HomeMy WebLinkAboutAgreement A-20-032 with Various Contractors.pdfAgreement No . 20-032
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 21st day of January, 2020 , by and between the
3 COUNTY OF FRESNO, a Political Subdivision of the State of California , hereinafter referred to as
4 "COUNTY", and each Contractor listed in Exhibit A, "Permanent Supportive Housing Vendor List ,"
5 attached hereto and by this reference incorporated herein , collectively herein after referred to as
6 "CONTRACTOR" and such additional CONTRACTOR as may from time to time during the term of this
7 Agreement , be added by COUNTY. Reference in this Agreement to "party" or "parties " shall be understood
8 to refer to COUNTY and each CONTRACTOR, unless otherwise specified .
9 WITNESS ETH
10 WHEREAS , COUNTY is authorized through its Department of Behavioral Health (DBH) Substance
11 Use Diso rder (SUD) Services Division is in need of permanent housing and supportive services for Fresno
12 County residents with SUD , mental health , and co-occurring disorders ; and
13 WHEREAS , CONTRACTOR's Permanent Supportive Housing (PSH) Program is a supportive
14 housing program designed to provide permanent housing and supportive services for Fresno County
15 residents with SUD, mental health , and co-occurring disorders .
16 WHEREAS , CONTRACTOR is qualified and willing to provide such services pursuant to the
17 terms and conditions of this Agreement.
18 NOW, THEREFORE , in consideration of their mutual covenants , terms and conditions herein
19 contained, the parties hereto agree as follows :
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1. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities for the
22 provision of permanent support ive housing as identified in Exhibit B "Scope of Work" incorporated
23 herein by reference , Exhibit C , "DBH Guiding Principles of Care Delivery ," incorporated herein by
24 reference , COUNTY's Request for Proposal (RFP) #20-011 dated September 17 , 2019 ; Addendum
25 No. One (1) dated September 26 , 2019 ; and Addendum No . Two (2) dated October 8 , 2019 ,
26 hereinafter collectively referred to as COUNTY RFP #20-011 , all incorporated herein by reference and
27 made part of this Agreement.
28 B. In the event of any inconsistency among these documents, the inconsistency
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shall be resolved by giving precedence in the following order of priority: 1) to this Agreement, including
any Exhibits and amendments attached hereto 2) to RFP #20-011, and; 3) to the Response to the RFP.
A copy of COUNTY’s RFP #20-011 shall be retained and made available during the term of this
Agreement by COUNTY’s Purchasing Division.
C. CONTRACTOR shall provide twenty four (24) permanent supportive housing
units and supportive services to clients referred exclusively by DBH and, consisting of individuals and
families with children, including perinatal, with a disabling condition as defined by the Department of
Housing and Urban Development (HUD) such as a significant addiction to alcohol or other drugs,
mental health issues and/or co-occurring disorders that are life-function impairing.
2. ADDITIONS/DELETIONS OF CONTRACTOR(S)
COUNTY’S DBH Director or her designee reserves the right at any time during the term
of this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A, “Permanent Supportive
Housing Vendor List.” It is understood any such additions will not affect compensation paid to the other
CONTRACTOR(S), and therefor such additions may be made by COUNTY without notice to or
approval from other CONTRACTOR(S) under this Agreement. These same provisions shall apply to the
deletion of any CONTRACTOR listed in Exhibit A, “Permanent Supportive Housing Vendor List,” except
that deletions shall be made by written mutual agreement between the COUNTY and the particular
CONTRACTOR to be deleted, or shall be in accordance with the provisions of Section FOUR (4),
TERMINATION, of this Agreement.
3. TERM
This Agreement shall be effective on the 1st day of January 2020 and shall terminate on
the 30th day of June 2022. This Agreement may be extended for two (2) additional consecutive twelve-
month periods starting July 1, 2022 upon written approval of both parties no later than thirty (30) days
prior to the first day of the next twelve-month extension period. The DBH Director or his or her designee
is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR(S)
satisfactory performance.
4. TERMINATION
A. Non Allocation of Funds - The terms of this Agreement, and the services to be
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provided hereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY;
or
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of
any breach of this Agreement or any default which may then exist on the part of the CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to the COUNTY with respect to
the breach or default. The COUNTY shall have the right to demand of the CONTRACTOR the
repayment to the COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which
in the judgment of the COUNTY were not expended in accordance with the terms of this Agreement.
The CONTRACTOR shall promptly refund any such funds upon demand.
C. Without Cause Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of
an intention to terminate to CONTRACTOR.
5. COMPENSATION
A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation at the rate of Eight Dollars Fifty-Six ($8.56) per day per housing unit, for the first day of
tenancy and all subsequent days, for up to Twenty-Four (24) units.
B. In no event shall the total compensation for actual service performed under this
Agreement be in excess of Seventy Five Thousand and No/100 Dollars ($75,000) for the first six (6)
month period from January 1, 2020 through June 30, 2020 and One Hundred Fifty Thousand and
No/100 Dollars ($150,000) for each twelve (12) month period from July 1, 2020 through June 30, 2024.
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CONTRACTOR shall be reimbursed to the extent that funds are available.
The contract maximum amount as identified in this Agreement may be reduced based upon
funding availability. In the event of such action, the COUNTY’s DBH Director or her designee shall
notify the CONTRACTOR in writing of the reduction in the maximum amount within thirty (30) days.
In the event that funding for these services is delayed by the State Controller, COUNTY may
defer payment to CONTRACTOR. The amount of the deferred payment shall not exceed the amount of
funding delayed by the State Controller to the COUNTY. The deferral by COUNTY shall not exceed the
period of time of the State Controller’s delay of payment to COUNTY plus forty-five (45) days. In
addition, if the State of California does not allocate funding for services described in the terms and
conditions of this Agreement, DBH shall not be obligated to reimburse CONTRACTOR for services
performed.
C. PAYMENTS
1) Payment by COUNTY shall be in arrears, based on CONTRACTOR’s
monthly invoices submitted for services provided during the preceding month, within forty-five (45) days
after receipt and verification of CONTRACTOR’s monthly invoices by COUNTY’s DBH..
2) If payment for services is denied or disallowed, and subsequently
resubmitted to COUNTY by CONTRACTOR, disallowed portion will be withheld from the next
reimbursement to CONTRACTOR until COUNTY has received reimbursement from State for said
services.
D. COMPLIANCE – If CONTRACTOR should fail to comply with any provision of
this Agreement, COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR’s
and COUNTY’s obligations under this section shall survive the termination of this Agreement with
respect to services provided during the term of this Agreement without regard to the cause of
termination of this Agreement.
E. QUALITY ASSURANCE – For services rendered herein, CONTRACTOR shall
assure that an on-going quality assurance component is in place and is occurring. CONTRACTOR shall
assure that records for each participant are of such detail and length that a review of said record will
verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates that
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appropriate services were not provided, COUNTY reserves the right to withhold payment for the
applicable unit(s) of service.
F. PUBLIC INFORMATION – CONTRACTOR shall disclose its funding source in all
public information; however, this requirement of disclosure of funding source shall not be required in
spot radio or television advertising.
G. LOBBYING ACTIVITY – CONTRACTOR shall not directly or indirectly use any of
the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
support or defeat legislation pending before the Congress of the United States or the Legislature of the
State of California.
H. POLITICAL ACTIVITY – CONTRACTOR shall not directly or indirectly use any of
the funds under this Agreement for any political activity or to further the election or defeat of any
candidate for public office.
I. It is understood that all expenses incidental to CONTRACTOR’S performance of
services under this Agreement shall be borne by CONTRACTOR. Payments by COUNTY shall be in
arrears, for services provided during the preceding month, within forty-five (45) days after receipt and
verification of CONTRACTOR’S monthly itemized invoices by COUNTY’s DBH. If CONTRACTOR fails
to comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
J. CONTRACTOR shall disclose all sources of revenue to COUNTY. Under no
circumstances will COUNTY funded staff time be used for fund-raising purposes.
6. INVOICING
A. CONTRACTOR shall invoice COUNTY by the twentieth (20th) of each month for
actual services rendered in the previous month in accordance with this Agreement. Invoices shall be
submitted via e-mail to the assigned staff analyst and to SAS@fresnocountyca.gov. CONTRACTOR
shall submit to COUNTY a monthly roster of residents, units occupied and other documentation and
reports as requested by COUNTY to support the invoiced expenditures. Reports and other
documentation required in this Agreement will be in a form and in such detail as acceptable to the
COUNTY’s DBH. No reimbursement for services shall be made until the invoice is received, reviewed,
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and approved by the COUNTY’s DBH.
B. If an invoice is incorrect or is otherwise not in proper form or substance,
COUNTY's DBH Director or her designee shall have the right to withhold payment as to only that
portion of the invoice that is incorrect or improper after five (5) days prior notice to CONTRACTOR.
CONTRACTOR agrees to continue to provide services for a period of ninety (90) days after notification
of an incorrect or improper invoice. If after said ninety (90) day period said invoice(s) is still not
corrected to COUNTY'S DBH Director's or her designee's satisfaction, COUNTY'S DBH, Director or her
designee may elect to terminate this Agreement, pursuant to the termination provisions stated in
Section Three (3), TERMINATION of this Agreement. In addition, CONTRACTOR shall submit all
invoices to COUNTY's DBH Director or her designee for services provided within ninety (90) days after
each twelve (12) month period expires or this Agreement is terminated. If invoices are not submitted
within ninety (90) days after each twelve (12) month period expires or this Agreement is terminated,
COUNTY's DBH Director or her designee shall have the right to deny payment on such invoices.
C. In addition to billing, CONTRACTOR shall submit on a monthly basis, an
Operational Expense Review, along with a general ledger, payroll register and supporting
documentation for any line items CONTRACTOR’s assigned Analyst selects, per modality, by the
twenty-fifth (25th) of each month. For the purposes of verifying costs are allowable and equitable,
CONTRACTOR shall submit any additional documentation as deemed necessary by DBH.
7. PROHIBITION ON PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing
of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
above, publicity of the services described in Section One (1), SERVICES, of this Agreement shall be
allowed as necessary to raise public awareness about the availability of such specific services when
approved in advance by the DBH Director or her designee, and at a cost to be provided for such items
as written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
expense(s).
8. NO THIRD-PARTY BENEFICIARIES
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It is understood and agreed by and between the parties that the services provided by
CONTRACTOR for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
Agreement is intended to confer on any person other than the parties hereto any right under or by
reason of this Agreement.
9. INDEPENDENT CONTRACTOR
In performance of the work, duties and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no
right to control or supervise or direct the manner or method by which CONTRACTOR shall perform its
work and function. However, COUNTY shall retain the right to administer this Agreement so as to verify
that CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
thereof.
Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees all
legally required employee benefits. In addition, CONTRACTOR shall be solely responsible and save
COUNTY harmless from all matters relating to payment of CONTRACTOR'S employees, including
compliance with Social Security withholding and all other regulations governing such matters. It is
acknowledged that during the term of this Agreement, CONTRACTOR may be providing services to
others unrelated to the COUNTY or to this Agreement.
10. NON-ASSIGNMENT / SUBCONTRACTS
Neither party shall assign, transfer or sub contract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
CONTRACTOR shall be required to assume full responsibility for all services and
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activities covered by this Agreement, whether or not CONTRACTOR is providing services directly.
Further, CONTRACTOR shall be the sole point of contact with regard to contractual matters, including
payment of any and all charges resulting from this Agreement.
If CONTRACTOR(S) should propose to subcontract with one or more third parties to
carry out a portion of services covered by this Agreement, any such subcontract shall be in writing and
approved as to form and content by COUNTY’s DBH Director, or her designee, prior to execution and
implementation. COUNTY’s DBH Director, or her designee, shall have the right to reject any such
proposed subcontract. Any such subcontract together with all activities by or caused by
CONTRACTOR(S) shall not require compensation greater than the total budget contained herein. An
executed copy of any such subcontract shall be received by COUNTY before any implementation and
shall be retained by COUNTY. CONTRACTOR(S) shall be responsible to COUNTY for the proper
performance of any subcontract. Any subcontractor shall be subject to the same terms and conditions
that CONTRACTOR(S) is subject to under this Agreement.
11. CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility
for planning and carrying out the services provided under this Agreement shall have any direct or
indirect personal financial interest in this Agreement. CONTRACTOR shall comply with all Federal,
State of California, and local conflict of interest laws, statutes, and regulations, which shall be
applicable to all parties and beneficiaries under this Agreement and any officer, agent, or employee of
COUNTY.
12. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes
its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
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Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
and signing a “Self-Dealing Transaction Disclosure Form”, attached hereto as Exhibit D and
incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the self-
dealing transaction or immediately thereafter.
13. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; that it
has not been convicted of a criminal offense related to the provision of health care items or services;
nor has it been reinstated to participation in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a
contract, that CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR
from responsibility for, or involvement with, COUNTY’s business operations related to the Federal
Health Care Programs and shall remove such CONTRACTOR from any position in which
CONTRACTOR’s compensation, or the items or services rendered, ordered or prescribed by
CONTRACTOR may be paid in whole or part, directly or indirectly, by Federal Health Care Programs or
otherwise with Federal Funds at least until such time as CONTRACTOR is reinstated into participation
in the Federal Health Care Programs. Further the CONTRACTOR agrees to the Disclosure of Criminal
History and Civil Actions and Certification regarding debarment suspension and other responsibility
matters primary covered transactions; CONTRACTOR must sign an appropriate Certification regarding
debarment, suspension, and other responsibility matters, attached hereto as Exhibit E, incorporated
herein by reference and made part of this Agreement.
A. If COUNTY has notice that CONTRACTOR has been charged with a criminal
offense related to any Federal Health Care Program or is proposed for exclusion during the term on any
contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or
the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
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subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
they have been convicted of a criminal offense related to the provision of health care items or services;
and or (3) they have been reinstated to participation in the Federal Health Care Programs after a period
of exclusion, suspension, debarment, or ineligibility.
In the event the potential employee or subcontractor informs CONTRACTOR that he or
she is excluded, suspended, debarred or otherwise ineligible, or has been convicted of a criminal
offense relating to the provision of health care services, and CONTRACTOR hires or engages such
potential employee or subcontractor, CONTRACTOR will ensure that said employee or subcontractor
does no work, either directly or indirectly relating to services provided to COUNTY.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement, (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have not
been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility. In the event that any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision
of health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1) CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case,
is providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense
relating to the provision of health care services.
2) Notwithstanding the above, COUNTY at its discretion may terminate this
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Agreement in accordance with the Section Three (3) TERMINATION of this Agreement or require
adequate assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible
employee or subcontractor of CONTRACTOR will perform work, either directly or indirectly, relating to
services provided to COUNTY. Such demand for adequate assurance shall be effective upon a time
frame to be determined by COUNTY to protect the interests of COUNTY beneficiaries.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating
to this Agreement.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of the
terms of this Agreement.
14. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the parties without, in any way, affecting the remainder.
Changes to the rates of service identified in Paragraph Three (3) – COMPENSATION –
may be made with written approval of COUNTY’s DBH Director, or designee. Said rate changes shall not
result in any change to the maximum compensation amount payable to CONTRACTOR, as stated herein.
Notwithstanding the above, changes to services, staffing, and responsibilities of
CONTRACTOR, as needed, to accommodate changes in the laws relating to permanent supportive
housing services may be made with the signed written approval of COUNTY’s DBH Director or designee
and CONTRACTOR through an amendment approved by COUNTY’s County Counsel and the COUNTY’s
Auditor-Controller’s Office.
In addition, this Agreement may be unilaterally amended by COUNTY upon thirty (30) days
written notice to CONTRACTOR. If CONTRACTOR does not give written notice of termination within thirty
(30) days, CONTRACTOR agrees that any such amendment by COUNTY shall be a part of this
Agreement.
In the event any part of this Agreement is found to be unlawful or legislation modifies the
entitlement of individuals being served, this Agreement shall automatically and without prior notice be
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modified to reflect that which is lawful and all other provisions shall remain in full force and effect.
In addition, minor changes as determined by COUNTY’s DBH Director or her designee
may be made with written approval of COUNTY’s DBH Director or her designee and CONTRACTOR(S).
Minor changes may include, but are not limited to, changes that will not significantly alter the services
provided pursuant to this Agreement or changes in addresses to which notices are to be sent. Changes to
line items in the budgets, attached hereto as Exhibit F, “Budgets,” as appropriate, that do not exceed ten
percent (10%) of the PROVIDER’s program total maximum compensation payable to PROVIDER, may be
made with the written approval of COUNTY’s DBH Director, or her designee, and PROVIDER. Changes to
the line items in the budget that exceed ten percent (10%) of the maximum compensation payable to the
PROVIDER may be made with the signed written approval of COUNTY’s DBH Director, or her designee,
through an amendment approved by County Counsel and Auditor. Any changes to the services shall not
result in any change to the maximum compensation.
15. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the
following insurance policies or a program of self-insurance, including but not limited to, an insurance
pooling arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00).
This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
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C. Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D. Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the California
Labor Code.
E. Molestation
Sexual abuse / molestation liability insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy
shall be issued on a per occurrence basis.
H. Cyber Liability
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to duties and obligations
undertaken by CONTRACTOR(S) in this agreement and shall include, but not be limited to, claims
involving infringement of intellectual property, including but not limited to infringement of copyright,
trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
electronic information, release of private information, alteration of electronic information, extortion and
network security. The policy shall provide coverage for breach response costs as well as regulatory fines
and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
insurance provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
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employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of
Behavioral Health, Contracts Division at 3133 N Millbrook Avenue, Fresno, California, 93703, stating that
such insurance coverages have been obtained and are in full force; that the County of Fresno, its officers,
agents and employees will not be responsible for any premiums on the policies; that for such worker’s
compensation insurance the CONTRACTOR has waived its right to recover from the COUNTY, its officers,
agents, and employees any amounts paid under the insurance policy and that waiver does not invalidate
the insurance policy; that such Commercial General Liability insurance names the County of Fresno, its
officers, agents and employees, individually and collectively, as additional insured, but only insofar as the
operations under this Agreement are concerned; that such coverage for additional insured shall apply as
primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents
and employees, shall be excess only and not contributing with insurance provided under CONTRACTOR's
policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30)
days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of
California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
rating of A FSC VII or better.
16. HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request,
defend the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
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attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
employees under this Agreement, and from any and all costs and expenses (including attorney’s fees and
costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation
who may be injured or damaged by the performance, or failure to perform, of CONTRACTOR, its
officers, agents, or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit
exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
17. SINGLE AUDIT
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual
audit in accordance with the requirements of the Single Audit Standards as set forth in 2 Code of
Federal Regulations (CFR) Part 200. CONTRACTOR shall submit said audit and management letter to
COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
there were negative findings, CONTRACTOR must include a corrective action plan signed by an
authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s Department of
Behavioral Health, Business Office for review within nine (9) months of the end of any fiscal year in
which funds were expended and/or received for the program. Failure to perform the requisite audit
functions as required by this Agreement may result in COUNTY performing the necessary audit tasks,
or at COUNTY’s option, contracting with a public accountant to perform said audit, or, may result in the
inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs related to this
Agreement are the sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do
not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s
only funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must
be performed and a program audit report with management letter shall be submitted by CONTRACTOR
to COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall
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be delivered to COUNTY’s Department of Behavioral Health, Business Office for review, no later than
nine (9) months after the close of the fiscal year in which the funds supplied through this Agreement are
expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks
or contracting with a qualified accountant to perform said audit. All audit costs related to this
Agreement are the sole responsibility of CONTRACTOR who agrees to take corrective action to
eliminate any material noncompliance or weakness found as a result of such audit. Audit work
performed by COUNTY under this section shall be billed to the CONTRACTOR at COUNTY’s cost, as
determined by COUNTY’s Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
minimum of ten (10) years, in accordance with 42 CFR Part 438.3(h), from the finalized cost settlement
process or, if an audit by the Federal government or DHCS has been started before the expiration of
the ten (10) year period, records shall be maintained until completion of the audit and final resolution of
all findings.
18. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by
the COUNTY, permit the COUNTY to audit and inspect all of electronic or print books and records as
well as inspection of the premises, physical facilities and equipment where Medicaid-related activities
are conducted to ensure CONTRACTOR'S compliance with the terms of this Agreement.
The refusal of CONTRACTOR to permit access to, and inspection of, electronic or print
books and records, physical facilities, and/or refusal to permit interviews with employees, as described
in this part, constitutes an express and immediate material breach of this Agreement and will be
sufficient basis to terminate the Agreement for cause or default.
The right to audit under this section exists for ten (10) years from the final date of the
agreement period or from the date of completion of any audit, whichever is later.
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Notwithstanding the provisions stated in Section Two (2), TERM, of this
Agreement, it is acknowledged by the parties hereto that this Agreement shall continue in full force and
effect until all audit procedures and requirements as stated in this Agreement have been completed to
the review and satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or
resulting from any audit and/or inspections including, but not limited to, actual costs incurred and the
payment of any expenditures disallowed by either COUNTY, State, or Federal governmental entities,
including any assessed interest and penalties.
If CONTRACTOR, through an audit by the STATE or COUNTY, is found to be in
violation of this contract which results in the recoupment of funds paid to CONTRACTOR, COUNTY
may, upon mutual consent between CONTRACTOR and COUNTY, enter into a repayment agreement
with the CONTRACTOR, with total monthly payments not to exceed twelve (12) months from the date
of the repayment agreement, to recover the amount of funds to be recouped. The monthly repayment
amounts shall be netted against the CONTRACTOR’s monthly billing for services rendered during the
month. COUNTY reserves the right to forgo a repayment agreement and recoup all funds immediately.
19. EVALUATION – MONITORING
CONTRACTOR shall participate in a review of the program at least yearly or more
frequently, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
information requested by the COUNTY, DHCS, and/or the subcontractor during the program evaluation,
monitoring, and/or review.
COUNTY’s DBH Director, or her designee, and DHCS or their designees shall monitor
and evaluate the performance of CONTRACTOR under this Agreement to determine to the best
possible degree the success or failure of the services provided under this Agreement. At the discretion
of the COUNTY, a subcontractor may be obtained by the COUNTY to independently evaluate and
monitor the performance of the CONTRACTOR. CONTRACTOR shall participate in the evaluation of
the program as needed, at the discretion of COUNTY.
COUNTY shall recapture from CONTRACTOR the value of any services or other
expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
discretion of the COUNTY, CONTRACTOR shall enter into a repayment agreement with the COUNTY,
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with total monthly payments not to exceed twelve (12) months from the date of the repayment
agreement, to recover the amount of funds to be recouped. The monthly repayment amounts shall be
netted against the CONTRACTOR’s monthly billing for services rendered during the month. COUNTY
reserves the right to forgo a repayment agreement and recoup all funds immediately.
20. REPORTS
A. CONTRACTOR(S) shall submit to COUNTY within twenty (20) calendar days all
program reports for the preceding month to DBH. CONTRACTOR shall also furnish to COUNTY such
statements, records, reports, data, and other information as COUNTY may request pertaining to
matters covered by this Agreement. In the event that CONTRACTOR fails to provide such reports or
other information required hereunder, it shall be deemed sufficient cause for COUNTY to withhold
monthly payments until there is compliance.
B. CONTRACTOR agrees to provide COUNTY with any reports which may be
required by State and/or Federal agencies for compliance with said Agreement.
C. COUNTY requires the submission of monthly reports detailing the work
accomplished during the reporting period, and problems, existing or anticipated, which should be
brought to COUNTY’s attention. At the end of each twelve (12) month period of this Agreement,
COUNTY may request CONTRACTOR to participate in a written evaluation of its performance relative
to this Agreement, in order for COUNTY to evaluate CONTRACTOR’S performance under this
Agreement.
D. In the event that CONTRACTOR fails to provide reports specified in this
Agreement, it shall be deemed sufficient cause for COUNTY to withhold payments until there is
compliance.
E. Americans with Disabilities (ADA) – Annually, upon request by DBH,
CONTRACTOR(S) shall complete a system-wide accessibility survey in a format determined by DBH
for each service location and modality and shall submit an ADA Accessibility Certification and Self-
Assessment, including an Implementation Plan, for each service location; and
F. Culturally and Linguistically Appropriate Services (CLAS) - Annually, upon
request by DBH, CONTRACTOR(S) shall complete an agency CLAS survey in a format determined by
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DBH and shall submit a CLAS Self-Assessment, including an Implementation Plan; and
G. Risk Assessment – Annually, upon request by DBH, CONTRACTOR shall submit
a Risk Assessment on a form and in a format to be provided by DBH. The Assessment must be
submitted to the COUNTY in hard copy as well as electronically by the due date set by COUNTY; and
H. Outcome Reports – CONTRACTOR shall submit outcomes reports as requested.
Outcomes reports and requirements are subject to change at COUNTY’s discretion; and
I. Cost Reports – On an annual basis for each fiscal year ending June 30th
CONTRACTOR(S) shall submit a complete and accurate detailed cost report(s). Cost reports must be
submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the due
date. Submittal must also include any requested support documents such as general ledgers and
detailed electronic (e.g. Excel) schedules demonstrating how costs were allocated both within
programs, if provider has multiple funding sources (e.g. DMC and SAPT), and between programs, if
CONTRACTOR provides multiple SUD modalities (e.g. residential, detox, sober living, outpatient, etc.).
Provider shall maintain general ledgers that reflect the original transaction amounts where each entry in
their accounting records represents one-hundred percent (100%) of the total transaction cost and can
be supported with the original source documentation (i.e. receipts, bills, invoices, payroll registers, etc.).
Bank statements reflecting purchases are not original source documents and will not be accepted as
such. All costs found to not be supported by original source documentation will be disallowed. Total
unallowable costs shall be allocated their percentage share of the indirect Costs along with the
Contractor’s direct costs. All reports submitted by CONTRACTOR(S) to COUNTY must be typewritten.
COUNTY will issue instructions for completion and submittal of the annual cost report, including the
relevant cost report template(s) and due dates within forty-five (45) days of each fiscal year end. All
cost reports must be prepared in accordance with Generally Accepted Accounting Principles.
Unallowable costs such as those denoted in 2 CFR 200 Subpart E, Cost Principles, 41 U.S.C. 4304,
and the Center for Medicare and Medicaid Studies (CMS) Provider Reimbursement Manual (PRM) 15-
1, must not be included as an allowable cost on the cost report and all invoices. Unallowable costs
must be kept in the provider’s General Ledger in accounts entitled Unallowable followed by name of the
account (e.g. Unallowable – Food) or in some other appropriate form of segregation in the provider’s
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accounting records. For further information on unallowable costs refer to regulations provided above. If
the CONTRACTOR(S) does not submit the cost report by the due date, including any extension period
granted by the COUNTY, the COUNTY may withhold payment of pending invoices until the cost
report(s) has been submitted and clears COUNTY desk audit for completeness and accuracy. Once the
cost reports have been approved by the County, originally-executed signed certification pages attesting
to the accuracy of the information contained in cost reports shall be submitted to the County.
1) CONTRACTOR(S) will be required to submit a cost report on a form
approved and provided by the COUNTY to reflect actual costs and reimbursement for services provided
through funding sources other than DMC. Contracts that include a negotiated rate per unit of service
will be reimbursed for actual costs incurred (the sum of both direct costs as defined in 2 CFR 200.413,
and allocated indirect costs as defined in 2 CFR 200.414) not to exceed the contract maximum. If the
cost report indicates an amount due to COUNTY, CONTRACTOR(S) shall submit payment with the
report. If an amount is due to CONTRACTOR(S) COUNTY shall reimburse CONTRACTOR within forty-
five (45) days of receiving and accepting the year-end cost report.
2) MULTIPLE FUNDING SOURCES – CONTRACTOR(S) with multiple
agreements for the same services (e.g. Outpatient, Residential) provided at the same location where at
least one of the Agreements is funded through DMC and the other funding is other federal or county
realignment funding will be required to complete DMC cost reports and COUNTY approved cost
reports. Such Agreements will be settled for actual allowable costs in accordance with Medicaid
reimbursement requirements as specified in Title XIX or Title XXI of the Social Security Act; Title 22,
and the State’s Medicaid Plan. Within forty-five (45) days of the reconciliation by COUNTY,
CONTRACTOR shall make payment to COUNTY or COUNTY shall reimburse CONTRACTOR as
appropriate.
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR(S)
agree to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit
settlement findings. DHCS audit process is approximately eighteen (18) to thirty-six (36) months
following the close of the State fiscal year. COUNTY may choose to appeal DHCS settlement results
and therefore reserves the right to defer payback settlement with CONTRACTOR(S) until resolution of
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the appeal.
CONTRACTOR shall furnish to COUNTY such statements, records, reports, data, and
information as COUNTY may request pertaining to matters covered by this Agreement. All reports
submitted to the COUNTY must be typewritten.
In the event that CONTRACTOR(S) fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments
until there is compliance. In addition, the CONTRACTOR shall provide written notification and
explanation to the COUNTY within fifteen (15) days of any funds received from another source to
conduct the same services covered by this Agreement.
21. PROPERTY OF COUNTY
A. CONTRACTOR shall submit purchase invoices for the purchase of any fixed
assets with their monthly invoices. All purchases over Five Thousand and No/100 Dollars ($5,000.00), and
certain purchases under Five Thousand and No/100 Dollars ($5,000.00) such as fans, calculators,
cameras, VCRs, DVDs and other sensitive items as determined by COUNTY’s DBH Director, or her
designee, made during the life of this Agreement shall be identified as fixed assets that can be
inventoried and maintained in COUNTY’s DBH Asset Inventory System. These assets shall be retained
by COUNTY, as COUNTY property, in the event this Agreement is terminated or upon expiration of this
Agreement. CONTRACTOR agrees to participate in an annual inventory of all COUNTY fixed assets and
shall be physically present when fixed assets are returned to COUNTY’s possession at the termination or
expiration of this Agreement. CONTRACTOR is responsible for returning to COUNTY all COUNTY
owned fixed assets, or the monetary value of said fixed assets if unable to produce the fixed assets at the
expiration or termination of this Agreement.
B. The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH Director or her designee, shall
fulfill the provisions of this Agreement as appropriate, and must be directly related to CONTRACTOR’s
services or activity under the terms of this Agreement. COUNTY’s DBH Director or her designee may
refuse reimbursement for any costs resulting from equipment purchased, which are incurred by
CONTRACTOR, if prior written approval has not been obtained from COUNTY.
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C. The terms and conditions described in this Section are not applicable to the
leasing of vehicles by CONTRACTOR with the funds provided under this Agreement.
22. RECORDS
A. RECORD ESTABLISHMENT AND MAINTENANCE – CONTRACTOR shall
establish and maintain records in accordance with State and Federal rules and regulations in addition
to those requirements prescribed by COUNTY with respect to all matters covered by this Agreement.
Except as otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period
of ten (10) years from the finalized cost settlement process, or from the date of completion of any audit,
whichever is later.
B. DOCUMENTATION – CONTRACTOR shall maintain a complete daily census of
all clients served, data collection and all statistical information required by COUNTY’s DBH Director or
her designee and the California Department of Health Care Services (DHCS). CONTRACTOR shall
maintain adequate records in sufficient detail to make possible an evaluation of services, and contain
all the data necessary in reporting to the State of California and/or Federal agency. All client records
shall be maintained pursuant to applicable State of California and Federal requirements concerning
confidentiality.
C. REPORTS – CONTRACTOR shall submit to COUNTY monthly fiscal and all
program reports as further described in Section Twenty (20) REPORTS. CONTRACTOR shall submit
a complete and accurate year-end cost report for each fiscal year affected by this Agreement, following
the end of each fiscal year affected by this Agreement. CONTRACTOR shall also furnish to COUNTY
such statements, records, reports, data, and information as COUNTY may request pertaining to matters
covered by this Agreement. All reports submitted by CONTRACTOR to COUNTY must be typewritten.
D. SUSPENSION OF COMPENSATION – In the event that CONTRACTOR fails to
provide reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance.
E. CLIENT CONFIDENTIALITY – CONTRACTOR shall conform to and COUNTY
shall monitor compliance with all State and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements of 42 CFR § 2.1 et seq., Welfare
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and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety Code §§ 11977 and 11812, Civil
Code, Division 1, Part 2.6, and CCR Title 22 § 51009.
23. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal beneficiary information;
abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies
that enter into a contractual relationship with the COUNTY for the purpose of providing services under
this Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-OWNED MOBILE, WIRELESS, OR HANDHELD DEVICES
CONTRACTOR may not connect to COUNTY networks via personally-owned mobile,
wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-OWNED COMPUTERS OR COMPUTER PERIPHERALS
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to
be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
means of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data
must be encrypted.
C. COUNTY-OWNED COMPUTER EQUIPMENT
CONTRACTOR or anyone having an employment relationship with the COUNTY
may not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
authorization from the COUNTY’s Chief Information Officer, and/or designee(s).
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D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential beneficiary information transmitted to one party by the other by
means of electronic transmissions must be encrypted according to Advanced Encryption Standards
(AES) of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data
maintained in computer files, program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential beneficiary information
provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR will be responsible for all costs incurred as a result of providing the required
notification.
24. COMPLIANCE WITH LAWS, POLICIES, AND RULES
CONTRACTOR shall comply with all applicable rules and regulations set forth in CCR
Titles 9 and 22, and California Health and Safety Code § 11750 et seq. CONTRACTOR shall comply
with any other Federal and State laws or guidelines applicable to CONTRACTOR’s performance under
this Agreement or any local ordinances, regulations, or policies applicable. Such provisions include,
but are not restricted to:
A. CONTRACTOR shall ensure that each beneficiary’s ability to pay for services is
determined by the use of the method approved by COUNTY.
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B. CONTRACTOR shall establish and use COUNTY’s approved method of
determining and collecting fees from beneficiaries.
C. CONTRACTOR shall furnish beneficiary records in accordance with the
applicable Federal, State and local regulations and requirements, including in such records a treatment
plan for each beneficiary, and evidence of each service rendered.
D. CONTRACTOR shall submit accurate, complete and timely claims and cost
reports, reporting only allowable costs.
E. CONTRACTOR shall comply with statistical reporting and program evaluation
systems as provided in State of California regulations and in this Agreement.
F. CONTRACTOR shall inform every beneficiary of their rights regarding Grievance
and Appeals as described in the Provider Manual, attached hereto and by this reference incorporated.
G. CONTRACTOR shall file an incident report for all incidents involving
beneficiaries, following the Protocol for Completion of Incident Report described in the Provider Manual,
attached hereto and by this reference incorporated.
H. In the event any law, regulation, or policy referred to in this Agreement is
amended during the term thereof, the parties hereto agree to comply with the amended provision as of
the effective date of such amendment. Exhibits will be updated as needed and no formal amendment of
this contract is required for new rules to apply.
25. NON-DISCRIMINATION PROVISION
ELIGIBILITY FOR SERVICES – CONTRACTOR shall prepare, prominently post in its
facility, and make available to the DBH Director or her designee and to the public all eligibility
requirements to participate in the program funded under this Agreement. CONTRACTOR shall not
unlawfully discriminate in the provision of services because of race, religious creed, color, national
origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military or veteran
status as provided by State of California and Federal law in accordance with Title VI of the Civil Rights
Act of 1964 (42 USC § 2000(d)); Age Discrimination Act of 1975 (42 USC § 1681); Rehabilitation Act of
1973 (29 USC § 794); Education Amendments of 1972 (20 USC § 1681); Americans with Disabilities
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Act of 1990 (42 USC § 12132); 45 CFR, Part 84; provisions of the Fair Employment and Housing Act
(California Government Code § 12900); and regulations promulgated thereunder (CCR Title 2, §
7285.0); Title 2, Division 3, Article 9.5 of the California Government Code commencing with section
11135; and CCR Title 9, Division 4, Chapter 6 commencing with section 10800.
A. EQUAL OPPORTUNITY – CONTRACTOR shall comply with California
Government Code, § 2990 and CCR Title 2, Division 4, Chapter 5, in matters related to the
development, implementation, and maintenance of a nondiscrimination program. CONTRACTOR shall
not discriminate against any employee or applicant for employment because race, religious creed,
color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or
military or veteran status. Such practices include retirement, recruitment, advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of compensation, use of
facilities, and other terms and conditions of employment. CONTRACTOR agrees to post in
conspicuous places, notices available to all employees and applicants for employment setting forth the
provisions of the Equal Opportunity Act (42 USC § 2000(e)) in conformance with Federal Executive
Order No. 11246. CONTRACTOR agrees to comply with the provisions of the Rehabilitation Act of
1973 (29 USC § 794).
B. SUSPENSION OF COMPENSATION – If an allegation of discrimination occurs,
DBH may withhold all further funds, until CONTRACTOR can show by clear and convincing evidence to
the satisfaction of DBH that funds provided under this Agreement were not used in connection with the
alleged discrimination.
C. NEPOTISM – Except by consent of the DBH Director or her designee, no person
shall be employed by CONTRACTOR who is related by blood or marriage to or who is a member of the
Board of Directors or an officer of CONTRACTOR.
D. NEW FACILITIES AND DISABILITY ACCESS – New facilities shall be
wheelchair accessible and provide access to the disabled, consistent with CCR Title 9, § 10820. If a
new facility will be utilized, a plan ensuring accessibility to the disabled must be developed. DBH shall
assess, monitor, and document CONTRACTOR’s compliance with the Rehabilitation Act of 1973 and
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Americans with Disabilities Act of 1990 to ensure that recipients/beneficiaries and intended
recipients/beneficiaries of services are provided services without regard to physical or mental disability
and that CONTRACTOR has provided a facility accessible to the physically disabled.
26. COMPLIANCE
CONTRACTOR(S) shall comply with all requirements of the “Fresno County Behavioral
Health Compliance Program Contractor Code of Conduct and Ethics” as set forth in Exhibit G. Within
thirty (30) days of entering into this Agreement with the COUNTY, CONTRACTOR(S) shall have all of
CONTRACTOR(S) employees, agents and subcontractors providing services under this Agreement
certify in writing, that they have received, read, understood, and shall abide by the requirements set
forth in Exhibit G. CONTRACTOR(S) shall ensure that within thirty (30) days of hire, all new employees,
agents and subcontractors providing services under this Agreement certify in writing that they have
received, read, understood, and shall abide by the requirements set forth in Exhibit G.
CONTRACTOR(S) understands that the promotion of and adherence to such requirements is an
element in evaluating the performance of CONTRACTOR(S) and its employees, agents and
subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
certification shall specify the type of training received and the date received. The certification shall be
provided to the COUNTY’s Compliance Officer at 1925 E Dakota Ave Fresno, CA 93726.
CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result of CONTRACTOR(S) violation of the terms of this
Agreement.
27. COMPLIANTS
CONTRACTOR shall log complaints and the disposition of all complaints from a
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beneficiary or a beneficiary's family. CONTRACTOR shall provide a summary of the complaint log
entries concerning COUNTY-sponsored beneficiaries to COUNTY at monthly intervals by the fifteenth
(15th) day of the following month, in a format that is mutually agreed upon. CONTRACTOR shall post
signs informing beneficiary of their right to file a complaint or grievance. CONTRACTOR shall notify
COUNTY of all incidents reportable to state licensing bodies that affect COUNTY beneficiaries within
twenty-four (24) hours of receipt of a complaint.
Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
beneficiaries, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or corrective
action taken to resolve the complaint.
28. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d, and
45 CFR Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal
access and participation in federally funded programs through the provision of comprehensive and
quality bilingual services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP beneficiaries, including, but not limited to,
assessing the cultural and linguistic needs of its beneficiaries, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR’s procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR assurances that minors shall not be used as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
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and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
CONTRACTOR’s “vital documents” (those documents that contain information that is critical for
accessing CONTRACTOR’s services or are required by law) shall be provided to participants at no cost
to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or
partners who interpret or translate for a program participant, or who directly communicate with a
program participant in a language other than English, demonstrate proficiency in the participant's
language and can effectively communicate any specialized terms and concepts peculiar to
CONTRACTOR’s services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR’s plan to
address all fifteen national cultural competency standards as set forth in the “National Standards on
Culturally and Linguistically Appropriate Services” (CLAS), attached hereto as Exhibit H, and
incorporated herein by this reference. County’s annual on-site review of CONTRACTOR shall include
collection of documentation to ensure all national standards are implemented. As the national
competency standards are updated, CONTRACTOR’s plan must be updated accordingly.
F. CONTRACTOR shall complete and submit county-issued CLAS self-assessment
annually. CONTRACTOR shall update CLAS plan as necessary.
29. CLEAN AIR AND WATER
In the event funding under this Agreement exceeds One Hundred Thousand Dollars
($100,000.00), the CONTRACTOR must comply with all applicable standards, orders, or requirements
issued under section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), section 506 of the Clean Water Act
(33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR
part 32).
30. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
104-191(HIPAA) and agree to use and disclose protected health information as required by law.
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COUNTY and CONTRACTOR acknowledge that the exchange of protected health
information between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security
of Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code
of Federal Regulations (CFR).
31. CHILD ABUSE REPORTING
CONTRACTOR shall utilize a procedure acceptable to the COUNTY to ensure that all of
CONTRACTOR’s employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement shall report all known or suspected child abuse or neglect to one or more of the
agencies set forth in Penal Code § 11165.9. This procedure shall include having all of
CONTRACTOR’s employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement sign a statement that he or she knows of and will comply with the reporting
requirements set forth in Penal Code § 11166. The statement to be utilized by CONTRACTOR for
reporting is set forth in Exhibit I, “Notice of Child Abuse Reporting,” attached hereto and by this
reference incorporated herein.
32. RESTRICTION ON DISTRIBUTION OF STERILE NEEDLES
CONTRACTOR shall adhere to the requirement that no funds shall be used to carry out
any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug
unless the DHCS chooses to implement a demonstration syringe services program for intravenous drug
users.
33. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
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managed care entity as defined in 42 CFR § 455.101, 455.104, and 455.106(a)(1), (2).
In accordance with 42 CFR §§ 455.101, 455.104, 455.105 and 455.106(a)(1), (2), the
following information must be disclosed by CONTRACTOR by completing Exhibit J “Disclosure of
Ownership and Control Interest Statement,” attached hereto and by this reference incorporated herein.
CONTRACTOR shall submit this form to the Department of Behavioral Health within thirty (30) days of
the effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via
email to DBHAdministration@fresnocountyca.gov attention: Contracts Administration.
A. Name and address of any person(s) whether it be an individual or corporation
with an ownership or controlling interest in the disclosing entity or managed care entity.
1) Address must include the primary business address, every business
location and P.O. Box address(es).
2) Date of birth and Social Security Number for individuals.
3) Tax identification number for other corporations or entities with ownership
or controlling interest in the disclosing entity.
B. Any subcontractor(s) in which the disclosing entity has five (5) percent or more
interest.
C. Whether the person(s) with an ownership or controlling interest of the disclosing
entity is related to another person having ownership or controlling interest as a parent, spouse, sibling
or child. Including whether the person(s) with ownership or controlling interest of the disclosing entity is
related to a person (parent, spouse, sibling or child) with ownership or has five (5) percent or more
interest in any of its subcontractors.
D. Name of any other disclosing entity in which an owner of the disclosing entity has
an ownership or control interest.
E. The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
period ending on the date of the request; and
F. Any significant business transactions between CONTRACTOR and any wholly
owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
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ending on the date of the request.
G. Any person(s) with an ownership or control interest in CONTRACTOR, or agent
or managing employee of CONTRACTOR; and has been convicted of a criminal offense related to that
person's involvement in any program under Medicare, Medicaid, or the title XX services program since
the inception of those programs.
H. The ownership of any subcontractor with whom CONTRACTOR has had
business transactions totaling more than twenty-five thousand dollars ($25,000) during the 12-month
period ending on the date of the request; and
I. Any significant business transactions between CONTRACTOR and any wholly
owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period
ending on the date of the request.
34. CHANGE OF LEADERSHIP / MANAGEMENT
Any and all notices between COUNTY and CONTRACTOR(S) provided for or permitted
under this Agreement or by law, shall be in writing and shall be deemed duly served when personally
delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
In the event of any change in the status of CONTRACTOR’s leadership or management,
CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of change.
Such notification shall include any new leader or manager’s name, address and qualifications.
“Leadership or management” shall include any employee, member, or owner of CONTRACTOR who
either a) directs individuals providing services pursuant to this Agreement; b) exercises control over the
manner in which services are provided; or c) has authority over CONTRACTOR’s finances.
35. NOTICES
A. The persons and their addresses having authority to give and receive notices
under this Agreement include the following:
COUNTY CONTRACTOR
Director, Fresno County Chief Executive Officer
Department of Behavioral Health Turning Point of Central California, Inc.
1925 E Dakota Ave PO Box 7447
Fresno, CA 93726 Visalia, CA 93290
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All notices between the COUNTY and CONTRACTOR provided for or permitted under
this Agreement must be in writing and delivered either by personal service, by first-class United States
mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A notice
delivered by personal service is effective upon service to the recipient. A notice delivered by first-class
United States mail is effective three COUNTY business days after deposit in the United States mail,
postage prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier
service is effective one COUNTY business day after deposit with the overnight commercial courier
service, delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the
recipient. A notice delivered by telephonic facsimile is effective when transmission to the recipient is
completed (but, if such transmission is completed outside of COUNTY business hours, then such
delivery shall be deemed to be effective at the next beginning of a COUNTY business day), provided
that the sender maintains a machine record of the completed transmission. For all claims arising out of
or related to this Agreement, nothing in this section establishes, waives, or modifies any claims
presentation requirements or procedures provided by law, including but not limited to the Government
Claims Act (Division 3.6 of Title 1 of the Government Code, beginning with section 810).
36. SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among CONTRACTOR(S). By execution of this Agreement, CONTRACTOR(S)
understands that a separate Agreement is formed between each individual CONTRACTOR and
COUNTY.
37. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
38. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any
one provision in the Agreement shall not affect the other provisions.
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39. ENTIRE AGREEMENT
This Agreement, including all Exhibits, COUNTY’s RFP #20-011 and CONTRACTOR’s
responses thereto, constitutes the entire agreement between the CONTRACTOR and COUNTY with
respect to the subject matter hereof and supersedes all previous Agreement negotiations, proposals,
commitments, writings, advertisements, publications, and understanding of any nature whatsoever
unless expressly included in this Agreement.
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IN WITNESS WHEREOF, the parties hereto have executed th is Agreement as of the day
and year first hereinabove written .
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Raymond R. Banks, Chief Executive O fficer
Print Name & Title
P.O. Box 7447
Visalia CA 93290-7447
Mailing Address
FOR ACCOUNTING USE ONLY:
Fund/Subclass: 0001/10000
ORG No.: 56302081
Account No .:7295
Requisition No.:
COUNTY OF FRESNO
~"ih~ ErnestBudc0Men: Chairman of the
Board of Supervisors of the County of
Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
35
Exhibit A
1
Permanent Supportive Housing
Vendor List
Vendor Service Addresses
Turning Point of Central California, Inc. Family Villa: 1475 E Bulldog Ave Fresno, CA 93710
Falcon Court: 4415 N Clark Ave Fresno, CA 93726
Exhibit B
Page 1 of 5
Scope of Work
Permanent Supportive Housing
Organization(s): Turning Point of Central California, Inc.
Mailing Address(s): P.O. Box 7447 Visalia, CA 93290
Service Addresses: 1475 E Bulldog Ave Fresno, CA 93710 & 4415 N Clark Ave Fresno, CA
93726
Services: Permanent Supportive Housing
Contract Term: January 1, 2020 through June 30, 2024
Contract Amount: See Exhibit B
Permanent Supportive Housing
I. Overview
Permanent supportive housing (PSH) is an intervention that combines affordable housing
assistance with support services to address the needs of chronically homeless people. The
services are designed to build independent living skills while connecting those served with
community-based services tailored to individualized needs. The Department of Behavioral
Health (DBH) provides a portion of the overall costs of the PSH program as match funds for
the Department of Housing and Urban Development (HUD) Continuum of Care (CoC) grants,
to help DBH clients access these services.
II. Background
Family Villa and Falcon Court provides PSH for families and individuals that meet the HUD
definition of homelessness with at least one adult family member having a mental health
and/or substance use disorder (SUD). HUD’s CoC grant supports several PSH or similar
programs in the region. In an effort to support individuals who may be receiving or have
received services from DBH to live as independently as possible, DBH is offering limited
funding for programs who provide housing through HUDs CoC grant.
III. Contract Start Date/Term
See Section “Term” of Agreement
IV. Target Population
Individuals and their families that meet the HUD definition of homelessness and who have a
mental health and/or SUD need. Participants must be engaged in a DBH treatment program
or have been part of a DBH treatment program. All participants will be assessed and/or
referred by Housing Access and Resource Team (HART), a DBH adult service program, to
ensure that eligibility criteria are met. DBH reserves the right to make referrals through other
appropriate DBH adult service programs in the future. DBH may consider additional
Exhibit B
Page 2 of 5
requirements to help limit participation to those DBH clients who most need these services.
DBH cannot guarantee any specific number of referrals.
V. Location of Services
Housing services will be provided primarily in the Fresno Metro area and ideally will be near
public transportation to allow individuals the opportunity to access and continue their
treatment needs. Services provided by Turning Point of Central California, Inc. will be
provided at the following locations: 1475 E Bulldog Ave Fresno, CA 93710 and 4415 N Clark
Ave Fresno, CA 93726.
VI. Description of Services
Turning Point will provide PSH services to individuals receiving, or who have received, mental
health and/or substance use disorder treatment services from DBH and referred by DBH. DBH
retains the first right of refusal for twenty-four (24) housing units provided through this
agreement. The parties understand that there is no guarantee that any or all of the 24 housing
units will be occupied by Fresno County families at any one time and that Turning Point will
only be paid for housing units when they are actually occupied by Fresno County families
referred by the COUNTY DBH pursuant to this Agreement.
Turning Point will provide the following site-based supportive services:
• Case Management
• Housing
• Life Skills Workshops
• Transportation
• Service Linkages
• Advocacy
The following services are examples of specific site-based supportive services that may be
provided to individuals as determined by their individualized needs which fall under the
categories listed directly above:
1. Case management
2. Life skills instruction
3. Crisis Intervention
4. Crisis Management
5. Assistance to clients to access/obtain community-based resources (for example, food,
clothing, physical health care, mental health care, employment, substance use disorder
treatment, legal assistance, emergency transportation, etc.)
6. Medication and symptom monitoring and appointment reminders
Exhibit B
Page 3 of 5
7. Assistance to clients in on-site and off-site social and recreational activities
8. Development of a tenant council amongst residents
9. Make available bus passes to assist individuals with public transportation
10. Assistance to clients in applying for public assistance or other benefits for which they may
be eligible
11. Coordination of any in-kind services offered by other providers or community-based
organizations in an effort to maintain stable housing and sober lifestyles and assist individuals
to become productive, self-sufficient, and independent
12. Coordination and daily reinforcement and help implementing services and goals including:
SUD relapse prevention;
Mental health management;
Development of life, social and parenting skills;
Crisis management;
Education and employment development;
Access of available mainstream community-based resources;
Assistance in achieving family stability such as helping with the parent’s abilities to
promote adequate child health and development;
Help with the development of good credit and rental histories;
Assistance with transportation, child-care, and health services.
Services will be individualized and client driven. The services included above should be made
available to individuals as needed.
To help ensure that individuals receiving services have the opportunity to be transitioned to
independent living situations Turning Point will develop transition plans that allow for
individuals to build the skills needed to leave PSH and enter permanent independent living
situations.
The transition plan should include areas such as job skill development, resume building,
employment searches, and education about publicly available resources such as Section 8
vouchers. Turning Point does not need to provide these services directly, but shall provide
referrals and linkages to community-based programs who have expertise in these areas.
Turning Point will be responsible for ensuring that individuals who participate in this program
have a plan in place should these services end or if those individuals no longer qualify for
participation.
Should Turning Point not be awarded CoC grant funds during the term of the resulting
agreement, DBH will not allocate funds and will discontinue all referrals to those applicants.
Exhibit B
Page 4 of 5
DBH Guiding Principles of Care:
Turning Point will be required to align program services and practices with the vision, mission,
and guiding principles of DBH. The “Guiding Principles of Care” are attached to this Exhibit A,
“Scope of Work.”
DBH branding and communications requirements:
The Department of Behavioral Health (DBH) is in the process of developing standardized
expectations for branding and communication for all Department of Behavioral Health
programs, inclusive of programs operated by agencies contracted to deliver services on behalf
of, and in partnership with, the Department. All decisions regarding DBH funded program
naming, program branding, program marketing, program signage, program website/webpage,
program brochures, program promotional materials and similar communications shall require
advanced approval by the Department. When branding and communication standards are
finalized, the Department will communicate them to all contracted partner agencies. Until that
time, this statement shall serve as notice that the successful respondent shall seek and obtain
the Department’s approval prior to commencing any branding, marketing or media
communication of this contracted DBH program and shall conform to standardized
requirements subsequent to their publication in the near future.
VII. Staffing
Staffing patterns may vary, but will allow for the level of support needed to maintain
individuals with mental health and/or SUD in permanent housing. Staff will be required to have
experience working with the target population. Professional staff with Alcohol and Other Drug
(AOD) accredited organization registration or certification through a recognized California
Department of Health Care Services approved body is preferred, though not required.
VIII. Hours of Operation
Staff should be on-site and available to assist individuals Monday through Sunday. Hours of
service may vary. Family Villa will provide on-site staff M-F 8am-10pm and Saturday/Sunday
from 9am-2pm. Falcon Court will provide on-site staff 24/7 with exceptions to account for staff
breaks.
IX. Average Client Length of Stay/ Term
Permanent Supportive Housing is not time limited.
X. Outcomes
Applicants will report annual outcomes related to the following categories:
• Residential Stability
o Objectives may include:
Percentage of residents who maintain residency
Percentage of residents who achieve independent, unsupported
permanent housing
Exhibit B
Page 5 of 5
Reduction in the number of days out of residence due to hospitalization,
incarceration, or lack of financial or family stability
• Increased Skills and/or Income
o Objectives may include:
Assisting all individuals with accessing public benefit programs which
they may be entitled to within 3 months of entering residency
Percentage of residents voluntarily participating in life skills activities
with goal of promoting self-sufficiency
Percentage of residents participating in SUD and/or mental health
treatment programs as needed
Percentage of residents attaining gainful employment or completing
vocational or general education program
• Achievement of Greater Self-Determination
o Objectives may include:
Percentage of residents who develop service plan that outlines
immediate and long term goals for self-sufficiency. At least one service
plan goal will address parenting and/or child development as applicable.
Percentage of residents who meet individualized plan goals
Percentage of residents who develop new enhancements to promote
sobriety
Percentage of residents who participate in recovery focused network or
tenant council
• Client Satisfaction
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 2017 Dec
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
Exhibit C
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 2017 Dec
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
Exhibit C
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 2017 Dec
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
Exhibit C
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 2017 Dec
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
Exhibit C
Page 4 of 4
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “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 on e
or more of its directors has a material financial interest”
The definition above will be utilized 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.
(5)Form must be signed by the board member that is involved in the self -dealing transaction
described in Sections (3) and (4).
Exhibit D
Page 1 of 2
(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
Signature: Date:
Exhibit D
Page 2 of 2
DISCLOSURE – CRIMINAL HISTORY & CIVIL ACTIONS:
In their proposal, the bidder is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively
referred to as “Bidder”):
Within the three-year period preceding the proposal, they have been convicted of, or
had a civil judgment rendered against them for:
o 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;
o violation of a federal or state antitrust statute;
o embezzlement, theft, forgery, bribery, falsification, or destruction of records; or
o false statements or receipt of stolen property
Within a three-year period preceding their proposal, they have had a public transaction
(federal, state, or local) terminated for cause or default.
Disclosure of the above information will not a utomatically eliminate a Bidder from
consideration. The information will be considered as part of the determination of whether to
award the contract and any additional information or explanation that a Bidder elects to submit
with the disclosed information will be considered. If it is later determined that the Bidder failed
to disclose required information, any contract awarded to such Bidder may be immediately
voided and terminated for material failure to comply with the terms and conditions of the
award.
Any Bidder who is awarded a contract must sign an appropriate Certificat ion Regarding
Debarment, Suspension, and Other Resp onsibility Matters, pages 2 and 3 of this Exhibit ,
Additionally, the Bidder awarded the contract must immediately advise the County in writing if,
during the term of the agreement: (1) Bidder becomes sus pended, debarred, excluded or
ineligible for participation in federal or state funded programs or from receiving federal funds
as listed in the excluded parties list system (http://www/epls/gov); or (2) any of the above
listed conditions become applicable to Bidder. The Bidder will indemnify, defend and hold the
County harmless for any loss or damage resulting from a conviction, debarment, exclusion,
ineligibility or other matter listed in the signed Certification Regar ding Debarment,
Suspension, and Other Responsibility Matters.
Exhibit E
Page 1 of 3
CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED
TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the pros pective 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 o f 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, pr oposal, 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.
Exhibit E
Page 2 of 3
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, th at 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 p ublic 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)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 prospect ive participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit E
Page 3 of 3
Exhibit F
Page 1 of 1
Budget Jan 1, 2020 - June 30, 2020 July 1, 2020 - June 30, 2021 July 1, 2021 - June 30, 2022 July 1, 2022 - June 30, 2023 July 1, 2023 - June 30, 2024
HUD $331,530.00 $663,060.00 $663,060.00 $663,060.00 $663,060.00
CLIENT FEES $25,500.00 $51,000.00 $51,000.00 $51,000.00 $51,000.00
COUNTY CONTRACT $37,595.52 $75,000.00 $75,000.00 $75,000.00 $75,000.00
TOTAL $394,625.52 $789,060.00 $789,060.00 $789,060.00 $789,060.00
Fresno County Daily Rate $8.56 $8.56 $8.56 $8.56 $8.56
HUD Funds a portion of the agreement through a separate grant received by Turning Point.
Client Fees are collected from tenants as part of the requirements of the HUD grant received by Turning Point.
County funds a portion of the rent based on a daily rate indicated above. The rate was calculated based on budgets submitted in RFP 20-011.
Turning Point Permanent Supportive Housing
January 1, 2020 through June 30, 2024
FRESNO COUNTY BEHAVIORAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations, rules
and guidelines that apply to the provision and payment of behavioral health services. Behavioral health
contractors and the manner in which they conduct themselves are a vital part of this commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor, contractor’s employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno County
DBH. After completion of this training, each contractor, contractor's employee and subcontractor must
sign the Behavioral Health Compliance Training Acknowledgment and Agreement form and return this
form to the Compliance officer or designee.
Contractor and its employees and subcontractor shall:
1.Comply with all applicable laws, regulations, rules or guidelines when providing and billing for
behavioral health services.
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, beneficiaries, and other behavioral health contractors 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 claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6.Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement of
any kind are submitted.
7.Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
8.Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9.Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other behavioral health contractors, or report any activity
that they believe may violate the standards of the Compliance Program, or any other applicable
Exhibit G
Page 1 of 3
Revised 09/20/18 Page 1 of 3
law, regulation, rule or guideline. Fresno 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 Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11.Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
12. Immediately contact the DBH Business Office inbox using the
DBHADPBusinessOffice@fresnocountyca.gov and your assigned DBH analyst and report any
overpayment.
Exhibit G
Page 2 of 3
Revised 09/20/18 Page 2 of 3
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
COMPLIANCE PROGRAM
2018 New Hire Behavioral Health Compliance Training
Acknowledgment and Agreement
I hereby acknowledge that I have completed the Mandatory New Hire Behavioral Health Compliance
Training which provided information on Fresno County’s Behavioral Health Compliance Program and that
I understand the contents thereof. I further acknowledge that I have received, read and understand
Fresno County’s Compliance Program policy titled “Prevention, Detection, and Correction of Fraud,
Waste and Abuse”. I agree to abide by the Code of Conduct, and all Compliance Program requirements
as they apply to my responsibilities as a County employee, contractor/subcontractor, volunteer or
student.
I understand and accept my responsibilities under this Acknowledgment and Agreement and understand
that any violation of the Code of Conduct 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 these policies can result in disciplinary action, up to and including termination of my
employment or contractual agreement with the County.
County Employees Only – Complete this Section
Full Name (printed): ________________________________________________
Job Title: _________________________________________________________
Discipline (for licensed staff only): [ ] Psychiatrist [ ] Psychologist [ ] Substance Abuse Specialist
[ ] LCSW [ ] LMFT [ ] NP [ ] RN [ ] LVN [ ] LPT
DBH Department: [ ] Adult MH [ ] Children MH [ ] Finance Division [ ] Managed Care
[ ] Administration [ ] Substance Abuse Services [ ] Other:
___________________
Cost Center#________ Program Name: _________________________________
Supervisor Name: __________________________________________
Employee Signature: _________________________________________Date:___/___/____
Phone: _______________ _
Contractors/Contractor Staff, Volunteers, Students only – Complete this Section
Agency Name (If applicable):______________________________________________
Full Name (Printed):____________________________________________________
Discipline (Indicate below if applicable):
Licensed: [ ] Psychiatrist [ ] Psychologist [ ] LCSW [ ] LMFT [ ] NP [ ] RN [ ] LVN [ ] LPT
[ ] MD
Unlicensed: [ ] Psychologist [ ] ACSW [ ] AMFT [ ] APCC [ ] Certified AOD Counselor
[ ] Registered AOD Counselor Other______________________________________________
Job Title (If different from Discipline): ___________________________________________
Signature: _________________________________________________Date:____/____/____
Phone: ________________________ E-mail:________________________________________
Mail this completed form with your original signature (not a copy) to:
Elizabeth Vasquez, Behavioral Health Compliance Officer Stop #100-Heritage Center
3133 N. Millbrook, Rm. 171, Fresno, CA 93703
2014 Annual Ack Rev: 1/8/14, 12/22/16, 1/8/18, 6/7/18
Exhibit G
Page 3 of 3
Revised 09/20/18 Page 3 of 3
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES
CONTRACTOR shall adhere to and develop written procedures in accordance with the below standards
adapted from the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in
Health Care:
Culturally Competent Care:
1.Organizations must ensure that beneficiaries receive from all staff members effective,
understandable, and respectful care that is provided in a manner compatible with
their cultural health beliefs and practices and prefer red language.
2.Organizations must implement strategies to recruit, retain, and promote at all levels
of the organization a diverse staff and leadership that are representative of the
demographic characteristics of the service area.
3.Organizations must ensure that staff at all levels and across all disciplines receive
ongoing education and training in culturally and linguistically appropriate service
delivery.
Language Access Services:
4.Organizations must offer and provide language assistance services, includi ng bilingual
staff and interpreter services, at no cost to beneficiarie s with limited English
proficiency at all points of contact, in a timely manner during all hours of operation.
5.Organizations must provide to beneficiarie s in their preferred language both verbal
offers and written notices informing them of their right to receive language assistance
services.
6.Organizations must assure the competence of language assistance provided to lim ited
English proficient beneficiarie s by interpreters and bilingual s taff. Family and friends
should not be used to provide interpretation services (excep t on the request of the
beneficiary).
7.Organizations must make available easily understood beneficiary-related materials
and post signage in the languages of the commonly encountered groups and/or
groups represented in the service area.
Organizational Supports:
8.Organizations must develop, implement, and promote a written strategic plan that
outlines clear goals, policies, operational plans, and management
accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
Exhibit H
Page 1 of 2
9.Organizations must conduct initial and ongoing organizational self -assessments of
CLAS related activities and are encouraged to integrate cultural and linguistic
competence-related measures into their internal audits, performance improvement
programs, beneficiary satisfaction Assessments, and Outcomes -Based Evaluations.
10.Organizations must ensure that data on the individual beneficiary ’s race, ethnicity,
and spoken and written language are collected in program records, integrated into the
organizations management information systems, and periodically updated.
11.Organizations must maintain a current demographic, cultural, and epidemiological
profile of the community as well as a nee ds assessment to accurately plan for and
implement services that respond to the cultural and linguistic characteristics of the
service area.
12.Organizations must develop participatory, collaborative partnerships with
communities and utilize a variety of form al and informal mechanisms to facilitate
community and beneficiary involvement in designing and implementing CLAS -related
activities.
13.Organizations must ensure that conflict and grievance resolution processes are
culturally and linguistically sensitive and capable of identifying, preventing, and
resolving cross-cultural conflicts or complaints by beneficiarie s.
14.Organizations must regularly make available to the public information about their
progress and successful innovations in implementing these standard s and to provide
public notice in their communities about the availability of this information.
15.Organizations must ensure communication regarding the organization’s progress in
implementing and sustaining CLAS to all stakeholders, constituents, and general
public.
CONTRACTOR shall develop written procedures in accordance with the above standards. The
provisions of this Agreement are not intended to abrogate any provisions of law or regulation existing
or enacted during the term of this Agreement.
Exhibit H
Page 2 of 2
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents, require that the undersigned report all known or suspected child abuse or
neglect to one or more of the agencies set forth in Penal Code (P.C.) section (§) 11165.9.
For purposes of the undersigned’s child abuse reporting requirements, “child
abuse or neglect” includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in
P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3,
and unlawful corporal punishment or injury as defined in P.C. §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect. (P.C §11166.) The child abuse report shall be made to any
police department or sheriff’s department (not including a school district police or
security department), or to any county welfare department, including Fresno County
Department of Children and Family Services’ 24 Hour CARELINE. (See PC §11165.9.)
For purposes of child abuse reporting, a “reasonable suspicion” means that it is
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child does
not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C.
§11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
__________________________________ ________________________
SIGNATURE DATE
0980fadx
Exhibit I
Page 1 of 1
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address (number, street) City State ZIP Code
CLIA Number Taxpayer ID Number (EIN) / Social Security Number Telephone Number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list all names
and addresses (primary, every business location, and P.O. Box address) of individuals or corporations under “Remarks” on
page 2. Identify each item number to be continued.
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
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
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 XVIII, XIX, or XX? ...................................................................................... ❒ ❒
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, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
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 (primary, every business location, and P.O. Box address) 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 DOB ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒Partnership ❒Corporation
❒Unincorporated Associations ❒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. .......................................................................................................... ❒ ❒
NAME DOB ADDRESS PROVIDER
Exhibit J
Page 1 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
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?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(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
Exhibit J
Page 2 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date. If the yes block for any item is checked, list requested additional information under the
Remarks Section on page 2, referencing the item number to be continued. If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form. Instructions are listed in question order for easy reference. No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION BE
CURRENT.
Item I - Under “Identifying Information” specify in what capacity the entity is doing business as (DBA) (e.g. name of trade or corporation).
Item II - Self-explanatory
Item III - List the names of all individuals and organizations having direct or indirect ownership interests, or controlling interest separately or
in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest - is defined as the possession of stock, equity in capital or any interest in the profits of the disclosing entity. A
disclosing entity is defined as a Medicare provider or supplier, or other entity that furnishes services or arranges for furnishing services under
Medicaid or the Maternal and Child Health program, or health related services under the social services program.
Indirect ownership interest - is defined as ownership interest in an entity that has direct or hospital-based home health agencies, are
not indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any
other entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership interest must
beds in the facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing
entity. Example: if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity, A's
interest equates to an 8 percent indirect ownership and must be reported.
Controlling interest - is defined as the operational direction or management of disclosing entity which may be maintained by any or all of
the following devices: the ability or authority, expressed or reserved, to amend or change the corporate identity (i.e., joint venture
agreement, unincorporated business status) of the disclosing entity; the ability or authority to nominate or name members of the Board of
Directors or Trustees of the disclosing entity; the ability or authority, expressed or reserved, to amend or change the by-laws, constitution,
or other operating or management direction of the disclosing entity; the right to control any or all of the assets or other property of the
disclosing entity upon the sale or dissolution of that entity; the ability or authority, expressed or reserved, to control the sale of any or all of
the assets, to encumber such assets by way of mortgage or other indebtedness, to dissolve the entity or to arrange for the sale or transfer of
the disclosing entity to new ownership or control.
Item IV-VII - (Changes in Provider Status) For Items IV-VII, if the yes box is checked, list additional information requested under
Remarks. Clearly identify which item is being continued.
Change in provider status - is defined as any change in management control. Examples of such changes would include; a change in Medical
or Nursing Director, a new Administrator, contracting the operation of the facility to a management corporation, a change in the composition of
the owning partnership which under applicable State law is not considered a change in ownership, or the hiring or dismissing of any employees
with 5 percent or more financial interest in the facility or in an owning corporation, or any change of ownership.
Item IV - (A & B) If there has been a change in ownership within the last year or if you anticipate a change, indicate the date in the
appropriate space.
Item V - If the answer is yes, list name of the management firm and employer identification number (EIN), or the name of the leasing
organization. A management company is defined as any organization that operates and manages a business on behalf of the owner of that
business, with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI - If the answer is yes, identify which has changed (Administrator, Medical Director, or Director of Nursing) and the date the change
was made. Be sure to include name of the new Administrator, Director of Nursing or Medical Director, as appropriate.
Item VII - A chain affiliate is any free-standing health care facility that is either owned, controlled, or operated under lease or contract by an
organization consisting of two or more free-standing health care facilities organized within or across State lines which is under the ownership or
through any other device, control and direction of a common party. Chain affiliates include such facilities whether public, private, charitable or
proprietary. They also include subsidiary organizations and holding corporations. Provider-based facilities, such as hospital-based home health
agencies, are not considered to be chain affiliates.
Exhibit J
Page 3 of 3