HomeMy WebLinkAboutAgreement A-24-297 Amendment 2 to Agreement with Central Star.pdf Agreement No. 24-297
1 AMENDMENT NO. 2 TO SERVICE AGREEMENT
2 This Amendment No. 2 to Service Agreement No. 23-278 ("Agreement") is dated
3 June 18, 2024 and is between Central Star Behavioral Health, Inc., a private for-profit
4 Corporation ("Contractor"), and the County of Fresno, a political subdivision of the State of
5 California ("County").
6 Recitals
7 A. On June 20, 2023, the County and the Contractor entered into County Service
8 Agreement No. 23-278 ("Agreement") for a qualified agency to provide certain Mental Health
9 Services Act (MHSA) Transitional Age Youth (TAY) Mental Health Services and Supports
10 program to deliver integrated mental health and supportive housing services to the TAY
11 population, ages 16 to 25 years of age, who have a serious mental illness and are at risk of
12 being hospitalized, homeless, and/or incarcerated.
13 B. On October 24, 2023, the County and the Contractor entered into Amendment No. 1 to
14 the Agreement ("Amendment No. 1"), to update rates for the Transitional Age Youth (TAY) Full
15 Service Partnership (FSP) program.
16 C. The County and the Contractor now desire to further amend the Agreement to correctly
17 label previously incorrectly labeled exhibits, update the insurance requirements, and to expand
18 service provision for the target population into a Continuum of Care which shall include
19 outpatient and intensive case management service levels for individuals stepping down from the
20 FSP program.
21 The parties therefore agree as follows:
22 1. All references in the Agreement to Exhibit Al shall be deemed references to
23 "Revised Exhibit At" which is attached and incorporated by this reference.
24 2. All references in the Agreement to "Exhibit G 1" shall be deemed references to
25 "Exhibit G 1 a and Exhibit G1b." Exhibit G 1 a and Exhibit G 1 b are attached and incorporated by
26 this reference.
27 3. All references in the Agreement to Exhibit H shall be deemed references to
28 "Revised Exhibit H," which is attached and incorporated by this reference.
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1 4. Pages 108 through 110 of the Agreement that was previously labeled as "h" shall
2 be labeled as "Exhibit E."
3 5. Pages 111 through 132 of the Agreement that was previously labeled as "h" shall
4 be labeled as "Exhibit F."
5 6. Pages 134 through 145 of the Agreement that was previously labeled as "h" shall
6 be labeled as "Exhibit G2."
7 7. When both parties have signed this Amendment No. 2, the Agreement,
8 Amendment No. 1, and this Amendment No. 2 together constitute the Agreement.
9 8. The Contractor represents and warrants to the County that:
10 a. The Contractor is duly authorized and empowered to sign and perform its
11 obligations under this Amendment.
12 b. The individual signing this Amendment on behalf of the Contractor is duly
13 authorized to do so and his or her signature on this Amendment legally binds the
14 Contractor to the terms of this Amendment.
15 9. The parties agree that this Amendment may be executed by electronic signature
16 as provided in this section.
17 a. An "electronic signature" means any symbol or process intended by an
18 individual signing this Amendment to represent their signature, including but not
19 limited to (1) a digital signature; (2) a faxed version of an original handwritten
20 signature; or (3) an electronically scanned and transmitted (for example by PDF
21 document) version of an original handwritten signature.
22 b. Each electronic signature affixed or attached to this Amendment (1) is
23 deemed equivalent to a valid original handwritten signature of the person signing this
24 Amendment for all purposes, including but not limited to evidentiary proof in any
25 administrative or judicial proceeding, and (2) has the same force and effect as the
26 valid original handwritten signature of that person.
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1 c. The provisions of this section satisfy the requirements of Civil Code
2 section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code,
3 Division 3, Part 2, Title 2.5, beginning with section 1633.1).
4 d. Each party using a digital signature represents that it has undertaken and
5 satisfied the requirements of Government Code section 16.5, subdivision (a),
6 paragraphs (1) through (5), and agrees that each other party may rely upon that
7 representation.
8 e. This Amendment is not conditioned upon the parties conducting the
9 transactions under it by electronic means and either party may sign this Amendment
10 with an original handwritten signature.
11 10. This Amendment may be signed in counterparts, each of which is an original,
12 and all of which together constitute this Amendment.
13 11. The Agreement as amended by this Amendment No. 2 is ratified and continued.
14 All provisions of the Agreement and not amended by this Amendment No. 2 remain in full force
15 and effect.
16 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 2 on the date stated in the introductory
2 clause.
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Central Star Behavioral Health, Inc. County of Fresno
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6 Kent Dunlap Nathan Magsig, Chairman of the Board of
President/CEO Supervisors of the County of Fresno
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1501 Hughes Way, Suite 150 Attest:
8 Long Beach, CA 90810 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.: 56304471
Account No.: 7295
14 Fund No.: 0001
Subclass No.: 10000
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Revised Exhibit Al
Page 1 of 19
Transition Age Youth(TAY)Continuum of Care
SCOPE OF WORK
ORGANIZATION/CONTRACTOR: Central Star Behavioral Health, Inc.
CORPORATE ADDRESS: 1501 Hughes Way,Suite 150, Long Beach,California 90810
SITE ADDRESS: 3433 W. Shaw Ave Suite 102, Fresno, CA 93711
PROGRAM DIRECTOR: Nona Akopyan
CONTRACT PERIOD: July 1, 2023—June 30, 2024 (term extension)
July 1, 2024—June 30,2025 (possible 12-month extension based on satisfactory performance)
I. BACKGROUND
The Contractor has successfully operated a Full-Service Partnership program to serve the Transitional
Age Youth of Fresno County over the last five years. The Contractor will build upon evidence-based
services and activities to offer an expanded continuum of unduplicated services. Integrated services
maximize the use of resources to broaden the scope, intensity, and accessibility of services and supports
to transitional age youth in rural and metropolitan areas who might otherwise not receive the services
they need.
The Contractor's experience with serving culturally and linguistically diverse individuals has supported
outreach, access and appropriate service delivery to populations that may not be adequately served by
traditional mental health and other support systems. The resulting service delivery system has proven
to be effective in assisting targeted populations with achieving and maintaining wellness and recovery.
The program includes three (3) distinct levels of care: 1) Outpatient (OP) services, 2) Intensive Case
Management (ICM), and 3) Full-Service Partnership (FSP).
II.TARGET POPULATION
The TAY program is designed to provide services to individuals between the ages of 16-25 with serious
emotional disturbance (SED) or serious mental illness (SMI), who meet medical necessity for and can
benefit from Specialty Mental Health Services (SMHS). The program will provide a range of services that
will be tailored to everyone's needs for service type, intensity, and duration. Persons served will
therefore be assigned to one (1) of three (3) levels of care upon completion of the intake/assessment:
Outpatient, Intensive Case Management, or Full Service Partnership.
Any individuals who do not require or benefit from SMHS or need medication only shall be linked to
their designated Managed Care Plan (MCP)to receive Non-Specialty Mental Health Services (NSMHS).
The Contractor will utilize the Transition of Care Tool to facilitate the linkage to the MCP and coordinate
care until successful transition has occurred.
Revised Exhibit Al
Page 2 of 19
III. LOCATION OF SERVICES
Services will be provided at each Contractor's clinic site, in the community, at home and education
locations, whichever is most comfortable for the person served. The Contractor must also be capable of
offering services through telehealth-phone and telehealth-video should the need arise.
IV. DESCRIPTION OF SERVICES
The intended benefit of creating a program such as the TAY Continuum of Care with multiple levels of
care is for maximum flexibility to move participants seamlessly between levels, as clinically indicated.
The Contractor shall provide a level of service and support that will reflect each person's unique and
individual needs.
A. Behavioral Health
1. Contractors shall provide these services to all participants in the program. Services will
include but are not limited to the following:
i. Provide support to the individual's family and other members of their social
network to help them manage the symptoms and illness of the youth/adult and
reduce the level of family and social stress associated with the illness.
ii. Make appropriate referrals and linkages to services that are beyond that of the
Contractors' services under this Agreement or as appropriate when
discharging/transitioning a youth/adult from the program.
iii. Coordinate services with any other community mental health and non-mental
health providers as well as other medical professionals.
iv. Assist persons served with accessing all entitlements or benefits for which they are
eligible (i.e., Medi-Cal,SSI,Section 8 vouchers, etc.).
v. Develop family support and involvement whenever possible.
vi. Refer person served to supported education and employment opportunities, as
appropriate.
vii. Provide or link to transportation services when it is critical to initially access a
support service or gain entitlements or benefits.
viii. Provide or refer to peer support activities, as appropriate.
ix. Ensure that clinically appropriate Evidence-Based Practices are utilized in service
delivery at all levels of care.
2. Contractor shall deliver a comprehensive specialty mental health program. Behavioral
health services include but are not limited to:
i. Assessment
Revised Exhibit Al
Page 3 of 19
ii. Treatment or Care planning/Goal setting
iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the
Child and Adolescent Needs and Strengths (CANS) assessment
iv. Individual therapy
v. Group therapy
vi. Family therapy
vii. Case management
viii. Consultation
ix. Linkage to additional services and supports.
x. Hospitalization/Post Hospitalization Support
3. Contractors will ensure that all services:
i. Be values-driven, strengths based, individual-driven, and co-occurring capable.
ii. Be culturally and linguistically competent.
iii. Be age, culture,gender, and language appropriate.
iv. Include accommodations for individuals with physical disability(ies)
4. Methods for service coordination and communication between program and other service
providers shall be developed and implemented consistent with Fresno County Mental
Health Plan (MHP) confidentiality rules.
5. Contractor shall maintain up-to-date caseload records of all individuals enrolled in services,
and provide individual, programmatic, and other demographic information to DBH as
requested.
6. Contractor shall ensure billable specialty mental health services meet any/all County, State,
Federal regulations including any utilization review and quality assurance standards and
provide all pertinent and appropriate information in a timely manner to DBH to bill Medi-Cal
services rendered.
7. Staffing should be appropriate for services needed at each level of care, which should
include case managers, therapists, peer support specialists, psychiatrists, and nurses.
B. Levels of Treatment
1. Outpatient (OP)
i. The OP level of care focuses primarily on therapeutic appointments for individual
and group treatment as well as case management and medication services, as
Revised Exhibit Al
Page 4 of 19
needed. Individuals at this level receive a minimum of one (1) contact per week
with at least one (1) of those contacts being face-to-face per month.
ii. Caseload
Maximum caseload: 1:40
iii. Length of Stay
Suggested length of stay is twelve (12) to eighteen (18) months, with each
Contractor evaluating the needs of each enrolled individual on an ongoing basis to
ensure that the level of care is clinically appropriate.
2. Intensive Case Management (ICM)
i. Individuals at this ICM level of care would benefit from regularly scheduled case
management, individual rehabilitation and/or individual therapy. Persons at this
level receive a minimum of one (1)to two (2) mental health contacts per week with
one of those contacts being face-to-face. These mental health contacts can include
but are not limited to individual therapy, family therapy,group therapy, case
management, peer support services and/or medication management.
ii. Caseload
maximum caseload: 1:30
iii. Length of Stay
Suggested length of stay is twelve (12) to twenty-four(24) months, with each
Contractor evaluating the needs of each enrolled individual on an ongoing basis to
ensure that the level of care is clinically appropriate.
3. Full Service Partnership (FSP)
i. This FSP level of care employs the concept of"whatever it takes", which focuses
on innovative approaches to "no fail" services. Individuals at this level meet the
State-defined FSP criteria and require higher intensity services to meet their
needs. FSP has an increased focus on engagement, collaboration with the person
served and stabilization to achieve mutually agreed upon treatment goals.
Services at this level of care shall be accessible 24/7. Individuals at the FSP level
shall receive a minimum of three (3) face-to-face contacts per week.
ii. Caseload
Maximum caseload: 1:15
iii. Length of Stay
Suggested length of stay is eighteen (18)to twenty-four (24) months, with
Contractor evaluating the needs of each enrolled individual on an ongoing basis to
ensure that the level of care is clinically appropriate.
Revised Exhibit Al
Page 5 of 19
C. Admission,Termination and Discharge
1. Entry Criteria
Person served must fall into at least one (1) of the following groups for FSP Level services:
i. Group One: Have a substantial impairment in at least two (2) of the following
categories because of a serious emotional disturbance/serious mental illness: self-
care, school functioning, family relationships, and ability to function in the
community. The individual must be at risk of, or already removed from,the home;
or the mental disorder and impairments have been present for more than six (6)
months or are likely to continue for more than one year without treatment.
ii. Group Two: Displays psychotic features, is at risk of suicide, and/or is at risk of
violence due to a mental disorder.
iii. Group Three: Meets special education eligibility requirements under Chapter 26.5
of the Government Code.
They are unserved or underserved AND they are in one of the following situations:
iv. Homeless or at risk of being homeless.
V. Aging out of the child and youth mental health system
vi. Aging out of the child welfare systems
vii. Aging out of the juvenile justice system
viii. Involved in the criminal justice system
ix. At risk of involuntary hospitalization or institutionalization, or
X. Have experienced a first episode of serious mental illness
Individuals under age 21 must meet one (1) of the following criteria for the OP and ICM
services:
i. Has a condition placing them at high-risk for a mental health disorder due to
experience of trauma evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DBH, involvement in the Child
Welfare system,juvenile justice involvement, or experiencing homelessness.
ii. Meets both of the following requirements:
a. Has at least one (1) of the following: a significant impairment, a reasonable
probability of significant deterioration in an important area of life
functioning, a reasonable probability of not progressing developmentally as
appropriate, a need for specialty mental health services, regardless of
presence of impairment,that are not included within the mental health
benefits that a Medi-Cal managed care plan is required to provide.
b. The individual's condition as described above is due to one (1) of the
following: a diagnosed mental health disorder, a suspected mental health
disorder that has not yet been diagnosed or significant trauma placing the
youth at risk of a future mental health condition, based on the assessment
of a licensed mental health professional.
Revised Exhibit Al
Page 6of19
Individuals 21 years of age or older must meet both of the following criteria for the OP and ICM
services:
i. The person served has one or both of the following: a. Significant impairment, where
impairment is defined as distress, disability, or dysfunction in social, occupational, or
other important activities. b.A reasonable probability of significant deterioration in an
important area of life functioning.
ii. The individual's condition as described in paragraph (i) is due to either of the following:
a.A diagnosed mental health disorder, according to the criteria of the current editions
of the Diagnostic and Statistical Manual of Mental Disorders and the International
Statistical Classification of Diseases and Related Health Problems. b. A suspected mental
disorder that has not yet been diagnosed.
2. Intake and Initial Assessment
The OP and ICM services are considered access points; therefore, individuals can be referred
directly to enter the TAY program based on meeting medical necessity for specialty mental
health services. Persons may be referred to the program for OP or ICM services through
various sources including, but not limited to DBH, schools, individuals, or other agencies.
Individuals will be referred to the TAY program for FSP services through DBH's Youth
Wellness Center or Urgent Care Wellness Center. Contractor shall contact the individual
within twenty-four(24) hours of receipt of the referral. A face-to-face meeting will be
scheduled within three (3) business days to begin the intake process.
For all levels of care, Contractor shall adhere to the timeliness standards set forth by the
state and County's DBH. An initial mental health assessment will be completed within a
clinically appropriate timeframe. If the timeframe exceeds thirty(30) days,justification for
this delay should be clearly represented in the clinical documentation.
3. Termination and Discharge
Individuals referred to the TAY program may be denied services if the individual does not
meet medical necessity for specialty mental health services, meets medical necessity for a
mental health diagnosis that is not covered by the County's MHP, and/or the individual is
over the age of 25 at the time of referral. Persons who are determined to be ineligible for
TAY services will be linked to other appropriate services and resources.
Discharge is determined on a case-by-case basis depending on the individual's progress
toward individualized treatment goals. Reasons for discharge include the person served
refuses or terminates services; the individual is transferred to another program mutually
agreed upon by the individual, parent/caregiver, and TAY; mutual agreement that the
treatment goals have been met; and/or the individual is 25 years old or older.
V. STAFFING
Revised Exhibit Al
Page 7 of 19
A. Contractor shall provide the following staffing components, at minimum:
1. Staffing shall be appropriate for services needed at each level of care, which would include
any combination of the following classifications: licensed or license-eligible therapists,
personal service coordinators, and family specialists.
2. Licensed or license-eligible therapists:
Provide linkages and therapeutic services to enrolled individuals and as identified in the
Individual Services and Supports Plan (ISSP).
3. Peer Support (or equivalent): Shall be occupied by a former person served or family
member with comparable experience to the youth, adult, and/or family receiving services.
4. Personal Service Coordinators (PSC): At least one (1) of the PSC positions shall be occupied
by a former person served or family member with comparable experience to the youth,
adult, and/or and family receiving services. These positions shall be recruited based on
linguistic and cultural needs of the targeted population (e.g., Latino, Southeast Asian,
African American, Native American). A bachelor's degree level is preferred for the
requirements of the PSC positions; however, 12 college units (including psychology,
counseling, etc.) with mental health experience can act as a substitute for the bachelor's
degree requirement.
a. Ensure the following is provided by the PSC:
1. Assign a primary PSC to each individual served at the FSP level of care. The
primary PSC will work with each person, and family member when appropriate,
to develop the person's ISSP. The ISSP is used to identify the individual's goals
and describe the array of services and supports necessary to advance these
goals based on the individual's needs and preferences and, when appropriate,
the needs and preferences of the person's family. ISSPs are reviewed by DBH's
MHP Managed Care during chart audits.
2. The PSC will act as a single point of responsibility and contact for the delivery of
personal service coordination for each person, as assigned. Personal service
coordination is the assistance provided to the individual, and their family when
appropriate,to access medical, educational, social,vocational, rehabilitative,
crisis intervention, or other community services,when needed.
3. Ensure all individuals that receive personal service coordination services also
receive mental health treatment services when a determination is made by
qualified staff using clinically proven assessment tools that a person served
would benefit from mental health treatment. Contractors shall institute mental
health treatment models to meet the mental health treatment needs of the
individuals engaged in services offered in this Agreement.
VI. HOURS OF OPERATION
Revised Exhibit Al
Page 8of19
The standard hours of operation will be Monday through Friday 8:00 AM until 5:00 PM; additional
services will be provided after 5:00 PM and on weekends, as needed,to address youth, adult, and/or
family concerns and/or provide services to persons served who are unavailable for services during
standard business hours. Contractor will be required to be available to provide services to the individual
by someone who is known to the person served during after hours operations.
Additionally, Contractors shall provide operational and clinical services in the field, as needed, and
temporarily extend office hours to accommodate and increase timeliness of services.
FSP services will be available to participants and their families twenty-four(24) hours a day, seven (7)
days a week.
VII. GOALS/OUTCOMES
CONTRACTOR will be required to submit measurable outcomes on an annual basis, as identified in DBH's
Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures, attached as Exhibit E.
Performance outcomes measures must be approved by COUNTY's DBH and satisfy all State and local
mandates. COUNTY's DBH will provide technical assistance and support in defining measurable
outcomes. All performance indicators will reflect the following four
(4) domains: effectiveness, efficiency, access, and satisfaction.These are defined below:
A. Full Service Partnership:
1. Effectiveness
a) Psychiatric Hospitalizations—To assess the degree of effectiveness for FSP level
services, CONTRACTOR will track decreases in the number of days hospitalized post-
enrollment and compare to the total number of days spent in the psychiatric setting
12 months prior to program enrollment.
b) Incarcerations—To reduce the total number of days spent confined in a jail or
prison setting, CONTRACTOR will track decreases and compare to the total number
of days spent incarcerated 12 months prior to program enrollment.
c) Homelessness—To reduce the total number of days spent homeless, CONTRACTOR
will track decreases and compare to the total number of days spent homeless 12
months prior to program enrollment.
d) Medical Hospitalizations—To reduce the total number of days spent in a hospital or
emergency department setting, CONTRACTOR will track decreases and compare to
the total number of days hospitalized 12 months prior to program enrollment.
e) Housing—Persons served in independent housing will develop a plan for assisting in
paying their own housing costs. Persons served will assume responsibility for
housing costs when deemed ready and appropriate.
f) Supplemental Security Income—Within six(6) months of enrollment, ninety-nine
percent (99%) of persons served without SSI will have made SSI applications.
Revised Exhibit Al
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CONTRACTOR shall provide a written report regarding these goals on a semi-annual
basis.
g) Productivity—Direct service productivity rate shall be a minimum of sixty-five
percent (65%).
2. Efficiency
a) Cost Per Person served—CONTRACTOR will efficiently use resources and maintain
or minimize costs per person served. Costs include all staffing and overhead costs
associated with program operations.
3. Access
a) Length of Time from Referral to First Contact—CONTRACTOR will provide timely
service for persons served requesting services.The goal wait time from referral to
first contact is within three (3) business days.
b) Length of Time from Referral to First Intake/Assessment Appointment—The goal
wait time from referral to first intake/assessment appointment is within ten (10)
business days.
c) Length of Time from Referral to First Psychiatry Appointment—The goal wait time
from referral to first psychiatry appointment is within fifteen (15) business days.
4. Satisfaction
a) Consumer Perception Survey—CONTRACTOR will gauge satisfaction of persons
served and collect data for service planning and quality improvement.The surveys
are conducted every six (6) months over a week period. Program beneficiaries are
encouraged to participate in completing the survey.The goal is for 75%of persons
served to be satisfied for each domain.
B. Intensive Case Management/Outpatient
1. Effectiveness
a) Psychiatric Hospitalization—To prevent hospitalizations and re-admissions for
persons served, CONTRACTOR will provide effective preventive interventions and
provide timely post-hospitalization follow-up services.The goal expectancy is for
10% or less of OP/ICM persons served to experience a psychiatric hospitalization.
Post-hospitalization follow-up services will occur within ten (10) days or less.
b) Inpatient Crisis Stabilization Services—To prevent crisis stabilization services and
re-occurrence of crisis stabilization services, CONTRACTOR will provide effective
preventative interventions and timely post-crisis stabilization follow up services.The
goal is for ten percent (10%) or less of OP/ICM persons served to experience a crisis
stabilization service.
c) Compliance—CONTRACTOR will comply with all requirements of the DBH Managed
Care Organizational Provider Manual.
Revised Exhibit Al
Page 10 of 19
d) Supplemental Security Income—Within six (6) months of enrollment, ninety-nine
percent (99%) of persons served without SSI will have made SSI applications.
CONTRACTOR shall provide a written report regarding these goals on a semi-annual
basis.
e) Productivity—Direct service productivity rate shall be a minimum of sixty-five
percent (65%).
2. Efficiency
a) Cost Per Person served—CONTRACTOR will efficiently use resources and maintain
or minimize costs per person served.
3. Access
a) Length of Time from Referral to First Contact—CONTRACTOR will provide timely
service for individuals requesting services.The goal wait time from referral to first
contact is within three (3) business days.
b) Length of Time from Referral to First Intake/Assessment Appointment—The goal
wait time from referral to first intake/assessment appointment is within ten (10)
business days.
c) Length of Time from Referral to First Psychiatry Appointment—The goal wait time
from referral to first psychiatry appointment is within fifteen (15) business days.
4. Satisfaction
a) Consumer Perception Survey—CONTRACTOR will gauge satisfaction of persons
served and collect data for service planning and quality improvement.The surveys
are conducted every six (6) months over a week period. Program beneficiaries are
encouraged to participate in completing the survey.The goal is for 75%of persons
served to be satisfied for each domain.
C. Contractor must address each of the categories referenced above and may additionally propose
other performance and outcome measures that are deemed best to evaluate the services
provided to persons served and/or to evaluate overall program performance. DBH may adjust
the performance and outcome measures periodically throughout the duration of the agreement,
as needed,to best measure the program as determined by the County. Contractor will be
required to utilize and integrate clinical tools as directed by DBH.
D. Contractor must utilize a computerized tracking system with which performance and outcome
measures and other relevant data, such as demographics, will be maintained. The data tracking
system may be incorporated into the selected Contractor's electronic health record (EHR) or be a
stand-alone database. County's DBH must be afforded read-only access to the data tracking
system, if applicable.
E. Contractor will be responsible for meeting with DBH on a monthly basis, or more often as agreed
upon between DBH and Contractor, for contract and performance monitoring. Contractor will be
Revised Exhibit Al
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required to submit monthly reports to the County that will include, but not be limited to: dollars
billed for Medi-Cal and MHSA(non-Medi-Cal) persons served; actual expenses; the number of
persons served served/anticipated to be served; utilization of services by persons served; and
staff composition. These reports will be due within thirty(30) days after the last day of the
previous month or payments may be delayed.
F. Additional reporting is required for FSPs by DHCS via the DCR system to ensure adequate
research and evaluation, regarding the effectiveness of services being provided and the
achievement of the outcome measures. Contractor will need to report person served/partner
information and outcomes of the FSP program directly into the DCR system. Data will be
submitted through an online interface using specific forms (see Exhibit F).
G. The Partnership Assessment Form gathers baseline information about the partner and is
completed once the partnership is established. Key Event Tracking provides a snapshot of
changes in key quality of life areas and is tracked on a continuous basis throughout the course
of the FSP. The Quarterly Assessment collects updated information about changes in quality of
life areas and is completed every three (3) months from the date the partnership is established.
H. In addition to the requirements set above,the following items listed below represent
program goals to be achieved by Contractor. The program's success will be based on the
number of goals it can achieve, resulting from performance outcomes. Contractor will utilize a
computerized tracking system with which outcome measures and other relevant person served
data, such as demographics, will be maintained.
I. Continuous improvement is a core tenant of the Department and MHSA. Over the past few years,
County DBH participated in a statewide FSP evaluation project. The result of the project required
that DBH should add another question to the State required DCR data as follows:
a. "How often do you get the social and emotional support that
you need? [Response options: always, usually, sometimes,
rarely, never]
J. Outcomes Regarding Crisis Interventions and Recidivism:
Each enrollee will have no more than six (6) key events (specifically incarceration, homelessness,
and crisis or inpatient hospitalization admission) during the first six(6) months in the TAY program.
There will be a reduction of key events for enrollees tracked as:
( No more than three (3) key events (incarceration, homelessness, and crisis or inpatient
hospitalization admission) during months six to twelve (6-12) of enrollment in program.
( No more than one (1) key event(incarceration, homelessness, and crisis or inpatient
hospitalization admission) during months thirteen to eighteen (13-18) of enrollment in
program.
1. FSP will reduce days of homelessness after being enrolled in the program, unless person served
declined housing assistance. Contractor shall notify DBH of an individual's decline and
Revised Exhibit Al
Page 12 of 19
document accordingly. Contractor must have clear documentation of efforts to house the
person served in an appropriate setting.
2. FSP will show a ninety percent (90%) reduction in days in inpatient psychiatric hospitalizations
after being enrolled in the FSP compared to the year prior to enrollment in the FSP.
3. FSP will show a ninety percent (90%) reduction in days incarcerated after being enrolled in the
FSP compared to the year prior to enrollment in FSP.
K. Outcomes Regarding Linkages and Referrals:
1. Within ninety(90) days of being enrolled in the FSP, one hundred percent(100%) of persons
served who did not have supplemental security income (SSI) will have made applications
completed to receive SSI. Contractor will provide this data as requested.
2. Within six(6) months of being enrolled in the FSP, one hundred percent(100%) of persons
served will have linkages to and documentation of a Primary Care Physician.
3. Within thirty (30) days of enrollment, one hundred percent (100%) of persons served will have
participated in forming their Individual Service Plan.
4. Within one hundred twenty (120) days of enrollment, one hundred percent(100%) of persons
served will be provided and/or linked to job coaching activities.
5. Where appropriate, within ninety (90) days of enrollment, at least seventy-five percent (75%)
of applicable persons served will have been offered the opportunity to participate in
Supportive Education and Employment Services.Within one hundred twenty (120) days of
enrollment, at least ninety-five percent(95%) of applicable persons served will have been
offered the opportunity to participate in Supportive Education and Employment Services.
Outcomes will be monitored to see if the person served has meaningful use of their time, stays in school
or maintains employment, hospitalizations and incarcerations are reduced as well as homelessness.
County's DBH will use State criteria for measuring these outcomes.
Contractor will be monitored regarding services delivered and if they meet the goals of the MHSA.
This program will use an effective method likely to bring about intended outcomes, based on one of, or
a combination of,the following standards (as defined by current MHSA regulations):
( Evidence-based practice standard
Promising practice standard
Community defined practices
Contractor will collect all data and fulfill all reporting requirements as specified in the applicable MSHA
regulations related to the program type, strategies, and standards indicated above or as indicated in
MHSA regulations. Contractor will work with County to ensure data, outcomes, and reports are
included in all required MHSA reports, plans, and updates.
Revised Exhibit Al
Page 13 of 19
Current MHSA Regulations can be found at the following website: https://mhsoac.ca.gov/wp-
content/uploads/MHSA-Jan2020 O.pdf
Contractor should understand all MHSA regulations to ensure they have the organizational capacity to
record,track, and report all required elements.
Contractors shall utilize a computerized tracking system with which performance and outcome
measures and other relevant person served data, such as demographics, will be maintained.The data
tracking system may be incorporated into the Contractors' electronic health records (EHR) systems or in
stand-alone databases (e.g.,Access or Excel spreadsheets). DBH must be afforded read-only access to
the data tracking system.The following items listed below represent program goals to be tracked and
achieved by the Contractors during the contract terms.
VIII.TRANSITION OPTIMIZATION FUNDS
One-time Transition Optimization Funds will be available to specialty mental health providers and Drug
Medi-Cal providers within FY 2023-24 to encourage Contractors to identify and implement organization
changes during the first year of CalAIM Payment Reform to improve outcomes for persons served and
create operational efficiencies. Contractor is expected to utilize the strategies, tools and knowledge
learned to their programming and continue to improve services for the population served.
A. Funding Allocation Methodology
1. Each participating contractor is eligible to apply for an allocation of Transition Optimization
Funds up to the maximum amounts stated in Article 4 of this Agreement and further
described below.Transition Optimization Funds will only be available from July 1, 2023
through June 30, 2024 and payments shall be on a quarterly basis.
2. Payments will be disbursed upon review and approval by DBH of each deliverable described
below. Quarterly progress reports shall be submitted to DBH in order to show progress as
outlined in the submitted plans and deliverables.
3. Payments will be dependent on Contractor demonstrating progress toward meeting
deliverables described in this Revised Exhibit B. Contractors who fail to submit progress
reports by stated deadlines, or who do not demonstrate adequate progress made, may be
determined ineligible for that quarter's payment at the sole discretion of the County.
4. All invoices will be submitted on a quarterly basis within fifteen (15) days following the end
of the quarter. Invoices submitted thereafter may not be eligible for payment.
B. Responsibilities
1. Letter of Intent
Contractor shall submit a letter of intent to DBH by July 31, 2023 identifying the selected
Transition Optimization Activity(ies) and commitment to meet the deliverable deadlines as
described below.The letter shall include all current Medi-Cal billable specialty mental health
and substance use disorder services agreements the Contractor has with the County.
Revised Exhibit Al
Page 14 of 19
The County shall respond to the Contractor's letter of intent within thirty(30) days.The
County's response shall include a breakdown of anticipated payments, as determined by the
County, depending on the Transition Optimization Activity(ies) chosen and depending on the
number of current Medi-Cal billable specialty mental health and substance use disorder services
agreements the Contractor has with the County.
2. Quarterly Reports
Contractor shall submit quarterly progress reports and invoices. Reports shall be submitted
on the dates indicated in the Schedule of Deliverables below. Invoices are due fifteen (15) days
after the end of each quarter.All activities shall be completed by June 30, 2024.The report shall
include updated plans/tools and progress Contractor has made toward the Transition
Optimization Activity(ies) described in each Contractors' letter of intent.
3. Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool, and Electronic Health
Record
i. Q1 Reports: July-Sept:
1. Letter of Intent: Due July 31, 2023
2. Fiscal Monitoring Tool, Equity Gap Analysis, and Electronic Health Record
Implementation Plans (if applicable): Due September 30, 2023
3. Fiscal Monitoring Tool Identified Practices and Strategies (if applicable): Due
September 30, 2023
ii. Q2 Report: Oct-Dec: Due January 15, 2024
iii. Q3 Report:Jan-Mar: Due April 15, 2024
iv. Q4 Report: Apr-June: Due July 15, 2024
V. All deliverables will be reviewed and approved by DBH prior to payment.
4. Eligible Transition Optimization Activities
i. Fiscal Monitoring Tools: Contractor shall submit to DBH a draft of their fiscal
monitoring tool that shall be used monthly on an ongoing basis to evaluate fiscal
health of the organization.Tools shall, at a minimum, monitor costs, productivity
targets and identify one or more practice pattern(s) the organization is employing
to increase direct care time to the Medi-Cal population.
1. Fiscal Monitoring Tools and Implementation Plan: Contractor shall develop
fiscal monitoring tools that will be used monthly to ensure their
organizational fiscal health and implementation plan. Fiscal monitoring tools
drafts and implementation plan shall be submitted to DBH by September
30, 2023.
i. Identified Practice: Identify at least one process improvement that
shall be modified by September 30, 2023.
Revised Exhibit Al
Page 15 of 19
ii. Quarterly Progress Reports: Quarterly progress reports shall be
submitted including but not limited to a narrative of progress,
obstacles, alternative solutions and outcomes.
iii. Funding for this activity shall be available up to $25,000 for the
initial agreement with Contractor and up to another$10,000 for
each additional agreement. County shall provide further details on
deliverables and payment schedule in County's response to the
Contractor's letter of intent.
ii. Equity Gap Analysis: Contractor shall produce a report identifying the
race/ethnicity of population served in FY 2022-23 compared to the County's
population as provided by the County. Contractor shall identify key disparities in
both persons served and amount of services and frequency of transitions to other
levels of care received. Contractor shall identify three (3) strategies they shall
employ during FY 2023-24 to reduce the disparities among underserved
population.
1. Report on Underserved Population: Contractor shall submit an Equity Gap
Report to the Department containing including, but not limited to,the
following:
i. Identify if it serves specific population within its program(s) and
identify whom the program(s) currently served based on data.
ii. Staffing/workforce information and demographics. Report the
staffing/workforce supporting the different programs and
populations served by the provider in Fresno County.This data is to
evaluate how the staffing reflects the populations it is serving.
iii. Comparison of the County penetration rates to the demographics of
persons served by the Contractor and program(s) under agreement
with DBH.
iv. Data on retention of persons served by demographics.Total persons
served and the average length of stay by demographics of the
persons served in programs.
i. Which populations are remaining in the programs by
demographics, which ones are having the shortest stays.
ii. How long is the average length of stay by the demographics.
V. Identify what data points the Contractor is missing at this time that
challenges its ability to thoroughly assess its equity gap analysis.
Examples: data is not collected, data that is missing or under
reported, data not captured in its processes, etc.
Revised Exhibit Al
Page 16 of 19
2. Equity Improvement Implementation Plan: Contractor shall submit an
Equity Improvement Implementation Plan related to improving health
equity by September 30, 2023.The plan shall include the following items at
a minimum:
i. Contractor shall select three (3) strategies from below:
i. Plan shall include specific efforts including, but not limited
to,the following and timelines to increase access to
underserved groups.
1. Outreach/Engagement with underserved
communities
2. Active attendance/participation in DBH's Diversity
Equity and Inclusion (DEI) workgroup
3. Plan for retention of persons served in programs
who are under represented
4. Improvement of demographic data collection
including Sexual Orientation Gender Identity
(SOGI)/LGBTQ data.
ii. Plan shall address workforce capacity to render services to
more underserved populations,through:
1. Development of bilingual personnel
2. Recruitment plan for more diverse workforce to
reflect populations served.
3. Training for workforce to increase capacity to be
culturally responsive
4. Development workforce pool for the future that can
be bilingual and bicultural
ii. Timeline for each effort shall be included in the plan.
iii. Contractor shall identify the measurement to be used to
demonstrate successful implementation of plan. Measure may be
identified by the Contractor to best support their plan and goals.
iv. Contractor shall develop and submit policies and procedures to
formally support equity effort.
3. Quarterly Progress Reports: Use available data including but not limited to,
External Quality Review Organization (EQRO) and EHR data to evaluate the
strategies deployed. Quarterly progress reports shall be submitted including
but not limited to a narrative of the progress, obstacles, alternative
Revised Exhibit Al
Page 17 of 19
solutions and outcomes.The final quarter shall include a comprehensive
final report on the outcomes.
4. Funding for this activity shall be available up to $25,000 for the initial
agreement with Contractor and up to another$10,000 for each additional
agreement. County shall provide further details on deliverables and
payment schedule in County's response to the Contractor's letter of intent.
C. Electronic Health Record (EHR):The implementation and expansion of the SmartCare EHR is an
essential component of improving oversight with the implementation of payment reform.
Furthermore, a standardized EHR will improve continuity of care, create transparency across the
system, remove obstacles for individuals accessing services and improve the overall outcomes for
persons served. For Contractors who plan to opt in to use SmartCare or have previously opted into
DBH's former EHR and intend to transition to SmartCare, user fees and costs shall be waived during
FY 2023-2024 and FY 2024-2025.
1. Option One: Current EHR Users
i. Strategic Plan: Contractors utilizing DBH's EHR as their current EHR, and who will
continue to utilize SmartCare beginning July 1, 2023, shall provide a plan,
including, but not limited to, how they will optimize Medi-Cal billing, illustrate
how they will utilize the information in the EHR to improve care for persons
served, and a training plan for their organization by September 30, 2023.
i. Quarterly Progress Reports: Quarterly progress reports shall be
submitted, including, but not limited to, a narrative on the progress,
obstacles, alternative solutions and outcomes.
ii. Total compensation for this EHR activity, Option 1, shall not exceed
$50,000.00 split among all current agreements between the
Contractor and the County for Medi-Cal billable specialty mental
health and substance use disorder services. County shall provide
further details on deliverables and payment schedule in County's
response to the Contractor's letter of intent.
2. Option Two: Non-EHR Users
i. Contractor shall submit an implementation plan by September 30, 2023 regarding
how they will transition to utilizing the SmartCare EHR by June 30, 2024.The plan
shall include, at a minimum, an identified Go Live Date, plan on how the current
record system will be maintained and utilized,training plan including number of
individuals, and additional supports.The Go Live Date must occur by June 30,
2024 to receive final payment. Contractor shall work closely with DBH to identify
needs, assignments, collaboration opportunities to transition.
ii. For Option 2,the Contractor shall not be reimbursed more than $200,000 split
among all current agreements between the Contractor and the County for Medi-
Cal billable specialty mental health and substance use disorder services.The total
Revised Exhibit Al
Page 18 of 19
maximum compensation available for this option, shall include costs for
maintaining current electronic health record/record system and additional
supports and training costs per user. Contractor shall transition both specialty
mental health and Drug Medi-Cal programming to the County's EHR and shall be
required to use the County's EHR for future eligibility agreements with DBH.
County shall provide further details on deliverables and payment schedule in
County's response to the Contractor's letter of intent.
IX. REPORTS
A. Contractors shall prepare an evaluation report annually, which will be submitted to County's DBH
and made available to partnering and interested local agencies and organizations (e.g., project
collaborators, other community agencies, and mental health treatment providers). Annual
evaluation reports will include the following information: demographics of the target population
served, services provided to each participant, number of hospitalizations, enrollment in school,
results of data analysis compared to planned process, output and outcome measures, barriers to
program implementation and measures taken to overcome those barriers, accomplishments of
program participants, lessons learned, and the final result of any and all satisfaction survey(s).
B. Contractors shall be expected to comply with all contract monitoring and compliance protocols,
procedures, data collection methods, and reporting requirements conducted by County.
C. Additional reports and outcome information may be requested by County at a later date, as needed.
D. Additional Reporting Requirements
Contractors will be responsible for meeting with DBH on a monthly basis, or more often as agreed
upon between DBH and Contractors, for contract and performance monitoring.
Contractors will be required to submit monthly reports to the County that will include, but not be
limited to: the number of persons served served/anticipated to be served; utilization of services by
persons served; and staff composition.These reports will be due within thirty (30) days after the last
day of the previous month or payments may be delayed.
Additional reporting is required for FSPs by DHCS. DHCS uses the FSP Data Collection and Reporting
(DCR)system to ensure adequate research and evaluation, regarding the effectiveness of services
being provided and the achievement of the outcome measures. Contractors will need to report
individual/partner information and outcomes of the FSP program directly into the DCR system. Data
will be submitted through an online interface using specific forms.The Partnership Assessment
Form gathers baseline information about the partner and is completed once the partnership is
established. Key Event Tracking provides a snapshot of changes in key quality of life areas and is
tracked on a continuous basis throughout the course of the FSP.The Quarterly Assessment collects
updated information about changes in quality of life areas and is completed every three (3) months
from the date the partnership is established.
Continuous improvement is a core tenant of the Department and the Mental Health Services Act
(MHSA). As a result of a multi-year statewide FSP evaluation project that the County DBH
participated in, another question has been added to the State required DCR data as follows:
Revised Exhibit Al
Page 19 of 19
"How often do you get the social and emotional support that you need?" Response options will be:
"always, usually, sometimes, rarely, or never".
X. COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Assist Contractors' efforts to evaluate the needs of each enrolled individual on an ongoing basis to
ensure that the level of care each person served is receiving is clinically appropriate.
B. Provide oversight and collaborate with contractors and other County Departments and
community agencies to help achieve State program goals and outcomes. Oversight includes,
but is not limited to, contract monitoring and coordination with the State Department of
Health Care Services in regard to program administration and outcomes.
C. Assist Contractors in making linkages with the total mental health system of care. This will be
accomplished through regularly scheduled meetings as well as formal and informal
consultation.
D. Participate in evaluating overall program progress and efficiency and be available to
contractors for ongoing consultation.
E. Gather outcome information from target person served groups and Contractors throughout each
term of this Agreement. County shall notify contractors when their participation is required. The
performance outcome measurement process will not be limited to survey instruments but will
also include, as appropriate, person served and staff interviews, chart reviews, and other
methods of obtaining required information.
F. Assist Contractors' efforts toward cultural and linguistic competency by providing the
following to contractors:
1. Technical assistance and training regarding cultural competency requirements at no
cost to contractors.
2. Mandatory cultural competency training for contractors' personnel, on an annual
basis, at minimum.
3. Technical assistance for translating information into County's threshold languages
(Spanish and Hmong). Translation services and costs associated will be the responsibility
of contractors.
Exhibit G1a
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
FSP and AOT
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1,140.98
Physicians Assistant $511.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LV N $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
Other Qualified Providers-Other Designated MH staff that bill $223.41
Service Unit Maximum Units that Can be Rate per Unit
Billed
Interactive Complexity 15 mins per 1 per allowed procedure per $16.50
unit provider per beneficiary
Sign Language or Oral Interpretive Services 15 mins per Variable $30.00
unit
Exhibit G1 b OP-ICM Rates
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
Field Based
(at least 50%of services are provided in the field)
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $988.85
Physicians Assistant $443.50
Nurse Practitioner $491.73
RN $401.65
Certified Nurse Specialist $491.73
LVN $211.00
Pharmacist $473.34
Licensed Psychiatric Technician $180.89
Psychologist/Pre-licensed Psychologist $397.68
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $257.35
Occupational Therapist $342.58
Mental Health Rehab Specialist $193.62
Peer Recovery Specialist $203.30
Other Qualified Providers-Other Designated MH staff that bill
medical $193.62
Revised Exhibit H
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)All-Risk Property Insurance. All-Risk Property Insurance with no coinsurance penalty
provision in an amount that will cover the total of County purchased and owned property
in possession of Contractor(s) and/or used in the execution of this Agreement.
Contractor must name the County as an Additional Loss Payee.
(D)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(E) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(F) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(G)Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
H-1
Revised Exhibit H
(H) Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under [identify
the Article, section, or exhibit containing data security obligations] of this Agreement; (iv)
system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security
Breach; (vii)failure to comply with privacy policy; (viii) payment card liabilities and costs;
(ix) infringement of intellectual property, including but not limited to infringement of
copyright, trademark, and trade dress; (x) invasion of privacy, including release of
private information; (xi) information theft; (xii) damage to or destruction or alteration of
electronic information; (xiii) cyber extortion; (xiv) extortion related to the Contractor's
obligations under this Agreement regarding electronic information, including Personal
Information; (xv) fraudulent instruction; (xvi) funds transfer fraud; (xvii) telephone fraud;
(xviii) network security; (xix) data breach response costs, including Security Breach
response costs; (xx) regulatory fines and penalties related to the Contractor's obligations
under this Agreement regarding electronic information, including Personal Information;
and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
H-2
Revised Exhibit H
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
H-3
Revised Exhibit H
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
H-4