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
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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;
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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
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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.
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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]
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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
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By: _
11 Deputy
12 For accounting use only:
13 Org No.:56302081
Account No.:7295
14 Fund No.:0001
Subclass No.:10000
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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4 Provider: CENTRAL CALIFORNIA RECOVERY, INC.
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6 Bye{ `��
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8 Print Name: C
9 SS
10 Title:
Ch rman of the Board, resident, or Vice President
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12 Date:
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B
Y_
16 .--
Print Name: ZItAfz
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18 Title: .Q /Z
19 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
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21 Date: �S/ U;
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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Provider: DELTA CARE, INC.
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6By IFZ�
�-
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8 Print Name: Rk itk
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10 Title:
Chairman of the Board, President, or Vice President
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12 Date: M
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14 ---
15 By
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17 Print Name:
18 Title: �V\
19 Secretary (ofCorporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
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21 Date:
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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4 Provider: FRESNO NEW CONNECTION, INC.
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B
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8 Print Name: �c�Zc in�� K�ti !/c���;
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10 Title:
Chairman of the Board, President, or Vice President
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12 Date:
i
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14 4-�
15 BY
16 c
17 Print Name
18 Title: �i�'�L� -
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Secretary Secretary,
(of Corporation), Assist nt Sreta ,
Chief Financial Officer, or Assistant Treasurer
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21 Date:
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DocuSign Envelope ID:96CO3AD9-OF3B-4E47-AOAF-7EO6398764DE
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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Provider: KINGS VIEW
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FDocuSigned by:
By
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8 Amanda Nugent
Print Name: of vi nP, PhD
9
CEO
10 Title:
Chairman of the Board, President, or Vice President
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12 Date: 5/2/2024
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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
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21 Date: 5/2/2024
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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4 Provider: MENTAL HEALTH SYSTEMS, INC.
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6 By 241L L Cq11q#hah
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8 Print Name: James C. Callaghan Jr.
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10 Title: CEO/President
Chairman of the Board, President, or Vice President
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12 Date: 05/01/24
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15 By David Tanner(�yy, 7D747519 PDT)
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Print Name: David Tanner
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18 Title: VP of Corporate Finance
19 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
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21 Date: 05/01/24
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The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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Provider: PRODIGY HEALTHCARE INC.
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By —
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8 Print Name: a / khC�
9 10 Title: PfC-IIelt,
Chairman of t-ie Board, President, or Vice President
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Print Name: ,1_ c1��! /�he*-?E�
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19 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
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1 PROVIDER (GROUP): Promesa Behavioral Health
2 -y
3 By: � -
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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: _
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13 By: —
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Print Name: Erlan Zuniga
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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
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (INDIVIDUAL): Promesa Behavioral Health
3 B
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5 Print Name: Lisa Welgant
6 C
7 Title: C C O
8 4/29/24
9 Date: _
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COUNTY OF FRESNO
Fresno, CA
1 The parties are executing this Amendment No. 1 to Agreement No. 23-294 on the date
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stated in the introductory clause.
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4 Provider: WESTCARE CALIFORNIA, INC.
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6
By
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8 Print Name: II� v� IV 1--)
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10 Title: .C-oC---�'
Chairman of the Board, President, or Vice President
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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 �--�-
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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
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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