Jr. 9 10 Title: CEO/President Chairman of the Board, President, or Vice President 11 12 Date: 05/01/24 13 14 15 By David Tanner(�yy, 7D747519 PDT) 16 Print Name: David Tanner 17 18 Title: VP of Corporate Finance 19 Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: 05/01/24 22 23 24 25 26 27 28 14 1 2 3 4 THIS PAGE INTENTIONALLY LEFT BLANK 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 15 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: PRODIGY HEALTHCARE INC. 5 6 By — 7 8 Print Name: a / khC� 9 10 Title: PfC-IIelt, Chairman of t-ie Board, President, or Vice President 11 12 Date: 1Z-0< Zy 13 14 15 By 16 Print Name: ,1_ c1��! /�he*-?E� 17 18 Title: 19 Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: AW2`{ 22 23 24 25 26 27 28 16 1 PROVIDER (GROUP): Promesa Behavioral Health 2 -y 3 By: � - 4 5 Print Name: Michael Der Manouel 6 President 7 Title: _ Chairman of the Board, or 8 President, or any Vice President 9 04/29/24 10 Date: _ 11 12 13 By: — 14 15 Print Name: Erlan Zuniga 16 Title: F 17 Secretary (of Corporation), or any Assistant Secretary, or 18 Chief Financial Officer, or 19 any Assistant Treasurer 20 Date: 04/29/24 21 22 23 24 25 26 27 28 17 COUNTY OF FRESNO Fresno, CA 1 PROVIDER (INDIVIDUAL): Promesa Behavioral Health 3 B 4 5 Print Name: Lisa Welgant 6 C 7 Title: C C O 8 4/29/24 9 Date: _ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 18 COUNTY OF FRESNO Fresno, CA 1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date 2 stated in the introductory clause. 3 4 Provider: WESTCARE CALIFORNIA, INC. 5 6 By 7 8 Print Name: II� v� IV 1--) 9 10 Title: .C-oC---�' Chairman of the Board, President, or Vice President 11 12 Date: 5/2/24 13 A'bLt.-}w.S -k, v, o. tLto\► o� 1—t�c_ COC7 -)n 14 �'e-cx.�...� •-i-1-�w �.L��v�n-� � -to Q-x-.t, A 15 By �--�- 16 Prin Mt, i r� I IR,�nc, 17 18 Title: &Y" 19 Secret ry(of Corporation), Assis nt ecretary, Chief Financial Officer, or Assistant Treasurer 20 21 Date: /o?G2!/ 22 23 24 25 26 27 28 19 Fresno County Department of Behavioral Health Exhibit A-i Non-DMC Outpatient Treatment Vendor List Provider Maximum Annual Allocations VENDOR CONTACT PHONE NUMBER/FAX EMAIL TYPE OF BUSINESS Contract Max Contract Max Contract Max Contract Max FY 2023-24 FY 2024-25 FY 2025-26 FY 2026-27 Central California Recovery,Inc. assessment_training_research@ Remitto: President (559)681-1947 yahoo.com 501(c)3 Non-Profit Corporation $120,000 $120,000 $120,000 $120,000 1204 W.Shaw Ave.#102 (559)273-2942 Fresno,CA 93711 Delta Care,Inc. Remitto: Executive Director (559)276-7558 deltacareinc@yahoo.com 501(c)3 Non-Profit Corporation $200,000 $200,000 $200,000 $200,000 4705 N.Sonora Ave.#113 Fresno,Ca 93722 Fresno New Connection,Inc. Remitto: Executive Director (559)248-1548 sud@teamfnc.com 501(c)3 Non-profit Corporation $200,000 $200,000 $200,000 $200,000 4411 N.Cedar Ave.#108 Fresno,CA 93726 Kings View Remitto: CEO (559)256-0100 MaRodriguez@kingsview.org 501(c)3 Non-profit Corporation $60,000 $60,000 $60,000 $60,000 1396 W.Herndon Ave. Fresno,CA 93711 Mental Health Systems,Inc. Remitto: CEO (858)573-2600 contact@turnbhs.org 501(c)3 Non-profit Corporation $45,000 $45,000 $45,000 $45,000 9465 Farnham St. CFO San Diego,CA 92123 Prodigy Healthcare Inc. Remitto: President (559)892-9452 jd@prodigy-hc.com 501(c)3 Non-profit Corporation $1,206,932 $1,206,932 $1,206,932 $1,206,932 P.O.Box 820 Fowler,Ca 93625 Promesa Behavioral Health Remitto: President (559)439-5437 mnajera@promesabehavioral.org 501(c)3 Non-profit Corporation $200,000 $200,000 $200,000 $200,000 7120 N.Marks Ave,#110 Fax:(559)439-5411 Fresno,Ca 93711 WestCare California,Inc. Remitto: Chief Operating Officer (559)251-4800 infoca@westcare.com 501(c)3 Non-profit Corporation $96,000 $96,000 $96,000 $96,000 1900 N.Gateway Blvd Fax:(559)453-7827 Fresno,CA 93727 $2,127,932 $2,127,932 $2,127,932 $2,127,932 **A list of current provider sites can be found at: https://www.fresnocountyca.goy/Departments/Behavioral-Health/Care-Services/Programs-Services/Substa nce-Use-Disorder-Services 6/4/2024 Exhibit B-I Non-Drug Medi-Cal Outpatient Treatment Scope of Work Contractors, as listed in the Exhibit A-I, Non-DMC Outpatient Treatment Vendor List, to this Master Agreement shall provide administrative and direct program services to County's Medi-Cal ineligible persons served. For persons served under the age of 21, the Contractor shall provide all medically necessary SUD services required pursuant to Section 1396d(r)(r) of Title 42 of the United States Code (Welfare & Institutions Code 14184.402(e)). Contractor shall deliver services using evidence-based practice models. Contractor shall provide said services in Contractor's program(s) as described herein. TARGET POPULATION Contractor shall provide services to the Medi-Cal ineligible perinatal and non-perinatal adult and adolescent populations residing in Fresno County who are assessed to have or to be at risk of developing a substance use disorder. SERVICES TO BE PROVIDED Contractor shall provide medically necessary covered Outpatient SUD services, to adults and adolescents residing in Fresno County, who meet access criteria for receiving SUD services. Services shall be furnished in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to persons served under fee-for- service Medicaid, as set forth in 42 CFR 440.230. Contractor shall ensure that the services are sufficient in amount, duration, or scope to reasonably be expected to achieve the purpose for which the services are furnished. Contractor may not arbitrarily deny or reduce the amount duration, or scope of a required service solely because of diagnosis, type of illness, or condition of the person served. 1 Exhibit B-I Placement in an appropriate level of care must be determined through an assessment based on the American Society of Addiction Medicine (ASAM) criteria and prescribed by the contractor's medical director or through a brief screening based on ASAM criteria for youth under age 21. Contractor shall observe and comply with all lockout and non-reimbursable service rules, as outlined in the Drug Medi-Cal Billing Manual. EARLY INTERVENTION SERVICES (ASAM LEVEL 0.5) Early intervention services (EIS) are available to persons served under 21 who are screened and determined to be at risk of developing an SUD. At risk persons served may receive any service component covered under the outpatient level of care (ASAM 1.0) as early intervention services. An SUD diagnosis is not required for EIS. A full assessment utilizing the ASAM criteria is not required for a person served under the age of 21 to receive EIS. An abbreviated ASAM screening tool may be used. If the person served under 21 meets diagnostic criteria for SUD, a full ASAM assessment shall be performed and the person served shall receive a referral to the appropriate level of care indicated by the assessment. EIS services may be delivered in a wide variety of settings and can be provided in person, by telehealth, or by telephone. EIS services do not limit or modify the Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. OUTPATIENT SERVICES (ASAM LEVEL 1.0) Outpatient services consist of up to nine (9) hours per week of medically necessary services for adults and up to six (6) hours per week of services for adolescents. Services may exceed the maximum hours based on individual medical necessity. 2 Exhibit B-I Services can be provided by a Licensed Practitioner of the Healing Arts (LPHA) or registered/certified counselor in-person, by telephone, or telehealth in any appropriate setting in the community, in conformance with HIPAA and 42 CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12) persons served. Outpatient services may be provided in person, by telehealth or by telephone. Outpatient services include the following service components: • Assessment • Care Coordination • Counseling (individual/group) • Family Therapy • Medication Services • Patient Education • Recovery Services • SUD Crisis Intervention Services INTENSIVE OUTPATIENT SERVICES (ASAM LEVEL 2.1) Intensive outpatient involves structured programming provided to persons served as medically necessary for a minimum of nine (9) hours and a maximum of nineteen (19) hours for adults and a minimum of six (6) hours and a maximum of nineteen (19) for adolescents. Providers may exceed maximum treatment hours when determined to be medically necessary. Intensive outpatient treatment services include the same service components listed under Outpatient 1.0. Services can be provided by an LPHA or registered/certified counselor in-person, by telephone, or telehealth in any appropriate setting in the community, in conformance with HIPAA and 42 CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12) persons served. PEER SUPPORT SERVICES Contractors that employ Medi-Cal Peer Support Specialists and have a designated Peer Support Supervisor can begin to offer Peer Support Services upon County approval. Medi-Cal Peer Support Specialists must have completed the Peer Support Specialist Training Program 3 Exhibit B-1 and received their certification and designated supervisors must have completed the supervisor training prior to billing for peer support services. Peer support services promote recovery, resiliency, engagement, socialization, self- sufficiency, self-advocacy, development of natural supports, and identification of strengths through structured activities such as group and individual coaching to set recovery goals and identify steps to reach the goals. Peer support services may be provided with the person served or significant support person(s) and may be provided in a clinical or non-clinical setting. Peer support services can include contact with family members or other people (collaterals) supporting the person served if the purpose of the collateral's participation is to focus on the treatment needs of the person served. Peer support services are delivered and claimed as a standalone service. Peer support services can be provided in conjunction with other services or levels of care, including inpatient and residential services, but shall be billed separately. There may be times when, based on clinical judgment, the person served is not present during the delivery of the service, but remains the focus of the service. Peer Support Services are based on a plan of care that includes specific individualized goals and is approved by a Behavioral Health Specialist or a Peer Support Supervisor. Peer support services consist of Education Skill Building Groups, Engagement services and Therapeutic Activity services. Peer Support Specialists are individuals in recovery with a current State-approved Medi- Cal Peer Support Specialist Certification Program certification and working under the direction of a Behavioral Health Professional. Behavioral Health Professionals must be licensed, waivered, or registered in accordance with applicable State of California licensure requirements and listed in the California Medicaid State Plan as a qualified DMC provider. RECOVERY SERVICES 4 Exhibit B-I Recovery Services are designed to support recovery and prevent relapse with the objective of restoring the person served to their best possible functional level. Recovery services can be utilized when the person served is triggered, when the person served has relapsed or simply as a measure to prevent relapse. Persons served do not need to be diagnosed as being in remission to access Recovery Services. Persons served may receive Recovery Services while receiving MAT services, including NTP services. Persons served may receive Recovery Services immediately after incarceration with a prior diagnosis of SUD. Services may be provided in person, by telehealth, or by telephone. Recovery Services can be delivered and claimed as a standalone service, concurrently with the other levels of care or as a service delivered as part of other levels of care. Contractors that do not opt to make recovery services available must refer and provide linkage to persons served to a contractor that provides recovery services. Recovery Services shall include the following service components: • Assessment • Care Coordination • Counseling (individual and group) • Family Therapy • Recovery Monitoring, which includes recovery coaching and monitoring designed for the maximum reduction of the person served's SUD • Relapse Prevention which includes interventions designed to teach persons served with SUD how to anticipate and cope with the potential for relapse for the maximum reduction of the person served's SUD. CLINICIAN CONSULTATION Clinician Consultation consists of LPHAs consulting with LPHAs, such as addiction medicine physicians, addiction psychiatrists, licensed clinicians, or clinical pharmacists, to support the provision of care. Clinician Consultation is not a direct service provided to persons served. Clinician Consultation is designed to support licensed clinicians with complex cases and may address medication selection, dosing, side effect management, adherence, drug-drug interactions, or level of care considerations. It includes consultations between clinicians designed to assist clinicians with seeking expert advice on treatment needs for specific persons served. These 5 Exhibit B-1 consultations can occur in person, by telehealth, by telephone, or by asynchronous telecommunication systems. CARE COORDINATION SERVICE Care Coordination services are defined as a service that assists persons served to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. Care coordination consists of activities to provide coordination of SUD care, mental health care, and medical care, and to support the person served with linkages to services and supports designed to restore the person served to their best possible functional level. Care Coordination services are provided to a person served in conjunction with all levels of treatment and may also be claimed as a standalone service. Care Coordination services may be provided by an LPHA, certified counselor or registered counselor. Contractors shall use care coordination services to coordinate with physical and/or mental health systems of care. Care coordination can be provided in clinical or nonclinical settings (including the community) and can be provided face-to-face, by telehealth, or by telephone. Care Coordination shall include one or more of the following components: • Coordination with medical and mental health providers to monitor and support comorbid health conditions. • Discharge planning, including coordinating with SUD treatment providers to support transitions between levels of care and to recovery resources, referrals to mental health providers, and referrals to primary or specialty medical providers. • Coordinating with ancillary services, including individualized connection, referral, and linkages to community-based services and supports including but not limited to educational, social, prevocational, vocational, housing, nutritional, criminal justice, transportation, childcare, child development, family/marriage education, cultural sources, and mutual aid support groups. Care Coordination shall be consistent with and shall not violate confidentiality of persons served as set forth in 42 CFR Part 2, and California law. 6 Exhibit B-I REFERRAL AND INTAKE PROCESS Contractor shall follow the referral and intake process as outlined in the Fresno County SUD Provider Manual. PROGRAM DESIGN Contractor shall maintain programmatic services as described herein. Contractor shall provide services allowable under their current DMC certifications. In addition to services specific to Contractor's DMC certification, contractor is expected to make the following services available: • Care coordination • Recovery services • Peer support services • Clinician Consultation • Contingency management (opt in providers only) DISCHARGE CRITERIA AND PROCESS Contractor will engage in discharge planning beginning at intake for each person served under this Agreement. Discharge planning will include regular reassessment of person served's functioning, attainment of goals, determination of treatment needs and establishment of discharge goals. When possible, discharge will include linkage to treatment at a lower level of care or intensity appropriate to person served's needs and provision of additional referrals and linkages to community resources for person served to utilize after discharge. CONTRACT DELIVERABLES, OBJECTIVES AND OUTCOMES Contractor shall comply with all requests regarding local, state, and federal performance outcomes measurement requirements and participate in the outcomes measurement processes as requested. Contractor shall work collaboratively with County to develop process benchmarks and monitor progress in the following areas: ■ Timeliness to care standards • Assessment within 10 days for Outpatient services 7 Exhibit B-1 ■ Engagement and retention in treatment • No Shows/Cancellations • Average length of stay • Readmissions within 30 days • Successful Ca1OMS discharge ■ Care Coordination • Referrals and linkage to other levels of care or services ■ Efficiency • Average annual cost of person receiving SUD services • Percentage of High-Cost Utilizers • Ratio of clinical staff to persons served • Clinical staff productivity ■ Surveys • Increase participation in Treatment Perception Survey (TPS) • Increase satisfaction reported in TPS • Increase participation in Employee Engagement Survey ■ Quality Assurance • Timely chart reviews • Participation in person served feedback groups Contractor will collaborate with the County in the collection and reporting of performance outcomes data, including data relevant to Healthcare Effectiveness Data and Information Set (HEDIS®) measures, as required by DHCS. Measures relevant to this Agreement are indicated below: ■ Follow up After Emergency Department Visit for Alcohol and Other Drug Abuse (FUA) ■ Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment REPORTING AND EVALUATION REQUIREMENTS Contractor shall complete all reporting and evaluation activities as required by the County and described herein. Refer to Article 1 of this Agreement for additional information on reporting and monitoring. 8 Exhibit B-I ORIENTATION, TRAINING AND TECHNICAL ASSISTANCE County will endeavor to provide Contractor with training and support in the skills and competencies to (a) conduct, participate in, and sustain the performance levels called for in the Agreement and (b) conduct the quality management activities called for by the Agreement. County will provide the Contractor with all applicable standards for the delivery and accurate documentation of services. County will make ongoing technical assistance available in the form of direct consultation to Contractor upon Contractor's request to the extent that County has capacity and capability to provide this assistance. In doing so, the County is not relieving Contractor of its duty to provide training and supervision to its staff or to ensure that its activities comply with applicable regulations and other requirements included in the terms and conditions of this Agreement. Any requests for technical assistance by Contractor regarding any part of this Agreement shall be directed to the County's designated contract monitor. Contractor shall require all new employees in positions designated as "covered individuals" to complete compliance training within the first 30 days of their first day of work. Contractor shall require all covered individuals to attend, at minimum, one compliance training annually. These trainings shall be conducted by County or, at County's discretion, by Contractor staff, or both, and may address any standards contained in this Agreement. Covered individuals who are subject to this training are any Contractor staff who have or will have responsibility for, or who supervises any staff who have responsibility for, ordering, prescribing, providing, or documenting person served care or medical items or services. Contractor shall require that physicians receive a minimum of five hours of continuing medical education related to addiction medicine each year. Contractor shall require that professional staff(LPHAs) receive a minimum of five hours of continuing education related to addiction medicine each year. 9 cot: Department of p Exhibit C-I Behavioral Health PPG 1.3.14 V#: 2 Section: DBH Policies & Procedures, Mental Health, Substance Use Disorder Effective Date: 07/09/2021 Revised Date: 01/10/2024 Policy Title: Guiding Principles of Care Delivery Approved by:Joseph Rangel (Behavioral Health Division Manager), Lesby Flores (Licensed Deputy Director of Behavioral Health), Stacy VanBruggen (Licensed Behavioral Health Division Manager), Susan Holt(Director of Behavioral Health) POLICY: The DBH Guiding Principles of Care Delivery define and guide our Behavioral Health System of Care. We expect 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. PURPOSE: The principles provide the clinical framework that influences decision- making in all aspects of care delivery including program design and implementation, service delivery, training of the workforce, allocation of resources, and measurement of outcomes. REFERENCE: N/A DEFINITIONS: Quadruple Aim — (1) deliver quality care, (2) maximize resources while focusing on efficiency, (3) provide an excellent care experience, and (4) promote workforce well-being. PROCEDURE: I. Principle One — Timely Access & Integrated Services A. Persons-served are connected with services in a manner that is efficient and effective. B. Collaborative care coordination occurs across agencies, plans for care are integrated, and whole person care considers all life domains such as physical health, education,employment, housing, spirituality and other social determinant of health. C. Barriers to access and treatment are identified and addressed. D. Excellent customer service ensures persons served are transitioned from one point of care to another without disruption of care. II. Principle Two — Strengths-Based A. Positive change occurs within the context of genuine trusting relationships. MISSION STATEMENT DBH,in partnership with our diverse communities,is dedicated to providing quality,culturally responsive,behavioral health services to promote wellness,recovery,and resiliency for individuals and families in our community. 0812021 Section: DBH Policies& Procedures, Mental Health,Substance Use Disorder Exhibit C-1 PPG 1.3.14 V#:2 Policy Title: Guiding Principles of Care Delivery B. Individuals, families, and communities are resourceful and resilient in the way they solve problems. C. Hope and optimism are created through the identification of, and focus on, the unique abilities of persons served. III. Principle Three — Person-Driven and Family-Driven A. Self-determination and self-direction are the foundations for recovery. B. Persons served optimize their autonomy and independence by leading the process, including the identification of strengths, needs, and preferences. C. Providers contribute clinical expertise, provide options, and support persons served in informed decision making, developing goals and objectives, and identifying pathways to recovery. D. Persons served partner with their provider(s) in determining the services and supports that would be most effective and helpful and they exercise choice in the services and supports they receive. IV. Principle Four— Inclusive of Natural Supports A. The person served identifies and defines family and other natural supports to be included in care. B. Persons served speak for themselves. C. 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. D. Providers assist persons served in developing and utilizing natural supports. V. Principle Five — Clinical Significance and Evidence Based Practices (EBP) A. Services are effective, resulting in a noticeable, measurable change in daily life. B. Clinical practice is informed by best available research evidence, best clinical expertise, and the values and preferences of those we serve. C. Other clinically and culturally significant interventions such as innovative, promising, and emerging practices are embraced. VI. Principle Six — Culturally Responsive A. Values, traditions, and beliefs specific to a person served's culture(s) are valued and leveraged to support the theirwellness, resilience, and recovery. B. Services are culturally grounded, congruent, and personalized to reflect the unique cultural experience of each person served. 2 1 P a g e Section: DBH Policies& Procedures, Mental Health,Substance Use Disorder Exhibit C-1 PPG 1.3.14 V#:2 Policy Title: Guiding Principles of Care Delivery C. Providers exhibit the highest level of cultural humility and responsiveness to the self-identified culture(s) of the person orfamily served in striving to achieve the greatest equity in care delivery. VII. Principle Seven — Trauma-informed and Trauma-Responsive A. The widespread impacts of all types of trauma are recognized and the various potential paths for recovery from trauma are understood. B. Signs and symptoms of trauma in persons served, team members, and others are recognized and persons served receive trauma-informed responses. C. Physical, psychological, and emotional safety for persons served and treatment team members is emphasized. VIII. Principle Eight— Co-Occurring Capable A. 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. B. Treatment of mental health and substance use disorders are integrated. A provider or team may deliver treatment for mental health and substance use disorders at the same time. IX. Principle Nine — Stages of Change, Motivation, and Harm Reduction A. Interventions are motivation-based and adapted to the person served's stage of change. B. Progression through stages of change is supported through positive working relationships and alliances that are motivating. C. Providers support persons served to develop strategies aimed at reducing negative outcomes of substance misuse through a harm reduction approach. D. Each person served defines their own recovery and recovers at their own pace when provided with sufficient dignity, time, and support. X. Principle Ten — Continuous Quality Improvement and Outcomes-Driven A. Individual and program outcomes are collected and evaluated for quality and efficacy. B. Strategies are implemented to achieve a system of continuous quality improvement and improved performance outcomes. C. Providers participate in ongoing professional development activities needed for proficiency in practice and implementation of treatment models. 3 1 P a g e Section: DBH Policies& Procedures, Mental Health,Substance Use Disorder Exhibit C-1 PPG 1.3.14 V#:2 Policy Title:Guiding Principles of Care Delivery XI. Principle Eleven — Health and Wellness Promotion, Illness and Harm Prevention, and Stigma Reduction A. The rights of all persons served are respected and persons served are treated with dignity. B. Behavioral health is recognized as essential for person served and community well-being. C. Promotion of health and wellness is interwoven throughout all aspects of DBH services. D. Specific strategies to prevent illness and harm are implemented at the individual, family, program, and community levels. E. Stigma is actively reduced by promoting awareness and accountability through creating positive change in attitudes, beliefs, practices, and policies within all systems. F. The vision of health and well-being for our community is continually addressed through collaborations between providers, persons served, families, and commu n ity members. 4 1 P a g e PROVIDER REPORTS Fresno County Substance Use Disorder Services Department of Behavioral Health Exhibit H-1 Report Purpose Submit to Notes Weekly Monthly Annual As Needed Tracks level of care determined at sas@ ASAM Level of Care screening,assessment,and reassessment fresnocountyca. Reports are provided monthly using excel 20t"of the (LOC) template provided by DBH. month and actual LOC referred to. gov Provides capacity and utilization 5th of DATAR information on publicly funded SUD DHCS Webpage following programs. month 24 hours of occurrence and Captures comprehensive client intake, Smartcare/ DBH submitted CaIOMS Treatment treatment, and outcomes for statewide CalOMS includes admission, discharge, and no later than Data analysis. EHR annual update information. five days after the preceding month Template provided by DBH. • Provider shall enter information per modality. If provider offers multiple levelsof care within a modality, Managed care requirement. Used to provider is to use the program ID t" sas@ with the lowest LOC e. 15 of Monthly Status Report monitor network adequacy standards. ( g.,for following (MSR) Provides status on DMC programs and is fresnocountyca.gov residential, enter info under 3.1 month used to update provider directory. instead of 3.5). • Providers are asked to report departing counselors via MSR as soon asthey become aware of the upcoming change. Provides information on length of waittime sas@ 15th of Wait List* for admission into a residential program. fresnocountyca.gov Applicable to residential providers only. following month 03-05-2024 Page 1 PROVIDER REPORTS Fresno County Substance Use Disorder Services Department of Behavioral Health Exhibit H-1 Report Purpose Submit to Notes weekly Monthly Annual As Needed Ineligible Persons Checks for clinicians'eligibility to provide sas@ 15th of Screening services based on sanctions or exclusion fresnocountyca.gov Template provided by DBH. current status. month Providers are expected to maintain missed appointment information until such time 15th of Missed Appointments Collects missed appointment data. N/A that DBH is able to collect that information following in its Electronic Health Record or other month database. DHCS requirement.Collects grievances at mcare@ 15th of Grievance Log Template provided b DBH following SUD programs. fresnocountyca.gov p p Y month Network Adequacy Used to monitor network adequacy sas@ Template provided by DBH. Submission Feb 1 Certification Tool (NACT) standards. fresnocountyca.gov dates may be subject to change. DMC Outpatient Timely data submission on client access to Entered at the time of first contact with the Timeliness and/or DMC Smart Care/ DBH As services, measuring performance against EHR person served. Instructions for completion to needed Opioid Timeliness established benchmarks for promptness. be provided by DBH. 03-05-2024 Page 2 PROVIDER REPORTS Fresno County Substance Use Disorder Services Department of Behavioral Health Exhibit H-I Report Purpose Submit to Notes weekly Monthly Annual As Needed DMC-ODS plans must submit detailed provider network data for various service levels using the X12 274 standard.This includes data for outpatient, intensive outpatient, residential, and opioid treatment programs, covering county- 25t"of DMC-ODS 274 Provider sas@ Network Data Reporting operated and contracted providers.The fresnocountyca.gov Template provided by DBH. following submission must meet specific format and Month compliance standards.Additionally, plans are required to participate in 274 workgroup meetings,with potential corrective actions or sanctions for non- compliance Culturally and Linguistically Used to monitor adherence to the National Appropriate Services CLAS Standards which are intended to sas@ late provided b TBD Template(CLAS) self-assessment advance health equity, improve quality, fresnocountyca.gov p p y DBH. and CLAS plan and help eliminatehealth care disparities. Americans with Used to monitor compliance with sas@ Disabilities Act(ADA)Self- legislation that prohibits discrimination fresnocountyca.gov Template provided by DBH TBD Assessment against people with disabilities. Cost Report Identifies costs and charges related to sas@ Due annually; date set by DHCS and DBH TBD program. fresnocountyca.gov 03-05-2024 Page 3 PROVIDER REPORTS Fresno County Substance Use Disorder Services Department of Behavioral Health Exhibit H-1 Report Purpose Submit to Notes weekly Monthly Annual As Needed Electronic copy: sas@ fresnocountyca.gov Hard copy: Mandated questionnaire used to Department of Risk Assessment determine a provider's risk category Behavioral Health Due annually; date set by DBH TBD classification. Substance Use Disorder Services Attn: Fiscal Analyst 3133 N Millbrook Ave Fresno, CA 93703 03-05-2024 Page 4 PROVIDER REPORTS Fresno County Substance Use Disorder Services Department of Behavioral Health Exhibit H-I Additional Reports Report Purpose Submit to Notes Weekly Monthly Annual As Needed Cultural Competency Surveys assessing provider cultural sas@ Complet P y competency,guiding training, and Template provided by DBH.Completed ed semi- Survey fresnocountyca.gov semi-annually or as determined by DBH. annually policy adjustments Y • Providers are required to complete an online report of any Documentation of any incidents incidents that compromise the LogicManager Incident within treatment settings, Logic Manager health and safety of clients, X Reporting supporting risk management and Website employees or community quality improvement efforts members. • Reports must be submitted within 48 hours of an incident. • Timeframes vary. Refer to MHSUDS IN #18-010E: https://www.dhcs.ca.gov/forms andpubs/Pages/Behavioral Heal Notice of Adverse Managed Care requirement. NOABD letters th Information Notice.aspx Benefit provide information to Medi-Cal persons mcare@fresnocount • Templates provided by DBH, X Determination served about their appeal rights and other yca.gov available at the Provider page: (NOABD) rights under the Medi-Cal program. https://www.co.fresno.ca.us/depar tments/behavioralhealth/ home/forproviders/ contractproviders/ substance-use-disorderproviders 03-05-2024 Page 5 Exhibit J-1 Fresno County Department of Behavioral Health Substance Use Disorder Outpatient Services Rates Approved Rates by Provider Rates Effective 7.01.2023 Provider Rate Minimum Direct Provider Type Per Hour Care Percentage Physicians Assistant $409.38 40% Nurse Practitioner $453.91 40% RN $370.76 40% Pharmacist $436.93 40% MD (typically in SUD system of care) $912.79 N/A Psychologist/Pre-licensed Psychologist $367.09 40% LPHA(MFT, LCSW, LPCC)/Intern or Waivered LPHA(MFT, LCSW, LPCC) $237.56 40% Alcohol and Drug Counselor $197.05 45% Peer Recovery Specialist $187.66 35% Fresno County Department of Behavioral Health Substance Use Disorder Outpatient Services Rates Supplemental Add-On Service Codes Rates Effective 7.01.2023 Maximum Units Service Unit That Can Be Rate Per Billed Unit 1 per allowed 15 minutes per procedure per Interactive Complexity $16.50 unit provider per person served Sign Language or Oral Interpretive Service 15 minutes perVariable $30.00 unit Revised 05/21/2024 1 of 1