HomeMy WebLinkAboutAgreement A-25-234 Master Agreement.pdf Agreement No. 25-234
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2 MASTER SERVICE AGREEMENT
3 This Master Service Agreement ("Agreement") is dated June 10, 2025 and is
4 between each Contractor listed in Exhibit A"List of Contractors" collectively hereinafter referred
5 to as ("Contractors"), and the County of Fresno, a political subdivision of the State of California
6 ("County"). Reference in this Agreement to party or"parties" shall be understood to refer to
7 County and each individual Contractor, unless otherwise specified.
8 Recitals
9 A. Assembly Bill 1997 provided that licensed Short-Term Residential Therapeutic Programs
10 (STRTP) are required to provide or ensure access to specialty mental health services to youth
11 and non-minor dependents placed in their care and have twelve (12) months from the date of
12 licensure to obtain mental health program approval, including Medi-Cal site certification, by a
13 local Mental Health Plan (MHP), in order to provide said specialty mental health services.
14 B. County, through its Department of Behavioral Health (DBH) operates a MHP as defined
15 by Title 9 of the California Code of Regulations (C.C.R.), Section 1810.228.
16 C. Fresno County youth and non-minor dependents placed in a STRTP within Fresno
17 County or outside of Fresno County and are in need of specialty mental health services.
18 D. Contractor(s) are qualified and willing to provide said services pursuant to the terms and
19 conditions of this Agreement.
20 The parties therefore agree as follows:
21 Article 1
22 Contractor's Services
23 1.1 Scope of Services. Contractor(s) shall perform all of the services provided in Exhibit
24 B to this agreement, titled "Fresno County Department of Behavioral Health Scope of Work".
25 1.2 Representation. Contractor(s) represents that it is qualified, ready, willing, and able
26 to perform all of the services provided in this Agreement.
27 1.3 Compliance with Laws. Contractor(s) shall, at its own cost, comply with all
28 applicable federal, state, and local laws and regulations in the performance of its obligations
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1 under this Agreement, including but not limited to workers compensation, labor, and
2 confidentiality laws and regulations. Additionally, Contractor(s) shall comply with laws,
3 regulations, and requirements in Exhibit C to this agreement, titled "Fresno County Behavioral
4 Health Requirements".
5 Article 2
6 County's Responsibilities
7 2.1 The County shall provide oversight and collaborate with Contractor(s), other County
8 Departments and community agencies to help achieve program goals and outcomes. In addition
9 to contractor monitoring of program, oversight includes, but not limited to, coordination with
10 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
11 2.2 County shall participate in evaluating the progress of the overall program, levels of
12 care components, and the efficiency of collaboration with the Contractor(s) staff and will be
13 available to Contractor(s) for ongoing consultation. County shall receive and analyze statistical
14 outcome data from Contractor(s) throughout the term of contract. County shall notify the
15 Contractor(s)when additional participation is required. The performance outcome measurement
16 process will not be limited to survey instruments but will also include, as appropriate, persons
17 served and staff surveys, chart reviews, and other methods of obtaining required information.
18 Article 3
19 Compensation, Invoices, and Payments
20 3.1 The County agrees to pay, and the Contractor(s) agrees to receive compensation for
21 the performance of its services under this Agreement as described in Exhibit D to this
22 agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
23 Conditions".
24 3.2 Additional Fiscal Requirements. Contractor(s) shall comply with all additional
25 requirements in Exhibit D to this Agreement.
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1 Article 4
2 Term of Agreement
3 4.1 Term. This Agreement is effective on July 1, 2025 and terminates on June 30, 2028
4 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
5 below.
6 4.2 Extension. The term of this Agreement may be extended for no more than two (2),
7 one-year periods only upon written approval of both parties at least thirty (30) days before the
8 first day of the next one-year extension period. The County's DBH Director, or his or her
9 designee, is authorized to sign the written approval on behalf of the County based on the
10 Contractor(s)'s satisfactory performance. The extension of this Agreement by the County is not
11 a waiver or compromise of any default or breach of this Agreement by the Contractor(s) existing
12 at the time of the extension, whether or not known to the County.
13 Article 5
14 Notices
15 5.1 Contact Information. The persons and their addresses having authority to give and
16 receive notices provided for or permitted under this Agreement include the following:
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For the County:
18 Director, Department of Behavioral Health
County of Fresno
19 1925 E Dakota Avenue
Fresno, CA 93726
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For the Contractor(s):
21 See Exhibit A
22 5.2 Change of Contact Information. Either party may change the information in section
23 5.1 by giving notice as provided in section 5.3.
24 5.3 Method of Delivery. Each notice between the County and the Contractor(s)
25 provided for or permitted under this Agreement must be in writing, state that it is a notice
26 provided under this Agreement, and be delivered either by personal service, by first-class
27 United States mail, by an overnight commercial courier service, by telephonic facsimile
28 transmission, or by Portable Document Format (PDF) document attached to an email.
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1 (A) A notice delivered by personal service is effective upon service to the recipient.
2 (B) A notice delivered by first-class United States mail is effective three County
3 business days after deposit in the United States mail, postage prepaid, addressed to the
4 recipient.
5 (C)A notice delivered by an overnight commercial courier service is effective one
6 County business day after deposit with the overnight commercial courier service,
7 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
8 the recipient.
9 (D)A notice delivered by telephonic facsimile transmission or by PDF document
10 attached to an email is effective when transmission to the recipient is completed (but, if
11 such transmission is completed outside of County business hours, then such delivery is
12 deemed to be effective at the next beginning of a County business day), provided that
13 the sender maintains a machine record of the completed transmission.
14 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
15 nothing in this Agreement establishes, waives, or modifies any claims presentation
16 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
17 of Title 1 of the Government Code, beginning with section 810).
18 Article 6
19 Termination and Suspension
20 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
21 contingent on the approval of funds by the appropriating government agency. If sufficient funds
22 are not allocated, then the County, upon at least 30 days' advance written notice to each
23 individual Contractor, may:
24 (A) Modify the services provided by the Contractor(s) under this Agreement; or
25 (B) Terminate this Agreement.
26 6.2 Termination for Breach.
27 (A) Upon determining that a breach (as defined in paragraph (C) below) has
28 occurred, the County may give written notice of the breach to Contractor(s). The written
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1 notice may suspend performance under this Agreement and must provide at least 30
2 days for Contractor(s) to cure the breach.
3 (B) If Contractor(s)fails to cure the breach to the County's satisfaction within the time
4 stated in the written notice, the County may terminate this Agreement immediately.
5 (C) For purposes of this section, a breach occurs when, in the determination of the
6 County, Contractor(s) has:
7 (1) Obtained or used funds illegally or improperly;
8 (2) Failed to comply with any part of this Agreement;
9 (3) Submitted a substantially incorrect or incomplete report to the County; or
10 (4) Improperly performed any of its obligations under this Agreement.
11 6.3 Termination without Cause. In circumstances other than those set forth above, the
12 County may terminate this Agreement by giving at least 30 days advance written notice to each
13 individual Contractor.
14 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
15 Economic Sanctions against Russia and Russian entities and individuals, the County may
16 terminate this Agreement if Contractor(s) is a target of Economic Sanctions or is conducting
17 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
18 thirty (30) days advance written notice to each individual Contractor.
19 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
20 under this Article 6 is without penalty to or further obligation of the County.
21 6.6 County's Rights upon Termination. Upon termination for breach under this Article
22 6, the County may demand repayment by Contractor(s) of any monies disbursed to
23 Contractor(s) under this Agreement that, in the County's sole judgment, were not expended in
24 compliance with this Agreement. Contractor(s) shall promptly refund all such monies upon
25 demand. This section survives the termination of this Agreement.
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1 Article 7
2 Independent Contractor
3 7.1 Status. In performing under this Agreement, each individual Contractor, including its
4 officers, agents, employees, and volunteers, is at all times acting and performing as an
5 independent contractor, in an independent capacity, and not as an officer, agent, servant,
6 employee, joint venturer, partner, or associate of the County.
7 7.2 For youth and foster children who are placed outside of their county of original
8 jurisdiction, Contractor specifically acknowledges it is an independent contractor, that no
9 relationship of employer-employee exists between Contractor and the county of original
10 jurisdiction ("County of Jurisdiction") or the county in which the foster child resides ("County of
11 Residence"). Neither facility nor facility's assigned personnel shall have any entitlement as an
12 employee of the County of Jurisdiction or the County of Residence, has no ability to act on
13 either County's behalf whatsoever as an agent nor to bind the County of Jurisdiction or the
14 County of Residence to any obligation whatsoever. Neither facility nor facility's personnel shall
15 be covered by worker's compensation or any employee benefits payable by either the County of
16 Jurisdiction or the County of Residence.
17 7.3 Verifying Performance. The County has no right to control, supervise, or direct the
18 manner or method of the Contractor(s)'s performance under this Agreement, but the County
19 may verify that Contractor(s) is performing according to the terms of this Agreement.
20 7.4 Benefits. Because of its status as an independent contractor, Contractor(s) has no
21 right to employment rights or benefits available to County employees. Contractor(s) is solely
22 responsible for providing to its own employees all employee benefits required by law. The
23 Contractor(s) shall save the County harmless from all matters relating to the payment of
24 Contractor(s)'s employees, including compliance with Social Security withholding and all related
25 regulations.
26 7.5 Services to Others. The parties acknowledge that, during the term of this
27 Agreement, Contractor(s) may provide services to others unrelated to the County.
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1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. Contractor(s) shall indemnify and hold harmless and defend the County
4 (including its officers, agents, employees, and volunteers) against all claims, demands, injuries,
5 damages, costs, expenses (including attorney fees and costs), fines, penalties, and liabilities of
6 any kind to the County, Contractor(s), or any third party that arise from or relate to the
7 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)'s obligation to indemnify and hold harmless
10 or defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 Contractor(s) shall comply with all the insurance requirements in Exhibit E to this
15 Agreement.
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. Contractor(s) 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 Contractor(s)'s records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. Contractor(s) shall, upon
22 request by the County, permit the County to audit and inspect all of such records and data to
23 ensure Contractor(s)'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, Contractor(s) 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 of this Agreement or any record or data that Contractor(s) may provide to the County.
3 The County's public disclosure of this Agreement or any record or data that Contractor(s) may
4 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
6 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 Contractor(s) may provide to the County, unless such disclosure is prohibited
11 by court order.
12 (C)This Agreement, and any record or data that Contractor(s) may provide to the
13 County, is subject to public disclosure under the Ralph M. 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 Contractor(s) may provide to the
16 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 6250) ("CPRA").
19 (E) This Agreement, and any record or data that Contractor(s) 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 of California 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 Contractor(s) 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 or data.
27 10.4 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in Contractor(s)'s possession or control,
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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 Contractor(s) deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of Contractor(s). Within five business days after the County's demand, Contractor(s)
5 shall (a) deliver to the County all of the requested records that are in Contractor(s)'s possession
6 or control, together with a written statement that Contractor(s), after conducting a diligent
7 search, has produced all requested records that are in Contractor(s)'s possession or control, or
8 (b) provide to the County a written statement that Contractor(s), after conducting a diligent
9 search, does not possess or control any of the requested records. Contractor(s) shall cooperate
10 with the County with respect to any County demand for such records. If Contractor(s) wishes to
11 assert that any specific record or data is exempt from disclosure under the CPRA or other
12 applicable law, it must deliver the record or data to the County and assert the exemption by
13 citation to specific legal authority within the written statement that it provides to the County
14 under this section. Contractor(s)'s assertion of any exemption from disclosure is not binding on
15 the County, but the County will give at least 10 days' advance written notice to Contractor(s)
16 before disclosing any record subject to Contractor(s)'s assertion of exemption from disclosure.
17 Contractor(s) shall indemnify the County for any court-ordered award of costs or attorney's fees
18 under the CPRA that results from Contractor(s)'s delay, claim of exemption, failure to produce
19 any such records, or failure to cooperate with the County with respect to any County demand for
20 any such records.
21 Article 11
22 Data Security
23 11.1 Contractor(s) shall comply with data security requirements in Exhibit F to this
24 Agreement.
25 Article 12
26 Disclosure of Self-Dealing Transactions
27 12.1 Applicability. This Article 12 applies if Contractor(s) is operating as a corporation, or
28 changes its status to operate as a corporation.
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1 12.2 Duty to Disclose. If any member of Contractor(s)'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 G to this Agreement) and submitting it to
4 the County before commencing the transaction or immediately after.
5 12.3 Definition. "Self-dealing transaction" means a transaction to which Contractor(s) is a
6 party and in which one or more of its directors, as an individual, has a material financial interest.
7 Article 13
8 Disclosure of Ownership and/or Control Interest Information
9 13.1 Applicability. This provision is only applicable if Contractor(s) is disclosing entities,
10 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
11 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
12 13.2 Duty to Disclose. Contractor(s) must disclose the following information as
13 requested in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest
14 Statement, Exhibit H:
15 (A) Disclosure of Five Percent (5%) or More Ownership Interest:
16 (1) In the case of corporate entities with an ownership or control interest in the
17 disclosing entity, the primary business address as well as every business location
18 and P.O. Box address must be disclosed. In the case of an individual, the date of
19 birth and Social Security number must be disclosed.
20 (2) In the case of a corporation with ownership or control interest in the
21 disclosing entity or in any subcontractor in which the disclosing entity has a five
22 percent (5%) or more interest, the corporation tax identification number must be
23 disclosed.
24 (3) For individuals or corporations with ownership or control interest in any
25 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
26 the disclosure of familial relationship is required.
27 (4) For individuals with five percent (5%) or more direct or indirect ownership
28 interest of a disclosing entity, the individual shall provide evidence of completion of a
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1 criminal background check, including fingerprinting, if required by law, prior to
2 execution of Contract. (42 C.F.R. § 455.434)
3 (B) Disclosures Related to Business Transactions:
4 (1) The ownership of any subcontractor with whom Contractor(s) has had
5 business transactions totaling more than $25,000 during the twelve (12) month
6 period ending on the date of the request.
7 (2) Any significant business transactions between Contractor(s) and any wholly
8 owned supplier, or between Contractor(s) and any subcontractor, during the five (5)
9 year period ending on the date of the request. (42 C.F.R. § 455.105(b).)
10 (C) Disclosures Related to Persons Convicted of Crimes:
11 (1) The identity of any person who has an ownership or control interest in the
12 provider or is an agent or managing employee of the provider who has been
13 convicted of a criminal offense related to that person's involvement in any program
14 under the Medicare, Medicaid, or the Title XXI services program since the inception
15 of those programs. (42 C.F.R. § 455.106.)
16 (2) County shall terminate the enrollment of Contractor(s) if any person with five
17 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
18 has been convicted of a criminal offense related to the person's involvement with
19 Medicare, Medicaid, or Title XXI program in the last ten (10) years.
20 13.3 Contractor(s) must provide disclosure upon execution of Contract, extension for
21 renewal, and within thirty-five (35) days after any change in Contractor(s) ownership or upon
22 request of County. County may refuse to enter into an agreement or terminate an existing
23 agreement with Contractor(s) if Contractor(s) fails to disclose ownership and control interest
24 information, information related to business transactions and information on persons convicted
25 of crimes, or if Contractor(s) did not fully and accurately make the disclosure as required.
26 13.4 Contractor(s) must provide the County with written disclosure of any prohibited
27 affiliations under 42 C.F.R. § 438.610. Contractor(s) must not employ or subcontract with
28 providers or have other relationships with providers Excluded from participation in Federal
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1 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42
2 C.F.R. §438.610.
3 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
4 DBHPlanAdministration(a�fresnocountyca.gov with a copy sent via email to the assigned DBH
5 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
6 with five (5) percent or greater direct or indirect ownership interest in Contractor(s) has been
7 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
8 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
9 person with five (5) percent or greater direct or indirect ownership interest in the Contractor(s)
10 did not submit timely and accurate information and cooperate with any screening method
11 required in C.F,R, Title 42, Section 455.416
12 Article 14
13 Disclosure of Criminal History and Civil Actions
14 14.1 Applicability. Contractor(s) is required to disclose if any of the following conditions
15 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
16 referred to as "Contractor(s)"):
17 (A) Within the three (3) year period preceding the Agreement award, they have been
18 convicted of, or had a civil judgment tendered against them for:
19 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
20 or performing a public (federal, state, or local) transaction or contract under a public
21 transaction;
22 (2) Violation of a federal or state antitrust statute;
23 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
24 or
25 (4) False statements or receipt of stolen property.
26 (B) Within a three (3) year period preceding their Agreement award, they have had a
27 public transaction (federal, state, or local) terminated for cause or default.
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1 14.2 Duty to Disclose. Disclosure of the above information will not automatically
2 eliminate Contractor(s)from further business consideration. The information will be considered
3 as part of the determination of whether to continue and/or renew this Agreement and any
4 additional information or explanation that Contractor(s) elects to submit with the disclosed
5 information will be considered. If it is later determined that the Contractor(s) failed to disclose
6 required information, any contract awarded to such Contractor(s) may be immediately voided
7 and terminated for material failure to comply with the terms and conditions of the award.
8 Contractor(s) must sign a "Certification Regarding Debarment, Suspension, and Other
9 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit I.
10 Additionally, Contractor(s) must immediately advise the County in writing if, during the term of
11 the Agreement: (1) Contractor(s) becomes suspended, debarred, excluded or ineligible for
12 participation in Federal or State funded programs or from receiving federal funds as listed in the
13 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
14 become applicable to Contractor(s). Contractor(s) shall indemnify, defend, and hold County
15 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility,
16 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
17 Responsibility Matters.
18 Article 15
19 General Terms
20 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
21 Agreement may not be modified, and no waiver is effective, except by written agreement signed
22 by both parties. Contractor(s) acknowledges that County employees have no authority to modify
23 this Agreement except as expressly provided in this Agreement.
24 (A) Notwithstanding the above, non-material changes to services, staffing, and
25 responsibilities of Contractor(s), as needed, to accommodate changes in the laws
26 relating to service requirements, may be made with the signed written approval of
27 County's DBH Director, or designee, and Contractor(s) through an amendment approved
28 by County's County Counsel and the County's Auditor-Controller/Treasurer-Tax
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1 Collector's Office. Said modifications shall not result in any change to the maximum
2 compensation amount payable to Contractor(s), as stated herein.
3 15.2 Rate Modification. In addition, changes to service rates provided in Exhibit D that
4 do not exceed five percent (5%) of the approved rate, or that are needed to accommodate state-
5 mandated rate increases, may be made with the written approval of the DBH Director, or
6 designee. These rate changes may not add or alter any other terms or conditions of the
7 Agreement. Said modifications shall not result in any change to the annual maximum
8 compensation amount payable to Contractor(s), as stated herein.
9 15.3 Separate Agreement. It is mutually understood by the parties that this Agreement
10 does not, in any way, create a joint venture among Contractors. By execution of this Agreement,
11 Contractors understand that a separate Agreement is formed between each individual
12 Contractor and County.
13 15.4 Addition/Deletion of Providers. The County reserves the right at any time during
14 the term of this Agreement to add Contractors to and remove Contractors from the list contained
15 on Exhibit A. It is understood that any such additions and removals will not affect compensation
16 paid to the other Contractors, and therefore such additions and removals may be made by
17 County without notice or approval of other Contractor(s) under this Agreement. The County's
18 DBH Director, or designee, may remove a Contractor from the Agreement where there is mutual
19 written consent between the DBH Director and Contractor.
20 15.5 Non-Assignment. Neither party may assign its rights or delegate its obligations
21 under this Agreement without the prior written consent of the other party.
22 15.6 Governing Law. The laws of the State of California govern all matters arising from
23 or related to this Agreement.
24 15.7 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
25 County, California. Contractor(s) consents to California jurisdiction for actions arising from or
26 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 15.8 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 15.9 Days. Unless otherwise specified, "days" means calendar days.
6 15.10 Headings. The headings and section titles in this Agreement are for convenience
7 only and are not part of this Agreement.
8 15.11 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 15.12 Nondiscrimination. During the performance of this Agreement, Contractor(s) 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(s) 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 15.13 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
26 of Contractor(s) under this Agreement on any one or more occasions is not a waiver of
27 performance of any continuing or other obligation of Contractor(s) and does not prohibit
28 enforcement by the County of any obligation on any other occasion.
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1 15.14 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
2 between Contractor(s) and the County with respect to the subject matter of this Agreement, and
3 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 15.15 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 15.16 Authorized Signature. Contractor(s) represents and warrants to the County that:
12 (A) Each individual Contractor is duly authorized and empowered to sign and
13 perform its obligations under this Agreement.
14 (B) The individual signing this Agreement on behalf of each individual Contractor is
15 duly authorized to do so and his or her signature on this Agreement legally binds the
16 Contractor(s) to the terms of this Agreement.
17 15.17 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.
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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 15.18 Counterparts. This Agreement may be signed in counterparts, each of which is an
12 original, and all of which together constitute this Agreement.
13 [SIGNATURE PAGE FOLL0INS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
CONTRACTOR COUNTY OFFRESNO
3
See Following Signature Pages
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5 Ernest Buddy Mend6s, Chairman of the Board
of Supervisors of the County of Fresno
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Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
By:
10 Deputy
11 For accounting use only:
12 Org No.:56302232
Account No.:7295
13 Fund No.:0001
Subclass No. 10000
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2 Promesa Behavioral Health
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5 Lisa Weigant, CEO
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8 Erlaln Zuniga, CFO
9 7120 N. Marks Avenue, Suite 110
Fresno, CA 93711
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2 For the Future, Inc.
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5 Salpy Boy4i4q, CEO
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8 Melissa Martire, CFO
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9 9800 Topanga Canyon Blvd, #309
Chatworth, CA 91311
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2 Guiding Our Youth
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5 Salpy Boyaj n, CEO
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8 Melissa Martire, CFO
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9 1197 E. Los Angeles Ave#338
Simi Valley, CA 93065
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2 Elite Family Systems
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5 Bill Sneed, President
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8 Jo arhadi, CFO
9 2935 4t" Street
Ceres, CA 95307
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2 The Virtuous Woman, Inc.
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5 Debora Manns, CEO
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8 Detra Jones, Assistant Executive Director
9 1620 Centinela Avenue, Suite 207
Inglewood, CA 90302
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2 Changing Faces, Inc.
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5 Adrian ooks, Executive Director
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8 Elise Blum nth 1, Clinical Director
9 4124 Odie Lane
Santa Maria, CA 93455
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2 Hesed Christian Ministries, Inc.
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44��ooks, Executive Director
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8 Elise Blumenthal, Clinical Director
9 425 Mooncrest Street
Santa Maria, CA 93455
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2 Quality Group Homes, Inc.
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5 J m Clark, Board President
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8 D.Mae Johnson, CEQ�
9 4928 E. Clinton Way,( uite 108
Fresno, CA 93727
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2 Hope for Youth, Inc.
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5 Clinard Fletcher, CEO
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8 Nelson Fowlkes, Treasurer
9 6790 W. Browning Avenue
Fresno, CA 93723
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2 Core Conditions, Inc.
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5 Curtis Donovan, CEO
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8 Jenni er Preston, CFO
9 4460 W. Shaw Avenue, #595
Fresno, CA 93722
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2 DN Associates Residential Care
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5 Curtis Donovan, CEO
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8 Jenni r Preston, CFO
9 4460 W. Shaw Avenue, #595
Fresno, CA 93722
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2 Scott's Social Services
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5 Rob Carter, CEO
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8 Tiffan Ca er, CFO
9 1780 Glenwood Drive
Bakersfield, CA 93306
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2 New Start Youth Facility Inc.
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5 Dirk Johnson EO
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8 Gin Sodaro, Administrator
9 2409 Belvedere Ave
Bakersfield, CA 93304
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2 2"d Home, Inc.
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5 Barbara Whee er, Board President
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8 Jennifer Fi b ector/CFO
9 1797 San Jose Avenue
Clovis, CA 93611
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2 Brighter Horizon Group Homes, Inc.
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8 Irina Vayntrub, Secretary
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12 n 2 MC ZA`)
13 C4 1 31 Y 03 Please see additional
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2 Center for Positive Changes
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5 A615erJ
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8 Deanna Mellos, Co-Executive Director
9 4950 Waring Road, Suite 4
San Diego, CA 92120
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2 Kern Bridges Youth Homes
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5 Jim VanderZwan, CEO
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8 Bianca Ruiz, ' ector of Mental Health
Services
9 1321 Stine Road
10 Bakersfield, CA 93309
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2 Manuch Inc.
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5 Ma ar nucharyan, Executive Director
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8 nuc r Manucharyan, CFO
9 PO Box 26622
Fresno, CA 93729
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2 Fresno Youth Care Homes
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5 Gloreta Johnson, CEO
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8 Sloane Golden, Secretary
9 1640 W. Shaw Avenue, Suite 100
Fresno, CA 93711
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2 Michigan House, Inc.
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5 arnett Fountain, ental Health irector
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8 Sena Streets, CFO
9 1617 W Shaw Ave, Suite B
Fresno, CA 93711
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2 Z.N.D. Residential, Inc.
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5 26b Graves, CEO
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7 2514 N. Whittier Avenue
8 Fresno, CA 93727
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Exhibit A
List of Contractors
Contracted Provider Contact
Mailing Address: 7120 N. Marks Avenue,Suite 110; Fresno,CA 93711
01 Promesa Behavioral Health Contact Person: Chief Executive Officer
Phone Number: (559)439-5437
Mailing Address:4460 W.Shaw Avenue,#595; Fresno,CA 93722
02 Core Conditions, Inc. Contact Person: Executive Director
Phone Number: (559)261-5083
Mailing Address:4460 W.Avenue,#595; Fresno,CA 93722
03 DN Associates Residential Care Contact Person: Executive Director
Phone Number: (559)261-5083
Mailing Address: 1797 San Jose Avenue; Clovis, CA 93611
04 2nd Home, Inc. Contact Person: Director
Phone Number: (559)790-2271
Quality Group Homes, Inc Mailing Address:4928 E. Clinton Way,Suite 108; Fresno,CA 93727
05 (dba Quality Family Services) Contact Person: Chief Executive Officer
Phone Number: (559)252-6844
Mailing Address: 6790 W. Browning Avenue; Fresno, CA 93723
06 Hope for Youth, Inc. Contact Person: Executive Director
Phone Number: (559)681-1470
Mailing Address: 1617 W.Shaw Ave,Suite B, Fresno CA 93711
07 Michigan House, Inc. Contact Person: Mental Health Director
Phone Number: (559)347-8197
Mailing Address: PO Box 26622; Fresno,CA 93729
08 Manuch Inc. Contact Person: Mental Health Director
Phone Number: (559)347-7627
Mailing Address: 1640 W.Shaw Avenue,Suite 100; Fresno, CA 93711
09 Fresno Youth Care Homes Contact Person: Executive Director
Phone Number: (559)840-1472
Brighter Horizon Group Homes, Mailing Address: 14622 Ventura Boulevard,Suite#544,Sherman Oaks,CA 91403
10 Contact Person: Chief Operating Officer
Inc. Phone Number: (310)909-3817
Mailing Address: 2514 N.Whittier Avenue; Fresno,CA 93727
11 Z. N. D. Residential, Inc. Contact Person: Chief Operating Officer
Phone Number: (559)554-9703
Mailing Address: 2935 41h Street; Ceres,CA 95307
12 Elite Family Systems Contact Person: Clinical Director
Phone Number: (209)531-2088
Mailing Address:4950 Waring Road,Suite 4;San Diego, CA 92120
13 Center For Positive Changes Contact Person: Executive Director
Phone Number: (619)660-3886
Mailing Address:4124 Odie Lane;Santa Maria, CA 93455
14 Changing Faces, Inc. Contact Person: Executive Administrator
Phone Number: (805)938-0125
Mailing Address:9800 Topanga Canyon Boulevard,#309;Chatsworth,CA 91311
15 For the Future, Inc. Contact Person: Chief Financial Officer
Phone Number: (714)625-1218
Mailing Address: 1197 E. Los Angeles Avenue,#338;Simi Valley, CA 93065
16 Guiding Our Youth Contact Person: Chief Financial Officer
Phone Number: (714)625-1218
Mailing Address:425 Mooncrest Street;Santa Maria,CA 93455
17 Hesed Christian Ministries, Inc. Contact Person: Executive Director
Phone Number: (805)937-5920
Effective Date 7.1.25
Exhibit A
List of Contractors
Mailing Address: 1321 Stine Road; Bakersfield,CA 93309
18 Kern Bridges Youth Homes Contact Person: Chief Executive Officer
Phone Number: (661)396-2301
Mailing Address: 2409 Belvedere Avenue; Bakersfield,CA 93304
19 New Start Youth Facility, Inc. Contact Person:STRTP Administrator
Phone Number: (661)487-2158
Mailing Address: 1780 Glenwood Drive; Bakersfield,CA 93306
20 Scott's Social Services Contact Person: Chief Executive Officer
Phone Number: (661)900-6342
Mailing Address: 1620 Centinela Avenue,Suite 207; Inglewood,CA 90302
21 The Virtuous Woman, Inc. Contact Person: Executive Director
Phone Number: (424)750-9293
Effective Date 7.1.25
EXHIBIT B
Page 1 of 15
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
A. Program Name
Short-Term Residential Therapeutic Program (STRTP)
B. Background
On October 11, 2015 and September 25, 2016, Assembly Bills 403 and 1997 were
signed into law, respectively, to implement provisions of the Continuum of Care
Reform (CCR). The provisions were founded on the collective belief among
stakeholders involved in California's child welfare system that all children served by
the foster care system need, deserve, and have an ability to be part of a loving family,
and not to grow up in a congregate setting. Assembly Bill 403 created a new youth
residential licensing category—the Short-Term Residential Therapeutic Program
(STRTP) —to replace the former group home Rate Classification Level (RCL)
structure. With this change, youth and non-minor dependents would receive short-
term, specialized, and intensive treatment, and 24-hour care and supervision within
the STRTP home in which they were placed. Assembly Bill 1997 further adopted the
requirement for all STRTPs to provide and ensure access to specialty mental health
services to youth and non-minor dependents placed in their care. This would allow for
the timely provision of services and greater care coordination for foster youth in the
system.
STRTPs are required to obtain and maintain STRTP licensure through the California
Department of Social Services (CDSS) and Mental Health Program Application
(MHPA) approval and Medi-Cal site certification through either the Department of
Health Care Services (DHCS) or their home county, if it is a delegate county. In order
to provide Medi-Cal billable services within Fresno County, STRTPs are required to
obtain and maintain Medi-Cal site certification.
C. Target Population
Fresno County youth, presumptive transfer youth, and AB1051 youth placed within
the care of the STRTP.
Entry Criteria
A licensed STRTP may accept youth, including non-minor dependents, for placement
who meet all of the following criteria:
1. Youth does not require inpatient care in a licensed health facility,
2. Youth has been assessed by a licensed mental health professional as
meeting the applicable criteria for placement in a STRTP program,
3. A determination has been made by the Interagency Placement
Committee (IPC) that the youth should be placed in a STRTP.
EXHIBIT B
Page 2of15
Referrals shall be submitted to the program from the Fresno County DSS and
Probation Department. The STRTP may also receive referrals from out-of-county
DSS and Probation Departments.
AB 1051 changes to the presumptive transfer process would necessitate an individual
contract between the STRTP and county of responsibility for all out of county youth
placed in the home. Out-of-county youth covered by the Master STRTP Agreement
are those:
1. Youth from a county which has signed onto the Fresno County DBH
county-to-county agreement; or
2. Youth who have had an exemption granted by Fresno County DBH for
the youth to be presumptively transferred.
Additionally, the STRTP shall ensure that American Indian youth receive specialty
mental health services in accordance with the Federal Indian Child Welfare Act (25
U.S.C. Sec 1901 et seq.).
D. Description of Services
The intended benefit of the STRTP program is to increase ease of access and
availability of mental health services for youth placed within the care of the STRTP.
The STRTP shall provide a level of service and support that will reflect each
participant's unique and individual needs.
A. Services Start Date
The requested services under this Agreement are effective July 1, 2025, or
when the agreement is fully executed.
Site certification/recertification must be completed no later than two months
after the agreement is fully executed.
B. Summary of Services
i. The STRTP shall provide these services to all individuals in the
program. Services will include but are not limited to the following:
a. Provide support to the youth's family and other members of the
youth's social network to help them manage the symptoms and
illness of the youth and reduce the level of family and social
stress associated with the illness.
b. Make appropriate referrals and linkages to services that are
beyond that of the STRTP's services under the resulting
agreement or as appropriate when discharging/transitioning a
youth from your program.
C. Coordinate services with any other community mental health and
non-mental health providers as well as other medical
professionals.
EXHIBIT B
Page 3 of 15
d. Assist person served/family with accessing all entitlements or
benefits for which they are eligible (i.e. Managed Care Plan
benefits, Medi-Cal, SSI, Section 8 vouchers etc.).
e. Develop family support and involvement whenever possible.
f. Refer individuals to supported education and employment
opportunities, as appropriate.
g. Provide or link to transportation services when it is critical to
initially access a support service or gain entitlements or benefits.
h. Provide or refer to peer support activities, as appropriate.
i. Ensure that clinically appropriate Evidence-Based Practices are
utilized in service delivery at all levels of care.
ii. The STRTP shall deliver a comprehensive specialty mental health
program. Behavioral health services include but are not limited to:
a. Assessment
b. Treatment or Care planning/Goal setting
C. Pediatric Symptom Checklist (PSC) 35 and the Child and
Adolescent Needs and Strengths (CANS) assessment
d. Individual therapy
e. Group therapy
f. Family therapy
g. Case Management
h. Medication Support
i. Intensive Home-Based Services
j. Intensive Care Coordination
k. Consultation
I. Linkage to additional services and supports
m. Hospitalization/Post Hospitalization Support
The STRTP will ensure that all services:
a. Be values-driven, Strengths-based, individual-driven, and co-
occurring capable.
b. Be culturally and linguistically competent.
C. Be age, culture, gender, and language appropriate.
EXHIBIT B
Page 4 of 15
d. Include accommodations for individuals with physical
disability(ies).
iv. Methods for service coordination and communication between program
and other service providers shall be developed and implemented
consistent with Fresno County Behavioral Health Plan (BHP)
confidentiality rules.
V. The STRTP shall maintain up to date caseload record of all individuals
enrolled in services, and provide individual, programmatic, and other
demographic information to DBH as requested.
vi. The STRTP shall ensure billable specialty mental health services meet
any/all County, State, Federal regulations including any utilization
review and quality assurance standards and provide all pertinent and
appropriate information in a timely manner to DBH to bill Medi-Cal
services rendered.
vii. STRTP specific programming
The STRTP program is designed so that youth and non-minor
dependents placed within the STRTP home have the ability to receive
services — including specialty mental health services — in one place.
Specialty mental health services are provided within the home by the
STRTP's mental health staff, with youth and non-minor dependents.
Frequency and intensity of specialty mental health services are
determined by the treatment plan of person served, or as identified in
their day-to-day needs. The STRTP shall have a plan to meet the
youth's mental health needs outside of the regular working hours of
mental health staff, including weekends.
Based on the acuity of this population, each youth shall receive a
minimum of two direct treatment encounters per week. The STRTP
shall ensure and document daily attempts to engage youth in a mental
health service when a youth is refusing to participate in all other
services offered by the program. All mental health services shall be
trauma-informed, culturally, and developmentally appropriate.
Additionally, all specialty mental health services shall meet Medi-Cal
standards and the STRTP shall collaborate with the Interagency
Placement Committee (IPC), Wrap Team, and Child and Family Team
(CFT) for treatment planning and linkage to support systems.
Additional services provided by the STRTP program include, but are not
limited to:
a. Crisis Intervention
b. EPSDT Supplemental Specialty Mental Health Services
c. Medication Support
Shall be provided via the STRTP's psychiatrist on staff or a
subcontracted psychiatrist.-The STRTP will monitor that the
following is adhered to by the psychiatrist for these services:
EXHIBIT B
Page 5 of 15
a) The psychiatrist shall examine each youth prior to
prescribing any psychotropic medication and include a
screening to determine whether there are potential
medical complications that may contribute to the youth's
health condition. This examination shall be noted in the
youth's record.
b) The psychiatrist shall sign a written medication review for
each youth prescribed psychotropic medication as
clinically appropriate, but at least every forty-five (45)
days. This review shall be included in the youth's record.
c) The psychiatrist shall review the course of treatment for
all youth who are not on psychotropic medication at least
every ninety (90) days and include the results of this
review in a progress note signed by the prescribing
physician at the time the review is completed.
d) Psychotropic medications for a youth placed in a STRTP
shall be administered in accordance with all applicable
State and Federal laws, which include but are not limited
to laws related to informed consent, documentation of
informed consent, and California Welfare & Institutions
(WIC) Code Sections 369.5 and 739.5.
e) A nurse practitioner, physician's assistant or registered,
licensed or vocational nurse acting within their scope of
practice; may perform the functions in subdivisions (b),
(c), and (d) under the direction of a psychiatrist. However,
each child shall be examined by a psychiatrist at least
one time during the child's stay at the STRTP.
viii. A licensed mental health professional (LMHP) or waivered/registered
professional shall perform a clinical review every ninety (90) days of the
youth's status and progress in treatment to determine whether the youth
should continue admission in the program or be transitioned to a
different level of care. The LMHP or waivered/registered professional
shall make this determination in consultation with the CFT. A report
documenting the clinical review shall be maintained in the youth's record
and provided to DBH upon request.
ix. The STRTP shall ensure continuity of care, services, and treatment as a
youth moves from his or her STRTP placement to home-based family
care or to a permanent living situation through reunification, adoption, or
guardianship, in accordance with the youth's case plan or treatment
plan. This includes notifying all outside treating mental health providers
when the youth is no longer residing in the STRTP. The STRTP shall
make appropriate referrals for mental health services if a youth does not
have an assigned mental health provider outside of the STRTP.
x. If at any time Fresno County MHP determines that the STRTP program
is not adhering to its policies and procedures as approved during the
site certification process, or MHPA regulations (evidenced by 3 or more
notices of noncompliance/corrective action plans) the STRTP will be
EXHIBIT B
Page 6 of 15
deemed as not properly performing its obligations under this Agreement
and will be subject to Article 6.2 of this Agreement.
C. Location of Services
Services shall be provided at the Contractor's licensed STRTP site, as shown
below. These sites shall maintain STRTP licensure through CDSS, as well as
mental health program application approval (MHPA) and Medi-Cal site
certification through the Fresno County Department of Behavioral Health
(DBH). The County must be notified of any addition or change to the location of
a STRTP and the new site must obtain its own, separate licensure, MHPA
approval, and Medi-Cal site certification. The STRTP must also be capable of
offering services through Telehealth-phone and Telehealth-video should the
need arise.
Promesa Behavioral Health
Barstow Niles 5
1415 W. Barstow 1853 E. Nees
Fresno, CA 93711 Fresno, CA 93720
Millbrook Spruce
4291 N. Millbrook 775 E. Spruce
Fresno, CA 93726 Fresno, CA 93720
Minarets Van Ness
718 E. Minarets 1027 N. Van Ness
Fresno, CA 93720 Fresno, CA 93726
Niles 4 Madera
1942 E. Nees 10120 Lanesbridge Road
Fresno, CA 93720 Madera, CA 93636
Core Conditions, Inc.
Brawler Core Conditions — Dakota
114 S. Brawley 3765 W. Dakota
Fresno, CA 93706 Fresno, CA 93722
DN Associates Residential Care
Blythe Polk
2142 N. Blythe 3793 N. Polk
Fresno, CA 93722 Fresno, CA 93722
2nd Home, Inc.
Sample Tenaya
2361 Sample Avenue 3239 E. Tenaya Way
Clovis, CA 93611 Fresno, CA 93710
San Jose
1797 San Jose Avenue
EXHIBIT B
Page 7 of 15
Clovis, CA 93611
Quality Group Homes, Inc. dba Quality Family Services
Belmont Millbrook
6224 W. Belmont Avenue 6250 N. Millbrook Avenue
Fresno, CA 93723 Fresno, CA 93710
Cambridge Perrin
2216 E. Cambridge Avenue 4165 E. Perrin Road
Fresno, CA 93703 Fresno, CA 93619
Clinton Sample
4862 E. Clinton Avenue 643 E. Sample Avenue
Fresno, CA 93703 Fresno, CA 93710
Gettysburg Yale
3804 E. Gettysburg Avenue 1105 E. Yale Avenue
Fresno, CA 93703 Fresno, CA 93704
Hope for Youth, Inc.
Harvard
4324 W. Harvard Avenue
Fresno, CA 93722
Michigan House, Inc.
Michigan House 1 Michigan House 2
1224 E. Michigan Avenue 1209 S. Hughes
Fresno, CA 93704 Fresno, CA 93706
Manuch Inc.
Aspen Manuch — Riverpine
5610 W. Donner Avenue 3043 W. Roberts Avenue
Fresno, CA 93721 Fresno, CA 93711
Inspiration Peak
7658 N. Santa Fe Avenue
Fresno, Ca 93722
Fresno Youth Care Homes
Weldon
64 E. Weldon
Fresno, CA 93704
Brighter Horizons Group Homes, Inc.
EXHIBIT B
Page 8of15
Cottonwood Elm
7133 E. Cornell Avenue 7133 E. Cornell Ave
Fresno, CA 93737 Fresno, CA 93737
Z.N.D. Residential, Inc.
Z.N.D. Residential
2514 N. Whitter Avenue
Fresno, CA 93727
Elite Family Systems
Banyan Leslie
1708 Banyan Court 2528 Leslie Lane
Ceres, CA 95307 Ceres, CA 95307
Scoffield
3212 Uranus Drive
Ceres, CA 95307
Center for Positive Changes
CFPC 1 CFPC.5
3482 Saddle Drive 5104 Eliiot Street
Spring Valley, CA 91977 Oceanside, CA 92057
CFPC 2 First Step Treatment Program
5972 Kenyatta Court 9671 Kenora Lane
San Diego, CA 92114 Spring Valley, CA 91977
CFPC 3 CFPC 7
1107 S. Mollison 5671 Churchward Street
El Cajon, CA 92020 San Diego, CA 92114
Changing Faces, Inc.
Changing Faces
4124 Odie Lane
Santa Maria, CA 93455
For the Future, Inc.
For the Future
4955 Alta Street
Simi Valley, CA 93065
Guiding Our Youth
Casarin Cutler
1672 Casarin Avenue 2136 Cutler Street
Simi Valley, CA 93065 Simi Valley, CA 93065
EXHIBIT B
Page 9of15
Hesed Christian Ministries, Inc.
Agape Homes
425 Mooncrest Street
Santa Maria, CA 93455
Kern Bridges Youth Homes
John & Dorothy Almklov Casa De Ninos
4301 De Ette Avenue 32549 Betty Jean Avenue
Bakersfield, CA 93313 McFarland, CA 93250
New Start Youth Facility, Inc.
New Start Youth Facility First Step
2409 Belvedere Avenue 6024 Friant Street
Bakersfield, CA 93304 Bakersfield, CA 93309
Scott's Social Services
Scott's Social Services I Scott's Social Services II
1780 Glenwood Drive 7701 Prism Way
Bakersfield, CA 93306 Bakersfield, CA 93313
The Virtuous Woman, Inc.
Protect Destiny Home of Hope #1 Protect Destiny Home of Hope #2
2306 W. 73rd Street 8711 Haas Avenue
Los Angeles, CA 90043 Los Angeles, CA 90047
D. Hours of Operation
The STRTP shall have services available between 9:00 am and 5:00 pm five
(5) days per week.
E. Care Coordination/Transition Plan
1. Intake and Initial Assessment
The STRTP shall complete the following, upon intake or as indicated
below.
i. Mental Health Assessment
A mental health assessment shall be completed by a licensed
mental health professional (LMHP) or waivered/registered
associate within five (5) calendar days of a youth's arrival.
A mental health assessment that was completed by an LMHP
within sixty (60) calendar days may also be used to meet this
requirement.
ii. Treatment Plan
EXHIBIT B
Page 10 of 15
Each youth admitted to the STRTP shall have a Treatment Plan
reviewed and signed by a LMHP, waive red/registered
professional, or the Head of Service (HOS), within ten (10)
calendar days of the youth's arrival at the STRTP.
The Treatment Plan shall be reviewed by a member of the
mental health program staff at least every thirty (30) calendar
days.
iii. Medication Support
Within the first thirty (30) days of youth's arrival, a psychiatrist
shall examine each youth prior to prescribing any psychotropic
medication and include a screening to determine whether there
are potential medical complications that may contribute to the
youth's health condition. This examination shall be noted in the
youth's record.
Medication support may be provided onsite or via telepsychiatry.
2. Transition and Discharge
Discharge planning, including transition planning that supports a step-
down process utilizing a CFT, permanency specialist (which may
include family finding) and child specific strategies to build natural and
formal support systems, shall begin at intake and is determined on a
case-by-case basis, depending on the youth's progress toward
individualized treatment goals. Additionally, linkages shall be made to
ongoing supports, such as specialty mental health resources, for all
youth. All transitions and discharges shall be discussed in a CFT to
ensure all members of the youths' support system are aware of the
recommendation being made by the STRTP.
F. Evidence Based Practices (EBPs)
The STRTP must use evidence-based practices (EBPs) found effective in
serving this target population. This includes the provision of training, ongoing
sustainability, and fidelity to a core competency for the STRTP's mental health
clinicians. Evidence-Based Practices (EBP) utilized in the STRTP include, but
are not limited to: Cognitive Behavioral Therapy (CBT), Trauma Focused CBT
(TF-CBT), Dialectical Behavioral Therapy (DBT), and Motivational Interviewing
(MI). Any additional evidence-based practices the STRTP would like to utilize
will require review and consultation with County.
G. County Shall
1. Assist the STRTP's efforts to evaluate the needs of each enrolled child
on an ongoing basis to ensure each child is receiving clinically
appropriate services.
2. Provide oversight and collaborate with the STRTP and other County
Departments and community agencies to help achieve State program
goals and outcomes. Oversight includes, but is not limited to, contract
monitoring and coordination with the State Department of Health Care
EXHIBIT B
Page 11 of 15
Services and California Department of Social Services in regard to
program administration and outcomes.
3. Assist the STRTP in making linkages with the total mental health
system of care. This will be accomplished through regularly scheduled
meetings as well as formal and informal consultation.
4. Participate in evaluating overall program progress and efficiency and
be available to the STRTP for ongoing consultation.
5. Gather outcome information from target person served groups and the
STRTP throughout each term of the resulting Agreement. County
shall notify the STRTP when their participation is required. The
performance outcome measurement process will not be limited to
survey instruments but will also include, as appropriate, person served
and staff interviews, chart reviews, and other methods of obtaining
required information.
6. Assist the STRTP's efforts toward cultural and linguistic competency
by providing technical assistance regarding cultural competency
requirements.
H. Staffing
The STRTP shall provide the following staffing components, at minimum:
1. Mental health program staff shall be consistent with the current
STRTP regulations and should be appropriate for services needed by
each youth, which would include any of the following classifications:
physicians, psychologists/waivered psychologists, LCSW/ASW,
LMFT/AMFT, LPCC/APCC, registered nurses, LVNs, psychiatric
technicians, and mental health rehabilitation specialists.
2. Of the direct service program staff required above, the STRTP shall
have one (1) half-time equivalent LMHP or waivered/registered
professional employed for each six (6) children admitted to the
program. A LMHP or waivered/registered professional who is
employed to meet this requirement may also be the head of service, if
employed at least forty (40) hours per week.
3. The STRTP shall ensure staff are qualified in education, experience,
and clinical competencies appropriate for their respective job
classifications.
4. The STRTP shall maintain adequate staffing levels in relation to the
number of open person-served cases at any given point and align with
the needs of the population. Clinician caseloads shall not exceed 6
individuals per clinician. Staffing levels shall not jeopardize the quality
of services provided to persons served.
5. Peer support staff shall not be counted as part of the mental health
program staff for the purpose of meeting regulatory staffing ratios and
shall only be hired and utilized as approved in the STRTP's MHPA
and site certification.
EXHIBIT B
Page 12 of 15
6. The STRTP will provide appropriate training for all staff to include but
not limited to trauma-informed practice, EBPs utilized, working with
specialized populations such as Human Trafficking, and co-occurring
competence to serve individuals with mental health and substance
use/abuse disorders.
7. The STRTP will comply with the training requirements and
expectations referenced in Exhibit C, Attachment D, Department of
Behavioral Health Training Requirements Reference Guide.
i. Trainings are to be completed by the STRTP's staff after contract
execution, in a timely manner. Completion deadlines for trainings
are listed in Exhibit C, Attachment E, within the descriptions.
Additionally, the execution of a new contract does not restart the
timeline for required trainings for staff. If staff have recently
completed a training under another contract, it will be accepted.
8. The STRTP will provide a sufficient number of licensed staffing and
will manage assignment of persons served within the program to
ensure that all services for persons with dual coverage are claimable
(e.g. Medicare/Medi-Cal dually enrolled persons).
I. General Requirements
1. Guiding Principles of Care Delivery: All services provided by the
STRTP shall be in accordance with DBH's Guiding Principles of Care
Delivery in accordance with Exhibit C, Attachment A.
2. Federal/HIPAA Laws: Strictly adhere with all applicable Federal
(including HIPAA laws), State of California and/or local laws and
regulations relating to confidentiality and protected health information.
3. Clinical Tools: Utilize and integrate clinical tools and peer review tools
as directed by DBH.
4. Interpreter/Translation Services: Provide/demonstrate ability to access
competent and appropriate linguistic services in the identified
individual's language of choice and have a working knowledge of
accessing and utilizing qualified staff/third-party interpreters or
language lines during provision of services. Interpretation/Translation
services will be at the cost of the STRTP.
5. Licensing, Certification, and Credentialing: MHP requires its
l ice nsed/registered/waivered and certified providers to comply with
and maintain professional competencies in their fields of expertise. To
ensure competency, the credentialing process is required for all new
and current provider staff. DBH's Credentialing Committee approval of
the STRTP's mental health program staff is necessary before service
delivery. The STRTP will be required to submit related documents to
the County's Plan Administration Division for review by DBH's
Credentialing Committee. The STRTP will define their protocol for
ensuring the Fresno County credentialing process is adhered to. If the
STRTP is not certified at the time of award, the STRTP will work with
EXHIBIT B
Page 13 of 15
DBH to execute the process for certification within sixty (60) days of
the start of the contract.
6. Compliance Program: The STRTP shall be responsible for conducting
internal monitoring and auditing of its agency. Internal monitoring and
auditing include, but are not limited to, billing practices,
I ice nsure/certification verification and adherence to County, State and
Federal regulations. If the STRTP identifies improper procedures,
actions or circumstances, including fraud/waste/abuse and/or systemic
issue(s), the STRTP is required to take prompt steps to correct said
problem(s) and is required to report to DBH any overpayments
discovered as a result of such problems.
The STRTP shall either adopt DBH's Compliance Plan/Program or
establish its own Compliance Plan/Program and provide
documentation to 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. The STRTP shall adhere to applicable DBH
Policies and Procedures relating to the Compliance Program or
develop its own compliance related policies and procedures.
The STRTP shall comply with the Fresno County Behavioral Health
Plan Compliance Program Code of Conduct and Acknowledgement
and Agreement Form in accordance with Exhibit C, Attachment H.
7. Cultural Responsivity: The STRTP shall be required to adhere to
DBH's Cultural Responsivity requirements included as Exhibit C,
Attachment J — National Standards for Culturally and Linguistically
Appropriate Services (CLAS).
8. Service Data for Billing Purposes
The STRTP 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.
The STRTP will be responsible for equipment to support the using of
the EHR. The STRTP may be required to utilize data entry forms,
portals, or related systems for compliance with County data reporting
requirements during the duration of the contract.
Data entry shall be the responsibility of the STRTP. 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 STRTP shall be the sole responsibility of the
STRTP.
The STRTP 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 the STRTP.
EXHIBIT B
Page 14 of 15
If the STRTP elects to not use the County's EHR for all clinical
documentation, the STRTP must submit a plan demonstrating how all
necessary requirements involving electronic health information
exchange between the STRTP and the county will be met.
9. Outcomes/Performance Monitoring
In an effort to satisfy required state, federal and other funding and
reporting requirements and to successfully administer, assess and
evaluate program outcomes effectiveness, the STRTP shall be asked
to collect data and measures applicable to services requested in this
Agreement and submit them in a timely manner to the Department.
The Department will collect data and develop required annual reports.
The data that shall be requested is necessary for the Department to
successfully complete its reporting and outcome requirements with
appropriate funders, which may include local, State and Federal
agencies.
The outcomes will be composed of two sections: a general data
requirement for systemic services delivery oversight and reporting,
and a specific data set dependent on the level of service, age range,
modality, funding source requirements, and other specific measures.
Outcomes shall include improvement in functioning as demonstrated
via IP-CANS assessment. IP-CANS assessments shall be conducted
at intake and in response to changes in the child's case including, but
not limited to, placement changes, visitation changes, and any
"significant changes in child circumstances or functioning". IP-CANS
assessments shall be completed at least every six (6) months even in
the absence of significant changes. Outcome measures shall be
expected after six (6) months of receiving services.
Both the general and specific data set requirements are outlined in
Exhibit C, Attachment E. As noted previously in this Agreement,
regulations are expected to change and the STRTP will be required to
adhere to new requirements and changes in collaboration with the
Department.
10. Cultural and Linguistically Appropriate Services (CLAS) and
demographic data to assess disparities outcomes: The STRTP
providing direct care and services shall adhere to the Cultural and
Linguistically Appropriate Services (CLAS) standards to adhere with
regulatory requirements and ensuring culturally and linguistically
responsive care. The STRTP shall provide annual documentation to
demonstrate implementation and compliance with CLAS standards,
which may include an organizational CLAS plan, training records,
records of interpreter/translation services utilized, etc.
Additionally, the STRTP will be required to collect the required
demographic data related to their funding source to meet outcomes
and evaluation requirements.
EXHIBIT B
Page 15 of 15
Participation on the annual diversity, equity and inclusion (formerly
Cultural Humility) survey provides the Department vital data necessary
to assess its effectiveness in meeting the Cultural Competency Plan
Requirements (CCPR), and thus the STRTP will be required to
participate in the annual survey process.
Specific CLAS and health disparities requirements will be outlined in
the resulting agreement.
11. Reports
The STRTP shall track data and provide reporting on the following
items and send all applicable information and reports to the DBH
Contract Analysts.
i. The STRTP shall be expected to comply with all contract
monitoring and compliance protocols, procedures, data collection
methods, and reporting requirements conducted by County.
ii. The STRTP will be responsible for meeting with DBH on a
monthly basis, or more often as agreed upon between County
and the STRTP for contract and performance monitoring.
iii. All reports will be due to the County by the 10th of each month,
unless otherwise specified, and will be reviewed for accuracy. (If
the 10th lands on a weekend or Holiday, reports will be due the
next business day). Reimbursement for monthly expenses may
be delayed in the event inaccurate reports are submitted.
iv. The STRTP shall submit a census report to the CWMH Team on
the 1 st and 15th of each month.
V. The STRTP shall provide DBH with Outcome Reports on an
annual and semi-annual basis, respectively. Outcome Report
formats will be established through County/STRTP collaboration.
Outcome Report measures may change, based on information or
measures needed.
vi. The STRTP will report and document all major and/or sensitive
incidents ("critical incidents") to the County. The County, at its
sole discretion, may require the STRTP to conduct all necessary
follow-up activities after reporting critical incidents. If there is any
doubt about whether an incident should be reported, the default
shall be for the STRTP to report the incident to the County.
vii. Additional reports and outcome information may be requested by
County at a later date, as needed.
Exhibit C
Page 1 of 23
Fresno County Behavioral Health Requirements
I. General Requirements
a. Guiding Principles. Contractor(s)shall align programs, services, and practices with the
vision, mission, and guiding principles of the Department of Behavioral Health (DBH), as
further described in Exhibit C—Attachment A to this Agreement,titled "Fresno County
Department of Behavioral Health Guiding Principles of Care Delivery".
b. Rights of Persons Served. Contractor(s) shall post signs informing persons served of
their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
Contractor(s) shall inform every person served of their rights as set forth in Exhibit C—
Attachment B to this agreement,titled "Rights of Persons Served".
c. Records. Contractor(s) shall maintain records in accordance with Exhibit C—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 from
the date of the end of this Agreement.
d. Licenses/Certificates. Throughout the term of this Agreement, Contractor(s) and
Contractor(s)'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 of America, State of California,
the County of Fresno, and any other applicable governmental agencies. Contractor(s)
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(s) and Contractor(s)'s
staff shall comply with all applicable laws, rules or regulations, as may now exist or be
hereafter changed.
e. Organizational Provider. Contractor(s) shall maintain requirements as a Behavioral
Health Plan (BHP) organizational provider throughout the term of this Agreement. If for
any reason,this status is not maintained, County may terminate this Agreement
pursuant to Article 6 of this Agreement.
f. Staffing. Contractor(s) agrees that prior to providing services under the terms and
conditions of this Agreement, Contractor(s) shall have staff hired and in place for
1
Exhibit C
Page 2 of 23
program services and operations or County may, in addition to other remedies it may
have, suspend referrals or terminate this Agreement, in accordance to Article 6 of this
Agreement.
g. Training. Contractor(s) agrees that its employees,volunteers, interns, and student
trainees or subcontractors of Contractor(s), in each case, are expected to perform
professional services per an agreement with County.Contractor(s) will comply with the
training requirements and expectations referenced in Exhibit C—Attachment D to this
Agreement,titled "Department of Behavioral Health Contractor Training Requirements
Reference Guide".
h. Credentialing and Recredentia ling. Each individual Contractor(s) staff shall not provide
any specialty mental health services without an approved credentialing application from
County. Contractor(s) 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 credentialing
privileges. Failure to comply with specified requirements can result in suspension or
termination of an individual or provider.
Upon request, Contractor(s) 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(s) 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(s) 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-credentia ling process.
2
Exhibit C
Page 3 of 23
i. Criminal Background Check. Contractor(s)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).
Contractor(s) shall provide evidence of completed consents when requested by the
County, Department of Health Care Services (DHCS) or the US Department of Health &
Human Services(US DHHS).
j. Clinical Leadership. Contractor(s) shall 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, Contractor(s)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(s) 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(s) 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 Contractor(s) shall not entitle Contractor(s)to any additional
compensation that is provided for under this Agreement.
m. Reports. Contractor(s) shall submit the following reports and data:
i. Outcome Data. Contractor(s) shall submit to County program performance
outcome data, as requested. Outcome data and outcome requirements are
listed in Exhibit C—Attachment E to this Agreement,titled "Program Outcomes
3
Exhibit C
Page 4 of 23
and Performance Measurements". Outcome data and outcome requirements
are subject to change at County's discretion.
ii. Additional Reports. Contractor(s) 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(s)fails to
provide such reports or other information required hereunder, it shall be
deemed sufficient cause for County to withhold monthly payments until there is
compliance. In addition, Contractor(s) 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(s) provide timely
access to services that meet the State of California standards for care. Contractor(s) 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(s) shall meet
to go over this monitoring tool, as needed but at least on a monthly basis. County shall
take corrective action if there is a failure to comply by Contractor(s)with timely access
standards.
o. Compliance with Behavioral Health Specific Laws.
i. Contractor(s) 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
4
Exhibit C
Page 5 of 23
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
the amended authority as of the effective date of such amendment without
amending this Agreement.
iii. Contractor(s) 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. Contractor(s)
shall adhere to all State requirements, including those identified in Exhibit C—
Attachment F to this Agreement, titled "State Behavioral Health Requirements".
p. Meetings. Contractor(s) 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(s) 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(s) 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)'s programs, in order to ensure
compliance with the terms and conditions of this Agreement.
r. Electronic Health Record. Contractor(s) currently maintains and may continue to
maintain its records in County's EHR system in accordance with Exhibit C—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
5
Exhibit C
Page 6 of 23
records of all and any services provided. If Contractor(s) 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(s) 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(s)will be responsible for obtaining its own
system, at its own cost, for electronic health records management.
Disclaimer
County makes no warranty or representation that information entered into the
County's DBH EHR system by Contractor(s)will be accurate, adequate, or satisfactory for
Contractor(s)'s own purposes or that any information in Contractor(s)'s possession or
control, or transmitted or received by Contractor(s), is or will be secure from
unauthorized access,viewing, use, disclosure, or breach. Contractor(s) is solely
responsible for person served information entered by Contractor(s) into the County's
DBH EHR system. Contractor(s) agrees that all Private Health Information (PHI)
maintained by Contractor(s) 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(s) 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(s)
must provide information by submitting a "Generative Artificial Intelligence
(GenAl) Reporting and Factsheet (STD 1000)." In addition, Contractor(s) must
notify the County of any new or previously unreported GenAl technology.At the
direction of the County, Contractor(s) 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.
6
Exhibit C
Page 7 of 23
t. Confidentiality. All services performed by Contractor(s) 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 S08
of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor(s)
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)'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(s) shall establish a procedure acceptable to the County's DBH
Director, or designee,to ensure that all of Contractor(s)'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)'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).
7
Exhibit C
Page 8 of 23
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
a. Basic Information Requirements. Contractor(s) 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(s) 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(s)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(s) 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(s) 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(s) 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 Contractor(s) if all the following conditions are met:
i. The format is readily accessible;
ii. The information is placed in a location on Contractor(s)'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;
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Exhibit C
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v. The individual is informed that the information is available in paper form
without charge upon request and Contractor(s) shall provide it upon
request within five (5) business days (42 C.F.R. §438.10(c)(6)).
c. Language and Format. Contractor(s) 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(s) shall ensure its written
materials that are critical to obtaining services are available in alternative formats, upon
request of the person served or potential person served at no cost.
Contractor(s) 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 Contractor(s)'s mental health
education materials, available in the prevalent non-English languages in the County(42
C.F.R. § 438.10(d)(3)).
Contractor(s) 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(s) 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(s) 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)-(5).
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(s). Beneficiary informing materials include but are not
limited to:
i. Consumer Handbook
ii. Provider Directory
iii. Grievance form
iv. Appeal/Expedited Appeal form
v. Advance Directives brochure
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Exhibit C
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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)
xi. Contractor(s) 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
5. 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(s) will ensure that its written materials include
taglines or that an additional taglines document is available.
e. Beneficiary Handbook. Contractor(s) 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(s) 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 BHIN 22-060.
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Exhibit C
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f. Accessibility. Required informing materials must be electronically available on
Contractor(s)'s website and must be physically available at Contractor(s)'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
font size.
Informing materials will be considered provided to the individual if Contractor(s)
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 Contractor(s)'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(s) 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(s) must follow the County's provider directory policy, in
compliance with MHSUDS IN 18-020.
Contractor(s) 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
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Exhibit C
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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.
Contractor(s)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(s) 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(s) certifies,that Contractor(s) 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(s)
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.hhs.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(s) certifies,that Contractor(s) does not
employ staff or individual contractors/vendors that are on the Social Security
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Exhibit C
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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.
e. Contractor(s) 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(s) 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(s) finds a provider that is excluded, it must promptly notify the County as
per 42 C.F.R. §438.608(a)(2), (4). Contractor(s) shall not certify or pay any excluded
provider with Medi-Cal funds, must treat 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(s) shall institute and conduct a Quality Assurance Process
for all services provided hereunder.
Contractor(s) 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)'s internal audit process.
Contractor(s) shall provide this notification and summary to County as requested by the
County.
b. Access to Records. Contractor(s)shall provide County with access to all documentation
of services provided under this Agreement for County's use in administering this
Agreement. Contractor(s) 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,
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Exhibit C
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documents, and the premises, equipment and facilities maintained by Contractor(s)
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
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(s) in the delivery of services provided under this Agreement. Full cooperation
shall be given by Contractor(s) in any auditing or monitoring conducted, according to this
Agreement.
b. Accessibility. Contractor(s) shall make all of its premises, physical facilities, equipment,
books, records, documents, agreements, computers, or other electronic systems
pertaining to Medi-Cal enrollees, Medi-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 Contractor(s) 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 Contractor(s) at any time if there is a reasonable possibility of fraud
or similar risk.The Department's inspection shall occur at Contractor(s)'s place of
business, premises, or physical facilities (42 CFR §438.230(c)(3)(iv))
c. Cooperation. Contractor(s) shall 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,
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Exhibit C
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County may audit, monitor, and/or request information from Contractor(s)to ensure
compliance with laws, regulations, and requirements, as applicable.
d. Probationary Status. County reserves the right to place Contractor(s) on probationary
status, as referenced in the Probationary Status Article, should Contractor(s)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,
inappropriate invoicing, untimely and inaccurate data entry, not meeting performance
outcomes expectations, and violations issued directly from the State. Additionally,
Contractor(s) 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(s) shall retain all records and documents originated or
prepared pursuant to Contractor(s)'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)'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(s) 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(s).
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(s) has not performed satisfactorily.
h. Site Inspection.Without limiting any other provision related to inspections or audits
otherwise set forth in this Agreement, Contractor(s) shall permit authorized County,
state, and/or federal agency(ies),through any authorized representative,the right to
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Exhibit C
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inspect or otherwise evaluate the work performed or being performed hereunder
including subcontract support activities and the premises which it is being performed.
Contractor(s) 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
Contractor(s).
VI. Complaint Logs and Grievances
a. Documentation. Contractor(s) shall log complaints and the disposition of all complaints
from a person served or their family. Contractor(s) shall provide a copy of the detailed
complaint log entries concerning County-sponsored persons served to County at
monthly intervals by the tenth (10th) day of the following month, in a format that is
mutually agreed upon. Contractor(s) 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(s) is notified by a person served or their representative of a
discrimination grievance, Contractor(s) shall report discrimination grievances to the
County within 24 hours. Contractor(s) 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(s) 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.
Contractor(s) shall ensure that its subcontractors comply with all applicable patients'
rights laws and regulations.
c. Incident Reporting. Contractor(s) 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
i. Contractor(s) shall be responsible for conducting internal monitoring and
auditing of its agency. Internal monitoring and auditing include, but are not
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Exhibit C
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limited to billing practices, lice nsure/certification verification and adherence to
County, State and Federal regulations.
1. Contractor(s) shall not submit false, fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind.
2. Contractor(s) shall bill only for those eligible services actually rendered
which are also fully documented.
3. Contractor(s) shall ensure all employees/service providers maintain
current l ice nsure/certification/registration/waiver status as required by
the respective licensing/certification Board, applicable governing State
agency(ies) and Title 9 of the California Code of Regulations.
ii. Should Contractor(s) identify improper procedures, actions or circumstances,
including fraud/waste/abuse and/or systemic issue(s), Contractor(s)shall take
prompt steps to correct said problem(s). Contractor(s) 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(s) at its request.
b. Compliance Program
i. 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(s) 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)'s Compliance Program must include the following elements:
1. Designation of a compliance officer who reports directly to the Chief
Executive Officer and the Contractor's Board of Directors and
compliance committee comprised of senior management who are
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Exhibit C
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charged with overseeing Contractor(s)'s compliance program and
compliance with the requirements of this account.The committee shall
be accountable to Contractor(s)'s Board of Directors.
iii. Policies and Procedures
1. Contractor(s) shall have written policies and procedures that articulate
Contractor(s)'s commitment to comply with all applicable Federal and
State standards. Contractor(s) shall adhere to applicable County DBH
Policies and Procedures relating to the Compliance Program or develop
its own compliance-related policies and procedures.
iv. Contractor(s) 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(s) shall implement and maintain written policies for all County DBH-
funded employees, and of any Contractor(s) 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(s) shall maintain documentation,verification or acknowledgement
that Contractor(s)'s employees, subcontractors, interns,volunteers, and
members of Board of Directors are aware of these Policies and Procedures and
Contractor(s)'s Compliance Program.
vii. Contractor(s) shall have a Compliance Plan demonstrating the seven (7)
elements of a Compliance Plan. Contractor(s) has the option to develop its own
or adopt County DBH's Compliance Plan. Should Contractor(s) develop its own
Plan, Contractor(s) shall submit the Plan prior to implementation for review and
approval to:
Fresno County DBH Compliance Office
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Exhibit C
Page 19 of 23
1925 E. Dakota Ave. Ste A
Fresno, California 93726
Or send via email to: DBHCompliance@fresnocountyca.gov
c. Program Integrity Requirements
i. As a condition for receiving payment under a Medi-Cal managed care program,
Contractor(s) shall comply with the provisions of Title 42 CFR Sections 438.604,
438.606, 438.608 and 438.610. Contractor(s) must have administrative and
management processes or procedures, including a mandatory compliance plan,
that are designed to detect and prevent fraud, waste or abuse.
ii. If Contractor(s) identifies an issue or receives notification of a complaint
concerning an incident of possible fraud,waste, or abuse, Contractor(s) 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)'s internal investigation concludes that fraud or abuse has
occurred or is suspected,the issue if egregious, or beyond the scope of
Contractor(s)'s ability to pursue, Contractor(s) shall immediately report to the
County DBH Compliance Office for investigation, review and/or disposition.
iv. Contractor(s) shall immediately report to DBH any overpayments identified or
recovered, specifying the overpayments due to potential fraud.
v. Contractor(s) 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(s) shall immediately report any information about a change in
Contractor(s)'s or Contractor(s)'s staff circumstances that may affect eligibility to
participate in the behavioral health program.
vii. Contractor(s) understands DBH, CMS, or the HHS Inspector General may inspect,
evaluate, and audit Contractor(s) at any time if there is a reasonable possibility
of fraud or similar risk.
d. Code of Conduct
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Exhibit C
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i. Contractor(s) 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(s) shall ensure that no false, fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind are submitted.
iii. Contractor(s) shall bill only for eligible services actually rendered and fully
documented.
iv. Contractor(s) shall act promptly to investigate and correct problems if errors in
claims or billing are discovered.
v. Contractor(s) shall comply with County's Code of Conduct and Ethics and the
County's Compliance Program in accordance with Exhibit C—Attachment H to
this Agreement,titled "Fresno County Mental Health Compliance Program".
e. Network Adequacy. Contractor(s) 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(s) 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(s) 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), Contractor(s) shall provide a person served the ability to choose
the person providing services to them.
VIII. Federal and State Laws.
a. Health Insurance Portability and Accountability Act. County and Contractor(s) 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(s) acknowledge that the exchange of PHI between them is only
for treatment, payment, and health care operations.
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Exhibit C
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County and Contractor(s) 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(s)to enter into an agreement containing specific requirements prior to the
disclosure of PHI, as set forth in, but not limited to,Title 45, Sections 164.314(a), 164.502(e)
and 164.504(e) of the Code of Federal Regulations.
b. Contractor(s) 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 Contractor(s) is a "Business Associate," as these terms
are defined by 45 CFR 160.103. As a Business Associate, Contractor(s) agrees to comply with
the terms of Exhibit C—Attachment I to this Agreement, titled "Health Insurance Portability
and Accountability Act (HIPAA) Business Associate Agreement".
IX. Quality Management Requirements.
a. Reporting.
i. Outcomes Reports. Contractor(s)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(s) 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(s) 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
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Exhibit C
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health outcomes and individuals' satisfaction with services over time. 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 recredentia ling, and person served
grievances. Contractor(s) shall measure, monitor, and annually report to the County on
its performance.
X. Cultural and Linguistic Competency
a. General.All services, policies and procedures shall be culturally and linguistically
appropriate. Contractor(s) 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 C—Attachment J to this Agreement,titled "National Standards on Culturally and
Linguistically Appropriate Services". Contractor(s) 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(s) 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)'s policies and procedures shall ensure compliance of any
subcontracted providers with these requirements.
c. Interpreter Services. Contractor(s) 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(s) shall avoid relying on an adult or minor child
accompanying the person served to interpret or facilitate communication; however, if
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Exhibit C
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the person refuses language assistance services, Contractor(s) must document the offer,
refusal, and justification in the file of the person served.
d. Interpreter Qualifications. Contractor(s) 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(s); (2) have demonstrated
proficiency in the language of the person served; (3) can effectively communicate any
specialized terms and concepts specific to Contractor(s)'s services; and (4) adheres to
generally accepted interpreter ethic principles. As requested by County, Contractor(s)
shall identify all who interpret for or provide direct communication to any program
person served in a language other than English and identify when Contractor(s) last
monitored the interpreter for language competence.
e. CLAS Standards. Contractor(s) shall submit to County for approval, within ninety(90)
days from date of contract execution, Contractor(s)'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 C—Attachment J,
"National Standards on Culturally and Linguistically Appropriate Services". As the CLAS
standards are updated, Contractor(s)'s plan must be updated accordingly.As requested
by County, Contractor(s) 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(s) 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(s)
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(s) shall create and sustain a forum that
includes staff at all agency levels to discuss cultural responsiveness. Contractor(s)shall
designate a representative from Contractor(s)'s team to attend County's Diversity, Equity
and Inclusion Committee.
23
Exhibit C -Attachment A
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH 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 C -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
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
2
rev 01-02-2020
Exhibit C -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 through stages of change are supported through positive working
relationships and alliances that are motivating
3
rev 01-02-2020
Exhibit C -Attachment A
Page 4 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
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 C—Attachment B
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
RIGHTS OF PERSON SERVED
Grievances
Fresno County Behavioral Health Plan (BHP) provides beneficiaries with a grievance and
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 MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP 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 materials must
be posted in prominent locations where Medi-Cal beneficiaries receive outpatient specialty
mental health services, including the waiting rooms of providers' offices of service.
Please note 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 at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any penalty,
change in mental health services, or any form of retaliation. All Medi-Cal beneficiaries can file
an appeal or 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 to the following address:
Fresno County Behavioral Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider concerns and
problems regarding payment authorization issues, other complaints and concerns.
Informal provider problem resolution process—the provider may first speak to a Fresno County
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. If the
attempt is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Exhibit C—Attachment B
Page 2of2
Formal provider appeal process—the provider has the right to access the provider appeal
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 MHP payment authorization, or
the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request for
payment authorization or a dispute with the MHP regarding the processing or payment of a
provider's claim to the MHP. The written appeal must be submitted to the MHP within 90
calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the provider in
writing of the decision, including a statement of the reasons for the decision that addresses
each issue raised by the provider, and any action required by the provider to implement the
decision.
If the appeal concerns a denial or modification of payment authorization request, the MHP
utilizes a DBH 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 30 calendar days of receipt of the decision.
Other complaints— 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 MHP. The
provider will receive a written response from the MHP within 60 calendar days of receipt of the
complaint. The decision rendered by the MHP is final.
Exhibit C—Attachment C
Page 1 of 3
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 of each person served; however, there is
no requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
A. Assessments
1. The following areas will be included as a part of a comprehensive record for each
person served:
• Presenting problems, including impairments in function, and current mental
status exam.
• Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
• Behavioral health history including mental health history, substance use/abuse,
and previous services
• Medical history including physical health conditions, medications, and
developmental history
• Psychosocial factors including family, social and life circumstances, cultural
considerations
• Strengths, risks, and protective factors, including safety planning
• Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
• The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
2. Timeliness/Frequency Standard for Assessment
• The time period to complete an initial assessment and subsequent assessments
for specialty mental health services (SMHS) is up to clinical discretion.
• Assessments shall be completed within a reasonable time and in accordance
with generally accepted standards of practice.
B. Problem list
The use of a Problem List has largely replaced the use of treatment plans and is
therefore required to be part of the 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 include, but is not limited to, the following:
• Diagnoses identified by a provider acting within their scope of practice
• Problems identified by a provider acting within their scope of practice
• Problems or illnesses identified by the person in care and/or significant support
person if any
Rev 04/2023 C-1
Exhibit C—Attachment C
Page 2 of 3
• The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
• Identifies a course of action to respond to the assessed needs of the person in
care
• Includes development of a transition plan when the person in care has achieved
the goals of the care plan
• Peer support services must be based on an approved care plan
• Must be provided in a narrative format in the person's progress notes
• Updated at least annually
2. Services requiring Treatments Plans
• Therapeutic Behavioral Services (TBS)
• Must have specific observable and/or specific quantifiable goals
• Must identify the proposed type(s) of intervention
• Must be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services when the plan for a person
served is used to establish that the services are provided under the direction
of an approved category of staff, and if the below staff are not the approved
category,
➢ a physician
➢ a licensed/ "waivered" psychologist
➢ a licensed/ "associate" social worker
➢ a licensed/ registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ 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 be documentation that the person served participated in and
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 served in the body of the plan, the signature of the person served on
the plan, or a 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 as the means by
which Contractor(s) documents the participation of the person served. When
Rev 04/2023 C-2
Exhibit C—Attachment C
Page 3of3
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 plan will include a written explanation of the refusal or
unavailability.
➢ Contractor(s)will give a copy of the plan for the person served to the person
served on request.
D. Progress Notes
1. Providers shall create progress notes for the provision of all SMHS. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. 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., symptom, condition, diagnosis, and/or
risk factors).
• The date that the service was provided to the beneficiary.
• Duration of the service, including travel and documentation time.
• Location of the beneficiary at the time of receiving the service.
• A typed or legibly printed name, signature of the service provider and date of
signature.
• ICD 10 code
• Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) code.
• Next steps including, but not limited to, planned action steps by the provider or by
the beneficiary, collaboration with the beneficiary, collaboration with other
provider(s) and any update to the problem list as appropriate.
2. Timeliness/Frequency of Progress Notes
• Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis services, which shall be completed within 24 hours.
• A note must be completed for every service contact
Rev 04/2023 C-3
CO U Exhibit C—Attachment D
Page 1 of 7
O� g6 Fresno County Department of Behavioral Health
ESQ Contractor Training Requirements Reference Guide
Contractor(s) must consider and include sufficient time and funds for required trainings.
This Training Requirements Reference Guide identifies the required trainings that
Contractor(s) is responsible for offering to all employees, volunteers, interns, and
student trainees of Contractor(s) 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(s), and those are identified within this
document. The remaining trainings are the responsibility of Contractor(s) to provide and
cover associated costs. The expectations for Contractor(s) staff attending County-
offered trainings are included within this guide.
I. Trainings 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(s)
shall be assigned this training in Quarter 4 of each calendar year.
An announcement from the Department of Behavioral Health (DBH) Compliance
Program, DBH Staff Development, or your Contract Analyst regarding this training
will be made prior to the assignment of this training. Contractor(s) will have the
option to complete the training either through the Relias Learning Management
System (LMS) or through Department of Behavioral Health's website. Contractor(s)
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(s) 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(s) 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 Eventbrite for each session; links to register can be
found on the webpage below:
https://www.fresnocountVca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComplianceDoc-Billing-Training
The expectation is that Contractor(s) 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 Staff DevelopmentCafresnocountyca.gov.
DBH New Hire General Compliance Training
Duration: 40 Minutes
Contractor(s) shall have their employees, subcontractors, volunteers, interns, 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 C,
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 Learning 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.fresnocountVca.gov/Departments/Behavioral-Health/Care-
Services/Behavioral-Health-Compliance/New-Hire-General-Compliance-Training
Contractor(s) 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:
DBHComplianceCcD_fresnocountyca.gov.
Invoicing Training
Duration: To be Confirmed
Contractor(s) 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
Exhibit B—Attachment D
Page 3of7
monitoring service volume and obtaining reimbursement. Contractor(s)'s staff
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.
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 Contractor(s) that will be using SmartCare as their full EHR.
Participants will have the opportunity to apply the California Mental Health Services
Authority's (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.fresnocountVca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor(s)at no cost and highly recommended.Although this training is not required,
selected Contractor(s)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 Contractor(s) 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.fresnocountVca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor(s)at no cost and highly recommended.Although this training is not required,
selected Contractor(s)is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DBH.
SmartCare Lite Electronic Health Record Mental Health Training* (Provider
Entry Only Training)
Duration: Time may vary
This training is for select Contractor(s) 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
CaIMHSA SmartCare trainings, user guide, and workflow information SmartCare Lite
Exhibit B—Attachment D
Page 4 of 7
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(s)at no cost and highly recommended.Although this training is not required,
selected Contractor(s)is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DBH.
II. 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(a�_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.
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(a)-fresnocountyca.gov.
III. Contractor(s) 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 California Advancing and
Innovating Medi-Cal (CaIAIM) BHQIP Modules in CaIMHSA's web-based training
Exhibit B—Attachment D
Page 5of7
system, Moodle. Providers are expected to complete training within 60 days of
beginning employment.
CaIMHSA's web-based training system, https://moodle.calmhsalearns.org.
Cultural Responsiveness Trainings
Duration: May vary based on Contractor(s)'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 eLearning system. Contractor(s)'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 eLearning 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)'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)'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
Contractor(s) is responsible for securing translation services and all
associated costs.
Health Insurance Portability and Accountability Act (HIPAA) Training
Duration: May vary based on selected training
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(a)(5). 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
Exhibit B—Attachment D
Page 6of7
Contractor(s) 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(s) 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;
this shall be done before the training begins, if possible. Other cell phone use,
such as texting, playing games or browsing the internet shall not permitted
while training 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.
Exhibit B—Attachment D
Page 7of7
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 C—Attachment E
Page 1 of 4
FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
PROGRAM OUTCOMES AND PERFORMANCE MEASUREMENTS
Contractor(s) shall adhere to the following outcome elements. Items below indicated with a single
asterisk (*) will be collected via the Fresno County Department of Behavioral Health (DBH) electronic
health record (EHR). Items indicated with a double asterisk(**)will be collected via DBH's EHR for full
users only. Items below indicated with a triple asterisk(***) are for internal quality improvement
activities only; they are not intended for use in outcomes reporting. Contractor(s)who opt to not fully
utilize DBH's EHR as their own EHR will be responsible for collecting and reporting these additional data
points. DBH will assist Contractor(s) in reviewing the requirements below no more than once every
quarter.
Quality of Service
1. Network Adequacy:Timeliness to Non-Psychiatric Service
1.1 Timeliness from the initial urgent/non-urgent request for services until the first
nonpsychiatric service offered by the program*
1.2 Timeliness from the initial urgent/non-urgent request for services until the first
nonpsychiatric service rendered by the program*
1.3 Timeliness from the first service until the first follow-up non-psychiatric service offered by
the program*
1.4 Timeliness from the first service until the first follow-up non-psychiatric service rendered by
the program*
1.5 Follow-up from the emergency department for behavioral health visits for individuals who
are currently enrolled with the program*
1.6 Follow-up from inpatient hospitalization for behavioral health visits for individuals who are
currently enrolled with the program*
2. Network Adequacy:Timeliness to Psychiatric Service
2.1 Timeliness from the initial urgent/non-urgent request for services until the first psychiatric
service offered by the program*
2.2 Timeliness from the initial urgent/non-urgent request for services until the first psychiatric
service rendered by the program*
3. Enrollment and Discharge
3.1 The length of stay for individuals receiving services with the program*
3.2 The reason for discharge for individuals discharging from the program*
4. No-Shows and Cancellations
4.1 The count of services that resulted in a no-show (i.e., less than 24 hours' notice) by the
person served**
4.2 The count of services that resulted in a cancellation (i.e., more than 24 hours' notice by the
person served**
4.3 The count of services that resulted in a cancellation by the service provider**
Quality of Clinical Care
1. Service Delivery
1.1 Average number of services provided to an individual by the program per week*
1.2 Average duration of services provided to an individual by the program*
1.3 Utilization of clinical tools,when appropriate**
1.4 Utilization of evidence-based practices,when appropriate**
2. Care Coordination
2.1 Referrals received by the Program from DBH and community partner agencies
Exhibit C—Attachment E
Page 2 of 4
2.1.1 Agency sending referral
2.1.2 Date of referral, date received, and date accepted/denied
2.1.3 Disposition/outcomes of referral, including date of first offered service
2.2 Referrals written by the Program to DBH and community partner agencies
2.2.1 Agency receiving referral
2.2.2 Reason for referral
3. Medication Monitoring, when applicable
3.1 Percentage of adults with a diagnosis of major depression, who were treated with and
remained on an antidepressant medication. ***
3.2 Percentage of children and adolescents 1-17 years of age who had a new prescription for an
antipsychotic medication and had documentation of psychosocial care as first-line treatment***
3.3 Percentage of individuals at least 18 years of age as of the beginning of the performance
period with schizophrenia or schizoaffective disorder who had at least two prescriptions
filled for any antipsychotic medication and who had a Proportion of Days Covered (PDC) of at
least 0.8 for antipsychotic medications during the performance period ***
Safety of Clinical Care
1. Grievances
1.1 The count, category, and trends of grievances submitted by individuals regarding services at
the Facility
2. Incident Reporting
2.1 The count, category, and trends of incidents reported regarding individuals served by the
Facility.
Member Experience
1. Consumer Perception Survey/Treatment Perception Survey
1.1 The program must comply with annual Consumer Perception Survey (MH) and/or Treatment
Perception Survey(SUD) requirements
2. Feedback and Improvement Groups
2.1 The program must, in coordination with the DBH Planning and Quality Management
Division, offer persons served the opportunity to participate in member experience focus groups
Population Description
1. Date of Birth/Age*
2. Race/Ethnicity*
3. Primary Language*
4. Gender Identity*
5. Sex-Assigned at Birth*
6. Sexual Orientation*
7. Diagnosis*
8. Food Insecurity*
9. Criminal Justice Involvement*
10. Housing Status*
11. Educational Attainment*
Exhibit C—Attachment E
Page 3 of 4
Program-specific Goals/Outcomes:
Contractor(s)will be required to collect data related to County-identified core outcome measures.
Measurement tools will include Child and Adolescent Needs and Strengths (CANS) and the Pediatric
Symptom Checklist(PSC-35) as primary outcomes measures.
CANS is a structured assessment tool utilized to identify youth's and family's actionable needs and
useful strengths. It provides a framework for developing and communicating about a shared vision and
uses the youth's and family's information to inform planning, support decisions, and monitor outcomes.
Contractor(s) shall complete the CANS assessment tool through a collaborative process, which includes
children and youth ages 6 up to age 21, and their caregivers(at a minimum).
The PSC-35 is a psychosocial screening tool designed to facilitate the recognition of cognitive, emotional,
and behavioral problems so appropriate interventions can be initiated as early as possible.
Parents/caregivers will complete PSC-35 (parent/caregiver version)for children and youth ages 3 up to
age 18.
These functional assessment tools need to be completed at the beginning of treatment, every six
months following the first administration, and at the end of treatment.
Contractor(s)'s performance shall be evaluated according to its scope of work goals and effectiveness
indicators stated in Exhibit A. Other goals that Contractor(s) shall be evaluated on by County DBH
utilizing the following performance outcomes:
Goal/Objective 1: Increase the delivery of mental health treatment services to unserved
and underserved clients and families with limited or no means of
payment.
Goal/Objective 2: Identify and build upon individual and family strengths and assets to
help parents and children develop new skills to enhance family
cohesion.
Outcome 1: Clients will gain skills to reduce family conflict and the ability to
identify familial strengths.
Outcome2: Clients will gain self confidence, increased ability to handle anger and
manage difficult situations, and experience improved individual
functioning.
Outcome Indicator: 85% of the clients that participate in the program will report
functional improvement measured by CANS (Child/Adolescent Needs
and Strengths) scores.
Outcome Indicator: 50% of the clients that complete the program will report a decrease
in school problems between start of program and end of program.
Exhibit C—Attachment E
Page 4 of 4
Outcome Indicator: 50% of the clients that complete the program will report a decrease
in inpatient mental health crisis visits between start of program and
end of program.
Outcome Indicator: 50% of the clients that complete the program will report a decrease
in recidivism into the Juvenile Justice System between start of
program and end of program.
Outcome Indicator: 85% of the clients participating in the program that are diagnosed
with mental health disorders, e.g., conduct disorder, oppositional
defiant disorder, disruptive behavior disorder, etc.,when they begin
the program will report improvement after successfully completing
the program.
Outcome Indicator: At a minimum, 80%of clients/families will report their satisfaction
with program services on the Contractor(s)'s consumer satisfaction
surveys, and the semi-annual State POQI survey.
Exhibit C —Attachment F
Page 1 of 18
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 Mental Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor(s) 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(s) 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(s) 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.
i
Exhibit C —Attachment F
Page 2 of 18
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
satisfaction of County that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent of County's Department of Behavioral Health Director,
or designee, no person shall be employed by Contractor who is related by
blood or marriage to, or who is a member of the Board of Directors or an
officer of Contractor.
5. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied
with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and
CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
A. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
2
Exhibit C —Attachment F
Page 3 of 18
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: Contractor(s) has made false
certification, or violated the certification by failing to carry out the requirements as
noted above. (Gov. Code §8350 et seq.)
3. 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 $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or 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 to the Sweatfree Code of Conduct as set forth on
3
Exhibit C —Attachment F
Page 4 of 18
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to
Contractor(s)'s records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to
determine Contractor(s)'s compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies
that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor 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 M 0410):
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 which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on their own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411
a). For the two (2) year period from the date they left state employment, no
former state officer or employee may enter into a contract in which they
engaged in any of the negotiations, transactions, planning, arrangements
or any part of the decision-making process relevant to the contract while
employed in any capacity by any state agency.
4
Exhibit C —Attachment F
Page 5 of 18
b). For the twelve (12) month period from the date they left state
employment, no former state officer or employee may enter into a
contract with any state agency if 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.
If Contractor violates any provisions of above paragraphs, such action by
Contractor shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODEIWORKERS' COMPENSATION: Contractor needs to be aware
of the provisions which require every employer to be insured against liability for
Worker's 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. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities 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 NAME CHANGE: An amendment is required to change
Contractor(s)'s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that Contractor(s) is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) shall be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
5
Exhibit C —Attachment F
Page 6 of 18
6. RESOLUTION: 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 to enter into an agreement,
authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, Contractor(s)
shall not be: (1) in violation of any order or resolution not subject to review
promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to
Section 13301 of the Water Code for violation of waste discharge requirements
or discharge prohibitions; or (3) finally determined to be in violation of provisions
of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form shall be completed by all
Contractors that are not another state agency or other governmental entity.
9. 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, at any time, inspect and audit any records or
documents of Contractor or its subcontractors, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid-related activities or
work is conducted. The right to audit under this section exists for ten (10) years
from the final date of the contract period or from the date of completion of any
audit, whichever is later.
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
subcontractor, as well as any person with an ownership or control interest, 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 (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases shall be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it shall promptly
notify Contractor(s) and take action consistent with § 438.610(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 provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
6
Exhibit C —Attachment F
Page 7 of 18
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. In collaboration with the County, Contractor will work to ensure
that individuals to whom Contractor(s) provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in Behavioral Health Information
Notice (BHIN) 21-073. Specifically, Contractor(s) will ensure that
the clinical record for each individual includes information as a
whole indicating that individual's presentation and needs are
aligned with the criteria applicable to their age at the time of
service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled individuals who meet either of
the following criteria, (1) or (11) below. If an individual under age 21
meets the criteria as described in (1) below, the beneficiary meets
criteria to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The individual has a condition placing them at high risk for
a mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
Exhibit C —Attachment F
Page 8 of 18
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM)
and the International Classification of Diseases and
Related Health Problems (ICD).
b. A suspected mental health disorder that has not yet
been diagnosed.
c. Significant trauma placing the individual at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for persons served who meet both of the following
criteria, (a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined
as distress, disability, or dysfunction in social,
occupational, or other important activities.
b. A reasonable probability of significant deterioration
in an important area of life functioning.
2. The individual's condition as described in paragraph (a) is
due to either of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the DSM and
ICD.
b. A suspected mental disorder that has not yet been
diagnosed.
c. ADDITIONAL CLARIFICATIONS
i. Criteria
1. A clinically appropriate and covered mental health
prevention, screening, assessment, treatment, or recovery
service listed within Exhibit A of this Agreement can be
provided and submitted to the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included in an individual
treatment plan; or
c. The individual had a co-occurring substance use
disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims,
including SMHS claims, include a current Centers for
8
Exhibit C —Attachment F
Page 9 of 18
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
d. MEDICAL NECESSITY
i. Contractor will ensure that services provided are medically
necessary in compliance with BHIN 21-073 and pursuant to
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 individual's chart as a whole will
demonstrate medical necessity as defined below, based on the
age of the individual at the time of service provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the
standards set forth in Section 1396d(r)(5) of Title 42 of the United
States Code.
e. COORDINATION OF CARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to this Agreement are coordinated among all
providers who are serving the individual, including all other SMHS
providers, as well as providers of Non-Specialty Mental Health
Services (NSMHS), substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services as applicable to ensure a person served-
centered and whole-person approach to services.
ii. Contractor shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services
and supports, including but not limited to educational, social,
prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage
education, cultural sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA
and California law compliant person served authorization to share
the individual's information with and among all other providers
involved in the individual's care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
9
Exhibit C —Attachment F
Page 10 of 18
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health
Services can be provided concurrently, if those services are
clinically appropriate, coordinated, and not duplicative. When a
person served meets criteria for both NSMHS and SMHS, the
individual should receive services based on individual clinical
need and established therapeutic relationships. Clinically
appropriate and covered SMHS can also be provided when the
individual has a co-occurring mental health condition and
substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s
receive timely mental health services without delay. Services are
reimbursable to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving a individual receiving both SMHS
and NSMHS, Contractor holds responsibility for
documenting coordination of care and ensuring that
services are non-duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016
and 22-017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) is necessary due to an
individual's specific needs and circumstances that could seriously
jeopardize the individual s life or health, or ability to attain,
maintain, 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 shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from face-to-face
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Exhibit C —Attachment F
Page 11 of 18
time and provide this information to County upon request.
Services shall be identified as provided in-person, by telephone,
or by telehealth.
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.
c. ASSESSMENT
i. Contractor shall ensure that all individuals' medical records
include an assessment of each individual's need for mental health
services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individual s aged 6 through 20, the Child and Adolescent
Needs and Strengths (CANS), and for individual s aged 3 through
18, the Pediatric Symptom Checklist-35 (PSC-35) tools are
required at intake, every six months during treatment, and at
discharge, as specified in DHCS MHSUDS INs 17-052 and 18-
048.
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. ICD-10
i. Contractor shall use the criteria set forth in the current edition of
the DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, Contractor(s) shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractor shall use the ICD diagnosis
code(s) to submit a claim for SMHS to receive reimbursement
from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by
CMS and may be updated during the term of this Agreement.
Changes to the lists of ICD diagnoses do not require an
amendment to this Agreement, and County may implement these
changes as provided by CMS
e. 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 identified
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
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Exhibit C —Attachment F
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ii. Contractor shall document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CT®) U.S. Edition, September 2022 Release, and ICD-
10-CM 2023.
iii. A 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 include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
added. However, Contractor shall update the problem list within a
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 in BHIN 22-019.
f. TREATMENT AND CARE PLANS
i. Contractor is not required to complete treatment or care plans for
persons served under this Agreement, except in the
circumstances specified in BHIN 22-019 and additional guidance
from DHCS that may follow after execution of this Agreement.
g. PROGRESS NOTES
i. Contractor shall create progress notes for the provision of all
SMHS services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the
service code selected for the service type as indicated by the
service code description.
iii. Progress notes shall include all elements specified in BHIN 22-
019, whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business
days of providing a service, with the exception of notes for crisis
services, which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that
are billed on a daily basis, such as residential and day treatment
services, if applicable.
h. TRANSITION OF CARE TOOL
i. Contractor shall use a Transition of Care Tool for any individual
whose existing services will be transferred from Contractor to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractor, as specified in BHIN 22-065, in order to ensure
continuity of care.
ii. Determinations to transition care or add services from an MCP
shall be made in alignment with County policies and via a person-
centered, shared decision-making process.
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Exhibit C —Attachment F
Page 13 of 18
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
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 DHCS provided form. The only
exception to this requirement is when the tool is translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations shall ensure that
person served confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for individuals served by Contractor under this
Agreement shall include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractor. Such consent shall be obtained at least
once prior to initiating applicable health care services and consent
shall include all elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices,
and Contractor shall allow access to all materials needed to
adequately monitor Contractor's adherence to telehealth
standards and requirements.
3. PROTECTIONS FOR PERSONS SERVED
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor shall be immediately forwarded to the
County's Department of Behavioral Helath (DBH) Plan
Administration Division or other designated persons via a secure
method (e.g., encrypted email or by fax) to allow ample time for
the DBH Plan Administration staff to acknowledge receipt of the
grievance and complaints and issue appropriate responses.
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Exhibit C —Attachment F
Page 14 of 18
ii. Contractor shall not discourage the filing of grievances and
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) shall be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs shall be issued to individuals anytime Contractor(s) has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice shall have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. Contractor(s) shall inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings shall be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor shall provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor shall maintain records of grievances and appeals and
shall review the information as part of its ongoing monitoring
procedures. The record shall be accurately maintained in a
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor shall comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
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)(1)-(2).)
4. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance.
Contractor(s) shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with
Contractor(s)'s services at least annually.
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Exhibit C —Attachment F
Page 15 of 18
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 to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. Contractor(s) shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by Contractor(s) at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan
with documented annual evaluations and documented revisions
as needed. The QI Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed Ql actions, and ensure follow-up of Ql processes.
Contractor shall ensure that there is active participation by
Contractor(s)'s practitioners and providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor shall have hours of operation during which
services are provided to Medi-Cal individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. If
Contractor(s)'s provider only serves Medi-Cal
beneficiaries, the provider shall provide hours of operation
comparable to the hours the provider makes available for
Medi-Cal services that are not covered by the Agreement
or another County.
2. Appointments data, including wait times for requested
services, shall be recorded and tracked by Contractor, and
submitted to the County on a monthly basis in a format
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Exhibit C —Attachment F
Page 16 of 18
specified by the County. Appointments' data should be
submitted to the County's Planning and Quality
Management Division or other designated persons.
3. Urgent care appointments for services that do not require
prior authorization shall be provided to individual s within
48 hours of a request. Urgent appointments for services
that do require prior authorization shall be provided to
persons served within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) shall be
made available to Medi-Cal individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, requests an appointment for a
medically necessary service. Non-urgent psychiatry
appointments (for both adult and children/youth) shall be
made available to Medi-Cal individual s within 15 business
days from the date the person served or a provider acting
on behalf of the individual, requests an appointment for a
medically necessary service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by 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 SMHS to Medi-Cal individuals on behalf of
Contractor, are registered through DHCS' Provider Application
and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20-
071 requirements, the 21 st Century Cures Act and the CMS
Medicaid and Children's Health Insurance Program (CHIP)
Managed Care Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), 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,
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Exhibit C —Attachment F
Page 17 of 18
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
5. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for individuals served through this
Agreement shall contain a warning banner regarding the PHI or
PII contained within the EHR. Contractors that utilize an EHR shall
maintain all parts of the clinical record that are not stored in the
EHR, including but not limited to the following examples of person
served signed documents: discharge plans, informing materials,
and health questionnaire.
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
6. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
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Exhibit C —Attachment F
Page 18 of 18
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
ii. Contractor shall file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and shall make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
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Exhibit C—Attachment G
Page 1 of 1
Electronic Health Record Requirements and Service Data
Contractor(s) 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(s)will be
responsible for equipment to support the use of the EHR. Contractor(s) 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 Contractor(s).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 Contractor(s).
Contractor(s)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(s).
If Contractor(s) elects to not use the County's EHR for all clinical documentation, Contractor(s) must
ensure all necessary requirements involving electronic health information exchange between
Contractor(s) and the County will be met.
Exhibit C-Attachment H
Fresno County Mental Health Plan
Compliance Program
CODE OF CONDUCT:
All Fresno County Behavioral/Mental Health Employees, Contractors (including Contractor's
Employees/Subcontractors), Volunteers and Students will:
1. Read, acknowledge, and abide by this Code of Conduct.
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.
3. NOT engage in any activity in violation of the County's Compliance Program, nor engage in any other
conduct which violates any applicable law, regulation, rule, or guideline. Conduct yourself honestly,
fairly, courteously, and with a high degree of integrity in your professional dealings related to their
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.
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Exhibit C —Attachment I
Page 1 of 5
Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement
1. The County is a "Covered Entity," and the Contractor is a "Business Associate,"
as these terms are defined by 45 CFR 160.103. In 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
Associate Agreement (BAA) to comply with the Business Associate requirements of HIPAA, to
govern the use and disclosures of PHI under this Agreement. "HIPAA Rules" 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 regulations, including, but not limited to California
Welfare and Institutions Code sections 5328, 10850, and 14100.2 et seq.; 42 CFR 2; 42 CFR
431; California Civil Code section 56 et seq.; the Health Insurance Portability and Accountability
Act of 1996, as amended ("HIPAA"), including, but not limited to, 45 CFR Parts160, 45 CFR
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 to 42 USC 17901 et seq.; and the Genetic Information Nondiscrimination Act ("GINA") of
2008 regarding the confidentiality of genetic information.
3. Except as otherwise provided in this Agreement, the Contractor, as a business
associate of the County, may use or disclose Protected Health Information ("PHI") to perform
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 of the Contractor.
4. Contractor shall protect, from unauthorized access, use, or disclosure of names
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
I
Exhibit C—Attachment I
Page 2of5
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 Department of Behavioral Health's (DBH's) HIPAA Representative, within
two (2) business days of discovery. The notification shall include, to the extent possible, the
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Exhibit C—Attachment I
Page 3 of 5
identification of each individual whose unsecured PHI has been, or is reasonably believed to
have been, accessed, acquired, used, disclosed, or breached. 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 DBH's
HIPAA 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 of Fresno County of Fresno County of Fresno
Department of Public Health Department of Public Health Department of Internal
HIPAA Representative Privacy Officer Services
(559) 600-6439 (559) 600-6405 Information Security Officer
P.O. Box 11867 P.O. Box 11867 (559) 600-5800
Fresno, California 93775 Fresno, California 93775 2048 North Fine Street
Fresno, California 93727
9. Contractor shall make its internal practices, books, and records relating 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.
10. Safeguards
Contractor shall implement administrative, physical, and technical safeguards as
required by 45 CFR 164.308, 164.310, and 164.312 that reasonably and appropriately protect
the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates,
receives, maintains or transmits on behalf of County; and to prevent access, use or disclosure
of PHI other than as 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 County's request, Contractor shall provide County with
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Exhibit C—Attachment I
Page 4 of 5
information concerning such safeguards.
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) or sensitive data to 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 or sub-award to 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 no copies 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 of such PHI infeasible. This provision shall apply to PHI that is in the
possession of subcontractors or agents, if applicable, of Contractor. If 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 shall 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
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Exhibit C—Attachment I
Page 5 of 5
be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA
regulations.
15. Regulatory References
A reference in the terms and conditions of these provisions to a section in the
HIPAA regulations means the section as in effect or as amended.
16. Survival
The respective rights and obligations of Contractor as stated in this Section shall
survive the termination or expiration of this Agreement.
5
Exhibit C-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.
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Exhibit C -Attachment J
Page 2 of 2
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
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 cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease 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 of life 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 due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & 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, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization'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 to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
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Exhibit D
Page 1 of 12
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
party, which includes but not limited to, maximum compensation, compensation structure,
invoicing, payments, billing, recoupments, audits, reviews, examinations, and other fiscal related
requirements.
Compensation
The County agrees to pay, and Contractor(s) agrees to receive, compensation for the
performance of its services as described below.
1. Specialty Mental Health Services (SMHS) Maximum Compensation.
The maximum compensation payable to Contractor(s) under this Agreement for the
period of July 1, 2025 through June 30, 2026 for SMHS is Fifteen Million and No/100 Dollars
($15,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to Contractor(s) under this Agreement for the
period of July 1, 2026 through June 30, 2027 for SMHS is Fifteen Million and No/100 Dollars
($15,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to Contractor(s) under this Agreement for the
period of July 1, 2027 through June 30, 2028 for SMHS is Fifteen Million and No/100 Dollars
($15,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to Contractor(s) under this Agreement for the
period of July 1, 2028 through June 30, 2029 for SMHS is Fifteen Million and No/100 Dollars
($15,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to Contractor(s) under this Agreement for the
period of July 1, 2029 through June 30, 2030 for SMHS is Fifteen Million and No/100 Dollars
($15,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
2. Total Maximum Compensation.
In no event shall the maximum contract amount for all the services provided by
Contractor(s) to County under the terms and conditions of this Agreement be in excess of
Seventy Five Million and No/100 Dollars ($75,000,000.00) during the entire term of this
Agreement.
Exhibit D
Page 2 of 12
In the event the maximum compensation amount in any individual fiscal year as noted is
not fully expended, said remaining unspent funding amounts shall rollover to each subsequent
fiscal year's established maximum compensation.
Contractor(s) 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 Contractor(s) 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.
Contractor(s)further acknowledges that County employees have no authority to pay
Contractor(s) except as expressly provided in this Agreement.
3. Fee-For-Service Reimbursement Rate Categories.
The program service components for Contractor(s) shall be categorized as Clinic-Based and
Contractor(s) shall be compensated according to the Clinic-Based rate schedule as indicated on
Exhibit D —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 Contractor(s) is afforded regular access. Designated sites shall be
identified by Contractor(s) and approved by County's DBH Director or designee in
writing. Only billable services will be considered for the purpose of this calculation.
(i) Clinic-Sites Based locations are defined as the following SmartCare
(EHR) Locations (CMS Places of Service) for this Agreement and will be
utilized to calculate the ratio of Clinic-Site Bases to Field Based services:
STRTP home; Telehealth provided in STRTP home.
All other SmartCare (EHR) Locations (CMS Places of Service) will be
considered as Field Based services under this Agreement.
County's DBH shall continuously monitor Contractor(s) 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 Contractor(s)will be notified in writing of any such
changes, as outlined in Article 5.
1.1 Specialty Mental Health Services Fee-For-Service Performance Incentives.
Contractor(s) is eligible to receive performance-based incentives to promote growth,
increase service delivery and overall wellness to our unserved and/or underserved
communities. If Contractor(s) meets the performance metrics outlined by County's DBH below,
Contractor(s) 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(s) providing SMHS and reimbursed through the
County's Fee-for-Service reimbursement structure. Any Contractor entered into this Agreement
Exhibit D
Page 3 of 12
after the initial contract fiscal year, shall be eligible after their second fiscal year term of an
Agreement. The initial performance actual claimed baseline will be set by Contractor(s)'s
performance in fiscal year one (1). County's DBH will use Contractor(s)'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 Contractor(s) exceeds the established performance baseline, Contractor(s) 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%
1 $1,100,000
2 +3.0% $1,133,000 $1,633,000 $500,000 $40,000
3 +1.0% $1,649,330 $1,500,000 $0 $0
4 +2.0% $1,682,317 $1,882,317 $200,000 $16,000
5 +3.5% $1,948,198 $2,048,198 $100,000 $8,000
In addition to meeting the performance-based incentive metrics above, Contractor(s)
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, Contractor(s) shall be ineligible for performance incentives
or withheld until such requirements are met and/or deemed to be satisfactory by County's DBH.
County's DBH will calculate and notify Contractor(s) of the award amounts, if any, within
ninety (90) days after all of Contractor(s)'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(s) for
performance-based incentives, if any, shall be made within forty-five (45) days after approval by
County.
Exhibit D
Page 4 of 12
Invoices
Contractor(s) shall submit monthly invoices, in arrears by the fifteenth (15th) day of each
month, in the format directed by the County. Contractor(s) shall submit invoices electronically to:
1) dbhinvoicereview@fresnocountyca.gov;
2) dbh-invoices@fresnocountyca.gov; and
3) the assigned County's DBH 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, County's DBH Director, 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 Contractor(s). Contractor(s) 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 period, the invoice is still not corrected to County's satisfaction, County's DBH
Director, or designee, may elect to terminate this Agreement, pursuant to the termination
provisions stated in Article 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(s) will follow the escalation process through the County's DBH Finance Division's
Invoice Review Team, up to the DBH Finance Division Manager, and including the County's
DBH Director and/or designee for the timely reimbursement of payment to Contractor(s).
Withholdings to an invoice by County's DBH shall be addressed by Contractor(s) and/or
Contractor(s) shall communicate any delays in resolving the incorrect or improper form with
County's DBH within ninety (90) days of receiving notice or the withholdings will stand in
perpetuity, or subject to County's discretion.
All final invoices for any fiscal year shall be submitted by Contractor(s)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 (120) days of the end of the 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's electronic health record (EHR) for the prior month.
Monthly payments for claimable services shall only be based on the units of time
assigned to each CPT or HCPCS code entered in the County's billing and transactional
database multiplied by the practitioner service rates in Exhibit D —Attachment A.
Any claimable services pending determination from Medicare, OHC, 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 by County's DBH. Claimable services that are pending
determinations must be addressed and invoiced to County's DBH within one hundred and
twenty (120) days following the month of service. Any delays to invoicing must be
communicated to and approved by County's DBH within one hundred and twenty (120) days
following the month of service or the services may be ineligible for payment at County's
discretion.
Exhibit D
Page 5 of 12
County's payments to Contractor(s) for performance of claimed services are provisional
and subject to adjustment until the completion of all settlement activities. County's adjustments
to provisional payments for claimed services shall be based on the terms, conditions, and
limitations of this Agreement or the reasons for recoupment 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. Corrective Action Plans.
Contractor(s) 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 a 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.
Payment
Payments shall be made by County to Contractor(s) in arrears, for services provided
during the preceding month, within forty-five (45) days after the date of receipt, verification, and
approval by County. All final invoices shall be submitted by Contractor(s) within one hundred
and twenty (120) days following the final month of service for which payment is 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
expended by Contractor(s) 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 Contractor(s), as specified in
this Agreement.
1. Incidental Expenses.
Contractor(s) is solely responsible for all of its costs and expenses that are not specified
as payable by the County under this Agreement. If Contractor(s) fails to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
2. Applicable Fees.
Contractor(s) shall not charge any persons served or third-party payers any fee for
service unless directed to do so by the County's DBH Director or designee at the time the
individual is referred for services. When directed to charge for services, Contractor(s) shall use
the uniform billing and collection guidelines prescribed by DHCS.
Contractor(s) will perform eligibility and financial determinations, in accordance with
DHCS' Uniform Method of Determining Ability to Pay (UMDAP), see BHIN 98-13, available at
dhcs.ca.gov, for all individuals unless directed otherwise by the County's DBH Director or
designee.
Exhibit D
Page 6 of 12
Contractor(s) shall not submit a claim to, or demand or otherwise collect reimbursement
from, the person served or persons 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
Regulations, Title 9, §1810.365(c).
Contractor(s) 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 as set forth in 42 C.F.R. § 438.106.
Specialty Mental Health Services Claiming Responsibilities
Contractor(s) shall enter claims data into the County's EHR/billing and transactional
database system using the California Mental Health Services Authority (CaIMHSA) Smart Care
Procedure Codes (available at nttps://2023.calmhsa.org/procedure-code-definitions/) by the
fifteenth (15ch) of every month for actual services rendered in the previous month. County's
EHR/billing and transactional database system will convert the CaIMHSA Procedure Codes to
Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System
(HCPCS) codes, as provided in the DHCS Billing Manual available at
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-LibrarV.aspx, as from time to time
amended.
Claims shall be complete and accurate and must include all required information
regarding the claimed services. Claims data entry into the County's EHR system shall be the
responsibility of Contractor(s). County shall monitor the volume of services, billing amounts and
service types entered into County's EHR system. Any and all audit exceptions resulting from the
provision and reporting of specialty mental health services by Contractor(s) shall be the sole
responsibility of Contractor(s). Contractor(s) will comply with all applicable policies, procedures,
directives, and guidelines regarding the use of County's EHR/information system.
Contractor(s) 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(s)will be responsible for billing the carrier and obtaining a payment/denial
or have validation of claiming with no response for ninety (90) days after the claim was mailed
Contractor(s) must report all third-party collections for Medicare, third-party or client-pay or
private-pay in each month. A copy of an explanation of benefits or CMS 1500 form (if no
response is received from the carrier after 90 days from date of submission of the CMS 1500) is
required as documentation. Contractor(s) 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.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal
Centers for Medicare and Medicaid Services as they relate to participation, coverage and
claiming reimbursement. To the extent they are applicable, Contractor(s)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(s) the value of any services or other
expenditures determined to be ineligible based on the County or State monitoring results. The
Exhibit D
Page 7 of 12
County reserves the right to enter into a repayment agreement with Contractor(s), with the term
of the repayment agreement not to exceed twelve (12) months from the date of the repayment
agreement, to recover the amount of funds to be recouped. The County has the discretion to
extend the term of repayment plan up to a total of twenty-four (24) months from the date of the
repayment agreement. The repayment agreement may be made with the signed written
approval of County's DBH Director, or designee, and respective Contractor(s) through a
repayment agreement. The monthly repayment amounts may be netted against Contractor(s)'s
monthly billing for services rendered during the month, or the County may, in its sole discretion,
forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
and County may seek requital from any other means, including, but not limited to, a separate
contract or agreement with Contractor(s).
Contractor(s) shall be held financially liable for any and all future disallowances/audit
exceptions due to Contractor(s)'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(s). Contractor(s) 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 DHCS audit and review process, cost report audit settlement if applicable, for Medi-
Cal eligible beneficiaries.
1. Reasons for Recoupment.
County will conduct periodic audits of Contractor(s) files to ensure appropriate clinical
documentation, that original third-party source documents support costs invoiced under hybrid
or cost reimbursement agreements, high quality service provision and compliance with
applicable federal, state and county or other funding source regulations.
Such audits may result in requirements for Contractor(s) to reimburse County for
services previously paid in the following circumstances:
(A) Identification of Fraud, Waste or Abuse as defined in federal regulation
(1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
section 14107.11, subdivision (d).
(2) Definitions for"fraud," "waste," and "abuse" can also be found in the
Medicare Managed Care Manual available at https://www.cros.gov/Regulations-
and-Guidance/Guidance/Manuals
(B) Overpayment of Contractor(s) by County due to errors in claiming or
documentation.
(C) Other reasons specified in the SMHS Reasons for Recoupment document
released annually by DHCS and posted on the DHCS BHIN website.
Contractor(s) shall reimburse County for all overpayments identified by Contractor(s),
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 of an offset against any payments then or
thereafter owing to County under this or any other Agreement between the County and
Contractor(s).
Exhibit D
Page 8 of 12
2. Internal Audits/Reviews.
Contractor(s) is responsible for ensuring the accuracy of all claims submitted for
reimbursement. This includes, but is not limited to, verifying that the services billed are properly
documented, correctly coded, and align with applicable SMHS definitions and standards.
Contractor(s) must also ensure that all supporting documentation is accurate, complete, and
reflects the services actually rendered.
In addition, Contractor(s)with medication prescribing authority shall adhere to County's
medication monitoring review practices. Contractor(s) 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)'s internal audit process.
Contractor(s) shall provide this notification and summary to County as requested by the County.
3. Confidentiality in Audit/Review Process.
Contractor(s) and County mutually agree to maintain the confidentiality of Contractor(s)'s
records and information of persons served, in compliance with all applicable State and Federal
statutes and regulations, including but not limited to HIPAA and California Welfare and
Institutions Code, Section 5328. Contractor(s) shall inform all of its officers, employees, and
agents of the confidentiality provisions of all applicable statutes.
Contractor(s)'s fiscal records shall contain sufficient data to enable auditors to perform a
complete audit and shall be maintained in conformance with standard procedures and
accounting principles.
Contractor(s)'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 Contractor(s) in a complete and timely manner.
4. Cooperation with Audits/Reviews.
Contractor(s) 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(s) shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractor(s) 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(s) 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(s) 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.
Exhibit D
Page 9 of 12
If Contractor(s) expends Seven Hundred Fifty Thousand and No/100 Dollars
($750,000.00) or more in Federal and Federal flow-through monies, Contractor(s) 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(s) 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(s) must
include a corrective action plan signed by an authorized individual. Contractor(s) 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(s). All audit costs related to this Agreement are the sole
responsibility of Contractor(s).
A single audit report is not applicable if Contractor(s)'s Federal contracts do not exceed
the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
Contractor(s)'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(s) to County as a minimum requirement to attest to Contractor(s)
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(s) who agrees to
take corrective action to eliminate any material noncompliance or weakness found as a result of
such audit. Audit work performed by County under this paragraph shall be billed to Contractor(s)
at County cost, as determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractor(s) 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(s) is a "subrecipient" (also known as a "pass-
through entity") as defined in 2 C.F.R. § 200 et seq., Contractor(s) 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(s) 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.
Exhibit D
Page 10 of 12
Contractor(s)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(s) 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(s) 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(s).
Other Financial Requirements
1. Notification of Changes.
Contractor(s) 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(s) 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(s) must immediately notify County of a change in ownership, organizational
status, Iicensure, or ability of Contractor(s) to provide the quantity or quality of the contracted
services in no event more than 15 days of the change.
2. Record Maintenance.
Contractor(s) 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 II, Subtitle A,
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 requirements 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.
Exhibit D
Page 11 of 12
Contractor(s) 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(s) shall comply with all local, state, and federal laws and regulations
regarding relinquishing or maintaining medical records.
Contractor(s) 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 is later.
3. Financial Reports.
Contractor(s) shall submit audited financial reports on an 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 terminated, ends its designated term, or Contractor(s)
ceases operation of its business, Contractor(s) shall deliver or make available to County all
financial records that may have been accumulated by Contractor(s) or subcontractor under this
Agreement, 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 by County or state or federal funding sources that may in any way affect the fiscal
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(s) 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 is 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(s). The amount of the deferred payment shall not exceed the
amount of funding delayed by the State Controller to the County. The period of time of the
deferral by County shall not exceed the period of time of the State Controller's delay of payment
to County plus forty-five (45) days.
6. Additional Financial Requirements
County has the right to monitor the performance of this Agreement to ensure the
accuracy of claims for reimbursement and compliance with all applicable laws and regulations.
Exhibit D
Page 12 of 12
Contractor(s) must comply with the False Claims Act employee training and policy
requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
Department of Health and Human Services may specify.
Contractor(s) agrees that no 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 https://www.opm.gov/ (U.S. Office 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, or at the direction of a physician during the period of exclusion when the
person providing the service knew or had reason to know of the exclusion, or to an individual or
entity when the County failed to suspend payments during an investigation of a credible
allegation of fraud [42 U.S.C. section 1396b(i)(2)].
Contractor(s) must maintain financial records for a minimum period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. Contractor(s) will be
responsible for any disallowances related to inadequate documentation.
7. Contractor(s) Prohibited from Redirection of Contracted Funds
Contractor(s) may not redirect or transfer funds from one funded program to another funded
program under which Contractor(s) provides services pursuant to this Agreement except
through a duly executed amendment to this Agreement.
Contractor(s) may not charge services delivered to an 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.
Exhibit D—Attachment A
Page 1 of 2
FEE-FOR-SERVICE RATE(S)
**Fee-for-Service rates are established by the Department of Health Care Services.
Contractor(s) acknowledges that the provider rates in the table below are all-inclusive rates
which account for program operating expenses. This includes, but is 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.g., salaries and wages,
benefits, bonuses, and other incentives), vehicle expenses (e.g. gas, maintenance,
insurance), training, assets/capital assets, utilities, and any direct and indirect overhead and
operating costs. Indirect cost expenses shall be determined by Contractor(s) under the Fee-
for-Service reimbursement structure.
Clinic/Site Based
(less than 50% of services are
provided in the field)
Provider Rate
Provider Type Per Hour
Licensed Physician $969.97
Physicians Assistant $435.02
Nurse Practitioner $482.34
Registered Nurse $393.99
Certified Nurse Specialist $482.34
Licensed Vocational Nurse $206.97
Registered Pharmacist $464.30
Licensed Psychiatric Technician $177.43
Psychologist (Licensed or Waivered) $390.09
LPHA(MFT LCSW LPCC)/ Intern or
Waivered LPHA(MFT LCSW LPCC) $252.44
Occupational Therapist $336.04
Mental Health Rehab Specialist $189.92
Peer Support Specialists $199.42
Community Health Worker $194.68
Medical Assistant $142.28
Other Qualified Providers $189.92
Exhibit D—Attachment A
Page 2 of 2
Maximum Units
Flat Rate Type Unit That Can Be Billed Rate
1 per allowed
Interactive Complexity 15 min per unit procedure per $18 89
provider per person
served
Sign Language/Oral Interpretive Services 15 min per unit Variable $31.88
Exhibit E
Page 1 of 3
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from Contractor(s) 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. Contractor(s) 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 Contractor(s)'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) Contractor(s)
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 Contractor(s) 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 Contractor(s).
E-1
Exhibit E
Page 2of3
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 Contractor(s)'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; (A) information theft; (xii) damage to or destruction or
alteration of electronic information; (xiii) cyber extortion; (xiv) extortion related to
Contractor(s)'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
Contractor(s)'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 Contractor(s) signs this Agreement, and
at any time during the term of this Agreement as requested by the County, Contractor(s)
shall deliver, or cause its broker or producer to deliver, to the County of Fresno,
Department of Behavioral Health —Attention Plan Administration, 1925 E Dakota Ave,
Fresno, CA 93726, or electronically to DBHPlanAdmin(aD_fresnocountyca.gov with a copy
to the assigned County's Department of Behavioral Health (DBH) Staff Analyst,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, Contractor(s) shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, Contractor(s) shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, Contractor(s) shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of Contractor(s) or its insurer to timely provide a written notice required by this
paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If Contractor(s) has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
E-2
Exhibit E
Page 3of3
limits, or both. To that end, Contractor(s) shall deliver, or cause its broker or producer to
deliver, to the County's Risk Manager certificates of insurance and endorsements for all
of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. Contractor(s) waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. Contractor(s) is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but Contractor(s)'s waiver of subrogation under this paragraph is effective
whether or not Contractor(s) obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If Contractor(s) fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to Contractor(s). The County may offset such
charges against any amounts owed by the County to Contractor(s) under this
Agreement.
(G)Subcontractors. Contractor(s) shall require and verify that all subcontractors used by
Contractor(s) to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
Contractor(s) to provide services under this Agreement using subcontractors.
E-3
Exhibit F
Page 1 of 8
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means Contractor(s)'s employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of Contractor(s)'s subcontractors, representatives, agents, outsourcers, and consultants,
and providers of professional services to Contractor(s), who have access to Personal
Information and are bound by law or in writing by confidentiality obligations sufficient to
protect Personal Information in accordance with the terms of this Exhibit.
(C)"Director" means the County's 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, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to Contractor(s) by or upon the authorization of the County,
under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
Contractor(s)'s (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable Contractor(s) to promptly
investigate and take remedial action under this Exhibit.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by Contractor(s) (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit.
F-1
Exhibit F
Page 2 of 8
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) Contractor(s) acknowledges that, in the course of its engagement by the County under
this Agreement, Contractor(s), or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) Contractor(s) acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
Contractor(s), or any Authorized Persons. Contractor(s)further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of Contractor(s)'s, or any Authorized Person's, Use of that Personal
Information.
(C) Contractor(s) agrees and covenants in favor of the County that Contractor(s) shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to Contractor(s) pursuant to the terms of this
Exhibit;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for Contractor(s)'s own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which Contractor(s) believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by Contractor(s), or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
F-2
Exhibit F
Page 3 of 8
before such Personal Information is offered by Contractor(s) for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and Contractor(s) shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) Contractor(s) shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were Contractor(s)'s own actions and omissions.
3. Information Security
(A) Contractor(s) covenants, represents and warrants to the County that Contractor(s)'s Use
of Personal Information under this Agreement does and will at all times comply with all
applicable federal, state, and local, privacy and data protection laws, as well as all other
applicable regulations and directives, including but not limited to California Civil Code,
Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-Beverly
Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3, beginning
with section 1747). If Contractor(s) Uses credit, debit or other payment cardholder
information, Contractor(s) shall at all times remain in compliance with the Payment Card
Industry Data Security Standard ("PCI DSS") requirements, including remaining aware at
all times of changes to the PCI DSS and promptly implementing and maintaining all
procedures and practices as may be necessary to remain in compliance with the PCI
DSS, in each case, at Contractor(s)'s sole cost and expense.
(B) Contractor(s) covenants, represents and warrants to the County that, as of the effective
date of this Agreement, Contractor(s) 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 Contractor(s)'s obligations under section 3(A) of this Exhibit,
Contractor(s)'s (or Authorized Person's) Security Safeguards shall be no less rigorous
than accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to Contractor(s)'s and Authorized
Persons' technical and administrative personnel who are necessary for
Contractor(s)'s, or Authorized Persons', Use of the Personal Information
pursuant to this Agreement;
(ii) ensuring that all of Contractor(s)'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,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
F-3
Exhibit F
Page 4 of 8
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of
Contractor(s), including any Authorized Person, or anyone with whom
Contractor(s) or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by Contractor(s),
Contractor(s) shall cause such Authorized Employees to abide strictly by Contractor(s)'s
obligations under this Exhibit. Contractor(s) shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) Contractor(s) shall, in a secure manner, backup daily, or more frequently if it is
Contractor(s)'s practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real-time access, at all times, to such
backups via a secure, remote access connection provided by Contractor(s), through the
Internet.
(F) Contractor(s) 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 Contractor(s) and shall be
F-4
Exhibit F
Page 5 of 8
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving Contractor(s)'s and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)Contractor(s) 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 Contractor(s)'s awareness or reasonable belief of a Security Breach,
Contractor(s) shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a�_fresnocountyca.gov, 559-600-5900, (which
telephone number and email address the County may update by providing notice to
Contractor(s)), and (ii) preserve all relevant evidence (and cause any affected
Authorized Person to preserve all relevant evidence) relating to the Security Breach. The
notification shall include, to the extent reasonably possible, the identification of each type
and the extent of Personal Information that has been, or is reasonably believed to have
been, breached, including but not limited to, compromised, or subjected to unauthorized
Use, Disclosure, or modification, or any loss or destruction, corruption, or damage.
(B) Immediately following Contractor(s)'s notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit, the Parties shall coordinate with each
other to investigate the Security Breach. Contractor(s) agrees to fully cooperate with the
County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of Contractor(s)'s other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, Contractor(s) shall, with respect to a Security Breach, be solely responsible,
at its cost, for all notifications required by law and regulation, or deemed reasonably
necessary by the County, and Contractor(s) shall provide a written report of the
investigation and reporting required to the Director within 30 days after Contractor(s)'s
discovery of the Security Breach.
(C) County shall promptly notify Contractor(s) of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon Contractor(s)'s receipt of that
notification, Contractor(s) shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit, all at Contractor(s)'s sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
F-5
Exhibit F
Page 6 of 8
In the event Contractor(s) discovers a Security Breach, Contractor(s) shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of Contractor(s)'s
receipt of notification of such Privacy Practices Complaint, Contractor(s) shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D) Contractor(s) shall take prompt corrective action to respond to and remedy any Security
Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at Contractor(s)'s sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. Contractor(s)
shall reimburse the County for all reasonable costs incurred by the County in responding
to, and mitigating damages caused by, any Security Breach, including all costs of the
County incurred relation to any litigation or other action described section 4(E) of this
Exhibit.
(E) Contractor(s) agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) Contractor(s) shall have and maintain a written information security policy that specifies
Security Safeguards appropriate to the size and complexity of Contractor(s)'s operations
and the nature and scope of its activities.
(B) Upon the County's written request, to confirm Contractor(s)'s compliance with this
Exhibit, as well as any applicable laws, regulations and industry standards, Contractor(s)
grants the County or, upon the County's election, a third party on the County's behalf,
permission to perform an assessment, audit, examination or review of all controls in
Contractor(s)'s physical and technical environment in relation to all Personal Information
that is Used by Contractor(s) pursuant to this Agreement. Contractor(s) shall fully
cooperate with such assessment, audit or examination, as applicable, by providing the
County or the third party on the County's behalf, access to all Authorized Employees and
other knowledgeable personnel, physical premises, documentation, infrastructure and
application software that is Used by Contractor(s) for Personal Information pursuant to
this Agreement. In addition, Contractor(s) shall provide the County with the results of any
audit by or on behalf of Contractor(s) that assesses the effectiveness of Contractor(s)'s
information security program as relevant to the security and confidentiality of Personal
Information Used by Contractor(s) or Authorized Persons during the course of this
Agreement under this Exhibit.
(C) Contractor(s) shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit that apply to Contractor(s)
with respect to such Personal Information by incorporating the relevant provisions of
these provisions into a valid and binding written agreement between Contractor(s) and
such Authorized Persons, or amending any written agreements to provide same.
F-6
Exhibit F
Page 7 of 8
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
Contractor(s) shall, and shall instruct all Authorized Persons to, promptly return to the County all
Personal Information, whether in written, electronic or other form or media, in its possession or
the possession of such Authorized Persons, in a machine readable form used by the County at
the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If
Contractor(s) is authorized to dispose of any such Personal Information, 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. Contractor(s) shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, Contractor(s) 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. Contractor(s) shall not retain any copy of any
Personal Information after returning or disposing of Personal Information as required by this
section 6. Contractor(s)'s obligations under this section 6 survive the termination of this
Agreement and apply to all Personal Information that Contractor(s) retains if return or disposal is
not feasible and to all Personal Information that Contractor(s) may later discover.
7. Equitable Relief. Contractor(s) 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 to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. Contractor(s) shall defend, indemnify and hold harmless the County, its officers,
employees, and agents, (each, a "County Indemnitee") from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit 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 Contractor(s)'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 Contractor(s)'s failure to comply with any of its obligations under this section 8.
The provisions of this section 8 do not apply to the acts or omissions of the County. The
provisions of this section 8 are cumulative to any other obligation of Contractor(s) to, defend,
indemnify, or hold harmless any County Indemnitee under this Agreement. The provisions of
this section 8 shall survive the termination of this Agreement.
F-7
Exhibit F
Page 8 of 8
9. Survival. The respective rights and obligations of Contractor(s) and the County as stated in
this Exhibit shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied 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 or Contractor(s) and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in Contractor(s)'s (or any Authorized Person's) possession or control,
or Use by Contractor(s) (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.
F-8
Exhibit G
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 G
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)
(5)Authorized Signature
Signature: Date:
Exhibit H
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address(number,street) City State ZIP Code
CILIA Number Taxpayer ID Number(EIN)/Social Security Number Telephone Number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list all names
and addresses (primary, every business location, and P.O. Box address)of individuals or corporations under"Remarks"on
page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest 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 n
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 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses (primary, every business location, and P.O. Box address) under "Remarks" on page 2. If more than
one individual is reported and any of these persons are related to each other, this must be reported under"Remarks."
NAME DOB ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME DOB ADDRESS PROVIDER
Exhibit H
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o n
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name FIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit H
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 I
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 1
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)