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California Forensic Medical Group Inc.-Comprehensive Medical Behavioral Health Care Services JJC_A-24-312.pdf
COD U Hall of Records,Room 301 County of Fresno 2281 Tulare Street Fresno,California Board of Supervisors 93721-2198 O 185 O Telephone:(559)600-3529 E 5� Minute Order Toll Free: 1-800-742-1011 FR www.fresnocou ntyca.g ov June 18, 2024 Present: 5- Supervisor Steve Brandau,Chairman Nathan Magsig,Vice Chairman Buddy Mendes, Supervisor Brian Pacheco,and Supervisor Sal Quintero Agenda No. 54. Probation File ID:24-0537 Re: Approve and authorize the Chairman to execute an Agreement with California Forensic Medical Group, Inc.,for comprehensive medical and behavioral health care services,including substance use disorder services,to youth detained at the County Probation Department Juvenile Justice Campus,effective July 1,2024, not to exceed five consecutive years,which'includes a three-year base contract and two optional one-year extensions,total not to exceed$22,158,748 APPROVED AS RECOMMENDED Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero Agreement No.24-312 County of Fresno Page 58 co Board Agenda Item 54 O 1856 O DATE: June 18, 2024 TO: Board of Supervisors SUBMITTED BY: Kirk Haynes, Chief Probation Officer, Probation Department David Luchini, Director, Department of Public Health Susan L. Holt, Director, Department of Behavioral Health SUBJECT: Agreement with California Forensic Medical Group, Inc.for Comprehensive Medical and Behavioral Health Care Services at County Juvenile Justice Campus RECOMMENDED ACTION(S): Approve and authorize the Chairman to execute an Agreement with California Forensic Medical Group, Inc.,for comprehensive medical and behavioral health care services, including substance use disorder services,to youth detained at the County Probation Department Juvenile Justice Campus, effective July 1, 2024, not to exceed five consecutive years,which includes a three-year base contract and two optional one-year extensions,total not to exceed $22,158,748. Approval of the recommended action will allow for the continuation of comprehensive medical and behavioral health, including substance use disorder(SUD), services for detained youth at the Juvenile Justice Campus (JJC). California Forensic Medical Group, Inc., dba Wellpath (CFMG) is the current provider. The recommended agreement will be administered by the Probation Department. It includes an annual $25,000 pharmacy cap per youth per year and will be funded with a combination of Health Realignment, Mental Health Realignment, Juvenile Justice Crime Prevention Act and Youth Offender Block Grant,American Rescue Plan Act(ARPA) State and Local Fiscal Recovery Funds (SLFRF)and Net County Cost funds. This item is countywide. ALTERNATIVE ACTION(S): There is no viable alternative action. The County's current agreement with CFMG for medical services expires on June 30, 2024.Additionally, the County's current agreement with Mental Health Systems, Inc. for substance use disorder services for youth detained at the JJC expires on June 30, 2024. If the recommended action is not approved, the County would be unable to provide health care services to youth detained at the JJC as mandated by Title 15 and 24 of the California Code of Regulations- Minimum Standards for Juvenile Facilities. FISCAL IMPACT: The five-year recommended agreement has provisions for a three-year base term and two optional one-year extensions, through June 30, 2029. The maximum compensation for the five-year recommended agreement is$22,158,748. The annual maximum compensation includes an annual fiscal year rate increase at a minimum three and a half percent(3.5%) or based on National Consumer Price Index(CPI), not to exceed five percent(5%), beginning FY 2025-26 and is as follows (shown is the annual compensation with the 5% increase per year after FY 2024-25): County of Fresno page 1 File Number.24-0537 File Number.24-0537 • FY 2024-25 $4,010,175 • FY 2025-26 $4,210,684 • FY 2026-27 $4,421,218 • FY 2027-28 $4,642,279 • FY 2028-29 $4,874,393 The recommended agreement will be offset with a combination of Health Realignment, Mental Health Realignment, Juvenile Justice Crime Prevention Act and Youth Offender Block Grant, ARPA SLFRF, and Net County Cost monies. Sufficient appropriations and estimated revenues will be included in the Probation Department's Org 3440 budget requests for the duration of the term. DISCUSSION: Title 15 and Title 24 of the California Code of Regulations-Minimum Standards for Local Detention Facilities requires that the County provide State and Federal mandated medical and behavioral health care to individuals housed in the JJC. On April 3, 2018, the Board approved County agreement number A-18-170 with CFMG for the provision of medical and behavioral health care services to youth detained in the County Probation Department's JJC through June 30, 2023. On November 8, 2022, under Board of Supervisors Administrative Policy 34, the Board determined that an exception to the competitive bidding requirements was satisfied and a suspension of competition was warranted due to unusual or extraordinary circumstances, as CFMG has been a key component in making progress in the jail's delivery of medical and mental health care including the development of complex medical policies and procedures which account for nearly one half of the County's remedial plan, as part of the County's 2015 consent decree. Changing medical and behavioral health care providers would delay finalization of the remedial plan, and the Board authorized County staff to develop renewal agreements with CFMG. On June 20, 2023, the Board approved Amendment I No. A-23-265 to Agreement A-18-170 to extend the term of the 2018 agreement for an additional three (3) months, through September 30, 2023, with the option of an additional three-month extension through December 31, 2023, to continue the provision of necessary medical and behavioral health care services to youth at the JJC and increase compensation accordingly, while negotiations were ongoing for the new agreement. On December 12, 2023, the Board approved Amendment 11 No. A-23-670 to extend the term for an additional six(6) months through June 30, 2024, and increase compensation, to complete negotiations for the new agreement. The recommended agreement differs from the current comprehensive medical and behavioral health care services agreement as follows: • The recommended agreement provides that SUD services, including medication assisted treatment (MAT)services, shall now be provided by CFMG.This follows the practice currently in place at the Jail facilities,with CFMG delivering medical, mental health and SLID services, and will ensure better care coordination for detained youth with co-occurring healthcare needs. • The recommended agreement provides an annual fiscal year maximum compensation increase at a minimum three and a half percent (3.5%)or based on National Consumer Price Index(CPI) not to exceed five percent (5%). • The liquidated damages amount is lower than in the current agreement, as discussed in more detail below. • In the current CFMG agreement, CFMG may terminate without cause with 90 days' notice, although CFMG must continue providing services until a new provider is found. The recommended agreement lists limited reasons why CFMG may terminate under this provision, has a required 90 -day negotiation period, and a 180-day notice period before termination. CFMG must also continue providing services until a new provider is found. This is discussed in more detail below. County of Fresno page 2 File Number:24-0537 File Number;24-0537 The recommended agreement provides for all medical and behavioral health care services, including substance use disorder and MAT services, provided to youth detained at the JJC and any Probation facility offsite from the JJC, with the exclusion of hospital inpatient healthcare costs and elective medical care costs.The recommended agreement requires CFMG to pay for all Detained Youth pharmacy costs, capped at$25,000 per year for each individual detained youth. CFMG shall have exclusive use of approximately 5,955 square feet at the JJC to provide these services, as well as use of County-provided medical and dental equipment. CFMG is required to provide janitorial services for all designated work areas at the JJC. The recommended agreement also provides that the annual compensation may be adjusted if the average daily population (ADP)of detained youth served exceed 150 detained youth in any calendar month or falls below 100 detained youth in any calendar month. If the ADP exceeds 150 detained youth in any month,the compensation payable to CFMG will be increased by$4.64 per day for the number of days in the month for each detained youth over 150. Conversely, if the ADP falls below 100 detained youth, CFMG shall rebate the County$4.64 per day for the number of days in the month for each detained youth less than 100. If either of these ADP changes occurs for 90 consecutive days or more, the parties must meet and negotiate to adjust the staffing levels and/or compensation to accommodate those changes. If the parties cannot agree during this negotiation, the agreement may be terminated, although CFMG would have to continue providing services until an alternate provider is located. The recommended agreement requires that CFMG track, provide sufficient documentation, and use specified billing codes for certain COVID-19 pandemic-related expenditures that may be reimbursable with ARPA SLFRF. The recommended agreement also specifies that the Probation Department may impose liquidated damages if CFMG fails to meet performance standards, including but not limited to failure or delay in providing or maintaining minimum staffing levels and failure to maintain National Commission on Correctional Health Care accreditation of the JJC. These liquidated damages are$1,500 per day against CFMG for each separate violation of any requirement or performance standard, excluding staffing level violations. These liquidated damages are lower than in the prior agreement,which specified $2,500 per day against CFMG for each separate violation. However, during the term of the current agreement, these liquidated damages have never been assessed against CFMG. For violations of staffing level requirements, CFMG must issue reimbursement to County of the daily salary and costs of any unfilled position per day of violation. This section provides CFMG a 60-day cure period before the liquidated damages are assessed. When the California Advancing and Innovating Medi-Cal (CaIAIM)Justice Involved initiative is fully implemented at JJC, the Probation Department will return to your Board with an amendment to incorporate Medi-Cal billing and revenue for eligible pre-release medical and behavioral health services provided by CFMG. The recommended agreement provides that County may terminate the recommended agreement without cause by giving 90-days' notice to CFMG. CFMG may terminate the recommended agreement without cause in the event of any material change circumstance by giving notification to the County of at least 180 days advance written notice after a 90-day good faith negotiation period. The recommended agreement defines"material change circumstance"as either: (1) new, amended, and/or repealed federal or state laws or regulations that render CFMG's performance completely impossible under the Agreement's existing terms, (2)extreme and unforeseen changes to legal/regulatory requirements, extreme and unforeseen changes to the applicable standard of care or changes to the site's medication formulary, or if the United States Food and Drug Administration that recommend, approve, or issue an emergency use authorization for a new therapy, diagnostic, or treatment modality that render CFMG's treatment of County's patients impossible under the agreement, or(3) CFMG's performance is rendered impossible by a Public Health Emergency declared pursuant to the Federal or State governments. However,whether the County or CFMG terminates pursuant to these provisions, CFMG must continue to County of Fresno Page 3 File Number:24-0537 File Number. 24-0537 provide services under the agreement until a successor contractor has commenced performing the services, provided the County is engaging in good faith to secure the successor contractor. REFERENCE MATERIAL: BAI #45, December 12, 2023 BAI#30, June 20, 2023 BAI #8, November 8, 2022 BAI #8.1,April 3, 2018 ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk-Agreement with CFMG CAO ANALYST: Fine Nai County of Fresno Page 4 File Number.24-0537 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Agreement No. 24-312 1 SERVICE AGREEMENT 2 This Service Agreement ("Agreement") is dated June 18, 2024 and is between 3 California Forensic Medical Group, Inc., a California stock corporation ("Contractor"), and the 4 County of Fresno, a political subdivision of the State of California ("County"). 5 Recitals 6 A. County is required under Title 15 of the California Code of Regulations to provide 7 necessary medical and behavioral health care to detained youth. 8 B. On April 3, 2018, County and Contractor entered into County Agreement No. A-18-170 9 for a qualified correctional health care organization to provide medical and behavioral health 10 care services to the youth detained at the County Probation Department ("Probation") Juvenile 11 Justice Campus, located at 3333 E. American Ave, Fresno, California, 93725 ("JJC"). 12 C. On November 8, 2022, County's Board of Supervisors authorized County staff to 13 develop a new agreement with Contractor, to allow for continuity of operations and services to 14 youth detained at the JJC, including the implementation of services to realigned youth detained 15 at the JJC as a result of the closure of the California Department of Corrections and 16 Rehabilitation, Division of Juvenile Justice. 17 D. Contractor represents that it has the necessary training, experience, expertise, 18 competency and skilled personnel with the proper licensure, certification, education and work 19 experience for the provision of medical and behavioral health care services within the JJC. 20 The parties therefore agree as follows: 21 Article 1 22 Contractor's Services 23 1.1 Scope of Services. Contractor shall perform all of the services provided in Exhibit A 24 to this Agreement, titled "Scope of Services," attached and incorporated by this reference. 25 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and 26 able to perform all of the services provided in this Agreement. 27 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all 28 applicable federal, state, and local laws and regulations in the performance of its obligations 1 DocuSign Envelope ID:AB22DESC-6AB7-437C-9F73-2CA1796B82A7 1 under this Agreement, including but not limited to workers compensation, labor, and 2 confidentiality laws and regulations. 3 Contractor shall provide services in conformance with all applicable State and Federal 4 statutes, regulations and subregulatory guidance, as from time to time amended, including but 5 not limited to: 6 . (A) California Code of Regulations, Title 15, Minimum Standards for Local Detention 7 Facilities; 8 (B) California Welfare & Institutions Code Section 5150, et seq. and 5600.4; 9 (C) California Penal Code Section 4011.6; 10 (D) California Education Code; 11 (E) California Code of Regulations, Title 9; 12 (F) California Code of Regulations, Title 22; 13 (G)California Welfare and Institutions Code, Division 5; 14 (H) United States Code of Federal Regulations, Title 42, including but not limited to 15 Parts 438 and 455; 16 (1) United States Code of Federal Regulations, Title 45; 17 (J) United States Code, Title 42 (The Public Health and Welfare), as applicable; 18 (K) Balanced Budget Act of 1997; 19 (L) Health Insurance Portability and Accountability Act (HIPAA); and 20 (M)Applicable Medi-Cal laws and regulations, including applicable sub-regulatory 21 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and 22 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of 23 County, state or federal contracts governing services for persons served as applicable to 24 county correctional facilities. 25 In the event any law, regulation, or guidance referred to in this section 1.3 is amended 26 during the term of this Agreement, the parties agree to comply with the amended authority as of 27 the effective date of such amendment without amending this Agreement. 28 2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Contractor recognizes that County operates its mental health and substance use 2 disorder programs under agreements with California State Department of Health Care Services 3 ("DHCS"), and that under these agreements, the State imposes certain requirements on County 4 and its subcontractors. Contractor shall adhere to all State requirements, including those 5 identified in Exhibit B, "Behavioral Health Requirements". 6 Contractor shall work with the County Health Officer who, under the Health and Safety 7 Code Section 101045, shall investigate health and sanitary conditions in every County detention 8 facility. Contractor shall work with County's Department of Public Health ("DPH") concerning 9 communicable disease and substance use screening and management, continuing medical 10 services, case management and coordination with California Advancing and Innovating Medi- 11 Cal (CaIAIM) requirements, reporting and Detained Youth referrals in the community. 12 1.4 Meetings. 13 (A) Monthly Administrative Meetings. Contractor shall schedule, facilitate, and hold 14 monthly administrative meetings with designated County staff and/or designees to 15 evaluate and address statistics, program needs, problems/issues that may arise, 16 interrelationships between County's JJC staff and Contractor's medical and behavioral 17 healthcare services staff, and relationships with providers of emergency, inpatient or 18 outpatient specialty care services. Contractor shall provide County staff with statistics in 19 electronic format covering medical and behavioral health services prior to the meeting. 20 (B) Continuous Quality Improvement ("CQI") Committee. Contractor shall organize a 21 CQI committee that includes Contractor and County designated staff. Contractor shall 22 schedule, facilitate and hold quarterly CQI committee meetings to identify opportunities 23 and develop strategies for improvement in quality care provided to Detained Youth. 24 Contractor shall provide County staff with CQI data and minutes from the prior meeting 25 prior to the upcoming meeting_ 26 (C) Probation JJC Meetings. Contractor shall participate in multi-disciplinary 27 meetings at JJC with Probation staff and Probation's other contracted providers. These 28 meetings include, but shall not be limited to, monthly institutional collaborative meetings 3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 ("JJC Management Team") and weekly, or as needed, transition meetings for Detained 2 Youth committed to JJC and preparing for re-entry into the community. Schedules for 3 these meetings may change based on the needs of Probation. 4 (D) Contractor shall participate in monthly, or as needed, workgroup meetings 5 consisting of staff from County's Department of Behavioral Health ("DBH") to discuss 6 service requirements, data reporting, training, policies and procedures, overall program 7 operations and any problems or foreseeable problems that may arise. Contractor shall 8 also participate in other County DBH meetings, including, but not limited to quality 9 improvement meetings, provider meetings, Behavioral Health Board ("BHB") meetings, 10 BHB Forensic subcommittee meetings, and bi-monthly contractor meetings. Schedules 11 for these meetings may change based on the needs of the County's DBH. 12 1.5 Contractor acknowledges that County's JJC is operated as a no hostage facility; 13 therefore, all services provided shall be performed in accordance with Probation's Hostage 14 Situation Policy, as well as Probation's JJC Manual Policy for Vendors, Volunteers and Student 15 Interns, as described in Exhibit C to this Agreement. Contractor shall comply with all Probation's 16 JJC policies, procedures and protocols related to safety and security of the Detained Youth and 17 facility. 18 1.6 Staffing. Contractor agrees that prior to providing services under the terms and 19 conditions of this Agreement, Contractor shall have staff hired and in place for program services 20 and operations or County may, in addition to other remedies it may have, suspend referrals or 21 terminate this Agreement, in accordance with Article 7 of this Agreement. 22 (A) Contractor shall, in performing all services and duties under this Agreement, 23 provide only qualified personnel who are licensed, certified and/or registered, as 24 necessary, to practice in the State of California, who are not debarred, excluded or 25 suspended by any local, State or Federal regulatory agency from practicing and are 26 acceptable to County's Chief of Probation, DPH Director, DBH Director, or their 27 respective designees. This section shall apply to all Contractor's subcontracted 28 personnel, pursuant to section 9.7, "Subcontracts." 4 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (B) Contractor, its staff members, and subcontractors participating in this Agreement 2 shall maintain throughout the term of this Agreement all licenses necessary for 3 Contractor to render medical and behavioral health care services as provided in this 4 Agreement, pursuant to all terms and conditions set forth in section 1.10, "Licenses and 5 Certification." Any failure to maintain any such licenses or any revocation or non-renewal 6 of any these licenses shall be grounds for termination of this Agreement by County. 7 (C) Contractor shall provide medical, technical, and support personnel as necessary, 8 to render medical and behavioral health care services to Detained Youth and fulfill all 9 duties under this Agreement. 10 (D) Contractor's staff and subcontractors working at the JJC shall be required to 11 pass a background investigation by County's Probation Department. Contractor's staff 12 and subcontractors must obtain mandatory security clearance from Probation, as 13 applicable, prior to commencing work. Contractor shall notify Probation a minimum of 14 three (3) weeks in advance of placement of a new employee or subcontractor to provide 15 adequate time for the background check process. Contractor shall be responsible for all 16 costs to obtain security clearances for all Contractor's prospective employees/staff within 17 County's JJC. Contractor shall also provide adequate time for employees/staff to attend 18 facility orientation and training by Probation, as applicable. 19 (E) County maintains the right to veto the use or employment of any of Contractor's 20 employees/staff on-site at the JJC provided by Contractor or any subcontractor under 21 the direction of Contractor. Contractor shall also remove any of Contractor's 22 employees/staff on-site at the JJC and replace that employee/staff in a timely manner 23 without limitation, when requested by Probation, DPH or DBH. The application for 24 access to the JJC is attached as Exhibit D "Probation Vendor Application." 25 (F) Contractor shall observe all applicable Probation policies and procedures 26 concerning the operation of the JJC facility. Contractor's staff shall sign 27 acknowledgements of certain Probation policies and procedures, as applicable and upon 28 Probation's request. Contractor shall also observe all DPH and DBH policies and 5 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 procedures, as applicable. Contractor's staff shall abide by the security regulations of the 2 JJC facility. Contractor must inform its employees and subcontractors of all such 3 regulations. 4 1.7 Minimum Staffing Plan. Contractor shall provide a plan to County's Chief Probation 5 Officer, or designee, for minimum staffing levels at the JJC. Contractor's staffing plan shall 6 include staffing of the following positions: a medical director, director of psychiatry, physicians, 7 psychiatrists, mid-level practitioners, licensed and unlicensed behavioral health clinicians, 8 optometrist, dentist, nurses, medical/dental/psychiatric assistants and technicians, alcohol and 9 drug counselors, and administrative staff. Exhibit E, "Minimum Staffing Levels," attached and 10 incorporated by this reference, includes the agreed-upon staffing levels necessary to provide all 11 health care services required under this Agreement for a maximum of 125 Detained Youth. 12 Contractor shall maintain, at a minimum, the staffing levels established in Exhibit E. 13 Contractor's staffing levels shall be designed to be as cost-effective as possible while still 14 meeting County's needs, fulfilling all requirements under this Agreement, and maintaining 15 compliance with Title 15 of the California Code of Regulations. In the event the total Detained 16 Youth population increases or decreases substantially so that changes to the staffing plan in 17 Exhibit E are necessary, upon County's or Contractor's request, the parties shall enter 18 negotiations in good faith to determine a mutually agreeable change to the staffing levels in 19 Exhibit E and compensation set forth in Article 4. 20 1.8 Behavioral Health Services. 21 (A) DBH Guiding Principles. Contractor shall align programs, services, and practices 22 with the vision, mission, and guiding principles of the County's DBH, as further described 23 in Exhibit F, "Fresno County Department of Behavioral Health Guiding Principles of Care 24 Delivery." 25 (B) Credentialing and Recredentialing. Contractor and their respective staff must 26 follow the uniform process for credentialing and recredentialing of service providers 27 established by County's DBH, including disciplinary actions such as reducing, 28 suspending, or terminating provider's privileges, which process County's DBH shall 6 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 provide to Contractor. Failure to comply with these requirements may result in 2 suspension or termination of an individual or provider. Contractor shall ensure all staff 3 who may provide any behavioral health care services to Detained Youth, including SUD, 4 shall be credentialed through County's DBH. In addition, Contractor shall provide 5 County's DBH Director, or designee, monthly staffing reports of all behavioral health 6 care staff, indicating staff licenses and/or certification are valid and current. 7 Upon request, the Contractor must demonstrate to the County that each of its 8 providers are qualified in accordance with current legal, professional, and technical 9 standards, and that they are appropriately licensed, registered, waivered, and/or 10 certified. 11 Contractor must not employ or subcontract with providers debarred, suspended 12 or otherwise excluded (individually, and collectively referred to as "Excluded") from 13 participation in Federal Health Care Programs, including Medi-Cal/Medicaid or 14 procurement activities, as set forth in 42 C.F.R. §438.610. See Article 12 below. 15 Contractor is required to verify and document at a minimum of every three (3) 16 years that each network provider that delivers covered services continues to possess 17 valid credentials, including verification of each of the credentialing requirements as per 18 the County's DBH's uniform process for credentialing and recredentialing. If any of the 19 requirements are not up-to-date, updated information should be obtained from network 20 providers to complete the re-credentialing process. 21 (C) Criminal Background Check. Contractor shall ensure that all providers and/or 22 subcontracted providers consent to a criminal background check, including fingerprinting 23 to the extent required under state law and 42 C.F.R. § 455.434(a). Contractor shall 24 provide evidence of completed consents when requested by the County, DHCS or the 25 US Department of Health & Human Services ("US DHHS"). 26 (D) Clinical Leadership. Contractor shall send to County upon execution of this 27 Agreement a detailed plan ensuring clinically appropriate leadership and supervision of 28 their clinical program. Recruitment and retaining clinical leadership with the clinical 7 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 competencies to oversee services based on the level of care and program design 2 presented herein shall be included in this plan. A description and monitoring of this plan 3 shall be provided. 4 (E) Timely Access. It is the expectation of the County that Contractor provides timely 5 access to services that meets the State of California standards for care. Contractor shall 6 track timeliness of services to persons served and provide a monthly report showing the 7 monitoring or tracking tool that captures this data. County and Contractor shall meet to 8 go over this monitoring tool as needed, but at least on a monthly basis. County shall take 9 corrective action if there is a failure to comply by Contractor with timely access 10 standards. Contractor shall also provide tracking tools and measurements for 11 effectiveness, efficiency, and persons served satisfaction as further detailed in Exhibit A. 12 (F) Electronic Health Record ("EHR"). Contractor may maintain its records in 13 County's EHR system in accordance with Exhibit B as licenses become available. The 14 person served record shall begin with registration and intake, and include person served 15 authorizations, assessments, plans of care, and progress notes, as well as other 16 documents as approved by County. County shall be allowed to review records of all 17 services provided, in accordance with applicable laws. If Contractor determines to 18 maintain its records in the County's HER, it shall provide County's DBH Director, or 19 designee, with thirty (30) days' notice. If at any time Contractor chooses not to maintain 20 its records in the County's HER, it shall provide County's DBH Director, or designee, 21 with thirty (30) days' advance written notice and Contractor will be responsible for 22 obtaining its own system, at its own cost, for electronic health records management. 23 (G)Disclaimer 24 County makes no warranty or representation that information entered into the 25 County's DBH HER system by County will be accurate, adequate, or satisfactory for 26 Contractor's own purposes or that any information in Contractor's possession or control, 27 or transmitted or received by Contractor, is or will be secure from unauthorized access, 28 viewing, use, disclosure, or breach. Contractor is solely responsible for person served 8 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 information entered by Contractor into the County's DBH HER system. Contractor 2 agrees that all Private Health Information (PHI) maintained by Contractor in County's 3 DBH HER system shall be maintained in conformance with all HIPAA laws, as stated in 4 section 18.1, "Health Insurance Portability and Accountability Act." 5 (H) Records. Contractor shall maintain behavioral health documentation records in 6 accordance with Exhibit B. All records of persons served shall be maintained for a 7 minimum of ten (10) years from the date of the termination or expiration of this 8 Agreement. 9 (1) Access to Records. Contractor shall provide County with access to all 10 documentation of services provided under this Agreement for County's use in 11 administering this Agreement, in accordance with applicable laws. Contractor shall allow 12 County, CMS, the Office of the Inspector General, the Controller General of the United 13 States, and any other authorized Federal and State agencies to evaluate performance 14 under this Agreement, and to inspect, evaluate, and audit any and all records, 15 documents, and the premises, equipment and facilities maintained by the Contractor 16 pertaining to such services at any time and as otherwise required under this Agreement. 17 (J) Quality Improvement Activities and Participation. Contractor shall comply with the 18 County's ongoing comprehensive Quality Assessment and Performance Improvement 19 ("QAPI") Program (42 C.F.R. § 438.330(a)) and work with the County to improve 20 established outcomes by following structural and operational processes and activities 21 that are consistent with current practice standards. 22 Contractor shall participate in quality improvement ("QI") activities, including 23 clinical and non-clinical performance improvement projects ("PIPs"), as requested by the 24 County in relation to State and Federal requirements and responsibilities, to improve 25 health outcomes and individuals' satisfaction with services over time. Other QI activities 26 include quality assurance, collection and submission of performance measures specified 27 by the County, mechanisms to detect both underutilization and overutilization of 28 services, individual and system outcomes, utilization management, utilization review, 9 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 1 provider appeals, provider credentialing and re-credentialing, and person served 2 grievances. Contractor shall measure, monitor, and annually report to the County on its 3 performance. 4 (K) Rights of Persons Served. Contractor shall comply with all applicable laws and 5 regulations relating to patients' rights, including but not limited to Welfare & Inst. Code 6 5325, Cal. Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The 7 Contractor shall ensure that its subcontractors comply with all applicable patients' rights 8 laws and regulations. 9 (L) Linkage to Care. Upon discharge of a Detained Youth from the JJC with 10 behavioral health diagnosis, either mental health or SLID, Contractor shall link the 11 Detained Youth with outside community service providers, such as County's DBH 12 Children's Division, as indicated in Exhibit A. 13 (M)Second-Generation Long-Acting Injectable Anti-Psychotic Medications. 14 Contractor's pharmacy subcontractor shall have available second-generation long-acting 15 injectable anti-psychotic medications ("LAI")for use within the County's JJC by 16 Contractor, at no cost to County. That subcontract shall be solely Contractor's 17 responsibility, and County shall bear no responsibility whatsoever for that subcontract. 18 Contractor's psychiatrists shall maintain sole responsibility for prescribing LAI 19 medications as clinically indicated. Upon the concurrence of Contractor's psychiatrists, 20 Contractor shall bridge medication for Detained Youth who enter the facility on such 21 prescribed LAI medications, as indicated in Exhibit A. Specifically, Contractor shall verify 22 prescription medications and Contractor's psychiatrists shall prescribe the same 23 medication to maintain individuals on a stable dosage if clinically appropriate. Within 24 seven (7) days of bridging medications, such Detained Youth shall receive a face-to-face 25 evaluation by Contractor's psychiatrists, who may then choose to continue the 26 prescription or change prescription as clinically appropriate. At any time while the 27 Detained Youth is in custody at JJC, Contractor's psychiatrists may initiate the use of 28 LAI medications as clinically indicated. 10 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Contractor shall ensure its subcontracted pharmacy will coordinate for delivery of 2 LAI medications to County's JJC. As described herein, Contractor shall be solely 3 responsible for the cost of LAI medication utilized by Contractor. 4 1.9 Licenses and Certifications. Throughout the term of this Agreement, Contractor shall 5 maintain all necessary licenses, certifications, and board registrations necessary for the 6 provision of the services hereunder and required by the laws and regulations of the United 7 States of America, State of California, County of Fresno, and any other applicable government 8 agencies. Contractor shall ensure that its professional health care employees are credentialed, 9 maintain all required licenses, and have access to continuing education units to continually 10 update their skills and knowledge to meet California-specific requirements. 11 Contractor shall notify County immediately in writing of its inability to obtain or maintain 12 such licenses, certifications, and board registrations, irrespective of the pendency of any related 13 appeal. Copies of licensure and certifications required for each applicable staffing position must 14 be kept on-site at all times, in compliance with Title 15 of the California Code of Regulations, 15 and made available for County to inspect, when requested. Additionally, Contractor shall comply 16 with all other applicable licensing laws, rules or regulations to the fullest extent, as any many 17 now exist or are hereafter changed. 18 1.10 National Commission on Correctional Health Care (NCCHC) Accreditation. 19 Contractor shall maintain NCHHC "Standards for Health Services" accreditation throughout the 20 remainder of the term of this Agreement, barring any obstruction from the physical design of the 21 facility or for other reasons that are beyond Contractor's control, and shall be responsible for the 22 payment of accreditation-related application, inspection and certification fees. Contractor shall 23 promptly supply the Chief Probation Officer, DPH Director, DBH Director, or designees, with a 24 hard copy (and electronic copy, if available) of subsequent updates or new publications made 25 available of the NCCHC accreditation standard through the term of this Agreement. Contractor's 26 failure to comply with any of the terms and duties contained in this section 1.10 shall be grounds 27 for County's termination of this Agreement pursuant to Article 7, "Termination and Suspension", 28 section 7.2, "Termination for Breach", as a failure "to comply with any term of this Agreement" or 11 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 an "improperly performed services"; in addition to the foregoing, in event of the Contractor's 2 failure to comply with this section 1.10, County shall have the right to assess liquidated 3 damages pursuant to section 4.9, "Liquidated Damages." 4 1.11 Minimize Transportation Needs. Contractor shall minimize the transportation of 5 Detained Youth for off-site health care treatment/services with the objective of reducing 6 outpatient health care costs. However, as necessary, Contractor shall arrange for emergency 7 and non-emergency transportation of County's Detained Youth. Contractor shall coordinate 8 between Probation and County's contracted emergency medical services ambulance provider 9 for any medical emergency that may arise. Contractor shall immediately notify the County 10 Watch Commander on staff at the County's JJC, as applicable, when a health care emergency 11 or a critical illness beyond Contractor's on-site capabilities has occurred. Contractor shall also 12 notify the County Watch Commander if transportation is needed for any of the services listed in 13 Exhibit A. County will be responsible for the costs of transportation, as described in Article 3, 14 "County's Responsibilities". 15 1.12 Detained Youth Death Notification. Contractor shall immediately notify the Chief 16 Probation Officer, DPH Director, DBH Director and County's Health Officer of a Detained Youth 17 death, but in any case, such notification shall be no later than 8:00 am the morning following the 18 Detained Youth's death. Contractor shall provide to the Chief Probation Officer, DPH Director, 19 DBH Director and County's Health Officer notification of the time of death and situation 20 surrounding the Detained Youth's death no later than 48 hours following the death. 21 1.13 Elective Medical Care. Contractor shall not be responsible for any Detained Youth's 22 elective medical care. Elective medical care is defined as medical care, which, if not provided 23 would not, in the reasonable medical opinion of Contractor's Medical Director, cause the 24 Detained Youth's health to deteriorate or cause definite harm to the Detained Youth's well- 25 being. Examples of such elective medical care may include, but are not limited to: breast 26 reduction, gastric bypass, purely cosmetic dental implants or facelift. 27 28 12 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 1.14 Janitorial Service. Contractor shall be responsible for providing its own janitorial 2 service for all designated work areas utilized by Contractor's staff and subcontractors at the 3 JJC. 4 1.15 Medical/Dental Equipment. Contractor, at its own cost, shall be responsible for the 5 repair, maintenance, housekeeping and replacement (if necessary) of all County-provided 6 and/or owned medical and dental equipment. In the event the Contractor determines additional 7 medical and dental equipment is necessary, Contractor shall be responsible for the full cost of 8 such items. Contractor shall reimburse County for all losses and damages resulting from the 9 negligent or careless use of County provided and/or owned medical and dental equipment or 10 other County property or facilities by Contractor's staff or subcontractors. 11 1.16 Consistent Federal Income Tax Position. Contractor acknowledges that the JJC 12 has been acquired or improved (and is situated on land that has been acquired) using net 13 proceeds of governmental tax-exempt bonds ("Bonds-Financed Facility"). Contractor agrees 14 that, with respect to this Agreement and the Bond-Financed Facility, Contract is not entitled to 15 take, and shall not take, any position (also known as "tax position") with the Internal Revenue 16 Service ("IRS") that is inconsistent with being a "service provider" to the County, as a "qualified 17 user"with respect to the Bond-Financed Facility, as "managed property," as all of those terms 18 are used in IRS Revenue Procedure 2016-44 and 2017-13, as applicable, and to that end, for 19 example, and not as a limitation, Contractor agrees that Contractor shall not, in connection with 20 any federal income tax return that they file with the IRS or any other statement or information 21 that it provides to the IRS, (a) claim ownership, or that it is a lessee, of any portion of the Bond- 22 Financed Facility, or (b) claim any depreciation or amortization (as referenced in IRS Revenue 23 Procedure 2016-44) or amortization deduction (as referenced in IRS Procedure 2014-13), 24 investment tax credit, or deduction for any payment as rent with respect to the Bond-Financed 25 Facility. 26 1.17 County's Chief Probation Officer, or designee, shall provide to Contractor a site map 27 with floor plans identifying the designated health care areas within County's JJC to be occupied 28 by Contractor for Contractor's use in performing all services and duties under this Agreement. 13 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Contractor acknowledges that the designated health care areas are confidential and shall 2 maintain the confidentiality of those areas and the provided site map. As detailed in Article 3, 3 "County's Responsibilities", section 3.1, "Office Space, Equipment and Inventory", herein, 4 County shall provide to Contractor in an "as-is" condition office and clinic space, furniture, 5 facilities, medical and dental equipment, telephones and other consumable and incidental 6 medical and office supplies within the designated health care areas in County's JJC to utilize 7 during the term of this Agreement. 8 (A) Contractor shall utilize all County office and clinic space, furniture, fixtures, 9 facilities, medical and dental equipment, and telephones within the designated health 10 care areas in County's JJC in a careful and proper customary manner. 11 (B) Contractor shall not utilize County office and clinic space, furniture, fixtures, 12 facilities, medical and dental equipment, and telephones within the designated health 13 care areas (1) in any manner that violates state or federal law; and (2) for any purpose 14 other than in the performance of its obligations under this Agreement. Contractor's 15 licensed and qualified staff are permitted to utilize County medical and dental equipment 16 to which they are qualified to utilize. 17 (C) Contractor, at its own cost, shall be responsible for the repair, maintenance, 18 housekeeping, and replacement (if necessary) of all County furniture, fixtures, and office 19 equipment. In the event Contractor determines additional furniture, fixtures, and/or office 20 equipment are necessary, Contractor shall be responsible for the full cost of such items. 21 Contractor shall reimburse County for all losses resulting from the negligent or careless 22 use of County furniture, fixtures, and office equipment or other County property or 23 facilities by Contractor's staff. 24 (D) Contractor shall not make any installations, alterations, replacements, or 25 improvements of any kind to County furniture, fixtures, facilities, and/or medical and 26 dental equipment without obtaining County's prior written consent. Contractor shall not 27 remove County furniture, fixtures, facilities, medical and dental equipment, and 28 telephones from its location in County's JJC. Contractor shall notify County any time 14 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 County furniture, fixtures, facilities, and/or medical, dental and office equipment is no 2 longer needed to request item removal, disposal or surplus. 3 (E) At all times during the term of this Agreement and thereafter, County shall be the 4 sole owner of all furniture, fixtures, medical and dental equipment, and telephones 5 contained within County's JJC, with the exception of additional (not replacement) 6 furniture, fixtures, medical and dental equipment, and telephones that Contractor 7 purchases for on-site uses during the term of this Agreement. Notwithstanding the 8 foregoing, upon Agreement termination or expiration, the County reserves the right to 9 purchase any equipment purchased by the Contractor for on-site uses. The purchase 10 price shall be negotiated at such time that the County requests to purchase Contractor's 11 equipment. Contractor shall not pledge, encumber, create a security interest in or permit 12 a lien to be attached to any of County's furniture, fixtures, facilities, and/or medical and 13 dental equipment. 14 (F) At the termination of this Agreement, Contractor will return all County furniture, 15 fixtures, facilities, medical and dental equipment, and telephones to County in working 16 order with the exception of reasonable wear and tear. If any of County's furniture, 17 fixtures, facilities, medical and dental equipment, and/or telephones require replacement 18 or repair, Contractor shall, at Contractor's expense, replace with the same or 19 comparable item or repair the item to working order. 20 (G)In regard to the assets described in section 3.1.c "Fixed Assets" and Exhibit G 21 "Office and Medical/Dental Equipment" herein, Contractor agrees to the following: 22 (1) To maintain all assets in good working order and condition, normal wear and 23 tear excepted. 24 (2) To label all assets, to perform periodic inventories as required by County and 25 to maintain an inventory list showing where and how the fixed asset is being used, in 26 accordance with procedures developed by County. All such lists shall be submitted 27 to County within ten (10) calendar days of any request by the County. 28 15 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (3) To report in writing to County immediately after discovery, the loss or theft of 2 any asset. For stolen items, Contractor must contact the local law enforcement 3 agency and submit a copy of the loss report to County within ten (10) calendar days 4 of such report. 5 (4) To maintain a policy of insurance for all risk personal property coverage that 6 shall be endorsed naming the County as an additional loss payee. 7 1.18 Probation currently utilizes an electronic case management system, "PRI MS" for 8 management of records for Detained Youth including health care records. Contractor must 9 utilize this system to report encounters and statistics related to health care services provided to 10 each Detained Youth. Entry of the records into PRI MS should occur no later than twelve (12)to 11 twenty-four (24) hours after services occurred. 12 1.19 Contractor shall ensure that the management and operational responsibilities for 13 SUD services are transitioned as seamlessly as possible from previous contracted provider's 14 management, to ensure continuity of care and minimal disruption to services provided. 15 Contractor shall work with County to develop a transition plan and timeline. It is understood by 16 the parties that Contractor shall have completed a "data migration" of the previous contractor's 17 collected data to Contractor prior to July 1, 2024, so that Contractor shall have County's prior 18 data in its data/records system no later than July 1, 2024. Contractor acknowledges that the 19 expectation and objective is that all such records/history shall be 100% migrated, accurate and 20 ready for use by Contractor on July 1, 2024. Notwithstanding the foregoing, Contractor shall not 21 be responsible for delays in the aforementioned transition plan/duties due to the previous 22 County-contracted provider's failure to promptly cooperate with Contractor. 23 1.20 Contractor shall respond to and process all medical record requests and subpoenas 24 for records, whether or not the Release of Information is directly addressed to County and/or 25 Contractor, so long as the Release of Information is otherwise lawful. Contractor shall provide a 26 quarterly report of all records released to the Chief of Probation Officer, or designee. 27 1.21 California Advancing and Innovating Medi-Cal (CaIAIM) Justice-Involved 28 Initiative. Contractor acknowledges that County is still undergoing implementation of the Cal- 16 DocuSign Envelope ID:AB22DEBC-6Al37-437C-9F73-2CA1796B82A7 1 AIM Justice-Involved Initiative, where pre-release Medi-Cal enrollment strategies are being 2 developed to ensure eligible incarcerated individuals receive a targeted set of services in the 3 ninety (90) days before their release as well as have continuity of coverage upon their release 4 and access to key services to help them successfully return to their communities. Contractor 5 agrees to work with County to transmit information obtained during the intake screen and 6 documented in the Contractor's EHR into CaIAIM Justice-Involved assessments. Contractor 7 shall work with County to establish electronic communication between the Contractor's 8 electronic medical record and the County's CalAIM assessments to support CalAIM 9 implementation for Detained Youth within the time frames established by DHCS. Contractor 10 shall work with County to incorporate additional billing structures that Contractor will need to 11 utilize as a result of this implementation. 12 1.22 American Rescue Plan Act (ARPA). The United States Treasury recognizes that 13 the pandemic exacerbated mental health and substance use challenges for many Americans, 14 which has proven to be true for individuals incarcerated at JJC, and the Final Rule allows 15 recipients to use State and Local Fiscal Recovery Funds (SLFRF) to cover an expansive array 16 of services for prevention, treatment, recovery, and harm reduction for mental health, substance 17 use, and other behavioral health challenges caused or exacerbated by the public health 18 emergency, which services respond to the public health impacts or negative economic impacts 19 of the COVID-19 pandemic. 20 Subject to availability of ARPA funds, Contractor shall track and provide sufficient 21 documentation for the following: 22 (A) Infectious disease prevention, related to COVID-19, identifying positive cases, 23 the number of Detained Youth currently undergoing monitoring, number of vaccinations, 24 and the number of Detained Youth currently receiving treatment for COVID-19 or related 25 complications, and the type of treatment provided. 26 (B) Behavioral health services and treatment for individuals detained, such as opioid 27 use disorder diagnoses, behavioral health care contacts, and the number of Detained 28 Youth receiving MAT treatment. 17 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 ARPA claims will be distinct and categorized under following categories: 2 o EC 1.6 Medical Expenses related to COVID-19, continue to be allowable. 3 Tracking methodology would suffice for COVID-19 expenses. 4 o EC 1.1 COVID-19 Vaccination, EC 1.2 COVID-19 Testing, or 1.3 Contact 5 Tracing 6 o EC 1.4 Prevention in Congregate Settings 7 o EC 1.5 Personal Protective Equipment 8 o EC 1.7 Other COVID-19 Public Health Expenses (including Communication, 9 Enforcement, Isolation/Quarantine) 10 o EC 1.11 Community Violence Interventions, if applicable. 11 Behavioral Health 12 o EC 1.12 Mental Health Services 13 o EC 1.13 Substance Use Services (i.e. opioid treatment services) 14 Other Public Health Service 15 o EC 1.14—Other 16 Article 2 17 Records and Reporting 18 2.1 Reports. The Contractor shall submit the following reports: 19 (A) Monthly Statistics Report on Health Care Utilization and Costs 20 Contractor shall provide County's Chief Probation Officer, County's DPH and 21 DBH Directors, or their respective designees, with monthly statistical reports on health 22 care services utilization and costs, due on the thirtieth (30th) of each month or by the 23 monthly administrative meeting, whichever is earlier, for both medical and behavioral 24 health care services provided during the preceding month, and using the data set and 25 report formats approved by County. Reports shall include, but not be limited to, the 26 following information: 27 o Sick call requests from Detained Youth 28 o Sick call visits 18 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 o Wait time (from sick call slip submittal to medical/behavioral health visit) 2 o Health appraisals/assessments/evaluations 3 o Detained Youth treated by a physician (and/or PA, NP or RN), including 4 psychiatrists 5 o Intake screenings 6 o Emergency department visits 7 o Medical and psychiatric inpatient hospitalizations 8 o Mandatory physicals for Detained Youth 9 o Off-site clinic services 10 o Crisis intervention and crisis stabilization 11 o Chronic care clinic statistics 12 o Suicide precautions 13 o Suicide attempts 14 o Pharmaceutical utilization (types of prescribed medications and costs) 15 o Dental services 16 o Optometry/Optician services 17 o Radiology services (utilization and costs) 18 o Laboratory services (utilization and costs) 19 o Number of dialysis treatments 20 o Case management/linkage services (to service providers operating out of 21 County's JJC and to service providers out in the community) 22 o Detained Youth tested and testing positive for gonorrhea and chlamydia 23 o Detained Youth tested and testing positive for HIV/AIDS 24 o Detained Youth tested and testing positive for syphilis 25 o Detained Youth tested and testing positive of Hepatitis C 26 o Detained Youth tested and testing positive for tuberculosis infection/disease 27 o Incidences of any other communicable diseases 28 o Detained Youth mortality review 19 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 o Number of transports (ambulance/custody transports) 2 o Behavioral health treatment services/program statistics 3 o Utilization of LAI medication 4 o Report requirements for emergency, inpatient hospitalization, and outpatient 5 specialty care services, as identified in Exhibit A 6 o MCIP provider and inpatient hospitalization reports 7 o Performance Reporting Metrics as described in Exhibit H 8 o Performance Metrics Compliance as described in Exhibit 1 9 (B) Upon request by County, Contractor must provide reports within a reasonable 10 period of time including, but not limited to, additional information related to Contractor's 11 performance of this Agreement, for example, specific statistical information or 12 performance-based standards data reports that may be required by Probation for 13 California Department of Juvenile Justice regulations. 14 (C) Contractor shall also, upon request by County, provide financial cost reports and 15 program information regarding Contractor's or County's claim for/from third party payers, 16 as needed for grant or other funding requirements on behalf of the County. This may 17 include, but not be limited to, ARPA and upcoming CalAIM Justice-Involved 18 implementation. 19 If County must substantiate costs for the State or other agency for auditing or other 20 grant or funding purposes, Contractor shall submit financial reports which shall include 21 all necessary and related costs regarding the providing of medical and behavioral health 22 care to Detained Youth upon request by County. 23 (D) Monthly Staffing Report 24 Contractor shall submit monthly staffing reports due by the tenth (loth) of each 25 month that identify all direct service and support staff by first and last name, applicable 26 licensure/certifications, and full-time hours worked to be used as a tracking tool to 27 determine if Contractor's program is staffed according to the requirements of this 28 Agreement. 20 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (E) DBH Annual Outcome Reports 2 Contractor shall submit to County clinical program performance outcome reports, 3 as requested. 4 Outcome reports and outcome requirements are subject to change at County's 5 discretion. Contractor shall provide outcomes as stated in Exhibit A. 6 (F) Contractor shall provide an annual report to County no later than January 315t of 7 each year for the previous calendar year of the Agreement of its compliance with current 8 California laws, regulations and codes, pursuant to Section 1.3 relating to medical and 9 behavioral health care programs at County's JJC. 10 (G)Contractor shall provide to County any applicable certifications and/or reports 11 obtained through Contractor's attainment of required accreditations, as set forth in 12 Sections 1.9 and 1.10. 13 (H)Contractor shall comply with the performance metrics as identified in Exhibits H 14 and I. If Contractor fails to deliver or fails to perform in accordance with the performance 15 metrics, liquidated damages will be assessed per Section 4.9 "Liquidated Damages". 16 (1) Contractor shall provide to County no later than March 1 It of each year the 17 annual percentage and dollar breakdown of cost to County of services provided the 18 preceding year under the Agreement in the format found in Exhibit J "Annual Summary 19 Report". It is understood that certain financial reports prepared and provided by 20 Contractor to County are proprietary in nature and confidential. Contractor shall mark 21 these reports as such. It is also understood that certain financial information will be 22 required from the Contractor in order for County to complete and submit reports, as 23 required by the State. 24 (J) Additional Reports 25 Contractor shall also furnish to County such statements, records, reports, data, 26 and other information as County may request pertaining to matters covered by this 27 Agreement. In the event that Contractor fails to provide such reports or other information 28 so required, it shall be deemed sufficient cause for County to withhold monthly payments 21 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 until Contractor complies. In addition, Contractor shall provide written notification and 2 explanation to County within five (5) days of any funds received from another source to 3 conduct the same services covered by this Agreement. 4 2.2 Records. 5 (A) Medical and Behavioral Health Care Records. 6 Contractor shall utilize an EHR system to maintain complete and accurate 7 medical and behavioral health care records, completely and separately, on each 8 individual Detained Youth, which shall include diagnostic studies, individual treatment 9 plan, and records of services provided by the various professional personnel in sufficient 10 detail to make possible an evaluation of services, and contain all the data necessary in 11 reporting to the State, including records of interviews and progress notes. 12 All such records shall be maintained pursuant to applicable NCCHC accreditation 13 standards and laws concerning confidentiality and security of information. Subject to 14 applicable law regarding confidentiality of such records, Contractor shall comply with 15 County's policy with regard to access by Detained Youth and Contractor's staff to 16 medical and behavioral health care records. No information contained in the medical 17 records shall be released by Contractor except as provided by County's policy, by a 18 court order, or otherwise in accordance with applicable law. All medical and behavioral 19 health care records shall be considered the property of County and shall be retained by 20 County at the termination of this Agreement. 21 Contractor shall allow designated County staff read-only access to health records 22 and to Contractor's EHR system, including ability to view reports. 23 Contractor shall maintain complete and accurate medical health, behavioral 24 health, optometry, and dental records separate from County's JJC confinement records 25 of the Detained Youth. 26 In order to maintain continuity of care and promote safety, County shall provide 27 Contractor with reasonable access to medical and behavioral health care records the 28 first day following the Effective Date of this Agreement. 22 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (B) Financial Records. 2 Contractor shall maintain complete and accurate financial records with respect to 3 the services rendered and the costs incurred under this Agreement, and to any 4 payments to each of Contractor's employees or subcontractors. All such records shall be 5 prepared in accordance with generally acceptable accounting procedures, shall be 6 clearly identified, and shall be kept readily accessible and available for inspection, as 7 described in Article 13, "Inspection, Audits and Public Records", herein. All such records 8 shall be retained by Contractor and kept accessible for a minimum of seven (7) years, or 9 longer, as required by law, following final payment and termination or expiration of this 10 Agreement. Upon termination or expiration of this Agreement, Contractor shall prepare 11 and submit to County a final cost report relative to compensation provided by County to 12 Contractor under this Agreement. 13 Contractor's obligations under this section 2.2(B) shall survive expiration or 14 termination of this Agreement. 15 2.3 Monitoring. County's staff and the DHCS, or their designees, shall have the right to 16 review and monitor records, programs, or procedures, at any time, in regard to persons served, 17 as well as the overall operation of Contractor's programs, to ensure compliance with the terms 18 and conditions of this Agreement. 19 Article 3 20 County's Responsibilities 21 3.1 Office Space, Equipment and Inventory 22 (A) Office/Clinic Space and Equipment 23 (1) County shall provide to Contractor in an "as is" condition office and clinic 24 space, furniture, fixtures, facilities, medical and dental equipment and other 25 consumable and incidental medical and office supplies within the designated health 26 care areas (approximately 5,955 square feet in size) in the JJC to utilize during the 27 term of this Agreement. Such County-provided office furniture, medical and dental 28 equipment, and other inventoriable assets available for Contractor's use, are listed in 23 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Exhibit G. County shall have the right to enter such areas at all times, it being 2 understood that Contractor may not control or exclusively possess such space. 3 (2) County shall provide Contractor with accessibility to County's computer 4 network, as appropriate via Virtual Private Network (VPN), Virtual Desktop 5 Infrastructure (VDI), or other mutually agreed upon secure connection, and County 6 will coordinate with Contractor, as needed, to maintain Contractor's cloud 7 infrastructure's ability to operate and interface effectively with County's existing 8 computer equipment and network. County shall not be responsible for any damage 9 whatsoever, including but not limited to, claims and losses suffered by Contractor to 10 Contractor's cloud infrastructure or external network resulting from County providing 11 Contractor with access to County's computer network. 12 County shall maintain responsibility for Contractor's costs for intranet line 13 charges and intranet logon charges, as County provides services. 14 (3) County shall provide only the equipment presently on-site as well as any 15 other equipment that County chooses to purchase and retain ownership of. 16 (4) County shall provide Contractor with space to store physical medical and 17 behavioral health care records, as necessary, of Detained Youth at the JJC. 18 (5) County shall pay for all building maintenance fees for the work areas utilized 19 by Contractor within the JJC. However, as indicated hereinabove, County will not be 20 responsible to provide the janitorial services for the designated work areas utilized by 21 Contractor as indicated in Article 1 "Contractor Services." 22 (6) The parties to this Agreement agree that no provision in this Agreement, 23 including without limitation all attached and incorporated documents, is intended to 24 create a possessory interest for Contractor in any property, building, facility and/or 25 equipment owned or possessed by County. Furthermore, no provision herein shall 26 be interpreted as providing Contractor a lease, license or possessory interest of any 27 kind whatsoever in any property, building, facility and/or equipment owned or 28 possessed by County. 24 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (B) Consumable and Incidental Supplies. County shall allow Contractor to use all 2 consumable and incidental medical, dental, and office supplies remaining within the JJC 3 upon commencement of services. At such time as this Agreement terminates, Contractor 4 shall leave all existing consumable and incidental medical, dental and office supplies 5 within County's JJC for impending use by County. Such examples of consumable and 6 incidental medical, dental and office supplies include, but are not limited to, the following: 7 syringes, latex gloves, bandages, gauze, cotton balls, paper, folders, envelopes, tape 8 dispensers, trash cans, ink/toner cartridges, blood pressure cuffs, and stethoscopes. 9 (C) Fixed Assets. All existing County equipment and/or additional equipment 10 purchased by Contractor at a cost of Five Thousand and No/100 Dollars ($5,000.00) or 11 over, including sales tax, shall be identified as fixed assets, and will be marked with an 12 assigned County Inventory Number (typically a FR#or a GR#). Such fixed assets are 13 identified in Exhibit G. These fixed assets shall be retained by County, as County 14 property, in the event this Agreement is terminated or upon expiration of this Agreement. 15 Contractor agrees to participate in an annual inventory of all County fixed assets and 16 shall be physically present when fixed assets are returned to County possession at the 17 termination or expiration of this Agreement. Contractor shall be responsible for returning 18 to County all County-owned fixed assets, or reimbursing to County the fair market value 19 of the fixed assets if Contractor is unable to produce the fixed assets at the expiration or 20 termination of this Agreement, barring any reasons that are beyond Contractor's control. 21 (D) Inventoriable Assets. The equipment listed in Section 3.1 and other property to 22 be provided by the County shall be inventoried at the beginning and the end of the 23 Agreement term by the Chief Probation Officer, or designee, and Contractor's 24 representative. Both parties shall participate in such inventory and sign an 25 acknowledgement of the final inventory result. All County's equipment is required to be 26 inventoried annually by County staff. Contractor shall participate and make designated 27 work areas available to County staff for the purpose of this inventory. 28 25 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 3.2 County Telephone System. County shall allow Contractor to utilize County's 2 existing telephones and telephone system. County currently has telephones within the County's 3 JJC for Contractor's use. County shall be responsible for Contractor's telephone costs (including 4 utilization and hardware) up to Ten Thousand Dollars ($10,000.00) annually throughout the term 5 of this Agreement. Any additional costs above Ten Thousand Dollars ($10,000.00) shall be the 6 responsibility of Contractor. Contractor shall be invoiced for the additional costs identified after 7 each one-year period of this Agreement, pursuant to the terms identified in Article 4 8 "Compensation, Invoices and Payments" herein. 9 3.3 Security. County shall be exclusively responsible to provide security for the 10 protection of Contractor's staff and to enable Contractor to safely and adequately provide the 11 comprehensive medical and behavioral health care services described in this Agreement. 12 County shall provide all Contractor's staff with security orientation. However, nothing in this 13 Agreement should be construed to make County's deputies or employees guarantors of the 14 safety of Contractor's employees, agents or subcontractors. Accordingly, in the event of an 15 unusual widespread disturbance (e.g., riot) beyond the Contractor's control that materially 16 affects the cost of Contractor of providing health care services hereunder(and as described in 17 Exhibit A), the parties shall meet and negotiate in good faith to determine a mutually agreeable 18 Agreement modification including, but not limited to, an adjustment to compensation set forth in 19 Article 4 "Compensation, Invoices and Payments" herein. 20 3.4 Utilities. County shall be responsible for all utilities costs, including water, sewage, 21 trash disposal, gas and electricity. 22 3.5 Average Daily Population. County shall record the average daily population of 23 Detained Youth ("ADP") at the JJC and shall provide this information to Contractor to identify 24 monthly fluctuations as described in Article 4 "Compensation, Invoices and Payments" no later 25 than five (5) business days after the first (1st) of each month immediately subsequent to the 26 calendar month for which services are rendered. 27 3.6 Transportation of Detained Youth. Immediately upon Contractor's request to 28 County to transport Detained Youth due to a medical emergency or a critical illness pursuant to 26 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Section 1.1, County shall provide emergency transportation by coordinating with its then 2 currently-contracted emergency medical services ambulance provider. In addition, upon 3 Contractor's request and when necessary, County's Probation shall provide non-emergency 4 transportation of Detained Youth to medical appointments. Transportation costs, including 5 services provided by County's contracted emergency medical services ambulance provider, as 6 well as transports provided by Probation for non-emergency off-site appointments, shall be the 7 responsibility of County and not the responsibility of Contractor. 8 3.7 Background Checks. County shall conduct background checks on all personnel 9 that Contractor will assign to work at County's JJC. The background check will be conducted at 10 Probation's expense. Probation shall immediately notify Contractor if an employee of Contractor 11 is determined to be unacceptable for admission into the County's JJC, or unacceptable to 12 provide these services at any location. 13 3.8 County shall compensate Contractor in accordance with Article 4, "Compensation, 14 Invoices and Payments" of this Agreement. 15 3.9 Contract Administration. The County shall provide oversight and collaborate with 16 Contractor and community agencies to help achieve program goals and outcomes. In addition to 17 Contractor monitoring of program, oversight includes, but not limited to, coordination with DHCS 18 in regard to program administration and outcomes. Probation shall be responsible for 19 Agreement administration, evaluation and oversight of the daily medical and behavioral health 20 programs and operation services provided by Contractor within JJC in close coordination with 21 an interdisciplinary team from DPH and DBH, as applicable. 22 County shall receive and analyze statistical outcome data from Contractor throughout 23 the term of this Agreement on a monthly basis. County shall notify the Contractor when 24 additional participation is required. The performance outcome measurement process will not be 25 limited to survey instruments but will also include, as appropriate, persons served and staff 26 surveys, chart reviews, and other methods of obtaining required information. 27 28 27 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Article 4 2 Compensation, Invoices, and Payments 3 4.1 The County agrees to pay, and the Contractor agrees to receive, compensation for 4 the performance of its services under this Agreement as described in Exhibit K to this 5 Agreement, titled "Payment Schedule." 6 Beginning the period of July 1, 2025 through June 30, 2026, the annual maximum 7 compensation may be increased by a percentage equal to a minimum of three and a half 8 percent (3.5%) or the National Consumer Price Index (CPI), but shall not exceed five percent 9 (5%). Contractor shall notify County's Chief Probation Officer, or designee, in writing before 10 June 1,st with the increase to be implemented by July 1st. If Contractor submits CPI percentage 11 increase to County's Chief Probation Officer, or designee, after June 111, the CPI percentage 12 increase will be effective thirty (30) days from the date received. 13 4.2 Maximum Compensation. For the period of July 1, 2024 through June 30, 2025, the 14 compensation paid to the Contractor for services provided to the County shall not exceed Four 15 Million, Ten Thousand, One Hundred Seventy-Five and No/100 Dollars ($4,010,175.00). County 16 shall pay Contractor in twelve (12) monthly payments at one-twelfth (1/121h) of the annual 17 compensation amount, not to exceed Three Hundred Thirty-Four Thousand, One Hundred 18 Eighty-One and 25/100 Dollars ($334,181.25). 19 For the period of July 1, 2025 through June 30, 2026, the compensation paid to the 20 Contractor for services provided to the County shall not exceed Four Million, Two Hundred Ten 21 Thousand, Six Hundred Eighty-Four and No/100 Dollars ($4,210,684.00), which reflects the 22 possible maximum increase of five percent (5%) from the prior twelve (12) month period. If the 23 CPI is less than 5%, this annual maximum compensation amount shall be calculated in 24 accordance with Section 4.1, using the prior year's maximum compensation as the baseline. 25 County shall pay Contractor in twelve (12) monthly payments at one-twelfth (1/121h) of the 26 annual compensation amount, not to exceed Three Hundred Fifty Thousand, Eight Hundred 27 Ninety and 31/100 Dollars ($350,890.31). 28 28 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 For the period of July 1, 2026 through June 30, 2027, the compensation paid to the 2 Contractor for services provided to the County shall not exceed Four Million, Four Hundred 3 Twenty-One Thousand, Two Hundred Eighteen and No/100 Dollars ($4,421,218.00), which 4 reflects the possible maximum increase of five percent (5%) from the prior twelve (12) month 5 period. If the CPI is less than 5%, this annual maximum compensation amount shall be 6 calculated in accordance with Section 4.1, using the prior year's maximum compensation as the 7 baseline. County shall pay Contractor in twelve (12) monthly payments at one-twelfth (1/12th) of 8 the annual compensation amount, not to exceed Three Hundred Sixty-Eight Thousand, Four 9 Hundred Thirty-Four and 83/100 Dollars ($368,434.83). 10 If performance standards are met and this Agreement is extended for an additional one- 11 year period pursuant to Article 5 "Term of Agreement," then for the period of July 1, 2027 12 through June 30, 2028, the compensation paid to the Contractor for services provided to the 13 County shall not exceed Four Million, Six Hundred Forty-Two Thousand, Two Hundred Seventy- 14 Nine and No/100 Dollars ($4,642,279.00), which reflects the possible maximum increase of five 15 percent (5%) from the prior twelve (12) month period. If the CPI is less than 5%, this annual 16 maximum compensation amount shall be calculated in accordance with Section 4.1, using the 17 prior year's maximum compensation as the baseline. County shall pay Contractor in twelve (12) 18 monthly payments at one-twelfth (1/121h) of the annual compensation amount, not to exceed 19 Three Hundred Eighty-Six Thousand, Eight Hundred Fifty-Six and 57/100 Dollars ($386,856.57). 20 If performance standards are met and this Agreement is extended for an additional one- 21 year period pursuant to Article 5, then for the period of July 1, 2028 through June 30, 2029, the 22 compensation paid to the Contractor for services provided to the County shall not exceed Four 23 Million, Eight Hundred Seventy-Four Thousand, Three Hundred Ninety-Three and No/100 24 Dollars ($4,874,393.00), which reflects the possible maximum increase of five percent (5%) 25 from the prior twelve (12) month period. If the CPI is less than 5%, this annual maximum 26 compensation amount shall be calculated in accordance with Section 4.1, using the prior year's 27 maximum compensation as the baseline. County shall pay Contractor in twelve (12) monthly 28 29 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 payments at one-twelfth (1/12th) of the annual compensation amount, not to exceed Four 2 Hundred Six Thousand, One Hundred Ninety-Nine and 40/100 Dollars ($406,199.40). 3 4.3 Increases or Decreases in Detained Youth Population. The parties agree and 4 acknowledge that the annual compensation is calculated based on an ADP of Detained Youth 5 between 100 and 150. If the ADP, calculated and averaged over a calendar month, rises above 6 150 or falls below 100, Contractor shall be compensated (whether an increase or decrease) at 7 the ADP rate, according to the rates outlined below, herein. 8 If the ADP exceeds 150 Detained Youth in any given calendar month, then the 9 compensation payable to the Contractor by County shall be increased by a rate of Four and 10 64/100 Dollars ($4.64) per day for the number of days in the identified calendar month for each 11 Detained Youth over 150. Conversely, if the ADP decreases below 100 Detained Youth in any 12 given calendar month, Contractor shall rebate County by a rate of Four and 64/100 Dollars 13 ($4.64) per day for the number of days in the identified calendar month for each Detained 14 Youth less than 100. 15 (A) The rates listed above are intended to cover additional costs in those instances 16 where minor, short-term increases in the Detained Youth population result in higher 17 utilization of routine supplies and services. However, the rates are not intended to 18 provide for any additional fixed costs (e.g., staffing positions or ancillary services costs), 19 which might prove necessary if the Detained Youth population changes significantly and 20 if the population change is sustained. Accordingly, if the ADP exceeds 150 or falls below 21 100 for a period of ninety (90) consecutive days or more, County and Contractor shall 22 meet and negotiate in good faith regarding the impact to staffing levels as a result of 23 such population change on this Agreement; in the event, the parties are unable to reach 24 an agreement on staffing level and/or compensation adjustments to accommodate any 25 such population change within a thirty (30) day period following notice by the party 26 requesting renegotiation, then either party may terminate the Agreement with ninety (90) 27 days advance written notice, subject to the requirements of Article 7, section 7.3. 28 30 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 4.4 Total Maximum Compensation. In no event shall total maximum compensation and 2 any other payment for services performed under this Agreement exceed Twenty-Two Million, 3 One Hundred Fifty-Eight Thousand, Seven Hundred Forty-Eight and No/100 ($22,158,748.00) 4 for the entire five (5) year term of the Agreement. The Contractor acknowledges that the County 5 is a local government entity, and does so with notice that the County's powers are limited by the 6 California Constitution and by State law, and with notice that the Contractor may receive 7 compensation under this Agreement only for services performed according to the terms of this 8 Agreement and while this Agreement is in effect, and subject to the maximum amount payable 9 under this section. The Contractor further acknowledges that County employees have no 10 authority to pay the Contractor except as expressly provided in this Agreement. 11 4.5 Medi-Cal County Inmate Program. Participation in the Medi-Cal County Inmate 12 Program (MCIP) through DHCS for Medi-Cal Covered Inpatient Hospitalization Services, is 13 approved by the County on an annual basis. Medi-Cal covered inpatient hospitalization services 14 are defined as allowable inpatient hospital care for incarcerated individuals in county 15 correctional facilities for an expected period of twenty-four (24) hours or longer provided to an 16 incarcerated individual who may be deemed Medi-Cal eligible as determined by the County's 17 Department of Social Services (DSS). Contractor will assist and coordinate with designated 18 County staff to identify Detained Youth requiring Medi-Cal eligibility determination. 19 If a Detained Youth's MCIP eligibility is denied, the Contractor will pay for inpatient 20 hospital services and will bill the County for reimbursement of costs, however, County will only 21 reimburse costs for services after DSS has made a final determination that the Detained Youth 22 is ineligible for MCIP. If Contractor pays for services before eligibility is fully determined, the 23 County will not reimburse Contractor for services paid to provider until the Detained Youth's 24 eligibility is fully determined. 25 Parties acknowledge and agree that cost of Medi-Cal Covered Inpatient Hospitalization 26 Services is not the financial responsibility of the Contractor and is hereby specifically excluded 27 from the scope of services within this Agreement, provided the Contractor complies fully with the 28 provisions of this Agreement. 31 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Contractor shall manage the clinical process and adjudicate claims on behalf of the 2 County. County retains sole responsibility for the enrollment of Detained Youth into MCIP and 3 agrees to timely apply for an eligibility determination of all Detained Youth who receive Medi-Cal 4 Covered Inpatient Hospitalization Services. It is Contractor's responsibility to promptly notify 5 County of Detained Youth's inpatient admission. If the County is not notified timely, the 6 Contractor may be responsible for the costs of inpatient services. 7 4.6 Reserved 8 4.7 Pharmacy Costs. Contractor is responsible for all Detained Youth pharmacy costs, 9 capped at Twenty-Five Thousand Dollars ($25,000.00) per year for each Detained Youth. 10 4.8 Invoices. The Contractor shall submit monthly invoices in arrears by the fifteenth 11 (15th) day of each month, for the prior month for which services have been rendered with 12 Payment Schedule as identified in Exhibit K, including a monthly staffing report and cost report 13 indicating the percentage of comprehensive medical and behavioral health expenses as 14 applicable. 15 The Contractor shall submit invoices electronically to: 16 1) ProbationInvoices@frescountyca.gov and 2) ProbationContracts@fresnocountyca.gov. 17 Invoices shall include the amount due for compensation as identified in Exhibit K, ADP count as 18 applicable, Staffing Report, and Cost Report. The Agreement number listed at the top right 19 corner of page one of this Agreement must appear on all invoices and correspondence relating 20 to this Agreement. County shall verify all ADP population changes identified in Contractor's 21 invoices prior to payment. 22 At the discretion of County's Chief Probation Officer, or designee, if an invoice is 23 incorrect or is otherwise not in proper form or substance, County's Chief Probation Officer, or 24 designee, shall have the right to withhold payment after five (5) business days prior notice to 25 Contractor. Contractor agrees to continue to provide services for a period of ninety (90) days 26 after notification of an incorrect or improper invoice. If after the ninety (90) day period, the 27 invoice is still not corrected to County's satisfaction, County's Chief Probation Officer, or 28 32 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 designee, may elect to terminate this Agreement, pursuant to the termination provisions stated 2 in Article 7 of this Agreement, subject to the requirements of Article 7, section 7.3. 3 4.9 Liquidated Damages. Liquidated damages shall be defined and specified in this 4 Section 4.9. Liquidated damages for delay shall not apply in force majeure circumstances or 5 when the delay is caused by other circumstances beyond the control of the Contractor. If 6 liquidated damages are imposed by County's Chief Probation Officer and the Contractor does 7 not agree, the action can be appealed to County's Chief Probation Officer, who shall decide 8 such dispute within thirty (30) days prior written notice. If the Contractor does not agree with the 9 decision of the County's Chief Probation Officer, the Contractor may appeal such decision to the 10 County's Board of Supervisors. The Board of Supervisors shall decide the action within an 11 additional thirty (30) days. If Contractor does not agree with the decision of the Board of 12 Supervisors, the Contractor shall have thirty (30) days to submit the decision to binding 13 arbitration in accordance with the American Arbitration Association, Commercial Arbitrative 14 Rule. Each party shall pay for its own costs and attorney fees for the arbitration. In the instance 15 where there is a dispute regarding potential damage amounts, the County may not withhold 16 payment of the monthly base compensation. 17 Contractor agrees that it has carefully examined the nature of the tasks it shall perform 18 under this Agreement and acknowledges that such tasks involve medical and behavioral health 19 services and attendant duties/requirements that are essential to the health and welfare of 20 Detained Youth. Contractor further agrees that time is of the essence in Contractor's 21 performance of its services under this Agreement. Furthermore, Contractor acknowledges that 22 the performance of its services under this Agreement according to the standards, requirements 23 and objectives delineated herein represent the reasonable acceptable limits of Contractor's 24 performance; and that any failure or delay whatsoever to meet such performance standards, 25 requirements and objectives will result in damage to County. Therefore, this Agreement 26 provides for the payment of liquidated damages from Contractor to County for any failure by 27 Contractor to meet the performance standards as set forth in Exhibit I "Performance Metrics 28 Compliance" including, but not limited to, failure or delay in providing or maintaining staffing 33 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 levels as set forth in Exhibit E "Minimum Staffing Levels," and/or failure to actively pursue and 2 obtain NCCHC accreditation of the JJC as provided herein. 3 The parties agree that payment under this provision shall be considered liquidated 4 damages, and not penalties, and that while determining the exact amount of actual damages is 5 impractical and cannot be precisely calculated, such sums recited in this Agreement represent a 6 reasonable endeavor by County and Contractor to estimate a fair compensation for the 7 foreseeable damages to the County from Contractor's failure to meet performance standards 8 and requirements as specifically set forth in this Section 4.9. 9 Liquidated damages shall be assessed under this Agreement as follows: 10 (A) One Thousand, Five Hundred and No/100 Dollars ($1,500.00) per day against 11 Contractor for each separate violation of any requirement or performance standard(s) 12 set forth in this Section 4.9, excluding staffing violations; and, 13 (B) For each separate violation of any staffing level requirement, Contractor shall 14 issue reimbursement to County of the daily salary rate and associated costs of any 15 unfilled position per day of violation. 16 The Liquidated Damages shall be subject to the following procedure(s): 17 (A) Contractor has thirty (30) days to correct the violation following County's delivery 18 of initial written notice of a violation. 19 (B) If Contractor fails to correct the violation within thirty (30) days as provided 20 above, County shall issue a second (2nd)written notice for the same violation; Contractor 21 shall have an additional, and final, thirty (30) days to correct the violation following the 22 County's delivery of the second (2nd) written notice for same violation. 23 (C) If Contractor fails to correct the violation following the second (2nd) written notice, 24 liquidated damages will be assessed against Contractor beginning on day sixty-one (61) 25 following County's delivery of initial written notice to correct the violation. 26 4.10 Payment. Payments shall be made by County to Contractor in arrears, for services 27 provided during the preceding month, within forty-five (45) days after the date of receipt, 28 verification, and approval by County. All final invoices and/or any final budget modification 34 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 requests shall be submitted by Contractor within sixty (60) days following the final month of 2 service for which payment is claimed. No action shall be taken by County on claims submitted 3 beyond the sixty (60) day closeout period. Any compensation which is not expended by 4 Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to 5 County. 6 4.11 Incidental Expenses. The Contractor is solely responsible for all of its costs and 7 expenses that are not specified as payable by the County under this Agreement. 8 4.12 Restrictions and Limitations. This Agreement shall be subject to any restrictions, 9 limitations, and/or conditions imposed by County or state or federal funding sources that may in 10 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also 11 contingent upon sufficient funds being made available by County, state, or federal funding 12 sources for the term of the Agreement. If the federal or state governments reduce financial 13 participation in the Medi-Cal program, County agrees to meet with Contractor to discuss 14 renegotiating the services required by this Agreement. 15 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll 16 over and is not available for services provided in subsequent years. 17 In the event that funding for these services is delayed by the State Controller, County 18 may defer payments to Contractor. The amount of the deferred payment shall not exceed the 19 amount of funding delayed by the State Controller to the County. The period of time of the 20 deferral by County shall not exceed the period of time of the State Controller's delay of payment 21 to County plus forty-five (45) days. 22 4.13 Financial Audit Report Requirements for Pass-Through Entities. If County 23 determines that Contractor is a "subrecipient" (also known as a "pass-through entity") as defined 24 in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the applicable cost 25 principles and administrative requirements including claims for payment or reimbursement by 26 County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. Contractor 27 shall observe and comply with all applicable financial audit report requirements and standards. 28 35 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Financial audit reports must contain a separate schedule that identifies all funds included 2 in the audit that are received from or passed through the County. County programs must be 3 identified by Agreement number, Agreement amount, Agreement period, and the amount 4 expended during the fiscal year by funding source. 5 Contractor will provide a financial audit report including all attachments to the report and 6 the management letter and corresponding response within six (6) months of the end of the audit 7 year to the County's DBH Director or designee. The County's Director or designee is 8 responsible for providing the audit report to the County Auditor. 9 Contractor must submit any required corrective action plan to the County simultaneously 10 with the audit report or as soon thereafter as it is available. The County shall monitor 11 implementation of the corrective action plan as it pertains to services provided pursuant to this 12 Agreement. 13 Article 5 14 Term of Agreement 15 5.1 Term. This Agreement is effective on July 1, 2024, and terminates on June 30, 2027 16 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension," 17 below. 18 5.2 Extension. The term of this Agreement may be extended for two (2) additional one- 19 year periods only upon written approval of both parties at least ninety (90) days before the first 20 day of the one-year extension period. The County's Chief Probation Officer, County's DPH 21 Director and County's DBH Director, or their respective designees, are authorized to sign the 22 written approval on behalf of the County based on the Contractor's satisfactory performance. 23 The extension of this Agreement by the County is not a waiver or compromise of any default or 24 breach of this Agreement by the Contractor existing at the time of the extension whether or not 25 known to the County. 26 Notwithstanding anything to the contrary in this section 5.2, if either party determines not 27 to extend this Agreement, as provided in this section 5.2, then such party shall provide written 28 36 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 notice of non-extension of this Agreement, not later than ninety (90) days prior to the expiration 2 of the then-current term of this Agreement. 3 Article 6 4 Notices 5 6.1 Contact Information. The persons and their addresses having authority to give and 6 receive notices provided for or permitted under this Agreement include the following: 7 For the County: 8 Chief Probation Officer County of Fresno 9 Probation Department 3333 E. American Ave., Suite B 10 Fresno, CA 93725 11 For the Contractor: California Forensic Medical Group, Inc. 12 Attn: Chief Legal Officer 3340 Perimeter Hill Dr. 13 Nashville, TN 37211 14 6.2 Change of Contact Information. Either party may change the information in section 15 6.1 by giving notice as provided in section 6.3. 16 6.3 Method of Delivery. Each notice between the County and the Contractor provided 17 for or permitted under this Agreement must be in writing, state that it is a notice provided under 18 this Agreement, and be delivered either by personal service, by first-class United States mail, by 19 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable 20 Document Format (PDF) document attached to an email. 21 (A) A notice delivered by personal service is effective upon service to the recipient. 22 (B) A notice delivered by first-class United States mail is effective three (3) County 23 business days after deposit in the United States mail, postage prepaid, addressed to the 24 recipient. 25 (C)A notice delivered by an overnight commercial courier service is effective one (1) 26 County business day after deposit with the overnight commercial courier service, 27 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to 28 the recipient. 37 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 6.4 Claims Presentation. For all claims arising from or related to this Agreement, 2 nothing in this Agreement establishes, waives, or modifies any claims presentation 3 requirements or procedures provided by law, including the Government Claims Act (Division 3.6 4 of Title 1 of the Government Code, beginning with section 810). 5 6.5 Notification of Changes. Contractor shall notify County in writing of any change in 6 organizational name, Head of Service or principal business address at least fifteen (15) 7 business days in advance of the change. This notice shall become part of this Agreement upon 8 acknowledgment in writing by the County, and no further amendment of the Agreement shall be 9 necessary provided that such change of address does not conflict with any other provisions of 10 this Agreement. 11 Contractor must immediately notify County of a change in ownership, organizational 12 status, licensure, or ability of Contractor to provide the quantity or quality of the contracted 13 services in no more than fifteen (15) days after the change. 14 Article 7 15 Termination and Suspension 16 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are 17 contingent on the approval of funds by the appropriating government agency. If sufficient funds 18 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the 19 Contractor, may: 20 (A) Modify the services provided by the Contractor under this Agreement; or 21 (B) Terminate this Agreement. 22 7.2 Termination for Breach. 23 (A) Upon determining that a breach (as defined in paragraph (C) below) has 24 occurred, the County may give written notice of the breach to the Contractor. The written 25 notice may suspend performance under this Agreement and must provide at least thirty 26 (30) days for the Contractor to cure the breach. 27 (B) If the Contractor fails to cure the breach to the County's satisfaction within the 28 time stated in the written notice, the County may terminate this Agreement immediately. 38 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (C) For purposes of this section, a breach occurs when, in the determination of the 2 County, the Contractor has: 3 (1) Obtained or used funds illegally or improperly; 4 (2) Failed to comply with any part of this Agreement; 5 (3) Submitted a substantially incorrect or incomplete report to the County; or 6 (4) Improperly performed any of its obligations under this Agreement. 7 7.3 Termination without Cause. In circumstances other than those set forth above, the 8 County may terminate this Agreement by giving at least ninety (90) days advance written notice 9 to the Contractor. Notwithstanding the foregoing, Contractor agrees to continue providing its 10 services under this Agreement until a successor contractor has commenced performing said 11 services, provided County is engaging in a good faith effort to secure a successor contractor. 12 Contractor shall meet and confer with County to assist in the transition to a successor 13 contractor. 14 7.4 Contractor may terminate this Agreement in the event of Material Changes In Scope 15 or Circumstances, or Emergency Circumstances if at any time during the term of this Agreement 16 the scope of services set out herein must materially be changed as a result of any of the 17 following, any of which Contractor notifies County renders Contractor's ability to provide the 18 requested scope of services impossible under the circumstances (a "Material Change 19 Circumstance"), including but any of the following: 20 (A) There is or are new, amended, and/or repealed federal or state law(s) or 21 regulation(s), any or all of which render performance under the Agreement completely 22 impossible under the Agreement's existing terms; 23 (B) There are extreme and unforeseen changes to legal/regulatory requirements 24 rendering the treatment of County's Detained Youth impossible under the Agreement, or 25 there are extreme and unforeseen changes to the applicable standard of care or 26 changes to the site's medication formulary that render the treatment of County's 27 Detained Youth impossible under the Agreement, or the United Sates Food and Drug 28 Administration ("FDA") or another regulatory body recommends, approves, or issues an 39 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 emergency use authorization for a new therapy/ies, diagnostics or treatment modality/ies 2 that render the Contractor's ability to provide services impossible under the Agreement; 3 (C)Contractor's performance hereunder is rendered impossible by a Public Health 4 Emergency (PHE) declared pursuant to Section 319 of the Public Health Service Act, a 5 Disaster declaration pursuant to the Stafford Act (2 U.S.C. §§ 5121-5207), or any similar 6 announcement or proclamation made by the Federal Government or any Federal 7 Agency, or the State of California, pursuant to an analogous provision of Federal or non- 8 Federal law or rule (each, an "Emergency Circumstance"). 9 The parties shall follow the procedures outlined: In the event of the occurrence of any 10 Material Change Circumstance, upon notice from a Party, the Parties shall meet and in good 11 faith re-negotiate the terms of this Agreement. Neither Party shall unreasonably delay or 12 withhold consent to such negotiations, or the proposed modifications resulting from such 13 negotiations. In the event the Parties are not able to reach mutually acceptable changes to the 14 Agreement after ninety (90) days of commencement of good faith negotiations, either Party may 15 thereafter terminate the Agreement without cause upon providing one hundred eighty (180) 16 days' notice thereafter. 17 Notwithstanding the foregoing, Contractor agrees to continue providing its services 18 under this Agreement, and County agrees to continue paying Contractor until a successor 19 contractor has commenced performing said services, provided County is engaging in a good 20 faith effort to secure a successor contractor. Contractor shall meet and confer with County to 21 assist in the transition to a successor contractor. 22 7.5 No Penalty or Further Obligation. Any termination of this Agreement by the County 23 under this Article 7 is without penalty to or further obligation of the County. 24 7.6 County's Rights upon Termination. Upon termination for breach under this Article 25 7, the County may demand repayment by the Contractor of any monies disbursed to the 26 Contractor under this Agreement that, in the County's sole judgment, were not expended in 27 compliance with this Agreement. The Contractor shall promptly refund all such monies upon 28 demand. This section survives the termination of this Agreement. 40 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 1 7.7 Dispute Resolution. If a dispute arises out of or relating to this Agreement, or the 2 breach of this Agreement, and if the dispute cannot be settled through negotiation, the parties 3 agree first to try in good faith to settle the dispute by non-binding mediation before resorting to 4 litigation or some other dispute resolution procedure, unless the parties mutually agree 5 otherwise. The mediator shall be mutually selected by the parties, but in the case of 6 disagreement, the mediator shall be selected by lot from among two (2) nominations provided 7 by each party. All costs and fees required by the mediator shall be split equally by the parties; 8 otherwise, each party shall bear its own costs of mediation. If mediation fails to resolve the 9 dispute within thirty (30) days, either party may pursue litigation to resolve the dispute. 10 Article 8 11 RESERVED 12 13 Article 9 14 Independent Contractor 15 9.1 Status. In performing under this Agreement, the Contractor, including its officers, 16 agents, employees, and volunteers, is at all times acting and performing as an independent 17 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint 18 venturer, partner, or associate of the County. 19 9.2 Verifying Performance. The County has no right to control, supervise, or direct the 20 manner or method of the Contractor's performance under this Agreement, but the County may 21 verify that the Contractor is performing according to the terms of this Agreement. 22 9.3 Benefits. Because of its status as an independent contractor, the Contractor has no 23 right to employment rights or benefits available to County employees. The Contractor is solely 24 responsible for providing to its own employees all employee benefits required by law. The 25 Contractor shall save the County harmless from all matters relating to the payment of 26 Contractor's employees, including compliance with Social Security withholding and all related 27 regulations. 28 41 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 1 9.4 Services to Others. The parties acknowledge that, during the term of this 2 Agreement, the Contractor may provide services to others unrelated to the County. 3 9.5 Operating Costs. Contractor shall provide all personnel, supplies, and operating 4 expenses of any kind required for the performance of this Agreement. 5 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this 6 Agreement, the Contractor will be performing hiring, training, and credentialing of staff, and 7 County will be performing additional staff credentialing to ensure compliance with State and 8 Federal regulations. 9 9.7 Subcontracts. Contractor shall obtain written approval from County's Chief 10 Probation Officer, or designee, before subcontracting any of the services delivered under this 11 Agreement. County's Chief Probation Officer, or designee retains the right to approve or reject 12 any request for subcontracting services. Any transferee, assignee, or subcontractor will be 13 subject to all applicable provisions of this Agreement, and all applicable State and Federal 14 regulations. Contractor shall be responsible for informing any subcontractors, and requiring any 15 subcontractors to comply with all the terms and conditions of this Agreement and of all the 16 Federal and State of California law requirements incorporated herein. Contractor shall be held 17 primarily responsible by County for the performance of any transferee, assignee, or 18 subcontractor unless otherwise expressly agreed to in writing by County's Chief Probation 19 Officer, or designee. The use of subcontractors by Contractor shall not entitle Contractor to any 20 additional compensation that is provided for under this Agreement. 21 Contractor shall remain legally responsible for the performance of all terms and 22 conditions of this Agreement, including, without limitation, all services provided by third parties 23 under subcontracts, whether approved by the County or not. 24 25 Article 10 26 Indemnity and Defense 27 10.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the 28 County (including its officers, agents, employees, and volunteers) against all claims, demands, 42 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and 2 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to 3 the performance or failure to perform by the Contractor (or any of its officers, agents, 4 subcontractors, or employees) under this Agreement. The County may conduct or participate in 5 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or 6 defend the County. 7 The foregoing clause shall obligate the Contractor to provide such protection, 8 indemnification, or defense to the extent of willful or negligent acts or omissions by the County, 9 its officers, employees, agents, or contractors. 10 10.2 Survival. This Article 10 survives the termination or expiration of this Agreement. 11 Article 11 12 Insurance 13 11.1 The Contractor shall comply with all the insurance requirements in Exhibit L to this 14 Agreement. 15 Article 12 16 Assurances 17 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal 18 Health Care Program. 19 (A) In entering into this Agreement, Contractor certifies that it is not excluded from 20 participation in Federal Health Care Programs under either Section 1128 or 1128A of the 21 Social Security Act. Failure to so certify will render all provisions of this Agreement null 22 and void and may result in the immediate termination of this Agreement. 23 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not 24 employ or subcontract with providers or have other relationships with providers excluded 25 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or 26 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct initial 27 and monthly exclusion and suspension searches of the following databases and provide 28 43 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 evidence of these completed searches when requested by County, DHCS or the US 2 Department of Health and Human Services (DHHS): 3 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded 4 Individuals/Entities (LEIE) Federal Exclusions 5 (2) www.sam..qov/content/exclusions - General Service Administration (GSA) 6 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List 7 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration 8 System (NPPES) 9 (4) any other database required by DHCS or US DHHS. 10 (C) In entering into this Agreement, Contractor certifies, that Contractor does not 11 employ staff or individual contractors/vendors that are on the Social Security 12 Administration's Death Master File. Contractor shall check the database prior to 13 employing staff or individual contractors/vendors and provide evidence of these 14 completed searches when requested by the County, DHCS or the US DHHS. 15 (D) Contractor is required to notify County immediately if Contractor becomes aware 16 of any information that may indicate their (including employees/staff and individual 17 contractors/vendors) potential placement on an exclusions list. 18 (E) Contractor shall screen and periodically revalidate all network providers in 19 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E. 20 (F) Contractor must confirm the identity and determine the exclusion status of all its 21 providers, as well as any person with an ownership or control interest, or who is an 22 agent or managing employee of the contracted agency through routine checks of federal 23 and state databases. This includes the Social Security Administration's Death Master 24 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and 25 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. § 26 455.436. 27 (G)If Contractor finds a provider that is excluded, it must promptly notify the County 28 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any 44 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded 2 provider as an overpayment, and any such inappropriate payments may be subject to 3 recovery. 4 Article 13 5 Inspections, Audits, and Public Records 6 13.1 Inspection of Documents. The Contractor shall make available to the County, and 7 the County may examine at any time during business hours and as often as the County deems 8 necessary, all of the Contractor's records and data with respect to the matters covered by this 9 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon 10 request by the County, permit the County to audit and inspect all of such records and data to 11 ensure the Contractor's compliance with the terms of this Agreement. Notwithstanding the 12 foregoing, nothing is this Agreement shall require Contractor to disclose or otherwise make 13 available records which constitute "Patient Safety Work Product" as defined by 42 U.S.C. 299b- 14 21, or which constitute "trade secrets" as defined by California law. 15 13.2 State Audit Requirements. If the compensation to be paid by the County under this 16 Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00), the Contractor is subject 17 to the examination and audit of the California State Auditor, as provided in Government Code 18 section 8546.7, for a period of three years after final payment under this Agreement. This 19 section survives the termination of this Agreement. 20 13.3 Pursuant to Title 15 of the California Code of Regulations, Contractor shall comply 21 with any request from the State of California, Department of Public Health authority to perform 22 an annual health inspection. Contractor shall also assist with such inspections as needed. 23 13.4 Internal Auditing. Contractor shall institute and conduct a Quality Assurance 24 Process for all services provided hereunder. This process shall include at a minimum a system 25 for verifying that all services provided and claimed for reimbursement shall meet specialty 26 mental health service definitions and be documented accurately. 27 In addition, Contractor shall adhere to County's medication monitoring review practices. 28 Contractor shall provide County with notification and a summary of any internal audit 45 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 exceptions, and the specific corrective actions taken to sufficiently reduce the errors that are 2 discovered through Contractor's internal audit process. Contractor shall provide this notification 3 and summary to County as requested by the County. 4 13.5 Confidentiality in Audit Process. Contractor and County mutually agree to 5 maintain the confidentiality of Contractor's records and information of Detained Youth served, in 6 compliance with all applicable State and Federal statutes and regulations, including but not 7 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall 8 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable 9 statutes. 10 Contractor's fiscal records shall contain sufficient data to enable auditors to perform a 11 complete audit and shall be maintained in conformance with standard procedures and 12 accounting principles. 13 Contractor's records shall be maintained as required by DBH and DHCS on forms 14 furnished by DHCS or the County. All statistical data or information requested by the County's 15 DBH Director or designee shall be provided by the Contractor in a complete and timely manner. 16 13.6 Reasons for Recoupment. County will conduct periodic audits of Contractor files to 17 ensure appropriate clinical documentation, high quality service provision and compliance with 18 applicable federal, state and county regulations. 19 Such audits may result in requirements for Contractor to reimburse County for services 20 previously paid in the following circumstances: 21 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation 22 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, 23 section 14107.11, subdivision (d). 24 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the Medicare 25 Managed Care Manual available at https://www.cros.gov/Regulations-and- 26 Guidance/Guidance/Manuals 27 (B) Overpayment of Contractor by County due to errors in claiming or 28 documentation. 46 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (C) Other reasons specified in the SMHS Reasons for Recoupment document 2 released annually by DHCS and posted on the DHCS BHIN website. 3 Contractor shall reimburse County for all overpayments identified by Contractor, County, 4 and/or state or federal oversight agencies as an audit exception within the timeframes required 5 by law or Country or state or federal agency. Funds owed to County will be due within forty-five 6 (45) days of notification by County, or County shall withhold future payments until all excess 7 funds have been recouped by means of an offset against any payments then or thereafter owing 8 to County under this or any other Agreement between the County and Contractor. 9 13.7 Cooperation with Audits. Contractor shall cooperate with County in any review 10 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This 11 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits. 12 In addition, Contractor shall comply with all requests for any documentation or files 13 including, but not limited to, files for persons served. 14 Contractor shall notify the County of any scheduled or unscheduled external evaluation 15 or site visits when it becomes aware of such visit. County shall reserve the right to attend any or 16 all parts of external review processes. 17 Contractor shall allow inspection, evaluation and audit of its records, documents and 18 facilities for ten (10) years from the term end date of this Agreement or in the event Contractor 19 has been notified that an audit or investigation of this Agreement has been commenced, until 20 such time as the matter under audit or investigation has been resolved, including the exhaustion 21 of all legal remedies, whichever is later pursuant to 42 C.F.R.§§438.3(h) and 438.2301(3)(i-iii). 22 13.8 Public Records. The County is not limited in any manner with respect to its public 23 disclosure of this Agreement or any record or data that the Contractor may provide to the 24 County. The County's public disclosure of this Agreement or any record or data that the 25 Contractor may provide to the County may include but is not limited to the following: 26 (A) The County may voluntarily, or upon request by any member of the public or 27 governmental agency, disclose this Agreement to the public or such governmental 28 agency. 47 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (B) The County may voluntarily, or upon request by any member of the public or 2 governmental agency, disclose to the public or such governmental agency any record or 3 data that the Contractor may provide to the County, unless such disclosure is prohibited 4 by court order. 5 (C)This Agreement, and any record or data that the Contractor may provide to the 6 County, is subject to public disclosure under the Ralph M. Brown Act (California 7 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950). 8 (D)This Agreement, and any record or data that the Contractor may provide to the 9 County, is subject to public disclosure as a public record under the California Public 10 Records Act (California Government Code, Title 1, Division 10, beginning with section 11 7920.000) ("CPRA"). 12 (E) This Agreement, and any record or data that the Contractor may provide to the 13 County, is subject to public disclosure as information concerning the conduct of the 14 people's business of the State of California under California Constitution, Article 1, 15 section 3, subdivision (b). 16 (F) Any marking of confidentiality or restricted access upon or otherwise made with 17 respect to any record or data that the Contractor may provide to the County shall be 18 disregarded and have no effect on the County's right or duty to disclose to the public or 19 governmental agency any such record or data. 20 13.9 Public Records Act Requests. If the County receives a written or oral request 21 under the CPRA to publicly disclose any record that is in the Contractor's possession or control, 22 and which the County has a right, under any provision of this Agreement or applicable law, to 23 possess or control, then the County may demand, in writing, that the Contractor deliver to the 24 County, for purposes of public disclosure, the requested records that may be in the possession 25 or control of the Contractor. Within ten (10) business days after the County's demand, the 26 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's 27 possession or control, together with a written statement that the Contractor, after conducting a 28 diligent search, has produced all requested records that are in the Contractor's possession or 48 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 control, or (b) provide to the County a written statement that the Contractor, after conducting a 2 diligent search, does not possess or control any of the requested records. The Contractor shall 3 cooperate with the County with respect to any County demand for such records. If the 4 Contractor wishes to assert that any specific record or data is exempt from disclosure under the 5 CPRA or other applicable law, it must deliver the record or data to the County and assert the 6 exemption by citation to specific legal authority within the written statement that it provides to 7 the County under this section. The Contractor's assertion of any exemption from disclosure is 8 not binding on the County, but the County will give at least ten (10) days' advance written notice 9 to the Contractor before disclosing any record subject to the Contractor's assertion of exemption 10 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs 11 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption, 12 failure to produce any such records, or failure to cooperate with the County with respect to any 13 County demand for any such records. 14 Article 14 15 Right to Monitor 16 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of 17 California or any subdivision or appointee thereof, including the Auditor General, shall have 18 absolute right to review and audit all records, books, papers, documents, corporate minutes, 19 financial records, staff information, records of persons served, other pertinent items as 20 requested, and shall have absolute right to monitor the performance of Contractor in the delivery 21 of services provided under this Agreement. Full cooperation shall be given by the Contractor in 22 any auditing or monitoring conducted, according to this agreement. 23 14.2 Accessibility. Contractor shall make all of its premises, physical facilities, 24 equipment, books, records, documents, agreements, computers, or other electronic systems 25 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished 26 under the terms of this Agreement, or determinations of amounts payable available at any time 27 for inspection, examination, or copying by County, the State of California or any subdivision or 28 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of 49 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Inspector General, the United States Controller General or their designees, and other 2 authorized federal and state agencies. This audit right shall exist for at least ten (10) years from 3 the final date of the Agreement period or in the event the Contractor has been notified that an 4 audit or investigation of this Agreement has commenced, until such time as the matter under 5 audit or investigation has been resolved, including the exhaustion of all legal remedies, 6 whichever is later (42 CFR §438.230(c)(3)(i)-(ii)). 7 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect, 8 evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud or 9 similar risk. The Department's inspection shall occur at the Contractor's place of business, 10 premises, or physical facilities (42 CFR §438.230(c)(3)(ii) and (iv)). 11 14.3 Cooperation. Contractor shall cooperate with County in the implementation, 12 monitoring and evaluation of this Agreement and comply with any and all reporting requirements 13 established by County. Should County identify an issue or receive notification of a complaint or 14 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request 15 information from Contractor to ensure compliance with laws, regulations, and requirements, as 16 applicable. 17 14.4 Probationary Status. County reserves the right to place Contractor on probationary 18 status, as referenced in the Probationary Status Article, should Contractor fail to meet 19 performance requirements; including, but not limited to violations such as high disallowance 20 rates, failure to report incidents and changes as contractually required, failure to correct issues, 21 inappropriate invoicing, untimely and inaccurate data entry, not meeting performance outcomes 22 expectations, and violations issued directly from the State. Additionally, Contractor may be 23 subject to Probationary Status or termination if agreement monitoring and auditing corrective 24 actions are not resolved within specified timeframes. 25 14.5 Record Retention. Contractor shall retain all records and documents originated or 26 prepared pursuant to Contractor's performance under this Agreement for a period of no less 27 than ten (10) years from the term end date of this Agreement or until such time as the matter 28 under audit or investigation has been resolved. Records and documents include but are not 50 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 limited to all physical and electronic records and documents originated or prepared pursuant to 2 Contractor's or subcontractor's performance under this Agreement including working papers, 3 reports, financial records and documents of account, records of persons served, prescription 4 files, subcontracts, and any other documentation pertaining to covered services and other 5 related services for persons served. 6 14.6 Record Maintenance. Contractor shall maintain all records and management books 7 pertaining to service delivery and demonstrate accountability for agreement performance and 8 maintain all fiscal, statistical, and management books and records pertaining to the program. 9 Records should include, but not be limited to, monthly summary sheets, sign-in sheets, and 10 other primary source documents. Fiscal records shall be kept in accordance with Generally 11 Accepted Accounting Principles and must account for all funds, tangible assets, revenue and 12 expenditures. Fiscal records must also comply with the Code of Federal Regulations (CFR), 13 Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles, 14 and Audit Requirements for Federal Awards. 15 All records shall be complete and current and comply with all Agreement requirements. 16 Failure to maintain acceptable records per the preceding requirements shall be considered 17 grounds for withholding of payments for billings submitted and for termination of Agreement. 18 Contractor shall maintain records of persons served and community service in 19 compliance with all regulations set forth by local, state, and federal requirements, laws, and 20 regulations, and provide access to clinical records by County staff. 21 Contractor shall comply with Article 18 and Article 1 regarding relinquishing or 22 maintaining medical records. 23 Contractor agrees to maintain and retain all appropriate service and financial records for 24 a period of at least ten (10) years from the date of final payment, the final date of the Agreement 25 period, final settlement, or until audit findings are resolved, whichever is later. 26 14.7 Agreement Termination. In the event this Agreement is terminated, ends its 27 designated term or Contractor ceases operation of its business, Contractor shall deliver or make 28 available to County all financial records that may have been accumulated by Contractor or 51 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 subcontractor under this Agreement, whether completed, partially completed, or in progress 2 within seven (7) calendar days of said termination/end date. 3 14.8 Facilities and Assistance. Contractor shall provide all reasonable facilities and 4 assistance for the convenience of the County's representatives in the performance of their 5 duties. All inspections and evaluations shall be performed in such a manner that will not unduly 6 delay the work of Contractor. 7 14.9 County Discretion to Revoke. County has the discretion to revoke full or partial 8 provisions of the Agreement, delegated activities or obligations, or application of other remedies 9 permitted by state or federal law when the County or DHCS determines Contractor has not 10 performed satisfactorily. 11 14.10 Site Inspection. Without limiting any other provision related to inspections or audits 12 otherwise set forth in this Agreement, Contractor shall permit authorized County, state, and/or 13 federal agency(ies), through any authorized representative, the right to inspect or otherwise 14 evaluate the work performed or being performed hereunder including subcontract support 15 activities and the premises which it is being performed. Contractor shall provide all reasonable 16 assistance for the safety and convenience of the authorized representative in the performance 17 of their duties. All inspections and evaluations shall be made in a manner that will not unduly 18 delay the work of the Contractor. 19 Article 15 20 Complaints Logs and Grievances 21 15.1 Documentation. Contractor shall log complaints and the disposition of all complaints 22 from a person served or their family. Contractor shall provide a copy of the detailed complaint 23 log entries concerning County-sponsored persons served to County at monthly intervals by the 24 tenth (10th) day of the following month, in a format that is mutually agreed upon. Contractor 25 shall allow beneficiaries or their representative to file a grievance either orally, or in writing at 26 any time with the County. In the event Contractor is notified by a beneficiary or their 27 representative of a discrimination grievance, Contractor shall report discrimination grievances to 28 the County within twenty-four (24) hours. The Contractor shall not require a beneficiary or their 52 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 representative to file a Discrimination Grievance with the County before filing the complaint 2 directly with the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for 3 Civil Rights. 4 15.2 Rights of Persons Served. Contractor shall post signs informing persons served of 5 their right to file a complaint or grievance, appeals, and expedited appeals. In addition, 6 Contractor shall inform every person served of their rights as set forth in Exhibit B. 7 15.3 Incident Reporting. Contractor shall file an incident report for all incidents involving 8 Detained Youth, following the protocol identified in Exhibit B. 9 Article 16 10 Compliance 11 16.1 Compliance. Contractor agrees to comply with County's DBH's Contractor Code of 12 Conduct and Ethics and the County's DBH's Compliance Program in accordance with Exhibit B. 13 Within thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of 14 Contractor's employees, agents, and subcontractors providing services under this Agreement 15 certify in writing, that he or she has received, read, understood, and shall abide by the 16 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of 17 hire, all new employees, agents, and subcontractors providing services under this Agreement 18 shall certify in writing that he or she has received, read, understood, and shall abide by the 19 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and 20 adherence to the Contractor Code of Conduct is an element in evaluating the performance of 21 Contractor and its employees, agents, and subcontractors. 22 Within thirty (30) days of entering into this Agreement, and annually thereafter, all 23 employees, agents, and subcontractors providing services under this Agreement shall complete 24 general compliance. All new employees, agents, and subcontractors shall attend the 25 appropriate training within thirty (30) days of hire. Each individual who is required to attend 26 training shall certify in writing that he or she has received the required training. The certification 27 shall specify the type of training received and the date received. The certification shall be 28 provided to County's DBH Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726. 53 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Contractor agrees to reimburse County for the entire cost of any penalty imposed upon County 2 by the Federal Government as a result of Contractor's violation of the terms of this Agreement. 3 16.2 Reporting. Contractor must have administrative and management arrangements or 4 procedures designed to detect and prevent fraud, waste and abuse of federal or state health 5 care funding. 6 Article 17 7 Federal and State Laws 8 17.1 Health Insurance Portability and Accountability Act. County and Contractor each 9 consider and represent themselves as covered entities as defined by the U.S. Health Insurance 10 Portability and Accountability Act of 1996, Public Law 104-191(HI PAA) and agree to use and 11 disclose Protected Health Information (PHI) as required by law. 12 17.2 County and Contractor acknowledge that the exchange of PHI between them is only 13 for treatment, payment, and health care operations. 14 17.3 County and Contractor intend to protect the privacy and provide for the security of 15 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology 16 for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations 17 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA 18 Regulations) and other applicable laws. 19 17.4 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require 20 Contractor and County to enter into an agreement before PHI is disclosed, as set forth in, but 21 not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal 22 Regulations. 23 17.5 Physical Accessibility. In accordance with the accessibility requirements of section 24 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must 25 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal 26 beneficiaries with physical or mental disabilities. 27 Article 18 28 Data Security 54 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 18.1 Data Security Requirements. Contractor shall comply with data security 2 requirements in Exhibit M to this Agreement. 3 4 Article 19 5 Publicity Prohibition 6 19.1 Self-Promotion. None of the funds, materials, property, or services provided directly 7 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or 8 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self- 9 promotion. 10 19.2 Public Awareness. Notwithstanding the above, publicity of the services described in 11 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the 12 availability of such specific services when approved in advance in writing by County's Chief 13 Probation Officer, DPH Director, DBH Director, or designees. Communication products must 14 follow County's graphic standards, including typefaces and colors, to communicate its authority 15 and project a unified brand. This includes all media types and channels, and all materials on 16 and offline, that are created as part of County's efforts to provide information to the public. 17 Article 20 18 Disclosure of Self-Dealing Transactions 19 20.1 Applicability. This Article 20 applies if the Contractor is operating as a corporation, 20 or changes its status to operate as a corporation. 21 20.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a 22 self-dealing transaction, he or she shall disclose the transaction by completing and signing a 23 "Self-Dealing Transaction Disclosure Form" (Exhibit N to this Agreement) and submitting it to 24 the County before commencing the transaction or immediately after. 25 20.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is 26 a party and in which one or more of its directors, as an individual, has a material financial 27 interest. 28 55 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Article 21 2 Disclosure of Ownership and/or Control Interest Information 3 21.1 Applicability. This provision is only applicable if Contractor is disclosing entities, 4 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.), 5 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2). 6 21.2 Duty to Disclose. Contractor must disclose the following information as requested in 7 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement, 8 Exhibit O: 9 (A) Disclosure of 5% or More Ownership Interest: 10 (1) In the case of corporate entities with an ownership or control interest in the 11 disclosing entity, the primary business address as well as every business location 12 and P.O. Box address must be disclosed. In the case of an individual, the date of 13 birth and Social Security number must be disclosed. 14 (2) In the case of a corporation with ownership or control interest in the 15 disclosing entity or in any subcontractor in which the disclosing entity has a five 16 percent (5%) or more interest, the corporation tax identification number must be 17 disclosed. 18 (3) For individuals or corporations with ownership or control interest in any 19 subcontractor in which the disclosing entity has a five percent (5%) or more interest, 20 the disclosure of familial relationship is required. 21 (4) For individuals with five percent (5%) or more direct or indirect ownership 22 interest of a disclosing entity, the individual shall provide evidence of completion of a 23 criminal background check, including fingerprinting, if required by law, prior to 24 execution of this Agreement. (42 C.F.R. § 455.434) 25 (B) Disclosures Related to Business Transactions: 26 (1) The ownership of any subcontractor with whom Contractor has had business 27 transactions totaling more than $25,000 during the 12-month period ending on the 28 date of the request. 56 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 (2) Any significant business transactions between Contractor and any wholly 2 owned supplier, or between Contractor and any subcontractor, during the 5-year 3 period ending on the date of the request. (42 C.F.R. § 455.105(b).) 4 (C) Disclosures Related to Persons Convicted of Crimes: 5 (1) The identity of any person who has an ownership or control interest in the 6 provider or is an agent or managing employee of the provider who has been 7 convicted of a criminal offense related to that person's involvement in any program 8 under the Medicare, Medicaid, or the Title XXI services program since the inception 9 of those programs. (42 C.F.R. § 455.106.) 10 (2) County shall terminate the enrollment of Contractor if any person with five 11 percent (5%) or greater direct or indirect ownership interest in the disclosing entity 12 has been convicted of a criminal offense related to the person's involvement with 13 Medicare, Medicaid, or Title XXI program in the last 10 years. 14 21.3 Contractor must provide disclosure upon execution of this Agreement, extension for 15 renewal, and within thirty (35) days after any change in Contractor ownership or upon request of 16 County. County may refuse to enter into an agreement or terminate an existing agreement with 17 Contractor if Contractor fails to disclose ownership and control interest information, information 18 related to business transactions and information on persons convicted of crimes, or if Contractor 19 did not fully and accurately make the disclosure as required. 20 21.4 Contractor must provide the County with written disclosure of any prohibited 21 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers 22 or have other relationships with providers excluded from participation in Federal Health Care 23 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. 24 §438.610. 25 21.5 Reporting. Submissions shall be scanned pdf copies and shall be sent via email to 26 DBHContractedServices6a fresnocountyca.gov. County may deny enrollment or terminate this 27 Agreement where any person with five percent (5%) or greater direct or indirect ownership 28 interest in Contractor has been convicted of a criminal offense related to that person's 57 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County 2 may terminate this Agreement where any person with five percent (5%) or greater direct or 3 indirect ownership interest in the Contractor did not submit timely and accurate information and 4 cooperate with any screening method required in 42 CFR, Section 455.416. 5 Article 22 6 Disclosure of Criminal History and Civil Actions 7 22.1 Applicability. Contractor is required to disclose if any of the following conditions 8 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively 9 referred to as "Contractor"): 10 (A) Within the three (3) year period preceding the Agreement award, they have been 11 convicted of, or had a civil judgment tendered against them for: 12 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain, 13 or performing a public (federal, state, or local) transaction or contract under a public 14 transaction; 15 (2) Violation of a federal or state antitrust statute; 16 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records; 17 or 18 (4) False statements or receipt of stolen property. 19 (B) Within a three (3)year period preceding their Agreement award, they have had a 20 public transaction (federal, state, or local) terminated for cause or default. 21 22.2 Duty to Disclose. Disclosure of the above information will not automatically 22 eliminate Contractor from further business consideration. The information will be considered as 23 part of the determination of whether to continue and/or renew this Agreement and any additional 24 information or explanation that Contractor elects to submit with the disclosed information will be 25 considered. If it is later determined that the Contractor failed to disclose required information, 26 any contract awarded to such Contractor may be immediately voided and terminated for 27 material failure to comply with the terms and conditions of the award. 28 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other 58 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit P herein. 2 Additionally, Contractor must immediately advise the County in writing if, during the term of the 3 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for 4 participation in Federal or State funded programs or from receiving federal funds as listed in the 5 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions 6 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless 7 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other 8 matter listed in the signed Certification Regarding Debarment, Suspension, and Other 9 Responsibility Matters. 10 Article 23 11 Cultural and Linguistic Competency 12 23.1 General.All services, policies and procedures must be culturally and linguistically 13 appropriate. Contractor must participate in the implementation of the most recent Cultural 14 Competency Plan for the County's DBH and shall adhere to all cultural competency standards 15 and requirements. Contractor shall participate in the County's efforts to promote the delivery of 16 services in a culturally competent and equitable manner to all individuals, including those with 17 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and 18 regardless of gender, sexual orientation, or gender identity including active participation in the 19 County's DBH's Diversity, Equity and Inclusion (DEI) Committee. 20 23.2 Policies and Procedures. Contractor shall comply with requirements of policies and 21 procedures for ensuring access and appropriate use of trained interpreters and material 22 translation services for all limited and/or no English proficient beneficiaries, including, but not 23 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the 24 policies and procedures, and monitoring its language assistance program. Contractor's policies 25 and procedures shall ensure compliance of any subcontracted providers with these 26 requirements. 27 23.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation 28 is available for any language and written translation is available in prevalent languages and that 59 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 auxiliary aids and services are available upon request, at no cost and in a timely manner for 2 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities. 3 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to 4 interpret or facilitate communication; however, if the beneficiary refuses language assistance 5 services, the Contractor must document the offer, refusal, and justification in the beneficiary's 6 file. 7 23.4 Interpreter Qualifications. Contractor shall ensure that employees, agents, 8 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly 9 communicate with a beneficiary in a language other than English (1) have completed annual 10 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the 11 beneficiary's language; (3) can effectively communicate any specialized terms and concepts 12 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic 13 principles. As requested by County, Contractor shall identify all who interpret for or provide 14 direct communication to any program beneficiary in a language other than English and identify 15 when the Contractor last monitored the interpreter for language competence. 16 23.5 Culturally and Linguistically Appropriate Service Standards. Contractor shall 17 submit to County's DBH for approval, within ninety (90) days from date of Agreement effective 18 date, Contractor's plan to address all fifteen (15) National Standards for Culturally and 19 Linguistically Appropriate Service (CLAS), as published by the Office of Minority Health and as 20 set forth in Exhibit Q "National Standards on Culturally and Linguistically Appropriate Services", 21 attached hereto and incorporated herein by reference and made part of this Agreement. As the 22 CLAS standards are updated, Contractor's plan must be updated accordingly. As requested by 23 County's DBH, Contractor shall be responsible for conducting an annual CLAS self-assessment 24 and providing the results of the self-assessment to the County. The annual CLAS self- 25 assessment instruments shall be reviewed by the County and revised as necessary to meet the 26 approval of the County. 27 23.6 Training Requirements. Cultural competency training for Contractor staff should be 28 substantively integrated into health professions education and training at all levels, both 60 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 academically and functionally, including core curriculum, professional licensure, and continuing 2 professional development programs. As requested by County's DBH, Contractor shall report on 3 the completion of cultural competency trainings to ensure direct service providers are 4 completing a minimum of twelve (12) hours of annual cultural competency training. 5 23.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that 6 includes staff at all agency levels to discuss cultural competence. Contractor shall designate a 7 representative from Contractor's team to attend County's DBH's DEI Committee. 8 Article 24 9 General Terms 10 24.1 Modification. Except as provided in Article 7, "Termination and Suspension," this 11 Agreement may not be modified, and no waiver is effective, except by written agreement signed 12 by both parties. The Contractor acknowledges that County employees have no authority to 13 modify this Agreement except as expressly provided in this Agreement. 14 24.2 Non-Assignment. Neither party may assign its rights or delegate its obligations 15 under this Agreement without the prior written consent of the other party. 16 24.3 Governing Law. The laws of the State of California govern all matters arising from 17 or related to this Agreement. 18 24.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno 19 County, California. Contractor consents to California jurisdiction for actions arising from or 20 related to this Agreement, and, subject to the Government Claims Act, all such actions must be 21 brought and maintained in Fresno County. 22 24.5 Construction. The final form of this Agreement is the result of the parties' combined 23 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be 24 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement 25 against either party. 26 24.6 Days. Unless otherwise specified, "days" means calendar days. 27 24.7 Headings. The headings and section titles in this Agreement are for convenience 28 only and are not part of this Agreement. 61 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 1 24.8 Severability. If anything in this Agreement is found by a court of competent 2 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in 3 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of 4 this Agreement with lawful and enforceable terms intended to accomplish the parties' original 5 intent. 6 24.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall 7 not unlawfully discriminate against any employee or applicant for employment, or recipient of 8 services, because of race, religious creed, color, national origin, ancestry, physical disability, 9 mental disability, medical condition, genetic information, marital status, sex, gender, gender 10 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to 11 all applicable State of California and federal statutes and regulation. 12 Contractor shall take affirmative action to ensure that services to intended Medi-Cal 13 beneficiaries are provided without use of any policy or practice that has the effect of 14 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic 15 group identification, sex, sexual orientation, gender, gender identity, age, medical condition, 16 genetic information, health status or need for health care services, or mental or physical 17 disability. 18 24.10 No Waiver. Payment, waiver, or discharge by either party of any liability or obligation 19 of the other party under this Agreement on any one or more occasions is not a waiver of 20 performance of any continuing or other obligation of the parties and does not prohibit 21 enforcement by the parties of any obligation on any other occasion. 22 24.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement 23 between the Contractor and the County with respect to the subject matter of this Agreement, 24 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements, 25 publications, and understandings of any nature unless those things are expressly included in 26 this Agreement. If there is any inconsistency between the terms of this Agreement without its 27 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving 28 62 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the 2 exhibits. 3 24.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to 4 create any rights or obligations for any person or entity except for the parties. 5 24.13 Authorized Signature. The Contractor represents and warrants to the County that: 6 (A) The Contractor is duly authorized and empowered to sign and perform its 7 obligations under this Agreement. 8 (B) The individual signing this Agreement on behalf of the Contractor is duly 9 authorized to do so and his or her signature on this Agreement legally binds the 10 Contractor to the terms of this Agreement. 11 24.14 Electronic Signatures. The parties agree that this Agreement may be executed by 12 electronic signature as provided in this section. 13 (A) An "electronic signature" means any symbol or process intended by an individual 14 signing this Agreement to represent their signature, including but not limited to (1) a 15 digital signature; (2) a faxed version of an original handwritten signature; or (3) an 16 electronically scanned and transmitted (for example by PDF document) version of an 17 original handwritten signature. 18 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed 19 equivalent to a valid original handwritten signature of the person signing this Agreement 20 for all purposes, including but not limited to evidentiary proof in any administrative or 21 judicial proceeding, and (2) has the same force and effect as the valid original 22 handwritten signature of that person. 23 (C)The provisions of this section satisfy the requirements of Civil Code section 24 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, 25 Part 2, Title 2.5, beginning with section 1633.1). 26 (D) Each party using a digital signature represents that it has undertaken and 27 satisfied the requirements of Government Code section 16.5, subdivision (a), 28 63 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 paragraphs (1) through (5), and agrees that each other party may rely upon that 2 representation. 3 (E) This Agreement is not conditioned upon the parties conducting the transactions 4 under it by electronic means and either party may sign this Agreement with an original 5 handwritten signature. 6 24.15 Counterparts. This Agreement may be signed in counterparts, each of which is an 7 original, and all of which together constitute this Agreement. 8 [SIGNATURE PAGE FOLLOWS] 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 64 ii DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 1 The parties are signing this Agreement on the date stated in the introductory clause. 2 California Forensic Medical Group, Inc. COUNTY OF FRESNO 3 DocuSigned by: _ 5 u a e;"MD, President of CFMG Nathan Magsig, Chairman of the Board of DocuSigned by: Supervisors of the County of Fresno 6 4t1Wt'd1NWrano, �,a4 ki-JYa") hP Attest: 7 MD, Vice President Bernice E. Seidel and Secretary of CFMG Clerk of the Board of Supervisors 8 County of Fresno, State of California 9 3340 Perimeter Hill Dr. Nashville, TN 37211 By: — 10 Deputy 11 For accounting use only: 12 Org No.: 34409999 Account No.: 7295 13 Fund No.: 0001 Subclass No.: 10000 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 65 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A Comprehensive Medical and Behavioral Health Care Services -JJC SCOPE OF SERVICES 1. Contractor shall provide to County's Detained Youth, aged 12 to 25, onsite at the JJC and off site (any service provided outside of the JJC), comprehensive medical and behavioral health care services, including dental, optometric and optician, pharmaceutical, diagnostic, chronic care, vaccine maintenance services, and other services, and include the capacity of telehealth that would typically be provided for in-home patients or in a primary care community-based setting. Telehealth shall also be provided for commonly utilized specialties, particularly if there are delays in receiving timely care. 2. Contractor shall be ready to implement and assume all responsibilities for comprehensive medical and behavioral health care services for Detained Youth at the JJC as of 12:01 AM on July 1, 2024. 3. Participation in the Medi-Cal County Inmate Program (MCIP) through the California Department of Health Care Services (DHCS)for Medi-Cal Covered Inpatient Hospitalization Services is approved by the County on a triennial basis. Medi-Cal covered inpatient hospitalization services are defined as allowable inpatient hospital care of youth in county correctional facilities, for an expected period of 24 hours or longer, provided to a patient who may be deemed Medi-Cal eligible as determined by the County Department of Social Services (DSS). County has chosen to participate in MCIP through June 2026 (current MCIP Participation Agreement No. A-23-169). County intends to continue participation in the next agreement cycle. Contractor will assist and coordinate with designated County staff to identify Detained Youth requiring Medi-Cal eligibility determination. If a Detained Youth's MCIP eligibility is denied, the Contractor will pay for inpatient hospital services and will bill County for reimbursement of costs. County will only reimburse costs for services after DSS has made a final determination that the Detained Youth is ineligible for MCIP. If Contractor pays for services before MCIP eligibility is fully determined, the County will not reimburse Contractor for services paid to provider until the Detained Youth's eligibility is fully determined. There is no guarantee that this program will be available or will continue to be available during the term of this Agreement. In the event the County does not participate in MCIP in future years, the County and Contractor agree to renegotiate inpatient hospital costs. County and Contractor acknowledge and agree that the cost of Medi-Cal Covered Inpatient Hospitalization Services is not the financial responsibility of the Contractor and will be specifically excluded from the scope of work within this Agreement, provided the Contractor complies in full with the provisions of the Agreement. Contractor shall manage the clinical process and adjudicate claims on behalf of the County. County retains sole responsibility for the enrollment of Detained Youth into MCIP and will agree to timely apply for an eligibility determination of all Detained Youth who receive Medi- Cal Covered Inpatient Hospitalization Services. It is Contractor's responsibility to promptly notify County of Detained Youth's admission to as an inpatient. If the County is not notified timely within 5 days of first inpatient service, the Contractor may be responsible for the costs of inpatient services. A-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 4. Contractor shall identify and provide treatment and therapy to all Detained Youth with behavioral health needs (mental health and/or substance use disorder (SUD)) as well as provide crisis intervention, crisis stabilization, and crisis de-escalation services. 5. Psychiatric inpatient hospitalization will remain the responsibility of the County; however, Contractor shall coordinate and cooperate with County's DBH-contracted provider of psychiatric inpatient services for admission of a Detained Youth. Contractor shall at a minimum facilitate quarterly meetings with County's DBH-contracted provider of Detained Youth psychiatric inpatient services. 6. All services provided by Contractor shall be carried out in conformity with all applicable provisions of Title 15 of the California Code of Regulations and the National Commission on Correctional Health Care (NCCHC) accreditation guidelines and standards, as described in this Agreement. 7. Contractor will have access to existing medical equipment and will be required to comply with County inventory requirements, as described in the Agreement. 8. Specific services provided on-site by Contractor shall include, but are not limited to: Behavioral Health • Anger management/treatment • Case management, care coordination, discharge planning, appropriate linkages and referrals, based on the individual's level of need. Detained Youth with scheduled release dates are expected to be linked to community services. Linkage assumes an appointment is made. • Collaboration and assistance with assessments, treatment, reports, consultation, and hearing reviews in accordance with Fresno County Superior Court Competency Protocol 709, when applicable. • Crisis intervention, crisis stabilization, and crisis de-escalation • Family/care-taker outreach and engagement • Individual and group therapy • Life skills groups • Mental health assessment and evaluation • Mental health treatment plan development • Participation in Family Behavioral Health Court, Juvenile Drug Court, and/or specialty/collaborative court hearings as may be required/ordered to facilitate alternatives to incarceration and assist in continuity of care • Peer support services • Psychiatric medication evaluation, education, administration, and monitoring • Psycho-education groups • Psychosocial assessments • Substance use disorder (SUD) services to include screening, assessment, treatment plan, counseling (individual and group therapy), and discharge planning and linkage to appropriate community services. The intake screen will include identifying individuals at risk for withdrawal from opioids and a determination within twelve (12) hours of booking for eligibility for medication assisted treatment (MAT). • Suicide prevention activities (Columbia Risk Rating Scale risk assessment for suicidal ideation, Collaborative Safety plan, training, intervention, and monitoring of Detained Youth on suicide watch). Actively pursue crisis intervention and de-escalation prior to safety cell placement with a duration of services to meet the level of need. A-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A • Complete in-house assessments and documentation as necessary for the County of Fresno Public Guardian to be appointed as probate conservator of the Detained Youth age 18 and over who are unable to provide for their needs due to cognitive disabilities. This includes completion of Superior Court Judicial form GC-335 Capacity Declaration —Conservatorship, and any necessary attachments. • Final programming selection will be at the discretion of the County. Medical Health • Chronic care services • Communicable disease control • Dental services • Detoxification and alcohol and other drug (AOD)withdrawal management, including MAT • First aid and emergency response/minor trauma capabilities (e.g. sutures) • Fit for confinement and intake health screening • Health appraisals • Health education (including diabetic treatment education and other chronic disease related information) • Laboratory • Medical and dental prosthetic devices, hearing aids, and durable medical equipment • Optometric and optician (including glasses) • Physical therapy • Prenatal, pregnancy, abortion, obstetrical care, and family planning • Referrals for specialty services • Sick call • Telehealth services for specialty referrals not available onsite • Vaccinations • X-ray (radiological) and EKG (electrocardiogram services) Other Services • Collaborate with all care providers in the facility to determine the appropriateness of services and establish efficiencies, where possible • Electronic health record (EHR) maintenance/data security/retention • Emergency on-call medical/psychiatric coverage • Environmental safety • Janitorial service for work areas staffed by Contractor • Medical waste disposal • Participate in Family Behavioral Health Court and other specialty/collaborative courts including staffing(s), etc., as requested by the Probation and Department of Behavioral Health • Pharmaceutical distribution/monitoring • Pharmaceuticals (and pharmacist consulting services) • Quality assurance/performance improvement • Re-entry discharge planning and coordination • Response to health records requests and release of information • Staff training, including but not limited to periodic in-service trainings • Statistics and record-keeping • Telehealth for specialty referrals A-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 9. Contractor shall operate a medical and behavioral health care program that meets the local community standards of care. 10. Contractor shall maintain National Commission on Correctional Health Care (NCCHC) accreditation in "Facility Health Services: Jails, Prisons and Juvenile Confinement Facilities" following the Standard for Health Services in Juvenile Detention and Confinement Facilities for the duration of the Agreement. 11. Contractor shall operate health care programs at staffing levels outlined in Exhibit E for 17.5- hour coverage (clinic hours) using only licensed, certified, and professionally trained personnel and shall ensure that services are provided competently. Should the need arise, Contractor shall be amenable to increasing hours of coverage up to 24 hours at County's request. Any modifications to staffing shall be approved by Probation, as the County's Agreement Administrator, in consultation with DPH and DBH. 12. Contractor shall provide appropriate level of staff coverage and/or responsiveness at all times for providing contracted services and 24/7 on-call support for medical/psychiatric matters by the responsible physician and/or psychiatrist assigned to the facility. 13. Contractor shall be responsible for the provision of emergency medical care to Detained Youth 7-days a week during clinic hours. Emergency medical care is defined as those medical services required for the alleviation of severe pain, or immediate diagnosis and treatment of unforeseen medical conditions, which, if not immediately diagnosed and treated, would lead to disability or death. An examination by an appropriate health professional is necessary to determine whether such an emergency exists. If a Detained Youth is transported to an Emergency Department for treatment, but not admitted as an inpatient, Contractor shall be responsible for the cost of the Emergency Department care. 14. Contractor shall be responsible for the provision of all non-emergency medical care, which, in the judgment of the applicable treating physician, requires hospitalization, as part of the course of treatment. 15. Contractor shall be responsible for the provision of specialized health care, which shall be provided by physicians, whose training focuses primarily in a specific field, including, but not limited to: neurology, cardiology, rheumatology, dermatology, oncology, orthopedics, ophthalmology, or OB/GYN services. Contractor shall arrange for these services to be provided through telehealth to the extent possible. 16. Contractor shall be responsible for dialysis treatments to Detained Youth, as necessary, and shall attempt to provide dialysis services on-site in order to minimize transportation and custody costs. If off-site treatment is required, Contractor shall provide coordination for Detained Youth requiring dialysis treatment. Contractor shall coordinate with County custody staff to transport Detained Youth to appropriate locations for dialysis treatment. 17. Contractor shall be responsible for all outpatient specialty care deemed necessary by the applicable treating physician, whether provided on an outpatient or inpatient basis, including, but not limited to, oral and maxillofacial surgery, cardiology, surgery, OB-GYN, orthopedics, ear, nose and throat services, ophthalmology, neurology and neurosurgery, urology, endocrinology, podiatry, plastic and reconstructive surgery, when deemed medically necessary, internal medicine, physical and occupational therapy, rheumatology and oncology. Contractor shall arrange for these services to be provided through telehealth to the extent possible. A-4 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 18. Contractor shall be responsible for the provision of specialty prenatal or obstetrical care deemed medically necessary by the applicable treating physician, especially for those women that encounter problems during pregnancy and/or are deemed "high-risk" by medical personnel. Prenatal care shall include evaluation by a board-certified OB or a clinician working with a board-certified OB within two (2) weeks of diagnosis of an uncomplicated pregnancy or within one (1) week of diagnosis if there is an urgent obstetric-gynecological care issue, with follow-up visit frequency as determined by the OB. 19. Contractor shall be financially responsible for medically-necessary and elective abortions. Contractor shall provide coordination for the abortion procedure. 20. If Contractor does not have the appropriate medical equipment for accurate diagnosis (e.g., MRI or CT scan) or is not capable of providing such service within the County's JJC, Contractor must coordinate with area hospitals or clinics to make such services available to Detained Youth. 21. Contractor shall provide Collaborative Correctional Care services, including: a. Detained Youth-Patient centered team care b. Population-based care c. Measurement-based treatment to target d. Evidence-based care e. Accountable care SERVICES PROVIDED 1. Contractor's responsibility for medical and behavioral health care services shall begin at intake screening and shall end at the completion of the discharge process of the Detained Youth from County custody, including care coordination and linkage to care, as appropriate. Care coordination shall also include care provided while in-custody and must include discharge planning to provide appropriate linkage to County-contracted or other community programs, and to contractors providing enhanced care management and community support services through California Advancing and Innovating Medi-Cal (CaIAIM)for eligible individuals upon release. Care coordination and collaboration must include the sharing of treatment-required information between providers essential to the provision of appropriate services and care, ensuring that patients receiving medications for chronic conditions have an appointment with a primary care provider in the community within two weeks of release. Due to the uncertain timing of releases from JJC, discharge planning documents including current diagnoses, medications, and copies of any completed outside referrals and diagnostic studies ordered by Contractor will be provided to Detained Youth at the time of release and to County-contracted staff or other community support services coordinating case management activities within 30 to 90 days of a scheduled release, or as outlined in CaIAIM. 2. Contractor shall identify, provide, and track chronic care services to Detained Youth including, but not limited to, chronic conditions identified in NCCHC standards. 3. Contractor shall make accommodations within the JJC in order to prevent unnecessary use of hospitalization and off-site specialty care service providers and security resources. When off- site specialty care is required, Contractor will make every effort to arrange for the service to be provided via tele-health as available. 4. Contractor shall staff a medical professional (i.e., Registered Nurse) to provide the medical and behavioral health care intake screening conducted at the time of booking. Contractor shall A-5 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A provide staffing for intake screening at all booking locations. Intake screening shall include a direct visual observation, a clinical screening interview, identification of all current and immediate healthcare needs, including a review of any behavioral health information available in DBH's EHR system, and an examination of any medications brought into the facility. Contractor must"bridge" all verified, valid prescriptions for Detained Youth entering the facility on prescribed medication that are not available for administration to Detained Youth within 24 hours. Contractor shall also document their determination of whether and how to bridge chronic care medications the Detained Youth report they have been taking within 24 hours, even if the medication has not been verified. 5. Contractor shall provide training to Probation staff to conduct a non-health care provider intake screening during non-clinic hours. Intake screening performed by Probation staff shall be reviewed and a new intake screening shall be conducted by Contractor licensed health care staff commencing on the next Contractor shift. 6. Contractor shall provide an initial health assessment that includes medical history, and a physical and mental health assessment, to include SUD and/or MAT. Health assessments must be completed within ninety-six (96) hours for all Detained Youth. The health assessment must be conducted by a mid-level practitioner, physician, or registered nurse, using appropriate Standardized Nursing Protocol. The Standardized Nursing Protocols and Mid- Level Practitioner Protocols shall be made available for County's DPH and/or DBH Director, or designee, and/or County's Health Officer for review. Additional health assessments of the Detained Youth shall be conducted annually after the initial health assessment is completed. 7. Contractor shall use the Fresno County SUD American Society of Addiction Medicine (ASAM) Patient Placement Criteria (PPC) II, as completed by a certified/registered counselor and a Licensed Practitioner of the Healing Arts (LPHA) to determine appropriate SUD treatment level of care. The LPHA will complete the Medical Necessity and Initial Determination of Diagnosis (IDD) within 72 hours. The completed ASAM PPC II assessment shall determine the appropriate frequency of SUD services. Frequency of services will match the level of need identified in the assessment and evaluation. SUD outpatient services shall consist of up to six (6) hours per week of medically necessary services for Detained Youth and up to nine (9) hours per week for Detained Youths age 18 and over. Services may exceed the maximum hours based on individual medical necessity. Services can be provided by an LPHA or registered/certified counselor in-person, by telephone, or telehealth in accordance with HIPAA and 42 Code of Federal Regulations (CFR) Part 2. Group size is limited to no less than two (2) and no more than twelve (12) persons served. 8. Contractor shall understand that County is seeking to redesign SUD treatment programming for Detained Youth at the JJC, and shall work with County to meet programming needs as indicated by court orders and client population demographics. The Contractor shall have the ability to provide the current programming as defined in "Attachment A", although programming is subject to change, as a result of the redesign referenced above. Contractor shall have the ability to provide services to address gang prevention, domestic violence, victim empathy, batterer's intervention classes, and/or shall be able to coordinate with County's other contracted providers of evidence-based practiced group intervention services. 9. Contractor shall ensure that there is a process for all Detained Youth to initiate requests for health care services on a daily basis and that those requests are readily available to all Detained Youth. Contractor shall use a priority system to triage requests within twenty-four (24) hours, not to exceed seventy-two (72) hours. Triage of sick call requests will be conducted by a registered nurse or licensed vocational nurse, within their scope of practice. A-6 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 10. Contractor shall be responsible for obtaining informed consent from the parent/legal guardian or court for the Detained Youth, except in cases of emergencies. Youth 18 years of age or older will have the right to authorize or decline medical care, when the Detained Youth's consent is sufficient pursuant to existing law. Procedures to follow for obtaining informed consent from Detained Youths are guided by the NCCHC "Privacy of Care" standard and any pertinent state regulations. 11. Contractor shall provide sick call 7-days/week, with emergency response on the weekends. 12. Contractor shall conduct sick call in designated areas of the clinics or housing units, in as much privacy as security concerns will allow. 13. Contractor shall provide emergency response care for minor trauma incidents (i.e., on-site medical care treatment for minor injuries such as sutures, sprains, etc.) in order to minimize Detained Youth transports. 14. Contractor shall provide psychiatric and psychotropic medication monitoring for the Detained Youth population, as well as court-ordered evaluations pursuant to Penal Code 4011.6. Contractor shall provide crisis coverage at County's JJC. 15. Contractor shall comply with the completion and submission of the Judicial Council of California JV-220 Application Regarding Psychotropic Medication. 16. Contractor shall be responsible for all psychiatric emergency services including intervention, crisis stabilization, and crisis de-escalation services for Detained Youths within County's JJC. 17. Contractor shall provide emergency, medically necessary and non-emergency dental services, including a dental screening upon admission, oral exam within twelve (12) months of admission, routine x-rays and dental treatment (not limited to extractions) and oral hygiene instruction and preventive education for Detained Youth. 18. Contractor shall provide pharmaceutical services at the JJC facility, including provision of currently prescribed chronic medications within 24 hours of entry into the JJC, in accordance with NCCHC standards, and may subcontract with a qualified, State of California licensed on- site pharmacy to provide pharmacy services including, but not limited to: a. Medical and psychotropic pharmaceuticals b. Dispensing and delivery of medications c. Over-the-counter medications d. Pharmacist consulting services e. Pharmaceutical electronic monitoring/ordering system f. Pharmaceutical disposal services g. Prescription medications for Detained Youth on temporary authorized release h. Long Acting Injectables (LAI) 19. Contractor shall provide on-site basic optometry services provided by a licensed optometrist. Services shall include assessment, treatment and consultation including examination of the eyes for health and vision problems, prescriptions for glasses, and diagnosis and treatment of eye disease. Contractor must provide, repair, or replace glasses, when necessary. All optometry equipment and supplies will be the responsibility of the Contractor. 20. Contractor shall be responsible to provide prescription medications, as necessary, for Detained Youth in custody of Probation, but who are on temporary authorized release. A-7 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 21. Contractor shall furnish and pay for the timely provision and repair of medical orthoses, prostheses, and other aids to impairment including, but not limited to, the following: braces, shoe inserts, splints, prostheses, prescription eyeglasses, hearing aids, corrective shoes, canes, walkers, and wheelchairs that are deemed medically necessary. 22. Contractor shall provide prenatal or obstetrical care (OB) services to Detained Youth. Prenatal care shall include evaluation by a Board-certified OB within two (2) weeks of diagnosis of an uncomplicated pregnancy or within one (1)week of diagnosis if there is an urgent obstetric- gynecological care issue, with follow-up visit frequency as determined by the OB. If the need arises to refer a Detained Youth to an off-site OB provider that is not available or appropriate for telehealth, (depending on what type of obstetrical care is necessary), then the Contractor will need to coordinate with JJC staff for transport for all off-site scheduled appointments. Contractor must coordinate care with DPH public health nurses for pregnant youth detained at JJC, including notification to DPH when a pregnant Detained Youth is identified. Before starting any medications, Contractor will provide a pregnancy test to the Detained Youth suspected of being pregnant to confirm pregnancy. Any pregnant Detained Youth will be provided timely and appropriate prenatal care, counseling, specialized obstetrical services, postpartum care, including post-partum mental health care when indicated. Care shall be within nationally accepted care guidelines and shall include: a. Pregnancy testing b. Comprehensive counseling in accordance with Detained Youth's expressed desires c. Routine and high-risk prenatal care d. Advice on appropriate levels of activity, safety precautions, and nutritional guidance e. Management of chemically addicted pregnant females f. Dietary supplements g. Observations for signs of toxemia 23. Contractor shall provide birth control, if medically necessary, and family planning education. Contractor will coordinate with outpatient providers for pregnancy termination services, in accordance with Title 15 and California Penal Code, section 3405 requirements. Contractor shall be responsible for the costs of all pregnancy termination services. For Detained Youth who are on a method of contraception at intake, continuation of contraception will be considered on a case-by-case basis. Plan-B will be available at intake for Detained Youth who report the need for emergency contraception. Detained Youth desiring to initiate contraception, including long-term options, will be scheduled with a provider to discuss available and clinically appropriate options at the Detained Youth's request sixty (60) days prior to a scheduled release from custody. 24. Contractor shall provide on-call professional radiological (x-ray) and electrocardiograph (EKG) services. These services must be made available at the County's JJC facility during clinic hours. Contractor must comply with the Radiation Control Laws and Regulations, as well as provide copies of resumes, licenses, and certifications of applicable staff. 25. Contractor shall be responsible for all laboratory services required for Detained Youth. STAT service requests must be made available and provided 24/7 by Contractor. Contractor will be responsible for all necessary supplies including, but not limited to, supplies for specimen collections, phlebotomy services, specimen pick-up and delivery, laboratory testing, critical test value reporting, and timely response for urgent and routine laboratory orders. Contractor or its subcontractors must be CLIA (Clinical Laboratory Improvement Amendments) certified. All laboratory services will be provided in accordance with Fresno County, State, and Federal A-8 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A client confidentiality requirement. STAT service requests must be made available and provided by Contractor. 26. Contractor shall maintain standards and certifications required by CLIA and shall maintain Clinical Laboratory Registration (CLR) with the State. All CLIA and CLR certification and/or registration fees will be the responsibility of Contractor. 27. Contractor shall obtain and maintain medical waste generator registration with the State of California for the JJC and develop a Medical Waste Management Plan, as required under the Medical Waste Management Act. Contractor shall be responsible for all fees associated with registration as a medical waste generator facility. 28. Contractor shall be responsible for the handling and disposal of medical and contaminated waste in accordance with all applicable state and local regulations. 29. Contractor shall provide for ancillary services (including coordination for laboratory, MRI, etc.) which can be performed off-site, but preferably shall be performed on-site. Contractor shall attempt to provide services on-site, as much as possible. 30. Contractor shall be responsible to coordinate dialysis treatments to Detained Youth in JJC that require dialysis treatment. Contractor shall attempt to provide on-site in order to minimize transportation and custody costs. 31. Contractor may provide psychiatry services via tele-psychiatry, as appropriate. 32. Contractor shall provide appropriate care coordination and linkage to care, including robust discharge planning, as appropriate. Care coordination shall include care provided while the Detained Youth is detained beginning at intake screening through to discharge planning including appropriate linkage to County-contracted or other community programs, upon release. Care coordination and collaboration must include the sharing of treatment-required information between providers essential to the provision of appropriate services and care, upon release of a Detained Youth from County's JJC. Care Coordination will also include the following: a. Coordinating aftercare arrangements b. Making referrals to appropriate community programs c. Coordinating appointments with community providers prior to release, including arranging either directly or indirectly for an appointment with a primary care provider within 14 days of release if a Detained Youth is prescribed a medication for a chronic condition d. Ensuring medications are continued with a 14-day supply following release e. Identifying Detained Youth at higher risk for medical, behavioral, substance use, or dental issues prior to release f. Linking with agencies providing CalAIM services to Detained Youth g. Providing relevant clinical information to medical providers including diagnoses, medications currently prescribed, and reports from outside specialty referrals and diagnostic studies for high-risk Detained Youth at least 30 to 90 days, or as outlined in CaIAIM, prior to scheduled release date h. Assisting Detained Youth with applying for financial help, if necessary i. Assisting Detained Youth to linkage to programs as County's DBH Children's Division or other programs, as applicable j. Coordinate with DPH Public Health Nurses upon release of Detained Youth who are pregnant A-9 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 33. Contractor shall assist Probation in developing a "Discharge Plan" for all Detained Youth being released from JJC custody. 34. Contractor shall develop and maintain an adequate infectious disease control program including the management of all reportable communicable diseases consistent with DPH infectious disease guidelines. The infectious disease control program must include testing all Detained Youth for tuberculosis (TB) within five (5) days of intake. Contractor shall also be able to identify and report communicable diseases as well as potential exposures to communicable diseases (including HIV, AIDS, TB, Hepatitis, STDs). The Contractor will be prepared to manage infectious disease under an emergency declaration as recommended by DPH, including testing, and immunizations when indicated. Contractor will provide infectious disease reports requested by DPH with enough detail and frequency for DPH to monitor screening, positive cases, exposures, and potential sources of exposure. Contractor shall also work closely with DPH on any significant emerging public health events impacting the community. 35. Contractor shall assume responsibility for utilization management for all Detained Youth who are transported to an emergency department and/or are hospitalized for any length of time while in custody. Contractor shall review and monitor the Detained Youth's medical case and shall make a good faith effort to actively pursue discharge of the Detained Youth from the hospital and coordinate transportation of the detainee at the earliest possible time at which Contractor has the ability to resume appropriate treatment and medical care of the Detained Youth or ward within JJC. Contractor shall obtain appropriate releases of information and coordinate discharge planning with the hospital/provider. 36. Contractor shall be responsive to and support criminal justice partners (Public Defender's Office, District Attorney's Office, and local law enforcement)who are attempting to secure appropriate services for Detained Youths with future release dates. 37. Contractor shall participate in specialty/collaborative treatment courts, civil and criminal, by providing staff to attend and inform on a Detained Youth's functioning while in custody, participation in services (including medication compliance), willingness to accept services upon release as a condition of participation in the specialty/collaborative treatment court, and community-based treatment recommendations. Contractor shall provide staff who is a clinician or under the direct supervision of a clinician. CLINIC AND RECORDS MANAGEMENT 1. Contractor will maintain all records in accordance with Section 1205 of Title 15 of the California Code of Regulations, NCCHC accreditation guidelines and standards. 2. Contractor shall implement its own clinic management system within the County's JJC. 3. Contractor shall utilize an EHR system beginning on the contracted start date of services for documentation, management, and monitoring of Detained Youth's medical and behavioral health care. Contractor must maintain complete and accurate medical health, behavioral health (mental health and SUD), optometry and dental records separate from the JJC Detained Youth confinement records. In any criminal or civil litigation where the medical or behavioral health condition of a Detained Youth is at issue, and/or upon written request of County Counsel or County's Risk Management, Contractor must provide the DPH Director, DBH Director, and/or A-10 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A County Health Officer(and/or designees)with access to such records. In the event of a possible HIPAA violation/breach/allegation, Contractor will cooperate with the County's Privacy and Security Officer(s), or designee(s). Contractor must allow designated County staff electronic read-only access to health records and to the full EHR system (including ability to view reports). Disclosure of medical and/or behavioral health information to JJC staff may be necessary for the health and safety of the Detained Youth and JJC staff and to properly manage or plan for placement and programming. Existing health care records and all health care records prepared by Contractor will remain the property of the County. During this Agreement term, Contractor will act as the custodian of records for the County and shall respond to subpoenas regarding health care records and/or treatment. At the termination of this Agreement, all health care records will remain the property of the County. Contractor will be responsible for responding to all records requests for medical and behavioral health care services in a timely manner and as allowable by HIPAA or other applicable laws, regulations, codes, and guidelines regarding medical and behavioral health care information. An accounting of records released shall be provided to Probation, DPH, and DBH at least quarterly. 4. County's DBH utilizes an EHR system for management of behavioral health care (mental health and SUD) records. Contractor must utilize this system to report all behavioral health care services (mental health and SUD) provided to Detained Youth. Documentation of the behavioral health services shall occur immediately and entry into the DBH EHR system shall occur no later than 45 days after service has occurred. County's preference is for Contractor's EHR system to have the capability to upload/enter the services in real-time or at least daily. Contractor shall send any staff who enter records of behavioral health care services to County DBH's Documentation and Billing Training as provided by County's DBH. 5. County's Probation currently utilizes an electronic case management system, "PRI MS" for management of Detained Youth records including health care records. Contractor must utilize this system to report encounters and statistics related to health care services provided to each Detained Youth. Entry of the records into PRI MS should occur no later than 12-24 hours after services occurred. 6. Contractor shall provide MCIP reports to County regarding the utilization of MCIP to pay for services. 7. Contractor shall develop and implement a written medical and behavioral health care plan with clear goals, objectives and policies and procedures for the County's JJC, including services provided to Detained Youth for both medical and behavioral health care services. Contractor shall provide County with a copy of said written plan, including all policies and procedures, upon completion. Contractor shall also provide County with any updates to said written plan, policies and procedures, as developed, throughout the term of this Agreement. 8. Contractor shall respond promptly to any and all requests by the courts for medical or behavioral health care records and information. 9. Contractor shall work with DPH, DBH, and Probation staff, as appropriate, to define the Contractor's roles in case of a disaster. Contractor shall develop and implement written A-11 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A procedures for a medical disaster plan in case of emergency or threat whether accidental, natural, or man-made. 10. Contractor shall establish a medical and behavioral health care services audit committee comprised of Contractor's staff. 11. County is required by the State Department of Health Care Services (DHCS) to collect data pertaining to behavioral health clients and services provided. Therefore, Contractor shall be responsible to report all persons serviced and services provided in behavioral health treatment program to County by entering the required components in County's DBH EHR system. A client demographic record shall be recorded at initial contact with the Detained Youth during the booking/intake process and then service records shall be recorded each time mental health and SUD services are provided. Periodic records (which contain data elements that may change, i.e., living arrangements) shall be updated and recorded at initial contact, annually, and at formal discharge. Reports shall be submitted by the 15th of the following month to Probation Contracts(@fresnocountyca.gov. 12. Contractor shall complete DHCS 1010 "Quarterly Report on Services Provided to Persons Detained in Jail Facilities" according to DHCS Behavioral Health Information Notice 22-029 as required by WIC Section 5402(a). DHCS 1010 reports shall be submitted five (5) days prior to the quarterly deadlines of October 30th, January 30th, April 30th and July 30th to DBHContractedServicesDivision@fresnocountyca.gov. PERFORMANCE AND OUTCOMES 1. Contractor's performance and outcome measures must address each of the categories referenced below and may additionally propose other performance and outcome measures that are deemed best to evaluate the services provided to Detained Youth and/or to evaluate overall program performance. Probation, DPH, and/or 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 County. Contractor must utilize a computerized tracking system with which performance and outcome measures and other relevant Detained Youth data, such as demographics, will be maintained. The data tracking system may be incorporated into the Contractor's EHR or be a stand-alone database. Probation, DPH, and DBH must be afforded read-only access to the data tracking system. Liquidated damages for non-compliance may apply. 2. Contractor shall submit annual program information regarding performance and outcomes, including measures that have been tracked for these specific purposes, and percentage of target met. All measures (i.e., proposed performance metrics should include, but are not limited to those as identified in Exhibits H and I, must meet the NCCHC standard as identified in this Agreement, as well as the categories identified below: a. Access to care: The ability of Detained Youth to receive the right service at the right time. Examples include: 1) Timeliness of bridging prescriptions 2) Timeliness of identifying Detained Youth who are seriously emotionally disturbed, as defined by the Contractor 3) Timeliness between Detained Youth's referral for assessment and completion of assessment; assessment to first treatment service; and first treatment service to next follow-up A-12 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit A 4) Timeliness of subsequent follow-up visits 5) Timeliness of response to sick call/health service requests b. Effectiveness: Objective results achieved through health care services. Examples include: 1) Effectiveness of crisis interventions 2) Effectiveness of treatment interventions (medical and behavioral health indicators) 3) Effectiveness of discharge planning (such as percentage of Detained Youth who are successfully linked to County programs, community providers, medical appointments upon release, and/or other community resources such as educational programs, stable housing, and jobs or job programs after release, with the ability to sort data by race and ethnicity) 4) Timely continuity of verified community prescriptions for medication(s), upon Detained Youth's release 5) Effectiveness of transportation coordination, upon release 6) Timely continuity of verified mental health referrals to community providers within 30 days of release 7) Percentage of Detained Youth completing in custody programming as referred to and provided by Contractor prior to release 8) Percentage of Detained Youth who have a plan of what to do when triggered or overwhelmed prior to release c. Efficiency: The demonstration of the relationship between results and the resources used to achieve them. Examples include: 1) Cost per Detained Youth 2) Number and percent of specialty referrals conducted by telehealth 3) Number of units of services per FTE (full time equivalent) by discipline 4) Number of Detained Youth served 5) Comparison of numbers served against industry standards d. Satisfaction and Compliance: The degree to which Detained Youth, County, and other stakeholders are satisfied with the services. Examples include: 1) Audits and other performance and utilization reviews of health care services and compliance with Agreement terms and conditions herein 2) Surveys of persons served, family members, other health care providers, and other stakeholders including access to community providers LIQUIDATED DAMAGES A Liquidated Damages clause is included in Section 4.9 of the Agreement in the event the Contractor fails to deliver the required services or perform in accordance with Agreement terms. The Liquidated Damages clause includes, but is not limited to the following: delay and/or failure to deliver completed reports; delay and/or failure to deliver or perform medical and behavioral health care services; failure to achieve agreed upon performance and outcome goals; and/or failure to maintain NCCHC accreditation of the JJC in the provision of medical and behavioral health care services. TRAINING/STAFF DEVELOPMENT 1. Contractor shall provide adequate orientation and training, at its cost, to all staff under their direction, including all required annual HIPAA confidentiality training. A-13 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 2. Contractor shall provide adequate annual training for JJC custody staff in medical and behavioral health observation of Detained Youth. 3. Contractor shall require a skills and competencies assessment of staff annually and include follow- up training, as required. 4. Contractor shall provide protocol and standardized procedures training, as appropriate. 5. Contractor shall assure the cultural competency of health care staff, which may be accomplished through regular training activities made available to all personnel. Contractor shall report on the completion of cultural competency trainings to ensure direct service providers are completing a minimum of 12 hours of cultural competency training annually. 6. Contractor shall comply with Prison Rape Elimination Act (PREA) of 2003 and agree to have all JJC staff trained initially and every two (2) years thereafter, by the Probation Department. 7. Pursuant to federal regulations (28 CF R§115.332), the Probation shall provide training to Contractor's personnel regarding their responsibilities under the Probation's sexual abuse and sexual harassment prevention, detection, and response policies and procedures at no cost to Contractor. 8. Contractor shall ensure all Contractor's employees, consultants, subcontractors or agents described in the Child Abuse Reporting Act, section 11164, et. seq. of the Penal Code,and while performing services under this Agreement, Contractor shall report all known or suspected child abuse or neglect to a child protective agency as defined in Penal Code section 11165.9. 9. Contractor must comply with Probation's Hostage Situation Policy, as well as Probation's JJC Manual Policy for Vendor's, Volunteers and Student Interns (Exhibit C). Contractor must adhere to JJC policies and Probation Department policies and any changes or updates to such policies. A background investigation will be completed for all staff involved. 10. Contractor shall provide annual training for Probation's correctional officers concerning various health care issues in the facilities. Such training will be jointly developed and scheduled with Probation staff as is mutually convenient, and may include subjects such as symptoms and signs of withdrawal, suicide prevention, seizures, and diabetes. The training provided to Probation's correctional officers shall comply with NCCHC minimum standards. STAFFING/FACILITIES 1. Contractor shall ensure that all personnel employed in the performance of this Agreement possess the required expertise, skill, and professional competence to perform their duties. 2. Contractor shall hire and maintain a Medical Director who will be responsible to assure the quality of health care provided within County's JJC and will provide clinical supervision to the mid-level practitioners and other ancillary personnel who perform services pursuant to this Agreement. The Medical Director must be a licensed physician. County prefers for the Medical Director to be Board Certified in internal medicine or family practice, but this is not a requirement. However, Contractor shall attempt to actively pursue recruiting a Board-Certified Medical Director. The Medical Director must have thorough knowledge of current principles and practices of medicine. ADMINISTRATION A-14 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 1. Contractor shall maintain a collaborative and open relationship with the County's DPH, DBH, and Probation in the provision of services and operations as well as future planning and evaluation of services. 2. Contractor shall communicate and consult frequently with the local medical and behavioral health community and other County-contracted providers, as well as family members including parents and guardians of the Detained Youth, as allowable by HIPAA regulations, to provide the most complete evaluation and treatment of incarcerated individuals. 3. Contractor shall coordinate with Probation, and County's contracted emergency response ambulance provider, as needed, for emergency transportation needs. 4. Contractor shall make every effort to minimize the need to transport Detained Youth from JJC to other providers for treatment by providing expanded services on-site, through telehealth services or by other methods to reduce outpatient costs as well as Probation's staff transportation and custody costs. 5. Contractor shall perform utilization review and case management services to monitor the necessity and appropriateness of inpatient hospital care and other outside medical services provided. 6. Contractor's health care personnel shall be available for court inquiries and/or appearances, when required. Contractor shall be expected to participate in the Juvenile Delinquency Court protocol related to competency to stand trial (in accordance with Welfare & Institutions Code Section 709). It will be Contractor's responsibility to compensate their staff for court appearances, which shall be at no added cost to County. 7. In the event of a HIPAA breach, violation, or allegation, Contractor shall fully cooperate with County Privacy and Security Officers, or designees. 8. Contractor shall provide appropriate and adequate bilingual services, including on-site Spanish- speaking personnel for monolingual Detained Youths. Contractor shall also make sign language interpretation available, as needed. 9. Contractor shall provide appropriate and adequate interpreter services to include, but not be limited to, the following County threshold languages: Spanish, Hmong, Laotian and Cambodian/Khmer. 10. Contractor shall establish and make available a process for receiving, investigating, and responding to and resolving any concerns relating to a Detained Youth (including families of said Detained Youth) grievances concerning medical or behavioral health care provided. 11. Contractor shall work with the County Health Officer who, under Section 101045 of the Health and Safety Code, shall investigate health and sanitary conditions in every county detention facility. Contractor shall prepare for, and participate in, said annual health inspection of the County's JJC. Contractor shall be responsible for the remediation of reported non-compliance pertaining to the provision of medical or behavioral health care services. 12. Contractor shall cooperate fully in aiding County to investigate, adjust, settle, or defend any claim, action, or proceeding, including writs of habeas corpus, brought in connection with the provision of medical or behavioral health care with which Contractor may be connected. A-15 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit A 13. Contractor shall establish and facilitate a medical and behavioral health care continuous quality improvement(CQI) committee comprised of Contractor's medical staff, and behavioral health staff with active participation of the County staff(to include the Chief Probation Officer, DPH Director, County Health Officer, DBH Director, and/or designees thereof). Said CQI committee shall meet quarterly to identify opportunities to develop strategies for improvement in quality care provided to all Detained Youth. Contractor must be willing to cooperate with County staff and provide information as requested in a timely manner. Contractor shall provide a data-driven quality improvement program with actions that lead to measurable improvements in medical and behavioral health care services. Data and statistical reports shall be provided to the CQI committee members by Contractor prior to the meeting and in electronic format. Minutes shall be taken, recorded, and disseminated to all invitees and participants of the CQI committee meetings. 14. Contractor must facilitate monthly administrative meetings. Monthly administrative meetings will include the County's Chief Probation Officer, DPH Director, County Health Officer, DBH Director, or their designees, and Contractor's staff. The purpose of these meetings will be to evaluate statistics, program needs, address problems/issues that may arise, and interrelationships between JJC staff, medical and behavioral health care services personnel as well as the Contractor's relationships with providers of emergency, inpatient, and outpatient specialty care services. Detained Youth grievances filed will also be reviewed. Minutes shall be taken, recorded, and disseminated to all invitees and participants at the monthly administrative meetings. 15. On a monthly basis, Contractor's behavioral healthcare staff will review with a multidisciplinary team comprised of DPH, DBH, and Probation staff, the number of Detained Youth who have been under constant watch in the prior month, any suicide attempts, and/or any Detained Youth who were sent out of the facility to the County's Youth Psychiatric Health Facility (PHF)for inpatient psychiatric hospitalization. Minutes shall be taken, recorded, and disseminated to all invitees and participants. 16. In the event of a Detained Youth's death, Contractor's physician shall conduct a mortality review of the case and will present their findings in a multidisciplinary mortality review meeting to be attended by Probation, DPH, DBH, County Counsel, and Contractor's staff. If Detained Youth had a history of a mental illness, a psychological autopsy must also be performed by the Contractor's psychiatrist and the results shall be presented at the mortality review. Minutes shall be taken, recorded, and disseminated to all invitees and participants. Reporting by Contractor shall comply with Title 15 mandates. 17. Contractor's administrative level agency representative, who is duly authorized to act on behalf of the Contractor, shall attend regularly scheduled Behavioral Health Board Forensic and SUD subcommittees, and regularly scheduled provider meetings with DBH and other DBH contracted providers of mental health and SUD services. 18. For all services provided by Contractor as described herein above, within this Exhibit A, Contractor shall provide reports to County regarding the utilization of services, treatments, and related costs. Contractor shall compile all patient information necessary and obtain all CPT (current procedural terminology) codes identified by the provider and prepare a report which includes the following information for each emergency visit, inpatient hospitalization, and outpatient specialty care service provided: Encounter ID Probation Number Detained Youth Name Detained Youth Birthdate Date of services A-16 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A Encounter Category Encounter Subcategory Primary Diagnosis Category Primary Diagnosis Code Primary Diagnosis Description Secondary Diagnosis Category Secondary Diagnosis Code Secondary Diagnosis Description Cost of Service/Treatment Provided Contractor shall submit these reports to County's Chief Probation Officer, DPH Director, DBH Director, or designees, on a quarterly basis. County may request additional report information throughout the term of the Agreement for the quarterly reports or on an ad hoc basis; however, in such circumstances, County and Contractor shall come to a mutually agreeable format of said reports. 19. Contractor shall provide Correctional Care Reports/STATs as identified in Exhibits H and I. EXCEPTIONS TO TREATMENT 1. Contractor will not be financially responsible for: a. Treatment costs incurred after a Detained Youth is released from the County's physical custody. b. Elective medical care: 1) Examples of elective medical care include: breast reconstruction, gastric bypass, or facelift. c. Psychiatric inpatient admissions or inpatient hospital hospitalizations. d. Health care services provided to an infant following birth, including all associated medical costs, will not be the responsibility of the Contractor. e. Any costs associated with smoking cessation treatment or classes. f. Any medical testing or obtaining samples, which are forensic in nature. g. Any experimental treatments. h. Any care provided without Contractor's prior knowledge. 2. Contractor shall not be responsible for additional costs that may occur as a result of an unusual widespread disturbance (e.g., youth riot) beyond the Contractor's control within the JJC. Such disturbance will be considered to have caused a material effect to the Contractor's cost if mass casualties have resulted from a single incident and multiple Detained Youth (i.e., ten or more victims) are required to be transported off-site for immediate emergency and/or inpatient hospitalization care. If such event occurs, parties will agree to meet and negotiate in good faith. 3. Contractor shall be responsible for all medical and behavioral health care according to the terms of this Agreement while Detained Youth are legally "in custody" of Probation. Detained Youth are considered "in custody" upon booking of the Detained Youth until the time the Detained Youth is legally released from Probation custody and will be maintained in the daily JJC ADP count regardless of where they are physically. However, individuals on supervised probation, or those that may be housed in an unidentified location (e.g., a witness or co-conspirator), shall not be included in the daily population count, and shall not be the responsibility of Contractor with respect to any claim, liability, cost, or expense for the payment and/or furnishing of health care services. A-17 DocuSign Envelope ID:Al322DEl3C-6Al37-437C-9F73-2CA17961382A7 Exhibit A Attachment A Contractor shall have the ability to provide the current SUD programming as defined below, although programming is subject to change, as stated in Exhibit A, "Services Provided" section, subsection 8. Contractor shall also coordinate with County's other contracted providers of evidence-based practiced group intervention services. Contractor will work non-traditional hours (evenings and weekends) as needed, and adapt staffing schedules in order to meet the scheduling needs of Detained Youth. Scheduling will be established in conjunction with and at the discretion of the County. 1. JJC SUD SERVICES Contractor shall implement effective and evidence-based SUD services to Detained Youth at the County's JJC regardless of housing location or status in their adjudication process. Every Detained Youth with a completed initial mental health assessment and an identified SUD need will be referred to services. The Fresno County SUD ASAM PPC II will be completed within 7 days by a LCSW/LMFT/LPCC, CADC I, 11, III or supervised ASW/AMFT/APCC for all referred Detained Youth. Additionally, the LCSW/LMFT/LPCC or supervised ASW/AMFT/APCC will complete the Medical Necessity and Initial Determination of Diagnosis (IDD) within 7 days of the referral. The completed ASAM PPC 11 assessment will determine the appropriate frequency of services. Based on the completion of the ASAM form, an individualized care plan will be completed for SUD treatment. SUD services will also include a minimum of one family session a month (a date and time for parents will be provided), not to exceed four a month. Upon release, Contractor shall provide Detained Youth a linkage to a community-based provider for appropriate placement in treatment based on the most recent assessment outcome. a. Group and individual therapy will include evidenced-based clinical practices such as Motivational Interviewing and at least two of the following four evidence-based practices: psychoeducation, trauma-informed treatment, cognitive behavioral therapy and relapse prevention. The two additional evidence-based practices may be chosen by Contractor and must be performed by trained providers within their scope of practice. Contractor shall internally monitor staff for training needs, quality of delivery, and fidelity of evidenced-based practices. 2. IN-CUSTODY SUBSTANCE ABUSE UNIT (SAU) PROGRAM SERVICES a. Currently the Fresno County Juvenile Delinquency Court adjudicates youth for drug and/or alcohol or other delinquency offenses into a six month in-custody Substance Abuse Unit (SAU) program at JJC. The Court has the sole discretion to modify eligibility criteria. Contractor shall coordinate referral, assessment, intake and treatment services with the Court and County. b. Contractor shall implement a streamlined organization of evidence-based models and services, such as motivational interviewing. c. Contractor shall incorporate the following interventions. Combining family sessions that are strength based and recognizing that the Detained Youth and family are part of a larger system and likely have needs other than substance use disorder or mental health that may impact their progress in treatment if not addressed. Contractor will partner with the Detained Youth and family to develop and implement a structured program that addresses academic, social, emotional, psychological, substance use, and socio-economic needs. Collaborative development of the Treatment Plan will guide the selection of appropriate treatment services: 1) Interventions: Treatment components will include process and community groups, psychoedu cation, individual counseling, individual therapy, cognitive behavioral therapy, A-18 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A family sessions, multi-family group sessions, case management, and discharge planning. Treatment components are further matched with specific and individual needs as identified during the intake, assessment, and evaluation process, or as indicated by court orders. 2) Urinalysis (UA) Drug Testing and Reporting: Urinalysis drug testing and reporting will be provided at the Fresno County Juvenile Justice Campus as needed by the Contractor. d. Contractor shall provide Detained Youth with the opportunity for at least one hour of daily programming to include, but not be limited to, trauma focused, cognitive, evidence-based, best practice interventions that are culturally relevant and linguistically appropriate, or prosocial interventions and activities designed to reduce recidivism. These programs should be based on the Detained Youth's individual needs as required by Juvenile Title 15 Minimum Standards Sections 1355 and 1356. 1) Psycho-Educational Groups 2) Individual Counseling 3) Family Outreach Psycho Educational Sessions 4) Discharge and Relapse Prevention Plan 5) Case Management 6) Pro-Social Activities 7) Adverse Childhood Experience 8) Emotional Regulation 9) Victim Empathy 3. IN-CUSTODY NEW HORIZONS PROGRAM SERVICES a. Currently the Fresno County Juvenile Delinquency Court adjudicates youth for drug and/or alcohol or other delinquency offenses into a twelve month in-custody New Horizons program at JJC. The Court has the sole discretion to modify eligibility criteria. In addition to intensive SUD and co-occurring mental health disorders, Detained Youth served under the New Horizons program often have committed serious and violent offenses that would have otherwise resulted in a longer-term commitment, may also be involved in the child welfare system, and have family histories of behavioral health needs, incarceration, and gang involvement. Contractor shall coordinate referral, assessment and intake with the Court and County. b. Contractor shall provide services as indicated in Attachment A, Section 2, subsections b through c. c. Data Reporting and Outcome Measures. Contractor shall provide Probation with monthly statistics on individual Detained Youth attendance for all group, individual and family sessions for each of the programs identified in this Attachment A. Contractor shall maintain a tracking log to identify delivery of services and length of time in services after each session for each Detained Youth. Contractor shall provide any other reports requested by Probation. d. Contractor shall provide Detained Youth with the opportunity for at least one hour of daily programming to include, but not be limited to, trauma focused, cognitive, evidence-based, best practice interventions that are culturally relevant and linguistically appropriate, or prosocial interventions and activities designed to reduce recidivism. These programs shall be based on the Detained Youth's individual needs as required by Juvenile Title 15 Minimum Standards Sections 1355 and 1356. 1) Psycho-Educational Groups A-19 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit A 2) Individual Counseling 3) Individual Therapy 4) Family Therapy and Family Outreach Psycho Educational Sessions 5) Vocational/ Independent Living Skills 6) Domestic Violence and Batterer's Intervention Program 7) Discharge Plan 8) Case Management 9) Pro-Social Activities 10)Adverse Childhood Experience 11)Emotional Regulation 12)Victim Empathy A-20 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 Exhibit B FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH BEHAVIORAL HEALTH REQUIREMENTS County's Department of Behavioral Health (DBH) is firmly committed to full compliance with all applicable laws, regulations, rules and guidelines that apply to the provision and payment of behavioral health care services. Any of Contractor's employees and/or its subcontractors who provide behavioral health care services to incarcerated individuals shall comply with the specific areas of requirements included within this exhibit. CONTRACTOR CODE OF CONDUCT AND ETHICS The manner in which providers of behavioral health care services conduct themselves is a vital part of this commitment to the compliance of all applicable requirements. County's DBH has established this Contractor Code of Conduct and Ethics with which Contractor, its employees, and its subcontractors shall comply. Contractor shall require any of its employees and subcontractors who provide behavioral health care services to attend a compliance training that will be provided by County's DBH. After completion of this training, Contractor's employee(s) and/or subcontractor(s) must sign the Contractor Acknowledgment and Agreement form and return this form to the County's DBH Compliance Officer, or designee. Contractor, its employees, and its subcontractors shall: 1. Comply with all applicable laws, regulations, rules or guidelines when providing any behavioral health care service. 2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their professional dealing related to their contract with the County and avoid any conduct that could reasonably be expected to reflect adversely upon the integrity of the County. 3. Treat County employees, persons served, and other behavioral health providers fairly and with respect. 4. NOT engage in any activity in violation of the County's Compliance Program, nor engage in any other conduct which violates any applicable law, regulation, rule or guideline. 5. Take precautions to ensure that behavioral health service information is prepared and B-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit B submitted accurately and timely in the County's DBH's electronic health record (EHR), and that all documented information is consistent with all applicable laws, regulations, rules or guidelines. 6. Ensure that no false, fraudulent, inaccurate or fictitious service information of any kind are submitted. 7. Submit only eligible services actually rendered and fully documented. Use service codes that accurately describe the services provided. 8. Act promptly to investigate and correct problems if errors in service information submitted are discovered. 9. Promptly report to the County's DBH Compliance Officer any suspected violation(s) of this Code of Conduct and Ethics by County employees or other behavioral health care providers, or report any activity that they believe may violate the standards of the County Compliance Program, or any other applicable law, regulation, rule or guideline. County prohibits retaliation against any person making a report. Any person engaging in any form of retaliation will be subject to disciplinary or other appropriate action by the County. Contractor may report anonymously. 10. Consult with the County's DBH Compliance Officer if you have any questions or are uncertain of any County Compliance Program standard or any other applicable law, regulation, rule or guideline. 11. Immediately notify the County's DBH Compliance Officer if they become or may become an "Ineligible Person" and therefore excluded from participation in the Federal Health Care Programs. B-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit B Fresno County Behavioral Health Compliance Program Contractor Acknowledgment and Agreement I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and Ethics. I herby acknowledge that I have received training and information on the Fresno County Behavioral Health Compliance Program and understand the contents thereof. I further agree to abide by the Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my responsibilities as a mental health contractor for Fresno County. I understand and accept my responsibilities under this Agreement. I further understand that any violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program may result in termination of my agreement with Fresno County. I further understand that Fresno County will report me to the appropriate Federal or State agency. For Individual Providers Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT Signature: Date For Group or Organizational Providers Group/Org. Name (print): Employee Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT ❑ Other: Job Title (if different from Discipline): Signature: Date: B-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B DOCUMENTATION STANDARDS FOR CLIENT RECORDS The documentation standards are described below under key topics related to client care. All standards must be addressed in the client record; however, there is no requirement that the record have a specific document or section addressing these topics. All medical records shall be maintained for a minimum of ten (10) years from the date of the end of this Agreement. A. Assessments 1. The following areas will be included as appropriate as a part of a comprehensive client record. • Presenting problems, including impairments in function, and current mental status exam. • Traumatic incidents which include trauma exposures, trauma reactions, trauma screenings, and systems involvement if relevant. • Behavioral health history including mental health history, substance use/abuse, and previous services. • Medical history including physical health conditions, medications, and developmental history. • Psychosocial factors including family, social and life circumstances, cultural considerations. • Strengths, risks, and protective factors, including safety planning. • Clinical summary, treatment recommendations, and level of care determination including diagnostic and clinical impression with a diagnosis. • The assessment shall include a typed or legibly printed name, signature of the service provider and date of signature. Behavioral health and relevant conditions affecting the client's physical health and mental health status will be documented, for example: living situation, daily activities, and social support. 2. The assessment shall include the provider's recommendation—and determination of medical necessity for services. • The time period to complete an initial assessment and subsequent assessments for mental health services is up to clinical discretion. • Assessments shall be completed within a reasonable time and in accordance with generally accepted standards of practice. B. Problem List The use of a Problem List has largely replaced the use of treatment plans and is therefore required to be part of the client record. The problem list shall be updated on an ongoing basis to reflect the current presentation of the person in care congruent with their most recent assessment. The problem list shall include, but is not limited to, the following: B-4 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B • Diagnoses identified by a provider acting within their scope of practice. • Problems identified by a provider acting within their scope of practice. • Problems or illnesses identified by the person in care and/or significant support person if any. • The name and title of the provider that identified, added, or removed the problem, and the date the problem was identified, added, or removed. • Providers shall update the problem list within a reasonable time and in accordance with generally accepted standards of practice. C. Treatment and Care Plan Requirements 1. Targeted Case Management • Specifies the goals, treatment, service activities, and assistance to address the negotiated objectives of the plan and the medical, social, educational, and other services needed by the person in care. • Identifies a course of action to respond to the assessed problems from the Problem List for the person in care. • Includes development of a transition plan when the person in care has achieved the goals of the care plan. • Peer support services must be based on an approved care plan. • Must be provided in a narrative format in the person's progress notes. • Updated at least annually. 2. Peer Support Services Peer support services must be based on an approved plan of care.The plan of care shall be documented within the progress notes in the person's clinical record and approved by any treating provider who can render reimbursable Medi-Cal services 3. Services requiring Treatment Plans • Intensive Home-Based Services (IHBS) • Intensive Care Coordination (ICC) • Therapeutic Behavioral Services (TBS) • Must have specific observable and/or specific quantifiable goals B-5 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 Exhibit B • Must identify the proposed type(s) of intervention have a proposed duration of intervention(s) • Must be signed (or electronic equivalent) by: ➢ the person providing the service(s), or ➢ a person representing a team or program providing services, or ➢ a person representing the MHP providing services ➢ when the client plan is used to establish that the services are provided under the direction of an approved category of staff, and if the below staff are not the approved category, ➢ a physician ➢ a licensed/"waivered" psychologist ➢ a licensed/"associate" social worker ➢ a licensed/ registered/marriage and family therapist or ➢ a registered nurse • In addition, ➢ Client plans will be consistent with the diagnosis, and the focus of intervention will be consistent with the client plan goals, and there will be documentation of the client's participation in and agreement with the plan. Examples of the documentation include, but are not limited to, reference to the client's participation and agreement in the body of the plan, client signature on the plan, or a description of the client's participation and agreement in progress notes. ➢ Client signature on the plan will be used as the means by which the Contractor documents the participation of the client. When the client's signature is required on the client plan and the client refuses or is unavailable for signature, the client plan will include a written explanation of the refusal or unavailability. ➢ The Contractor will give a copy of the client plan to the client on request. D. Progress Notes 1. Providers shall create progress notes for the provision of all SMHS. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code description. Each progress note should be understandable when read independently of other progress notes, providing an accurate picture of the person's condition, treatment provided, and response to care at the time the service was provided. Progress notes shall include: • The type of service rendered. • A narrative describing the service, including how the service addressed the beneficiary's behavioral health need and is working towards resolving identified problem from current Problem List. (e.g., symptom, condition, diagnosis, and/or risk factors). • The date that the service was provided to the beneficiary. • Duration of the service, including travel and documentation time. B-6 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B • Location of the beneficiary at the time of receiving the service. • A typed or legibly printed name, signature of the service provider and date of signature. • ICD 10 code to its highest specificity as clinically appropriate. • Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code. • Next steps including, but not limited to, planned action steps by the provider or by the beneficiary, collaboration with the beneficiary, collaboration with other provider(s) and any update to the problem list as appropriate. 2. Group Progress Notes • For groups facilitated by multiple practitioners, a single progress note signed by one of the practitioners can be used to document the group service provided. Progress notes need to contain the information as noted above and modifications and additional information as noted below: o Information about the specific involvement and specific amount of time of involvement of each practitioner in the group activity. Travel and documentation time should be captured separately. o A list of group participant names needs to be maintained. Please note, due to confidentiality standards, the full list of group participants must not be kept in any single participant's personal health records: instead the MHP or practitioner must maintain the full participant list outside of any participant's health records. 3. Timeliness/Frequency of Progress Notes • Progress notes shall be completed within 3 business days of providing a service, except for notes for crisis services, which shall be completed within 24 hours. • A note must be completed for every service contact and with every attempted service engagement. B-7 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B PROTOCOL FOR COMPLETION OF INCIDENT REPORT The Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete a written report of any incidents compromising the health and safety of persons-served, employees, or community members. The incident report must include a thorough description of: the incident itself, information about the person-served, type of event, location, people directly involved, action taken, and outcome (if known). The report must be submitted to the Department of Behavioral Health's web-based Incident Tracking Portal within 24 hours of the incident or knowledge of the incident. An incident is any event which jeopardizes the health and/or safety of persons-served through MHP/SUD programs, employees, or members of the community. Incidents include, but are not limited to: Death of any person-served Attempted suicide (of all severities) - Self-harming behaviors regardless of their perceived underlying cause, whether they appear related to mental health issues, suicidality, or behavioral problems. Homicide or attempts at homicide Injury connected to services or at a service site (self-inflicted or by accident and resulting in serious injury) - Violence, Abuse or Assault connected to services or at a service site (toward person-served, others or property; resulting in serious injury) - Overdoses The Incident Report must be completed for all incidents through DBH's current incident reporting portal, Logic Manager, athttps://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=1 82be0c5cdcd5072bb1 864cdee4d3d6e • The reporting portal is available 24 hours a day, every day. • In the rare event the Incident Tracking Portal is unavailable due to outage or maintenance, and an incident needs to be reported, employees may complete the Fresno County DBH Incident Report form and email encrypted to DBHlncidentReporting@fresnocountyca.gov. • Any employee of the Contractor can submit an incident using the reporting portal at any time. No login is required. B-8 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B • The designated administrator of the Contractor can add information to the follow up section of the report after submission. • When an employee submits an incident within 24 hours from the time of the incident or first knowledge of the incident, the Contractor's designated administrator, the assigned contract analyst and the Incident Reporting email inbox will be notified immediately via email from the Logic Manager system that there is a new incident to review. • Meeting the 24 hour incident reporting requirements will be easier as there are no signatures to collect. • The user guide attached identifies the reporting process and the reviewer process, and is subject to updates based on DBH's selected incident reporting portal system. • Employees involved in a crisis incident should be offered appropriate Employee Assistance Program (EAP) or similar related wellness and recovery assistance. In conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the workforce, Contractor shall align their practices around this vision and ensure needed debriefing services are offered to all employees involved in a crisis incident. Employees shall be afforded all services to strengthen their recovery and wellness related to the crisis incident. Appropriate follow-up with the employee shall be carried out and a plan for workforce wellness shall be submitted to DBH. • Unusual Occurrence Reporting to DHCS o Unusual Occurrences may include but are not limited to physical injury and death. The MHP will report Unusual Occurrences to DHCS as determined necessary. The Unusual Occurrence Report (UOR) will include: ■ 1. A written description of the incident and outcome of the incident ■ 2. List of persons-served directly involved/having direct knowledge of the incident ■ 3. Report of provider's investigation and conclusion o DBH may request contracted providers attest that an Intensive Analysis or similar (i.e. incident review, possible cause) has occurred. DBH may request additional analysis or information, when necessary. Questions about incident reporting, how to use the incident reporting portal, or designating/changing the name of the administrator who will review incidents for the Contractor should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract analyst. B-9 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B cor, Mental Health Plan (MHP) and Substance Use Disorder (SUD) Services 1 Incident Reporting System INCIDENT REVIEWER ROLE— User Guide Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete a written report of any incidents compromising the health and safety of persons served, employees, or community members. Incident reports are made through an on online reporting portal hosted by Logic Manager. It's an easier way for any employee to report an incident at any time. A few highlights: • No supervisor signature is immediately required. • Additional information can be added to the report by the program supervisor/manager without having to resubmit the incident. • When an incident is submitted, the assigned contract analyst, program supervisor/manager, clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email notification of a new incident and can log in any time to review the incident. Everything that was on the original paper/electronic form matches the online form. • Do away with submitting a paper version with a signature. • This online submission allows for timely action for the health and safety of the persons- served, as well as compliance with state reporting timelines when necessary. As an Incident Reviewer, the responsibility is to: • Log in to Logic Manager and review incident submitted within 48 hours of notification of incident. • Review incident for clarity, missing information and add in additional information deemed appropriate. • Notify DBHlncidentReporting(a�fresnocountyca.gov if there is additional information to be report after initial submission • Contact DBHlncidentReporting(a)fresnocountyca.gov if there are any concerns, questions or comments with Logic Manager or incident reporting. Below is the link to report incidents https://fresnodbh.logicmanager.com/incidents/?t=9&p=l&k=182be0c5cdcd5072bbl864cdee4d3d6e The link will take employees to the reporting screen to begin incident submission. B-10 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B LogicManager Incident Report E - ® Please complete this lofm Client lntormadon Home of ranhty' Nameof Reporting P�rP/' faclbtyAddrecs' roc illy y Phone t:unrtx.r' 4tcntal Heahh or Substance Use OlsoreMr Proynnl?' Client Rrsl Name' Client last Name' Client first Name' Client Last Name' Ghent Date of Birth Client Address Client ID Gender' County of Origin' summary Subject o Incident(check all that applyl' If Other specify(i.e.fire,poisoning,epidemfc outbreaks,other catastruphes(evenh that jeopardize the welfate and safety of clients,staff and lot members of the community): Description of the Incident' B-11 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B Similar to the paper version, multiple incident categories can be selected Incident(check all that apply)' Medical Emergency x Deathof Dllent - Homicide/Homicide Attempt AWOL/Elapement from locked facility Violence/Abuse/Assault(toward others,client and/or property Attempted Suicide(resulting in serious Injury) Injury(self-inflicted or by accident) Medication Error <— C O o fresnodbh.logicmanager.com/incidents/?t=9&pzl&k=T82bc.Oc5cdcd5072bblB&4cdec4d3d6e Due of incident' Time of Incident' Location of Incident' Key People Directly Involved in Incident(witnesses,staff)' Did the Injured Parry seek Medical Attention? r Attach any additional details Add File or Drop File Here Reported By Name' Reported By Email' Reported On 10/30/2019 B-12 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on Add File to load a file. <- C O G fresnodhh.logicmanageccom or Drop File Here Reported By Na—' Reported By Email' Reported On 10/30/2019 Follow Up Action Taken(check all that apply)' Please specify If other Description ofAclion Taken' Outcome" Similar to the paper version, multiple Action Taken categories can be selected. - Follow Up Action Taken(check all that apply)' Law Enforcement Contacted x Called 9111EMS - Consulted with Physician First Aid/CPR Administered Client removed from building Parent/Legal Guardian Contacted Other When done entering all the information, simply click submit. Any fields that have a red asterisk, require information an will prevent submission of the form if left blank. outcome r B-13 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B A"Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the Form" to ubmit another incident. LogicManager Thank you for your submission[ A Notification email will be received when a new incident is reported, or a new comment has been made regarding an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show. ::ed 1 0 0-M SL SYSTEM LogicManager via custom -.support@ logicmanager.com <customcr.support@ log icmanager.com> Notification- To DBH Ind Repomng ©If there are problems with how this message is displayed,tuck here to vrew d in a web br ser. Click hereto download pictures.To help proted your privacy,outlook prevented automall download of some pictures In this message. CALITIONIII-EXTERNAL EMAIL-THINK BEFORE YOU CLICK RgF.I-e4e1 vW end I:aJ hwn b dmrFwtl u•S+�n.To hdp pe W2 ro- pnry.MYveI,pr�nnW�broee donr3»f N Nn prtLe�tr�Ne InWnk. 6Wldre+Yr,Uer. Hi Wei Arevalo, You have received a notification through Logiddanager.Please see the details below Type:Incident Report Subject:102 Notification To:Idda Areva!o Open this incident in LooicManager If using Inlemet Explorer,click here to open the notification. This email was generated by LogicManager.It you have any technical issues, please email suoportMbnictranaeeccom. B-14 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B Enter in email address and password. First time users will be prompted to set up a password. C 4 G fres nod bh.my.logicmanager.corn,A,iw, LogicManager Once logged in, the main screen will show reviewer task(incidents to review). Click on analyst/supervisor follow up to view the incident. A Your Task List TASK NAME SOUFCE STATUS ASSIGNED I'O ASSIGNED 6V DUE DATE 1 B-15 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and facility information. No edits can be made to this se Analyst Follow Up Ia n r .�.ImmD,r uamal hallh Pe wD:u�xe Uxt�wiE<t P,oyamr• uenr��x.aM1n The next tab is Sum ary: No edits can be made to this section. Analyst Follow Up wDtea t, Intben:lmet4 all[Dal apVlYl' DE.m Pmwm x - If Othn-spmfy 0',lire.paisoninL tod—outbrtaI,otheruusnaphes..venr:tDatleupaldre Niewellste and tarnY of�hen[:.suttaMfor membersMthecammuniry�: peav�ptrori of the mDEm1' B l V fi tl = = = / ;= E b onemi�x�eem' IOry0R019 rime.P/ln[iEenl' t«aDw onae�eem' I Tas11D'91).5ou�te:101:null et ( t > Ir [RNDEt B-16 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these sum-tofields. Be cli I SAVE when edits are made.Then Ca el to Exit out of the incident. Analyst Follow Up 1:'.. ,. Fa IIO'.',UI, Action TeY-knock 111 Inm a,pI,j Law cnl.'e—neeomereed Please:pecny itamer D cnptmn of Action Take:i I Outwme' t addedmformanon cause at death-caner per coroner 10.31-11 Task ID:313 Saurce.-null c< c e > » c-uC L O The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding documents.Then Cancel to Exit out of the incident. Analyst Follow Up Documents. 'Q Add Document Home Type source Upload Date Uploaded By I�y ND documents yet. Drop files here or click on the Add Document dropdo- Task ID:313 source:103:null I c L•111._L O `� If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBIV]IT button is on every tab. If further information needs to be included, email DBHlncidentReporting@fresnocountyca.gov B-17 DocuSign Envelope ID:Al322DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit B To get back to the home view, click on the Lo is Manager icon at any time. Any incidents that still need review will show on this screen, cli next incident and start the review process again. A Your Task List TASK 1111.1E SOvNCE STAI'U5 ASSIGNEDTO ASSIGNED BY DUE DATE .. .•t mctl ttvt StSiENlaBcntanigei B-18 DocuSign Envelope ID:Al322DEBC-6AB7-437C-9F73-2CA17961382A7 XnIDIL U PolicyFresno County Probation Department • NEW JJC Policy Manual Vendors, Volunteers and Student Interns 309.1 PURPOSE AND SCOPE This policy establishes guidelines for using Juvenile Justice Campus vendors, volunteers, and student interns, to supplement and assist Department personnel in their duties. Vendors and volunteers are staff members who can augment Department personnel and help complete various tasks. 309.1.1 DEFINITIONS Definitions related to this policy include: Student intern - A college, university, or graduate student gaining practical experience in a chosen field while performing services the intern's field while under supervision. Vendor- An individual representing a company, outside agency, or non-profit organization, who is assigned to one of our facilities, performs a service for the Department, and may receive compensation for services rendered. Volunteer-An individual who performs a service for the Department without promise,expectation, or receipt of compensation for services rendered. This may include unpaid chaplains and student interns. 309.2 POLICY The Fresno County Probation Department shall ensure that vendors, volunteers and student interns are properly appointed, trained, and supervised to carry out specified tasks and duties in order to create an efficient Department and improve services to the community. 309.3 ELIGIBILITY Requirements for participation as a vendor, volunteer or student intern for the Department may include but are not limited to: (a) Being at least 18 years of age. (b) Possession of liability insurance for any personally owned equipment, vehicles, or animals utilized during volunteer or student intern work. (c) No conviction of a felony, any crime of a sexual nature or against children, any crime related to assault or violence, any crime related to dishonesty, or any crime related to impersonating a law enforcement officer. (d) Ability to meet physical requirements reasonably appropriate to the assignment. (e) A background history and character suitable for a person representing the Department, as validated by a background investigation. The Chief Probation Officer or the authorized designee may allow exceptions to these eligibility requirements based on organizational needs and the qualifications of the individual. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. C-1 Vendors,Volunteers and Student Interns-79 Published with permission by Fresno County Probation Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xnID11 U Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Vendors, Volunteers and Student Interns 309.4 RECRUITMENT, SELECTION, AND APPOINTMENT The Fresno County Probation Department shall endeavor to recruit and appoint only those applicants who meet the high ethical, moral, and professional standards set forth by this Department. 309.4.1 RECRUITMENT Volunteers and student interns are recruited on a continuous basis consistent with Department policy on equal opportunity, nondiscriminatory employment terms. A primary qualification for participation in the application process should be an interest in and an ability to assist the Department in serving the public. Requests for volunteers and student interns should be submitted in writing by interested Department staff members to the Personnel Unit through the requester's immediate supervisor. A complete description of the volunteer's or intern's duties and a requested time frame should be included in the request. All Department staff members should understand that the recruitment of volunteers and student interns is enhanced by creative and interesting assignments. Vendors are recruited/selected in accordance with the Fresno County Purchasing Office contract/ agreement process. 309.4.2 SELECTION Vendor,volunteer and student intern candidates shall successfully complete the following process before appointment: (a) Submit the appropriate written application. (b) Current TB skin test (completed within the last 6 months). (c) Successfully complete an appropriate-level background investigation, which may include fingerprinting, and/or obtaining information from local, state, federal and Department of Motor Vehicle databases. 309.4.3 APPOINTMENT Volunteers and student interns shall be placed only in assignments or programs consistent with their knowledge, skills, and abilities and the needs of the Department. Volunteers' and student interns' interests will be considered when placed in assignments. Volunteers and student interns serve at the discretion of the Chief Probation Officer. Vendors are appointed and placed in accordance with the Fresno County Purchasing Office contract/agreement. 309.5 IDENTIFICATION As representatives of the Department, vendors, volunteers and student interns are responsible for presenting a professional image to the community. Vendors, volunteers and student interns shall dress appropriately for the conditions and performance of their duties, in compliance with Personal Appearance Standards and Uniform and Non-Uniform attire policies unless excluded by the Department. Necessary safety equipment will be provided. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Vendors,Volunteers and Student Interns-80 Published with permission by Fresno County Probation C-Z Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xnipli L. Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Vendors, Volunteers and Student Interns Vendor, volunteers and student interns will be issued Fresno County Probation Department identification cards, which must be carried at all times while on-duty. The identification cards will be the standard Fresno County Probation Department identification cards, except that"Volunteer" or"Student Intern" will be indicated on the cards. 309.6 PERSONNEL WORKING AS STUDENT INTERNS Qualified regular Department personnel, when authorized, may also serve as student interns. However, this Department shall not utilize the services of student interns such a way that it would violate employment laws or collective bargaining agreements or memorandums of understanding (e.g., an officer participating as a student intern for reduced or no pay). Therefore, staff members shall consult with the Personnel Unit prior to allowing regular department personnel to serve in a student intern capacity (29 CFR 553.30). 309.7 PERSONNEL UNIT The function of the Personnel Unit is to provide a central coordinating point for effective volunteer management within the Department, and to direct and assist efforts to jointly provide more productive volunteer services. The responsibilities of the Personnel Unit include but are not limited to: (a) Recruiting, selecting, and training qualified volunteers and student interns. (b) Maintaining records for each vendor, volunteer and student interns. (c) Completing and disseminating, as appropriate, all necessary paperwork and information. (d) Maintaining a liaison with colleges and universities that provide student interns to promote the intern program with both students and the educational system. (e) Maintaining volunteer and student intern orientation and training materials and outlining expectations, policies, and responsibilities for all volunteers and student interns. 309.8 DUTIES AND RESPONSIBILITIES Volunteers assist department personnel as needed. Assignments of volunteers may be to any division within the Department, as needed. Volunteers should be placed only in assignments or programs consistent with their knowledge, skills, interests, abilities and the needs of the Department. Student interns should be assigned to areas that meet the needs of both their educational program and the Department. Vendors will be assigned per the contract/agreement. 309.8.1 COMPLIANCE Vendors, volunteers and student interns shall be required to adhere to all Department policies and procedures. Policies and procedures are available on the Department website and will be made available to each vendor, volunteer, and student intern upon appointment. The vendor, volunteer and student interns shall become thoroughly familiar with these policies and procedures as directed by the Chief Probation Officer or the authorized designee. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Vendors,Volunteers and Student Interns-81 Published with permission by Fresno County Probation C-3 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 pipit y Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Vendors, Volunteers and Student Interns Whenever a rule, regulation, or guideline in this Custody Manual refers to regular Department personnel, it shall also apply to a vendor, volunteers and student interns, unless by its nature it is inapplicable. Vendors, volunteers and student interns are required by this Department to meet Department- approved training requirements as applicable to their assignments. 309.9 TASK-SPECIFIC TRAINING Task-specific training is intended to provide the required instruction and practice for vendors, volunteers and student interns to properly and safely perform their assigned duties. Training should correspond to the assignment as determined by the program coordinator. Vendors, volunteers and student interns will be provided with an orientation program to acquaint them with the policies of the Department and procedures applicable to their assignments. Vendors, volunteers and student interns should receive position-specific training to ensure they have adequate knowledge and skills to complete the required tasks. They also should receive ongoing training as deemed appropriate by their supervisors or the volunteer or student intern coordinator. Training should reinforce to vendors,volunteers and student interns that they shall not intentionally represent themselves as,or by omission give the impression that they are,officers or other full-time staff members of the Department.They shall always represent themselves as vendors,volunteers or student interns. All vendors, volunteers and student interns shall comply with the standards of conduct and with all applicable orders and directives, whether oral or written, issued by the Department. 309.9.1 STATE REQUIREMENTS The vendor, volunteer and student intern initial orientation shall include the following: safety and security issues and anti- discrimination policies. 309.10 SUPERVISION Each vendor, volunteer or student intern must have a clearly identified supervisor who is responsible for direct management of that individual.This supervisor will be responsible for day-to- day management and guidance of the work of the vendor, volunteer or student intern and should be available for consultation and assistance. Functional supervision of vendors, volunteers and student interns is the responsibility of the supervisor or the authorized designee in charge of their assigned duties. The following are some considerations that supervisors or the authorized designee should keep in mind while supervising vendors, volunteers and student interns: (a) Take the time to introduce vendors, volunteers and student interns to staff members on all levels. (b) Ensure vendors, volunteers and student interns have work space and necessary office supplies. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Vendors,Volunteers and Student Interns-82 Published with permission by Fresno County Probation C-4 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xnIDIT lr Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Vendors, Volunteers and Student Interns (c) Make sure the work is challenging. Do not hesitate to give vendors, volunteers and student interns assignments or tasks that will utilize these valuable resources. (d) Ensure the work for student interns meets the needs of their educational program, while also meeting the needs of the Department. 309.10.1 EVALUATIONS Student interns may need evaluations as a requirement of their educational program. 309.10.2 FITNESS FOR DUTY No vendor, volunteers or student intern shall report for work or be at work when the individual judgment or physical condition has been impaired due to illness or injury, or by the use of alcohol or drugs, whether legal or illegal. Vendors, volunteers and student interns shall report to their supervisors any change in status that may affect their ability to fulfill their duties. This includes but is not limited to: (a) Driver's license (b) Arrests. (c) Criminal investigations. (d) All law enforcement contacts. 309.11 INFORMATION ACCESS Vendors, volunteers and student interns should not have access to or be in the vicinity of criminal histories, investigative files, or information portals. Unless otherwise directed by a supervisor, the duties of the position, or Department policy, all such information shall be considered confidential. Only that information specifically identified and approved by authorized staff members shall be released. Confidential information shall be given only to persons who have a need and a right to know as determined by Department policy and supervisory personnel. A vendor, volunteer or student intern whose assignment requires the use of, or access to, confidential information will be required to be fingerprinted to the California Department of Justice to obtain clearance.Vendors, volunteers and student interns working this type of assignment shall receive training in data practices and shall be required to sign a CLETS Employee/Volunteer Statement before being given an assignment with the Department. Subsequent unauthorized disclosure of any confidential information verbally, in writing, or by any other means by the vendor, volunteer, or student intern is grounds for immediate dismissal and possible criminal prosecution. Vendors, volunteers and student interns shall not address public gatherings, appear on radio or television, prepare any article for publication, act as correspondents to newspapers or other periodicals, release or divulge any information concerning the activities of the Department, or maintain that they represent the Department in such matters without permission from the proper Department personnel. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Vendors,Volunteers and Student Interns-83 Published with permission by Fresno County Probation C-5 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Xf wit u Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Vendors, Volunteers and Student Interns 309.11.1 RADIO AND DATABASE ACCESS USAGE The supervisor or the authorized designee shall ensure that radio and database access training is provided for vendors, volunteers, and student interns whenever necessary. 309.12 EQUIPMENT Any property or equipment issued by the Department shall be for official and authorized use only. Any property or equipment issued to a vendor,volunteer or student intern shall remain the property of the Department and shall be returned at the termination of service. 309.13 TERMINATION OF SERVICES If a vendor or volunteer is the subject of a personnel complaint or becomes involved in an internal investigation,the matter shall be investigated in compliance with the Personnel Complaints Policy. If a student intern is the subject of or is involved in an internal investigation, the coordinator of the educational program that sponsors the intern should be notified. Vendors and volunteers are considered at-will and may be removed from service at the discretion of the Chief Probation Officer or the authorized designee, with or without cause. Vendors and volunteers shall have no property interest in their continued appointments.Vendors and volunteers may resign from service with the Department at any time. It is requested that vendors and volunteers who intend to resign provide advance notice and a reason for their decision. 309.14 ISSUED DATE • 02/18/2022 Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Vendors,Volunteers and Student Interns -84 Published with permission by Fresno County Probation C-6 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Xf wix lr • Fresno County Probation Department NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) 400.1 PURPOSE AND SCOPE The purpose of this policy is to establish a plan to appropriately respond to emergencies within the facility and to ensure all affected staff members receive timely training regarding emergency response. This policy is intended to protect the community, staff members, visitors, youth, and all others who enter the Juvenile Justice Campus (JJC), while allowing the facility to fulfill its primary purpose (15 CCR 1327). Facility emergencies related to fire will be addressed in the Fire Safety Plan Policy. 400.2 POLICY It is the policy of this Department to have emergency response plans in place to quickly and effectively respond to and minimize the severity of any emergency within the facility. 400.3 EMERGENCY PROCEDURES The Chief Probation Officer or the authorized designee shall develop, publish, and periodically review and update facility-specific policies, procedures, and emergency response plans that shall include but not be limited to (15 CCR 1327): (a) Escapes, disturbances, and the taking of hostages. (b) Civil disturbances, active shooters, and terrorist attacks. (c) Fire and natural disasters. (d) Periodic testing of emergency equipment. (e) Mass arrests. (f) Emergency evacuation of the facility (see the Emergency Evacuation Plan Policy). (g) A program to provide all youth supervision staff members with an annual review of emergency procedures. (h) Other emergencies as needs are identified. The facility emergency response plans are intended to provide all staff members with current methods, guidelines, and training for minimizing the number and severity of emergency events that may threaten the security of the facility or compromise the safety of staff members, youth, or the community. The emergency response plans are intended to provide information on specific assignments and tasks for staff members. Where appropriate, the emergency response plans will include persons and emergency departments to be notified. The emergency response plans shall include procedures for continuing to house youth in the facility, the identification of alternative facilities outside the boundaries of the disaster or threat Copyright Lexipol,LLC 2024/01103,All Rights Reserved. �-� Emergency Procedures-Facilities(Title 15,§ Published with permission by Fresno County Probation 1327)-94 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Xf DrE u Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) and the potential capacity of those facilities, youth transportation options, and contact information for allied agencies. The emergency response plans shall be made available to all staff members, contractors, and volunteers working in the facility as needed. Confidential policies and procedures that relate to the security of the facility may be kept in a separate manual (15 CCR 1327). 400.3.1 EMERGENCY SUSPENSION OF REQUIREMENTS The Chief Probation Officer or the authorized designee shall authorize only those regulations directly affected by the emergency to be suspended. When a suspension occurs for longer than three days, the Chief Probation Officer or the authorized designee shall notify the Board of State and Community Corrections in writing. In no event shall a suspension continue for more than 15 days without the approval of the Chairperson of the Board of State and Community Corrections for a time specified by the Chairperson (see the Emergency Suspension of Standards or Requirements attachment). 400.4 LOCKDOWN Upon detecting any significant incident that threatens the security of the facility, such as a riot, power outage or hostage situation, staff members shall immediately notify Institutional Core Central Control (ICCC) and the Watch Commander. The Watch Commander may determine whether to order a partial or full lockdown of the facility and shall notify the Deputy Chief or the authorized designee as soon as practicable. If a lockdown is ordered, all youth will be directed back to their housing areas. All youth in transit within the facility will either be escorted back to their housing areas or to another secure location. The Watch Commander should instruct staff members not directly involved in the lockdown to escort any visitors and nonessential contractors out of the facility. A head count shall be immediately conducted for all youth, visitors, contractors, volunteers, and staff members. The Watch Commander shall be immediately notified of the status of the head count. If any person is unaccounted for,the Watch Commander shall direct an immediate search of the facility and notify the Chief Probation Officer or the authorized designee as soon as practicable. All visitors and volunteers will be required to enter through the lobby and sign the visitor logbook when they enter and leave the facility. If the lobby is closed, the visitor logbook will be placed in a designated area for them to sign accordingly. ICCC shall log in all vehicles and the number of people in the vehicle. In the event the camera or speaker box is not working, the ICCC officer shall work with security officers to determine the number of people in the vehicle. When leaving the facility, the maintenance/contractor worker(s) shall call ICCC if the camera or speaker box is not working properly to inform them they are leaving the facility. The ICCC officer shall log that the maintenance/contractor(s) left the facility. Lockdown shall not be used as a form of punishment. It is only intended to facilitate order and maintain security of the JJC. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures- Facilities(Title 15, § Published with permission by Fresno County Probation C-8 1327)-95 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xnwiI l., Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) 400.5 HUNGER STRIKE Upon being made aware that one or more youth is engaging in a hunger strike, the staff member will notify the Watch Commander, who will notify the Chief Probation Officer or the authorized designee. The Chief Probation Officer or the authorized designee should evaluate the basis for the strike and seek an appropriate resolution. The Chief Probation Officer or the authorized designee shall notify the youth's parent/guardian,the youth's probation officer, the local authority having supervisory jurisdiction, and the youth's social worker (if applicable) of the incident and periodically provide updates on the status of the youth. 400.5.1 NOTIFICATION OF QUALIFIED HEALTH CARE PROFESSIONALS The Chief Probation Officer or the authorized designee shall notify the Medical Director to review, coordinate, and document any medical actions taken, based on protocols and/or at the direction of qualified health care professionals, in response to a hunger strike. Qualified health care professionals shall monitor the health of any youth involved in a hunger strike and make recommendations to the Chief Probation Officer or the supervisory staff member responsible for oversight of the incident. If a youth is engaging in a hunger strike due to a mental condition, the appropriate medical protocols for mental health will be followed. 400.5.2 RESPONSE TO HUNGER STRIKES Beginning at the line staff member level, a resolution to grievances shall be sought at the lowest level. The Youth Grievances Policy shall guide staff members on resolving youth grievances. If the hunger strike remains unresolved, the Chief Probation Officer or the authorized designee may direct the appropriate staff member to observe the room area, including trash containers, of the youth involved for evidence of food items and of food hoarding. 400.5.3 LEGAL GUIDANCE If attempts to resolve the grievance are unsuccessful or not reasonably possible, the Chief Probation Officer shall consider consulting with legal resources as appropriate to develop other steps to resolve the issues. 400.6 RESPONSE TO DISTURBANCES Staff members shall attempt to minimize the disruption to normal facility operations caused by a disturbance by attempting to isolate and contain the disturbance to the extent possible. Staff members when applicable shall immediately notify the Chief Probation Officer through the chain of command of the incident (15 CCR 1327). 400.6.1 NOTIFICATIONS The Watch Commander shall notify the Chief Probation Officer or the authorized designee of the disturbance as soon as practicable through the chain of command. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities(Title 15,§ Published with permission by Fresno County Probation C_9 1327)-96 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Xmyn %, Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) The Chief Probation Officer or the authorized designee shall notify the involved youth's parent/ guardian, the youth's probation officer, the local authority having supervisory jurisdiction, and the youth's social worker (if applicable) as soon as practicable (15 CCR 1327). 400.6.2 NOTIFICATION OF QUALIFIED HEALTH CARE PROFESSIONALS If medical action reasonably appears necessary, the Chief Probation Officer or the authorized designee shall notify the appropriate qualified health care professionals to review, coordinate, and document medical actions based on protocols and/or at the direction of the Medical Director (15 CCR 1327). 400.6.3 REPORTING The Chief Probation Officer or the authorized designee shall order that an incident report be completed with the details of the disturbance no later than the end of the shift (see the Report Preparation Policy). If appropriate, a crime report shall be initiated, and prosecution sought (15 CCR 1327). 400.7 RIOTS Riots occur when youth forcibly and/or violently take control, or disrupt in large numbers with violence or attempt to take control of any area within the Juvenile Justice Campus: Staff members shall make reasonable attempts to prevent youth-on-youth violence but shall also take measures to avoid aggravating the problem and making the situation worse (15 CCR 1327). 400.7.1 RESPONSE TO RIOTS Once the area of the disturbance is secured and isolated from other areas of the facility, time is generally on the side of officers. If possible, the process of quelling the disturbance should slow down so officers can develop response plans, ensure there are adequate facility personnel to effectively take the required actions, and ensure that responding officers are appropriately equipped with protective gear. Officers shall evaluate their response given the totality of circumstances in any situation, but generally shall not enter the space where a riot is occurring until sufficient officers are present to safely suppress the riot. Nothing in this policy shall prohibit any staff member from assisting other staff members who are being assaulted. Other housing units must be secured, with sufficient officers remaining at their posts to continue to supervise the unaffected units. If officers are unable to contain, control, and resolve the riot, a request for assistance shall be made to the appropriate law enforcement agency (see the Mutual Aid section in this policy). The request shall be made by the Chief Probation Officer or the authorized designee. When the riot has been suppressed, all involved officers must immediately return to their assigned posts and normal operations should resume. All youth who have participated in a riot shall be separated and secured as soon as practicable. If necessary, injured youth shall receive a medical evaluation and treatment. If an injured youth Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities(Title 15, § Published with permission by Fresno County Probation C-1 U 1327)-97 Department DocuSign Envelope ID:AB22DEBC-6AS7-437C-9F73-2CA1796B82A7 pipit l. Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) is medically cleared to remain in the Juvenile Justice Campus, the youth will be reclassified and moved to appropriate housing. If a crime has occurred with injury or death due to the riot, the Fresno Sheriffs Office shall be notified to investigate the matter (15 CCR 1327). 400.7.2 QUALIFIED HEALTH CARE PROFESSIONAL RESPONSE If necessary, a Watch Commander or the authorized designee should notify the qualified health care professionals and identify a staging area for medical emergency responders and for medical triage. The Medical Director or the authorized designee shall be included in developing the response plan as it relates to the potential for a medical response, medical triage and treatment activities, and the safety and security of medical staff members during the incident (15 CCR 1327). 400.7.3 NOTIFICATIONS As soon as practicable, the Watch Commander or a responsible officer shall notify the Chief Probation Officer or the authorized designee. The Chief Probation Officer or the authorized designee shall notify any involved youth's parent/ guardian, the youth's probation officer, the local authority having supervisory jurisdiction, and the youth's social worker (if applicable) (15 CCR 1327). 400.7.4 REPORTING The Chief Probation Officer or the authorized designee shall order that a report be written detailing the incident by the end of the shift (see the Report Preparation Policy) unless approved by a supervisor to be completed at a later time (15 CCR 1327). 400.8 HOSTAGES The Department does not recognize the taking of hostages as a reason to relinquish control of the Juvenile Justice Campus. Signage will be posted in the lobbies, and visiting area that JJC is a no hostage facility. It is the policy of the Fresno County Probation Department to use all available resources reasonably necessary to bring about a successful end to a hostage situation (15 CCR 1327). 400.8.1 RESPONSE TO HOSTAGE INCIDENT Institutional Core Central Control (ICCC) should immediately be notified at the earliest sign of a hostage incident. Institutional Core Central Control (ICCC)shall notify the Chief Probation Officer through the chain of command as soon as practicable. The Chief Probation Officer or the authorized designee shall make every effort to ensure that the hostage incident remains confined to the smallest area possible. All door controls accessible to youth shall be disabled. Emergency exits that lead outside the secure perimeter shall be guarded (15 CCR 1327). Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities(Title 15, § Published with permission by Fresno County Probation C-11 1327 98 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xnIDIT Lo Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) 400.8.2 NOTIFICATION OF QUALIFIED HEALTH CARE PROFESSIONALS At the direction of the Watch Commander or the authorized designee, the qualified health care professionals shall be notified in order to identify a location and form a logistical plan for medical triage. The location also shall serve as a medical staging area for other medical emergency responders (15 CCR 1327). 400.8.3 HOSTAGE RESCUE Communications with the hostage-taker should be established as soon as practicable.The Watch Commander or the authorized designee shall document, if known, the number of hostages, any demands, and any injuries. No promises or denials will be made until a hostage negotiator arrives on scene. Hostage-taker demands for officers to open doors will not be met. A hostage rescue team should be immediately summoned, and the established protocols for resolving the situation shall be implemented. The Chief Probation Officer or the authorized designee shall be consulted regarding decisions faced by the hostage rescue team (15 CCR 1327). 400.8.4 REPORTING Following the conclusion of a hostage incident, the Chief Probation Officer or the authorized designee shall order that an incident report be completed by the end of the shift (see the Report Preparation Policy) unless approved by as supervisor at a later time (15 CCR 1327). 400.9 ESCAPES Upon being made aware that an escape may have occurred or did occur, the staff member shall notify the on-duty Watch Commander. The Watch Commander shall notify the Chief Probation Officer through the chain of command as soon as practicable. Once the escape is verified and immediate actions have been taken inside the facility (e.g., lockdown), the Watch Commander should ensure that all local law enforcement agencies are notified (15 CCR 1327). 400.9.1 YOUTH COUNTS As soon as the facility is fully locked down, a full youth head count should be taken. All youth who are outside of the secure perimeter of the facility (e.g., court, work details) shall be located and identified. The identity of any missing youth shall be disclosed, and the youth's facility record shall be accessed by the Chief Probation Officer or the authorized designee (15 CCR 1327). 400.9.2 SEARCH Concurrent with the lockdown, the area surrounding the facility shall be searched for the escapee. Areas where a youth may be hiding or may have discarded clothing shall be searched first. Any witnesses shall be interviewed. Booking staff members will develop a flyer with the youth's name, description, latest picture, classification status, and charges, and supply it to other staff members and local law enforcement. Copyright Lexipol,LLC 2024/01/03,all Rights Reserved. Emergency Procedures-Facilities(Title 15, § Published with permission by Fresno County Probation C-1 2 1327)-99 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xn1D11 U Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) Local law enforcement shall also be given the youth's last known address and a list of associates (15 CCR 1327). 400.9.3 REPORTING Following the conclusion of an attempted escape or an escape, the Chief Probation Officer or the authorized designee shall order that an incident report be completed by the end of the shift. The incident report shall focus on events and physical plant weaknesses that contributed to the escape (see the Report Preparation Policy). The Deputy Chief shall review the reports, interview involved parties, and develop action plans to minimize the risk of future occurrences (15 CCR 1327). 400.10 CIVIL DISTURBANCES OUTSIDE OF THE DETENTION FACILITY Upon being notified that Juvenile Justice Campus space will be needed in response to a civil disturbance, potentially involving mass arrests, the Watch Commander shall notify the Chief Probation Officer or the authorized designee (15 CCR 1327). 400.11 DEBRIEFING All responding staff members, including medical responders, shall be debriefed, as determined by the Chief Probation Officer or the authorized designee, on serious facility emergencies as soon as practicable after the conclusion of the incident. The staff members shall examine the incident from the perspective of what worked, what actions were less than optimal, and how the response to a future incident might be improved. Depending on the degree of the situation,it may be necessary to bring in Mental Health professionals to help facilitate the debriefing to include any youth involved. If appropriate, the details of the incident will be used to develop a training course for responding to facility disturbances. The goal of any debriefing process is continuous improvement. The debriefing shall be focused on the incident, an improved response, and systemic changes that may be required. A moderator shall ensure that no individual or group involved in the response is publicly ridiculed. 400.12 EMERGENCY HOUSING OF YOUTH The Chief Probation Officer or the authorized designee shall develop a plan on the emergency housing of youth in the event of a full or partial evacuation of the facility. The plan shall address when youth should be housed in place, identification of alternate facilities and the potential capacity of those facilities,youth transportation options, and contact information for allied agencies. This plan shall be reviewed at least annually and revised if necessary. 400.13 MUTUAL AID The magnitude and anticipated duration of a facility emergency may necessitate interagency cooperation and coordination. The Deputy Chief shall ensure that any required memorandums of understanding or other agreements are properly executed, and that any anticipated mutual aid is requested and facilitated for the safe keeping and transportation of youth during the facility emergency and evacuation process (see the Emergency Evacuation Policy). For a large-scale emergency response, see the Emergency Evacuation Policy and Emergency Staffing Policy. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities(Title 15, § Published with permission by Fresno County Probation C-1 3 1327)- 100 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 xn1DII U Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) When another agency requests assistance from this Department, the Deputy Chief or authorized designee may authorize, if available, an appropriate number of personnel to assist. Staff members are reminded that their actions when rendering assistance must conform with applicable laws and be consistent with the policies of this Department. When mutual aid assistance is rendered, a report shall be prepared and submitted by the handling staff member unless otherwise directed by a supervisor (15 CCR 1327). 400.14 REVIEW OF EMERGENCY PROCEDURES The Deputy Chief shall ensure that there is a review of emergency procedures at least annually (15 CCR 1327). This review shall be documented and placed in the staff member's JJC and Departmental training file. This review should also include the signatures or initials of the staff members responsible for the review. At a minimum, the review shall include: (a) Assignment of staff members to specific tasks in emergency situations. (b) Instructions for using the alarm systems and signals. (c) Systems for the notification of appropriate persons outside the facility. (d) Information on the location and use of emergency equipment in the facility. (e) Description of evacuation routes and procedures. 400.15 FIRE This Department shall identify and conform to applicable federal, state, and/or local fire safety codes, and establish a process for creating, disseminating, and training all individuals in the facility on the emergency plans for fire safety and evacuation(see the Fire and Life-Safety Policy,Juvenile Detention Manual Policy, and Fire Safety Plan Policy). 400.16 NATURAL DISASTER The Chief Probation Officer or the authorized designee shall be prepared to operate a safe and secure facility in the event of a natural disaster emergency. 400.17 OTHER TYPES OF EMERGENCIES Facility emergencies that could negatively affect the good order of the facility and the safety of staff members, youth, contractors, volunteers, and visitors include but are not limited to an outbreak of infectious disease, a work stoppage or strike by staff members, and other disruptions. The Chief Probation Officer or the authorized designee shall be responsible for ensuring that an appropriate facility emergency plan exists for these types of emergencies. 400.18 PERIODIC TESTING OF EMERGENCY EQUIPMENT The Chief Probation Officer or the authorized designee is responsible for scheduled and periodic testing of emergency power systems which are completed by the Internal Services Department. All testing and inspections shall be documented, and the results included in a report to the Deputy Chief or the authorized designee. Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities(Title 15,§ Published with permission by Fresno County Probation C-1 4 1327)- 101 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 xni► n u Fresno County Probation Department NEW JJC Policy Manual NEW JJC Policy Manual Emergency Procedures - Facilities (Title 15, § 1327) 400.19 TRAINING Officers shall review emergency procedures (See Emergency Procedures form located in the Department Case Management system) annually (15 CCR 1327). This facility will provide emergency preparedness training as part of orientation training for all staff members assigned to the facility. On an annual basis emergency training shall occur for each shift. The assigned Watch Commander/Supervising Juvenile Correctional Officer shall document in the Watch Commander log as well as provide JJC Administration a memorandum/e-mail of what training occurred and retained in accordance with established records retention schedules. 400.20 REFERENCES See Facilities Emergencies Procedure for additional guidance. 400.21 ISSUED DATE • 04/17/2023 Copyright Lexipol,LLC 2024/01/03,All Rights Reserved. Emergency Procedures-Facilities (Title 15, § Published with permission by Fresno County Probation C-1 5 1327)- 102 Department DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit D A, L. - NO Cp L. .5�� �O Fresno County Probation Department @gToN� Kirk Haynes, Chief Probation Officer ��, 1856 L. FREc�� Fresno County Probation Department Attn:Personnel 3333 E.American Ave. Phone: (559)600-4825 Fresno, CA 93725 Fax: (559)600-1307 PROBATION VENDOR APPLICATION FOR PROBATION PERSONNEL USE ONLY Local Records Check: CLETS/DMV: Fingerprints: TB Test Results: CONTACT INFORMATION (Print clearly in ink) Name: (Last, First, MI) Maiden or other name(s) used: Address: (number&street) City State Zip Code Driver's License# SS#: DOB: SEX: Phone#: ( ) Email Address: EMPLOYMENT Name of Current Employer Position/Title How Long Address: (number&street) City, State,Zip Code Phone# PREA(Prison Rape Elimination ACT) The Prison Rape Elimination Act(PREA)was passed in 2003. The purpose of the act is to "provide for the analysis of the incidence and effects of prison rape in Federal,State,and local institutions and to provide information, resources, recommendations and funding to protect individuals from prison rape." 1. Will you be willing to abide by all PREA Standards, which will include an orientation/training ❑Yes ❑No o (Please note:Selecting"No"to the question above may result in the rejection of your application) o (If you answer"Yes"to any question below, please provide the date,offense, city/state &an explanation on a separate piece of paper and attach to this form) 2. Have you ever been arrested for any crime(s) and/or arrested or convicted for sexual abuse, or any other sexual misconduct? ❑Yes ❑ No 3. Have you ever been investigated for sexual harassment? ❑Yes ❑No Page 1 of 2 The County of Fresno is an equal employment opportunity employer Revised(04/17/2018) D-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 Exhibit D j EMERGENCY CONTACTS List any medical conditions you feel we should be aware of: In case of an emergency, notify: Name Telephone Relationship 1 2 CONFIDENTIAL RELEASE OF INFORMATION In addition to completing this form,the following steps must be done: o You must provide recent TB test results (from within the past 6 months). o You will be subject to a background check,which may include fingerprints. I grant my permission for the Probation Department to make background, criminal, and vehicle record checks, which are standard procedures for all vendor applicants. I certify that all statements made on this application are true to the best of my knowledge. I understand that untruthful and/or misleading answers are cause for rejection of my application. Applicant's Signature Date Reviewer's Signature ❑ Approved ❑ Denied Date FOR OFFICE USE ONLY JJC Personnel Date received: Date received: Date ID issued: Approved by: Date sent to Administration: ID issued to: Date sent to Personnel: Date applicant contacted: Initials: Notes: Page 2 of 2 The County of Fresno is an equal employment opportunity employer Revised(04/17/2018) D-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit E MINIMUM STAFFING LEVELS Juvenile Justice Center- 17.5 Hour Coverage (5:30AM- 11:OOPM) Medical Service Staffing Plan Juvenile Justice Campus Facility Medical Staffing- 17.5 Hours Scheduled Weekly HoursTotal Position SUN MONHours Day Shift Health Services Administrator (RN) 8 8 8 8 8 40 1.0 Administrative Assistant 8 8 8 8 32 0.8 Medical Director 8 8 0.2 Nurse Practitioner 8 8 8 8 8 40 1.0 Registered Nurses (RNs), 0600-1830 12 12 12 12 12 12 12 84 2.1 Licensed Vocational Nurses (LVNs) 0600-1430 8 8 81 8 8 8 8 56 1.4 Dentist 8 8 0.2 Dental Assistant 8 8 0.2 Optometrist 4 4 0.1 Total Day Shift 1 201 44 56 601 441 36 201 2801 7.0 Evening Shift RNs (1030-2300) 121 12 121 12 12 12 121 84-1 2.1 LVNs (1430-2300) 81 8 81 8 8 8 8 56 1.4 Total Evening Shift 201 20 201 20 20 20 20 140 3.5 Totals64 76 80 • BehavioralHealth Services StaffingPlan CampusJuvenile Justice P0 Mental Health Staffing- 17.5 Hours ScheduledWeekly HoursTotal Position • ' Hours Day Shift Psychiatrist 8 8 0.2 LCSW/LMFT/LPCC 8 16 16 16 16 16 8 96 2.4 Administrative Assistant 0 0 Total Day Shift 8 16 16 24 16 16 8 104 2.6 Evening Shift LCSW/LMFT/LPCC (1430-230 81 81 8 81 81 561 1.4 Total Evening Shift 81 81 81 81 8 81 81 561 1.4 924e1 lilo liCPT �K 01 E-1 DocuSign Envelope ■ ■ Exhibit E SUD Staffing(Substance Abuse Unit, New Horizons and Discharge Planning Programs) - � Scheduled Weekly Hours -8 Hours Total FTE's Position SUN MON TUE WED THU FRI SAT Hours Day Shift MHC - 8 8 8 8 8- 1 1.0 . . I ay Shift ®®®®®- 1601 1 Total 0 32 32 32 32 32 0 160 4,�+ MEDICAL, MENTAL HEALTH and SUD TOTAL 56 120 132 144 120 112 56 740 18.5 DocuSign Envelope ID:Al322DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit F Fresno County Department of Behavioral Health Guiding Principles of Care Delivery DBH VISION: Health and well-being for our community. DBH MISSION: The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and communities in Fresno County who are affected by, or are at risk of, mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment. DBH GOALS: Quadruple Aim • Deliver quality care • Maximize resources while focusing on efficiency • Provide an excellent care experience • Promote workforce well-being GUIDING PRINCIPLES OF CARE DELIVERY: The DBH 11 principles of care delivery define and guide a system that strives for excellence in the provision of behavioral health services where the values of wellness, resiliency, and recovery are central to the development of programs, services, and workforce.The principles provide the clinical framework that influences decision-making on all aspects of care delivery including program design and implementation, service delivery, training of the workforce, allocation of resources, and measurement of outcomes. 1. Principle One -Timely Access & Integrated Services o Individuals and families are connected with services in a manner that is streamlined, effective, and seamless o Collaborative care coordination occurs across agencies, plans for care are integrated, and whole person care considers all life domains such as health, education, employment, housing, and spirituality o Barriers to access and treatment are identified and addressed o Excellent customer service ensures individuals and families are transitioned from one point of care to another without disruption of care 1 rev 01-02-2018 F-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit F Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 2. Principle Two - Strengths-based o Positive change occurs within the context of genuine trusting relationships o Individuals, families, and communities are resourceful and resilient in the way they solve problems o Hope and optimism is created through identification of, and focus on, the unique abilities of individuals and families 3. Principle Three - Person-driven and Family-driven o Self-determination and self-direction are the foundations for recovery o Individuals and families optimize their autonomy and independence by leading the process, including the identification of strengths, needs, and preferences o Providers contribute clinical expertise, provide options, and support individuals and families in informed decision making, developing goals and objectives, and identifying pathways to recovery o Individuals and families partner with their provider in determining the services and supports that would be most effective and helpful and they exercise choice in the services and supports they receive 4. Principle Four- Inclusive of Natural Supports o The person served identifies and defines family and other natural supports to be included in care o Individuals and families speak for themselves o Natural support systems are vital to successful recovery and the maintaining of ongoing wellness; these supports include personal associations and relationships typically developed in the community that enhance a person's quality of life o Providers assist individuals and families in developing and utilizing natural supports. 5. Principle Five - Clinical Significance and Evidence Based Practices (EBP) o Services are effective, resulting in a noticeable change in daily life that is measurable. o Clinical practice is informed by best available research evidence, best clinical expertise, and client values and preferences o Other clinically significant interventions such as innovative, promising, and emerging practices are embraced 2 rev 01-02-2018 F-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit F Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 6. Principle Six-Culturally Responsive o Values, traditions, and beliefs specific to an individual's or family's culture(s) are valued and referenced in the path of wellness, resilience, and recovery o Services are culturally grounded, congruent, and personalized to reflect the unique cultural experience of each individual and family o Providers exhibit the highest level of cultural humility and sensitivity to the self- identified culture(s) of the person or family served in striving to achieve the greatest competency in care delivery 7. Principle Seven -Trauma-informed and Trauma-responsive o The widespread impacts of all types of trauma are recognized and the various potential paths for recovery from trauma are understood o Signs and symptoms of trauma in individuals, families, staff, and others are recognized and persons receive trauma-informed responses o Physical, psychological and emotional safety for individuals, families, and providers is emphasized 8. Principle Eight- Co-occurring Capable o Services are reflective of whole-person care; providers understand the influence of bio-psycho-social factors and the interactions between physical health, mental health, and substance use disorders o Treatment of substance use disorders and mental health disorders are integrated; a provider or team may deliver treatment for mental health and substance use disorders at the same time 9. Principle Nine -Stages of Change, Motivation, and Harm Reduction o Interventions are motivation-based and adapted to the client's stage of change o Progression though stages of change are supported through positive working relationships and alliances that are motivating o Providers support individuals and families to develop strategies aimed at reducing negative outcomes of substance misuse though a harm reduction approach o Each individual defines their own recovery and recovers at their own pace when provided with sufficient time and support 3 rev 01-02-2018 F-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit F Fresno County Department of Behavioral Health Guiding Principles of Care Delivery 10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven o Individual and program outcomes are collected and evaluated for quality and efficacy o Strategies are implemented to achieve a system of continuous quality improvement and improved performance outcomes o Providers participate in ongoing professional development activities needed for proficiency in practice and implementation of treatment models 11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma Reduction o The rights of all people are respected o Behavioral health is recognized as integral to individual and community well-being o Promotion of health and wellness is interwoven throughout all aspects of DBH services o Specific strategies to prevent illness and harm are implemented at the individual, family, program, and community levels o Stigma is actively reduced by promoting awareness, accountability, and positive change in attitudes, beliefs, practices, and policies within all systems o The vision of health and well-being for our community is continually addressed through collaborations between providers, individuals, families, and community members 4 rev 01-02-2018 F-4 v 0 Z m C v E E 0 u 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C C C C C C C C C C C C C C C C C C C C C C Ln (1) v a) (7) (L) a) N (1) v (1) v N N N 0) (1) a) (1) (1) v (L) a) 7 > > > > > > > > > > > > > > > > > > > > > > mIsi N N N N N N N N N N N N N N N N N N N N N N O O C. 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O M rl .� .--i .--i .--i .--i ,-i .--i .--i N N N N N N N O a) a) a) aJ U U U U U U U U U lu U U U U U lu U v L C)0 @ Ln co m I^ V > 41 r S 0) v Cr X W Q 0 f X E E E E E m i W v W W 6L u E E ) >. n ') T M M 0 0 v Ln cn U') U) U o v a) g W a) a L iL u m 7 LL it LL LL LL OC C O O O J O O a) a) JO+ a) -0 .0 a) _ G U N m W i U @ LL N N N N N N N N J Y J Y J U J u J -u U V r Ln o 6 m a) m a) u n .— a) rn a) 0 0 tT v a) a) v a a) v a) m m m m m v a) '^ 'rnwr w C w E w = u u u u u u u u LTA- rn� rn� ° m F t@ 0 3 N m a).N a) a) m a) a1 O O O O O O O O O O C O C O C O C O C C C 0 Q Q'L.L ('J d' Z lY J J J J J J J J 2 0 2 o2 = 0 2 SD ❑ ❑ Q c m m C7 N � Q LL U N Cl) > O m 00 Ln m N V' lQ n 00 m O .--i N m Ln to n 00 ti- Ln I- m .ti .--i N Ln to oo 00 00 00 00 O1 m m m m m CY) LT Ol O O LL C V- Ln Ln Ln Ln Ln Ln Ln Ln Ll') U"1 Ll'1 Ln Ln Ln Ln Ln Ln Ln m l0 l0 C M Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln In Ln Ln Ln Ln Ln Ln m m m Ln Ln L C C C C C C C C C C C C C C C C m v a) aJ a) v a1 a1 a1 a1 a) a1 a) a1 a1 a1 a1 E E E E E E E E E E E E E E E E a n a n n a n n n n n n o n n n m � � g � g 5 g Q u CL)u O C O u 6 O' O- O' 6 O' 0- u 0- O" 07 0- O" Q 6 u U U U U U LL LJJ W LiJ LU W LU LU LL W W LU LL LU L1 W C C C a1 E E C C V 0 o m o ro co v a) v a) v v v a) v a a v a) v v a) _U U_ V_ V_ U_ u_ u U_ U_ u U_ u_ u_ u_ Lil m n L1 Q a a ft J= Et LJ= ❑ Q ¢ Q ¢ J w ¢ ¢ O O O O 0 O O O O 10 O O O O 0 O N N m N Ln N w N m Ln m m Ln En m LA Ln (n Ln 1n Ln N N w m Q 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 t n n a n n D. Cl n n n n n n d n n n d n n n n E E E E E E E E E E E E E E E E E E E E E E m (a m m m co m m m m Lo Lo m m m m m m m m m m a) (U U U U U U U U U U U U U U U U U U U U U U U CL 2 v a) a) a) a) a) a) a) v a) a) 0) v a) v a) a) a) a) v a) a) O u u u u u u u u u u u u u u u u u u u u u u > C N vy'i in in in (n in m in in m Ln m in in in in m in Ln in C O .a 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 w r-1 r'1 r'1 r"1 rl r'1 r"1 rl rl r1 r"1 rl r'1 r"1 r1 r'1 r'1 r"1 rl n n r'1 0 u c v a) a) a) v a) o a) v a) v v v a) v a) a) v v v v a) Ol i 01 C C C C C C C C C C C C C C C C C C C C C C v a) a) a) v a) 0 a) v a) v a) v v v v a) v v a) w a) L •'^ > > > > > > > > > > > > > > > > > > > > > > 7 O 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 U V Q rl r"1 n n r-1 r'L r'1 r"1 r-1 r'L L"1 r'1 r'1 rl rl r"1 r'1 r'1 r"1 r-1 r'1 r'f O ❑ 0 z c v E E 0 U Z' 0 0 0 0 0 0 0 0 0 0 0 0 C C C C C C C C C C C C N v v v v v N N N v v v v N N N N N O O O (D to n co N m N C) O O C)O O O O O O C C C C 0) O) aT Q) 0) m 07 m i+ m m m m 7 7 7 7 7 7 7 U v N N v m m m m m m m m O o 0 0 `o U U U U U U U U J U U U U n Cm m Ln Ln n n n n n ko n m N N N N O O O O O O O O U U U U U U U U U U U U L O d-+ •N 1 � .Q 41 (V t a LJ tn io W Q o .a F X 'u. N N N N LL I.L m LE C j C E; C C m m m U i- v = v v m o u Lv �v L a U U �o U a m v ` a m m-va 3- 3-0 3 > f > � > `o a) C C C C 0 ❑ D d W d W d 4. LU ❑ � •1a m y co 00 � W r O 00 Q U. LLL U N [n t0 n 00 0) a' m Ln [f' to fn Ln ti > O Cl O O Ln O Ln O Ln d' O LL. C ko �o Lo ko Ln Ln Ln Ln Ln Ln C M Ln Ln Ln Ln Ln Ln Ln Ln Ln co Ln CO r C C C C E E E E mM cc 7 7 7 7 U C U C U C U C U C U C U C U C LD W W W W v v v•O v-0 v"O "O a)a v v E v E v E v E v E v E v v U y v v v v _ _ w uNi E E E ❑ Q O O O O J W J W J W J W J W J W J W J W N N � m Ln W Cn tn Ln L Ln mE Q 7 7 7 7 7 m 7 7 7 7 7 7 = n 0- n n n 0- 0- 0n n n n 0- 4.1E E E E E E E E E E E E - m m m m m m m m m m m m a = V U U U U U U U U U U U C 0 v v v v v v v v v v v v o U L U U U U i U U U i U > C N Ln Ln in W (A to to m ) u � o a � > > > > > > > > > > W a� r, r, 0 o v v v v v v a v v v v v o O) G1 C C C C C C C C C C C C V 'N a) 0) v v a) 0) a) v v v a) v C G N > > > > > > > > > > > > U raj r='1 r=j r7j n 0 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit H Performance Reporting Metrics The following performance metrics under this Agreement shall be reported to County on a monthly basis. Performance metrics may be updated or added throughout the term of this Agreement. Reporting metrics should be compiled into a monthly report for review and discussion. These will serve as key performance indicators and annualized to review trends and analyze overall performance, based on both NCCHC standards and community standards of care. Intake and TB screening/testing • Number and percentage of Detained Youths who received TB testing within 5 days of intake. • Number of Detained Youths with initial positive TB screening result who receive a chest x-ray within 5 days. • Number and percentage of Detained Youths evaluated for compliance with Americans with Disabilities Act (ADA). Access to Care/Health Care Services • Number and percentage of health service request forms (medical, dental, mental health, substance use disorder or other) triaged within 24 hours by a RN. Request forms must be signed/dated by the RN with priority and disposition documented. o Number and percentage performed outside of 24-hour window and action plan to remediate • Number of post-booking wellness checks that require emergency services within 48 hours. • Number and percentage of Detained Youths evaluated by a provider within emergency health service request timeframes for emergent medical, mental health or dental request. o Number and percentage performed within emergency health service request timeframes and action plan to remediate • Number and percentage of Detained Youths evaluated by a provider within 24 hours of an urgent medical, mental health or dental request. • Number of Detained Youths scheduled for an appointment with a provider within 72 hours of a non-urgent request for medical, dental, mental health or substance use disorder services. • Average number of days between the receipt of routine health care requests to initial face-to-face evaluation by a RN, physician/mid-level practitioner, psychiatrist, licensed mental health professional (LMPH), or dentist. • Number of Detained Youths referred by nurse to physician or mid-level practitioner and seen within timeframes for emergent problems, within 24 hours for urgent concerns, and within 14 days for non-urgent concerns. • Number of scheduled sick call appointments by provider type (nursing, physician or mid-level practitioner, dental, psychiatric, and LMHP) • Number of missed appointments and reason(s) o Refusal/No show o Cancelled by provider o Rescheduled by provider o Custody escort not available H-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit H o Provider absent • Number of Detained Youth screened for gonorrhea and chlamydia, and number and percentage of Detained Youth who screen positive for gonorrhea and chlamydia who are subsequently tested for HIV and syphilis • Number and percentage of Detained Youth with a documented history of substance abuse who are continued on MAT or initiated on MAT • Number of Detained Youths monitored for drug and/or alcohol withdrawal • Number of Detained Youths being detoxified and monitored by a physician • Number of Detained Youths admitted and assessed by a physician, including a health and physical (H&P), within 72 hours. • Number of Detained Youths separated or in room confinement/safety room and monitored 3 days per week by medical and/or mental health staff. Continuity of Care • Number of Detained Youths with chronic illness with verified/valid prescriptions that receive medication within a day. • Number of Detained Youth entering the facility with verified, valid prescriptions or chronic care medications reported but not verified that are not available for administration within 24 hours that are bridged by Contractor or have a documented note explaining the plan for bridging within 24 hours. • Number of Detained Youths with high acuity health conditions that are evaluated by a physician or mid-level practitioner within 24 hours of incarceration. • Number of Detained Youths with lower acuity health conditions evaluated by a physician or mid-level practitioner within 72 hours of incarceration. • Number of Detained Youths seen by a psychiatrist, physician or mid-level practitioner upon return from hospitalization (medical or psychiatric) or emergency department. • Number of Detained Youths whose scheduled specialty appointment exceeds 3 months that are examined by a physician or mid-level practitioner monthly. • Number of Detained Youths referred to specialty care o Average time from referral to appointment. Behavioral Health Care Service • Number of Detained Youths with verified/valid prescriptions receive psychiatric "bridged" medications within 24 hours. • Number of Detained Youths seen by a psychiatrist within 7 days of receiving bridged medications. • Number and percentage of Detained Youths with mental health evaluation completed • Number of Detained Youths prescribed psychiatric medications (by Contractor's psychiatrist, not bridged) and seen by a psychiatrist within 30 days of the initial visit. • Number of Detained Youths seen by a psychiatrist at intervals that do not exceed every 90 days. • Number of Detained Youths with a mental health diagnosis. • Number of Detained Youths with a substance use disorder. o Number of Detained Youths receiving SUD services. • Number of Detained Youths receiving psychiatric medications. • Number of Detained Youths receiving routine behavioral health care services. • Number of Detained Youths with crisis management plans. H-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit H • Number of Detained Youths with behavioral management plans. • Number of Detained Youths place on 5150 holds. • Number of Detained Youths separated or in room confinement/safety room and offered and/or participated in three out of cell mental health contacts (individual/group therapy or educational programming) per week. Chronic Disease Management • Number of Detained Youths with a chronic illness. • Number of Detained Youths identified with needing chronic care that are evaluated by a physician or mid-level practitioner at intervals that do not exceed every 90 days. • Percentage of type 1 diabetics with uncontrolled Hba1 c, greater than 9 • Percentage of type 1 diabetics with uncontrolled Hba1 c, greater than 9 Medication Assisted Treatment (MAT) • Number of Detained Youths receiving MAT services for Substance Use Disorder including Opioid Use Disorder (OUD) (includes Detained Youths with verified pre- incarceration community prescription for MAT who are continued, Detained Youths where MAT was initiated in the JJC, and Detained Youths in custody at JJC for more than one month who are MAT continued from the previous month) as well as MAT for alcohol and stimulants o Number of Detained Youth on methadone o Number of Detained Youth on buprenorphine (e.g., Suboxone®, Bunavail®, Zubsolv®, Sublocade®, Subutex®) o Number of Detained Youth on naltrexone (e.g., Vivitrol®, oral naltrexone) • Number of Detained Youths withdrawn from MAT o Number of Detained Youth withdrawn from methadone o Number of Detained Youth on buprenorphine o Number of Detained Youth on naltrexone • Number of Detained Youths continued on MAT o Number of Detained Youth continued on methadone o Number of Detained Youth continued on buprenorphine o Number of Detained Youth continued on naltrexone • Number of Detained Youths initiated on MAT o Number of Detained Youth continued on methadone o Number of Detained Youth continued on buprenorphine o Number of Detained Youth continued on naltrexone • Other o Detainees reporting methamphetamine/stimulant use (includes amphetamines, cocaine, misuse of prescription stimulants) at intake o Units naloxone (e.g., Narcan®, Evzio®) dispensed to detainees and/or visitors o Units of naloxone administered in custody Operational Management • Staff turnover rate — Monthly and annual • Number of open positions • Pharmaceutical spend in aggregate H-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit H • Pharmaceutical spend by individual. For purposes of privacy, reporting may be anonymized • Staff competency compliance % rates • Custody staff health-related training compliance H-4 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit I Performance Metrics Compliance The following under this Agreement shall be reported to County on a monthly basis. Performance metrics and/or compliance rates may be updated or added throughout the term of this Agreement. Metrics will include maintaining compliance with NCCHC Accreditation Standards. Intake and TB Screening/ estin • of Detained Youths Receive TB test within 5 days of intake Note 1 • of Detained Youths With initial positive TB screening result who Note 1 receive chest x-ray within 5 days • of Detained Youths Evaluated for compliance with ADA Note 1 Access to Care/Health Care Services % of Detained Youths Receive intake screening performed within 4 Note 1 hours of booking or if no Contractor staff on duty at time of booking, within 4 hours of Contractor staff returning to duty % of Detained Youths Receive initial health assessment within 96 Note 1 hours Ex A % of health service request Medical Note 1 forms triaged within 24 hours Dental Mental health SUD Other • of Detained Youths Evaluated by provider immediately for Note 1 emergent medical, mental health, or dental request • of Detained Youths Evaluated by provider within 24 hours for Note 1 urgent medical, mental health, or dental request • of Detained Youths Scheduled for an appointment within 72 Note 1 hours of a non-urgent request for medical, dental, mental health or SUD service • of Detained Youths Referred by RN to physician or mid-level Note 1 practitioner and • seen within timeframe for emergent problems; • seen within 24 hours for urgent concerns; or • seen within 14 days for non-urgent concerns #of scheduled sick call Nursing Nursing Sick Calls/FTE appointments conducted per Mid-Level Practitioner Mid-Level Sick Calls/FTE week Physician Physician Sick Calls/FTE Psychiatric Psychiatric Visits/FTE LMHP LMHP Visits per FTE Dental Dental Visits per FTE #of Detained Youths Scheduled for medical, mental health or Year 1 —establish baseline dental sick call and the following: rates for each measure • #who show up for their appointment 1-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit I Performance Metrics Compliance • #of no shows by Years 2-5— Develop plan to o Not brought by Probation improve prior year rate o Court o Refusal o Not in-custody (NIC) o Other • #of appointments canceled by provider • # of appointments rescheduled by provider % of Detained Youths Provided with immunizations if not up-to- Note 1 date with immunizations in accordance with current public health guidelines within 14 days of admission (exception: Contractor shall not be held responsible when non- compliance is due to lack of parental consent for immunization s % of Detained Youths Monitored for drug and/or alcohol withdrawal Note 1 % of Detained Youths Being detoxified and monitored by physician Note 1 # of Detained Youths Referred to specialty care with average time Year 1 —establish baseline from referral to appointment rates for each measure Years 2-5 — Develop plan to improve prior year rate • of Detained Youths Admitted to OHU and assessed by Note 1 h sician, including H&P, within 72 hrs • of Detained Youths In separated or room confinement/safety cell Note 1 housing and monitored 3 days/week by medical and/or mental health staff Continuity of Care • of Detained Youths With chronic illness with verified/valid Note 1 prescriptions that receive medication within 24 hours • of Detained Youths With chronic illness who report taking a Note 1 medication for their chronic illness that has been verified but is not available for administration within 24 hours that are bridged by Contractor with an alternative medication or have a documented note explaining their plan for bridging within 24 hours. • of Detained Youths Have high acuity health conditions evaluated Note 1 by physician/mid-level practitioner within 24 hours • of Detained Youths Have lower acuity health conditions Note 1 evaluated by physician/mid-level practitioner within 72 hours • of Detained Youths Seen by psychiatrist, physician or mid-level Note 1 ractitioner upon return from hospitalization 1-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit I Performance Metrics Compliance (medical or psychiatric) or emergency de artment % of Detained Youths With scheduled specialty appointment Note 1 exceeding 3 months that are examined by a h sician or mid-level practitioner month) % of Detained Youths With behavioral health (mental health and/or Note 1 SUD) diagnoses discharged with links to County programs and/or community providers • of Detained Youths With successful transportation coordination Note 1 upon release % of Detained Youths Provided with 14-day supply of essential Note 1 medications or provided a verified community 30-day supply prescription upon discharge % of Detained Youths Under active management of Care Manager Note 1 with treatment plan for chronic medical and/or behavioral health, including discharge Ian • of Detained Youths Pregnant Detained Youth provided with links Note 1 to County programs and/or community providers upon discharge Behavioral Health Care Service • of Detained Youths With mental health evaluation completed, Note 1 including Columbia Risk Severity rating scale, within 30 days or sooner after positive screening (NCCHC) • of Detained Youths Having verified/valid prescriptions and Note 1 receive psychiatric "bridged" medications within 24 hours • of Detained Youths Seen by psychiatrist within 7 days of Note 1 receiving bridged medications % of Detained Youths Prescribed psychiatric medications (not Note 1 bridged) and seen by psychiatrist within 30 da s of initial visit • of Detained Youths Seen by a psychiatrist at intervals that do Note 1 not exceed every 90 days • of Detained Youths With ASAM and IDD completed within 72 Note 1 hours after positive screening for SUD (Ex A # of Detained Youths Having SUD and receiving SUD services (Ex Note 1 A) • 6 hours per week of medically necessary services • Up to 9 hours per week for Detained Youths aged 18 and over • Group size limited to no less than 2 and no more than 12 1-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit I Performance Metrics Compliance Chronic Disease Management % of Detained Youths On a chronic disease program and 85% Compliance evaluated by provider at intervals not exceeding 90 days Diabetes Management Type 1 Diabetic Patients with Hba1 C 90th percentile—29.44% uncontrolled/Unrecorded > 9 Type 2 Diabetic Patients with Hba1 C 90th percentile—29.44% uncontrolled/Unrecorded > 9 MAT Eligibility Intake screening will include identifying 85% Compliance Detained Youths at risk for withdrawal from opioids and a determination within 12 hours of eli ibility for MAT Client and Stakeholder Satisfaction Client and Stakeholder Conduct annual satisfaction survey with Net Promoter Score > 50 Satisfaction input from members of Probation, facility command staff, Fresno DPH, Fresno DBH and other key county personnel. Grievances Reduction of medical, mental health and Establish baseline in Year 1 SUD grievances from current levels and maintenance of satisfactory grievance levels over time. Operational Management Staff Turnover Rate Medical Monitored on an ongoing Mental Health basis. Currently rates for SUD healthcare staff turnover at 22%. Develop plan for improvement #of open positions Medical Monthly reporting Mental Health SUD Staff competency rates Medical Monitored on an ongoing Mental Health basis. SUD % of custody staff with As required by NCCHC. Custody staff to 90% Compliance health-related training receive health training at least every 2 years provided by Contractor and be trained in basic screening. Note 1: Contractor shall maintain compliance with all current NCCHC Accreditation Standards and provide evidence of performance on a monthly basis. As NCCHC standards are updated or modified, reports will be modified to reflect current requirements. Performance levels must remain above minimum performance standards as established by NCCHC. In the event that performance levels fall below minimum performance standards, Contractor will develop and implement a plan of correction and provide monthly reporting on progress. Contractor will provide to County updated standards as those are made available by NCCHC. 1-4 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA17961382A7 Exhibit J Annual Summary Report (Year) All Services for JJC: Percentage Dollars Medical Services: (%) Pharmaceuticals: (%) ER Visits (not inpatient): (%) Behavioral Health: (%) SUD: (%) MAT: (%) TOTAL: 100% J-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit K PAYMENT SCHEDULE - 17.5 Hour Schedule BASE AMOUNT EXCLUDES IN-PATIENT CARE SERVICES* YEAR 1 YEAR 2 YEAR 3 YEAR 4** YEAR 5 7/1/2024-6/30/2025 7/1/2025-6/30/2026 7/1/2026-6/30/2027 7/1/2027-6/30/2028 7/1/2028-6/30/2029 Base Amount* $ 4,010,175 1 $ 4,210,684 1 $ 4,421,218 $ 4,642,279 $ 4,874,393 up to 5% up to 5% up to 5% up to 5% MONTHLY TOTALS: JULY $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 AUGUST $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 SEPTEMBER $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 OCTOBER $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 NOVEMBER $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 DECEMBER $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 JANUARY $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 FEBRUARY $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 MARCH $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 APRIL $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 MAY $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 JUNE $ 334,181.25 $ 350,890.31 $ 368,434.83 $ 386,856.57 $ 406,199.40 $ 4,010,175 $ 4,210,684 $ 4,421,218 $ 4,642,279 $ 4,874,393 YEARS 1-3 TOTAL: $ 12,642,077 YEARS 1-5**TOTAL: $ 22,158,748 *Subsequent years after year one includes a percent increase equal to 3.5%or the National Consumer Price Index,not to exceed a maximum of 5%. **Years four and five are additional 12-month period extensions,if performance standards are met by the Contractor. K-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit L 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 Three Million Dollars ($3,000,000) per occurrence and an annual aggregate of Six Million Dollars ($6,000,000). 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 provide a blanket endorsement to this policy on behalf of 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 for the sole negligence of Contractor. (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)Workers Compensation. Workers compensation insurance as required by the laws of the State of California with statutory limits. (D) 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. (E) Professional Liability. Professional liability insurance with limits of not less than Ten Million Dollars ($10,000,000) per claim and an annual aggregate of Ten Million Dollars ($10,000,000). If Contractor has 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 four years after completion of services under this Agreement. Coverage must include sexual abuse/ molestation liability coverage. (F) 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 Article 18 L-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit L 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 which may be evidenced through a blanket waiver of subrogation. (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 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. L-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit L (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 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. L-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M Data Security 1. Definitions Capitalized terms used in this Exhibit M have the meanings set forth in this section 1. (A) "Authorized Employees" means the Contractor's employees who have access to Personal Information. (B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all of the Contractor's subcontractors, representatives, agents, outsourcers, and consultants, and providers of professional services to the Contractor, who have access to Personal Information and are bound by law or in writing by confidentiality obligations sufficient to protect Personal Information in accordance with the terms of this Exhibit M. (C) "Director" means the County's Probation Chief, Director of Behavioral Health, or designees. (D) "Disclose" or any derivative of that word means to disclose, release, transfer, disseminate, or otherwise provide access to or communicate all or any part of any Personal Information orally, in writing, or by electronic or any other means to any person. (E) "Person" means any natural person, corporation, partnership, limited liability company, firm, or association. (F) "Personal Information" means any and all information, including any data, provided, or to which access is provided, to the Contractor by or upon the authorization of the County, under this Agreement, including but not limited to vital records, that: (i) identifies, describes, or relates to, or is associated with, or is capable of being used to identify, describe, or relate to, or associate with, a person (including, without limitation, names, physical descriptions, signatures, addresses, telephone numbers, e-mail addresses, education, financial matters, employment history, and other unique identifiers, as well as statements made by or attributable to the person); (ii) is used or is capable of being used to authenticate a person (including, without limitation, employee identification numbers, government-issued identification numbers, passwords or personal identification numbers (PINs), financial account numbers, credit report information, answers to security questions, and other personal identifiers); or (iii) is personal information within the meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision (e). Personal Information does not include publicly available information that is lawfully made available to the general public from federal, state, or local government records. (G)"Privacy Practices Complaint" means a complaint received by the County relating to the Contractor's (or any Authorized Persons) privacy practices, or alleging a Security Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly investigate and take remedial action under this Exhibit M. (H)"Security Safeguards" means physical, technical, administrative or organizational security procedures and practices put in place by the Contractor (or any Authorized Persons) that relate to the protection of the security, confidentiality, value, or integrity of M-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M Personal Information. Security Safeguards shall satisfy the minimal requirements set forth in section 3(C) of this Exhibit M. (1) "Security Breach" means (i) any act or omission that compromises either the security, confidentiality, value, or integrity of any Personal Information or the Security Safeguards, or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage to, any Personal Information. (J) "Use" or any derivative of that word means to receive, acquire, collect, apply, manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose of Personal Information. 2. Standard of Care (A) The Contractor acknowledges that, in the course of its engagement by the County under this Agreement, the Contractor, or any Authorized Persons, may Use Personal Information only as permitted in this Agreement. (B) The Contractor acknowledges that Personal Information is deemed to be confidential information of, or owned by, the County (or persons from whom the County receives or has received Personal Information) and is not confidential information of, or owned or by, the Contractor, or any Authorized Persons. The Contractor further acknowledges that all right, title, and interest in or to the Personal Information remains in the County (or persons from whom the County receives or has received Personal Information) regardless of the Contractor's, or any Authorized Person's, Use of that Personal Information. (C)The Contractor agrees and covenants in favor of the Country that the Contractor shall: (i) keep and maintain all Personal Information in strict confidence, using such degree of care under this section 2 as is reasonable and appropriate to avoid a Security Breach; (ii) Use Personal Information exclusively for the purposes for which the Personal Information is made accessible to the Contractor pursuant to the terms of this Exhibit M; (iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal Information for the Contractor's own purposes or for the benefit of anyone other than the County, without the County's express prior written consent, which the County may give or withhold in its sole and absolute discretion; and (iv) not, directly or indirectly, Disclose Personal Information to any person (an "Unauthorized Third Party") other than Authorized Persons pursuant to this Agreement, without the Director's express prior written consent. (D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it, or any Authorized Person, is required to disclose Personal Information to government regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be required by applicable law, Contractor shall (i) immediately notify the County of the specific demand for, and legal authority for the disclosure, including providing County with a copy of any notice, discovery demand, subpoena, or order, as applicable, M-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 Exhibit M received by the Contractor, or any Authorized Person, from any government regulatory authorities, or in relation to any legal proceeding, and (ii) promptly notify the County before such Personal Information is offered by the Contractor for such disclosure so that the County may have sufficient time to obtain a court order or take any other action the County may deem necessary to protect the Personal Information from such disclosure, and the Contractor shall cooperate with the County to minimize the scope of such disclosure of such Personal Information. (E) The Contractor shall remain liable to the County for the actions and omissions of any Unauthorized Third Party concerning its Use of such Personal Information as if they were the Contractor's own actions and omissions. 3. Information Security (A) The Contractor covenants, represents and warrants to the County that the Contractor's Use of Personal Information under this Agreement does and will at all times comply with all applicable federal, state, and local, privacy and data protection laws, as well as all other applicable regulations and directives, including but not limited to California Civil Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song- Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3, beginning with section 1747). If the Contractor Uses credit, debit or other payment cardholder information, the Contractor shall at all times remain in compliance with the Payment Card Industry Data Security Standard ("PCI DSS") requirements, including remaining aware at all times of changes to the PCI DSS and promptly implementing and maintaining all procedures and practices as may be necessary to remain in compliance with the PCI DSS, in each case, at the Contractor's sole cost and expense. (B) The Contractor covenants, represents and warrants to the County that, as of the effective date of this Agreement, the Contractor has not received notice of any violation of any privacy or data protection laws, as well as any other applicable regulations or directives, and is not the subject of any pending legal action or investigation by, any government regulatory authority regarding same. (C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit M, the Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than accepted industry practices and, at a minimum, include the following: (i) limiting Use of Personal Information strictly to the Contractor's and Authorized Persons' technical and administrative personnel who are necessary for the Contractor's, or Authorized Persons', Use of the Personal Information pursuant to this Agreement; (ii) ensuring that all of the Contractor's connectivity to County computing systems will only be through the County's security gateways and firewalls, and only through security procedures approved upon the express prior written consent of the Director; (iii) to the extent that they contain or provide access to Personal Information, (a) securing business facilities, data centers, paper files, servers, back-up systems and computing equipment, operating systems, and software applications, M-3 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M including, but not limited to, all mobile devices and other equipment, operating systems, and software applications with information storage capability; (b) employing adequate controls and data security measures, both internally and externally, to protect (1) the Personal Information from potential loss or misappropriation, or unauthorized Use, and (2) the County's operations from disruption and abuse; (c) having and maintaining network, device application, database and platform security; (d) maintaining authentication and access controls within media, computing equipment, operating systems, and software applications; and (e) installing and maintaining in all mobile, wireless, or handheld devices a secure internet connection, having continuously updated anti-virus software protection and a remote wipe feature always enabled, all of which is subject to express prior written consent of the Director; (iv) encrypting all Personal Information at advance encryption standards of Advanced Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile devices, including but not limited to hard disks, portable storage devices, or remote installation, or (b)transmitted over public or wireless networks (the encrypted Personal Information must be subject to password or pass phrase, and be stored on a secure server and transferred by means of a Virtual Private Network (VPN) connection, or another type of secure connection, all of which is subject to express prior written consent of the Director); (v) strictly segregating Personal Information from all other information of the Contractor, including any Authorized Person, or anyone with whom the Contractor or any Authorized Person deals so that Personal Information is not commingled with any other types of information; (vi) having a patch management process including installation of all operating system and software vendor security patches; (vii) maintaining appropriate personnel security and integrity procedures and practices, including, but not limited to, conducting background checks of Authorized Employees consistent with applicable law; and (viii) providing appropriate privacy and information security training to Authorized Employees. (D) During the term of each Authorized Employee's employment by the Contractor, the Contractor shall cause such Authorized Employees to abide strictly by the Contractor's obligations under this Exhibit M. The Contractor shall maintain a disciplinary process to address any unauthorized Use of Personal Information by any Authorized Employees. (E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the Contractor's practice to do so more frequently, Personal Information received from the County, and the County shall have immediate, real time access, at all times, to such backups via a secure, remote access connection provided by the Contractor, through the Internet. (F) The Contractor shall provide the County with the name and contact information for each Authorized Employee (including such Authorized Employee's work shift, and at least one M-4 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M alternate Authorized Employee for each Authorized Employee during such work shift) who shall serve as the County's primary security contact with the Contractor and shall be available to assist the County twenty-four (24) hours per day, seven (7) days per week as a contact in resolving the Contractor's and any Authorized Persons' obligations associated with a Security Breach or a Privacy Practices Complaint. (G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door, time bomb, drop dead device, worm, virus, or other code of any kind that may disable, erase, display any unauthorized message within, or otherwise impair any County computing system, with or without the intent to cause harm. 4. Security Breach Procedures (A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach, the Contractor shall (i) notify the Director of the Security Breach, such notice to be given first by telephone at the following telephone number, followed promptly by email at the following email addresses and telephone numbers: incidents(-)fresnocountyca.gov, (559) 600-5900, (559) 600-4645, DBH Contracted Services a(..fresnocountyca.gov and Pro bation Contracts(a.fresnocountyca.gov (which telephone number and email address the County may update by providing notice to the Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized Person to preserve all relevant evidence) relating to the Security Breach. The notification shall include, to the extent reasonably possible, the identification of each type and the extent of Personal Information that has been, or is reasonably believed to have been, breached, including but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or modification, or any loss or destruction, corruption, or damage. (B) Immediately following the Contractor's notification to the County of a Security Breach, as provided pursuant to section 4(A) of this Exhibit M, the Parties shall coordinate with each other to investigate the Security Breach. The Contractor agrees to fully cooperate with the County, including, without limitation: (i) assisting the County in conducting any investigation; (ii) providing the County with physical access to the facilities and operations affected; (iii) facilitating interviews with Authorized Persons and any of the Contractor's other employees knowledgeable of the matter; and (iv) making available all relevant records, logs, files, data reporting and other materials required to comply with applicable law, regulation, industry standards, or as otherwise reasonably required by the County. To that end, the Contractor shall, with respect to a Security Breach, be solely responsible, at its cost, for all notifications required by law and regulation, or deemed reasonably necessary by the County, and the Contractor shall provide a written report of the investigation and reporting required to the Director within 30 days after the Contractor's discovery of the Security Breach. M-5 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M (C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that notification, the Contractor shall promptly address such Privacy Practices Complaint, including taking any corrective action under this Exhibit M, all at the Contractor's sole expense, in accordance with applicable privacy rights, laws, regulations and standards. In the event the Contractor discovers a Security Breach, the Contractor shall treat the Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the County whether the matter is a Security Breach, or otherwise has been corrected and the manner of correction, or determined not to require corrective action and the reason for that determination. (D)The Contractor shall take prompt corrective action to respond to and remedy any Security Breach and take mitigating actions, including but not limiting to, preventing any reoccurrence of the Security Breach and correcting any deficiency in Security Safeguards as a result of such incident, all at the Contractor's sole expense, in accordance with applicable privacy rights, laws, regulations and standards. The Contractor shall reimburse the County for all reasonable costs incurred by the County in responding to, and mitigating damages caused by, any Security Breach, including all costs of the County incurred relation to any litigation or other action described section 4(E) of this Exhibit M. (E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation or other action to protect the County's rights relating to Personal Information, including the rights of persons from whom the County receives Personal Information. 5. Oversight of Security Compliance (A) The Contractor shall have and maintain a written information security policy that specifies Security Safeguards appropriate to the size and complexity of the Contractor's operations and the nature and scope of its activities. (B) Upon the County's written request, to confirm the Contractor's compliance with this Exhibit M, as well as any applicable laws, regulations and industry standards, the Contractor grants the County or, upon the County's election, a third party on the County's behalf, permission to perform an assessment, audit, examination or review of all controls in the Contractor's physical and technical environment in relation to all Personal Information that is Used by the Contractor pursuant to this Agreement. The Contractor shall fully cooperate with such assessment, audit or examination, as applicable, by providing the County or the third party on the County's behalf, access to all Authorized Employees and other knowledgeable personnel, physical premises, documentation, infrastructure and application software that is Used by the Contractor for Personal Information pursuant to this Agreement. In addition, the Contractor shall provide the County with the results of any audit by or on behalf of the Contractor that assesses the effectiveness of the Contractor's information security program as relevant to the security and confidentiality of Personal Information Used by the Contractor or Authorized Persons during the course of this Agreement under this Exhibit M. (C)The Contractor shall ensure that all Authorized Persons who Use Personal Information agree to the same restrictions and conditions in this Exhibit M. that apply to the M-6 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M Contractor with respect to such Personal Information by incorporating the relevant provisions of these provisions into a valid and binding written agreement between the Contractor and such Authorized Persons, or amending any written agreements to provide same. 6. Return or Destruction of Personal Information. Upon the termination of this Agreement, the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County all Personal Information, whether in written, electronic or other form or media, in its possession or the possession of such Authorized Persons, in a machine readable form used by the County at the time of such return, or upon the express prior written consent of the Director, securely destroy all such Personal Information, and certify in writing to the County that such Personal Information have been returned to the County or disposed of securely, as applicable. If the Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit M, such certification shall state the date, time, and manner (including standard) of disposal and by whom, specifying the title of the individual. The Contractor shall comply with all reasonable directions provided by the Director with respect to the return or disposal of Personal Information and copies of Personal Information. If return or disposal of such Personal Information or copies of Personal Information is not feasible, the Contractor shall notify the County according, specifying the reason, and continue to extend the protections of this Exhibit M to all such Personal Information and copies of Personal Information. The Contractor shall not retain any copy of any Personal Information after returning or disposing of Personal Information as required by this section 6. The Contractor's obligations under this section 6 survive the termination of this Agreement and apply to all Personal Information that the Contractor retains if return or disposal is not feasible and to all Personal Information that the Contractor may later discover. 7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or obligations set forth in this Exhibit M may cause the County irreparable harm for which monetary damages would not be adequate compensation and agrees that, in the event of such breach or threatened breach, the County is entitled to seek equitable relief, including a restraining order, injunctive relief, specific performance and any other relief that may be available from any court, in addition to any other remedy to which the County may be entitled at law or in equity. Such remedies shall not be deemed to be exclusive but shall be in addition to all other remedies available to the County at law or in equity or under this Agreement. 8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its officers, employees, and agents, (each, a "County Indemnitee") from and against any and all infringement of intellectual property including, but not limited to infringement of copyright, trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage to, Personal Information, Security Breach response and remedy costs, credit monitoring expenses, forfeitures, losses, damages, liabilities, deficiencies, actions,judgments, interest, awards, fines and penalties (including regulatory fines and penalties), costs or expenses of whatever kind, including attorneys' fees and costs, the cost of enforcing any right to indemnification or defense under this Exhibit M and the cost of pursuing any insurance providers, arising out of or resulting from any third party claim or action against any County Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized Employee's or Authorized Person's, performance or failure to perform under this Exhibit M or M-7 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit M arising out of or resulting from the Contractor's failure to comply with any of its obligations under this section 8. The provisions of this section 8 do not apply to the acts or omissions of the County. The provisions of this section 8 are cumulative to any other obligation of the Contractor to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The provisions of this section 8 shall survive the termination of this Agreement. 9. Survival. The respective rights and obligations of the Contractor and the County as stated in this Exhibit M shall survive the termination of this Agreement. 10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit M is intended to confer, nor shall anything in this Exhibit M confer, upon any person other than the County or the Contractor and their respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever. 11. No County Warranty. The County does not make any warranty or representation whether any Personal Information in the Contractor's (or any Authorized Person's) possession or control or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint. M-8 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit N Self-Dealing Transaction Disclosure Form In order to conduct business with the County of Fresno ("County"), members of a contractor's board of directors ("County Contractor"), must disclose any self-dealing transactions that they are a party to while providing goods, performing services, or both for the County. A self-dealing transaction is defined below: "A self-dealing transaction means a transaction to which the corporation is a party and in which one or more of its directors has a material financial interest." The definition above will be used for purposes of completing this disclosure form. Instructions (1) Enter board member's name,job title (if applicable), and date this disclosure is being made. (2) Enter the board member's company/agency name and address. (3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the County. At a minimum, include a description of the following: a. The name of the agency/company with which the corporation has the transaction; and b. The nature of the material financial interest in the Corporation's transaction that the board member has. (4) Describe in detail why the self-dealing transaction is appropriate based on applicable provisions of the Corporations Code. The form must be signed by the board member that is involved in the self-dealing transaction described in Sections (3) and (4). N-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit N (1) Company Board Member Information: Name: Date: Job Title: (2) Company/Agency Name and Address: (3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to) (4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code § 5233 (a) (5) Authorized Signature Signat Date ure: N-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796682A7 Exhibit O DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT I. Identifying Information Name of entity D/B/A Address(number,street) City Slate ZIP code CLIA number Taxpayer ID number(EIN) Telephone number ( ) II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued. YES NO A. Are there any individuals or organizations having a direct or indirect ownership or control interest of five percent or more in the institution, organizations, or agency that have been convicted of a criminal offense related to the involvement of such persons or organizations in any of the programs established by Titles XVIII,XIX, or XX?......................................................................................................................... o 0 B. Are there any directors, officers, agents, or managing employees of the institution, agency, or organization who have ever been convicted of a criminal offense related to their involvement in such programs established by Titles XVI ll, XIX, or XX?...................................................................................... o 0 C. Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organizations, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0 III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are related to each other, this must be reported under"Remarks." NAME ADDRESS EIN B. Type of entity: o Sole proprietorship o Partnership o Corporation O Unincorporated Associations o Other(specify) C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations under"Remarks." D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses of individuals, and provider numbers........................................................................................................... o 0 NAME ADDRESS PROVIDER NUMBER O-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit O YES NO IV. A. Has there been a change in ownership or control within the last year? ....................................................... 0 0 If yes, give date. B. Do you anticipate any change of ownership or control within the year?....................................................... 0 0 If yes,when? C. Do you anticipate filing for bankruptcy within the year?................................................................................ 0 0 If yes, when? V. Is the facility operated by a management company or leased in whole or part by another organization?.......... 0 0 If yes, give date of change in operations. VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... 0 0 VII. A. Is this facility chain affiliated? ...................................................................................................................... 0 0 If yes, list name, address of corporation, and EIN. Name EIN Address(number,name) City State ZIP code B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain? (If yes, list name, address of corporation, and EIN.) Name EIN Address(number,name) City State ZIP code Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the information requested may result in denial of a request to participate or where the entity already participates, a termination of its agreement or contract with the agency, as appropriate. Name of authorized representative(typed) Title Signature Date Remarks O-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit P CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. P-1 DocuSign Envelope ID:A622DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit P CERTIFICATION (1) The prospective primary participant certifies to the best of its knowledge and belief, that it, its owners, officers, corporate managers and partners: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date: (Printed Name & Title) (Name of Agency or Company) P-2 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit Q 1 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principal Standard: 1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and practices,preferred languages,health literacy,and other communication needs. Governance,Leadership,and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and allocated resources. 3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in the service area. 4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate timely access to all health care and services. 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing. 7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement,Continuous Improvement,and Accountability: 9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's planning and operations. 10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. 13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts or complaints. 15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public. .f Think Cultural Health y U.S.Department of littps://www.thinkculturalhealth.hlis.gov/ //�� Health and Human Services 'cr O 1 Y 1 H Office ofMinorilyHeallh contact@thinkculturalhealth.hhs.gov ''`rrnu Q-1 DocuSign Envelope ID:AB22DEBC-6AB7-437C-9F73-2CA1796B82A7 Exhibit Q The Case for the National CLAS Standards Health equity is the attainment of the highest level of health for all people) Currently,individuals across the United States from various cultural backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3 Though health inequities are directly related to the existence of historical and current discrimination and social injustice,one of the most modifiable factors is the lack of culturally and linguistically appropriate services,broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. Of all the forms of Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in the issue not only an individual concern but also a public health concern. In the United States,it health care is the most has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane. inadequate and/or inequitable care is$1.24 trillion." Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr. the quality of care and services.56 By providing a structure to implement culturally and linguistically appropriate services,the National CLAS Standards will improve an organization's ability to address health care disparities. The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of these Standards will help advance better health and health care in the United States. Bibliography 1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minodtyhealth.hhs.gov/npa 2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/ 3.U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www. healthypeople.gov/2020/topicsobjectives2020/overvi ew.aspx?topicld=39 4.LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www. jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%20Health%201nequalities%20in%20the%20United%20States.pdf 5.Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquaf.pdf 6.Goode,T D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The Commonwealth Fund website:http://www.commonweelthfund.org/usr doc/Goode_evidencebasecultiinguisticcomp_962.pdf 7.U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http:// minodtyhealth.hhs.gov/npa/files/Plans/HHS/HHS_PlaR-complete.pdf B.National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286 tl4` Think Cultural Health U.S.Department of hops://www.thlnkculturalhealth.hhs.gov/ Health and Human Services p M H owceofMinorityHealth contact@thinkculturalhealth.hhs.gov Q-Z