HomeMy WebLinkAboutAgreement A-25-256 with RH Community Builders LP.pdf Agreement No. 25-256 SERVICE AGREEMENT
2 This Service Am ("Agreement") is dated June 10, 2025 andi between
3 RH Community Builders LP. a |imnited California partnership ("Contractor"), and the County of
4 Fresno, a political subdivision uf the State of California ("Counb').
5 Recitals
6 A. Innovation funds from Mental Health Services Act are being utilized to test a
7 secondary phase too lodging pilot project thataeeketoaddnasaunhoumedperoone. vvhoopeno[
D engaged in care, and are in the pre-contemplation stage of change. The initial pilot was
S conducted with RH Community Builders, who were selected through a request for proposal
10 process in2O2D.
11 B. The project uoes a specific model and staffing ino standalone setting to try and
12 engage persons not in uana and historically resistant to oons. The p jact'afirst phase which
13 pnaoanUy has run for yeoro, has yielded positive namu|ty in engaging the majority of the
14 participants with the model and approach that has been tested.
15 C. County seeks to test specific models and approaches for engagement of a target
10 population that is unhoused, or at-risk of homelessness, with a behavioral health condition, but
17 |a not engaged in care and has historically been resistant 10 care services. The test iadesigned
18 to help identify effective engagement in a specific setting geared towards supporting those
19 individuals. The second phase seeks to broaden the population served to also target individuals
20 living with m substance-use disorder.
21 D. To maintain the continuity of the project, it is essential for County to implement the
22 second phase of the project withtheexistingprogronn. The fidelity of the project ionnona |ike\y
23 to he maintained by continuing to work with the Contractor. As this project has limited funding
24 availability and limited timelines for implementation and assessment, the challenges of having a
25 new vendor would delay the project. TheControutorhaebmeninVo|vedvv|ththepnmQrannfronnitm
26 inception and has all the components in places to start services immediately. |t was determined
27 that the best interest of the County would be served by not securing competitive bids or issuing
28 a request for proposal.
1
1 The parties therefore agree as follows:
2 Article 1
3 Contractor's Services
4 1.1 Scope of Services. The Contractor shall perform all of the services provided in
5 Exhibit A to this agreement, titled "Fresno County Department of Behavioral Health Scope of
6 Work".
7 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
8 able to perform all of the services provided in this Agreement.
9 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
10 applicable federal, state, and local laws and regulations in the performance of its obligations
11 under this Agreement, including but not limited to workers compensation, labor, and
12 confidentiality laws and regulations. Additionally, Contractor shall comply with laws, regulations,
13 and requirements in Exhibit B to this agreement, titled "Fresno County Behavioral Health
14 Requirements".
15 Article 2
16 County's Responsibilities
17 2.1 The County shall provide oversight and collaborate with Contractor, other County
18 Departments and community agencies to help achieve program goals and outcomes. In addition
19 to contractor monitoring of program, oversight includes, but not limited to, coordination with
20 Mental Health Services Oversight and Accountability Commission in regard to program
21 administration and outcomes.
22 2.2 County shall participate in evaluating the progress of the overall program, levels of
23 care components, and the efficiency of collaboration with the Contractor staff and will be
24 available to Contractor for ongoing consultation. County shall receive and analyze statistical
25 outcome data from Contractor throughout the term of contract. County shall notify the
26 Contractor when additional participation is required. The performance outcome measurement
27 process will not be limited to survey instruments but will also include, as appropriate, persons
28 served and staff surveys, chart reviews, and other methods of obtaining required information.
2
1 Article 3
2 Compensation, Invoices, and Payments
3 3.1 The County agrees to pay, and the Contractor agrees to receive compensation for
4 the performance of its services under this Agreement as described in Exhibit C to this
5 agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
O COOditiODS"
7 3.2 Additional Fiscal Requirements. The Contractor shall comply with all additional
8 requirements in Exhibit Cbn this Agreement.
9 Article
10 Term mfAgreement
11 4.1 Term. This Agreement is effective on July 1, 2025, and terminates on June 30. 2027.
12 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
13 below.
14 4.2 Extension. The term of this Agreement may be extended for no more than one, one-
15 year period only upon written approval of both parties at least thirty (30) days before the first day
16 of the next one-year extension period. The County's DBH Director or his or her designee is
17 authorized to sign the written approval on behalf of the County based on the Contractor's
18 satisfactory performance. The extension of this Agreement by the County is not a waiver or
19 compromise of any default or breach of this Agreement by the Contractor existing at the time of
20 the extension whether or not known to the County.
21 Article 5
22 Notices
23 5.1 Contact Information. The persons and their addresses having authority to give and
24 receive notices provided for or permitted under this Agreement include the following:
25
For the County:
20 []|pe/tor. Department ofBehavioral Health
County ofFresno
27 1S25F Dakota Avenue
Fresno, CA9372O
28
3
1 For the Contractor:
Chief Executive Officer
2 RH Community Bui|dero, LP
3040 N. Fresno Street
3 Framno, CA937D5
4 5.2 Change of Contact Information. Either pmdx may change the information in section
5 5.1 by giving notice as provided in section 5.3.
8 5.3 Method of Delivery. Each notice between the County and the Contractor provided
7 for or permitted under this Agreement must be in vvribng, state that it in o notice provided under
8 this Agreement, and be delivered either by personal service, by first-class United States rnoi|. by
S an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
10 Document Format (POF) document attached b) anemail.
11 (A) A notice delivered by personal service is effective upon service to the recipient.
12 (B) A notice delivered by first-class United States mail iaeffective three County
13 buo|ngmo days after deposit in the United States rnoi|, postage pnapaid, addressed to the
14 recipient.
15 (C)A notice delivered by an overnight commercial courier service is effective one
16 County business day after deposit with the overnight commercial courier service,
17 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
18 the recipient.
19 (D)A notice delivered by telephonic facsimile transmission or by PDF document
20 attached to an *rnoi| is effective when transmission to the recipient is completed (but. if
21 such transmission is completed outside of County business houre, then such delivery is
22 deemed to be effective at the next beginning of County business day), provided that
23 the sender maintains o machine record of the completed transmission.
24 5.4 Claims F»m»sem*mtion' For all doinnm arising from or related tn this Agreement,
25 nothing in this Agreement establishes, vvaiveo, or modifies any claims presentation
26 requirements orprocedures provided by law, including the Government Claims Act(Division 3.6
27 of Title 1 of the Government Code, beginning with section 81O).
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4
1 Article 6
2 Termination and Suspension
3 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
4 contingent on the approval of funds by the appropriating government agency. If sufficient funds
5 are not allocated, then the County, upon at least 30 days' advance written notice to the
6 Contractor, may:
7 (A) Modify the services provided by the Contractor under this Agreement; or
8 (B) Terminate this Agreement.
9 6.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, the County may give written notice of the breach to the Contractor. The written
12 notice may suspend performance under this Agreement and must provide at least 30
13 days for the Contractor to cure the breach.
14 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
15 time stated in the written notice, the County may terminate this Agreement immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of the
17 County, the Contractor has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this Agreement;
20 (3) Submitted a substantially incorrect or incomplete report to the County; or
21 (4) Improperly performed any of its obligations under this Agreement.
22 6.3 Termination without Cause. In circumstances other than those set forth above, the
23 County may terminate this Agreement by giving at least 30 days advance written notice to the
24 Contractor.
25 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
26 Economic Sanctions against Russia and Russian entities and individuals, the County may
27 terminate this Agreement if the Contractor is a target of Economic Sanctions or is conducting
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1 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
2 thirty (30) days advance written notice to the Contractor.
3 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
4 under this Article 6 is without penalty to or further obligation of the County.
5 6.6 County's Rights upon Termination. Upon termination for breach under this Article
6 6, the County may demand repayment by the Contractor of any monies disbursed to the
7 Contractor under this Agreement that, in the County's sole judgment, were not expended in
8 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
9 demand. This section survives the termination of this Agreement.
10 Article 7
11 Independent Contractor
12 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
13 agents, employees, and volunteers, is at all times acting and performing as an independent
14 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
15 venturer, partner, or associate of the County.
16 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
17 manner or method of the Contractor's performance under this Agreement, but the County may
18 verify that the Contractor is performing according to the terms of this Agreement.
19 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
20 right to employment rights or benefits available to County employees. The Contractor is solely
21 responsible for providing to its own employees all employee benefits required by law. The
22 Contractor shall save the County harmless from all matters relating to the payment of
23 Contractor's employees, including compliance with Social Security withholding and all related
24 regulations.
25 7.4 Services to Others. The parties acknowledge that, during the term of this
26 Agreement, the Contractor may provide services to others unrelated to the County.
27
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6
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractor(or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Contractor shall comply with all the insurance requirements in Exhibit D to this
15 Agreement.
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. The Contractor shall make available to the County, and
19 the County may examine at any time during business hours and as often as the County deems
20 necessary, all of the Contractor's records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
22 request by the County, permit the County to audit and inspect all of such records and data to
23 ensure the Contractor's compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 years after final payment under this Agreement. This section survives the termination of this
28 Agreement.
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1 10.3 Public Records. The County is not limited in any manner with respect to its public
2 disclosure nf this Agreement or any record or data that the Contractor may provide to the
3 County. The County's public disclosure of this Agreement or any record or data that the
4 Contractor may provide to the County may include but is not limited to the following:
5 (A) The County may voluntarily, or upon request by any member of the public or
8 governmental agency, disclose this Agreement to the public or such governmental
7 agency.
8 (B) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose to the public or such governmental agency any record or
10 data that the Contractor may provide tothe {}uuntv, un|ama such disclosure is prohibited
11 by court order.
12 (C)This Agreement, and any record or data that the Contractor may provide to the
13 County, ie subject to public disclosure under the Ralph K8. Brown Act(California
14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
15 (D)This Agreement, and any record or data that the Contractor may provide to the
18 County, is subject to public disclosure as a public record under the California Public
17 Records Act(California Government Code, Title 1, Division 7. Chapter 3.5. beginning
18 with section G250) (''CPFB\^).
19 (E) This Agreement, and any record or data that the Contractor may provide to the
20 County, is subject to public disclosure as information concerning the conduct of the
21 people's business of the State ofCalifornia under California Constitution, Article 1.
22 section 3. subdivision (b).
23 (F) Any marking of confidentiality or restricted access upon or otherwise made with
24 respect to any record or data that the Contractor may provide to the County shall be
25 disregarded and have no effect on the County's right or duty to disclose to the public or
26 governmental agency any such record ordata.
27 10.4 Public Records Act Requests. |f the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
8
1 and which the County has a right, under any provision of this Agreement or applicable law, to
2 possess or control, then the County may demand, in writing, that the Contractor deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of the Contractor. Within five business days after the County's demand, the
5 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
6 possession or control, together with a written statement that the Contractor, after conducting a
7 diligent search, has produced all requested records that are in the Contractor's possession or
8 control, or(b) provide to the County a written statement that the Contractor, after conducting a
9 diligent search, does not possess or control any of the requested records. The Contractor shall
10 cooperate with the County with respect to any County demand for such records. If the
11 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
12 CPRA or other applicable law, it must deliver the record or data to the County and assert the
13 exemption by citation to specific legal authority within the written statement that it provides to
14 the County under this section. The Contractor's assertion of any exemption from disclosure is
15 not binding on the County, but the County will give at least 10 days' advance written notice to
16 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
17 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
18 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
19 failure to produce any such records, or failure to cooperate with the County with respect to any
20 County demand for any such records.
21 Article 11
22 Data Security
23 11.1 Contractor shall comply with data security requirements in Exhibit E to this
24 Agreement.
25 Article 12
26 Disclosure of Self-Dealing Transactions
27 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation,
28 or changes its status to operate as a corporation.
9
1 12.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
2 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
3 "Self-Dealing Transaction Disclosure Form" (Exhibit F to this Agreement) and submitting it to the
4 County before commencing the transaction or immediately after.
5 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
6 a party and in which one or more of its directors, as an individual, has a material financial
7 interest.
8 Article 13
9 Disclosure of Ownership and/or Control Interest Information
10 13.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
11 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
12 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
13 13.2 Duty to Disclose. Contractor must disclose the following information as requested in
14 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
15 Exhibit G:
16 (A) Disclosure of Five Percent(5%) or More Ownership Interest:
17 (1) In the case of corporate entities with an ownership or control interest in the
18 disclosing entity, the primary business address as well as every business location
19 and P.O. Box address must be disclosed. In the case of an individual, the date of
20 birth and Social Security number must be disclosed.
21 (2) In the case of a corporation with ownership or control interest in the
22 disclosing entity or in any subcontractor in which the disclosing entity has a five
23 percent (5%) or more interest, the corporation tax identification number must be
24 disclosed.
25 (3) For individuals or corporations with ownership or control interest in any
26 subcontractor in which the disclosing entity has a five percent(5%) or more interest,
27 the disclosure of familial relationship is required.
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1 (4) For individuals with five percent(5%) or more direct or indirect ownership
2 interest of a disclosing entity, the individual shall provide evidence of completion of a
3 criminal background check, including fingerprinting, if required by law, prior to
4 execution of Contract. (42 C.F.R. §455.434)
5 (B) Disclosures Related to Business Transactions:
6 (1) The ownership of any subcontractor with whom Contractor has had business
7 transactions totaling more than $25,000 during the twelve (12) month period ending
8 on the date of the request.
9 (2) Any significant business transactions between Contractor and any wholly
10 owned supplier, or between Contractor and any subcontractor, during the five (5)
11 year period ending on the date of the request. (42 C.F.R. §455.105(b).)
12 (C) Disclosures Related to Persons Convicted of Crimes:
13 (1) The identity of any person who has an ownership or control interest in the
14 provider or is an agent or managing employee of the provider who has been
15 convicted of a criminal offense related to that person's involvement in any program
16 under the Medicare, Medicaid, or the Title XXI services program since the inception
17 of those programs. (42 C.F.R. §455.106.)
18 (2) County shall terminate the enrollment of Contractor if any person with five
19 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
20 has been convicted of a criminal offense related to the person's involvement with
21 Medicare, Medicaid, or Title XXI program in the last ten (10)years.
22 13.3 Contractor must provide disclosure upon execution of Contract, extension for
23 renewal, and within thirty-five (35) days after any change in Contractor ownership or upon
24 request of County. County may refuse to enter into an agreement or terminate an existing
25 agreement with Contractor if Contractor fails to disclose ownership and control interest
26 information, information related to business transactions and information on persons convicted
27 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
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1 13.4 Contractor must provide the County with written disclosure of any prohibited
2 affiliations under 43C.F.R. § 43O.O1O. Contractor must not employ or subcontract with providers
3 or have other relationships with providers Excluded from participation in Federal Health Care
4 Pnognannm. including W1edi-CaKW1edicaid or procurement activities, as set forth in 42 C.F.R.
5 §438.010.
0 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
7vxiih a copy sent via email bJthe assigned DBH
0 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
S with five (5) percent or greater direct or indirect ownership interest in Contractor has been
10 conv icted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
11 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
12 person with five (5) percent or greater direct or indirect ownership interest in the Contractor did
13 not submit timely and accurate information and cooperate with any screening method required
14 inC.F.F|. Title 42. Section 455418
15 Article 14
16 Disclosure of Criminal History and Civil Actions
17 14.1 Applicability. Contractor io required tudisclose if any of the following conditions
18 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
19 referred toaa ^ConLractor''):
20 (A) Within the three (3) year period preceding the Agreement award, they have been
21 convicted of, or had a civil judgment tendered against them for:
22 (1) Fraud or criminal offense in connection with obtaining, attempting toobtain,
23 or performing a public (federal, state, or local)transaction or contract under a public
24 transaction;
25 (2) Violation ufafederal or state antitrust statute;
20 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
27 or
28 (4) Fo|aa statements or receipt of stolen property.
12
1 (B) Within a three (3) year period preceding their Agreement award, they have had a
2 public transaction (federal, state, or local)terminated for cause or default.
3 14.2 Duty to Disclose. Disclosure of the above information will not automatically
4 eliminate Contractor from further business consideration. The information will be considered as
5 part of the determination of whether to continue and/or renew this Agreement and any additional
6 information or explanation that Contractor elects to submit with the disclosed information will be
7 considered. If it is later determined that the Contractor failed to disclose required information,
8 any contract awarded to such Contractor may be immediately voided and terminated for
9 material failure to comply with the terms and conditions of the award.
10 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
11 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit H.
12 Additionally, Contractor must immediately advise the County in writing if, during the term of the
13 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
14 participation in Federal or State funded programs or from receiving federal funds as listed in the
15 excluded parties list system (http://www.epis.gov); or(2) any of the above listed conditions
16 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless
17 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other
18 matter listed in the signed Certification Regarding Debarment, Suspension, and Other
19 Responsibility Matters.
20 Article 15
21 General Terms
22 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
23 Agreement may not be modified, and no waiver is effective, except by written agreement signed
24 by both parties. The Contractor acknowledges that County employees have no authority to
25 modify this Agreement except as expressly provided in this Agreement.
26 (A) Notwithstanding the above, non-material changes to services, staffing, and
27 responsibilities of the Contractor, as needed, to accommodate changes in the laws
28 relating to service requirements, may be made with the signed written approval of
13
1 CountvoO8H Director, o/designee, and Contractor through enamendment approved
2 by County's County Counsel and the County's Auditor-Controller/Treasurer-Tax
3 Collector's Office. Said modifications shall not result in any change to the maximum
4 compensation amount payable to Contractor, oa stated herein.
5 (B) Rate Modification. In addition, changes to service rates on Exhibit C —
6 Attachment A that do not exceed five percent (5%) of the approved rate, or that are
7 needed to accommodate state-mandated rate increases, may be made with the written
0 approval of the DBH Director, or designee, subject to applicable legislation, availability of
S funds and review of Contractor performance. These rate changes may not add or alter
10 any other terms or conditions of the Agreement. Said modifications shall not result inany
11 change to the annual maximum compensation amount payable to Contractor, as stated
12 herein.
13 /C\ Budget Modification. Changes to Account/Line Item amounts, which, when
14 aggregated, do not exceed ten percent(10%) of the total maximum compensation
15 payable to Contractor for the entire contract term, may be made with the written approval
10 of Contractor(s) and County's DBH Director or designee. Said modifications are subject
17 to County's DBH review in accordance with the Budget Modification Request Guide
18 available at hftps://www.fresnocountyca.gov/Departments/Behavioral-
19 Heo|th/Providerm/Contnact-ProvidepReoourcee/Notificotiona-A0000ioted-Duounmente.
20 15.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
21 under this Agreement without the prior written consent uf the other party.
22 15.3 Governing Law. The laws of the State uf California govern all matters arising from
23 or related to this Agreement.
24 15.4 Jurisdiction and Venue. This Agreement ie signed and performed inFresno
25 County. California. Contractor consents to California jurisdiction for actions arising from or
28 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
27 brought and maintained in Fresno County.
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1 15.5 Construction. The final form of this Agreement is the result of the parties' combined
2 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
3 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
4 against either party.
5 15.6 Days. Unless otherwise specified, "days" means calendar days.
6 15.7 Headings. The headings and section titles in this Agreement are for convenience
7 only and are not part of this Agreement.
8 15.8 Severability. If anything in this Agreement is found by a court of competent
9 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
10 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
11 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
12 intent.
13 15.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
14 not unlawfully discriminate against any employee or applicant for employment, or recipient of
15 services, because of race, religious creed, color, national origin, ancestry, physical disability,
16 mental disability, medical condition, genetic information, marital status, sex, gender, gender
17 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
18 all applicable State of California and federal statutes and regulation.
19 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
20 beneficiaries are provided without use of any policy or practice that has the effect of
21 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
22 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
23 genetic information, health status or need for health care services, or mental or physical
24 disability.
25 15.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
26 of the Contractor under this Agreement on any one or more occasions is not a waiver of
27 performance of any continuing or other obligation of the Contractor and does not prohibit
28 enforcement by the County of any obligation on any other occasion.
15
1 15.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
2 between the Contractor and the County with respect to the subject matter of this Agreement,
3 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
4 publications, and understandings of any nature unless those things are expressly included in
5 this Agreement. If there is any inconsistency between the terms of this Agreement without its
6 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
7 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
8 exhibits.
9 15.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to
10 create any rights or obligations for any person or entity except for the parties.
11 15.13 Authorized Signature. The Contractor represents and warrants to the County that:
12 (A) The Contractor is duly authorized and empowered to sign and perform its
13 obligations under this Agreement.
14 (B) The individual signing this Agreement on behalf of the Contractor is duly
15 authorized to do so and his or her signature on this Agreement legally binds the
16 Contractor to the terms of this Agreement.
17 15.14 Electronic Signatures. The parties agree that this Agreement may be executed by
18 electronic signature as provided in this section.
19 (A) An "electronic signature" means any symbol or process intended by an individual
20 signing this Agreement to represent their signature, including but not limited to (1) a
21 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
22 electronically scanned and transmitted (for example by PDF document) version of an
23 original handwritten signature.
24 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
25 equivalent to a valid original handwritten signature of the person signing this Agreement
26 for all purposes, including but not limited to evidentiary proof in any administrative or
27 judicial proceeding, and (2) has the same force and effect as the valid original
28 handwritten signature of that person.
16
1 (C)The provisions of this section satisfy the requirements of Civil Code section
2 1633.5, subdivision (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3,
3 Part 2, Title 2.5, beginning with section 1633.1).
4 (D) Each party using a digital signature represents that it has undertaken and
5 satisfied the requirements of Government Code section 16.5, subdivision (a),
6 paragraphs (1) through (5), and agrees that each other party may rely upon that
7 representation.
8 (E) This Agreement is not conditioned upon the parties conducting the transactions
9 under it by electronic means and either party may sign this Agreement with an original
10 handwritten signature.
11 15.15 Counterparts. This Agreement may be signed in counterparts, each of which is an
12 original, and all of which together constitute this Agreement.
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2 RH COMM UNITY'BUIVDERS, LP
COUNTY OF FRESNO
3 a
4 Wayne Ru#ledge, Chio Executive Officer
5 3040 N. Fresno Street Ernest Buddy M des, Chairman of the
Fresno. CA 93705 Board of Supervisors of the County of Fresno
6
Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9 -
By: -
10 06puty
12 BY:
13 Print Name: Brad Hardie
14 Title: President
Secretary (of Corporation), or any
15 Assistant Secretary, or Chief
Financial Officer, or any Assistant
16 Treasurer
17 For accounting use only.
18 Org No.: 56304793
Account No.:7295
19 Fund No.: 0001
Subclass No. 10000
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EXHIBIT A
Page I of 8
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
1. PROGRAM NAME—The Lodg- e 2.0
11. BACKGROUND
The project uses a specific model, staffing, (specifically peers and certified peers) and setting
to assist a broader population. Including those referred from outreach teams, crisis teams,
and hospitals, post crisis, those with a substance use disorder(SUD), co-occurring diagnosis
including some additional rehabilitation care for those with SUD on site.
111. TARGET POPULATION
The target population shall be adults 18 years and older living with a Severe Mental Illness
(SMI) Co-Occurring Disorder, or a SUD only who are in the precontemplation and
contemplative stage of change to engage in the behavioral health system and experiencing
homelessness or are at risk of becoming homeless. The program will not be open to referrals
from organizations serving Fresno County's much larger homeless population, nor is this
program geared towards families. Rather, the target population would be persons who meet
all of the following specific criteria for testing and research purposes:
1. Have an SMI, Co-Occurring or SUD
2. Homeless or at-risk of homelessness
3. Not engaged in behavioral health outpatient services (including those who have not
recently been in care. So not totally resistant, may have accessed care through the
emergency department, hospitals and/or jails)
4. Eligible for Fresno County Department of Behavioral Health (DBH) services
EXHIBIT A
Page 2 of 8
IV. DESCRIPTION OF SERVICES
A. Services Start Date:
July 1, 2025—June 30, 2027
B. Summary of Services
Contractor will provide short-term lodging services to individuals with severe mental illness,Co-
Occurring or SUD who are experiencing or at risk of homelessness.The intent of these services is
to gain insight through a pilot research project on what can enhance and increase engagement of
individuals who are homeless or at risk for homelessness,with or severe mental illness,SUD or
Co-occurring and who are not engaging in care due to being in the precontemplation and
contemplative stage of change.
C. Location of Services:
SERVICE ADDRESS: 1040 N. Pleasant Ave. Fresno, CA. 93728
D. Hours of Operation:
24 hours 7 days a week
E. Schedule of Services:
Services are available to be provided 24-hours, 7-days a week. Service hours are flexible
to meet needs of individuals who are unavailable during standard business hours,
including scheduled appointments on Saturdays and Sundays as needed.
F. Average Person Served Length of Stay:
The length of stay is 90 days. The anticipated average individual length of stay in the
Lodge 2.0 shall be in accordance with each individual's assessed needs, but not exceed
90 days.
G. Referral Sources and Referral Process:
Services will be provided to individuals that are referred through a Fresno County
approved referral source such as the Emergency Room, Crisis Intervention Team,
Psychiatric hospital, Outreach Teams, DBH Housing Teams, LPS Conservatorship, SUD
outreach and mobile Crisis. All individuals will be immediately enrolled in The Lodge 2.0
and within 72 hours and a Peer Support Specialist will engage the individual to do an
additional assessment to gain a better understanding of the individual's needs and
barriers.
Intake to The Lodge 2.0 will be brief and only gather basic information and demographics
to allow individuals to settle in before additional assessments are conducted. The Peer
Support Specialist will begin building rapport with the individual and encourage the
individual to begin attending supports that are most appropriate for their needs. Peer
support staff to be trained to use motivational interviewing as a primary engagement tool.
Individuals will be rapidly accepted into The Lodge 2.0 after a brief screening to ensure
they meet criteria for the program. The Lodge 2.0 will operate under low-barrier standards,
meaning referred individual's may still be active in addiction, but will not be permitted to
EXHIBIT A
Page 3 of 8
bring illegal drugs or alcohol into the facility (while still using a harm reduction approach)
with linkages to MAT, NTP, etc.
Staff will be trained to search individual's belongings upon entry and allow individuals to
surrender any drugs, alcohol, or weapons without penalty. Individual's will be permitted to
bring their personal belongings into the facility and RHCB will provide a secure location for
other belongings such as camping gear, trailers, or excessive belongings.
At the time of arrival, individuals and the staff will complete an inventory form of which a
copy will be provided to the individual and placed in the individual's file. Individuals will not
be penalized for surrendering illegal drugs or weapons, but such items will not be
returned. Illegal drugs, weapons, and alcohol will be logged into a destruction log and
immediately disposed of properly by a member of the Management Team.
Once an individual's belongings have been searched, staff will assist the individual with
getting settled into their bed_ All bedroom areas will have access to showers. Individuals
will have access to no cost laundry facilities and offered hygiene supplies and clothing if
needed. RHCB understands that individuals may enter The Lodge 2.0 immediately after
crisis and may need time to rest and become comfortable. Individuals will not be
pressured to immediately engage if they are not ready, and individuals will drive the pace
of their treatment throughout their stay at The Lodge 2.0.
The Lodge 2.0 will be well equipped with all needed supplies including hygiene product,
clothes, and other necessities to ensure that individuals feel their physiological needs are
met. The Lodge 2.0 will offer three full meals per day with snacks available between
meals.
H. Care Coordination/Transition Plan:
RHCB will operate The Lodge with a Housing First model based on the philosophy that
safe and stable housing will be the entry point to services, not the reward for entry into
services. RHCB fully embraces the principles of Housing First including harm reduction
where individuals do not have to be clean and sober to enter housing and individuals are
not required to participate in scheduled services such as groups or individual meetings
during their stay. RHCB will seek to remove as many barriers as possible to make it
possible for individuals to receive services. The Lodge 2.0 will accept referred individuals
to"come as you are", including with their pets and belongings. RHCB will work with
individuals to keep their pets with them while in services and provide kennels for pets
along with ample storage space for individuals to secure their belongings.
Sobriety will not be a condition of entry into The Lodge 2.0 and staff will be trained to
recognize when an individual is under the influence or going through withdrawal. All staff
will be trained on emergency protocols and when emergency medical personal should be
contacted. Narcan will be available as needed and all staff will be trained in administering
Narcan as well as the safety protocols to follow administration. Narcan will be stored and
secured in the Medication Cabinet and in common areas to allow easy access. Individuals
will be encouraged to participate in recovery services such as Narcotics
EXH|BITA
Page 4of8
Anonymous (NA) and Alcoholics Anonymous (AA) if substance use disorder treatment iom
needed. Clients will also be linked to residential, or outpatient substance use disorder
treatment through Fresno County if they express a desire for treatment. The Peer Support
Specialists and Case Managers will be fully trained on how hlaccess treatment services
and be available to support individuals in accessing services. RHCBxviU provide
transportation to and from treatment if services become an active piece of the individua[m
treatment plan.
The Lodge will aim to not only |ink, but fully anQmge, individuals into additional services,
Individuals will become engaged into the Coordinated Entry System (CEG)toensure
individuals become eligible for housing programs. Individuals will be considered
successfully discharged when they have been accepted and engaged by an ongoing
service provider and are in the care they were linked UJ for 3O-days after discharge from
the Lodge 2.O.
i Evidence-BasedPractice(s):
* Trauma Informed Care
* Harm Reduction
* K8mUv$1iona| Interviewing
J. County shall:
1. Assist Contractor to evaluate the needs of each person served on an ongoing basis to
ensure that the level of care they are receiving i$ clinically appropriate.
2, Provide oversight, through County's DBH Director, or designee, and collaborate with
Contractor and other County Departments and community agencies to help achieve State
program goals and outcomes. In addition hoAgreement monitoring ofprogrann(a).
oversight includes, but not limited to, coordination with the OAC in regard to program
administration and outcomes.
3. Assist the Contractor in making linkages with the total mental health avmtern. This will
be accomplished through regularly scheduled meetings as well aa formal and informal
consultation.
4. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with Contractor's staff and will be available b»the Contractor for ongoing
consultation.
5. Gather outcome information from Contractor throughout each term of this Agreement.
County [)BHstaff shall notify the Contractor when its participation ie required. The
performance outcome measurement process will not be limited to survey instruments but
will also include, as approphate, person served and staff interviews, chart reViewo, and
other methods of obtaining required information.
G. Assist the Contractor's efforts towards cultural and linguistic competency by providing
the following[o Contractor:
"Technica| assistance and training regarding cultural proficiency requirements.
^ Mandatory cultural proficiency training for Contractor personnel, at nnininlunn
once per year.
EXHIBIT A
Page 5 of 8
• Technical assistance for translating information into County's threshold languages
(Spanish and Hmong). Translation services and costs associated will be the
responsibility of the Contractor,
V. STAFFING
A. StaffinglPerson Served Ratio:
Staff providing direct services to individuals includes the following:
• Certified Peer Support Specialists
• Case Managers
• Clinicians
• Certified SUD Counselor
• Overnight Monitor
[XH|0TA
Page 6of8
RHCB will also support the program with interns who are currently pursuing degrees in
Alcohol and Drug Counseling and Social Work to provide additional resources to the
individuals served. The Lodge 2.0 will also be supported by a Office Manager and Janitor.
The Lodge 2.O will bo staffed 24/7hy Peer Support Specialists and will have bilingual staff
available 24/7. All staff will also be trained on accessing the Language Line t¢ provide
translation services, if needed. At a minimum. The Lodge 2.0vvi|| be staffed at a
ratio of1:1O for direct staff to individuals served and mt many times, there will be a ratio of
1:7.5 staff toindividuals served.
B. Staffing Plan
Staffing shall be appropriate to adequately deliver services to the target population.
Staffing shall include the following classifications: Peer Support Specialists, Case
Managers, licensed or registered associate therapist, SUD Counselors, and Overnight
Monitors. Staffing shall consider the linguistic and cultural needs of the community when
recruiting for all positions as well aa personal and professional experiences.
Staff shall possess appropriate licenses and certificates and be qualified |naccordance
with applicable statutes and megu|mboM$. Contractor shall oLtain, maintain, and umn1p|y
with all necessary government authorizations, permits and licenses required to conduct its
operations. In m4dition, the contractor shall comply with all applicable Fedora|. State, and
local |avva, ru|es, regu|otione, and orders in its operations including compliance with all
applicable safety and health requirements astothe contractor's employees. Clinical staff
shall ottoin, maintain and comply with all regulations as set forth by the Board of
Behavioral Sciences (BBS).
Staff must comply with and maintain professional oonloetenokaa in their fields of expertise.
To ensure competency, the credentialing process is required for all new and current
licensed providers. Credentialing Committee approval of contractors licensed staff is
necessary before service delivery. Contractor will be required to submit related documents
to the CoUnty'$ Planned Administration Division for review bythe Department of
Behavioral Health's Credentia|ing Committee. Contractor will
C. Staff Training
° Trauma Informed Care
° PrmACT
* Harm Reduction
* Motivational Interviewing
* Peer Certification (peers only)
* Cultural Proficiency
V11' OUTCOMES/PERFORMANCE MONITORING
Throughout the process of services, RHCBwill provide regular updates toDBHsummarizing
how the goals and objectives were met through the provision of services. R|HCB shall actively
participate with [>BH and any outside consultants for performance monitoring and reporting
requirements.
EXHIBIT
Page 7ofQ
Access A]care:The ability of individuals to receive the rightaen/ime at the right time.
Examples include:
1. Timeliness of bridging prescriptions
2. Timeliness of identifying clients with a serious mental illness,Co-Occurring or SUD
3. Timeliness of accessing GUO
4. Tlnna|inoms between individual referral for assessment and completion of
5 ����aonnen�� assessment to first treatment service; and first treatment service to next
� .
follow-up.
G. Timeliness mf subsequent follow-up visits
7. Timeliness of response to sick call/health service requests
8. Timeliness of promoting self-determination and independent functioning
9. Timeliness of accessing treatment of mental health conditions
B. Effectiveness:Objective results achieved through health care services. Examples include:
1. Effectiveness of crisis interventions
2. Effectiveness of treatment interventions (medical and behavioral health indicators)
]. Effectiveness of discharge planning (such as percentage of clients successfully linked
to County prognanne, oun0nnunitv providers, and/or other community resources after
ny|eamm)
4. Timely continuity of verified community prescriptions for medication(s), upon
individua|'m release
5. Effectiveness of transportation coordination, upon release
C. Efficiency: The demonstration of the relationship between results and the resources used
to achieve them. Exernp|an include:
l. Cost per individual served
2. Number mfunits of services per FTE by discipline
3. Number of individuals served per general population
4. Comparison of numbers served against industry standards
D. Satisfaction and Compliance:The degree towhich individuals, Counb/, and other
stakeholders are satisfied with the services. Examples include:
1. Audits and other performance and utilization reviews of health care services and
compliance with agreement terms and conditions
2. Surveys mf persons served, family members, other health care providenm, and other
stakeholders
The following items listed below represent program goals to be achieved by RHCB.
Effectiveness:
A. 80Y6 of individuals will successfully engage in outpatient mental health or substance abuse
treatment.
B. The number of unique visits to the Crisis Stabilization Unit for each individual served will be
reduced by75Y6.
C. The number 0f unique visits tothe Emergency room will ba reduced buO596 for each
individual served.
D. Reducing ovepdooen, increasing new justice invV|vement, and reducing drug use byOD%.
EXHIBIT
Page of
A. RHCB will establish a baseline cost per individual served in the initial partial year.
B. RHCB will reduce cost per individual served annually thereafter.
C. RHCB will utilize Medi-Cal claiming where possible.
Access:
A. Wait time from admission into the Lodge 2.0 to initial peer assessment by RHCB will be 72
hours or less.
B. Once an individual has moved from the "pre-contemplative" stage and determined that they
are interested in seeking mental-health services, a mental-health assessment by RHCB will
be done within 48 hours.
Satisfaction:
A. 85% of individuals served will report"Satisfied" or"Very Satisfied"with services on RHCB's
individuals served exit survey.
B. 85% of the families of individuals served that are actively involved in the lives of individuals
served will rate "Significant" or"Critical" in response to Importance of The Lodge in your loved
one accessing ongoing services.
During the term of this Agreement, additional data collection opportunities may be identified
and implemented to support the Mental Health Services Act (MHSA) Innovation Component
research aspects of The Lodge program.
DBH and RHCB will review additional outcomes, MHSA requirements and CARF standards to
establish any further agreed upon outcomes to be tracked. RHCB will actively collaborate with
a third-party consultant to develop and refine data collection and reporting processes in order
to ensure compliance with MHSA Innovation Component requirements.
ADDITIONAL PERFORMANCE MONITORING REQUIREMENTS
RHCB shall:
A. Be required to comply with any requirements as related to performance outcomes, quality
of life and/or customer satisfaction as a Medi-Cal Organizational Provider, as described in
Exhibit K.
B. Be required to comply with all State regulations regarding State Performance Outcomes
measurement requirements and participate in the outcomes measurement process as
required by DBH.
C. Participate in performance outcomes throughout each term of this Agreement. DBH will
notify RHCB when its participation is required. The performance outcome measurement
process will not be limited to survey instruments but will also include, as appropriate,
individual and staff interviews, chart reviews, and other methods of obtaining needed
information.
Exhibit
Page 1mf28
Fresno County Behavioral
Health
Requirements
General Requirements
..
a. Guiding Principles.Contractor shall align programs,services,and practices with the
vision,mission,and guiding principles of the DBH,as f urther described in Exhibit B—
Attachment A to this Agreement,titled"Fresno County Department of Behavioral Health
Guiding Principles of Care De|ivery".
b. Rights of Persons Served.Contractor shall post signs informing persons served of their
right to file a complaint or grievance,appeals,and expedited appeals, In addition,
Contractor shall inform every person served of their rights as set forth in Exhibit B—
Attachment B to this agreement,titled "Rights of Persons Served".
c. Records.Contractor shall maintain records in accordance with Exhibit B—Attachment C
to this Agreement,titled"Documentation Standards for Persons Served Records".All
records of the person served shall be maintained for a minimum of ten(10)years f rom
the date of the end of this Agreement.
d. Licenses/Certificates.Throughout the term of this Agreement,Contractor and
Contractor's staff shall maintain all necessary licenses,permits,approvals,certificates'
waivers and exemptions necessary for the provision of the services hereunder and
required by the laws and regulations of the United States uf America,State ofCalifornia,
the County of Fresno,and any other applicable governmental agencies.Contractor shall
notify County immediately in writing of its inability to obtain or maintain such licenses,
permits,approvals,certificates,waivers and exemptions irrespective of the pendency of
any appeal related thereto.Additionally,Contractor and Contractor's staff shall comply
with all applicable laws,rules or regulations,as may now exist or be hereafter changed.
e. Organizational Provider.Contractor shall maintain requirements asa Behavioral Health
Plan(RHP)organizational provider throughout the term of this Agreement. |f for any
reason,this status is not maintained,County may terminate this Agreement pursuant to
Article Gof this Agreement.
f. Staffing.Contractor agrees that prior to providing services under the terms and
conditions of this Agreement,Contractor shall have staff hired and in place for program
services and operations or County may, in addition to other remedies it may have,
1
Exhibit B
Page 2 of 23
suspend referrals or terminate this Agreement, in accordance to Article 6 of this
Agreement.
g. Training.Contractor agrees that its employees,volunteers,interns,and student trainees
or subcontractors of Contractor,in each case,are expected to perform professional
services per an agreement with County.Contractor will comply with the training
requirements and expectations referenced in Exhibit B—Attachment D to this
Agreement,titled "Department of Behavioral Health Contractor Training Requirements
Reference Guide".
h. Credentialing and Recredentialing.Each individual Contractor staff shall not provide any
specialty mental health services without an approved credentialing application from
County.Contractor and their respective staff must follow the uniform process for
credentialing and recredentialing of service providers established by County,including
disciplinary actions such as reducing,suspending,or terminating provider's privileges.
Failure to comply with specified requirements can result in suspension or termination of
an individual or provider.
Upon request,the Contractor must demonstrate to the County that each of its
providers are qualified in accordance with current legal,professional,and technical
standards,and that they are appropriately licensed,registered,waivered,and/or
certified.
Contractor must not employ or subcontract with providers debarred,suspended
or otherwise excluded (individually,and collectively referred to as"Excluded")from
participation in Federal Health Care Programs,including Medi-Cal/Medicaid or
procurement activities,as set forth in 42 C.F.R. §438.610.See section IV below.
Contractor is required to verify and document at a minimum every three years that each
network provider that delivers covered services continues to possess valid credentials,
including verification of each of the credentialing requirements as per the County's
uniform process for credentialing and recredentialing.If any of the requirements are not
up-to-date,updated information should be obtained from network providers to
complete the re-credentialing process.
L Criminal Background Check.Contractor shall ensure that all providers and/or
subcontracted providers consent to a criminal background check,including
fingerprinting to the extent required under state law and 42 C.F.R.§455.434(a).
2
Exhibit B
Page 3 of 23
Contractor shall provide evidence of completed consents when requested by the County,
DHCS or the US Department of Health& Human Services(US DHHS).
j. Clinical Leadership.Contractorshall send to County upon execution of this Agreement,a
detailed plan ensuring clinically appropriate leadership and supervision of their clinical
program.Recruitment and retaining clinical leadership with the clinical competencies to
oversee services based on the level of care and program design presented herein shall
be included in this plan.A description and monitoring of this plan shall be provided.
k. Additional Responsibilities.The parties acknowledge that,during the term of this
Agreement,the Contractor will hire,train,and credential staff,and County will perform
additional staff credentialing to ensure compliance with State and Federal regulations, if
applicable.
I. Subcontracts.Contractor shall obtain written approval from County's Department of
Behavioral Health Director,or designee,before subcontracting any of the services
delivered under this Agreement.County's Department of Behavioral Health Director,or
designee,retains the right to approve or reject any request for subcontracting services.
Any transferee,assignee,or subcontractor will be subject to all applicable provisions of
this Agreement,and all applicable State and Federal regulations.
Contractor shall be held primarily responsible by County for the performance of
any transferee,assignee,or subcontractor unless otherwise expressly agreed to in
writing by County's Department of Behavioral Health Director,or designee.The use of
subcontractors by Contractorshall not entitle Contractorto any additional compensation
that is provided for under this Agreement.
m. Reports.The Contractor shall submit the following reports and data:
i. Outcome Data.Contractor shall submit to County program performance
outcome data,as requested.Outcome data and outcome requirements are
listed in Exhibit B—Attachment E to this Agreement,titled"Program Outcomes
and Performance Measurements". Outcome data and outcome requirements
are subject to change at County's discretion.
ii. Additional Reports.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
3
Exhibit B
Page 4 of 23
deemed sufficient cause for County to withhold monthly payments until there is
compliance.In addition,Contractor shall provide written notification and
explanation to County within five(5)days of any funds received from another
source to conduct the same services covered by this Agreement.
n. Timely Access.It is the expectation of the County that Contractor provide timely access
to services that meet the State of California standards for care.Contractor shall track
timeliness of services to persons served and provide a monthly report showing the
monitoring or tracking tool that captures this data.County and Contractor shall meet to
go over this monitoringtool,as needed but at least on a monthly basis.County shall take
corrective action if there is a failure to comply by Contractor with timely access
standards.
o. Compliance with Behavioral Health Specific laws,
i. Contractor shall provide services in conformance with all applicable State and
Federal statutes,regulations and sub regulatory guidance,as from time to time
amended, including but not limited to:
1. California Code of Regulations,Title 9;
2. California Code of Regulations,Title 22;
3. California Welfare and Institutions Code,Division 5;
4. United States Code of Federal Regulations(CFR),Title 42,including but
not limited to Parts 438 and 455;
5. United States CFR,Title 45;
6. United States Code,Title 42(The Public Health and Welfare),as
applicable;
7. Balanced Budget Act of 1997;
8. Health Insurance Portability and Accountability Act(HIPAA);and
9. Applicable Medi-Cal laws and regulations,including applicable sub-
regulatory guidance,such as Behavioral Health Information Notices
(BHINs),Mental Health and Substance Use Disorder Services
Information Notices(MHSUDS INs),and provisions of County's,state or
federal contracts governing services for persons served.
ii. In the event any law,regulation,or guidance referred to in this section is
amended during the term of this Agreement,the parties agree to comply with
4
Exhibit B
Page 5 of 23
the amended authority as of the effective date of such amendment without
amending this Agreement.
iii. Contractor recognizes that County operates its behavioral health programs
under an agreement with DHCS,and that under said agreement the State
imposes certain requirements on County and its subcontractors.Contractorshall
adhere to all State requirements,including those identified in Exhibit B—
Attachment F to this Agreement,titled"State Behavioral Health Requirements".
p. Meetings. Contractor shall participate in monthly,or as needed,workgroup meetings
consisting of staff from County's DBH to discuss service requirements,data reporting,
training, policies and procedures,overall program operations and any problems or
foreseeable problems that may arise.Contractor shall also participate in other County
meetings,such as but not limited to quality improvement meetings, provider meetings,
audit meetings, Behavioral Health Board meetings,bi-monthly contractor meetings,etc.
Schedule for these meetings may change based on the needs of the County.
q. Monitoring.Contractor agrees to extend to County's staff,County's DBH and the
California Department of Health Care Services (DHCS),or their designees,the right to
review and monitor records,programs,or procedures,at any time,in regard to persons
served,as well as the overall operation of Contractor's programs,in order to ensure
compliance with the terms and conditions of this Agreement.
r. Electronic Health Record.Contractor currently maintains and may continue to maintain
its records in County's EHR system in accordance with Exhibit B—Attachment G,
"Electronic Health Record Requirements and Service Data",free of charge,as licenses
become available. The person served record shall begin with registration and intake,and
include person served authorizations,assessments,plans of care,and progress notes,as
well as other documents as approved by County.County shall be allowed to review
records of all and any services provided.If Contractor determines to maintain its records
in the County's EHR, it shall provide County's DBH Director,or designee,with a thirty
(30)day notice. If at any time Contractor chooses not to maintain its records in the
County's EHR,it shall provide County's DBH Director,or designee,with thirty(30)days
advance written notice and Contractor will be responsible for obtaining its own system,
at its own cost,for electronic health records management.
5
Exhibit B
Page 6 of 23
Disclaimer
County makes no warranty or representation that information entered into the
County's DBH EHR system by Contractor will be accurate,adequate,or satisfactory for
Contractor's own purposes or that any information in Contractor's possession or control,
or transmitted or received by Contractor,is or will be secure from unauthorized access,
viewing,use,disclosure,or breach.Contractor is solely responsible for person served
information entered by Contractor into the County's DBH EHR system.Contractor agrees
that all Private Health Information(PHI) maintained by Contractor in County's DBH EHR
system will be maintained in conformance with all HIPAA laws,as stated in section IX,
"Federal and State laws."
s. Generative Artificial Intelligence Technology Use&Reporting
i. During the term of the Agreement,Contractor must notify the County in writing
if their services or any work under this Agreement includes,or makes available,
any previously unreported Generative Artificial Intelligence (GenAl)technology,
including GenAl from third parties or subcontractors.Contractor must provide
information by submitting a"Generative Artificial Intelligence(GenAl) Reporting
and Factsheet(STD 1000)" In addition,Contractor must notify the County of
any new or previously unreported GenAl technology.At the direction of the
County,Contractor shall discontinue the use of any new or previously
undisclosed GenAl technology that materially impacts functionality, risk or
contract performance,until use of such GenAl technology has been approved by
the County.
ii. Failure to disclose GenAl use to the County and failure to submit the GenAl
Reporting and Factsheet(STD 1000)may be considered a breach of this
Agreement and are grounds for immediate termination in accordance with
Article 6 of this Agreement.
t. Confidentiality.All services performed by Contractor under this Agreement shall be in
strict conformance with all applicable Federal,State of California and/or local laws and
regulations relating to confidentiality.
u. Physical Accessibility. In accordance with the accessibility requirements of section 508
of the Rehabilitation Act and the Americans with Disabilities Act of 1973,Contractor
6
Exhibit B
Page 7 of 23
must provide physical access,reasonable accommodations,and accessible equipment
for Medi-Cal beneficiaries with physical or mental disabilities.
v. Publicity Prohibition.
i. Self-Promotion.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.
ii. Public Awareness. Notwithstanding the above,publicity of the services
described in Exhibit A of this Agreement shall be allowed as necessary to raise
public awareness about the availability of such specific services when approved
in advance by County's DBH Director or designee.Communication products
must follow DBH branding standards,including typefaces and colors,to
communicate our authority and project a unified brand.This includes all media
types,platforms,and all materials on and offline that are created as part of
DBH's efforts to provide information to the public.
w. Child Abuse Reporting Act.
i. Contractor shall establish a procedure acceptable to the County's DBH Director,
or designee,to ensure that all of the Contractor's employees,consultants,
subcontractors or agents described in the Child Abuse Reporting Act,section
1116 et seq.of the Penal Code,and performing services under this Agreement
shall report all known or suspected child abuse or neglect to a child protective
agency as defined in Penal Code section 11165.9.This procedure shall include:
1. A requirement that all Contractor's employees,consultants,
subcontractors or agents performing services shall sign a statement that
they know of and will comply with the reporting requirements as
defined in Penal Code section 11166(a).
2. Establishing procedures to ensure reporting even when employees,
consultants,subcontractors,or agents who are not required to report
child abuse under Penal Code section 11166(a),gain knowledge of or
reasonably suspect that a child has been a victim of abuse or neglect.
II. Informing Materials for Persons Served
Exhibit B
Page 8 of 23
a. Basic Information Requirements.Contractor shall provide information in a manner and
format that is easily understood and readily accessible to the persons served(42 C.F.R. §
438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
understood language,format,and alternative formats that take into consideration the
special needs of individuals in compliance with 42 C.F.R.§438.10(d)(6).Contractor shall
inform the persons served that information is available in alternate formats and how to
access those formats in compliance with 42 C.F.R.§438.10,
Contractor shall provide the required information in this section to each
individual receiving Specialty Mental Health Services(SMHS) under this Agreement and
upon request(1915(b) Medi-Cal Specialty Mental Health Services Waiver,§(2),subd.
(d),at p.26.,attachments 3,4;Cal.Code Regs.,tit.9,§1810.360(e)).
Contractor shall utilize the County's website that provides the content required
in this section and 42 C.F.R.§438.10 and complies with all requirements regarding the
same set forth in 42 C.F.R.§438.10.
Contractor shall use the DHCS/County-developed beneficiary handbook and
persons served notices(42 C.F.R. §§438.10(c)(4)(ii),438.62(b)(3)).
b. Electronic Submission.Persons served information required in this section may only be
provided electronically by the Contractor if all the following conditions are met:
I. The format is readily accessible;
ii. The information is placed in a location on the Contractor's website that
is prominent and readily accessible;
III. The information is provided in an electronic form which can be
electronically retained and printed;
iv. The information is consistent with the content and language
requirements of this Agreement;
v. The individual is informed that the information is available in paper form
without charge upon request and the Contractor shall provide it upon
request within five(5)business days(42 C.F.R. §438.10(c)(6)).
c. Language and Format.Contractor shall provide all written materials,including taglines,
for persons served or potential persons served in a font size no smaller than twelve(12)
point(42 C.F.R.438.10(d)(6)(ii)).Contractor shall ensure its written materials that are
critical to obtaining services are available in alternative formats,upon request of the
8
Exhibit B
Page 9 of 23
person served or potential person served at no cost.
Contractor shall make its written materials that are critical to obtaining services,
including,at a minimum,provider directories,beneficiary handbook,appeal and
grievance notices,denial and termination notices,and the Contractor's mental health
education materials,available in the prevalent non-English languages in the County(42
C.F.R. §438.10(d)(3)).
Contractor notify persons served,prospective persons served,and members of
the public that written translation is available in prevalent languages free of cost and
how to access those materials(42 C.F.R.§438.10(d)(5)(i),(iii);Welfare&Inst.Code§
14727(a)(1);Cal.Code Regs.tit.9§ 1810.410,subd.(e),para.(4)).Contractor shall make
auxiliary aids and services available upon request and free of charge to each person
served(42 C.F.R.§438.10(d)(3)-(4)).
Contractor shall make oral interpretation and auxiliary aids,such as
Teletypewriter Telephone/Text Telephone(TTY/TDY)and American Sign Language(ASL),
available and free of charge for any language in compliance with 42 C.F.R.§438.10(d)(2),
(4)-(S).
d. Beneficiary Informing Materials.Each person served must receive and have access to
the beneficiary informing materials upon request by the individual and when first
receiving SMHS from Contractor.Beneficiary informing materials include but are not
limited to:
L Consumer Handbook
ii. Provider Directory
iii. Grievance form
iv. Appeal/Expedited Appeal form
v. Advance Directives brochure
vi. Change of Provider form
vii. Suggestions brochure
viii. Notice of Privacy Practices
ix. Notice of Adverse Benefit Determination(NOABDs—Including Denial
and Termination notices)
x. Early& Periodic Screening, Diagnostic and Treatment(EPSDT) poster(if
serving individuals under the age of 21)
9
Exhibit B
Page 10 of 23
A. Contractor shall ensure beneficiary informing materials are displayed in
the threshold languages of Fresno County at all service sites,including
but not limited to the following:
1. Consumer Handbook
2. Provider Directory
3. Grievance form
4. Appeal/Expedited Appeal form
S. Advance Directives brochure
6. Change of Provider form
7. Suggestions brochure
All beneficiary informing written materials will use easily understood language and
format(i.e.material written and formatted at a 6th grade reading level),and will use a
font size no smaller than twelve(12) point.All beneficiary informing written materials
shall inform beneficiaries of the availability of information in alternative formats and
how to make a request for an alternative format. Inventory and maintenance of all
beneficiary informing materials will be maintained by the County's DBH Plan
Administration Division.Contractor will ensure that its written materials include taglines
or that an additional taglines document is available.
e. Beneficiary Handbook. Contractor shall provide each person served with a beneficiary
handbook at the time the individual first accesses services and thereafter upon request.
The beneficiary handbook shall be provided to beneficiaries within fourteen(14)
business days after receiving notice of enrollment.Contractor shall give each individual
notice of any significant change to the information contained in the beneficiary
handbook at least thirty(30) days before the intended effective date of change as per
SHIN 22-060.
f. Accessibility.Required informing materials must be electronically available on
Contractor's website and must be physically available at the Contractor's facility lobby
for individuals'access.
Informing materials must be made available upon request,at no cost, in
alternate formats(i.e., Braille or audio)and auxiliary aids(i.e.,California Relay Service
(CRS)711 and American Sign Language)and must be provided to persons served within
five(5)business days.Large print materials shall be in a minimum of eighteen(18)point
10
Exhibit B
Page 11 of 23
font size.
Informing materials will be considered provided to the individual if Contractor
does one or more of the following:
i. Mails a printed copy of the information to the persons served's mailing
address before the individual receives their first specialty mental health
service;
ii. Mails a printed copy of the information upon the individual's request to
their mailing address;
iii. Provides the information by email after obtaining the agreement of the
person served to receive the information by email;
iv. Posts the information on the Contractor's website and advises the
person served in paper or electronic form that the information is
available on the internet and includes applicable internet addresses,
provided that individuals with disabilities who cannot access this
information online are provided auxiliary aids and services upon request
and at no cost;or,
v. Provides the information by any other method that can reasonably be
expected to result in the person served receiving that information.If
Contractor provides informing materials in person,when the individual
first receives specialty mental health services,the date and method of
delivery shall be documented in the file of the person served.
g. Provider Directory.Contractor must follow the County's provider directory policy, in
compliance with MHSUDS IN 18-020.
Contractor must make available to persons served,in paper form upon request
and electronic form,specified information about the County provider network as per 42
C.F.R.§438.10(h).The most current provider directory is electronically available on the
County website and is updated by the County no later than thirty(30)calendar days
after information is received to update provider information.A paper provider directory
must be updated at least monthly as set forth in 42 C.F.R.§438.10(h)(3)(i).
Any changes to information published in the provider directory must be
reported to the County within two(2)weeks of the change.
11
Exhibit B
Page 12 of 23
Contractor will only need to report changes/updates to the provider directory
for licensed,waivered,or registered mental health providers.
III. Assurances
Certification of Non-exclusion or Suspension from Participation in a Federal Health Care
Program.
a. In entering into this Agreement,Contractor certifies that it is not excluded from
participation in Federal Health Care Programs under either Section 1128 or 1128A of the
Social Security Act. Failure to so certify will render all provisions of this Agreement null
and void and may result in the immediate termination of this Agreement.
b. In entering into this Agreement,Contractor certifies,that the Contractor does not
employ or subcontract with providers or have other relationships with providers
excluded from participation in Federal Health Care Programs,including Medi-
Cal/Medicaid or procurement activities,as set forth in 42 C.F.R.§438.610.Contractor
shall conduct initial and monthly exclusion and suspension searches of the following
databases and provide evidence of these completed searches when requested by
County, DHCS or the US Department of Health and Human Services(DHHS):
i. www.oig.hhs.gov/exclusions-Office of Inspector General's List of Excluded
Individuals/Entities(LEIE)Federal Exclusions
ii, www.sam.gov/content/exclusions -General Service Administration(GSA)
Exclusions Extract
iii. www.Medi-Cal.ca.gov-Suspended&Ineligible Provider List
iv, https://nppes.cros.iihs.gov/#/-National Plan and Provider Enumeration System
(NPPES)
v. Any other database required by DHCS or US DHHS.
c. In entering into this Agreement,Contractor certifies,that Contractor does not employ
staff or individual contractors/vendors that are on the Social Security Administration's
Death Master File. Contractor shall check the database prior to employing staff or
individual contractors/vendors and provide evidence of these completed searches when
requested by the County, DHCS or the US DHHS.
d. Contractor is required to notify County immediately if Contractor becomes aware of any
information that may indicate their(including employees/staff and individual
contractors/vendors) potential placement on an exclusions list.
12
Exhibit B
Page 13 of 23
e. Contractor shall screen and periodically revalidate all network providers in accordance
with the requirements of 42 C.F.R.,Part 455,Subparts B and E.
f. Contractor must confirm the identity and determine the exclusion status of all its
providers,as well as any person with an ownership or control interest,or who is an
agent or managing employee of the contracted agency through routine checks of federal
and state databases.This includes the Social Security Administration's Death Master File,
NPPES,the Office of Inspector General's LEIE,the Medi-Cal Suspended and Ineligible
Provider List(S&I List)as consistent with the requirements of 42 C.F.R. §455.436.
g. If Contractor finds a provider that is excluded,it must promptly notify the County as per
42 C.F.R.§438.608(a)(2),(4).The Contractor shall not certify or pay any excluded
provider with Medi-Calfunds,musttreat any payments made to an excluded provider as
an overpayment,and any such inappropriate payments may be subject to recovery.
IV. Inspection and Audit Requirements
a. Internal Auditing.Contractor shall institute and conduct a Quality Assurance Process for
all services provided hereunder.
Contractor shall provide County with notification and a summary of any internal
audit exceptions and the specific corrective actions taken to sufficiently reduce the
errors that are discovered through Contractor's internal audit process.Contractor shall
provide this notification and summary to County as requested by the County.
b. Access to Records.Contractor shall provide County with access to all documentation of
services provided under this Agreement for County's use in administering this
Agreement.Contractor shall allow County,the Centers for Medicare and Medicaid
Services (CMS),the Office of the Inspector General,the Controller General of the United
States,and any other authorized Federal and State agencies to evaluate performance
under this Agreement,and to inspect,evaluate,and audit any and all records,
documents,and the premises,equipment and facilities maintained by the Contractor
pertaining to such services at any time and as otherwise required under this Agreement.
V. Right to Monitor
a. Right to Monitor.County or any subdivision or appointee thereof,and the State of
California or any subdivision or appointee thereof, including the Auditor General,shall
have absolute right to review and audit all records, books,papers,documents,corporate
13
Exhibit B
Page 14 of 23
minutes,financial records,staff information,records of persons served,other pertinent
items as requested,and shall have absolute right to monitor the performance of
Contractor in the delivery of services provided under this Agreement. Full cooperation
shall be given by the Contractor in any auditing or monitoring conducted,according to
this agreement.
b. Accessibility.Contractor shall make all of its premises, physical facilities,equipment,
books,records,documents,agreements,computers,or other electronic systems
pertaining to Medi-Cal enrollees, Med i-Cal-related activities,services, and activities
furnished under the terms of this Agreement,or determinations of amounts payable
available at any time for inspection,examination,or copying by County,the State of
California or any subdivision or appointee thereof,CMS,U.S. Department of Health and
Human Services(HHS)Office of Inspector General,the United States Controller General
or their designees,and other authorized federal and state agencies.This audit right will
exist for at least ten(10)years from the final date of the Agreement period or in the
event the Contractor has been notified that an audit or investigation of this Agreement
has commenced,until such time as the matter under audit or investigation has been
resolved,including the exhaustion of all legal remedies, whichever is later (42 CFR
§438.230(c)(3)(I)-(ii)).
The County,DHCS,CMS,or the HHS Office of Inspector General may inspect,
evaluate,and audit the Contractor at any time if there is a reasonable possibility of fraud
or similar risk.The Department's inspection shall occur at the Contractor's place of
business, premises,or physical facilities (42 CFR§438.230(c)(3)(iv))
c. Cooperation.Contractorshall cooperate with County in the implementation,monitoring
and evaluation of this Agreement and comply with any and all reporting requirements
established by County.Should County identify an issue or receive notification of a
complaint or potential/actual/suspected violation of requirements,County may audit,
monitor,and/or request information from Contractor to ensure compliance with laws,
regulations,and requirements,as applicable.
d. Probationary Status.County reserves the right to place Contractor on probationary
status,as referenced in the Probationary Status Article,should Contractor fail to meet
performance requirements;including,but not limited to violations such as failure to
report incidents and changes as contractually required,failure to correct issues,
14
Exhibit B
Page 15 of 23
inappropriate invoicing,untimely and inaccurate data entry,not meeting performance
outcomes expectations,and violations issued directly from the State.Additionally,
Contractor may be subject to Probationary Status or termination if agreement
monitoring and auditing corrective actions are not resolved within specified timeframes.
e. Record Retention.Contractor shall retain all records and documents originated or
prepared pursuant to Contractor's performance under this Agreement,including
grievance and appeal records,and the data, information and documentation specified in
42 CFR parts 438.604,438.606,438.608,and 438.610 for a period of no less than ten
(10)years from the term end date of this Agreement or until such time as the matter
under audit or investigation has been resolved. Records and documents include but are
not limited to all physical and electronic records and documents originated or prepared
pursuant to Contractor's or subcontractor's performance under this Agreement including
working papers, reports,financial records and documents of account,records of persons
served,prescription files,subcontracts,and any other documentation pertaining to
covered services and other related services for persons served.
f. Facilities and Assistance.Contractor shall provide all reasonable facilities and assistance
for the safety and convenience of the County's representatives in the performance of
their duties.All inspections and evaluations shall be performed in such a manner that
will not unduly delay the work of Contractor.
g. County Discretion to Revoke.County has the discretion to revoke full or partial
provisions of the Agreement,delegated activities or obligations,or application of other
remedies permitted by state or federal law when the County or DHCS determines
Contractor has not performed satisfactorily.
h. Site Inspection.Without limiting any other provision related to inspections or audits
otherwise set forth in this Agreement,Contractor shall permit authorized County,state,
and/or federal agency(ies),through any authorized representative,the right to inspect
or otherwise evaluate the work performed or being performed hereunder including
subcontract support activities and the premises which it is being performed.Contractor
shall provide all reasonable assistance for the safety and convenience of the authorized
representative in the performance of their duties.All inspections and evaluations shall
be made in a manner that will not unduly delay the work of the Contractor.
V1. Complaint Logs and Grievances
is
Exhibit B
Page 16 of 23
a. Documentation.Contractor shall log complaints and the disposition of all complaints
from a person served or their family.Contractor shall provide a copy of the detailed
complaint log entries concerning County-sponsored persons served to County at
monthly intervals by the tenth(loth)day of the following month,in a format that is
mutually agreed upon.Contractor shall allow persons served or their representative to
file a grievance either orally,or in writing at any time with the Behavioral Health Plan. In
the event Contractor is notified by a person served or their representative of a
discrimination grievance,Contractor shall report discrimination grievances to the County
within twenty-four(24)hours.The Contractor shall not require a person served or their
representative to file a Discrimination Grievance with the County before filing the
complaint directly with the DHCS Office of Civil Rights and the U.S. Health and Human
Services Office for Civil Rights.
b. Rights of Persons Served.Contractor shall comply with applicable laws and regulations
relating to patients' rights,including but not limited to Wel.&Inst.Code 5325,Cal.Code
Regs.,tit.9,sections 862 through 868,and 42 CFR§438.100.The Contractor shall
ensure that its subcontractors comply with all applicable patients' rights laws and
regulations.
c. Incident Reporting.Contractor shall file an incident report for all incidents involving
persons served,following County DBH's Incident Reporting protocol.
VII. Compliance Requirements
a. Internal Monitoring and Auditing
L Contractor shall be responsible for conducting internal monitoring and auditing
of its agency. Internal monitoring and auditing include,but are not limited to
billing practices,licensure/certification verification and adherence to County,
State and Federal regulations.
1. Contractor shall not submit false,fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind.
2. Contractor shall bill only for those eligible services actually rendered
which are also fully documented.
3. Contractor shall ensure all employees/service providers maintain
current licensu re/certifi catio n/regist ratio n/wa iver status as required by
16
Exhibit B
Page 17 of 23
the respective licensing/certification Board,applicable governing State
agency(ies)and Title 9 of the California Code of Regulations.
ii. Should Contractor identify improper procedures,actions or circumstances,
including fraud/waste/abuse and/or systemic issue(s),Contractor shall take
prompt steps to correct said problem(s).Contractor shall report to DBH any
overpayments discovered as a result of such problems no later than five(5)
business days from the date of discovery,with the appropriate documentation,
and a thorough explanation of the reason for the overpayment. Prompt
mitigation,corrective action and reporting shall be in accordance with the DBH
Overpayment Policy and PPG-Prevention,Detection,Correction of Fraud,Waste
and Abuse which will be provided to Contractor at its request.
b. Compliance Program
L The County DBH has established a Compliance Office for purposes of ensuring
adherence to all standards,rules and regulations related to the provision of
services and expenditure of funds in Federal and State health care programs.
Contractor shall either adopt DBH's Compliance Plan/Program or establish its
own Compliance Plan/Program and provide documentation to County DBH to
evaluate whether the Program is consistent with the elements of a Compliance
Program as recommended by the United States Department of Health and
Human Services,Office of Inspector General.
ii. Contractor's Compliance Program must include the following elements:
1. Designation of a compliance officer who reports directly to the Chief
Executive Officer and the Contactor's Board of Directors and compliance
committee comprised of senior management who are charged with
overseeing the Contractor's compliance program and compliance with
the requirements of this account.The committee shall be accountable
to the Contractor's Board of Directors.
iii. Policies and Procedures
1. Contractor shall have written policies and procedures that articulate the
Contractor's commitment to comply with all applicable Federal and
State standards.Contractor shall adhere to applicable County DBH
,.7
Exhibit B
Page 18 of 23
Policies and Procedures relating to the Compliance Program or develop
its own compliance-related policies and procedures.
iv. Contractor shall establish and implement procedures and a system with
dedicated staff for routine internal monitoring and auditing of compliance risks,
prompt response to compliance issues as they arise,investigation of potential
compliance problems as identified in the course of self-evaluation and audits,
correction of such problems promptly and thoroughly(or coordination of
suspected criminal acts with law enforcement agencies)to reduce the potential
for recurrence, and ongoing compliance with the requirements under this
Agreement.
v. Contractor shall implement and maintain written policies for all County DBH-
funded employees,and of any contractor or agent,that provide detailed
information about the False Claims Act and other Federal and State laws,
including information about rights of employees to be protected as
whistleblowers.
vi. Contractor shall maintain documentation,verification or acknowledgement that
the Contractor's employees,subcontractors,interns,volunteers,and members
of Board of Directors are aware of these Policies and Procedures and the
Contractor's Compliance Program.
vii. Contractor shall have a Compliance Plan demonstrating the seven(7)elements
of a Compliance Plan.Contractor has the option to develop its own or adopt
County DBH's Compliance Plan.Should Contractor develop its own Plan,
Contractor shall submit the Plan prior to implementation for review and
approval to:
Fresno County DBH Compliance Office
1925 E. Dakota Ave.Ste A
Fresno,California 93726
Or send via email to:DBHCompliance@fresnocountyca.gov
c. Program Integrity Requirements
i. Asa condition for receiving payment under a Medi-Cal managed care program,
Contractor shall comply with the provisions of Title 42 CFR Sections 438.604,
438,606,438.608 and 438.610.Contractor must have administrative and
18
Exhibit B
Page 19 of 23
management processes or procedures,including a mandatory compliance plan,
that are designed to detect and prevent fraud,waste or abuse.
ii. If Contractor identifies an issue or receives notification of a complaint
concerning an incident of possible fraud,waste,or abuse,Contractor shall
immediately notify County DBH;conduct an internal investigation to determine
the validity of the issue/complaint;and develop and implement corrective
action if needed.
iii. If Contractor's internal investigation concludes that fraud or abuse has occurred
or is suspected,the issue if egregious,or beyond the scope of the Contractor's
ability to pursue,the Contractor shall immediately report to the County DBH
Compliance Office for investigation,review and/or disposition.
iv. Contractor shall immediately report to DBH any overpayments identified or
recovered,specifying the overpayments due to potential fraud.
v. Contractor shall immediately report any information about changes in the
circumstances of the person served that may affect the person's eligibility,
including changes in the residence of the person served or the death of the
individual.
vi. Contractor shall immediately report any information about a change in
Contractor's or Contractor's staff circumstances that may affect eligibility to
participate in the behavioral health program.
vii. Contractor understands DBH,CMS,or the HHS Inspector General may inspect,
evaluate,and audit the Contractor at any time if there is a reasonable possibility
of fraud or similar risk.
d. Code of Conduct
L Contractor shall take precautions to ensure that claims are prepared and
submitted accurately,timely and are consistent with all applicable laws,
regulations,rules or guidelines.
ii. Contractor shall ensure that no false,fraudulent, inaccurate or fictitious claims
for payment or reimbursement of any kind are submitted.
iii. Contractor shall bill only for eligible services actually rendered and fully
documented.
i9
Exhibit B
Page 20 of 23
iv. Contractor shall act promptly to investigate and correct problems if errors in
claims or billing are discovered.
v. Contractor shall comply with County's Code of Conduct and Ethics and the
County's Compliance Program in accordance with Exhibit B—Attachment H to
this Agreement,titled "Fresno County Mental Health Compliance Program".
e. Network Adequacy.Contractor shall ensure that all services covered under this
Agreement are available and accessible to persons served in a timely manner and in
accordance with the network adequacy standards required by regulation. (42 C.F.R.
§438.206(a),(c)).
Contractor shall submit,when requested by County and in a manner and format
determined by the County,network adequacy certification information to the County,
utilizing a provided template or other designated format.
Contractor shall submit updated network adequacy information to the County
any time there has been a significant change that would affect the adequacy and
capacity of services.
To the extent possible and appropriately consistent with CCR,Title 9,§1830.225
and 42 C.F.R.§438.3 (1),the Contractor shall provide a person served the ability to
choose the person providing services to them.
Vlll. Federal and State Laws.
a. 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(PHI) as required by law.
County and Contractor acknowledge that the exchange of PHI 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 PHI
pursuant to this 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 an agreement containing specific requirements prior to the
20
Exhibit B
Page 21 of 23
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.
b. Contractor and County mutually agree to maintain the confidentiality of records and
information of persons served in compliance with all applicable State and Federal statutes
and regulations, including, but not limited to, HIPAA,California Confidentiality of Medical
Information Act(CMIA),and California Welfare and Institutions Code section 5328.The
Parties shall inform all of their employees and agents who perform services under this
Agreement of the confidentiality provisions of all applicable statutes.
c. The County is a"Covered Entity,"and the Contractor is a"Business Associate,"as these
terms are defined by 45 CFR 160.103.As a Business Associate,Contractor agrees to comply
with the terms of Exhibit B—Attachment 1 to this Agreement,titled"Health Insurance
Portability and Accountability Act(HIPAA)Business Associate Agreement".
IX. Quality Management Requirements.
a. Reporting.
i. Outcomes Reports.Contractor shall complete Outcomes Reports in the format
set by County.Outcomes reports shall be submitted to County's DBH for review
within thirty(30)days of the end of each quarter.
b. Quality Improvement Activities and Participation.Contractor shall comply with the
County's ongoing comprehensive Quality Assessment and Performance Improvement
(QAPI)Program(42 CFR.§438.330(a))and work with the County to improve established
outcomes by following structural and operational processes and activities that are
consistent with current practice standards.
Contractor shall participate in quality improvement(QI)activities,including
clinical and non-clinical performance improvement projects(PIPs),as requested by the
County in relation to State and Federal requirements and responsibilities,to improve
health outcomes and individuals'satisfaction with services overtime.Other QI activities
include quality assurance,collection and submission of performance measures specified
by the County, mechanisms to detect both underutilization and overutilization of
services, individual and system outcomes, utilization management,utilization review,
provider appeals,provider credentialing and recredentialing, and person served
grievances.Contractor shall measure,monitor,and annually report to the County on its
performance.
21
Exhibit B
Page 22 of 23
X. Cultural and Linguistic Competency
a. General.All services,policies and procedures shall be culturally and linguistically
appropriate.Contractor shall participate in the implementation of the most recent
Cultural Competency Plan for the County and shall adhere to all Culturally and
Linguistically Appropriate Service(CLAS)standards and requirements as set forth in
Exhibit B—Attachment 1 to this Agreement,titled "National Standards on Culturally and
Linguistically Appropriate Services". Contractor shall participate in the County's efforts to
promote the delivery of services in a culturally responsive and equitable manner to all
individuals,including those with limited English proficiency and diverse cultural and
ethnic backgrounds,disabilities,and regardless of gender,sexual orientation,or gender
identity including active participation in the County's Diversity, Equity and Inclusion
Committee.
b. Policies and Procedures.Contractor shall comply with requirements of policies and
procedures for ensuring access and appropriate use of trained interpreters and material
translation services for all limited and/or no English proficient persons served,including,
but not limited to,assessing the cultural and linguistic needs of the person served,
training of staff on the policies and procedures,and monitoring its language assistance
program.Contractor's policies and procedures shall ensure compliance of any
subcontracted providers with these requirements.
c. Interpreter Services.Contractor shall notify its persons served that oral interpretation is
available for any language and written translation is available in prevalent languages and
that auxiliary aids and services are available upon request,at no cost and in a timely
manner for limited and/or no English proficient persons served and/or persons served
with disabilities. Contractor shall avoid relying on an adult or minor child accompanying
the person served to interpret or facilitate communication;however,if the person
refuses language assistance services,the Contractor must document the offer,refusal,
and justification in the file of the person served.
d. Interpreter Qualifications.Contractor shall ensure that employees,agents,
subcontractors,and/or partners who interpret or translate for a person served or who
directly communicate with a person in a language other than English(1)have completed
annual training provided by County at no cost to Contractor;(2)have demonstrated
proficiency in the language of the person served;(3)can effectively communicate any
22
Exhibit B
Page 23 of 23
specialized terms and concepts specific to Contractor's services;and(4)adheres to
generally accepted interpreter ethic principles. As requested by County,Contractor shall
identify all who interpret for or provide direct communication to any program person
served in a language other than English and identify when the Contractor last monitored
the interpreter for language competence.
e. CLAS Standards.Contractor shall submit to County for approval,within ninety(90)days
from date of contract execution,Contractor's plan to address all fifteen(15) National
Standards for Culturally and Linguistically Appropriate Service(CLAS),as published by
the Office of Minority Health and as set forth in Exhibit B—Attachment 1,"National
Standards on Culturally and Linguistically Appropriate Services".As the CLAS standards
are updated,Contractor's plan must be updated accordingly.As requested by County,
Contractor shall be responsible for conducting an annual CLAS self-assessment and
providing the results of the self-assessment to the County.The annual CLAS self-
assessment instruments shall be reviewed by the County and revised as necessary to
meet the approval of the County.
f. Training Requirements.Cultural responsiveness training for Contractor staff should be
substantively integrated into health professions education and training at all levels,both
academically and functionally,including core curriculum,professional licensure,and
continuing professional development programs.As requested by County,Contractor
shall report on the completion of cultural responsiveness trainings to ensure direct
service providers are completing annual cultural responsiveness training.
g. Continuing Cultural Responsiveness.Contractor shall create and sustain a forum that
includes staff at all agency levels to discuss cultural responsiveness.Contractor shall
designate a representative from Contractor's team to attend County's Diversity,Equity
and Inclusion Committee.
G J
Exhibit B -Attachment A
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
D8H VISION:
Health and well-being for our community.
08H MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce.The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
Exhibit B-Attachment A
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2, Principle Two-Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on,the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four - inclusive of Natural Supports
a 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
a Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five -Clinical Significance and Evidence Based Practices ON
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 values and preferences of those we serve
2
rev 01-02-2020
Exhibit B -Attachment A
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
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 person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
3
rev 01.02-2020
Exhibit B -Attachment A
Page 4 of 4
Fresno County Department of Behavioral Wealth
Guiding Principles of Care Delivery
a 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
10. Principle Ten- Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion Illness and Harm Prevention and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
Exhibit 8 —Attachment B
Page 1of2
FRESN0>COUNTY BEHAVIORAL HEALTH PLAN
RIGHTS OF PERSON SERVED
Grievances
Fresno County Behavioral Health Plan (BHP)provides beneficiaries witha grievanceand
appeal process and an expedited appeal process to resolve grievances and disputes at the
earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the BHP and its fee-for-service
providers give verbal and written information bmK8edi-Ca| beneficiaries regarding the following:
^ How bo access specialty mental health services
^ How b»file a grievance about services
^ How bz file for e State Fair Hearing
The BHP has developed a Consumer Guide, a beneficiary rights poster, a grievance form, an
appeal form, and Request for Change of Provider Form.All of these beneficiary atnha(s must
be posted in prominent locations where yWodi-Cal baneho|ohaa receive outpatient specialty
mental health services, including the wafting rooms mf providers'cfficmoofservice.
Please nob* that all fee-for-service providers and contract agencies are required to give the
individuals served copies of all current beneficiary information annually at the time their
treatment plans are updated and etintake.
Beneficiaries have the right to use the grievanceand/or appeal process without any penalty,
change in mental health aen/ioeo, or any form of retaliation.All Mmdi-Cal beneficiaries can file
on appeal mr state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written request.
Forms can be sent tm the following address:
Fresno County Behavioral Health Plan
P.<]. Box 450}3
Fresno, CA93718-988O
(800)8 37 more information)
Provider Problem Resolution and Appeals Process
The BHP uses e simple, informal procedure in identifying and resolvingprovider concerns and
problems regarding payment authorization imeuee, other complaints and concerns.
Informal provider problem resolution process—the provider mayfirst speak tomFraonoCounb/
Department of Behavioral Health (DBH)team member regarding his or her complaint or
concern.
The DBH Team Member will attempt to settle the complaint or concern with the provider. |fthe
attempt io unsuccessful and the provider chooses ho forego the informal grievance process,the
provider will be advised bofile a written complaint to the BHP address (listed above\.
ExNbbB-AttachmedB
Page 2nf2
Formal provider appea/Process—the provider has the right to access the provider
process at any time before, during, or after the provider problem resolution process has begun,
when the complaint concerns a denied or modified request for BHP payment authorization, or
the process or payment ofo provider's claim tV the BHP.
Payment authorization issues—the providermayap |a denied or modified request for
payment authorization or a dispute with the BHP regarding the processing or payment of a
provider's claim to the BHP.The vvhtban appeal nnustbesubrnitted0othe8HPvviUlin0O
calendar days of the date of the receipt of the non-approval ofpayment.
The BHP shall have 6O calendar days hnmibanaceiotofthemppeal to inform the provider >n
writing of the decision, including a statement of the reasons for the decision that addresses
each issue raised by the provider, and any acbon required by the provider to implement the
decision.
|f the appeal concerns a denial or modification of payment authorization request, the BHP
utilizes o OBH Team Member who was not involved in the initial denial or modification decision
to determine the appeal decision.
If the DBH Team Member reverses the appealed decision, the provider will be asked to submit a
revised request for payment within 3O calendar days ofreceipt of the decision.
Other comp
jaints—if there are other issues or complaints,which are not related to payment
authorization issues, providers are encouraged to send a letter of complaint to the BHP.The
provider will receive a written response from the BHP within 60 calendar days of receipt of the
complaint. The decision rendered buy the BHP imfinal.
Exhibit 8—Attachment C
Page of
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served.All standards must be addressed in the record ofeach person served; however, there is
no requirement that the record have specific document orsection addressing these topics. All
nnedioo| records shall be maintained fora minimum nf 10 years from the deba of the end of the
Agreement.
A. Aamamomnento
1.The following areas will be included as a part of a comprehensive record for each
person served:
* Presenting pu)b|ernm, including impairments infunction, and current mental
status exam.
* Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement ifrelevant
* Behavioral health history including mental health histury, substance use/abuse,
and previous services
* Medical history including phvoino| health omnd0ona, nnedinmtiono, and
developmental history
* Peyoh0000ia|factors including fonni|y. social and life circumstances, cultural
considerations
* Sbgnodho, hokm, and protective factors, including safety planning
p Clinical summary,treatment recommendations, and level of care determination
including diagnostic and clinical impression with adiagnosis
• The assessment mhmU include a typed orlegibly printed nomn*, signature of the
service provider and date of signature.
3' Timeliness/Frequency Standard for Assessment
° The time period bo complete aninitial assessment and subsequent assessments
forSW4H8 |auptoclinical discretion.
^ Assessments shall be completed within a reasonable time and inaccordance
with generally accepted standards ofpractice.
B. Problem list
The use of a Problem List has largely replaced the use of treatment plans and is
therefore required tobepart of the record for each person served. The problem list shall
be updated on an ongoing basis to reflect the current presentation of the person in care.
The problem list shall inc|udm, but is not limited to, the following:
* Diagnoses identified bvm provider acting within their scope of practice
* Problems identified bxa provider acting within their scope ofpractice
p Problems orillnesses identified bv the person in care and/or significant support
person ifany
° The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
R°vD4/2O23 C-1
Exhibit 8—Attachment C
Page 2of3
C.Treatment and Care Plan Requirements
1.Targeted Case Management
* Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives ofthe plan and the medical, aoc|m|, educational, and other
services needed bv the person |ncare
° Identifies a course of action to respond b»the assessed needs mf the person in
care
* Includes development ofa transition plan when the person in care has achieved
the goals of the care plan
° Peer support services must be based onan approved care plan
° Must be provided inm narrative format in the pmroon'u progress notes
• Updated mt least annually
2. Services requiring Treatments Plans
* Therapeutic Behavioral Services(TB8)
* Must have specific observable and/or opeoific quantifiable goals
• Must identify the proposed h/pe(o)nfintervention
* Must besigned (or electronic equivalent)by:
> the person providing the aemin (e) or
> aponamn representing etaamn or program providing |oea. or
> a person representing the MHP providing services when the plan for a person
served is used to establish that the services are provided under the direction
ofan approved category of staff, and if the below staff are not the approved
> a physician
> a licensed/"vvmivene1''psychologist
> a licensed/^mesoniotm^ apoia| worker
> aUoanged/ iotnnxd/nlanioge and family therapist nr
> aragistared nurse
* In addition,
> Plans for each person served will be consistent with the diagnosis, and the
focus of intervention will be consistent with the plan goals for the person served,
and there will bm documentation that the person served participated inand
agreed with the plan. Examples of the documentation include, but are not
limited to, reference to the participation by the person served and agreement by
the person oan/ed in the body of the plan,the signature of the person served on
the plan, ore description of the participation by the person served and
agreement by the person served in progress notes.
}~ The signature on the plan by the person served will be used mo the means bv
which the Contractor documents the participation uf the person served. When
the signature of the person served is required on the plan for the person served
and the person served refuses or is unavailable for signature, the plan for the
person served o|on will include a written explanation of the refusal or
unavailability.
ExhibitB—Attachmon C
Page 3of3
> The Contractor will give o copy of the plan for the person served to the person
served onrequest.
D. Progress Notes
1. Providers shall create progress notes for the provision of all SK0H8. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. Progress notes shall include:
* The type of service rendered.
* A narrative describing the service, including how the service addressed the
beneficiary's behavioral health need (e.g.' aynnobon}, oondition, die8nueio, and/or
risk factors).
w The date that the service was provided tothe beneficiary.
w Duration mf the service, including travel and documentation time.
• Location of the beneficiary ed the time of receiving the service.
• A typed or legibly printed name, signature of the service provider and date of
signature.
v |CO1Ocode
* Current Procedural Terminology (CPT)or Healthcare Common Procedure
Coding System /HCPCS\code.
w Next steps including, buinotUnnitadto. olannedamUonobaoabvtheprmvidermrbv
the beneficiary, collaboration with the benefk:iary, collaboration with other
prmvider(n)and any update bz the problem list as appropriate.
2. Timeliness/Frequency of Progress Notes
* Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis amrvioes, which ohm|| be completed within 24 hours.
~ A note must be completed for every service contact
RovO4/2O2a C-3
CO Exhibit B—Attachment D
Page 1 of 7
0 o Fresno County Department of Behavioral Health
lm_l� Contractor Training Requirements Reference Guide
Contractor must consider and include sufficient time and funds for required trainings.
This Training Requirements Reference Guide identifies the required trainings that
Contractor is responsible for offering to all employees, volunteers, interns, and student
trainees of Contractor or its subcontractors who, in each case, are expected to perform
professional services while contracted by County. There are some trainings offered by
the County at no cost to Contractor, and those are identified within this document. The
remaining trainings are the responsibility of Contractor to provide and cover associated
costs. The expectations for Contractor staff attending County-offered trainings are
included within this guide.
I. Trainin-gs Provided by County DBH
DBH Annual General Compliance Refresher Training
Duration: 60 Minutes
General Compliance Refresher Training is an annual requirement for all employees,
contractors, volunteers, interns, and student trainees working in behavioral health
programs who are in their second or more years of service.This training is a
modified version of the self-paced General Compliance Training and Contractor shall
be assigned this training in Quarter 4 of each calendar year.
An announcement from the DBH Compliance Program, DBH Staff Development, or
your Contract Analyst regarding this training will be made prior to the assignment of
this training. Contractor will have the option to complete the training either through
the Relias Learning Management System (LMS) or through Department of
Behavioral Health's website. Contractors are given approximately a 60-day window
to complete this training from the training announcement date.
Mental Health Documentation & Billing Training
Duration: 1 Hour 30 Minutes
All contracted provider organization employees, subcontractors, volunteers, interns,
and students providing services are to complete Documentation & Billing Training
within 30 business days of hire or contract effective date. If contract effective date is
a renewal, existing staff will not need to retake the training if they have already
completed it with their agency. Contractor shall be required to complete this training
as a prerequisite for providing direct services, processing billing, conducting quality
assurance services, clinical supervision,or other similar services under this
agreement. Contractor is expected to contact their assigned contract analysts if they
are unsure about training requirements for any specific classifications.
Training for Providers of Specialty Mental Health Service
Exhibit B—Attachment D
Page 2 of 7
Documentation & Billing is a training provided at least one time per month.
Registration is completed via Eventhrite for each session; links to register can be
found on the webpage below:
https:/twww.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComplianceDoc-Billing-Trainin-g
The expectation is that Contractor will register their County-funded employees at
least one week in advance of the training date. For any registration issues or other
questions about the training, they can contact
DBH StaffDevelopment(cDfresnocountyea.go .
DBH New Hire General Compliance Training
Duration:40 Minutes
Contractor shall have their employees, subcontractors, volunteers, intems, and
student trainees who, in each case,are expected to provide services under this
Agreement with County, complete the New Hire Compliance Training within 30
business days of hire or effective date of this Agreement, per Compliance Exhibit B,
Attachment H. If contract effective date is for a renewed agreement, existing staff will
not need to retake the training if the staff member has already completed the training
within the same calendar year as the effective date of the renewed agreement.
New Hire General Compliance is self-paced and can be completed either through
Relias Leaming Management System(LMS) or on the Department of Behavioral
Health's website.Additional information on how to complete the training can be
found on the following webpage:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Care-
Services/Be havi oral-H ealth-Compl i ance/N ew-H i re-Ge neral-Compl iance-Tra in i nq
Contractor shall require its County-funded employees and subcontractors to
complete this compliance training.After completion of this training, participants must
sign the Contractor Acknowledgment and Agreement form and return this form to the
DBH Compliance officer or designee. For additional questions about the training,
please contact your Contract Analyst or the DBH Compliance team at:
DBHCompliance(cb.fi-esnocountVca.gov.
Invoicing Training
Duration:To be Confirmed
Contractor shall be responsible for collection and managing data in a manner to be
determined by the California Department of Health Care Services (DHCS)and
Mental Health Plan in accordance with applicable rules and regulations. DBH's
Electronic Health Record (EHR)is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. Contractor's staff
Exhibit B—Attachment D
Page 3 of 7
responsible for checking Medi-Cal eligibility shall attend DBH's Finance Division
training on equipment reporting for assets, intangible and sensitive minor assets,
DBH's EHR system and related cost reporting.
Notice of Adverse Benefit Determination (NOABD)Training
Duration: 8 Minutes
A Notice of Adverse Benefit Determination (NOABD)is a formal mechanism for
notifying a person served of an adverse benefit determination in writing (e.g., denial
or limited authorization of a requested service, denial of payment for a service, or
failure to provide services in a timely manner).
This training outlines usage practices,timelines, and examples for each type of
NOABD. Contractor can find the training in the Announcements section on the
following webpage:hftps://www.fresnocountVca..qov/Departments/Behavioral-
Health/Providers/Contract-Provider-Resources/Notifications-Associated-Documents.
Contractor shall be responsible for completing this training within 60 days of hire or
contract effective date.
SmartCare Full Electronic Health Record New User Mental Health Training*
Duration:4 Hours
This is a basic training for new users who are direct clinical service providers
employed by Contractors that will be using SmartCare as their full EHR. Participants
will have the opportunity to apply CalMHSA:s SmartCare training materials and
review relevant SmartCare workflows, clinical documents, and forms.
Training dates and reference material can be found on the following link:
https://www.fresnocountyea.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DBH.
SmartCare Electronic Health Record New User Front Desk Training*
Duration:4 Hours
This is a basic training for new users who are employed by Contractors that will be
using SmartCare as their full EHR. Participants will have the opportunity to review
how to navigate SmartCare, perform coverage information set up, error corrections,
set up Appointments, and basic troubleshooting of common issues.
Training dates and reference material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
Exhibit B—Attachment D
Page 4 of 7
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DOH.
SmartCare Lite Electronic Health Record Mental Health Training* (Provider
Entry Only Training)
Duration:Time may vary
This training is for select Contractors that do not intend to fully use County DBH's
SmartCare EHR system but rather only some functions, otherwise referred to as a
"SmartCare Lite User". This training is intended to supplement and reinforce the
CalMHSA SmartCare trainings, user guide, and workflow information SmartCare Lite
Users.This supplemental training/technical support is offered by the DBH Planning
and Quality Management Division's Quality Improvement Team upon request.
Required prerequisite material can be found on the following link:
https://www fresnocountyca gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DOH.
11. Trainings for Specialty MH Providers by Specialization
Mobile Crisis Services Trainings
Duration: 21 Hours
Any contracted provider providing mobile crisis services shall complete the state-
required training series. For example, the current training series is provided by the
Medi-Cal Mobile Crisis Training and Technical Assistance Center(M-TAC). This ten-
part training series is available on the DBH Relias learning management system. For
assistance with assigning the trainings, please contact
DBHRelias(-),Fresnocountyca.gov.
California Integrated Practice Child &Adolescent Needs & Strengths (CA IP
CANS)
Duration: 6 Hours 30 Minutes
The CA IP CANS is a structured assessment for identifying youth and family
actionable needs and useful strengths. It provides a framework for developing and
communicating about a shared vision and uses youth, ages 6 and youth up to age
20, and family information to inform planning, support decisions, and monitor
outcomes.
Exhibit B—Attachment D
Page 5 of 7
DBH provides this training to prepare attendees for certification testing and use of
the tool. For any questions about the training or assistance with registration, please
contact DBHStaffDevelopment(@-fresnocountyea.go .
Ill. Contractor is Responsible for Ensuring and/or Providing
These Trainings are Offered and Completed
CalAIM Behavioral Health Quality Improvement Program (BHQIP)Training
Any contracted clinical provider is required to complete the CalAIM BHQIP Modules
in CaIMHSAs web-based training system, Moodle. Providers are expected to
complete training within 60 days of beginning employment.
CalMHSAs web-based training system, https:Hmoodle.calmhsalearns.org.
Cultural Responsiveness Trainings
Duration: May vary based on Contractor's training preference
Contracted Provider Organization shall have DBH-funded providers complete annual
trainings on cultural competency, awareness, and diversity as identified by
Contractor(s), and/or via the County's eLeaming system. Contractor's DBH-funded
providers shall be appropriately trained in providing services in a culturally sensitive
manner and shall attend civil rights training as identified by Contractor's), or online
via the County's eLeaming system.
Information on annual cultural responsiveness training requirements will be provided
by the DBH Division Manager serving as Ethnic Services Manager and Diversity
Services Coordinator. Both parties are working locally and at the state level to
address the need for thorough training to improve culturally responsive care and to
meet the National Culturally and Linguistically Appropriate Services standards,while
also understanding the impact that the training hours can have on productivity in fee-
for-service programs.
For additional information, they are to contact their assigned contract analyst.
DBH is available to assist Contractor's efforts toward cultural and linguistic
responsiveness by providing the following:
• Technical assistance regarding culturally responsive training requirements.
• Mandatory cultural responsiveness training for Contractor's DBH-funded
staff if training capacity allows.
• Technical assistance for translating information into County's threshold
languages (currently Spanish and Hmong and subject to change). Selected
Contractors are responsible for securing translation services and all
associated costs.
Health Insurance Portability and Accountability Act(HIPAA) Training
Duration: May vary based on selected training
Exhibit B—Attachment D
Page 6 of 7
As a covered entity, or a business associate of a covered entity, providers shall meet
the training requirements described in the HIPAA Privacy Rule 45 CFR§
164.530(b)(1) and the HIPAA Security Rule 45 CFR § 164.308(aX5). Providers may
use their discretion to select an appropriate HIPAA training.Training shall be
completed by all DBH-funded staff within 30 days of contract execution or hire and
annually thereafter.
Language Assistance Program Training
Contractor shall be responsible for implementing policies and procedures and
training staff to ensure access and appropriate use of trained interpreters and
material translation services for all Limited English Proficient(LEP)persons served.
This includes, but is not limited to, assessing the cultural and linguistic needs of its
persons served. The vendor(s) procedures shall include ensuring compliance of any
sub-contracted providers with these requirements.
IV. Training Expectations for Contractor Employees when
Attending County-provided Training
Expectations for Attendees: -
1) Attendees are to adhere to wearing business casual attire, broadly defined as
a code of dress that blends traditional business wear with a more relaxed style
that is still professional and appropriate for an office environment, unless
specifically directed otherwise or instructed by Trainers. Attendees are
expected to dress in respectful, culturally inclusive attire.
2) Interested attendees shall register at least one week in advance of the training
date.
3) Attendees shall be expected to be ready and prepared to be engaged by the
training start time. Attendees are also expected to arrive back on time from
breaks, including lunch, and attend the training through completion.
4) Attendees who arrive 15 minutes late, or more, shall be requested to return to
their work site and their organization will be notified. Similarly, attendees may
not leave a training prior to the scheduled end time.Those who miss 15 minutes
or more of training in total throughout the day may be asked to re-enroll for a
later training date if one is available.
5) Personal use of cell phones, laptops and tablets, except for in cases of
emergency, should not be used during training and should be set to silent.Any
calls shall be taken outside of the training space.Attendees shall inform trainers
and/or Staff Development if they are expecting to be contacted for any reason;
Exhibit B—Attachment D
Page 7 of 7
this shall be done before the training begins, if possible. Other cell phone use,
such as texting, playing games or browsing the intemet shall not permitted
whiletraining is in session.If conduct is deemed disruptive to colleagues and/or
the trainer, attendees shall be asked to leave the training and return to their
work site. Organization will be notified.
6) At times, attendees shall be required to complete pre- and post-training class
assignments, as part of the learning objectives. Attendees shall be required to
complete assigned activities to receive Continuing Education Credits, and
certification, and training credit, if applicable.
7) Attendees shall be expected to complete pre- and/or post-training evaluations,
when available.
8) Attendees shall notify Staff Development with their supervisor copied at (559)
600-9680 or DBHStaffDevelopment(a).fresnocountyca.gov at the earliest
possible date if they can no longer attend a training for which they have
registered.
Use of DBH Training Facilities
Parking
Attendees shall park in undesignated stalls at DBH training sites.Any parking
restrictions shall be communicated prior to the training date or prior to the training start
time.
Use of Facilities
Attendees shall be respectful while occupying the training space, keeping it and the
surrounding area neat and clean.Attendees are encouraged to bring a reusable water
bottle but shall be cognizant of and clean any spills. If the training allows for food,
attendees shall ensure that their area is clean and dispose of any waste prior to leaving
the training space.
Exhibit 8—Attachment E
Page 1of2
OUTCOMES AND PERFORMANCE MEASUREMENTS
Throughout the process of services, RHCB will provide regularupdates hoD8H summarizing how the goals and
objectives were met through the provision of services. RHC8 shall actively participate with D8Hond any outside
consultants for performance monitoring and reporting requirements.
Access/o care: The ability of individuals to receive the right service eg the right time.
Examples include:
1. Timeliness o[ bridging prescriptions
2. Timeliness of identifying clients with amohouu mental iUneao. Co-Occurring o/SUD
3. Timeliness of accessing 8UO
4. llmu|inena between individual efommi for assessment and completion of
5. assessment; assessment to first treatment service; and first treatment service to next follow-up.
G. llme|inaao of subsequent follow-up { ita
7. Timeliness of response to sick call/health service requests
8. llme|inouo of promoting self-determination and independent functioning
A. Timeliness of accessing treatment of mental health conditions
B. Effectiveness: Objective results achieved through health care services. Examples include:
1. Effectiveness of crisis interventions
2. Effectiveness nf treatment interventions (medical and behavioral health indicators)
3. Effectiveness of discharge planning (such as percentage of clients successfully linked to County
programs, community providers, and/or other community resources after release)
4. Timely continuity of verified community pomohpUona fnrmedicm|ion(u). upon|ndividuo|'o release
5. Effectiveness of transportation coordination, upon release
C. Efficiency: The demonstration of the relationship between results and the resources used to achieve them.
Examples include:
1. Coat per individual served
2. Number of units of services per FTEbydiscipline
3. Number ufindividuals served pergeneral population
4. Comparison of numbers served against industry standards
D. Satisfaction and Compliance. The degree to which individuals, County, and other stakeholders are satisfied
with the services. Examples include:
1. Audits and other performance and Utilization nwiays of health care services and compliance with
agreement terms and conditions
2. Surveys of persons served, family members, other health care providers, and other stakeholders
The following items listed below represent program goals to be achieved by RHOB.
Effectiveness:
A. GO% of individuals will successfully in outpatient mental health or substance abuse treatment.
B. The number of unique visits to the Crisis Stabilization Unit for each individual served will be reduced by 75%.
C. The number of unique visits to the Emergency mom will be reduced by 85%for each individual served.
D. Reducing over-dooas, increasing new justice involvement, and reducing drug use by 68%.
Efficiency:
A. RHC8 will establish a baseline cost per individual served in the initial partial year.
B. RHCB will reduce cost per individual served annually thereafter.
Exhibit B—Attachment E
Page 2 of 2
Access:
A. Wait time from admission into the Lodge 2.0 to initial peer assessment by RHCB will be 72 hours or less.
B. Once an individual has moved from the"pre-contemplative"stage and determined that they are interested in
seeking mental-health services, a mental-health assessment by RHCB will be done within 48 hours.
Satisfaction:
A. 85% of individuals served will report"Satisfied"or"Very Satisfied"with services on RHCB's individuals served
exit survey.
B. 85% of the families of individuals served that are actively involved in the lives of individuals served will rate
"Significant"or"Critical"in response to Importance of The Lodge in your loved one accessing ongoing services.
During the term of this Agreement, additional data collection opportunities may be identified and implemented to
support the Mental Health Services Act(MHSA)Innovation Component research aspects of The Lodge program.
DBH and RHCB will review additional outcomes, MHSA requirements and CARF standards to establish any
further agreed upon outcomes to be tracked. RHCB will actively collaborate with a third-party consultant to
develop and refine data collection and reporting processes in order to ensure compliance with MHSA Innovation
Component requirements.
ADDITIONAL PERFORMANCE MONITORING REQUIREMENTS
RHCB shall:
A. Be required to comply with any requirements as related to performance outcomes, quality of life and/or
customer satisfaction as a Medi-Cal Organizational Provider..
B. Be required to comply with all State regulations regarding State Performance Outcomes measurement
requirements and participate in the outcomes measurement process as required by DBH.
C. Participate in performance outcomes throughout each term of this Agreement. DBH will notify RHCB
when its participation is required. The performance outcome measurement process will not be limited to
survey instruments but will also include, as appropriate, individual and staff interviews, chart reviews, and
other methods of obtaining needed information.
2
Exhibit B—Attachment F
Page 1 of 17
STATE BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Behavioral Health Plan
(directly or through contract)providing Short-Doyle/Meth-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq;California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code;Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of,or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
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.
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractor can show clear and convincing evidence to the
1
ExhibitB—AttachmentF
Page 3of17
satisfaction of County that funds ided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent mfC ' Department of Behavioral Health Director,
or designee, no person shall bm employed bv Contractor who|o related bv
blood mr marriage to, or who iom member of the Board of Directors oran
officer cfContractor.
5^
Contractor shall comply laws and regulations, including but not
limited to, laxvo, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. Contractor has, unless exempted, complied
with the non-discrimination program requirements. Code§ 12S98(a-f)and
CCR. T0e 2. Section 111 O2\(Not applicable to public mrdit|mm.)
2' DRUG-FREE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free VVorkolaoaAotof1SS0ondvviU9novideedruQ-
fnaexvod«p|acebvtakingthafo||mwingoctionn:
A. Publish a statement notifying empl eeS1hatuD|avvfu| nlsnufactuoe.
diathbution, dimpanoabon, possession or use ofocontrolled substance is
prohibited and specifying actions tobe taken against employees for
violations.
b. Establish m Drug-Free Awareness Program tm inform employees about:
1 the dangers of drug abuse inthe workplace;
2\ the pensnn'oororgonbsation'n policy of maintaining adrug-free
workplace;
3\ any available counseling, rehabilitation and employee assistance
programs; and,
4\ penaltiesthat may be imposed upon employees for drug abuse
C. Every employee who works on this Agreement will:
1\ receive o copy of the company's drug-fram workplace policy
statement; and,
2\ agree to abide bv the terms of the company's statement oma
condition of employment on this Agreement.
Failure b)comply with these requirements may result insuspension of payments
under this Agreement or termination of this Agreement or both andContractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractor has made
false certif ication, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code§8350 et seq.)
2
ExhibitB-AttachmmntF
Page 3of17
-'
NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor
certifies that no more than one(1)final unappealable finding of contempt of court
by a Federal court has been issued against Contractor within the immediately
preceding two (2)year period because of Contractor's failure to comply with an
order of a Federal court,which orders Contractor to comply with an order of the
National Labor Relations Board. (Pub. Contract Code§10296) (Not applicable to
public entities.)
4. CONTRACTS FOR LEGAL SERVICES t5O,OOO OR MORE-PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6O72ufthe Business and Professions Code, effective
January 1. 2O03.
Contractor agrees to make effort ho provide a minimum number of
hours of pro bono legal services during each year of the contract equal tothe
lessor of3O multiplied number of full time attorneys in the finn'o offices|n
the State, with the number uf hours prorated onen actual day basis for any
contract period ofless than a full year or1O94of its contract with the State.
Failure bomake a good faith effort may be cause for non-renewal ofmstate
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. Contractor hereby d | that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning Qf Public Contract Code Section 10388 and 1O285.1. and |seligible to
contract with the State cfCalifornia.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering ofapparel,
garments or corresponding anoesmVhmw. orUleprocunymnentof
equipmmant, materials, or supplies, other than procurement related toa
public works contract, declare under penaltyof perjury that noapparel,
gannanba or correspondingaccessories, equipment, materials, or
supplies furnished to the state pursuant&o the contract have been
laundered or produced in whole or in part by sweatshop kabor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, ur with the
benefit of sweatshop labor,forced labor,convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. Contractor further declares under penalty of
perjury that they adhere tuthe Svvmatfree Code of Conduct ao set forth on
the California Department of Industrial Relations vvebsite located at
vw^xw.dir.co.gov. andPub||oContnnotCodm8enUon81O8.
b. Contractor agrees to cooperate fully'n providingreasonable access bzthe
Contractor's records, documents, agents or employees, or premises if
reasonablyhosmd officials of the contracting agency,the
Department uf Industrial Relations, mr the Department mf Justice to
3
EuhibitB—/ttochmentF
Page 4of17
determine the Contractor's compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts cf$1OO.0OOormore, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100.00Oor more, Contractor certifies
that CORT—RACTOR |min compliance with Public Contract Code Section
1O295'35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. needs to be aware of the following
provisions regarding current or former state employees. If Contractor has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency shall be contacted immediately for clarification.
Current State Employees(Pub. Contract Code 410410):
a\. No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and whichi sponsored mr funded bv any state
aQmnoy, unless the employment, activity ow enterprise io required as m
condition of regular state employment.
b). hJo officer or employee shallcontract on their own behalf amun
independent Contractor with any state agency to provide goods or
Former State Employees(Pub.Contract Code§ 0411):
a}. For the two( ' ' period the date Uh |e� emp
loyment,' former state officer or employee may enter into m contract|nwhich they
engaged in any of the negotiations, tranaectiono, planning, unonQemnontn
or any part uf the decision-making process relevant to the contract while
employed in any capacity bv any state agency.
b\. For the twelve(12)month period from the date they left state
employment, no former state officer p| ee may enter into o
contract with any state agencyif they were employed by that state agency
in a policy-making position in the same general subject area as the
proposed contract within the twelve(12) month period prior to them
leaving state service.
|f Contractor violates any provisionsmfabmvepa naohm such actio
Contnacboraha|| nynderthioAoraernantvoid. (Pub. CmntnaotCodeR1O420)
4
ExhibitB—AttachmentF
Page 5of17
M ern Lmrsof boards and commissimns are esemptfmm this section if they donot
receive paymentother than payment of each meeting oy the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code 81O43O /e\\
2^ needs be aware
of the provisions which require every employer to be insured against liability for
Workers Compensation or to undertake self-insurance in accordance with the
provisions, and Contractor affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. Contractor assures the State that it
complies with the Americans with Disabilit es Act(ADA)of 1990,which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR amendment io required bz change the
name nn listed on this Agreement. Upon receipt oflegal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior toapproval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
o. When agreements are to be performed in the state by corporations,the
contracting agencies will bm verifying that the Contractor iecurrently
qualified hodobusiness in California in order to ensure that all obligations
due bo the state are fulfilled.
b. "Doing business" is defined in R&TC SeoUon331O1 as actively engaging
in any transaction for the purpose of financial or pecuniary gain orprofit.
Although there are some statutory excepbons to baxatiom, rarely iUa
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations(thomo incorporated outside of
California) good standing in order tubm qualified todo
business inCalifornia. Agencieswill determine whether e corporation io
in good standing by calling the Office of the Secretary of State.
@' : A County, city, district, or other local public body shall provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body,which by law has authority ho enter into anagreement,
authorizing execution of the agreement.
7' AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
Contractor shall not be: (1) in violation of any order o,resolution not subject tn
review promulgatedbxthe State Air Resources Board oron air pollution control
district; (2)subject to cease and desist order not subject to review issued
ExhibitB—AttmohmentF
Page Rof17
pursuant to Section 13301of the Water Code for violation of waste discharge
requirements or discharge prohibitions; or(3)finally determined h»beinviolation
of provisions of federal law relating hz air or water pollution.
8^ This form shall be completed bvall
Contractors that are not another state agency or other governmental entity.
-~
INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS,the Office of the Inspector General,the Comptroller General,
and their designees may, et any time, inspect ondaudKanyreoondnor
documents of Contractor or its subcontractors, and may, at any time, inspect the
pnannieem, physical facilities, and equipment where Medicaid-related activities or
work im conducted.The right to audit under this section exists for ten (1O)years
from the final date of the contract period or from the date of completion of any
audit, whichever|olater.
Federal database checks.
Consistent with the requirements at§455.436 of this chapter,the State shall
confirm the identity and determine the exclusion status of Contractor, any
eubcontnootor, as well as any person with an ownership or control intanamy, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities E|E\. the System for Award Management
(SAyN). and any other databases oothe State ur Secretary may prescribe. These
databases shall be consulted upon contracting and no less frequently than
monthly thereafter. |f the State finds a party that is exc|uded, it shall promptly
notify the Contractor and take action consistent with§438.W10/c\.
The State shall ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network pnovider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL(CAL-AIM)
REQUIREMENTS
1' SERVICES AND ACCESS PROVISIONS
o. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, with Section
14705.5 of California Welfare and Institutions Code toobtain m
certification ofonindividum|'s eligibility for Specialty Mental Health
Services/SMHS\under yNedi-Ca|.
ExhibitB—Attaohmon F
Page 7of17
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. |n collaboration with the County, Contractor will work toensure
that individuals tm whom the Contractor provides Gk8HSmeet
access criteria, aa per Department of Health Care Services
guidance specified in Behavioral Health Information
Notice |N)21-O73. Specifically,the Contractor will ensure that
the clinical record for each individual includes information moe
whole indicating that individua|'o presentation and needs any
aligned with the criteria applicable to their age at the time of
service provision asspecifiedbelow.
ii. For enrolled individuals under 21 years ofage, Contractor shall
provide all medically necessary SK8HS requiredpursuant to
Section 1396d(hof Title 42of the United States Code. Covered
SK8H8 shall be provided to enrolled individuals who meet either qf
the following criteria, (1)or(11) below. If an individual under age 21
meets the criteria ao described inU\ below, the beneficiary meets
criteria to access SMHS; it is ot necessary to establishthat the
beneficiary also meets the criteria in/b below.
1. The individual has a condition placing them ot high riskfor
m mental health disorder due tu experience oftrauma
evidenced bv any uf the following: scoring in the high-risk
range under a trauma screening tool approved bvOHC8.
involvement in the child vvelf are system,juvenile juoUoo
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. Anmammnab|e probability of significant deterioration
inan important area of life functioning
o. Armoaonob|e probability of not progressing
developmentally as appropriate.
d. A need for 8K8HS' regardless of presence of
impairment, that are not included within the mental
health benefits that oMedi-Ca| Managed Care Plan
(K8CP)imrequired to provide.
AND the | idua|'onond0onmmdanchb*wdineubpmragnyph
/|| o-d\above ia due to one of the following:
a. AUiagnoaed mental health dioorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of yWanba| Disorders(D8K8)
and the International Classification mfDiseases and
Related Health Prob|enmm0C[]\.
b. Aauepectmd mental health disorder that has not yet
been diagnosed.
o. Significant trauma placing the individual at risk of
future mental health cmnditiom, based on the
assessment ofm licensed mental health
ExhibitB—AUaohmentF
Page 8of17
iii. For individuals 21 years of age ovolder, Contractor shall provide
covered SyWH8 for persons served who meet both of the following
criteria, (a) and /b\ba|ow:
1. The individual has one or both ofthe following:
a. Significant impairment,where impairment is defined
oe distress, disability, or dysfunction insocial,
occupational, other important activities.
b. A reasonable probability of signif icant deterioration
in an important area of life functioning.
2. TheinUividum|'s condition oe described )n paragraph (a)m
due to either of the following:
o. Adiagnosed mental health dioordar, according to
the criteria in the current editions of the O8PWand
|CD.
b A suspected mental disorder that has not yet been
diagnosed.
o. ADDITIONAL CLARIFICATIONS
i Criteria
1. A clinically appropriate and coveredmental health
prevention, screening, mmaeeonnent treatment, or recovery
service listed within Exhibit Aof this Agreement can ba
provided and submitted @o the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining e
diagnoois, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included inanindividual
treotnn*ru ; or
o. The individual had o co-occurring substance use
disorder.
ii Diagnosis Not Prerequisite
1. Per BH|N21-O7S. o mental health diagnosisie not a
prerequisite for access bz covered SK0H8.This does not
e|irn|nm1e the requirement that all K8edi-Cm|c|oinna.
including @K8HS claims, include e current Centers for
Medicare f& Medicaid Services(CMS)approved |C[]
diagnosis code
d. MEDICAL NECESSITY
L Contractor will ensure that services provided are medically
necessary in compliancewith BH|N21 073and pursuantb»
Welfare and Institutions Code section 14184.402(a). Services
provided to a person served shall be medically necessary and
clinically appropriate to address the individual's presenting
condition. Documentation in each individua|'s chart as m vvhuka will
demonstrate medical nommaeih/ as defined be|ovv, booed on the
mQm of the individual at the time of service provision.
8
Exhibit B—/ttaohmmntF
Page 9of17
ii For individuals 21 years Cf age or older, o service|a"medically
necessary"ora"medical necessity"when itio reasonable and
necessary ho protect life, to prevent significant illness mrsignificant
disability, urto alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
Ui. For individuals undor21 yearsof age, e een/ioa is"medically
necessary"orm"medical necessity"if the service meets the
standards set forth|n Section 1395d/rV5\ of Title 42of the United
States Code.
e. COORDINATION C)FCARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to thisAgreement are coordinated among all
providers who are serving the individual, including all other SMHS
prmvidero, as well as providers of Non-Specialty K8enbe| Health
Services(NSyWH8). substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services aaapplicable to ensure a person served-
centered and whole-person approach to services.
i|. Contractor shall ensure that care coordination activities support
the monitoring and treatment ofoonorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual obz community-based services
and ouppoMe, including but not limited to educational, social,
prevocationa|. v000buna|. housing, nutritional, criminal justice,
transportation, childcare, child development,f i maniage
education, cultural sources, and mutual aid support groups.
W. Contractor shall engage inoareoomrd|nodunaotivitieo beginning
et intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a H|FAA
and California law compliant person served authorization to share
thaindividum|'s information with and among all other providers
involved in the indk/iduo|'n care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG O[)C)R
i. Per BH|N22-011. Specialty and Non-Specialty K4ento| Hoa|Mh
Services can be providedconcurrently, if those services are
clinically appropriate, coordinated, and not duplicative.When a
person served meets criteria for both NS|NHSand SK8HS.U)a
individual should receive services based on individual clinical
need and established therapeutic relationships. Clinically
appropriate and covered SMHS can also ba provided when the
individual has e co-occurring mental health condition and
substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual a
receive timely mentalhealth services without delay. Services are
reimbursable to Contractor by County even when:
9
Exhibit B—Attachment F
Page 1Onf17
1. Services are provided prior to determination ofodiagnosis,
during the assessment or prior 0o determination mfwhether
SMH8 access criteria are met, even if the assessment
u|Urnaba|y indicates the individual dmsm not meet criteria for
8W1H8.
2. |f Contractor| i individual receiving both GK8H8
and N8yWHS. Contractor holds responsibility for
documenting coordination of care and ensuring that
services are non-dup|icative.
2' AUTHORIZATION AND DOCUMENTATION PROVISIONS
m. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHC8policy.
ii Contractor shall have|n place, and follow,written policies and
for completing requests for initial and continuing
authorizations of services, ae required bv County guidance.
iii. Contractor shall respond ho County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provideContractor with written notice ofauthorization
determinations within the bnoefnanmem set forth inBH|Na22-018
and 22-017. or any subsequent DHCGnotices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) ka necessary due toan
indivkjue|'a specific needs and circumstances that could seriously
jeopardize the individual o life orhealth, or ability to attain,
rna|ntain, or regain maximum function.
b. DOCUMENTATION REQUIREMENTS
i. Contractor will follow all documentation requirements as specified
in Article 4.2-4.8 inclusive in compliance with federal, state and
County requirements.
ii All Contractor documentation oheU be accurate, connp|ete, and
leoiU|a. nhmU list each date nfservice, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from faoe-bo-faoe
time and provide this information ho County upon request.
Services shall bu identified am provided in-pwnmon. bvtelephone,
orbvte|ahmmlth.
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractor agrees to
satisfy the chart documentation requirements set forth in BHIN 22-
019 and the contract between County and DHCS. Failure to
comply with documentation standards specified in this Article
require corrective action plans.
o. ASSESSMENT
10
ExhibitB—AttaohmentF
Page 11of17
|. Contractor shall ensure that all individuals' medical records
include an assessment of each |ndividua|'g need for mental health
services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements os identified inBH>N22~O1Sand
document the assessment in theindK/idua[e medical record.
Ui For individual s aged through 20. the Child and Adolescent
Needs and Strengths (CANS), and for individual saQed 3through
18, the Pediatric Gyrnmtmrn Checklist-35 (PSC-35)tools are
required at intmhe, every six months during treatment, and at
diamhorQe, as specified in OHC@ K4HGU[7S |Nm 17-052and 18'
O48.
iv' The time period for providers to complete an initial assessment
and subsequent assessments for SMHS are up to clinical
discretion of County; however, Contractor's providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. |CD-1O
i. Contractor shall use the criteria set forth in the current edition uf
the OSyWgo the clinical tool to make diagnostic determinations.
ii Once mDSM diagnosis im determined, the Contractor shall
determine the corresponding mental health diagnosis in the
current edition of |CD. Contractor shall use the |CO diagnosis
oodm(e)tosubmit o claim for 8yWHGbn receive reimbursement
from County.
iii The|CD Tabular List of Diseases and Injuries is maintained by
CMS and may bo updated during the term of this Agreement.
Changes to the lists of ICD d egdonotrequireen
amendment hothis Agreement, and County may implement these
changes as provided by CMS
a. PROBLEM LIST
i. Contractor will create and maintain a Problem List for each
individual served under this Agreement.The problem list is a list of
symptoms, conditions, diagnoses, and/or risk factors idantifked
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
ii. Contractor shall document problem list that adheres to industry
standards utilizing at minimum current8NC}K8EO International,
Systematized Nomenclature of Medicine Clinical Terms
SNQK8EDCT@\ U.G. Edition, Septemnber2022 Re(aoma. and |CO-
10-CyW 2023.
iii. /\problem identified during a service encounter may be addressed
by the service provider during that service encounter and
subsequently added to the problem list.
iv. The problem list shall ino|uda, but is not limited to, all m|mnnenta
specified inBH|N22-019.
v. County does not requirethe problem list to be updated within
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
11
ExhibitB—AttauhmentF
Page 12of17
added. However, Contractor shall update the list within e
reasonable time such that the problem list reflects the current
issues facing the person served, in accordance with generally
accepted standards of practice and in specific circumstances
specified inBH|N22'O1S.
f. TREATMENT AND CARE PLANS
|. Contractor ionot required0ocomplete treatment or care plans for
persons served under this Agreement, except in the
circumstances specified inBH\N22-01S and additional guidance
from OHC8 that may follow after execution of this Agreement.
O. PROGRESS NOTES
i Contractor shall create progress notes for the provision of all
8yWHS services provided under this Agreement.
ii Each progress note shall provide sufficientdetail bo support the
service code selected for the service type amindicated by the
service code description.
iii Progress notes shall include all elements specified inBH|N32'
019. vvhwtherthenotebmfmrmnindividum| ormgroupoerv|oe.
iv. Contractor shall complete progress notes within three business
days of providing a service,with the exception of notes for crisis
services,which shall ba completed within 24hours.
v. Providers shall complete a daily progress note for services that
are billed ono daily basis, such oa residential and day treatment
eervices, if applicable.
h. TRANSITION OF CARE TOOL
L Contractor shall use o Transition of Care Tool for any individual
whose existing services will be transferred from Contractor hoon
&4ndi-Co| Managed CareP|an (K4CP)pmvkJerorvvhmnN8K8H8
will be added to the existing' mental health treatment provided by
Contractor, me specified inBH|N22-0]5. in order hoensure
continuity of care,
ii. Determinations tm transition care or add services from onMCP
shall be made in alignment with County policies and via a person-
centered, shared decision-makingoa
iii. Contractor may directly use the OHCS-providmd Transition ofCare
Tool, found at hftps://www.dhcs.ca.gov/Pages/Screening-and-
Services.aspx, or obtain a copy of that tool provided by the
County, Contractor may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Transition of Care Tool, including the specific wording and order of
fields, shall remain identical to the[}HCG provided form.The only
exception bo this requirement io when the tool in translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use ta|ahealth. when it deems clinically
appropriate, aoa mode of delivering behavioral health services in
12
ExhibitB—AttoohmentF
Page 13of17
accordance with |applicable County, state, and federal
naquinamentm, including those related to ivacv/oemudtv,
efficiency, and standards of care. Such services will conform bz
the definitions and meet the requirements included |n the K8edi'Ce|
Provider Manual: Tm|mhealth. available in the DHCSTeeheo|th
Resources page at:
hftps://www.dhcs.c&qov/provqovpart/Pages/Telehealth Resources
-aspx.
H. All bd h hh equipmentandmen/ice|mcebonmohm|| enaunethat
person served confidentiality iemaintained.
iii. Licensed providers and staff may provideservices via telephone
and te|ehem|tham long os the service in within their scope of
practice.
iv. Medical records for individuals served bv Contractor under this
Agreement shall include documentation nf written orverbal
consent for ba|ehmalthor telephone services if such services are
provided by Contractor. Such consent shall be obtained at least
prioronce to initiating applicable health care services and consent
shall include all elements as specif ied in BHIN 22-019.
v. County may ot any time audit Contractor's tdehealthpractices,
and Contractor shall allow access 0u all materials needed tu
adequately monitor Contractor's adherence hotm|ehealth
standards and requirements.
3^ PROTECTIONS FOR PERSONS SERVED
a' GRIEVANCES,APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances(as defined bv42C.F.Fl 43B.4OO) and complaints
received by Contractor shall be immediately forwarded bnthe
County'$DBH Plan Administration Division or other designated
persons via e secure method (e.g., encrypted email or bv fax)bo
allow ample time for the DBHPlan Administration staff to
acknowledge receipt of the grievance and complaints and issue
appropriate responses.
ii Contractor shall not discourage the filing of grievances and
individual odo not need tm use the term ^ghevanne^for a
complaint bobe captured oaan expression of dissatisfaction and,
therafona. o grievance.
iii Aligned with MHSUDS IN 18-010E and 42 C.F.R. 38.404. the
appropriate and delegated Notice of Adverse Benefit
Determination( OABO shall be issued bv Contractor within the
specified Ummfremeo using the template provided bv the County.
iv. NOABQa shall be issued bo individuals the Contractor has
made mr intends ho make an adverse benefit determination that
includes the reduction, suspension, or termination ofapreviously
authorized service and/or the failure to provide services inatimely
manner.The notice shall have o clear and concise explanation of
the raason/s\ for the decision as established bv []HCG and the
County.The Contractor shall inform the County immediately after
issuing eN(]ABD.
13
EnhibitB—A#achmentF
Page 14of17
v. Procedures and timeframes for
and responding to adverse benefit determinations, appeals, and
state hearings aheU be followed ms per42CF.R., Part 438.
Subpart F /42C.F.R. §§438.4OO -438.424\
vi Contractor shall provide individuals any reasonable assistance in
completing forms and taking other procedural steps related tum
grievance mr appeal such mm auxiliary aids and interpreter
services.
vii. Contractor shall maintain records ofgrievances and appeals and
shall review the information as part of its ongoing monitoring
procedures. The record shall be accurately maintained ina
manner accessible to the County and available upon request to
DHC8.
b. Advanced Directives
I. Contractor shall comply with all County policiesandprocedun»o
regarding Advanced Directives in compliance with the
requirements of42C.F.R.§§422.128and 438.8U\ U\. /3\mnd /4\.
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement(42 C.F.R. §438.62(b)(l)-(2).)
in accordance with applicable state and federal regulations,
QUALITY IMPROVEMENT PROGRAM
o. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms ho assess person
served/family satisfaction based on C ntv's guidance. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating person served's grievances,appeals and State
Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
4. Informing the County and individuals of the results of
persons served/family satisfaction activities.
ii Contractor, if applicable, shall implement mechanisms uamonitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision ofa person licensed b)
prescribe or dispense prescription dru0o, at least annually and as
required bvDBH.
iii Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality mfcare
concerns.The Contractor shall take appropriate follow-up action
when such an occurrence ie identified.The results of the
intervention shall be evaluated bv the Contractor mtleast annually
and shared with the County.
14
ExhibitB—AttachmentF
Page 15of17
iv. Contractor shall assist County, oo needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County bm create e{J|Work Plan
with documented annual evaluations and documented revisions
oo needed. The Cl|Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi Contractor shall attend and participate in the C ' Quality
Improvement Committee end policy decisions,
review and evaluate neau|bo ofC)|activities, including P|Pa,
ineUb/0e needed C>| ocUons, and ensure follow-up ofO| processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in theC)|C.
vii Contractor shall participate, ae required, in annual, independent
omharna|quo|hv reviewa(EQRL)of the quality, Unna|inena,and
access to the services covered under this Contract,which are
conducted pursuant 0oSubpart Emf Part 43Dof the Code of
Federal Regulations. (42C.F.A!. §&438.35O(a) and 43O.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor shall have hours of operation during which
services are provided hoK4edi-Cm|individuals that are no
less than the hours of operation during which the provider
offers services tonun-K8edi-Co| individual m. |fthe
Contractor's provider only serves K8edi-Ca| beneficiaries,
the provider shall providehours of operation comparablehn
the hours the provider makes available for N1edi-Ca|
services that are not covered by the Agreement oranother
County.
2. Appointments data, including wait times for requested
services, shall be recorded and tracked by Contractor, mnd
submitted to the County on a monthly basis in aformm1
specified by the County.Appointments' datamhouhj be
submitted bz the Cmuntv'o Planning and Quality
Management Division or other designated persons.
3. Urgent care appointments for services that donot require
prior authorization shall be provided hz individual mwithin
48 hours mfa request. Urgent appointments for services
that do require prior authorization shall ba provided tn
persons served within 38 hours ofrequest.
4. Non-urgent non-p hi mental health services,
including, but not limited h»Assessment, Targeted Case
Management, and Individual and Group Theru
appointments (for both adult and children/youth) shall be
made available toMedi-Ca| individuals within 10bueinems
days from the date the individual mra provider acting on
behalf ofthe individucd, requests an appointment for
medically necessary service. Non-urgent psychiatry
appointments both adult and children/youth) be
made available toK8edi-Ce| individual axvithin 15 business
15
ExhibitB-AttochmentF
Page 16of17
days from the date the person served or a provider acting
on behalf of the individual, requests an appointment for a
medically
5. Applicable appointment thnaebanderdennaybaexbsndedif
the referring or treating providerhas determined and noted
in the individuo|'a record that o longer waiting hod will
not have m detrimental impact on the health ofthe
individual.
0. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined bv the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
i. Contractor shall ensure that all of its required clinical staff,who
are rendering SK4HG&oW1edi-Co| individuals on behalf of
Contractor, are registeredthrough [JHCS' PmxviderAoo|ioaUon
and Validation for Enrollment/PAVE\portal, pursuant buBH|N20-
071 requirements,the 21st Century Cures Act and the CMS
Medicaid and Chi|dren'e Health Insurance Program (CHIP)
Managed Care Final Rule.
ii SK8HS licensed individuals required to enroll via the^{}rdering.
Referring and Prescribing" /[>RP\ PAVE enrollment pathway (i.e.
PAVE application package)available through the DHCS PED
Pave Portal, include: Licensed Clinical Social Worker/UCSVV\.
Licensed Marriage and Family Therapist (UNFT). Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants bo institute a Physician Incentive Plan,
Contractor shall submit the proposed plan bz the County which will
in turn submit the Plan tothe State for approval, in accordance
with the provisions uf42C.F.R'8488.O(n).
-^
DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i Contractor shall have a secure email system and send any email
containing P|| or PHI ino secure and encrypted mnonner.
Contractor's email transmissions shall display e warning banner
stating that data is confidentia|, systems activities are monitored
and logged for administrative and security purpoeem, systems use
is for authorized users only, and that users are directed tm log off
the system J they do not agree with these requirements.
16
ExhibitB—AMachmedF
Page 17of17
ii. Contractor shall institute compliant password management
policies and prooedunan, which shall include but not be limited bo
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed 6t least once
every 90dmyn.
iU. Any Electronic Health Records/EHRa\maintained bvContractor
that contain PHI or P11 for individuals served through this
Agreement shall contain a warning banner regarding the PHI mr
P|| contained within the EHRi. Contractors that utilize anEHFlshall
maintain all partsof the clinical record that are not stored inthe
EHFl. including but not limited bo the following examples ofperson
served signed documents:discharge p|gnm, informing materials,
and health questionnaire.
iv. Contractor entering data into any County electronic oymterne mho||
mnaUna that staff are trained to enter and maintain data within this
system.
-^
PROGRAM INTEGRITY
m. Credential' and Re-cradmnUghnoofProviders
i Contractor shall ensure that all of their network providers
de/iverinDcoven*dservioea. aiQnmnddabaanetbeataton
statement ona form provided bv County, in which each provider
attests to the following:
1. Any limitationsor inabilities that affect theprovider's ability
to perform any of theposition's essential functions, with or
without accommodation;
2. /\history of \oma of license or felony convictions;
3. /\history of loss or limitation of privilegesordisciplinary
4 A lack of present illegal drug and
5. The application's accuracy and completeness
ii' Contractor shall file and keep track of attestation statements,
nrmdenUaUng applications and credentialing status for all of their
providers and shall make those available to the County upon
request at any time.
iii. Contractor ie required bx sign enannue| mthaobaUonobabennentmt
the time of Agreementrenewal in which they will attest that they
will follow C ' Cnedenba|inQ Policy and K0HGUOS IN 18-019
and ensure that all of their rendering providers are nredonUohadaa
per established guidelines.
17
Exhibit B—Attachment G
Page 1 of 1
Electronic Health Record Requirements and Service Data
Contractor will provide accurate and timely input of services provided in the County's Electronic Health
Record(EHR).The current EHR is a web-based application and requires a computer with a minimum of
16 GB RAM using either Edge or Chrome as the browser,and a stable high speed internet connection.
Additional drivers may be needed to scan documents into the EHR. Contractor will be responsible for
equipment to support the using of the EHR. Contractor may be required to utilize data entry forms,
portals,or related systems for compliance with County data reporting requirements during the duration
of this Agreement.
Data entry shall be the responsibility of the Contractor.The County shall monitor the number and
amount of services entered into the EHR. Any and all audit exceptions resulting from the provision and
billing of Medi-Cal services by the Contractor shall be the sole responsibility of the Contractor.
Contractor will utilize the County's EHR for all Behavioral Health Plan billing and reporting functions and
may elect to utilize the County's EHR for all clinical documentation,at no additional cost to Contractor.
If Contractor elects to not use the County's EHR for all clinical documentation,the Contractor must
ensure all necessary requirements involving electronic health information exchange between the
Contractor and the County will be met.
Exhibit 8'Attachment H
Fresno County Mental Health Plan
Compliance Program
CODE OF CONDUCT:
All Fresno County Behavioral/Mental Health Employees, Contractors(including Contractor's
Ennp|oyees/Subcontractors), Volunteers and Students will:
1. Read,acknowledge, and abide by this Code ofConduct.
2. Be responsible for reviewing and understanding Compliance Program policies and procedures including
the possible consequences for failure to comply or failure to report such non-compliance.
]. NOT engage in any activity in violation ofthe County's Compliance Program, nor engage in any other
conduct which violates any applicable law, regulation, rule, or guideline. Conduct yourself honestly,
fairly, courteously, and with a high degree of integrity ipyour professional dealings related 1otheir
employment/contract with the County and avoid any conduct that could reasonably be expected to
reflect adversely upon the integrity of the County and the services it provides.
4. Practice good faith in transactions occurring during the course of business and never use or exploit
professional relationships or confidential information for personal purposes.
5. Promptly report any activity or suspected violation of the Code of Conduct,the polices and procedures
of the County,the Compliance Program, or any other applicable law, regulation, rule or guideline.All
reports may be made anonymously. 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.
6. Comply with not only the letter of Compliance Program and mental health policies and procedures, but
also with the spirit of those policies and procedures as well as other rules or guidelines adopted by the
County. Consult with you supervisor or the Compliance Office regarding any Compliance Program
standard or other applicable law, regulation, rule or guideline.
7. Comply with all laws governing the confidentiality and privacy of information, Protect and retain
records and documents as required by County contract/standards, professional standards,
governmental regulations, or organizational policies.
8. Comply with all applicable laws, regulations, rules, guidelines,and County policies and procedures
when providing and billing mental health services. Bill only for eligible services actually rendered and
fully documented. Use billing codes that accurately describe the services provided. Ensure that no false,
fraudulent, inaccurate, or fictitious claims for payment or reimbursement of any kind are prepared or
submitted. Ensure that claims are prepared and submitted accurately and timely and are consistent
with all applicable laws, regulations, rules and guidelines.Act promptly to investigate and correct
problems if errors in claims or billings are discovered.
9. Immediately notify your supervisor, Department Head,Administrator,or the Compliance Office if you
become or may become an ineligible/Excluded Person and therefore excluded from participation in the
Federal health care programs.
ExhibitB—Attochment|
Page 1of5
Health Insurance Portability and Accountability Act N@UPAAJ
Business Associate Agreement
1. The County is a''Cowered Entdv.^and the Contractor ioa "Business Associate,"
oo these terms are defined by45CFR18O.1O3. |n connection with providing services under the
Agreement, the parties anticipate that the Contractor will create and/or receive Protected Health
Information("PHI")from or on behalf of the County.The parties enter into this Business
/\m000iata Agreement(BAA)to comply with the Business Associate requirements of H|PAA,to
govern the use and disclosures of PHI under this Agreement. "HIPAA Rule�'shall mean the
Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164.
2. The parties to this Agreement shall be in strict conformance with all applicable
federal and State of California laws and nagu|edionm, ino|uding, but not limited to California
Welfare and Institutions Code eectiono5328. 10850. and 14100.2 etoeq.; 42 CFR 2;42CFR
431; California Civil Code section 56 et seq.; the Health Insurance Portability and Accountability
Act of1SS0. mm amended /^H|PAA^\. including, but not limited to, 45CFRPorta1OO.45CFR
162, and 45 CFR 164; the Health Information Technology for Economic and Clinical Health Act
("HITECH")regarding the confidentiality and security of patient information, including, but not
limited bo42UGC17gO1edaeq.; and the Genetic Information Nondiscrimination Act rG|NA"\mf
2UOB regarding the confidentiality mf genetic information.
3. Except as otherwise provided in this Agreement, the Contractor, as a business
associate of the Cmunh/, may use ordisclose Protected Health Information ("PH|'')huperform
functions, activities or services for or on behalf of the County, as specified in this Agreement,
provided that such use or disclosure shall not violate HIPAA Rules. The uses and disclosures of
PHI may not be more expansive than those applicable to the County, as the"Covered Entity"
under the HIPAA Rules, except as authorized for management, administrative or legal
responsibilities mf the Contractor.
4. Contractor shall pnoteot,from unauthorized oucemo, use, or disclosure of narnae
and other identifying information concerning persons receiving services pursuant to this
Agreement, except where permitted in order to carry out data aggregation purposes for health
Exhibit B—Attachment I
Page 2 of 5
care operations. (45 CFR Sections 164.504(e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i).)
This pertains to any and all persons receiving services pursuant to a County funded program.
Contractor shall not use such identifying information for any purpose other than carrying out
Contractor's obligations under this Agreement.
5. Contractor shall not disclose any such identifying information to any person or
entity, except as otherwise specifically permitted by this Agreement, authorized by law,or
authorized by the client/patient.
6. For purposes of the above sections, identifying information shall include, but not
be limited to name, identifying number, symbol, or other identifying particular assigned to the
individual, such as finger or voice print, or a photograph.
7. Contractor shall provide access, at the request of County, and in the time and
manner designated by County,to PHI in a designated record set (as defined in 45 CFR Section
164.501), to an individual or to County in order to meet the requirements of 45 CFR
Section164.524 regarding access by individuals to their PHI.
Contractor shall make any amendment(s)to PHI in a designated record set at the
request of County, and in the time and manner designated by County in accordance with 45
CFR Section 164.526.
Contractor shall provide to County or to an individual, in a time and manner
designated by County, information collected in accordance with 45 CFR Section 164.528, to
permit County to respond to a request by the individual for an accounting of disclosures of PHI
in accordance with 45 CFR Section 164.528.
8. Contractor shall report to County, in writing, any knowledge or reasonable belief
that there has been unauthorized access, viewing, use, disclosure, or breach of PHI not
permitted by this Agreement, and any breach of unsecured PHI of which it becomes aware,
immediately and without reasonable delay and in no case later than two(2) business days of
discovery. Immediate notification shall be made to County's Information Security Officer and
Privacy Officer and DBH's HIPAA Representative, within two(2)business days of discovery.
The notification shall include, to the extent possible, the identification of each individual whose
2
ExhibitB—Attachman |
Page 3nf5
unsecured PHI has been, oriareasonably believed to have been, acoemaed, ocqu|red, used.
disclosed, orbreached. Contractor shall take prompt corrective action to cure any deficiencies
and any action pertaining to such unauthorized disclosure required by applicable Federal and
State Laws and regulations. Contractor shall investigate such breach and is responsible for all
notifications required by law and regulation or deemed necessary by County and shall provide a
written report of the investigation and reporting required to County's Information Security Officer
and Privacy Officer and Q8H'o H|P/#\Representative. This written investigation and
description of any reporting necessary shall be postmarked within the thirty (30) working days of
the discovery of the breach to the addresses below:
County ofFresno County ofFresno County mfFresno
Department of Public Health Department of Public Health Department of Internal
H|PA\Repreaentmtivo Privacy Officer 8on/iceo
)000'8438 (559)800-6405 Information Security Officer
P.(].Box 11887 P.O.Box 11887 /569\800-5800
Fresno, Ca|ifmrnim93775 Fresno, California 83775 2O48 North Fine Street
Fresno, California 93727
g. Contractor shall make its internal pnaoUoeo, book$, and records ra|ohn8 to the
use and disclosure of PHI received from County, or created or received by the Contractor on
behalf of County, available to the United States Department of Health and Human Services
upon demand.
18. Safeguards
Contractor shall implement administrative, physical, and technical safeguards as
required bv45CFR 104.308. 164.310. and 184.312 that reasonably and appropriately protect
the confidentiality, integrUn, and availability of PHI, including electronic PH[ that it oreabem,
receives, maintains or transmits on behalf of County; and to prevent access, use or disclosure
of PHI other than an provided for by this Agreement. Contractor shall develop and maintain a
written information privacy and security program that includes administrative, technical and
physical safeguards appropriate to the size and complexity of Contractor's operations and the
nature and scope of its activities. Upon Countv'a request, Contractor shall provide County with
information concerning such safeguards.
3
ExMibitB—Attachment |
Page 4of5
Contractor shall implement strong access controls and other security safeguards
and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI)mr sensitive data hz authorized users only.
11. Mitigation of Harmful Effects
Contractor shall mitigate,to the extent practicable, any harmful effect that is
known to Contractor of an unauthorized access, viewing, use, disclosure, or breach of PHI by
Contractor or its subcontractors in violation of the requirements of these provisions.
12. Contractor's Subcontractors
Contractor shall ensure that any of its subcontractors, if applicable, to whom
Contractor provides PHI received from or created or received by Contractor on behalf of County,
agree to the same restrictions and conditions that apply to Contractor with respect to such PHI;
and to incorporate,when applicable, the relevant provisions of these provisions into each
subcontract mr sub-award ho such subcontractors.
13. Effect of Termination
Upon termination or expiration of this Agreement for any reason, Contractor shall
return or destroy all PHI received from County(or created or received by Contractor on behalf of
County)that Contractor still maintains in any form, and shall retain mocopies of such PHI. If
return or destruction of PHI is not feasible, it shall continue to extend the protections of these
provisions to such information, and limit further use of such PHI to those purposes that make
the return or destruction Vf such PHI infeasible. This provision shall apply ho PHI that im |nthe
possession of subcontractors mragents, if applicable, of Contractor. |f Contractor destroys the
PHI data, a certification of date and time of destruction shall be provided to the County by
Contractor.
14. Interpretation
The terms and conditions in these provisions ahmU be interpreted as broadly as
necessary to implement and comply with HIPAA,the HIPAA regulations and applicable State
laws. The parties agree that any ambiguity in the terms and conditions of these provisions shall
be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA
4
Exhibit B—Attachment |
Page 5of5
15. Regulatory References
A reference in the terms and conditions of these provisions to a section in the
H|P/A regulations means the section asin effect oramamended.
10. Survival
The respective rights and obligations nfCun8nyctoramatatodinth|eSeoUnnahoU
survive the termination nr expiration nf this Agreement.
5
Exhibit 6-Attachment J
Page 1 of 2
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership,and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote,and support a culturally and linguistically diverse governance, leadership,and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them,to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement,Continuous Improvement,and Accountability:
9. Establish culturally and linguistically appropriate goals, policies,and management accountability, and infuse them
throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
-k. THINK If
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Exhibit 8-Attachment J
Page 2of2
The Case for the Enhanced National CK AS Standards
�F,6-/na t a,'�,,d h7h11ma/�
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cuKoei
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability ofhealth services (HHS Office ofDisease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality oflife for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths duo to inadequate and/or inequitable care is $1.24 trillion (LaNeist, Caskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services(Beach et al., 2004; Goode, Dunne, &8ronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CUAS Standards will improve an organiomUun's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action ho
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address nsda| and ethnic health disparities across the country. Similar to these initiatives, the
enhanced Nationa|CLAS Standards are intended toadvance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health onne organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
oxmivgrapov'
oaaco'M.c Cooper,�A. Robinson,K. s'o e^mrL �nuosw.*,m*e N.R.- --~-n�/mp�w�"omm*�mmoenuuv.VwnV
Publication No.04-EO08-02).����/ and Quality
Goode, evidence base for cultural and Publication No.m62).
Retrieved from The Commonwealth Fund website;http://www,commonwealthfund.org/usr_doc/Goode�-evidencebaseculdinguisticcomp-962.pdf
Lavost,r.x,oasmn,o.z'm Richard,p (20o ) The economic burden m health inequalities mt,eunitedsmtes.nmrie,edonmmeJom,c=mzrxx*wuomamEmnomic
Studies webs »+wv eu le$ e0/0mEconomicO/o2
National Partnership for Action m End Health Disparities.(m/1).National stakeholder strategy for achieving health equity.Retrieved from o.s.Department m Health and
Human Services,Office of Minority Health website:o��6+^m°m/^vmvmealm.*ns.omVnpa8emn*tes/mntem.o,px?w~l&lwm~z3un~mo
U.S.Departmentm Health and Human Services.(mu).HHS action plan to reduce racial andethnic health disparities:x nation free m disparities/n health and health care.
Retrieved from http://minorityhealth,hhs.gov/npa/files/Plans/HHS/HH�Plari_complete.pdf
U.S.Department m Health and Human Services,Office of Disease Prevention and Health Promotion.(znm).mamyneonlezom:yocialomennmnmsmxaum.xetrie"ed
mxnhttp://www.heaiuyvaople.00wzo iew.asnnomcm~m
o.s.Department m Health and Human Services,Office m Minority Health(2014.National Partnership for Action m End Health Disparities.Retrieved from
http://m/nomvmeam`.hhs.ymVnna
World Health Organization.(zum).Social determinants vrhealth.Retrieved fromoun:8«ww.whm.im/muaLdeterm'voots/+m
THINK
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Exhibit
Page 1of15
Fresno County Department of Behavioral Health Financial Terms and Conditions
Fresno County Department of Behavioral Health is committed to ensuring timely and
accurate compensation for the delivery of services in our communities and fulfilling all
associated responsibilities of the funding sources related to this Agreement. This document
provides guidance on this Agreement's financial terms and conditions, responsibilities of each
padx, which includes but not limited to, nnmnirnumm compensation, compensation structure,
invoioin0, payrnerda, biUing, reooVpnnenta, oudds, revievva, exorninatimna, and other fiscal related
requirements.
Compensation
The County agrees to pay, and the Contractor agrees to receive, compensation for the
performance of its services me described below.
I. Specialty Mental Health Services (SMHS) Maximum Compensation.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2025 through June 30, 2026 for SMHS is Nine Hundred Sixty Four Thousand
Four Hundred Ten and No/1OO Dollars ($904.41O.00). which ianot a guaranteed sum but shall
be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 for SMHS is One Million Sixty Thousand Eight
Hundred Fifty One and No/10O Dollars ($1.O8O,851.00). which ionot a guaranteed sum but shall
bo paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1. 2027 through June 30. 2028 for SK4HS is One Million One Hundred Eighty Eight
Thousand One Hundred Fifty Three and No/10O Dollars($1.188.153.00). which im not o
guaranteed sum but shall be paid only for services rendered and received.
2, Non-Treatment Supports Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2025 through June 30, 2026 is One Million One Hundred Fifty Four Thousand
Eight Hundred Ten and No/100 Dollars ($1,154,810.00), which will be reimbursed base by
mrtuo|cmstinmocordanoevviththebudQetinExhibitC —AttaohnmentB.
The maximum compensation payable to the Contractor under this Agreementfor the
period of July 1, 2026 through June 30, 2027 is One Million One Hundred Fifty Four Thousand
Eight Hundred Ten and No/1 00 Dollars ($1,154,810.00), which will be reimbursed base by
aotuo{coatin0000rdoncevviththebudgetinEmhibitC—AttmchnnentB.
The maximum compensation payable tm the Contractor under this Agreementfor the
period of July 1, 2027 through June 30, 2028 is One Million One Hundred Fifty Four Thousand
Eight Hundred Eleven and No/1OD Dollars ($1.154.811.00). which will be reimbursed base by
actual cost in accordance with the budget in Exhibit C —Attachment B.
Exhibit C
Page 2 of 15
3. Total Maximum Compensation.
In no event shall the maximum contract amount for all the services provided by the
Contractor to County under the terms and conditions of this Agreement be in excess of Six
Million Six Hundred Seventy Seven Thousand Eight Hundred Forty Five and No/100 Dollars
$6,677,845.00 during the entire term of this Agreement.
The Contractor acknowledges that the County is a local government entity and does so
with notice that the County's powers are limited by the California Constitution and by State law,
and with notice that the Contractor may receive compensation under this Agreement only for
services performed according to the terms of this Agreement and while this Agreement is in
effect, and subject to the maximum amount payable under this section.
The Contractor further acknowledges that County employees have no authority to pay
the Contractor except as expressly provided in this Agreement.
See table below for compensation breakdown by Fiscal Year and Total Maximum
Compensation for this Agreement.
Fiscal Year SMHS Maximum FY Non-Treatment Maximum Total FY Maximum
(FY) Compensation FY Compensation Compensation
2025-2026 $964,410.00 $1,154,810.00 $2,119,220.00
2026-2027 $1,060,851.00 $1,154,810.00 $2,215,661.00
2027-2028 $1,188,153.00 $1,154,811.00 $2,342,964.00
$3,213,414.00 $3,464,431.00 $6,677,845.00
4. Fee-For-Service Reimbursement Rate Categories.
The Lodge services provided by the Contractor under this Agreement shall be reimbursed
according to the rate schedule as indicated in Exhibit C —Attachment A, attached hereto and
incorporated herein by reference and made part of this Agreement. The Lodge services
provided by the Contractor under this Agreement shall be categorized as Clinic-Site Based and
the Contractor shall be compensated according to the Clinic-Site Based rate schedule as
indicated on Exhibit C—Attachment A, attached hereto and incorporated herein by reference
and made part of this Agreement:
(A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
provide less than fifty percent(50%) of services in the field. In the field services are
those services that do not occur through telehealth and do not occur in designated
sites in which the Contractor is afforded regular access. Designated sites shall be
identified by the Contractor and approved by County's DBH Director or designee in
writing. Only billable services will be considered for the purpose of this calculation.
W Clinic-Site Based locations are defined as the following SmartCare (EHR)
Locations (CMS Places of Service) for this Agreement and will be utilized
Exhibit C
Page 3 of 15
to calculate the ratio of Clinic-Site Bases to Field Based services: 1040 N
Pleasant Ave Fresno, CA 93728.
All other SmartCare (EHR) Locations (CMS Places of Service)will be
considered as Field Based services under this Agreement.
(B) Field Based: Field based programs shall be defined as programs that provide more
than fifty percent (50%) of services in the field,
(i) During the term of this Agreement, Contractor is eligible to submit a
proposal for compensation at the Field Base reimbursement rate category
ninety (90) days prior to each new fiscal year to County's DBH for
consideration. County's DBH will provide a decision to Contractor prior to
the start of the next fiscal year. If approved, County's DBH will issue a
rate change notification according to the modification section below and
Contractor's performance will be monitored for the Field Based mode of
service delivery requirements as outlined above.
(ii) If Contractor is deemed eligible to receive compensation at the Field
Based reimbursement rates in accordance with the above paragraph and
Contractor is subsequently unable to meet the mode of service delivery
requirements, as defined above, Contractor will be subjected to
recoupment at County's discretion.
(iii) County's DBH will complete Field Based mode of service delivery
analysis and recoupment reconciliation for said Contractor within ninety
(90) days following the end of the targeted quarter or within ninety(90)
days after all billable services for the targeted quarter has been entered in
the Electronic Health Record (EHR) by the Contractor, whichever is later.
The recoupment amount will be the difference in value of any services
paid to Contractor throughout the targeted quarter after being reconciled
at the respective fiscal year's Clinic-Site Based rate schedule and after
any claiming adjustments may have been applied, if any. County's DBH
will inform the Contractor of the result and, if necessary, the recoupment
shall be processed and applied based on terms, conditions, and
limitations as set forth herein.
(iv) If Contractor does not meet the Field Based mode of service delivery
requirements after any targeted quarterly review, County's DBH shall
recommend and reassign the Contractor to the Clinic-Site Based rate
category. Contractor may appeal the rate category reassignment to
County's DBH within thirty (30) days of receiving notice or the rate
category change will stand with a written notification as set forth below,
County's DBH shall continuously monitor the Contractor and analyze data to review
accuracy of rate categories assigned. County's DBH Director or designee shall have the
authority to reassign rate categories, and the Contractor will be notified in writing of any such
changes, as outlined in Article 5.
6. Specialty Mental Health Services Fee-For-Service Performance Incentives.
Exhibit C
Page 4 of 15
Contractor is eligible to receive performance-based incentives to promote growth,
increase service delivery and overall wellness to our unserved and/or underserved
communities. If the Contractor meets the performance metrics outlined by County's DBH below,
Contractor is eligible to a portion of the Medi-Cal reimbursements received and recorded by
County's DBH.
This opportunity, subject to County's discretion, is only available after the second fiscal
year term of this Agreement for Contractor providing SIVIHS and reimbursed through the
County's Fee-for-Service reimbursement structure. The initial performance actual claimed
baseline will be set by the Contractor's performance in fiscal year one (1). County's DBH will
use the Contractor's State-approved claimed dollar amount, as received and recorded by
County's DBH, for services that were performed, claimed, and approved by the State in fiscal
year one (1) and adjust it with any subsequent State rate changes, if any, to finalize a
performance baseline for fiscal year two (2). After completing the claiming of services and
receipt of Medi-Cal reimbursements for fiscal year two (2), if the Contractor exceeds the
established performance baseline, the Contractor is eligible to be compensated for eight percent
(8%) of the Medi-Cal reimbursements that were generated above the established performance
baseline amount of fiscal year two (2).
Each subsequent fiscal year's performance baselines will be adjusted annually to either
the prior fiscal year's actual State-approved claimed amount plus adjusted for any subsequent
State rate increases, or any of the previously established performance baseline amounts plus
adjusted for any State rate increases for the upcoming fiscal year, whichever is higher. The new
performance baseline shall always be calculated from the higher value between the State-
approved claimed amount and the previous fiscal year's performance baseline amount
regardless of projected performance in the upcoming fiscal year. The rate adjustment shall
always be a positive amount and the performance base shall not decrease from one fiscal year
to the next.
The table below illustrates the annual baseline adjustments. This table is an example
only and is not binding. The actual details will be determined and finalized between both parties
at the conclusion of year one (1).
Example:
Fiscal Rate State Amount Additional
Year Increase Baseline Approved Exceeding Amount Paid
Claim Amount Baseline 8 0)
1 OREM $1,100,000
2 +3.0% $1,133,900-- - $1,633,000 $500,000 $40,000
3 +1.0%411-1 1 649,330 $1,500,000 $0 $0
4 +2.0% $11682,31.7 $1,882,317 $200,000 $16,000
5 +3.53/,T$ ,94$,198 $2,048,198 $100,000 $8,0001
In addition to meeting the performance-based incentive metrics above, Contractor must
be in satisfactory standing with the Agreement's performance outcomes and reporting
requirements prior to being awarded the incentive payment. At the discretion of County's DBH
Director or designee, if it is determined that the required outcomes are not met and/or reports
are not submitted in full and on time, the Contractor shall be ineligible for performance
Exhibit
Page Sof1S
incentives or withheld until such requirements are met and/or deemed tobasatisfactory by
CouM1y's DBH.
CoWnh/'m DBH will calculate and notify Contractor ofthe avvond amounte, if any, within
ninety (90) days after all of Contractor's State-approved claimed services are received and
recorded by County's DBH for the targeted fiscal year or within nine (9) months following the
end of the targeted fiscal year, whichever is later. County's payments to Contractor for
performance-based inoentives, if any, oho8 be made within forty-five (45)days after approval by
County.
Invoices
The Contractor shall submit monthly invoices, in arrears by the fifteenth (15m) day of
each nnonth, in the format directed by the County. The Contractor shall submit invoices
electronically to:
1) dbhinvoicerevi nocountvce.gow;
2\ dbh-invoicao@freonucounh/ca.gox; and
3\ the assigned County`aDBH Staff Analyst.
At the discretion of County's DBH Director or designee, if an invoice is incorrect or is
otherwise not in proper form or substance, Cmunb/'s [}BH Dinector, or designee, shall have the
right to withhold payment as to only the portion of the invoice that is incorrect or improper after
five (5) days prior notice to Contraotor. Contractor agrees to continue to provide services for a
period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
(90) day pehuU, the invoice is still not corrected toCounty's satisfaction. County'o OBH [Jinactor,
or designee, may elect to terminate this Agreement, pursuant to the termination provisions
stated inArticle 6 of this Agreement. If County's DBH does not provide notice of incorrect or
otherwise improper invoices and causes delay in the reimbursement process, Contractor will
follow the escalation process through the Courdy'o [)BH Finance Division's Invoice Review
Tamnn. up to the OBH Finance Division K8enager, and including the Countv'a DBH Director
and/or designee for the timely reimbursement of payment to Contractor.
Withholdings to an invoice by County's DBH shall be addressed by the Contractor and/or
Contractor shall communicate any delays iM resolving the incorrect or improper form with
County's OBH within ninety (SO)days of receiving notice or the withholdings will stand in
perpetuity, ur subject to County's discretion.
All final invoices for any fiscal year shall be submitted by Contractor within one hundred
and twenty (120)days following the final month for which payment is claimed in that fiscal year,
No action may be taken by County on any invoices submitted after one hundred and twenty
(12O) days of the end cfthe fiscal year where services are performed.
1. Specialty Mental Health Claimable Services Invoices.
For specialty mental health services, invoices shall be based on claims entered into the
County'a electronic health record (EHR) for the prior month.
Monthly payments for claimable services shall only be based on the units Cftime
assigned to each CPT or HCPCS code entered in the County's billing and transactional
database multiplied by the practitioner service rates in Exhibit C—Attachment A.
Exhibit
Page 6of15
Any claimable services pending determination from K8ediooFe. [}HC, and any other third-
party source will not be reimbursed until Explanation of Benefits (EOB) are processed and the
balance is transferred to the Medi-Cal coverage plan, and ready to claim to the Medi-Cal
coverage plan, or the appropriate coverage plan(s), as deemed appropriate by the Agreement's
funding resources or approval byCounb/'eC)BH. Claimable services that are pending
determinations must be addressed and invoiced toC¢unty'sDBH within one hundred and
twenty (120) days following the month of service.Any delays to invoicing must be
communicated to and approved byCounty'aDBH within one hundred and twenty /12O\ days
following the month of service or the services may be ineligible for payment at County's
discretion.
Cuunty'a payments to Contractor for performance Of claimed services are pruvioional
and subject to ac8uatnnard until the completion of all settlement activities. Counb/'s adjustments
to provisional payments for claimed services shall be based on the terms, conditions, and
limitations of this Agreement orthe reasons for mecoupnment set forth herein.
Any claimable services entered into the County's EHR beyond four(4) months from the
month of service may be ineligible for payment, subject to the determination of the County.
2' Cost Reimbursement Based Invoices.
Invoices for cost reimbursement services shall be based on actual expenses incurred in
the month of service. Contractor shall submit monthly invoices and general ledgers to County
that itemize the line item charges for monthly program costs. The invoices and general ledgers
will serve mg tracking tools to determine if Contractor's costs are in accordance with its budgeted
cost. Failure to submit reports and other supporting documentation shall be deemed sufficient
cause for County to withhold payments until there iscompliance.
Contractor must report all revenue collected from athird-pmrtv. client-pay orprivate-pay
in each monthly invoice. In addition. Contractor shall submit nnordh|y invoices for reimbursement
that equal the amount due less any revenue collected and/or unallowable cost such as lobbying
or political donations from the monthly invoice reimbursements.
3. Corrective Action Plans.
Contractor shall enter services into the County's EHR/billing and transactional database
and submit invoices in accordance with the specified deadlines, ensuring all information is
accurate. Failure to meet the requirements set forth above will result in the implementation of
corrective action plan at the discretion of the County's DBH Director, or designee, and may
result in financial penalties or termination of Agreement per Article 6 of this Agreement.
Paymen
Payments shall bemade by County to Contractor in arrears, for services provided during
the preceding mnonth, within forty-five (45) days after the date of receipt, xerificadion, and
approval by County. All final invoices shall be submitted by Contractor within one hundred and
twenty (12O) days following the final month of service for which payment io claimed for each
fiscal year. No action shall be taken by County on claims submitted beyond the one hundred
and twenty (120) day closeout period of each fiscal year. Any compensation which is not
Exhibit
Page 7of15
expended by Contractor pursuant to the terms and conditions of this Agreement shall
automatically revert to County.
Payments shall be made upon certification or other proof satisfactory to the County that
services have been performed or actual expenditures incurred by the Contractor, as specified in
this Agreement.
1. Incidental Expenses.
The Contractor is solely responsible for all of its costs and expenses that are not
specified as payable by the County under this Agreement. If Contractor fails to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
2. Applicable Fees.
Contractor shall not charge any persons served or third-party payers any fee for service
UM|ese directed to do so by the County's DBH Director ordesignee at the time the individual is
referred for services. When directed to charge for services, Contractor shall use the uniform
billing and collection guidelines prescribed byDHC8.
Contractor will perform eligibility and financial determinations, in accordance with [}HC8'
Uniform Method of Determining Ability to Pmy(UK0DAp). see BH|N 98-13. available at
for all individuals unless directed otherwise by the County'a DBH Director or
designee.
Contractor shall not submit a o|ainn to, or demand or otherwise collect reimbursement
from, the person served orpersons acting on behalf of the person served for any specialty
mental health or related administrative services provided under this Agreement, except to
collect other health insurance coverage, share of cost, and co-payments (California Code of
Reou|mtions. Title 9. §1810.365/o\.
The Contractor must not bill persons served, for covered services, any amount greater
than would be owed if the County provided the services directly and otherwise not bill persons
served eo set forth in42C.F.R. §438.1O8.
Specialty Mental Health Services Claiming Responsibilities
Contractor shall enter claims data into the Countv'eEHR/biUinQ and transactional
database system using the California Mental Health Services Authority (Ca|W0HSA) Smart Care
Procedure Codes (available at nttps://2023.calmhsa.org/procedure-code-definitions/) by the
fifteenth (15m) of every month for actual services rendered in the previous month. County`e
EHR/biUinQ and transactional database system will convert the Ca|K8HS/4 Procedure Codes to
Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System
(HCPCS) codes, ae provided in the C}HCG Billing Manual available at
. aG from time to time
amended.
Claims shall be complete and accurate and must include all required information
regarding the claimed services. C|minne data entry into the Oountv's EHRsystern shall be the
responsibility of Contractor. County shall monitor the volume of services, billing amounts and
service types entered into Cnunb/'s EHR system. Any and all audit exceptions resulting from the
Exhibit
Page 8of1S
provision and reporting of specialty mental health services by Contractor shall be the sole
responsibility of Contractor. Contractor will comply with all applicable policies, procedures,
direotives, and guidelines regarding the use ofCountv's EHRXinfonnation system.
Contractor must provide all necessary data to allow County to bill Medi-Cal for services
and meet State and Federal reporting requirements. The necessary data can be provided by a
variety of means, including but not limited to:
If a person served has dual coverage, such as other health coverage (OHC) or Federal
Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
have validation of claiming with no response for ninety (8O) days after the claim was mailed
Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
pay in each month. A copy ufmn explanation mf benefits orCyNG15D0 form (if no response is
received from the carrier after WOdays from date mf submission ofthe CK8S15OO\ is required oo
documentation. Contractor must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1\the requirement of the Medicare Act, 42
U.8.C. section 1385et seq; and 2\ the regulation and rules promulgated bx the Federal Centers
for Medicare and Medicaid Services me they relate to portioipotion, coverage and claiming
reimbursement. Tothe extent they are applicable, Contractor will be responsible for compliance
as of the effective date of each Federal, State or local law or regulation specified.
Recoupments, Audits, Reviews, and Examinations
County shall recapture from Contractor the value of any services or other expenditures
determined to be ineligible based oM the County Vr State monitoring results. The County
reserves the right to enter into a repayment agreement with Contractor, with the term of the
repayment agreement not to exceed twelve /12l months from the date of the repayment
agreement, to recover the amount of funds tobe recouped. The County has the discretion to
extend the term of repayment plan uptoa total of twenty-four C24\ months from the date ofthe
repayment agreement. The repayment agreement may be made with the signed written
approval of County's DBH Director, or designee, and respective Contractor through a
repayment agreement. The monthly repayment amounts may be netted against the Contractor's
monthly billing for services rendered during the month, orthe County may, in its sole discretion,
forego a repayment agreement and recoup all funds immediately. This remedy ie not exclusive,
and County may seek requital from any other means, ino|udinQ, but not limited to, eeeparate
contract or agreement with Contractor.
Contractor shall be held financially liable for any and all future disallowances/audit
exceptions due to Contractor's deficiency discovered through the State audit process and
County utilization review for services provided during the course of this Agreement. At County's
election, the disallowed amount will be remitted within forty-five (45) days to County upon
notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
receive reimbursement for any units of services rendered that are disallowed or denied by the
Fresno County MHP utilization review process or claims review process or through the State of
California OHCS audit and review pr000so, cost report audit settlement if applicable, for K8edi-
Ca| eligible beneficiaries.
1. Reasons fmnRecoupmnent.
County will conduct periodic audits of Contractor files to ensure appropriate clinical
documentation, that original third-party source documents support costs invoiced under hybrid
Exhibit
Page Qof15
or cost reimbursement agreements, high quality service provision and compliance with
applicable federa|, state and county or other funding source regulations.
Such audits may result in requirements for Contractor to reimburse County for services
previously paid in the following circumstances:
kA\ Identification of Fraud, Waste o[Abuse as defined in federal regulation
(1) Fraud and abuse are defined inC.F.R. Title 42. G455.2 and VV&| Code,
section 14107.11. subdivision /d\.
(2) Definitions for^frmVd," "waste." and ^ebuaa" can also be found inthe
Medicare Managed Care Manual available at hftps://wxmv.crna.gov/ReQu|mUonm-
and-Guidmnoe/Guidonce/N1anua|e
(8) Overpayment of Contractor by County due bo errors in claiming or
documentation.
/C\ Other reasons specified in the SK8HS Reasons for Fleooupnnentdocument
released annually by-[)HC8 and posted ¢n the OHCSBH|Nwebsite.
Contractor shall reimburse County for all overpayments identified by Contractor, County,
and/or state or federal oversight agencies as an audit exception within the timeframes; required
by law or Country or state or federal agency. Funds owed to County will be due within forty-five
(45) days of notification by County, or County shall withhold future payments until all excess
funds have been recouped by means ofanoffset against any payments then or thereafter owing
to County under this or any other Agreement between the County and Contractor.
2. UntemmaUAudits/Revi$wans.
Contractor is responsible for ensuring the accuracy of all claims submitted for
reimbursement. This includes, but im not limited to, verifying that the services billed are properly
documented, correctly coded, and align with applicable SMHS definitions and standards.
Contractor must also ensure that all supporting documentation is accurata, comp|ete, and
reflects the services actually rendered.
In addition, Contractors with medication prescribing authority shall adhere to County's
medication monitoring review practices. Contractor shall provide County with notification and a
summary of any internal audit exceotiona, and the specific corrective actions taken to sufficiently
reduce the errors that are discovered through Contractor's internal audit process. Contractor
shall provide this notification and summary to County as requested by the County.
3. Confidentiality in AuditlRewiewwProcess.
Contractor and County mutually agree to maintain the confidentiality of Contractor's
records and information of persons served, in compliance with all applicable State and Federal
statutes and regulations, including but not limited bz H|PAAand California Welfare and
Institutions Code, Section 5328. Contractor shall inform all of its officers, employees, and agents
of the confidentiality provisions 0f all applicable statutes.
Contractor's fiscal records shall contain sufficient data bz enable auditors to perform
complete audit and shall be maintained in conformance with standard procedures and
accounting principles.
Exhibit C
Page 10 of 15
Contractor's records shall be maintained as required by DBH and DHCS on forms
furnished by DHCS or the County. All statistical data or information requested by the County's
DBH Director or designee shall be provided by the Contractor in a complete and timely manner.
4. Cooperation with Audits/Reviews.
Contractor shall cooperate with County in any review and/or audit initiated by County,
DHCS, or any other applicable regulatory body. This cooperation may include such activities as
onsite program, fiscal, or chart reviews and/or audits.
In addition, Contractor shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractor shall notify the County of any scheduled or unscheduled external evaluation
or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
all parts of external review processes.
Contractor shall allow inspection, evaluation and audit of its records, documents and
facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
has been notified that an audit or investigation of this Agreement has been commenced, until
such time as the matter under audit or investigation has been resolved, including the exhaustion
of all legal remedies, whichever is later pursuant to 42 C.F.R.§§438.3(h) and 438.2301(3)(i-iii).
5. Single Audit Clause.
If Contractor expends Seven Hundred Fifty Thousand and No/100 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 Office of
Management and Budget(OMB) 2 CFR 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 DBH Finance Division 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.
A single audit report is not applicable if Contractor's Federal contracts do not exceed the
Seven Hundred Fifty Thousand and No/100 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 solvency. Said audit
report shall be delivered to County's DBH Finance Division 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
Exhibit C
Page 11 of 15
performed by County under this paragraph shall be billed to Contractor at County cost, as
determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractor shall make available all records and accounts for inspection by County, the
State of California, if applicable, the Controller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
6. Financial Audit Report Requirements for Pass-Through Entities
If County determines that Contractor is a "subrecipient" (also known as a"pass-through
entity") as defined in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the
applicable cost principles and administrative requirements including claims for payment or
reimbursement by County as set forth in 2 C.F.R. §200 et seq., as may be amended from time
to time. Contractor shall observe and comply with all applicable financial audit report
requirements and standards.
Financial audit reports must contain a separate schedule that identifies all funds included
in the audit that are received from or passed through the County. County programs must be
identified by Agreement number, Agreement amount, Agreement period, and the amount
expended during the fiscal year by funding source.
Contractor will provide a financial audit report including all attachments to the report and
the management letter and corresponding response within six months of the end of the audit
year to the County's DBH Director or designee. The County's Director or designee is
responsible for providing the audit report to the County Auditor.
Contractor must submit any required corrective action plan to the County simultaneously
with the audit report or as soon thereafter as it is available. The County shall monitor
implementation of the corrective action plan as it pertains to services provided pursuant to this
Agreement.
In the event this Agreement is terminated, Contractor shall be entitled to compensation
for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
and conditions of this Agreement through and including the effective date of termination. This
provision shall not limit or reduce any damages owed to the County due to a breach of this
Agreement by Contractor.
Property of County
This section shall only apply to the program components and services provided under
Cost Reimbursement. County and Contractor recognize that fixed assets are tangible and
intangible property obtained or controlled under County for use in operational capacity and will
benefit County for a period more than one (1) year.
1. Agreement Assets.
Assets shall be tracked on an agreement-by-agreement basis. All assets shall fall into
the"Equipment' category unless funding source allows for additional types of assets. Items of
sensitive nature shall be purchased and allocated to a single agreement. All items containing
Exhibit
Page 12of1S
Health Insurance Portability and Accountability Act (H|PAA)/Proteched Health Information (FnH|)
data are considered sensitive. At a minimum, the following types ofitems are considered tobe
assets:
A\ Computers (desktops and |aotops\;
/EU Copiers, cell phones, tebhets, and other devices with any H|PA\datm
/C\ Modular furniture
(0) Land
(E) Any items over$5.00O
(F) Items of$5OOor more with m |ifoapanofat least two (2) years:
a. Televisions
b. Washers/Dryers
c. Printers
d. Digital Cameras;
m. CtherequipmoDt/fumnituna
f. Items in total when purchased or used ama group fall into one or more ofthe
above categories
Contractor shall ensure proper tracking for contact assets that include the following
asset attributes adaminimum:
(A) Description ufthe asset;
(B) The unique identifier ofthe asset if applicable, i.e., serial number;
(C) The acquisition date;
(C}) The quantity Cf the asset;
(E) The location of the asset orto whom the asset iaassigned;
(F) The cost of the asset at the time ofacquisition;
(G) The source of grant funding ifapplicable;
(H) The disposition date, and
(|) The method mfdisposition (surplus, transferred, destroyed. lost).
2. Retention and Maintenance.
Assets shall be retained by [ouMb/` as County pnopertv, in the event this Agreement ie
terminated or upon expiration of this Agreement. Contractor agrees to participate inanannual
inventory of all County fixed and inventoried assets. Upon termination or expiration ofthis
Agreement, Contractor shall be physically present when fixed and inventoried assets are
returned to County possession. Contractor is responsible for returning ho County all County
owned undepnacimted fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement. Contractor
further agrees to the following:
N\\ Maintain all items of equipment in good working order and condition, normal wear
and tear exceotad;
Unn-
(B) Label all `equipment with County assigned program number, toperform
periodic inventories as required by County and to maintain mn inventory list
showing where and how the equipment ig being used in accordance with
procedures developed bvCounty. All such lists shall be submitted toCounty
within ten /1U\ days of any request therefore; and
Exhibit C
Page 13 of 15
(C) Report in writing to County immediately after discovery, the loss or theft of any
items of equipment. For stolen items, the local law enforcement agency must be
contacted, and a copy of the police report submitted to County.
3. Equipment Purchase.
The purchase of any equipment by Contractor with funds provided hereunder shall
require the prior written approval of County's DBH Director or 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 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.
4. Modification of Assets.
Contractor must obtain prior written approval from County's DBH whenever there is any
modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by Contractor for a use which does not
qualify under this Agreement, Contractor shall reimburse County in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of
funds not provided under this Agreement. These requirements shall continue in effect for the
life of the property. In the event this Agreement expires, the requirements for this paragraph
shall remain in effect for activities or property funded with said funds, unless action is taken by
the State government to relieve County of these obligations.
Other Financial Requirements
1. Notification of Changes.
Contractor shall notify County in writing of any change in organizational name, Head of
Service or principal business at least fifteen (15) business days in advance of the change.
Contractor shall notify County of a change of service location at least six (6) months in advance
to allow County sufficient time to comply with site certification requirements. Said notice shall
become part of this Agreement upon acknowledgment in writing by the County, and no further
amendment of the Agreement shall be necessary provided that such change of address does
not conflict with any other provisions of this Agreement.
Contractor must immediately notify County of a change in ownership, organizational
status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
services in no event more than 15 days of the change.
2. Record Maintenance.
Contractor shall maintain all records and management books pertaining to service
delivery and demonstrate accountability for agreement performance and maintain all fiscal,
statistical, and management books and records pertaining to the program. Records should
include, but not be limited to, monthly summary sheets, sign-in sheets, and other primary source
documents. Fiscal records shall be kept in accordance with Generally Accepted Accounting
Principles and must account for all funds, tangible assets, revenue and expenditures, Fiscal
records must also comply with the Code of Federal Regulations (CFR), Title 11, Subtitle A,
Exhibit
Page 14cf15
Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.
All records shall be complete and current and comply with all negUinernmrdg in this
Agreement. Failure to maintain acceptable records per the preceding requirements shall be
considered grounds for withholding of payments for billings submitted and for termination of this
Agreement.
Contractor shall maintain records of persons served and community service in
compliance with all regulations set forth by local, state, and federal requirements, laws, and
regulations, and provide access to clinical records by County staff.
Contractor shall comply with all |ooa|, state, and federal |avvo and regulations regarding
relinquishing ormaintaining nnediom| records.
Contractor shall agree to maintain and retain all appropriate service and financial
records for a period of at least ten (10) years from the date of final payment, the final date of this
Agreement, final settlement, or until audit findings are resolved, whichever i$ later.
3. Financial Reports.
Contractor shall submit audited financial reports unen annual basis to the County. The
audit shall be conducted in accordance with Generally Accepted Accounting Principles and
generally accepted auditing standards.
4. Agreement Termination.
In the event this Agreement is tannineted, ends its designated temm, or Contractor
ceases operation of its business, Contractor shall deliver or make available to County all
financial records that may have been accumulated by Contractor or subcontractor under this
Aoremrnent. whether completed, partially completed or in progress within seven (7) calendar
days of said termination/end date.
5' Restrictions and Limitations.
This Agreement shall be subject to any restrictions, limitations, and/or conditions
imposed bv County or state or federal funding sources that may in any way affect the fiaco|
provisions of, or funding for this Agreement. This Agreement is also contingent upon sufficient
funds being made available by County, state, or federal funding sources for the term of this
Agreement. If the federal or state governments reduce financial participation in the Medi-Cal
program, County agrees to meet with Contractor to discuss renegotiating the services required
by this Agreement.
Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
over and im not available for services provided in subsequent years.
In the event that funding for these services is delayed by the State Controller, County
may defer payments to Contractor. The amount of the deferred payment shall not exceed the
amount of funding delayed by the State Controller to the County. The periodof time ofthe
deferral by County shall not exceed the period of time of the State Controller's delay ofpayment
to County plus forty-five (45) days.
Exhibit
Page 1Sof15
6. Additional Financial Requirements
County has the right to monitor the performance of this Agreement hJ ensure the
accuracy Vf claims for reimbursement and compliance with all applicable laws and regulations.
Contractor must comply with the False Claims Act employee training and policy
requirements set forth in42 U.S.C. 138Oa/a\(G8) and ao the Secretary Cf the United States
Department of Health and Human Services may specify.
Contractor agrees that nm part of any federal funds provided under this Agreement shall
be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
Executive Schedule at hftpm:/Awvvw.opnn.gov/(U.B. CJffime of Personnel Management), as from
time to time amended.
Federal Financial Participation is not available for any amount furnished to an Excluded
individual or entity, orat the direction ofa physician during the period of exclusion when the
person providing the service knew or had reason to know ofthe exclusion, ortoan individual or
entity when the County failed to suspend payments during an investigation of a credible
allegation of fraud F¢2U.@.C. section 13SOb(i)/2U.
Contractor must maintain financial records for m minimum period often (10) years or until
any di$pute, audit or inspection is naao|ved, whichever is later. Contractor will be responsible for
any disallowances related io inadequate documentation.
7. Contractor Prohibited from Redirection of Contracted Funds
Contractor may not redirect or transfer funds from one funded program to another funded
program under which Contractor provides services pursuant to this Agreement except through a
duly executed amendment to this Aqreemert.
Contractor may not charge services delivered toon eligible person served under one funded
program to another funded program unless the person served is also eligible for services under
the second funded program.
ExhibitC—AttachmentA
FEE-FOR-SERVICE RATE(S)
^°Fee-fopSen/iue rates are established by the Department of Health Care Services.
Contractor acknowledges that the provider rates in the table below are all-inclusive rates
which account for program operating expenses. This includes, but im not limited to, staff time
spent on direct patient care, staff time not spent on direct patient care(e.g.time spent on
documentation,travel, and paid time off). total staff compensation (e.Q.. salaries and wages,
benefdo, bonuaeo, and other incentives), vehicle expenses(a.A. gas, rnaintenence,
inmunance), truining, assets/capital oaaets, uti!itiea, and any direct and indirect overhead and
operating costs. Indirect cost expenses shall be determined by the Contractor under the Fee-
for-Service reimbursement structure.
Exhibit C-Attachment A
Maximum
Units That Can
Fiat Rate Type Unit Be Billed Rate
1 per allowed
Interactive Complexity 15 min per procedure per $18 89
unit provider per
person served
Sign Language/Oral Interpretive Services 15 min per Variable $31.88
unit
Lodge
RH Community Builders, LP
Maximum Compensation FY 25-26 964,410
Maximum Compensation FY 26-27 1,060,851
Maximum Compensation FY 27-28 $ 1,188,153
Maximum Compensation FY 28-29
Maximum Compensation FY 29-30
Program Maximum Compensation 3,2�13,414
Lodge
RH Community Builders, LP
Fiscal Year(FY) 2025-26
PROGRAM EXPENSES
1000: DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 IDirector 0.16 $ 19,951 $ 19,951
1102 1 Fiscal Analyst 0.12 8,770 8,770
1103 1Office Manager 0.51 23,397 23,397
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.79 52,118 $ 52,118
Acct# Program Position FTE Admin Program Total
1116 ICase Manager 1.02 $ 59,529 $ 59,529
1117 lClinician 1.02 84,988 84,988
1118 lClinical Supervisor 0.51 53,042 53,042
1119 Janitor 0.51 24,461 24,461
1120 Monitor 0.77 31,915 31,915
1121 Peer Support 1 1.53 73,378 73,378
1122 Peer Support 11 2.04 106,322 106,322-
1123 1 Peer supervisor 0.51 31,885 31,885
1124 1Program manager 0.51 44,553 44,553.
1125 ISUD Counselor 0.51 31,885 31,885
1126 - -
1127 -
1128 -
1129 -
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal F-8.93 $541,958 $ 541,9581
Admin Program Total
Direct Personnel Salaries Subtotal 9.72 $ 52,118 $541,958 $ 594,076
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 483 $ 5,355 $ 5,838
1202 Worker's Compensation 3,951 50,486 54,437
1203 Health Insurance 3,351 46,195 49,546
1204 Other(specify) - -
1205 Other(specify) - -
1206 Other(specify) - - -
Direct Employee Benefits Subtotal:T$ 7,785 $ 102,036 $ 109,821
Direct Payroll Taxes& Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 3,127 $ 30,518 $ 33,645
1302 FICA/MEDICARE 1,563 14,259 15,822
1303 SUI 521 5,419 5,940
1304 Other(specify) - - -
1305 Other(specify) - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 5,211 $ 50,196 $ 55,407
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 65,114 $ 694,190 $ 759,304
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
9%1 91%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 1,612
2004 IClothing, Food, & Hygiene 109,033
2005 1 Education Support -
2006 lEmployment Support -
2007 1 Household Items for Clients -
2008 JIVIedication Supports -
2009 Program Supplies- Medical 459
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 10ther(specify)
2014 1 Other(specify) -
2015 fOther(specify)
2016 1Other(specify)
DIRECT CLIENT CARE TOTAL $ 111,104
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 4,963
3002 Printing/Postage 225
3003 Office, Household&Program Supplies 13,211
3004 Advertising 380
3005 Staff Development&Training 2,445
3006 Staff Mileage 1,095
3007 -Subscriptions & Memberships -
3008 lVehicle Maintenance 845
3009 Other Vehicle Insurance 1,002
3010 Company Car Gas 918
3011 Timekeeping 700
3012 Required Insurance Coverages 7,570
DIRECT OPERATING EXPENSES TOTAL:j $ 33,354
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 18,421_
4002 Rent/Lease Building 85,680
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security 5,508
4006 Utilities 19,385
4007 Other(specify) -
4008 Other(specify) -
EOther(specify) -
Other(specify) -
4009 DIRECT FACILITIES/EQUIPMENT TOTAL:j 128,994
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 5,429
5002 HMIS(Health Management information System)
5003 Contractual/Consulting Services(Specify) 336
5004 Translation Services 246
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
1 5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:r$ 6,011
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 104,983
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 104,983
INDIRECT COST RATE 10.00%71
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 7,500
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 568
7003 Furniture& Fixtures 2,992
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 10ther(specify)
FIXED ASSETS EXPENSES TOTAL $ 11,060
TOTAL PROGRAM EXPENSES $ 1,154,810
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Rev Allocated By DBH $ -
8102 Bidder Other Revenue $ -
Total $
8200-REALIGNMENT
Acct# Line Item Description Amount
E8201 Realignment $ -
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# Revenue MHSA.Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI -Prevention & Early Intervention
8303 1 INN - Innovations Lodge 1,154,810
8304 IWET-Workforce Education&Training -
8305 JCFTN -Capital Facilities&Technology
MPSA TOTAL $ 1,154,810 .
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8 8
005 Other(Specify)
8006 Other(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES"r"810
NET PROGRAM COST: $ (0)1
Lodge
RH Community Builders,LP
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Director The Lodge-Innovation Funds/DBH/Fresno 0.16
The Lodge-SMHS/DBH/Fresno 0.17
A-23-627/Phoenix Landing/DBH/Fresno 0.34
A-23-627/Sierra Terrace/DBH/Fresno 0.33
Total 1.00
Position Contract#/Name/Department/County FTE%
Fiscal Analyst The Lodge-Innovation Funds/DBH/Fresno 0.12
The Lodge-SMHS/DBH/Fresno 0.13
A-23-627/Phoenix Landing/DBH/Fresno 0.25
A-23-627/Sierra Terrace/DBH/Fresno 0.25
A-22-267/Master Lease/DBH/Fresno 0.25
Total 1.00
Position Contract#/Name/Department/County FTE%
Office Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager The Lodge-Innovation Funds/DBH/Fresno 1.02
The Lodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinician The Lodge-Innovation Funds/DBH/Fresno 1.02
The Lodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinical Supervisor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Janitor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Monitor The Lodge-Innovation Funds/DBH/Fresno 0.77
The Lodge-SMHS/DBH/Fresno 0.73
Total 1.50
Position Contract#/Name/Department/County FTE%
Peer Support I The Lodge-Innovation Funds/DBH/Fresno 1.53
The Lodge-SMHS/DBH/Fresno 1.47
Total 3.00
Position Contract#/Name/Department/County FTE%
Peer Support it The Lodge-Innovation Funds/DBH/Fresno 2.04
The Lodge-SMHS/DBH/Fresno 1.96
Total 4.00
Position Contract#/Name/Department/County FTE%
Peer Supervisor The Lodge-innovation funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
SUD Counselor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Lodge
RH Community Builders,LP
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 759,304
Administrative Positions 52,118
1101 Director _ 19,951 1.16 FTE,responsible for overall management of the operations and services
1102 Fiscal Analyst 8,770 .12 responsible for grant invoicing and bookkeeping
1103 Office Manager 23,397 .51 FTE responsible for admin operations including Medi-Cal billing
1104 0 _._ -
1105 0
1106 0 _
1107 0
1108 0
1109 10
L 1110 0
1111 0
--
1112 0 - — ----- -_ .
1113 0
1114 0
1115 0
Program Positions 541,958
1116 lCase Manager 59,529 1.02 FTE bachelors level case managers,SLID experience preferred
1117 Clinician 94,988 1.02 FTE licensed or licensed eligible clinicians
1118 Clinical Supervisor 53,042 .51 FTE responsible for clinical oversight of the program
1119 J.Janitor 24,461 .51 FTE janitor responsible for common area cleaning
1120 JIVIonitor 31,915 .77 FTE overnight security monitors
1121 1 Peer Support 1 73,378 1.53 peer support specalists I
1122 Peer Support II 106,322 2.04 peer support specalists 11 _
1123 Peer Supervisor 31,885 .56 FTE responsible for peer overnight of the program.
1124 Program Manager 44,553 .51 FTE responsible for the day to day operations of the program
1125 SUD Counselor 31,885 .51 FTE responsible for DUS counseling services
1126 0
1127 0
1128 0
1129 0 _
1130 0
1131 0 _
1132 0
1133 0 _
1134 0
Direct Employee Benefits 109,821
1201 Retirement 5,838 Employer contribution to Retirement plan
1202 Worker's Compensation 54,437 Workers Compensation expense based on employee classification
1203 Health Insurance 49,546 Employer health care cost
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 55,407
1301 OASDI 33,645 OASDI for employee salaries
1302 FICA/MEDICARE 15,822 FICA/MEDICARE for employee salaries
1303 SUI 5,940 SUI for employee salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 111,104
2001 jChild Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,612 includes vehicle GPS subscription,client bus passes and vehicle washes
2004 Clothing,Food,&Hygiene 109,033 Includes client food,basic client items including clothing,linen,and hygiene products
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 459 Includes basic medical supplies include PPE for clients
2010 Utility Vouchers -
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 33,354
3001 Telecommunications 4,963 Cost of cellphones,landline,fax,email and internet
3002 Printing/Postage 225 Includes business cards and postage
3003 Office,Household&Program Supplies 13,211 Includes office supplies,cleaning supplies,program supplies,and staff PPE
3004 Advertising 380 Includes cost of employee uniforms
3005 Staff Development&Training 2,445 Includes Pro-ACT,Motivational Interviewing,and other trauma informed training
3006 Staff Mileage 1,095 Mileage reimbursment for staff travel
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 845 Vehicle repairs
3009 Other Vehicle Insurance 1,002 Auto insurance for program vehicles
3010 Company Car Gas 918 Cost of gas for company vehicles
3011 Timekeeping 700 Cost of employee timekeeping software
3012 Required Insurance Coverages 7,570 Required insurance policies for program
4000:DIRECT FACILITIES&EQUIPMENT 128,994
4001 1 Building Maintenance 18,421 Minor repairs and maintenance to facility
4002 Rent/Lease Building 85,680 Monthly rent for The Lodge
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security 5,508 24/7 security patrol
4006 Utilities 19,385 Includes PGE,water and garbage
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 6,011
5001 1 Consultant(Network&Data Management) 5,429 IT consulting services
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services(Specify) 336 Staff onboarding expenses,drug testing,livescan,DMV reports
5004 Translation Services 246 Translation services when bilingual staff are not avaliable
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 104,983
6001 Administrative Overhead 104,983 Allocation of indirect expenses
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 11,060
7001 1 Computer Equipment&Software 7,500 Replacement expense of staff computers
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 568 Replacement expense of HIPPA compliant devices including cell phones and ipads
7003 Furniture&Fixtures 2,992 Replacement expense desks,common area furniture,and minimal bed replacements
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 LOther(specify)
7008 10ther(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,154,810
Lodge
RH Community Builders, LP
Fiscal Year(FY) 2026-27
PROGRAM EXPENSES
1000: DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 IDirector 0.16 $ 19,951 $ 19,951
1102 Fiscal Analyst 0.12 8,770 8,770
1103 Office Manager 0.51 23,397 23,3971
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
Direct Personnel Admin Salaries Subtotal 0.79 52,118 52,118
Acct# Program Position FTE Admin Program Total
1116 Case Manager 1.02 $ 59,529 59,529
1117 Clinician 1.02 84,988 84,988
1118 Clinical Supervisor 0.51 53,042 53,0421
1119 Janitor 0.51 24,461 24,461
1120 Monitor 0.77 31,915 31,915
1121 Peer Support 1 1.53 73,378 73,378
1122 Peer Support 11 2.04 106,322 106,322
1123 Peer Supervisor 0.51 31,885 31,885
1124 Program Manager 0.51 44,553 44,553
1125 SUD Counselor 0.51 31,885 31,885
1126 - -
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.93 $541,958 11 $ 541,958
Admin Program Total
Direct Personnel Salaries Subtotal 9.72 $ 52,118 $541,958 $ 594,076
Direct Employee Benefits
Acct# I Description Admin Program Total
1201 lRetirement $ 483 $ 5,355 $ 5,838
1202 Worker's Compensation 3,951 50,486 54,437
1203 lHealth Insurance 3,351 46,195 49,546
1204 10ther(specify) - - -
1205 Other(specify) - - -
1206 10ther(specify) - - -
Direct Employee Benefits Subtotal:1 $ 7,785 1 $102,036 1 $ 109,821
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 3,127 $ 30,518 $ 33,645
1302 FICA/MEDICARE 1,563 14,259 15,822
1303 SUI 521 5,419 5,940
1304 Other(specify) - - -
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 5,211 $ 50,196 $ 55,407
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 65,114 $694,190 $ 759,304
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
9%1 91%
2000: DIRECT CLIENT SUPPORT
r
Line Item Description Amount
Child CareClient Housing SupportClient Transportation &Support 1,644
Clothing, Food,& Hygiene 109,001
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 IMedication Supports -
2009 1program Supplies-Medical 459
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify)
2013 Other(specify) -
2014 10ther(specify) -
2015 Other(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 111,104
3000: DIRECT OPERATING EXPENSES
Acct# I Line Item Description Amount
3001 Telecommunications $ 4,963
3002 Printing/Postage 225
3003 Office, Household&Program Supplies 13,211
3004 Advertising 380
3005 IStaff Development&Training 2,445
3006 Staff Mileage 1,095
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 845
3009 Other Vehicle Insurance 1,002
3010 Company Car Gas 918
3011 Timekeeping 700
3012 Required Insurance Coverages 7,570
DIRECT OPERATING EXPENSES TOTAL:1 $ 33,354
4000: DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 18,421
4002 Rent/Lease Building 85,680
4003 Rent/Lease Equipment -
4004 1 Rent/Lease Vehicles -
4005 Security 5,508
4006 Utilities 19,385
4007 Other(specify) -
4008 Other(specify) -
4009 10ther(specify) -
4010 10ther(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 128,994
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ 5,429
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) 336
5004 ITranslation Services 246
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 6,011
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 104,983
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify) -
6011 Other(specify) -
6012 10ther(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 104,983
INDIRECT COST RATE 10.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 7,500
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 568
7003 Furniture&Fixtures 2,992
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 FiscalRocks -
FIXED ASSETS EXPENSES TOTAL $ 11,060
TOTAL PROGRAM EXPENSES $ 1,154,810
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL ' $ - '
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI - Prevention &Early Intervention -
8303 INN - Innovations Lodge 1,154,810
8304 WET-Workforce Education &Training -
8305 JCFTN -Capital Facilities&Technology -
MHSA TOTAL $ 1,154,810
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH -
8002 Client Fees -
8003 Client Insurance -
8004 Grants (Specify)
8005 Other(Specify) -
8006 Other(Specify) -
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $1,154,810
NET PROGRAM COST: $ 0
Lodge
RH Community Builders,LP
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Director The Lodge-Innovation Funds/DBH/Fresno 0.16
The Lodge-SMHS/DBH/Fresno 0.17
A-23-627/Phoenix Landing/DBH/Fresno 0.34
A-23-627/Sierra Terrace/DBH/Fresno 0.33
Total 1.00
Position Contract#/Name/Department/County FTE%
Fiscal Analyst The Lodge-Innovation Funds/DBH/Fresno 0.12
The Lodge-SMHS/DBH/Fresno 0.13
A-23-627/Phoenix Landing/DBH/Fresno 0.25
A-23-627/Sierra Terrace/DBH/Fresno 0.25
A-22-267/Master Lease/DBH/Fresno 0.25_
Total 1.00
Position Contract#/Name/Department/County FTE%
Office Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager The Lodge-Innovation Funds/DBH/Fresno 1.02
The Lodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinician The Lodge-Innovation Funds/DBH/Fresno 1.02
TheLodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinical Supervisor The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Janitor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Monitor The Lodge-Innovation Funds/DBH/Fresno 0.77
TheLodge-SMHS/DBH/Fresno 0.73
Total 1.50
Position Contract#/Name/Department/County FTE%
Peer Support I The Lodge-Innovation Funds/DBH/Fresno 1.53
TheLodge-SMHS/DBH/Fresno 1.47
Total 3.00
Position Contract#/Name/Department/County FTE%
Peer Support 11 The Lodge-Innovation Funds/DBH/Fresno 2.04
The Lodge-SMHS/DBH/Fresno 1.96
Total 4.00
Position Contract#/Name/Department/County FTE%
Peer Supervisor The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
SUD Counselor The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Lodge
RH Community Builders,LP
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 759,304
Administrative Positions 52,118
1101 IDirector 19,951 1,16 FTE,responsible for overall management of the operations and services
1102 Fiscal Analyst 8,770 .12 responsible for grant invoicing and bookkeeping
1103 Office Manager 23,397 .51 FTE responsible for admin operations including Medi-Cal billing
1104 0 -
1105 0
1106 0 _
1107 0
1108 0
1109 0 --
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 541,958
1116 1 Case Manager 59,529 1.02 FTE bachelors level case managers,SUD experience preferred
1117 Clinician 84,988 1.02 FTE licensed or licensed eligible clinicians
1118 1 Clinical Supervisor 53,042 .51 FTE responsible for clinical oversight of the program
1119 Janitor 24,461 .51 FTE janitor responsible for common area cleaning
1120 Monitor 31,915 .77 FTE overnight security monitors
1121 Peer Support 1 73,378 1.53 peer support specalists 1
1122 Peer Support II 106,322 2.04 peer support specalists 11
1123 Peer Supervisor 31,885 .56 FTE responsible for peer overnight of the program.
1124 Program Manager 44,553 .51 FTE responsible for the day to day operations of the program
1125 SUD Counselor 31,885 .51 FTE responsible for DUS counseling services
1126 0 -
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 109,821
1201 lRetirement 5,838 Employer contribution to Retirement plan
1202 Worker's Compensation 54,437 Workers Compensation expense based on employee classification
1203 Health Insurance 49,546 Employer health care cost
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 55,407
1301 JOASDI 33,645 OASDI for employee salaries
1302 FICA/MEDICARE 15,822 FICA/MEDICARE for employee salaries
1303 SUI 5,940 SUI for employee salaries
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 111,104
2001 1 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,644 Includes vehicle GPS subscription,client bus passes and vehicle washes
2004 Clothing,Food,&Hygiene 109,001 Includes client food,basic client items including clothing,linen,and hygiene products
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical 45-9 Includes basic medical supplies include PPE for clients
2010 Utility Vouchers ( -
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 33,354
3001 Telecommunications 4,963 Cost of cellphones,landline,fax,email and internet
3002 Printing/Postage 225 Includes business cards and postage
3003 Office,Household&Program Supplies 13,211 Includes office supplies,cleaning supplies,program supplies,and staff PPE
3004 Advertising 380 Includes cost of employee uniforms
3005 Staff Development&Training 2,445 Includes Pro-ACT,Motivational Interviewing,and other trauma informed training
3006 Staff Mileage 1,095 Mileage reimbursment for staff travel
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 845 Vehicle repairs
3009 Other Vehicle Insurance 1,002 Auto insurance for program vehicles
3010 Company Car Gas 918 Cost of gas for company vehicles
3011 Timekeeping 700 Cost of employee timekeeping software
3012 Required Insurance Coverages 7,570 Required insurance policies for program
4000:DIRECT FACILITIES&EQUIPMENT 128,994
4001 Building Maintenance 18,421 Minor repairs and maintenance to facility
4002 Rent/Lease Building 85,680 Monthly rent for The Lodge
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security 5,508 24/7 security patrol
4006 Utilities 19,385 includes PGE,water and garbage
4007 Other(specify) -
4008 other(specify)
4009 Other(specify)
4010 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 6,011
5001 Consultant(Network&Data Management) 5,429 IT consulting services
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) 336 Staff onboarding expenses,drug testing,livescan,DMV reports
5004 Translation Services 246 Translation services when bilingual staff are not available
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
60W:INDIRECT EXPENSES 104,983
6001 Administrative Overhead 104,983 Allocation of indirect expenses
6002 Professional Liability Insurance - _
6003 Accounting/Bookkeeping
6004 External Audit _
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 11,060
7001 1 Computer Equipment&Software 7,500 Replacement expense of staff computers
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 568 Replacement expense of HIPPA compliant devices including cell phones and ipads
7003 Furniture&Fixtures 2,992 Replacement expense desks,common area furniture,and minimal bed replacements
7004 leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 _I Other(specify)
-70-0-8 Fiscalflocks
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,154,810
Lodge
RH Community Builders, LP
Fiscal Year(FY)2027-28
PROGRAM EXPENSES
Direct Employee Salaries Di 1000: DIRECT SALARIES&BENEFITS
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.17 $ 19,951 $ 19,951
1102 Fiscal Analyst 0.12 8,770 8,770
1103 Office Manager 0.51 23,397 23,397
1104 - -
1105
1106
1107
1108
1109
1110
1111 — - -
1112
113
114
1115
Direct Personnel Admin Salaries Subtotal 0.79 52,118 $ 52,118
Acct# Program Position FTE Admin Program Total
1116 Case Manager 1.02 $ 59,529 $ 59,529
1117 Clinician 1.02 84,988 84,988
1118 Clinical Supervisor 0.51 53,042 53,042
1119 Janitor 0.51 24,461 24,461
1120 Monitor 0.77 31,915 31,915
1121 Peer Support 1 1.53 73,378 73,378
1122 Peer Support 11 2.04 106,322 106,322
1123 Peer Supervisor 0.51 31,885 31,885
1124 Program Manager 0.51 44,553 44,553
1125 SUD Counselor 0.51 31,885 31,885
1126 - -
1127 - -
1128 - -
1129 - -
1130 -
1131 -
1132 -
1133
-
Direct Personnel Program Salaries Subtotal 8.93 $ 541,958 541,958 ,
Admin Program Total
Direct Personnel Salaries Subtotal 9.72 $ 52,118 $ 541,958 $ 594,076
Direct Employee Benefits
Acct# I Description Admin Program Total
1201 1 Retirement $ 483 $ 5,355 $ 5,838
1202 Worker's Compensation 3,951 50,486 54,437
1203 Health Insurance 3,351 46,195 49,546
1204 Other(specify) - - -
1205 Other(specify) - - -
1206 10ther(specify) - - -
Direct Employee Benefits Subtotal:1 $ 7,785 1 $ 102,036"1 $ 109,821
Direct Payroll Taxes&Expenses:
Acct# I Description Admin Program Total
1301 OASDI $ 3,127 $ 30,518 $ 33,645
1302 FICA/MEDICARE 1,563 14,259 15,822
1303 SUI 521 5,419 5,940
1304 Other(specify) - -
1305 Other(specify) - -
1306 10ther(specify) - -
Direct Payroll Taxes&Expenses Subtotal: $ 5,211 $ 50,196 $ 55,407
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 65,114 $ 694,190 $ 759,304
IRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE Admin Program
9%1 91%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,644
2004 IClothing, Food, & Hygiene 109,002
2005 lEducation Support -
2006 1 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies- Medical 459
2010 1 Utility Vouchers -
2011 10ther(specify)
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify) -
Fresno County Department of Behavioral Healtbontract Budget Narrative Revised 2/7/2020
2015 Other(specify)
2016 1Other(specify) DIRECT CLIENT CARE TOTAL 111,105 1
3000:DIRECT OPERATING EXPENSES
Acct# I Line Item Description Amount
3001 Telecommunications $ 4,963
3002 Printing/Postage 225
3003 Office, Household &Program Supplies 13,211
3004 Advertising 380
3005 Staff Development&Training 2,445
3006 Staff Mileage 1,095
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 845
3009 Other Vehicle Insurance 1,002
3010 Company Car Gas 918
3011 Timekeeping 700
3012 Required Insurance Coverages 7,570
DIRECT OPERATING EXPENSES TOTAL: 33,3541
4000: DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 18,421
4002 Rent/Lease Building 85,680
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security 5,508
4006 Utilities 19,385
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:[$ 128,994J
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network& Data Management) $ 5,429
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) 336
5004 Translation Services 246
5005 Other(specify) -
5006 other(specify)
5007 Other(specify)
5068 1Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 6,011
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 104,983
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 jOther(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 104,983
INDIRECT COST RATE 10.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 7,500
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 568
7003 Furniture& Fixtures 2,992
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 10ther(specify)
FIXED ASSETS EXPENSES TOTAL $ 11,060
TOTAL PROGRAM EXPENSES $ 1,154,811
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL 1 $ - )
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI -Prevention &Early Intervention -
8303 INN -Innovations Lodge 1,154,811
8304 IWET-Workforce Education&Training -
8305 JCFTN -Capital Facilities&Technology -
MHSA TOTAL][—$ 1,154,811
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH -
8002 Client Fees -
8003 Client Insurance -
8004 lGrants(Specify)
8005 10ther(Specify) -
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $ -
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,154,811
NET PROGRAM COST: $ 0
Lodge
RH Community Builders,LP
Fiscal Year(FY)2027-28
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Director The Lodge-Innovation Funds/DBH/Fresno 0.16
TheLodge-SMHS/DBH/Fresno 0.17
A-23-627/Phoenix landing/DBH/Fresno 0.34
A-23-627/Sierra Terrace/DBH/Fresno 0.33
Total 1.00
Position Contract#/Name/Department/County FTE%
Fiscal Analyst The Lodge-Innovation Funds/DBH/Fresno 0.12
TheLodge-SMHS/DBH/Fresno 0.13
A-23-627/Phoenix Landing/DBH/Fresno 0.25
A-23-627/Sierra Terrace/DBH/Fresno 0.25
A-22-267/Master Lease/DBH/Fresno 0.25
Total 1.00
Position Contract#/Name/Department/County FTE%
Office Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager The Lodge-Innovation Funds/DBH/Fresno 1.02
TheLodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinician The Lodge-Innovation Funds/DBH/Fresno 1.02
TheLodge-SMHS/DBH/Fresno 0.98
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinical Supervisor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Janitor The Lodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Monitor The Lodge-Innovation Funds/DBH/Fresno 0.77
The Lodge-SMHS/DBH/Fresno 0.73
Total 1.50
Position Contract#/Name/Department/County FTE%
Peer Support I TheLodge-Innovation Funds/DBH/Fresno 1.53
The Lodge-SMHS/DBH/Fresno 1.47
Total 3.00
Position Contract#/Name/Department/County FTE%
Peer Support II The Lodge-Innovation Funds/DBH/Fresno 2.04
The Lodge-SMHS/DBH/Fresno 1.96
Total 4.00
Position Contract#/Name/Department/County FTE%
Peer Supervisor TheLodge-Innovation Funds/DBH/Fresno 0.51
TheLodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Manager The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FIFE%
SUD Counselor The Lodge-Innovation Funds/DBH/Fresno 0.51
The Lodge-SMHS/DBH/Fresno 0.49
Total 1.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Lodge
RH Community Builders,LP
Fiscal Year(FY)2027-28 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 7S9,304
Administrative Positions 52,118
1101 Director _ 19,951 .16 FTE,responsible for overall management of the operations and services
1102 Fiscal Analyst 8,770 .12 responsible for grant invoicing and bookkeeping
1103 Office Manager 23,397 .51 FTE responsible for admin operations including Medi-Cal billing
1104 0 -
1105 0
1106 0
1107 0
1108 0 _
1109 0
1110 0
1111 0 -
1112 0
1113 0
1114 0
1115 10
Program Positions 541,958
1116 Case Manager 59,529 1.02 FTE bachelors level case managers,SUD experience preferred
1117 Clinician 84,988 1.02 FTE licensed or licensed eligible clinicians
1118 Clinical Supervisor 53,042 .51 FTE responsible for clinical oversight of the program
1119 Janitor 24,461 .51 FTE janitor responsible for common area cleaning
1120 IMonitor 31,915 .77 FTE overnight security monitors
1121 1 Peer Support 1 73,378 1.53 peer support specalists 1
1122 Peer Support 11 106,322 12.04 peer support specalists 11
1123 Peer Supervisor 31,885 .56 FTE responsible for peer overnight of the program.
1124 Program Manager 44,553 .51 FTE responsible for the day to day operations of the program
1125 SUD Counselor 31,885 .51 FTE responsible for DUS counseling services
1126 0 -
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 109,821
1201 Retirement 5,838 Employer contribution to Retirement plan
1202 Worker's Compensation 54,437 Workers Compensation expense based on employee classification
1203 Health Insurance 49,546 Employer health care cost
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 55,407
1301 1 OASDI 33,645 OASDI for employee salaries
1302 FICA/MEDICARE 15,822 FICA/MEDICARE for employee salaries
1303 ISUI 5,940 SUI for employee salaries
1304 Other(specify) -
1305 Other(specify)
1116- 1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 111,105
2001 Child Care
2002 Client Housing Support -
2003 Client Transportation&Support 1,644 Includes vehicle GPS subscription,client bus passes and vehicle washes
2004 Clothing,Food,&Hygiene 109,002 Includes client food,basic client items including clothing,linen,and hygiene products
2005 Education Support -
2006 Employment Support
2007 1 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical 459 Includes basic medical supplies include PPE for clients
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 33,354
3001 ITelecommunications 4,963 Cost of cellphones,landline,fax,email and internet
3002 Printing/Postage 225 Includes business cards and postage
3003 Office,Household&Program Supplies 13,211 Includes office supplies,cleaning supplies,program supplies,and staff PPE
3004 Advertising 380 Includes cost of employee uniforms _
3005 Staff Development&Training 2,445 Includes Pro-ACT,Motivational Interviewing,and other trauma informed training
3006 Staff Mileage 1,095 Mileage reimbursment for staff travel
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 845 Vehicle repairs
3009 Other Vehicle Insurance 1,002 Auto insurance for program vehicles
3010 Company Car Gas 918 Cost of gas for company vehicles
3011 Timekeeping 700 Cost of employee timekeeping software
3012 Required Insurance Coverages 7,570 Required insurance policies for program
4000:DIRECT FACILITIES&EQUIPMENT 128,994
4001 Building Maintenance 18,421 Minor repairs and maintenance to facility
4002 Rent/Lease Building 85,680 Monthly rent for The Lodge
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security 5,508 24/7 security patrol
4006 Utilities 19,385 Includes PGE,water and garbage
4007 Other(specify) -
4008 10ther(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 6,011
5001 Consultant(Network&Data Management) 5,429 IT consulting services
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) 336 Staff onboarding expenses,drug testing,livescan,DMV reports
5004 Translation Services 246 Translation services when bilingual staff are not avaliable
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 104,983
6001 Administrative Overhead 104,983 Allocation of indirect expenses
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 1 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 11,060
7001 Computer Equipment&Software 7,500 Replacement expense of staff computers
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 568 Replacement expense of HIPPA compliant devices including cell phones and ipads
7003 Furniture&Fixtures 2,992 Replacement expense desks,common area furniture,and minimal bed replacements
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify) --
-7-008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,154,811
Exhibit D
Page 1 of 3
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A)Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury.The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B)Automobile Liability.Automobile liability insurance with limits of not less than One
Million Dollars($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D)Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy,then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and(3)if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse /molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence,with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks.The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property(including but not limited to
information or data)that is in the care, custody,or control of the Contractor.
D-1
Exhibit D
Page 2 of 3
Definition of Cyber Risks.°Cyber Risks"include but are not limited to(i)Security
Breach,which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii)data breach; (iii) breach of any of the Contractor's obligations under Article 11
of this Agreement; (iv)system failure; (v)data recovery; (vi)failure to timely disclose
data breach or Security Breach; (vii)failure to comply with privacy policy; (viii) payment
card liabilities and costs; (ix) infringement of intellectual property, including but not
limited to infringement of copyright, trademark, and trade dress; (x)invasion of privacy,
including release of private information; (xi) information theft; (xii)damage to or
destruction or alteration of electronic information; (xiii)cyber extortion; (xiv)extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi)funds
transfer fraud; (xvii)telephone fraud; (xviii) network security; (xix)data breach response
costs, including Security Breach response costs; (xx)regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi)credit monitoring expenses.
2. Additional Requirements
(A)Verification of Coverage.Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office,the Contractor shall mail and email,or
cause its broker or producer to mail and email,to the County of Fresno, Department of
Behavioral Health -Attention Plan Administration, 1925 E Dakota Ave, Fresno CA
93726, or electronically to DBHPlanAdmin@fresnocountyca.gov with a copy to the
assigned County's DBH Staff Analyst, certificates of insurance and endorsements for all
of the coverages required under this Agreement.
(i) Each insurance certificate must state that: (1)the insurance coverage has been
obtained and is in full force; (2)the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and(3)the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned.The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
D-2
Exhibit
Page 3of3
(v) The cybmrliability insurance certificate must also state that it is endorsed, and
include nn endorsement, bo cover the full replacement value of damage to,
e|h*neUon of. loss of, or destruction of intangible property (including but not limited
0o information ordata) that is in the omra,cusbody, or control of the Contractor.
(B)Acceptability of Insurers.All insurance policies required under this Agreement must be
issued by admitted insurers licensed todobusiness in the State of California and
possessing cd all times during the term of this Agreement an&KA. Best, Inc. rating ofno
less than A:VU.
(C)Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy ms required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the !Insurer to, provide written notice to the
County not less than 1O days in advance ofcancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 3O days in
advance of cancellation or change.The County in its sole discretion may determine that
the failure of the Contractor orits insurer to timely provide owritten notice required by
this paragraph ieo breach mf this Agreement.
(D)Cmunty`s Entitlement to Greater Coverage. |f the Contractor has Pr obtains insurance
with broader coverage, higher||mnKa. orboth. thon\whotimrequiredunderthis
Agreement,then the County requires and ia entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall de|iver, or cause its broker orproducer
to deliver, to the County's Risk Manager certif icates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E)Waiver mf Subrogation.The Contractor waives any right bo recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement.The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such anendorsement.
(F) Cmunty`s Remedy for Contractor's Failure to Maintain. |f the Contractor fails bzkeep
in effect at all times any insurance coverage required under this Agreement,the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage tmthe Contractor.The County may offset such
charges against any amounts owed bv the County b7 the Contractor under this
Agreement.
(G)Smbcomtvmotovs. The Contractor shall require and verify that all subcontractors used bv
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement.This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
Q-3
Exhibit E
Page 1of8
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "AuthorizedEmployees" means the Contractor's employees who have access to
Personal Information.
(B)^Amuthmrized Persons"means: (i)any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcarg. and
oonmubonts, and providers of professional services tothe Contracbor, who have access
to Personal Information and are bound by law orinwriting by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit.
(C)^Dimmxtmv, means theCuunb/'o Director of the Department of Behavioral Health or his or
her designee.
(D)"Disclose"or any derivative of that word means to disclose, release, transfer,
disseminate, orotherwise provide access bnmr communicate all or any part ofany
Personal Information orally, in writing, or by electronic or any other means bJany person.
(E)"Person" means any natural peraon, corporation. partnership, |irnited |iob||hv company,
firm,orassociation.
(F) "Personal Information" means any and all information, including any data, provided,or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Aonaernmnt` including but not|inniW*d to vital records. that: (i) idenUf|Ga,
describes, mv relates to, mr is associated with, urky capable of being used bo identify,
describe, or relate to, or associate vvith, a person (inc|udinQ, without limitation, namnee,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used nrincapable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs),financial account numbers, credit report information, answers to security
questiono, and other personal identifiers); or Uii\ is personal information within the
meaning of California Civil Code section 1798.3. subdivision /a\ or 1798.80. subdivision
(e). Personal Information does not include publicly available information that islawfully
made available to the general public from federal, state,or local government records.
(G)^Privmcy Practices Complaint" means a complaint received by the County relating to
the Contractors (or any Authorized Paroon'a) privacy pracdoee, or alleging mSmuuritv
Bnyaoh. ��uchomn�o|a|ntohmU have sufficient detail to enable the(�on�ao�xtopromptly
investigate and take remedial action under this Exhibit.
(H)^Secmrity Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor(or any Authorized
Persons) that relate to the protection of the security, confidentiality, value,or integrity of
Personal |nfmmnmUmn. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C)of this Exhibit.
F-1
Exhibit
Page 2of0
(|) "Security Breach" means(i)any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
orUi\ any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption ufor damage to, any Personal Information.
(J) "Use"or any derivative of that word means to receive, acquire, collect, apply,
manipulate, onnp|uy, prVcees, trannnnit, disoern|nmte, mooeea, sbona, dimz|oae, or dispose
of Personal Information.
2- Standard of Cmmm
(A)The Contractor acknowledges that, in the course of its engagement bv the County under
this Agn*ement, the Contractor, ur any Authorized Persons. may Use Personal
Information only aa permitted in this Agreement.
/B\The Contractor acknowledges that Personal Information io deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information)and is not confidential information of,or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
hAht, td|e, and interest in orhothe Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
re]mndkaso of the Contnoctor'o. or any Authorized Parson'o. Use of that Personal
Information.
(C)The Contractor agrees and covenants in favor of the Country that the Contractor shall:
U\ keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2ooia reasonable and appropriate to avoid a
Security Breach;
(ii) use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit'
.
(iii) not Use, Oisokoom, md[ rent, !icenoe, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County,without the County'aexpremo prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not. directly orindirectly, Disclose Personal Information toany person(an
"Unauthorized Third Party")other than Authorized Persons pursuant to this
Agreement,without the Director's express prior written consent.
(D)Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
mr any Authorized Person, is required to disclose Personal Information togovernment
regulatory authorities, or pursuant too legal proceeding, or otherwise am may ba
required by applicable |avv. Contractor shall /i\inmnmediate|y notify the County of the
specific demand for, and|mgod authority for the disclosure, including providing County
with a copy of any notice,discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authoritieo, or in n*|oUon to any legal proceeding, and (ii) pnornoUy notify the County
before such Personal Information is offered by the Contractor for such disclosure so that
F-2
Exhibit
Page 3of8
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County ho minimize the scope of such
disclosure of such Personal Information.
/E\The Contractor shall remain liable ho the County for the actions and omissions ofany
Unauthorized Third Party concerning its Use of such Personal Information us if they
were the Contractor's own actions and omissions.
3' Information Security
(A)The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and |ncm[ privacy and data protection |awo, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4,Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1871 (California Civil Code, Oivieion3. Part 4. Title 1.3,
beginning with section 1747\. |f the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Gbandard("PC| OSS^) requinamnenb;, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices ao may be necessary ho remain incompliance
with the PC| OSS. in each case, a1 the Contractor's sole cost and expense.
(B)The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations undera*cbon3/A\ofthioExhibit. tha
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, cda minimum, include the following:
0 limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(0 ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
/iii\ to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
inn|uding, but not limited to, all mobile devices and other nquipmant, operating
systems, and software applications with information storage capability; (b)
employing adequate controls and data security measures, both internally and
externally,to protect(1)the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2)the Counh/'n operations from
F-3
Exhibit
Page 4ofO
disruption and abuse; (o)having and maintaining natworK, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e)installing and maintaining in all mobile, xvins|meo, or
handheld devices a secure |nternat connection, having continuously updated
and-virus software protection and a remote wipe feature always enabled, all of
which io subject bo express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards(AE8)of128 bit or higher (a)stored on any mobile
devices, including but not limited to hard disks, portable storage deviueo, or
remote installation, cv/b\transmitted over public or wireless networks(the
encrypted Personal Information must be subject to password or pass phrase, and
be stored onasecure server and transferred by means ofo Virtual Private
Network (VPN}connection, or another type of secure connection, all mf which im
subject tm express prior written consent of the Direotor};
(/) strictly segregating Personal Information from all other information of the
Contnacior, including any Authorized Pereon, or anyone with whom the
Contractor orany Authorized Person deals so that Personal Information is not
commingled with any other types ofinformation;
/vi\ having patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriateprivacy and information security training bmAuthorized
(D)During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E)The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
Countv, and the County nhmU have immediate, real-time access, sd all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
available to assist the County twenty-four(24)hours per day, seven (7)days per week
mna contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach oro Privacy Practices Complaint.
F-4
Exhibit
Page 5mf8
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm,virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system,with or without the intent to cause harm.
4' Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i)notify the Director ofthe Security Breach, such notice b)bagiven
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidentspfresnocountyca.gov, 55E-800-5800' (mhich
telephone number and email address the County may update by providing notice tothe
Contractor), and (ii)preserve all relevant evidence(and cause any affected Authorized
Person to preserve all relevant evidence) relating to the Security 8namoh.The notification
shall ino)ude, to the extent reasonably poaaib|e, the identification of each type and the
extent of Personal Information that has been, or is reasonably believed to have been,
breached, including but not limited to, compromised, or subjected bounauthorized Use,
Disclosure, or modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification ho the County ofo Security Breach, ao
provided pursuant to section 4(A)of this Exhibit, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access bothe facilities and operations
Uii\ facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, |ogo, fi|mo, data reporting and other
materials required 0m comply with applicable law, re0u|odon, industry standards,
oram otherwise reasonably required bv the County.
To that end, the Contractor shall, with respect tua Security Breach, besolely
responsible, sd its cost, for all notifications required bv law and regulation, ordeemed
reasonably necessary bv the County, and the Contractor shall provide a written report nf
the investigation and reporting required bo the Director within 3O days after the
Contractor's discovery nf the Security Breach.
(C)County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint,and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit, all at the Contractor's sole
expgnee, in accordance with applicable privacy rights, |awe, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach.Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
F-5
Exhibit
Page 8nfG
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D)The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence ofthe Security Breach and correcting any deficiency |nSecurity
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, |awa, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating darnaQesceumgdbv.anySecurbvBreach. indudingeU
costs of the County incurred relation bo any litigation or other action described section
4(E)of this Exhibit.
(E)The Contractor agrees to cooperate, at its ao|m expense,with the County in any litigation
or other action to protect the Countvs rights relating to Personal |nformnaUon, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A)The Contractor shall have and maintain awritten information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the Cuunb/'oe|eoUon. m third poMx on the
Counb/'mbmhaK' permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement.The
Contractor shall fully cooperate with such assessment, audit or examination, as
app|ioab|e, by providing the County or the third party on the Cuuntx'abahmlf. access to
all Authorized Employees and other knowledgeable personnel, physical premises,
doournentmtion, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. \naddition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course mf this Agreement under this Exhibit.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the nmrne restrictions and conditions in this Exhibit. that apply bz the Contractor
with respect bo such Personal Information by incorporating the relevant provisions of
U1meg provisions into o valid and binding written agreement between the Contractor and
such Authorized Pen*ona, or amending any written agreements to provide same.
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information,whether inwritten, electronic orother yo,nn or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal |nfonnation, and oarbfv in writing to the County that such Personal
F-O
Exhibit
Page 7of8
Information have been returned to the County or disposed of securely, ao applicable. If the
Contractor isauthorized to dispose of any such Personal |nfonnaUon, as provided in this Exhibit,
such certification shall state the date, time, and manner(including standard) of disposal and by
whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided bv the Director with respect to the return or disposal uf Personal Information
and copies cf Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feooib|e, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit to all such Personal
Information and copies of Personal Information. The Contractor shall not retain any copy of any
Personal Information after returning or disposing of Personal Information as required by this
section 6.The Contractor's obligations under this section 8 survive the termination ofthis
Agreement and apply to all Personal Information that the Contractor retains if return or disposal
is not feasible and to all Pmnauna| Information that the Contractor may later discover.
7' Equitable Relief.The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled bo seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled cd law or in equity. Such
remedies shall not be deemed hohaexclusive but shall be in addition to all other remedies
available bo the County nd law orin equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee")from and againstany and all
infringement of intellectual property inn|uding, but not limited bJ infringement of oopyright,
trademark, and trade dress, invasion mf privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, creditnnonitohng
expenoao, forfeitures, losses, damages, liabilities, deficiencies, actions, 'udQnnanty, in$eraet,
awards,fines and penalties (including regulatory fines and pmna0om). costs mr expenses nf
whatever kind, including attorneys'fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit and the cost of pursuing any insurance providers,
arising out of or resulting from any third party claim or action against any County Indemnitee in
relation to the Contractor's, its officers, employees, or agents, or any Authorized Employee's or
Authorized Person's, performance or failure to perform under this Exhibit or arising out of or
resulting from the Contractor's failure ho comply with any of its obligations under this section 8.
The provisions of this section 8 do not apply to the acts or omissions of the County.The
provisions of this section 8ere cumulative to any other obligation of the Contractor to, defend,
indemnify, hold harmless any County |ndmnondee under this Agreement. The provisions of
this section shall survive the termination of this Agreement.
9. Survival. The respective hohtamndobUoatkoneofthwContnacborondthmCountvammbabed
in this Exhibit shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express orimplied in the provisions of in this Exhibit is
intended to confer, nor shall anything in this Exhibit confer, upon any person other than the
County ur the Contractor and their respective successors orassignees, any rights, remedies,
Exhibit
Page 8mf8
11. y0o County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's(or any Authorized Paroon'a\ possession or control,
or Use by the Contractor(or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
Exhibit F
Page 1 of 2
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 one
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 F
Page 2 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)
(S)Authorized Signature
Signature: Date:
Exhibit G
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
RH Community Builders LP
Address(number,street) City State ZIP Code
3040 N Fresno Street Fresno CA 93703
CILIA Number Taxpayer ID Number(EIN)/Social Security Number Telephone Number
84-2737051 ( 55%492-1373
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 YES No
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX?......................................................................................................................... n X
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?...................................................................................... o X
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)........... o X
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
AHBH LLC 83-2013062
Wayne Rutledge and Rena Rutledge Recovable Trust 352 W Bedford Ave Fresno CA 93711
B. Type of entity: o Sole proprietorship ® Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o X
NAME DOB ADDRESS PROVIDER
Exhibit G
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n X
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o X
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o X
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?......... o X
VII. A. Is this facility chain affiliated? ...................................................................................................................... o
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
Brad Hardie President
Signature Date
5/23/2025
Remarks
Exhibit G
Page 3 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 H
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit
2of2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department uragency;
(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 bzobtain, or performing o public
(Federal, State or local)transaction or contract under a public transaction; violation of
Federal or State antitrust statutes orcommission of embezzlement, thm#, horgery,
bribery, falsification or destruction of records, making false *tmdemenb;, or receiving
stolen property;
(o) /d\ Have not within m three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local)terminated for cause or
default.
(2)Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this pnupmee{.